Failing the Test: Did Our Discomfort With Numbers Doom Health Reform?

While the implications of our national falling-out with numbers on the strength of our technical workforce are obvious, the policy implications of this trend may be more insidious.
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Academic physicians interested in analyzing medical decisions among patients have increasingly turned their attention toward "numeracy," or facility and ease with numbers, as a predictor of medical decision-making. That literature, unsurprisingly, has shown that patients who are less numerate make poorer decisions about their health. Findings from a study published in the peer-reviewed journal Medical Decision Making in 2001 summarize this phenomenon well: the authors showed that numeracy was an important predictor of how subjects valued their current health. In fact, those with the lowest numeracy scores actually valued worse health over better health!

Among the more well-known, disheartening trends in American society are stagnant math and science scores relative to our international counterparts. Increasingly, young Americans are balking at the numerical disciplines, leaving them to more motivated and increasingly better-trained internationals. Every four years, the International Center for Education Statistics produces the "Trends in International Math and Sciences Study" (TIMSS), which evaluates math and science aptitude among American 4th and 8th graders relative to their peers internationally. The most recent TIMMS report reflects data from 2007. The findings showed that compared to the first study in 1995, scores in science and math have stagnated among US students, as compared to stark improvements in several other countries (including Iran).

While the implications of our national falling-out with numbers on the strength of our technical workforce are obvious, the policy implications of this trend may be more insidious. Let's turn our attention healthcare reform, considering that we're now mourning "what could have been" after watching the saga of its troubling life, from its infancy as a campaign promise, to its childhood as a mandate following Pres. Obama's victory, to its chaotic adolescence under the influences of populism in town-hall meetings this past summer, and finally to the fateful near-death accident that's left it teetering on the edge.

A central conundrum many on the left have struggled with, is that the demographic most likely to oppose healthcare reform seems to be the same demographic most likely to benefit from it. If numeracy is a key predictor of the ability to value health among a small sample of Americans, did poor American numeracy doom healthcare reform?

After all, the reform package was built around two empiric arguments that would address crucial policy imperatives, the economic imperative to lower healthcare costs, and the moral imperative to improve health coverage. Reform would reel in healthcare costs as a proportion of GDP from the current 16% (estimated to be 37% by 2050 at current rates), and it would expand coverage to between 31 and 36 million Americans, decreasing the proportion of America's uninsured by up to 78%. Clearly, both of these arguments are quantitatively complex, and therefore, implicitly dependent on the American public's ability to understand and evaluate percentages, proportions, ratios, and returns. Both ultimately failed.

As American math and science skills continue to stagnate, the outlook for appropriate, yet empirically complicated social policy looks bleak. While healthcare reform may be the first on Obama's ambitious list of policy targets that has suffered as a consequence of poor numeracy among the American populous, it won't likely be the last. Climate change poses another scientifically and mathematically challenging series of trade-offs that are poorly understood and perceived skeptically by many Americans. Forthcoming climate change legislation may suffer the same troubled and tragically short life as its older brother.

With this understanding, even in light of pressing concerns over poor health outcomes and rising healthcare costs, a quickly deteriorating environment, belligerent banks, and a plethora of other urgent policy foci, equitable access to high quality education, especially in the sciences and math, may be the most important policy focus of them all. Frankly, if a group of subjects with poor quantitative skills don't have the ability to value better health over worse health in a simulation, we can't expect an increasingly less numerate population to make sound decisions about our national health, our economy, or our shared Earth. In a democracy "for the people, and by the people", it is crucial that "the people" can understand the theoretical underpinnings, complex trade-offs, and difficult decisions that frame our social policy.

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