Addendum: Large Polling Error in 2020 US Presidential

Early in 2022, I posted some preparatory observations about polling for the 2020 US Presidential election.  These were based off recommendations by AAPOR (American Association for Public Opinion Research), responding to widespread criticism of how the 2016 polls performed. 

The post-hoc evaluation of 2020 polling was released by AAPOR in July 2021.  Of the 5 ‘takeaways’ that I previously noted, the situation ostensibly improved in 2020.  State-level polling was a concern in 2016, but according to AAPOR, polls were “remarkably accurate” in 2020.  Mode effects (online, phone, etc.) didn’t seem to make an important contribution.  There was improved analysis of educational differences between Democratic and Republican votes.  But weighting for this didn’t adequately correct for polling error.  Nor did attention to partisanship, or demographics. 

In fact, the 2020 polls were worse than 2016.  National polling error was the highest in 40 years, and on the state level, it was the highest in 20 years.  Average topline results underestimated Trump certified vote tallies by 3.3 percentage points.  The Biden percentage of victory was erroneously predicted to be 1.0 percentage point higher than it was.

Briefly, their analysis of this historically poor polling result doesn’t shed much light on what went wrong, or how to fix it.  This is not a “shy Trump” question, like I raised 2 years ago.  The problem wasn’t that people gave socially-desirable answers. It appears there is essentially a sub-segment of Republicans who are systematically disinclined to respond to polls at all.  This might best be explained by distrust of polling. It results in a substantial block of voters that don’t get sampled.  Their invisibility produces error.  Unlike other overlooked respondents, many of them do go on and vote. 

The current reality is that polling is flummoxed by how to collect opinions from people who are so fundamentally withdrawn.  They won’t express their opinions in non-partisan channels.  They probably aren’t alienated only by pollsters, but by plenty of other institutions too.  Maybe there are psychographic markers to spot these lost respondents; certainly some experts are looking for them. The levels of polarization in US discourse might make it necessary to think about sampling plans within partisan categories.  It may not bode well for the future of polling, because persistently large error obviously threatens the value and usefulness of the results from polls.  Without objective polling results, the side that screams loudest may appear to be the largest block of voters.

Medicare Advantage, Deciphered

Another open enrollment season for Medicare plans has gone by, making this a good time to ask how Medicare Advantage (MA) actually works. This privatized alternative to traditional (“original”), government Medicare tempts elders with an advertising blitz during the 2-month window when it is possible to switch plans. As with many products or services however, the glossy exterior that is depicted in these ads is doesn’t necessarily portray what enrollees will actually experience.  How coverage is engineered by various MA plans is one matter, beyond the scope of this post. First, it’s worthwhile to consider why and how this parallel system exists. It is a topic that ought to interest enrollees and taxpayers alike.

About 40% of Medicare beneficiaries use one of more than 3,500 MA plans, which are run by private insurers and can offer additional benefits beyond traditional Medicare.  It is an holistic alternative to the piecemeal design of traditional, government-run Medicare, with its Parts A, B & D. The most visible drawback is that it relies on narrow networks, and thus constrains access to specialists. MA limits choice. In contrast, providers are essentially required to accept traditional Medicare, which opens up more treatment options. Beneficiaries in traditional Medicare can also exercise choices by purchasing supplemental coverage.

These surface characteristics bely what is actually going on with MA.   Read more…

Playing a Stronger Hand to Lower Healthcare Costs in the USA

For US health insurance, the elephant in the living room is the cost of its privatized components.  As years go by, it becomes increasingly difficult to prop up political support for how healthcare is financed.  Patients will become more aware of how much more they pay for services that are similar to what they would obtain at a far lower cost in other countries.  To better tackle costs, a stronger public hand is proposed using various methods.  The boundaries between these proposals and their definitions are easily muddled.  They include Medicare For All (M4A) and a “public option”.  It may be exceedingly difficult to accomplish changes on a federal level.  The next wave of solutions are emanating from a handful of states.  Each state is an experimental laboratory for potential remedies.

These state-level solutions don’t extend Medicare, as that of course, is a federal program.  Embracing Medicare may spell doom anyhow.  It is notoriously piecemeal and cumbersome. Newer components, particularly Parts C (Medicare Advantage) and Part D (drug benefits) were designed as federally-subsidized income streams for private companies.  Once deductibles and other expenses are tallied, these aren’t necessarily saving patients money in comparison to traditional Medicare.  Supplemental coverage doesn’t figure in emerging solutions either.  Those programs were designed by the healthcare industry and therefore do more to enhance revenue streams than to alleviate cost burdens for patients.  If Medicare eligibility was only expanded down to age 60, or even 55 or 50, it might improve affordabilty (see estimates).  But the money saved by patients would be lost by hospitals.  They operate on the higher revenue that they enjoy from privately-insured customers- and can be expected to oppose having more patients that produce the less generous Medicare reimbursements.  These are the kinds of impediments that perennially stymie improved health coverage in the US.  It may simply be too complicated to work within the existing Medicare structure.  On the other hand, can states begin with a clean sheet of paper, and design better solutions?   Read more…