TIME Health Care

How to Solve Obamacare’s Youth Enrollment Problem

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Shocked man holding 'Affordable Care Act' sign Getty Images/Flickr Open / Getty Images/Flickr Open

Take advantage of peer pressure and that young people care what others think

When the first Obamacare enrollment numbers were released, there was nervousness that only 24% of those signing up were in the important 18 to 34 age category. Those who initially signed up through the Affordable Care Act tended to be older and potentially less healthy, and that kind of population didn’t bode well for premiums—or the law’s economic viability. So the question at hand was this: How do we get more young people to enroll?

Currently Obamacare uses financial penalties to get people to sign up. The result is either resentment or just plain avoidance. Young people in particular are upset because they know they’re paying for their elders. But a new quantitative science, called social physics, shows us that the key isn’t just to make it in their economic self-interest, but to make doing so benefit their own circle of people.

Social physics is a new quantitative science that not only describes how networks of people behave, but also accurately predicts patterns of human behavior and influences those patterns. It harnesses big data to radically change our ideas about why people decide to change their behavior, and how new ideas reach them and move them.

For instance, in one community experiment, my MIT research group offered people financial rewards for healthier behavior. The result was a small improvement, but one that disappeared as soon as the experiment ended. However, in a second community, we gave people rewards only when their neighbors or members of their workgroup improved. The improvement was up to eight times greater, and, perhaps just as important, the pattern of healthier behavior continued even after the experiment’s money ran out.

What explains the difference? Social network incentives raise community awareness and create social pressure to work together. Individual incentives are just that: They engage only the individual and miss the power of community engagement. When people interact in small groups, the ability to punish or reward peers is effective at promoting trusted cooperative behavior.

The social physics approach to getting everyone to cooperate focuses on changing the connections between people rather than getting individual people to change their behavior. Social network incentives act by generating social pressure around the problem of finding cooperative behaviors; people experiment with new behaviors to find ones that are better. The social pressure generated is a function of the cost of the behavioral mismatch between the behavior of the individuals, the value of the relationship, and the amount of interaction. All this means that the most effective network incentives should be focused on the people who have the strongest social ties and the most interaction with others.

You can also use social physics in online environments. For instance, with colleagues at the Swiss Federal Institute of Technology, we encouraged buddy groups within a digital social network around energy use: When someone saved energy, then gift points were given to his or her buddies. This social network incentive caused electricity consumption to drop by 17%, twice that seen in earlier energy conservation campaigns and more than four times more effective than the typical energy reduction campaign. Just as in the health experiment, behavior change was most effective when it leveraged the strength of the surrounding social ties.

So how can the Obama administration use social physics to increase outreach to young people ahead of National Youth Enrollment Day on Feb. 15?

The simplest example would be to offer discounts to young people in workgroups or in the local neighborhood—but only if everyone signs up. If you offered each person $5 a month if everyone were to sign up, it would be a real topic of conversation among young people. If you offered $50 up front, it would be something they would have to do, because otherwise they would be ostracized by their peers—even though $50 is less than $5 per month. Using social physics, rather than economics, could drive young people to sign up in droves.

Alex Pentland is the author of Social Physics: How Good Ideas Spread—The Lessons from a New Science (The Penguin Press; February 2014), and a professor at MIT.

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