Stated vs Revealed Preferences: Health Care Edition

In social science, much research centers on the idea of preferences. Preferences are a key element of decision theory, which suggests that individuals have some order of preference over a set of outcomes. More generally, we can think of such varied topics as voter choice and grocery shopping as preferences. There are two ways to measure preferences.

The first is stated preferences. Often, individuals even have preferences over things that they cannot control or we cannot measure directly. Say, for example, that we are trying to ascertain how strongly people prefer environmentally friendly products to less eco-friendly products. If we just want to know their stated preferences, we can simply ask them. (Although, if we want to run a scientific survey, it gets less simple the more accurate we want to be.)

On the other hand, say we want their revealed preferences, so we observe their actual behavior. Behavior with regard to eco-friendly products centers on purchases, so we look at whether individuals tend to purchase eco-friendly products more than the alternatives. (It turns out they don’t. h/t to Adam Ozimek) Economists generally prefer to work with revealed preferences, and as a political scientist so do I. The definitions of “hard” or “soft” data might be fuzzy, but when I talk about hard data this is the kind of thing I mean: actual, observable behavior. Sometimes survey research is your only alternative, but I have a hard time thinking of an instance in which it would be ideal. [edit: it's important to note--which I neglected to do earlier--that revealed preferences often get screwed up outside of the context of a free market; in the US even sugar isn't a free-market commodity thanks to high tariffs; this potentially undermines what I say later about health care but I think the main point still holds]

Now to apply this to health care. Karl Smith had a post over the weekend citing several studies that indicate that consumers don’t actually care how effective certain hospitals/treatments are when making health care decisions. This is based on actual patient behavior (revealed preferences). Of course if you ask anyone, they would say that they want the most effective treatment possible.

This is the difference between stated and revealed preferences–everyone says they want effective treatment, but when it comes to making health care decisions, as Karl argues, often they simply feel the need to do something. On one level this is completely fine: if you’re spending your own money and it’s just to make you feel better in an emotional sense, go for it. Whether that means purchasing lots of movie tickets, lollipops, health care, whatever. But when you start spending other people’s money (government health care) it seems reasonable that the public (“other people”) take an interest in the efficacy of various procedures or treatments. I’m not talking about death committees or anything like that, but if the government is funding your health care then they have a right to say no to certain treatments. This is the same principle that leads me to believe that the government should have a right to tell people in NYC that they can’t buy cola with food stamps. It doesn’t mean you can’t buy cola (or health care), it just means that you have to use other (ahem, your own) money to do it. If it’s too expensive, find a cheaper alternative. That might mean more competitiveness in the market for health care. It might mean people going to other countries for treatment (not ideal but certainly possible). And it might even mean that more people become aware of homeopathic alternatives.

On a lighter note, here’s a clip from Scrubs that always comes to mind when I think about the effectiveness vs cost of certain health care procedures:

What is the purpose of professional conferences?

Having just returned from a pleasant trip to WPSA 2011, I thought it would be appropriate to return to the intended question-and-answer format. Last night I was fortunate enough to have dinner with some friends of my mentor who were in town for the conference of the Pop Culture Association/American Culture Association. I suspect that the reasons below would hold true for other professional organizations like theirs, but they are based only on my limited experience in political science and may not even hold true across the breadth of my discipline. Anyways, I see five inter-related purposes to academic conferences:

1. To share the latest ongoing research. This allows attendees to stay up-to-date with the latest findings in fields of interest to them, as well as to have ideas stimulated for new projects. Substantively-focused conferences like the International Studies Association and the Peace and Justice Studies Association are even better for this than traditional regional organizations in my opinion.

2. Socialization. Applies both to people who are new to the profession (such as myself) and to those who are already in a given field. You can see the practices of others and the types of questions they’re exploring. This is useful whether you agree or disagree with their work: if you like it, you can emulate it; if you hate it, you can respond to it/ fill a gap that the current literature may be missing. You can also gain new perspectives–my panel on terrorism this morning included a couple of former military members, who always bring interesting thoughts into these discussions.

3. Travel. It would be silly to pretend that the perk of funded travel isn’t an important aspect of any profession that allows it. Occasionally travel to a new place can ignite new interests (there were a lot of Mexico-related presentations in San Antonio, for instance) but usually it’s just fun.

4. To talk out ideas. This is related to the first two, but different. Most people I know use conference papers as an intermediate step between their initial research and submitting for journal publication. A good panel (not all of them are) allows you to get comments and suggestions that hopefully prevent you from embarrassing yourself in front of journal reviewers. I think there is a benefit to being able to compress your thoughts into a 15-minute presentation, whereas professors are typically called on to elaborate on ideas in 75-minute classes. The same is true of writing short articles (20-40 pages) as opposed to books: like any other muscle, the brain is strengthened by expansion and contraction. I’ll take this up again in a couple weeks when I write about the purpose of academic journals.

5. Improved teaching. This one is closely related to several of the above, but worth mentioning in its own right because teaching is often viewed as separate from research. The two are integrally related in my opinion. You can’t be a top-notch teacher unless you know how to do your own research, and vice-versa. Keeping up with the latest developments, getting to know others in your field, practicing the presentation of your ideas to an audience, and taking an occasional break for travel can all help someone stay fresh in their teaching. Some presenters may attend conferences for expressly this reason, with no intention of publishing their papers.

Anything I’ve missed? Other questions out there? If we get any questions that aren’t within my purview, a few colleagues have agreed to be occasional guests here. Many thanks to them, and to you for reading.

WPSA 2011

The 2011 Conference of the Western Political Science Association starts today in San Antonio, TX. I’ll be there this evening and presenting tomorrow and Saturday. Dr. Kennedy and I will present a more quantitative version of what we did in DC last week. My Saturday presentation is a portion of my thesis research discussing the effects on violence when terrorist leaders are forcibly removed.

MCDthesis

My thesis, "Adverse Consequences"

If I get the chance to attend any interesting panels I’ll mention them here. Also open to restaurant recommendations.

Sidenote: Mexico Agonistes

Duncan Currie writes this about Mexico’s drug violence and its relation to political and economic issues in National Review Online:

Drug seizures make for good photo-ops, but they rarely have a big impact on the DTOs [Drug-Trafficking Organizations--md]. By contrast, killing or arresting senior drug lords can cripple their gangs. Over the past few years, Mexico has taken down a long list of kingpins. Alas, these victories have not yielded a sustained reduction in violence.

The only way for this to make sense is if success against drug gangs is measured in some other way than decreasing violence. And it may very well be: it is perfectly logical to measure “success against drug gangs” as decreasing the quantity of drugs flowing across the border. However:

1) I know of no evidence that any decrease in drug traffic has actually occurred. In fact, the continued violence seems to indicate that there is still a profit in running drugs across the border, so I would argue that the level has probably remained the same or increased slightly to allow the traffickers to finance their feuds.

2) I get that Mexico is a close ally of the US and that they are sort of doing our bidding by attempting to eradicate/decrease their local drug trade. But to me it seems like their more important interest is keeping violence down within their own borders. Matt Yglesias has a couple of posts that touch on this point, both directly and indirectly.

Finally, if knocking off leaders is increasing violence in Mexico, maybe they/we should try another strategy. That is the subject of one of my forthcoming papers, which I will share here as it progresses.

Orientalism and Globalization

Since the last post was about nationalism, it seems logical to take a step into the international system. This post will do so in two ways, by looking at international relations through a colonial/post-colonial framework known as Orientalism, and then responding to Orientalism with an argument from globalization.

Orientalism is a theory typically associated with the Edward Said book of the same name and subsequent works. To (over)simplify, Said et al describe Orientalism as the beliefs and actions in the West that facilitated the colonial enterprise. Specifically it is the collection of attitudes that political and military officials–and even some artists/writers–in France, Britain, and the US (“the West”) about people in the Middle East and Asia (“the East/Orient”). These attitudes often included thinking of Orientals as “the Other” in a way that allowed Westerners to subjugate them. Most scholars of Orientalism insist that this attitude continues today in the US as a form of neo-colonialism. More generally, Said and company’s argument is essentially that powerful people/states construe less powerful people/states in a way that allows the former to dominate the latter. I know all of this is a bit foggy, but trying to summarize hundreds if not thousands of pages of argument into one paragraph can be a bit tricky.

Now to the response from Globalization. I object to Said’s theory of Orientalism not on any factual grounds, but because of its implications. While I admit that the colonial enterprise resulted in a lot of suffering in many cases, on the whole I am of the opinion that it generally raised living standards in most of the places where it was undertaken (sub-Saharan Africa may be an exception, although I think this has more to do with ethnic conflict than with colonialism per se). If Orientalism’s argument is about power (as I asserted above), then Globalization is about economics. To again oversimplify, I take Globalization to be the process by which economic actors (states, corporations, and individuals) have become increasingly interconnected over the last couple of decades. It is this era that made 9/11 possible: before the widespread availability of cheap air travel, those attacks would’ve been impossible. Before the advent of 24-hour news networks that exposed residents of third world countries to international politics, the 9/11 attacks would’ve been unimaginable.

In the era of Globalization, in which a small group of terrorists with access to technology (both of the laptop computer variety and the more lethal, Semtex variety) can destroy skyscrapers and cause billions of dollars worth of damage to the world economy, Orientalism no longer makes sense. Traditional power structures are no longer the only way of dominance. While it is almost certainly true that the West construed Orientals (remember that typically means Middle Easterners, not just East Asians) as the “Other” throughout the colonial period, today the reverse is happening. Five or ten years ago (it may be less true today), young people from Casablanca to Calcutta saw the US and its allies on TV and immediately perceived them as an enemy. Some have called this Occidentalism. I don’t agree entirely with the Occidentalist argument either, but what I’m saying is that the cultural power of the West is no longer hegemonic. To continue to berate the West as Orientalist when it is trying to bring freedom to those same countries is both inaccurate and irresponsible.

I welcome discussion of this in the comments. More on this topic will almost certainly come as I read a couple of John Gray’s books over the summer.

Nationalism, Briefly Described

It’s a little unfair to ask people to comment on the viability of this endeavor with only one post*–or even two, really–so I thought I’d add another to give it some more flavor. Still kinda on a DC high–went to Old Town Alexandria today (pictures to follow, if I feel like it).

On the metro ride down there I started reading Imagined Communities, a book about nationalism that I’ve been meaning to read for about two years. Since part of the purpose of this blog is to familiarize any potential readership with important (to me at least) concepts in political science, I thought I would take this as an opportunity to briefly describe nationalism.

As Anderson puts it, “nation-ness is the most universally legitimate value in the political life of our time.” To show just how thoroughly nationalism has permeated political discourse in our time, think through this series of examples with me. When you refer to the country in which I (and probably you) live in everyday conversation, what do you call it? Probably “America,” right? But of course everyone knows that the formal name of our country is “the United States of America.” Everyone from Canada on down to Argentina and Chile technically lives in “America.” We choose this term not because of geographical accuracy, but because it describes how we think of this country: as “one nation under God” rather than a loose coalition of separate states, as it was under the articles of confederation.

The point becomes a bit more clear when we consider states that do not refer to themselves in nationalistic ways. Both the Soviet Union (USSR) and the United Kingdom (which unites England, Wales, Scotland, and Northern Ireland) long resisted the tendency to refer to themselves as a nation in that way. Alternately, most of the revolutions of the twentieth century (and, for different reasons, our own in the 19th) were national ones: “Socialist Republic of Vietnam,” “Islamic Republic of Iran,” and so on. These revolutions presumed a common identity among a nation of people.

This may seem trivial, or perhaps obvious, but that last bit gets at the meat of the matter: the idea of the “nation” is a powerful metaphor that motivates people to make important choices, including but not limited to the kinds of choices that risk (and often take or lose) lives. The idea of the nation really began in the 18th century in the Americas and Europe, and gained a lot of ground in the Napoleonic era through its amalgamation as the “nation-state.”

Again we often think of these two terms as synonymous with “country,” but they have important connotations of their own. A state refers to a group of people who share a common land. An ethnicity is a group of people who share a common past. A nation is a group of people who share a common future; this is why it is a powerful motivator for things like revolutions. One common, but not uncontroversial, example is Jews and Israel. For much of the latter half of the second millenium AD, Jews in Europe shared a common ethnicity (obviously), but many of them saw their future as assimilation in various other countries. It wasn’t until the tragedies of the pogroms and the holocaust that they became a nation, needing a unified response against those threats. And in 1948 they became a state.

The two most important things to draw from all this is that 1) definitions carry weight in political science and 2) we define most political terms in a way that refers to people and their beliefs and behaviors. Though Anderson also admits in his introduction that “nation, nationality, nationalism — all have proved notoriously difficult to define, let alone analyse.”

I plan to reflect on these matters in a more personal way tomorrow morning, when I take the opportunity to visit Arlington National Cemetery. For now, see Regina Spektor’s “Uh-Merica.”

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* In social science we call this “small sample size bias” and it can be a real problem for empirical research.

You study politics, right?

Right, sort of.* I study a few very specific aspects of politics: political violence, religion-and-politics, and the Middle East. Obviously there is a substantial of overlap between these three fields, and when that occurs I am doubly or even triply fascinated, but I am also interested in them independently of one another. For instance, a paper that I’m working on about violence in Mexico is about as interesting to me as a book about religion and politics in Europe, which is in turn about as interesting as an ongoing project about Turkish foreign policy.

Which brings me to the introduction to this blog. Since I’m in DC today presenting a portion of that Turkish project, it seemed like as good a time as any to get this started. It’s been in the back of my mind for a while, but being here gave me the impetus to start. Today my coauthor/mentor and I presented a paper to the Young Scholars on Turkey (YSOT) Conference. I may do a follow-up post about our topic and how it develops, but for now suffice to say that it was well received.

As I continue my work on the projects mentioned, and develop new lines of research, I will mention them here. This blog will also serve as a catch-all for outlining my own thoughts on topics raised in the media or in my studies, and for giving updates that may be of general interest. As a rule, I plan to write like strangers are reading, even if in reality no one is. Any benefit derived from this blog by its readers is purely incidental to its may purpose of forcing me to get in the regular habit of writing, which will in turn stimulate further thinking.

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*The ability to give qualified answers like this is considered de rigueur in academia, which should be helpful as I progress through graduate school and into the profession.