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The House has passed the first comprehensive reform package of the health insurance industry in decades, which is now up for debate in the Senate. This is a highly complex issue, but there are some quite basic reasons why it's so difficult to accomplish significant reform, and in part these have to do with psychological responses to change and uncertainty.
A few years ago I was fortunate to work with a couple of organizational consultants, and they introduced me to the concept of NICs and PUFs. These funny sounding acronyms give insight into why health care reform is so difficult for many people to support. (And once you have this shorthand for thinking about scenarios, you find ways that they apply in all aspects of life.)
The two acronyms, and their counterparts PICs and NUFs, refer to the likelihood that something will happen, whether the impact with be positive or negative, and how quickly the impact will happen.
PICs: Positive, Immediate and Certain. This is the best case--a good impact will be for sure happening to me soon.
NICs: Negative, Immediate and Certain. This is the worst case--a bad impact that will surely happen, and right away. People instinctively avoid these as much as possible.
PUFs: Positive, Uncertain and Future. Something good may happen, but if it does, it will be in an indeterminate future, and I don't really know how good it will be if it does happen.
NUFs: Negative, Uncertain and Future. The opposite of course, that something bad may happen at some point in the future, with an uncertain degree of badness.
Applying these to the health care debate, they clearly illustrate why there is resistance to reform.
The consequences of reform in terms of money-out-of-pocket, quality of care, and choice of care are all unclear for most people, naturally so since the changes are complex. It's therefore unclear whether the changes will be positive or negative in nature. Depending on one's financial situation, job security, and satisfaction with current health care service, one may be inclined to see the change going more in the positive or negative direction.
The battle over the public option partly revolves around whether people will get bumped off their existing plans and onto a government plan. This would represent potentially a large scale change, and again may be seen positively or negatively depending on one's circumstances. But when that switch may happen is unclear. Would the introduction of the public plan cause an immediate sweeping change as employers dropped their private insurance for the public plan, or would the status quo hold? Since this is unclear, people have differing opinions about how it will play out.
People who see PICs in health care reform obviously support it--they think it will bring positive changes, quickly. This may be because they stand to gain personally, or see immediate benefits for those who are currently under- or uninsured.
People who see NICs are against reform, believing that it will have immediate negative results, whether for themselves or others.
PICs and NICs are going to be hard for politicians to sway as they are pretty entrenched in their positions (anchored by the Certainty and the perceived near-term consequences). Immediate impacts, whether positive or negative, often have a more powerful influence than ambiguous longer-term ones. That's why dieting is difficult--immediate pleasure of a cupcake now vs possible ambiguous connection to expanded waistline later. It's also why saving is difficult--the benefits in the far of future feel less compelling that buying the latest gadget or trinket today.
It’s the PUFs and NUFs that are the swing votes in the health care debate, and here we are tending to see the “devil you know is better than the devil you don’t” dynamic playing out. With something as literally life and death as health care and insurance, the glass-half-empty NUFs tend to outweigh optimistic PUFs. If there is a chance of a negative result that you can’t define or predict, then it can seem safer to stick with the status quo rather than hold out hope for an ambiguous improvement at an indeterminate point in the future.
One of the main themes at TEDGlobal this year was a lively debate between optimistic and pessimistic voices on the social potential (or doom) of the web. This outlook was somewhat more somber than I expected at a TED conference, perhaps – as some attendees suspected – due to the cultural differences between Long Beach and Oxford. There was definitely a palpable sense of enlightened skepticism at the conference, a distinctly European tone that serves as welcome counterweight to the Californian brand of optimism that TED is often associated with (just read this amusingly British commentary in the Times of London).
One of the most vocal and polemic representatives of this kind of socio-techno-skepticism was Internet researcher Evgeny Morozov. Arguing that the web impedes democratization, he chastised social web apostles for naively believing that the medium is the action and scoffed at the phenomenon of “slacktivism” (saving the world one click at a time through Facebook Causes). Morozov coined some catchy terms such as “iPod liberalism” and “Spinternet: (Spin + Internet) to expose what he considers a rather one-sided view of online activism and in fact a delusional assumption about the social power of global, collective voices on the web. Morozov's biting sarcasm (“There was a time when governments had to torture people to get intelligence. Now they just need to go to their Facebook pages.”) was refreshing and welcome amidst the usual choir of politics 2.0 cheerleaders, however, he failed to provide much evidence for his heretical claims. He might indeed underestimate the smartness and agility of digital natives, especially when he questioned the role of Twitter during the Iranian protests. Sure, each new technology comes with Faustian ambivalence, but even though the Twitter protesters may not have lead to any substantial change (yet), I’d argue that the worldwide attention (and sympathy) for the cause of the Iranian people was significantly enhanced through the hundreds of thousands of Twitterers who used #iranelection (especially given #CNNfail). Was this ad-hoc Twitter community a political movement? Maybe not. But it politicized and generated social power that can instigate political change. Or does Morozov really think Obama won the election because of TV commercials and townhall meetings?
Anthropologist Stefana Broadbent added some more nuances to the discussion: She drew from research she conducted and presented some interesting numbers that prove what she calls the “democratization intimacy” – the observation that most social web users communicate with a nucleus of 1-5 people and cultivate strong ties rather than adding weak ones to their networks. In other words: They aren't expanding their circle of friends but strengthening their most important relationships. And they do this at work: According to a recent Pew study, more than 50% of office workers in the US use email and messaging services for private communications. Broadbent concluded that we are witnessing a “re-appropriation of the personal sphere:” “Through their communication channels, people are breaking an imposed isolation that institutions are imposing on them.”
Jonathan Zittrain had begun the session with a general state-of-the-web analysis that was a real shock-and-awe fireworks. It says something about the unstoppable momentum of the Internet if talks like his consist mainly of screenshots of goofy web sites like “Cats that Look Like Hitler,” social phenomena like couchsurfing, and other Internet memorabilia. Apparently, the Web is much wilder than theorists can make it. Indeed, the Internet does not have a business model, as Zittrain poignantly remarked, and yes, it is a verb not a noun. Consequently, he ended his talk with a simple: “Let’s march.”
Speaking of verbs and nouns (and marching), Aza Raskin from the Mozilla Foundation wants to bring language back into the user experience in order to turn a functional task management paradigm into what he calls “you-centric computing” – putting the user in charge, making computing human(e). And yet, as rain followed sun in Oxford this week, idealism was immediately juxtaposed with a rather melancholic interlude: a short film titled “Real Human Interface,” starring a human, imprisoned in a small (in and out)box, nurtured by a constant flow of mundane communication and tasks. A sad and lonely tale of OK Computer happiness and the 21st century answer to what Alain de Botton calls the quintessential 21st century question:
“What do you do?” – Interfacing.
(Credit:
Design Policy)
Design is not the answer to everything, but it certainly has an important role to play in almost everything that holds a society together.
In light of the current economic crisis, several U.S. professional design organizations (AIGA, IDSA, and others), design education accreditation organizations, and Federal Government officials have seized the historic opportunity and joined forces to launch an initiative to shape a U.S. National Design Policy. In a moment of great global uncertainty and an erosion of national confidence, designers are perfectly positioned to take on a leadership role in "Re-designing America's Future," and the proposed policy is supposed to give them a more effective platform. "Design is the world remade in human form," the initiative's Web site states. And there's a lot of remaking to do these days. We know that "beautiful things work better." These days, however, only "meaningful" things make a real difference. And collective action is required.
As a result of a November 2008 meeting in Washington, the initiative has published "Redesigning America's Future: Ten design policy proposals for the United States of America's economic competitiveness and democratic governance." The document strives to demonstrate how design "improves policy success by making it relevant to the People." As stated in the document: "Design serves to advance the goals of the United State's economic competitiveness by saving time and money and simplifying the use, manufacturing, and maintenance of goods and services. It enhances democratic governance by improving the performance and delivery of government services."
More details can be found on the U.S. National Design Policy Initiative Web site, including a downloadable version of the "Redesigning America's Future" report.
National Congresspeople received the publication in their mail boxes January 20. If you support the initiative and want them to act upon it, you can write them directly.
In addition, you can take part in a viral video campaign that asks supporters to record a brief "I Pledge" endorsement to be uploaded to the initiative's YouTube page or the Facebook page.
(Credit:
design mind)
A somewhat unconventional yet challenging task: Newsweek invited four "hot (and nonpartisan) design firms" to provide ideas and design direction for "resurrecting the Republican brand," featured in this week's (December 29) print issue. The full-page feature presents concepts by frog design (full disclosure: my employer), Pentagram, Razorfish, and The Groop.
The article is not available online so check it out at a news stand (and support print media!).
The National Journal writes that when Arun Chaudhary was a teenager, his father asked him why he didn't want to get into politics. "I can't, Dad," he recalled saying. "I have a funny name." Now Arun Chaudhary, the son of an immigrant Indian father and a Jewish mother, is as close to politics as one can be: He took leave from his day job -- professor at the NYU film school -- to become Barack Obama's videographer (or, so the official title, director of field production).
After 10 months on the campaign trail, Chaudhary has more than 850 videos posted (three of them below) on the BarackObama.com website and on YouTube. His short clips from Obama's town hall meetings, big rallies, and on-the-road moments draw an average of 10,000 viewers each, and they have become a main tenet of a campaign that has successfully translated the concept of web 2.0 (or however you want to call it), with its collaborative formats, micro-crowds, public deliberation, and social aggregation, into the realm of political communication.
A new type of political auteur in the age of YouTube, the 32-year old filmmaker has developed a unique style that is innovative, fresh, and -- like the candidate -- challenges convention. Obama's campaign is a networked, open-sourced, and interactive effort, as Henry Jenkins observed, and in this spirit of "from me to we," Chaudhary playfully (and with distinct irony) remixes elements of amateur-style video, traditional polit-documentary, CNN b-roll, slick TV commercial, cinematic production, and behind-the-scene outtakes into a vibrant, eclectic, and authentic voice of the campaign that is bigger than the sum of its parts. As the maker of moving pictures of a movement, he achieves what every great documentary filmmaker wants to achieve: To document and write history at the same time.
Arun Chaudhary will speak about his work for Obama and his experiences traveling with the campaign in a special edition of frog's Design Mind speaker series on July 16 in New York. The event will be videotaped, of course.
More details soon. Save the date!
The Huffington Post's new "Fundrace 2008" feature allows you to see who the big donors are in the 2008 presidential race campaigns, with a Google maps mash-up that lets you search by region, donor name, party affiliation and donation amount. It's a light-hearted but also serious look at who the big donors are (it mostly tracks donations over $200) and, in some cases, you can see who's playing "both sides". They also track donations from employees at specific companies. For example, Microsoft and Google employees have primarily given to Democrats by over 2:1 ratios.
A great example of using technology to bring greater transparency to the democratic process.
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