Adventures in Old Age

A candid look at aging, old age, and eldercare.

Opinions Are Like Sphincters, Everyone Has One--But Knowledge Is Power

Twelve percent believe Noah's wife was Joan of Arc.

Opinions are like sphincters, everyone has one. (Actually, I'll admit that's the cleaned-up version--so to speak--so, please, no scholarly objections from people who recall Harry Callahan in The Dead Pool, 1988.)

But the point is that it's easy to have an opinion but it's quite another thing to have an informed or educated opinion.

Or to put it still another way, public opinion polling is a snapshot of the populace's level of ignorance at a given time.

The National Science Foundation compiles polling statistics on the public's knowledge of science, and regularly comes up with results showing that one-half or less of the public knows that the earth revolves around the sun, that humans did not live at the same time as dinosaurs, or that electrons are smaller than atoms.

But in case you think I'm picking on scientific ignorance, the results are not much better for religion. We are one of the most believing countries in the world. According to a Gallup poll, almost 80 percent of Americans believe in God, contrasted to a Eurobaramoter poll showing that only 38 percent of United Kingdom subjects believe in God.

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But when pollsters looked at religious knowledge, the results were similar to the findings about whether the earth revolves around the sun. Another Gallup poll found that despite the fact that three-quarters of us believe in God, only half could name any one of the four Gospels, only 42 percent could recite even five of the Ten Commandments, and the same percentage, 42, could not name who delivered the Sermon on the Mount. Another researcher, George Barna, found that 12 percent of his respondents believed Noah's wife was Joan of Arc. (He didn't ask if the wedding was in the Ark of the Covenant.)

Given these levels of ignorance, when it comes to the government we get, do we have any basis to complain?

De Tocqueville visited America and was inspired to say, "People get the government they deserve," and our own H. L. Mencken added, "And they deserve to get it good and hard."

Interpolating these polling results to politics, do I have any reason to trust the public's good sense, or to do little more than to throw up my hands and emigrate?

After we also cast blame on our education system as well as our intellectually incurious culture, what is to be done?

I was prompted to write this post after reading one by Nate Silver, the guru of political prognostication at fivethirtyeight.com, who correctly predicted the outcome of 49 out of 50 states in the 2008 presidential election. Silver recently posted "Health Care Polls: Opinion Gap or Information Gap?" in which he argues that opposition to health care reform is based on misinformation and lying--kind of like believing we should rewrite our textbooks to take into account all the people who believe humans lived with dinosaurs or Noah married Joan of Arc. He analyzes the latest Kaiser Health Tracking Poll, and concludes that surveyed respondents would likely support a bill that had particular provisions, but they were often unaware the either the Senate or the House bill had those provisions. In many cases, their opposition to the bill was based on ignorance about what was actually in the bill.

"What we see is that most individual components of the bill are popular -- in some cases, quite popular. But awareness lags behind. Only 61 percent are aware that the bill bans denials of coverage for pre-existing conditions. Only 42 percent know that it bans lifetime coverage limits. Only 58 percent are aware that it set up insurance exchanges. Just 44 percent know that it closes the Medicare donut hole -- and so on and so forth," writes Silver.

Yet, when made aware that the bill does contain such provisions, support for it increases dramatically. Awareness of bills mandated inclusion of pre-existing condition coverage increases support by a net of +39, for example.

"How would public opinion change if people were fully informed about the content of the bills? It's hard to say for sure, but on average, the individual components of the bill are favored by a net of +22 points. An NBC poll in August also found that support went from a -6 net to a +10 when people were actually provided with a description of the bill," Silver observes.

He is not optimistic about perceptions changing in the short term, but if the bill were enacted, he argues its popularity would increase over time when citizens realize, for example, they wouldn't lose coverage if they lost a job.

The problem with selling the bill is that opposition can be expressed in easily digestible sound bites--even if they are false--while support requires the attention span to understand the actual contents of the bill. In an earlier post, "Is Health Care Reform the New Iraq War?" he looked at how untruths about Iraq--their possession of weapons of mass destruction including a nuclear capability, Saddam Hussein's ties to Al Qaeda--initially created a very favorable climate of support for the war. Once the public relied how untrue these claims were, both the war and the administration proclaiming them sunk in popularity.

Silver sees a similar dynamic at play with health care: "Once again, one side has told a lot of lies to help alter the course of public opinion. Some of these lies, like death panels or the government takeover meme, are not very subtle. Others are a little more clever: the notion, for instance, that we could easily require insurers to cover all people with pre-existing conditions without either adopting an individual mandate or substantially escalating premiums."

The difference in opinion that occurs when people are correctly informed, points to the benefits of a methodology called Deliberative Polling, which embodies the idea that knowledge is empowering.

Deliberative Polling was developed in 1988 by James Fishkin, a political scientist at Stanford, who describes it as "a practice of public consultation that employs random samples of the citizenry to explore how opinions would change if they were more informed."

Presaging Silver's recent postings, the web page for Deliberative Polling states the problem: "Citizens are often uninformed about key public issues. Conventional polls represent the public's surface impressions of sound bites and headlines. The public, subject to what social scientists have called ‘rational ignorance', has little reason to confront trade-offs or invest time and effort in acquiring information or coming to a considered judgment."

In the case of health care reform, rational ignorance might be: "I have a good health care plan. Is it worth my time and effort to study the issue to see if it would benefit others? I'd rather watch American Idol or Emma or football, which gives me guaranteed pleasure. And, besides, there's very little chance that my informed vote would make a difference."

To counter this problem--requiring a significant but not undue investment of time--Fishkin proposes this process: "Deliberative Polling is an attempt to use television and public opinion research in a new and constructive way. A random, representative sample is first polled on the targeted issues. After this baseline poll, members of the sample are invited to gather at a single place for a weekend in order to discuss the issues. Carefully balanced briefing materials are sent to the participants and are also made publicly available. The participants engage in dialogue with competing experts and political leaders based on questions they develop in small group discussions with trained moderators. Parts of the weekend events are broadcast on television, either live or in taped and edited form. After the deliberations, the sample is again asked the original questions. The resulting changes in opinion represent the conclusions the public would reach, if people had opportunity to become more informed and more engaged by the issues."

Well before Silver's recent analysis, in 2005, Fishkin's Center for Deliberative Democracy conducted a "National Deliberative Poll on Health Care and Education": "Nearly one thousand adult Americans engaged in a national scientific experiment to see what the public would think about education and health care--if only people became more informed about the issues and talked about them together."

A randomly selected sample of 981 adults took pre- and post-experiment questionnaires on health care and education policy issues. Three hundred and sixty participated in three or more one hour one hour discussions and the remaining 621 were a control group that did not deliberate.

(This was part of the PBS Network's By the People Project.)

The attitudes of the participants underwent some significant changes as a result of the deliberation. I'll focus on the health care results.

Although both before and after participants in the deliberative group felt that the uninsured were a significant problem (45 percent before and 49 percent after picked it as the most important), there were more significant changes when it came to remedies.

When asked "would you be willing to pay more than you do now for health care if this meant that many more Americans would have health insurance coverage," the percentage answering yes went up from 52 percent to 62 percent.

A national single payer system also attracted increased support, "where a government entity accepts all health care fees and pays out all health care costs for everyone." The number supporting this option went from 51 percent to 57 percent after deliberation.

One could argue that this was an already liberally biased group, since pre-test majorities supported both paying more to cover the uninsured and a single payer. This misses the point. The key to the deliberative process is not the absolute number who supported a given provision before and after, but the degree of attitude change.

Support for some provisions remained stagnant or went down. Support for higher taxes to increase funding for Medicare and Medicaid remained high but essentially unchanged--59 percent versus 58 percent. And support for employer mandated coverage declined from 51 to 44 percent.

Aside from changes in attitudes, there were very significant changes in the knowledge of the participants. "For example, the percentage able to identify the number of Americans who are uninsured (45 million) rose from 30 percent to 50 percent."

There were also increases in tolerance. To me, always a good thing. Participants agreeing with the idea that "people with views very different from mine often have good reasons for their opinions" increased from 67 percent to 75 percent, while the percentage disagreeing declined from 21 percent to 8 percent.

And there was a feeling that knowledge is empowering. Those who agreed that "People like me don't have any say about what the government does" declined from 52 percent to 38 percent.

The deliberative polling process has been used around the world: in Australia on changing from a monarchy to a republic and reconciliation with the aborigines; in Denmark on the adoption of the Euro as a currency; and in my own town of New Haven, Connecticut on regional economic cooperation between the city and suburbs.

Of course, one could agree with Nate Silver and Mark Twain that "A lie can get halfway around the world before the truth can even get its boots on."

I mean I have my own share of "rational ignorance" as I rush to complete this post before the NFL championship games begin.

But one can hope.

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Click here to read the first chapter of my book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare (Avery/Penguin, 2009). It provides a unique, insider's perspective on aging in America. It is an account of my work as a psychologist in nursing homes, the story of caregiving to my frail, elderly parents--all to th accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."

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Ira Rosofsky, Ph.D., is a psychologist in Connecticut who works in eldercare facilities and the author of Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare.

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