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ELLEN ANDREWS

Thinking is hard work. Adult brains are only 2% of our body weight, but they use 20% of our body’s energy. To handle the load, we have evolved hard-wired shortcuts called cognitive biases that sometimes backfire. Public policymaking is not immune – it’s riddled with biases that are driving poor decisions.

We all use them to save time, fit in with our neighbors, confirm our values, and generally feel better about ourselves. Cognitive biases are usually adaptive, allowing us to function in a complex and fast-paced world, unaware that we’re cutting corners. But too often cognitive biases cause new problems, leading us off course, to make the same mistakes over and over.

Researchers have identified over a hundred cognitive biases. Some are more common in state policymaking.

  • Confirmation Bias (and its corollary the Ostrich Effect) – We are more likely to believe information that confirms our existing beliefs, and to ignore negative information or experiences. This is why it’s so hard to change minds.
  • Anchoring – We are more influenced by the first thing we hear or read. Policymakers are often swayed to expand a program because of early success. But early adopters are the most enthusiastic and best-resourced champions of the concept, well positioned to succeed. They’re often featured in case studies and invited to speak to policymakers about their success. But programs often hit a wall trying to grow beyond the first successes.
  • Optimism bias (and the Planning Fallacy) – We ignore obstacles, believing that everything will work out. We routinely underestimate the time needed to implement a policy, the risks, and the costs, even if we’ve tried something just like it before. Connecticut has a history of repeating bad ideas and being surprised when they fail.
  • Status quo bias – We prefer things we are more familiar with. This is another reason that real change is hard. Even though everyone agrees that healthcare costs are out of control and quality isn’t what it should be, nothing meaningful changes. We often use the endless need for more data as a barrier to reform.
  • The IKEA Effect – People place more value on things that they had a hand in building. Policymakers resist changing course when faced with the failure of policies they approved. They underestimate the problems and continue to believe that small changes will work, despite the evidence.
  • Sunk Cost Fallacy – Faced with troubled programs, policymakers are more likely to double down and throw more money and time at failed programs, rather than endure the reality that the idea didn’t work and it’s time to move on.
  • False Consensus Bias – People tend to believe that everyone shares their information, values, and experiences. People are reluctant to disagree with policymakers.

It’s not easy, but overcoming bias is fixable. First, we must acknowledge and recognize biases in ourselves – we are human. These are big, important decisions. Take the time to explore all the options and objectively assess the risks. Become curious about other points of view, especially thoughtful, evidence-based differences. Spend time with people who disagree with you. Be open to being wrong.

We also need to craft better processes. Input from public hearings and public comment on agency proposals shouldn’t just bounce off – listen and build trust. Convening committees of like-minded members who already agree with pre-determined outcomes is just a waste of time. Strengthen checks and balances in public decision-making. Allowing an agency alone to make critical decisions on healthcare services or how much Connecticut healthcare costs can rise is set up to fail. Regular legislative approval of critical decisions allows for more input and better outcomes. Public transparency in monitoring and evaluation is key. Make the data available to the public. We can’t know what we’re missing. We never know where the next great idea is going to come from. Then have the capacity and the political will to revise or reverse course if necessary.

There’s wide agreement that healthcare in Connecticut needs reform. But there’s little agreement on what’s broken or how to fix it. We have a long history of reform failures, but we can do better by avoiding our biases.

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Ellen Andrews, Ph.D.

Ellen Andrews, Ph.D., is the executive director of the CT Health Policy Project. Follow her on Twitter@CTHealthNotes.

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