The Cost of Outliers

The Cost of Outliers

Malcolm Gladwell is well known for his book Outliers, about people who become extremely successful thanks to intense practice, good luck, and supportive situations that enable their early practice and skill development. If you have read his book, you probably have at least a little exposure to the idea that some people are unique and can have a surprising influence on the world. But one area you probably haven’t considered with the impact of outliers, unless you study healthcare economics, is in medical spending.

 

In his book The Opioid Crisis Wake-Up Call, Dave Chase explains the issues with outliers in our system. “Six to eight percent of plan members are spending 80 percent of the plan dollars,” Chase writes.

 

We probably imagine that our healthcare costs are so expensive because so many American’s don’t eat well and don’t exercise. I have argued in the past that we don’t support a universal healthcare system in our country because many people think the problem is that others are not taking responsibility for themselves and are simply fat and lazy, costing more for the rest of us. The reality is that a huge amount of our total healthcare spending, as much as 80% according to Chase, is from a tiny percent of the population. Our outliers are driving the cost of healthcare up at an alarming rate, and it is not simply because these outliers are fat and lazy.

 

The people who spend the most on healthcare mostly have rare diseases, congenital conditions, or need extreme emergency acute care. Chase writes, “They tend to have complex health problems, usually with multiple comorbidities.” Because we don’t recognize that most of our spending goes toward outliers, and because we are biased against a vision of fat and lazy people, we adopt policies that bankrupt these outliers who often were simply born with bad luck when it comes to health.

 

What is really detrimental to our system is that these outliers are often misdiagnosed. Chase writes, “In any given year, about 20 percent of the outlier group is completely misdiagnosed. This means that about 16 percent of plan dollars each year are being wasted on treatments for diseases the patients don’t have.” It will always be difficult to treat outliers. They are not typical patients, and have multiple health issues that interact in complex ways. But because we don’t make their care easy and because healthcare in the United States has so many barriers, we end up failing this population, and the errors and failures mean that we waste a huge amount of money and resources in their care. It doesn’t just cost the individual, but everyone on the healthcare plan.

Immediate Evaluations

I will be honest with this one. I think President Donald Trump is a despicable human being, a lazy thinker, and too incompetent (not to mention unaware of his incompetence) to serve as President of the United States. As a result of my disliking of the President, I feel that I cannot trust anything he says. This is troubling because I am likely to immediately dismiss his evaluations and policies, assuming that they are wrong and potentially corrupt. I’m not going to blame myself 100% here (the President has done many things to make me and others suspicious of what he says), but I think it is important for me to recognize and acknowledge that I immediately dismiss anything he says and immediately assume that anything he thinks is wrong.

 

The President is such a polarizing individual that he, and my reactions to him, serve as useful examples of how quickly we can make judgments about what other people say. We pick up on direct cues from others and interpret indirect identity cues to begin to make judgments about what others say, before they have even said anything.

 

In his book How to Win Friends and Influence People, Dale Carnegie quotes from the book On Becoming a Person by Carl Rogers, “Our first reaction to most of the statements (which we hear from other people) is an evaluation or judgment, rather than an understanding of it.”

 

When a friend that we get along with and share similar interests and identities with starts to say something about a sports team that we don’t have strong opinions about, we will probably agree with them in an instinctive manner. At the same time, when our uncle posts on Facebook about how terrible the political party we vote for is, we will likely scroll right by or block his post without actually giving it a second thought. There may not really be a reason to instantly agree with our friend about how good LeBron James is or to debate our uncle about his political philosophy, but we should nevertheless be aware of how quickly we make judgments about what other people think, say, and post on social media.

 

If we occupy a key decision-making role in a company, if we have to make decisions about our child’s education, and if we are thinking about our long-term retirement plans, it would be helpful for us to consider how quickly judgments happen. If we really like our financial adviser, we might instinctively agree with what he says, even if his advice isn’t as well researched and accurate as it should be. If we have had a combative relationship with our college-aged child, we might not be happy to hear that they switched out of a pre-med major, even if we know in our hearts that becoming a doctor might not be a good route for our son or daughter. If we understand how quickly our minds make decisions for us, we can push back and hopefully make better ore informed decisions. We can at least be aware of times when we make a snap judgment and try to seek other sources of information and consider that we might be wrong, and that the advice or decision of another are actually sound.

Trust In Government

People today have lost trust in government. We have too many actors, too many points of view, too many opinions, and too many bad stories about the government. The days when politicians were less ideological, less partisan, and could be more moderate with their views and opinions are behind us. This does not mean, however, that we are stuck in a system of gridlock and argument for ever. We can still challenge our own assumptions and the assumptions of others by better understanding our political system and thinking more deeply about our opinions. Working through our priors and getting beyond our negativity and cynicism gives us a way to improve our own thought process and ultimately to improve government and the ways in which society interacts with government.

 

In Political Realism Jonathan Rauch writes, “Gone is the trust that government will “do the right thing,” replaced by an assumption that transactional politics is a rigged game played by and for special interests.” In our country we hate interest groups and lobbyists. We hate anyone with money who seems to be interfering in our elections or our processes, and cry out against the evils of big money. Except, not always. We only seem to hate special interests and lobbyists when they don’t represent us. Most republicans probably don’t think of the NRA as a special interest or as a lobbying group, and most Democrats probably don’t think of unions as evil big money organizations. When you begin to think about the groups and activists that you support or favor, you start to gain a better understanding of why lobbyists and interest groups exist. By looking inward and trying to understand your own political ideas, beliefs, and assumptions, you can begin to better understand other people’s opinions, beliefs, and assumptions, giving you a way to better relate to people with different thoughts.

 

Reflecting and looking inward also helps us see just how transient our policy beliefs truly are. When we become more self-aware and more self-reflective, we are able to better understand where our beliefs and opinions come from. I try to follow politics actively, trying to focus more on the policy side than on the horse-race political side, and I notice constantly that my opinions are greatly shaped by the person who comes up with an idea. When President Trump says something, I have an almost visceral reaction assuming that his idea is full of self-interest and short sighted thoughts and is undoubtedly the opposite of what we should actually do in terms of policy. At the same time however, I know that my thoughts and opinions on things like national debt are woefully underdeveloped. I can recognize that I have some thoughts and beliefs about how our nation and society should be structured, but those thoughts are not necessarily based on scientific evidence, but general thoughts, my view of my identity, and to some extent my own self-interest. What this means, is that I should back away to some extent when I recognize that  my opinion is influenced by prejudices and judgement about the opposing political party or politician.

 

This may not help us achieve more transactional politics and it may not increase trust in government directly, but this strategy can help us begin to back away from such staunch opposition to opposing parties and people. By recognizing when we don’t have full information and when we are allowing our judgement of the speaker to shape our beliefs of the policy, we can start to be more civil in our discussions. This in turn can help us as a country moderate our discussions and opinions, and ultimately, bring politics back to the center where it can be more transactional and less volatile.

Immediate Reactions

Author Colin Wright discusses the ways in which our unconscious brain picks up on small cues and differences about people that we meet before we are able to form complete judgements of others as human beings. These small cues and differences shape the way we think about other people and influence our behavior, often times without us ever realizing.  In his book, Come Back Frayed, Wright explains this phenomenon by writing the following:

 

“It’s remarkable how our peculiarities can set us apart so dramatically and rapidly. Even before we truly recognize each other as humans, as complete people with depth and density, we recognize things about strangers that help us categorize the world. These biases, and sometimes prejudices, color the world around us with tones that guide our actions and opinions.”

 

Before we have met someone we are already preparing ourselves for what we expect our interactions with them to be like. These biases are huge because they prevent us from treating everyone as openly and fairly as we would like, and they exist within ourselves and within the other person at the same time. The way we frame the other person and the types of expectations we bring to a  conversation shape the actions and behaviors that we will have. If we instantly feel negative feelings at the sight of another, it is unlikely that our interactions with them will be positive.

 

Wright would encourage us to become more self-aware and to develop processes of self-recognition so that we can acknowledge those moments when we have immediate reactions to another person. We can develop skills to notice when the tribal part of our brain labels someone as an outsider, and drives us to act in ways that push the other person away. Becoming self-aware helps us see the ways in which these small cues influence much of the way we interact with the world, and gives us the power to better control the world around us.

 

If we fail to gain perspective over our instant reactions to other people, then we will never allow people who are different from us to truly participate in society. Our actions will be colored by the reactionary perceptions of our brain, and we will never develop the empathy needed to improve the world for all of those around us. Accepting  that we judge others before ever meeting them, and before we ever consider who they are as human beings, give us the ability to overcome biases, and to help society become more connected and unified regardless of race, ideology, age, or gender.