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Mice Don’t Know When to Let It Go, Either
Animals, like humans, are reluctant to give up on pursuits they’ve invested in, psychologists report.
Suppose that, seeking a fun evening out, you pay $175 for a ticket to a new Broadway musical. Seated in the balcony, you quickly realize that the acting is bad, the sets are ugly and no one, you suspect, will go home humming the melodies.
Do you head out the door at the intermission, or stick it out for the duration?
Studies of human decision-making suggest that most people will stay put, even though money spent in the past logically should have no bearing on the choice.
This “sunk cost fallacy,” as economists call it, is one of many ways that humans allow emotions to affect their choices, sometimes to their own detriment. But the tendency to factor past investments into decision-making is apparently not limited to Homo sapiens.
In a study published on Thursday in the journal Science, investigators at the University of Minnesota reported that mice and rats were just as likely as humans to be influenced by sunk costs.
The more time they invested in waiting for a reward — in the case of the rodents, flavored pellets; in the case of the humans, entertaining videos — the less likely they were to quit the pursuit before the delay ended.
“Whatever is going on in the humans is also going on in the nonhuman animals,” said A. David Redish, a professor of neuroscience at the University of Minnesota and an author of the study.
This cross-species consistency, he and others said, suggested that in some decision-making situations, taking account of how much has already been invested might pay off.
“Evolution by natural selection would not promote any behavior unless it had some — perhaps obscure — net overall benefit,” said Alex Kacelnik, a professor of behavioral ecology at Oxford, who praised the new study as “rigorous” in its methodology and “well designed.”
“If everybody does it, the reasoning goes, there must be a reason,” Dr. Kacelnik said.
Even more important than the similarity among species was the study’s finding that sunk cost effects appeared only after the subjects had decided to pursue a reward, Dr. Redish noted, not while they were still deliberating whether to do so.
In effect, the animals seemed to consider the deliberation time not to be part of their investment — an indication, Dr. Redish said, that different brain processes might be at work in different aspects of decision-making.
The idea runs counter to the notion that “time is time, and you’re wasting it either way,” he said.
Shelly Flagel, an associate professor of psychiatry at the University of Michigan who was not involved in the study, said the research had “far-reaching implications across fields including education, economics, psychology, neuroscience and psychiatry.”
For example, she said, persisting in a behavior even though it has adverse consequences is reminiscent of the conduct “exhibited by people with addictions.”
“Once they start searching for their next ‘fix,’ they will often go hours or days on the same quest, even if it means giving up food, relationships, their job,” Dr. Flagel said.
Learning more about the distinct processes that go awry in psychiatric disorders like addiction might yield new strategies for treatment, she added.
In the study, led by a doctoral student, Brian M. Sweis, three research laboratories at the University of Minnesota collaborated to conduct tests on mice, rats and humans. The rodents were trained to forage for the flavored pellets — banana, chocolate, grape or plain — in a square maze with a “restaurant” in each corner.
The humans were taught to “forage” on a computer for videos of kittens, “dance landscapes” or bicycle accidents. Both rodents and humans were given an overall time limit for the foraging tasks.
In the rodents’ version of the task, the animal first entered an “offer zone” outside a restaurant and heard a pitched tone that informed it how long the wait would be for the pellet reward — a delay that varied randomly from 1 to 30 seconds.
The animal could skip the offer, in which case it was withdrawn, or it could enter the “wait zone” of the restaurant, setting off a countdown signaled by a descending tone. At any time during the countdown, the rodent could choose to leave the restaurant, but once it left it could not return without going all the way around through the other restaurant offer zones.
In the human version of the experiment, subjects were offered a video and presented with buttons saying “stay” or “skip.” A download bar informed them how long they would have to wait to view the video. Clicking the “stay” button started a countdown, and the screen showed the progression of the download.
The study found that the more time the rodents spent in the “wait zone,” the more likely they were to stick out the delay to the end, even though the longer they waited, the more it cut into their overall time to seek food.
Similarly, the longer the human subjects spent waiting for a video to download, the more likely they were to stay the course until the download was finished.
Surprisingly, the amount of time that the subjects — rodent or human — spent deliberating whether to accept the “offer” of a reward did not affect whether they quit before receiving it or stayed through to the end.
“Obviously, the best thing is as quick as possible to get into the wait zone,” Dr. Redish said. “But nobody does that. Somehow, all three species know that if you get into the wait zone, you’re going to pay this sunk cost, and they actually spend extra time deliberating in the offer zone so that they don’t end up getting stuck.”
Dr. Flagel, of the University of Michigan, noted that as compelling as the new research was, it was not without limitations, including the fact that the tasks presented to humans and rodents, though similar in some ways, were still quite different.
“The challenge moving forward,” Dr. Flagel said, “is going to be to know that one is truly capturing the same phenomenon across species. Or perhaps more appropriately, what is the meaning of the differences that will be revealed between species?”
House panel advances bill that would temporarily halt ObamaCare’s employer mandate
The House Ways and Means Committee on Thursday approved legislation that would chip away at ObamaCare, including a measure that would temporarily repeal the law’s employer mandate.
The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R-Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022.
Congress repealed the penalty associated with the individual mandate last year, but it doesn’t take effect until 2019.
“I think it’s fair, if we relieve the burden for individuals, that we stand with our small and mid-sized companies,” Kelly said.
Powerful lobbying groups like the U.S. Chamber of Commerce have pushed for a repeal of the employer mandate.
The other measure, sponsored by Reps. Peter Roskam (R-Ill.) and Michael Burgess (R-Texas), would allow the use of ObamaCare’s tax credits for plans outside of the exchanges in the individual market. It would also allow anyone to purchase a catastrophic plan — plans that are cheaper but cover fewer services and are currently only available for those under the age of 30.
The bill “provides a much needed offramp for pressure people are feeling right no in terms of premiums increases and limited choices,” Roskam said.
Both measures advanced on party-line votes.
Democrats opposed the bills, saying they would cost too much and destabilize ObamaCare.
‘What The Health?’ ACA Under Fire. Again.
https://khn.org/news/podcast-khns-what-the-health-aca-under-fire-again/
Democrats in the Senate are gearing up to fight President Donald Trump’s nominee to the Supreme Court, U.S. Circuit Judge Brett Kavanaugh. They argue he is not only a potential threat to abortion rights, but also to the Affordable Care Act.
Meanwhile, the Trump administration continues its efforts to undermine the workings of the Affordable Care Act. This week, officials announced a freeze on payments to insurers who enroll large numbers of sicker patients, and another cut to the budget for “navigators” who help people understand their insurance options and enroll for coverage.
This week’s panelists for KHN’s “What the Health?” are:
Julie Rovner of Kaiser Health News
Margot Sanger-Katz of The New York Times
Anna Edney of Bloomberg News
Julie Appleby of Kaiser Health News
Among the takeaways from this week’s podcast:
- One reason Democrats are rallying around the health issue rather than the abortion issue is that there is more unity in their caucus over health than abortion. Also, the two key Republican senators who support abortion rights — Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) — also voted against GOP efforts to repeal the Affordable Care Act last year.
- The Trump administration’s action on risk-adjustment payments sent yet another signal to insurers that the federal government does not necessarily have their backs and is willing to change the rules along the way.
- The Trump administration says it wants to cut to payments for navigators because they are not cost-effective. But the navigator money does not come from taxpayers or government sources. It is paid from insurance industry user fees. These funds also go to support ACA advertising — which has also been cut. However, the user fees have not been reduced. In theory, reducing these fees could provide savings that could be passed on to consumers.
- After being called out on Twitter by Trump, drugmaker Pfizer this week announced it would delay some already-announced price increases on about 100 of its drugs. It is worth noting that the president used his bully pulpit and gained some success. The six-month delay will mean that consumers will not experience an increase in cost at the pharmacy for at least that time period. But it still raises questions.
- The Trump administration worked to block a World Health Organization resolution to promote breastfeeding. But while this seemed a clear case of promoting the interests of infant formula companies over public health experts, there was pushback from some women who say they are unable to breastfeed and feel stigma when they opt for formula instead. On the other hand, formula can be dangerous in developing countries without easy access to clean water.
Forty Years of Winning Friends and Influencing People
An interview with former US Representative Henry Waxman of California.
Of the more than 12,000 Americans who have served in Congress since it convened in 1789, few have had careers as fruitful as Henry Waxman’s. Representing west Los Angeles and its surrounding areas for 40 years, Waxman, 78, left a remarkable imprint on US health policy. His manifold accomplishments were capped by the passage of the Affordable Care Act (ACA) in 2010. A son of south-central Los Angeles, he worked at his father’s grocery store, earned a law degree at the University of California, Los Angeles, and in 1968 won a seat in the State Assembly. He was elected to the US House in 1974 in an era when bipartisanship was ordinary and health care had yet to become an overwhelming economic and political force in American life. Waxman was known in Congress for his persistence at wearing down opposition. Republican Senator Alan Simpson of Wyoming famously called him “tougher than a boiled owl” after negotiating the landmark Clean Air Act amendments of 1990. Waxman led efforts to ban smoking in public places and to require nutrition labels on food products. I talked with him recently about his experiences, the future of health policy, and the changing language of health reform. The transcript has been lightly edited for length and clarity.
Q: In 1974, when Los Angeles voters first sent you to Washington, health policy wasn’t the ticket to political influence. You are a lawyer, not a doctor. What drew you to health care?
A: When I was first elected to the California State Assembly in 1968, I believed that if I specialized in a policy area I would have more impact than if I tried to be an expert on everything. Health policy fit my district in Los Angeles, and I could see that government needed to be involved in a whole range of decisions, from health care services to biomedical research to public health. I was chairman of the Assembly Committee on Health. I was elected to Congress in 1974 in a Democratic wave election. I wanted to get on a health policy committee, which was Energy and Commerce. Democrats picked up so many seats and there were so many committee vacancies that year that it was easy to claim one, and I got on that committee. Within four years there was a vacancy for chair of the health and environment subcommittee, and I stepped up to that. It gave me a lot more impact.
Q: What role do you think health care will play in the upcoming elections?
A: If the Democrats do as well as I expect and hope, it will be more because of what Trump was doing in the health area than anything else. Even though people value health care services and insurance, the idea that the president and the GOP wanted to take away health insurance and reduce benefits for people who needed it — that was something they didn’t expect and were angry about.
Q: Is it feasible to provide health coverage to everyone?
A: I have always felt we needed access to universal health coverage. It wasn’t until we got the ACA under Obama that we were able to narrow the gap of the uninsured — those who couldn’t get insurance through their jobs, who weren’t eligible for Medicare and Medicaid, who had preexisting conditions, or who couldn’t afford the premiums. The ACA helped people have access to an individual health policy by eliminating insurance company discrimination and giving a subsidy to those who couldn’t afford coverage. It wasn’t a perfect bill, but it was important. The idea that Republicans would come along and bring back preexisting conditions as a reason to deny people coverage is what drove enough GOP senators to stop the GOP repeal bill from going forward last year. We’ll see what they do by way of executive orders or through the courts to try to frustrate people’s ability to buy insurance.
The Republican ACA repeal bill last year was a real shock because they also wanted to repeal the Medicaid program and allow states to cut funds for people in nursing homes, people with disabilities, and low-income patients who rely so heavily on that program. And they had proposals to hurt Medicare that House Speaker Paul Ryan had been advancing. The American people do not want to deny others insurance coverage and access to health services.
Q: Bipartisanship has gone out of style. Can it be revived?
A: It doesn’t look very likely now, but I built my legislative career on the idea that there could be bipartisan consensus to move forward on legislation. All the big bills had bipartisan support. The only bill that got through on a strictly partisan basis was the Obamacare legislation, and I regretted that. The Republicans just wanted to denigrate it and scare people into believing the ACA would provide for death panels, hurt people, take away their insurance, and keep them from getting access to care. None of that was true.
Q: A growing number of Democrats want to establish a single-payer health care system for the state. Do you agree with them?
A: A lot of people mistake the phrase “single payer” with universal health coverage. While I share the passion of people who want to cover everybody, single payer is not a panacea. My goal is universal health coverage. The Republican attempt last year to repeal the ACA and send 32 million Americans into the ranks of the uninsured was an albatross around their necks.
But the Democrats could turn this winning issue into a loser if some make a single-payer bill such as Medicare for All into a litmus test. I cosponsored single-payer legislation in Congress with Senator Ted Kennedy, and I always sought to bring the nation closer to universal coverage. I authored laws to bring Medicaid to more children and to establish the Children’s Health Insurance Program, and I led the fight to enact the ACA. These bills were very important. If we passed something like a single-payer bill, which would be extremely hard to do, we would be passing up opportunities to make progress. A lot of people who want a Medicare for All bill don’t realize that those of us on Medicare have to pay for supplemental insurance, because Medicare doesn’t cover everything. Medicare doesn’t generally cover certain services like nursing home care, so to get help you have to impoverish yourself to qualify for Medicaid.
One organization is sending out letters telling voters to support a single-payer bill and you won’t have to pay anything anymore. We can’t afford something like that. Democrats can embrace a boundless vision for a health care future without being trapped by a rigid model of how to get there. We should increase the number of people with comprehensive health insurance and focus on lowering costs. People with Medicare don’t want to give it up. People have health insurance on the job.
I would rather expand on what we have and build it out to cover everybody.
People don’t seem to remember that Democrats could barely muster the votes for the ACA when we had 60 votes in the Senate and a 255–179 majority in the House. Even if we recapture Congress and the presidency, I don’t think we would get a Medicare for All bill passed. It would require such a high tax increase that people would be absolutely shocked.
Q: What would be the national impact of California adopting a universal coverage plan?
A: Californian progress would be a model for the rest of the country, and we would be doing what’s right for the people of California who don’t have access to coverage. I think California is a trendsetter — for good and for bad. Proposition 13 and term limits started in California and spread to other states, and I think they have been a disservice. We’ve also done a lot of good things in California, and the rest of the country follows those things as well.
People who try to marginalize California do so at their own risk. People around the country look at California as a leader. California embraced the ACA, expanded Medicaid, and has been moving forward on making sure our public health care system is reforming itself to represent the needs for population health care and to ensure that uninsured low-income patients get access to decent, good-quality health care.
Q: More states are adopting work requirements in Medicaid. Do you think that will become the standard nationwide?
A: Work requirements are inconsistent with the Medicaid law. We’re talking about making people go to work to get health care when they’re sick. I just don’t think it makes sense. The courts may throw it out, and if not, at some point there will be a reaction against it, and it will be repealed by a future Congress.
Q: Some see parallels between the conduct of tobacco companies and opioid makers. Do you think “Big Pharma” will be held to account like “Big Tobacco?”
A: In the difficult fight against big tobacco, one of the lessons we learned was that even an extremely powerful group like the tobacco industry could be beaten if you keep pushing back. Even though there was overwhelming public support for regulation of tobacco, it took until 2009 before we could enact tobacco regulation by giving the Food and Drug Administration (FDA) authority to act. In the meantime, there were lawsuits by states to recover money they spent under Medicaid programs to cope with the harm from smoking. With opioids, there will be more and more lawsuits against distributors and manufacturers whose actions resulted in deaths of people from opioid addiction. Congress now is grappling with many bills to help people who are addicted, to prevent addiction from spreading further, and to restrict the ability to get the drug product. I’m optimistic we can come to terms with this crisis.
Q: What have you been doing since retiring from Congress?
A: I wanted to stay in the DC area near my son, Michael Waxman, and his family. He had a traditional public relations firm and he asked me to join him. In the health area, we represent Planned Parenthood in California, public hospitals in California, community health centers at the national level, and hospitals that get 340b drug discounts because they serve many low-income patients. We have foundation grants to work on problems of high pharmaceutical prices, and foundation grants to have a program to make sure women know about the whole range of health services available to them for free under the ACA. I enjoy working with my son and pursuing causes I would have pursued as a member of Congress.
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HENRY KOTULA 