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Choice Architecture, the Web, and the Health Care Bill

BY Nancy Scola | Thursday, March 25 2010

Way back in June, some punk wrote a piece for Seed Magazine which argued the web, used wisely, gave the Obama administration an opportunity not available to past governments to architect choices in ways designed to shape citizens' behaviors to their liking. It was pretty clear that an Obama presidency was probably going to involve a more significant web component than, say, the Bush one did. So there was no great insight on that part. But the argument was that the Obama administration had at their fingertips a maturing field of information architecture in the web design world that they could couple with what was at least a superficial interest amongst Obamans for what's known in economics as choice architecture. (This was back in the days that all anyone could talk about was Nudge and Animal Spirits.) Even to me, the piece was little more than a "What If?," speculative story. And maybe comparing the U.S. Treasury Department to Woot.com was too much of a stretch.

But perhaps the overall vision of a government making concerted use of the marraige of information architecture and choice architecture wasn't so crazy after all. The just-signed Patient Protection and Affordable Care Act is putting the Obama administration in the position to shape the way that Americans make choices about their health, via some new, mandated web portals and templates that will filter out into the states. Government Health IT's John Moore reports:

[T]he new law tasks the Department of Health and Human Services with creating a Web portal through which a resident in any state will be able to locate “affordable health insurance coverage options.”

HHS will also help states develop and maintain Internet portals for health insurance exchanges, which will enable small businesses and people lacking employer-provided insurance to purchase coverage.

The state portals will direct people and employers to health plans and help them determine whether they are eligible to participate. A “model template” portal will be made available to the 50 state exchanges.

State Internet portals would also provide insurance seekers with quality rating information on the health plans offered through an exchange. Insurance buyers would be able to browse enrollee satisfaction information, so they can make comparisons among plans.

Of course, the idea that this government, any government, would be using the web to worm their way into citizens' brains, shaping human behaviors as they see fit, can be unsettling. But I put that to Barry Schwartz, the Swarthmore psychologist and author of The Paradox of Choice, last summer. Schwartz argued that every supermarket and every online store is pointing people in one direction or another; there's no neutral design online or off. "Get over the idea that you’re not pushing people one way or another," he said. And, of course, influencing human behavior is the building block of public policy. In health care, as in life, there's a tidal wave of information that people are going to have to make sense of with help or without. "The challenge we have now is to shape how we navigate that information in meaningful ways,” said Schwartz at the time. “The people who truly figure that out," he argued, "are going to be the ones to run the world." I suggested at the time that perhaps they already were. We'll see.

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