Richard Thaler on a public option and health care

In his latest Economic View column, Richard Thaler argues that the debate over what a public option for means for the future of health care in America has gotten way out of hand.

We clearly don’t need any more distractions from the two main issues of health care reform: how to deal with our large uninsured population and how to make the entire system more cost effective. So, for now, let’s ignore the shouted rhetoric about whether “death panels” want to kill off Grandma or whether President Obama wants to turn the country into a socialist state.

But even if we discard these absurdities, and tune out the raucous scenes at town-hall meetings, one big distraction remains: the question of whether a “public option” should be part of the health care solution. To me, the issue is a red herring, and is getting in the way of genuine reform.

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The dentist bib as choice architecture

Talya Miron-Shatz, a psychology post-doctorate at Princeton with Daniel Kahneman, recently received a crown and a root canal in the same sitting from two different dentists. Since the two procedures were separate from one another, neither dentist seemed to know the local anesthetic that the other was providing to Talya. With poor communication, Talya almost received a double dose of Novocaine (or something similar). There has to be a better way to prevent these kind of errors, she thought.

And here’s my two cents for human engineering. Dental patients wear a bib around their neck. How about if the (dental) office purchased a Sharpie, and had each doctor write down how many injections he/she gave the patient, and their exact location. Better still, how about if this was pre-marked on the bib?

Read the full post as Psychology Today.

The secret to the medical checklist nudge

In the field of medicine, there is perhaps no better nudge than Peter Provonost’s medical checklist. Adapted from pre-flight preparations by airline crews, the medical checklist is a six-step set of routine actions for preventing Intensive Care Unit line infections that doctors may otherwise forget to do because of time constraints, stress, or distractions. The success of this checklist in Michigan hospitals has been well documented. After two years the checklist had prevented 43 infections and eight deaths, saving $2m dollars in costs. (The graph below comes from a lecture by former Congressional Budget Office Director Peter Orszag.)

Changemakers, an initiative by the non-profit social entrepreneurship group Ashoka, is preparing to launch a competition to generate medical nudges (more on that in a later post), and the contest organizers have selected the checklist as one of their case study examples. They remind us why the checklist is such a brilliant idea. It’s not the six simple steps. It’s the observing nurses who provide instant feedback ensuring that the medical checklist is followed.

Pronovost’s masterstroke came next: asking ICU nurses to observe doctors’ behaviors after the lists were posted. If they didn’t follow the list, nurses should intervene. Nurses were also to ask doctors daily whether lines ought to be removed, so as not to leave them in longer than necessary.

“When we first said it, the nurses said, ‘Hey, I’m gonna get my head bit off’,” recalls Pronovost. “And docs said, ‘You can’t have nurses second-guessing me in public’. So I pulled all the teams together and said, ‘Is it acceptable that we can harm patients here in this country?’ And everyone said, ‘No’.”…

(Provonost) made the nudge public – involving nurses and reframing the issue as one about harming patients, not authority, Provonost created a cultural shift, empowering everyone in ICU to nudge each other toward right choices to preventing infections.

A killer iphone app for prescription drugs

Epocrates helps compile prescription drug lists – even when you’ve forgotten the name and only remember the color, size, and shape of the pills.

Assorted links

Gamblers in New Jersey who voluntarily ban themselves from casinos can’t take their name of the list. We thought this was exactly how the of program was supposed to work.

Using an ambulance to take someone to the emergency room for a minor ailment – like a headache – is costly. The Richmond Ambulance Authority was recently recognized for an innovative program that routes non-life-threatening calls to an emergency room nurse. Costs are down; ambulance trips are down; response time to real emergencies is down.

A cell phone service that lets you snap pictures of the food you eat, send them to a licensed nutritionist, who then responds with facts and advice about your choices.

A reader proposes a nudge to create a routine now. You’ll thank him later.

Reader Travis Walker says he is contributing more to his 401(k) thanks to Nudge – and he didn’t even need a default rule! Recognizing the power of routines in daily lives, Walker sends along a proposal for a structured plan to help “procrastinators” take care of routine check-ups or maintenance on their bodies, their cars, or their homes. He specifically sketches out the idea as it would pertain to health, calling it the Health Care Agreement Account (HCA).

Continue reading the post here.