Anecdotes, Facts, Marriage and Health Care

Storytelling is a powerful tool – and never more so than in public policy.

What got me thinking about this was a story in the New York Times, Health Benefits Inspire Rush to Marry, or Divorce." According to the Times, "it is not uncommon" for couples to get married or break up at least partly in order to have health insurance.

Except, as the Times candidly admits, "there is no way to know how often it happens." The story has compelling anecdotes and quotes from lawyers and advocacy groups saying they believe it happens "regularly."

But the only actual data point is a Kaiser Family Foundation survey that shows 5 percent of those surveyed saying that in the past year they or someone in their household decided to get married "mainly" to have access to health care benefits. (It's question 12, if you want to have a look). And poll results in the single digits are notoriously unreliable – the margin of error really kicks in. This poll had a margin of error of plus or minus 3 percent, which means this number could really be 8 percent, or only 2 percent. In cases like this, just a few respondents in a sample of 1,500 people can make a huge difference.

The much more accurate way of looking at the results is that 92 percent, a huge majority, don't marry "mainly" for health benefits. Even if there were problems with the poll and the results move a few points, we're still talking about overwhelming numbers. And it fits more closely with what other research tells us about attitudes on marriage .

That said, I'm sure the people quoted in the story are telling the truth about what they've seen and experienced. People do factor in economics and health benefits when they get married. Surveys show lower-income people, in fact, are more likely to cite economic considerations as important factors in a successful marriage . We just don’t know how many marry because of health insurance, how big a factor it is, or whether this is increasing or decreasing.

There's a reason why this matters, and it has to do with how people process ideas. When Public Agenda brings people together in focus groups or community forums to talk about public issues, they don’t usually quote statistics. They tell stories – anecdotes about things that have happened to them or people they know, or just stories they've heard. Human beings are storytellers by nature and we use anecdotes and narratives to make sense of the world. Reporters know this; that's why they're trained to find the "human angle." Politicians know this too, which is why nearly every president brings some exemplary person to the State of the Union to stand up, take a bow and buttress a point.

I'm not saying the policy world should give up on storytelling. On the contrary, we should roll with it. Statistics without stories just lie there, lifeless. But not every anecdote illustrates a larger trend. Worse, anecdotes without facts can actually lead us in the wrong direction. That's why we conduct surveys and compile statistics.

If you look at the survey data again, you'll see much more solid indications of how our troubled health insurance system changes people’s behavior. Half say they've put off going to the doctor, and even more say they save medical visits for only the most serious conditions . Nearly three in 10 say they've skipped doses on their medication because of the cost. In the Kaiser survey, some 18 percent say they've decided to stay in a job rather than leave in order to keep better health benefits, and roughly the same number say they've "used up all or most of their savings" because of medical bills. One in five say they've had difficulty paying other bills.

These are much more statistically solid and disturbing numbers. Maybe we've heard those stories before; maybe we're tired of those anecdotes. But the best stories aren't always the best indicator of what's really going on – and what needs to be fixed.