Simple solutions to address social issues: Big Brains podcast with Harold Pollack

Show Notes

Prof. Harold Pollack may be famous for his “financial index card” of advice, but it’s his application of simple solutions to complex issues that’s reshaping how we tackle crime and health care.

What can be done to reduce the number of people who end up in jail for failing to appear in court? How can we build a health care system that works for everyone? As co-director of the Crime Lab and Health Lab, the School of Social Service Administration scholar promotes “evidence-based optimism” to produce social impacts through science.

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Transcript

Paul Rand: In 2013 University Chicago professor Harold Pollack found himself in the national headlines for one really small idea.

PBS Newshour: It couldn't get any simpler. All the financial advice you really need might just fit on a four by six index card.

Paul Rand: The idea came to Pollack after he mentioned it in an interview with journalists Helaine Olen that he could jot down everything anyone needs to know about finance. On a small card then people dared him to do it.

PBS Newshour: So Pollack put ten items on an index card took a snapshot and posted it online. It promptly went viral.

Paul Rand: The Index Card was a hit. It was featured in The Washington Post, Forbes, And NPR.

PBS Newshour: And thus was born Pollack and Olan short new book "The Index Card, A Few Simple Rules".

Harold Pollack: I think we're all both terrified and intimidated by all of the things that we have to do to save for retirement. If you turn on financial TV and it's like you know President Trump's in a tiff with China and the stock market is doing some crazy thing and maybe I should be buying more bonds maybe I should buy more stocks. What do I think about bitcoin and it's incredibly intimidating.

Paul Rand: That's Pollack. The genius of the card was in its simplicity. In a world with so much noise and confusion clear coherent ideas seem to cut through the clutter.

Harold Pollack: What a lot of people seem to be hungry for is something that is comprehensible. Basically pushes them in a commonsense direction and I think that's why by incredibly not original set of tips that I put on this index can't seem to be helpful to people.

Paul Rand: That search for commonsense answers to complicated questions as driven Pollack's work beyond finances as he's conducted research on two of the most complex issues our society has tried to fix. Crime and health care.

Harold Pollack: What folks have shown is. Yeah there's a lot about this environment that is really hard. But here are some interventions that really do reduce crime among young people, reduce violence, make people healthier.

Paul Rand: From the University of Chicago this is Big Brains. A podcast about the stories behind the breakthroughs that are reshaping our world. On this episode, Harold Pollack's straightforward advice to tackle finances crime and health care. I'm your host Paul Rand. We'll start with the story behind the little card that started it all.

Harold Pollack: So I was a professor at the University of Michigan and then I was recruited to the University of Chicago. Four months after we arrived, my mother-in-law died suddenly very tragically, and my wife's brother Vincent was living with my mother-in-law, he had to move into our house. He was 340 pounds, he has an IQ in the 50s, he has something called Fragile X syndrome and it was a profound challenge for us. If you had to bare the entire cost of taking care of a person with profound disability, it would bankrupt you. When he moved, in because he was so large, we had to buy some new furniture so he could sit in comfortably, and I remember we bought a lazy boy chair and it was like nine hundred fifty dollars or something like that and I just remember thinking in a very matter of fact way, I will just hemorrhage my money. Suddenly, I'm like, wow, I have to totally change the way I live. I had the skills of a professor of public policy, but I'd never really directed them towards personal finance. So I start watching TV, and I start reading books, and I see very quickly that the expert conversation about saving and investing is so much simpler than than this sort of world of self-help and financial cable TV and all of that in fact a lot of the advice that you'd get from the personal finance industry was actually fairly toxic right. And so I started joking to people you know you know the problem that this industry has is that the best advice for most people is available for free in the library and you could basically jot down on an index card. I had a blog, and one day I interviewed Helaine Olen, who's a personal finance writer, and I made this joke to her whilst talking about her book and then people started emailing and saying, well kind of where's the index card. So I figured well you know people are asking for it I better do it. So I reached into the drawer, I pulled out one of my daughter's four by six index cards and I just scribbled with a with a pen nine things on an index card and I took a picture of it with my iPhone and I posted it and it got like 400,000 hits and those that simplicity of it that people really seemed to value. And there's nothing on there that you know represents an original research contribution that I've made, it's all things that are quite obvious to people who teach finance over at Booth but there are things that are not obvious to a lot of people. It's funny it won Money Magazine's best new idea of the year 2014. And so my colleagues at the Booth School you know who really do the stuff. They were like looking out and they were like: 'You're kidding.'

Paul Rand: The ideas on Pollack's index card, which is easy to find with a quick google search, are straightforward. Max out your 401K, save 20 percent of your income, pay your credit card balance in full every month, but it streamlined something that many people find too complicated. Now, Pollack and his colleagues have taken that same approach to tackling a whole other problem: crime. In 2008, he co-founded the University Chicago's Crime Lab, a part of the UChicago Urban Labs.

Harold Pollack: I would say the mission of the urban labs is to give people a sense of evidence-based optimism that that we have feasible realistic interventions that can genuinely help.

Paul Rand: Evidence-based optimism. That's a cool phraseology.

Harold Pollack: Yeah. And if you look at say the Crime Lab. Everyone in Chicago doesn't matter where you are in politics everyone is sad and really concerned about the violence problem. You know it just all around. Right. But the causes of it are so deep, and they're so profound and poignant that we can easily become very pessimistic and therefore passive about opportunities in the here and now to really make a difference. You know if what we have to do to reduce violence is get rid of all of the negative messages in popular culture that reach young people or get rid of poverty and discrimination and racism. Those things are all important but, wow, you know, I don't have a plans for how to get rid of those things in the near term and it's easy to become discouraged by the scale of the challenge and to say you know, historically, Chicago has spent a century getting ourselves into this mess and and to and to sort of throw up our hands and I think what the work of Jens Ludwig, Roseanna Ander, and all the people at the Crime Lab, what folks have shown is: Yeah there's a lot about this environment that is really hard. But here are some interventions that really do reduce crime among young people, reduce violence, make people healthier, make it more likely that young person will graduate from high school. You know there's violence prevention interventions like Becoming a Man that's gotten a lot of attention there's also a small group tutoring. There's a whole variety of things that can really help.

Paul Rand: The interventions the Crime Lab has developed all stem from Pollack's view that sometimes simple solutions can actually answer the most complex questions, like why does one person fall into crime while another does not. Or what can be done to reduce our prison population. The answers to those questions after the break.

(Break)

Paul Rand: The Crime Lab has uncovered some inexpensive crime interventions that have shown incredible results. For example, in New York the Crime Lab managed to help reduce the number of people who end up in jail for failing to appear in court by 32 percent. How they do it? By simply redesigning the summons form to make relevant information stand out in bold text, and by sending text message reminders. In Chicago, their program, Choose To Change, has showed that if you engage youth who are at risk of committing a violent crime with cognitive behavioral therapy mentorships you can dramatically decrease arrests.

Harold Pollack: So, Becoming A Man, for example you know it's a pretty simple intervention. It's a once a week group intervention with young people. Very often we're asked wouldn't it be better if there was a family component, wouldn't it be better if there was more counseling and I sort of say yeah we'd be better but we have tens of thousands of kids who need services in Chicago. And if I make it a really expensive and complex thing I can't reach all the people that need help.

Paul Rand: So back to the simplicity idea of making this work.

Harold Pollack: So simplicity is so critical and part of simplicity is economy. You know that we're in a resource constrained environment. You know if I have an intervention that costs thirty thousand dollars per kid and I bring them down to the University of Chicago Department of Psychiatry and give them a fantastic intervention, wow.

Paul Rand: For one kid.

Harold Pollack: I can do that for. There are some people who have sufficiently profound issues that that intervention might well be cost effective. But, wow that's gonna be a small group because we just can't we can't do that on a big scale. Right. So so. So that's one thing that we look for, we also look for things that that we think would give generalizable lessons to other places and that build an infrastructure that can be generative for other things that we want to do. I'm very interested in understanding how we can use the 911 system to create a data resource so that not only can we respond more safely once when there's a 911 call but we can identify people so before there's a 911 call we can go out and try to help them. So we look for things that create an infrastructure so that they're generative of other things that we want to do. And we also look for things that have scientific credibility. It is remarkable when you can do a rigorous scientific trial ideally a randomized trial you can't always do that but often you can. It is amazing how people respond to that. When you say here's the treatment group of kids and here's the control group of kids and here's the difference in outcome. Funders, citizens, everybody they respond to that in a way that nothing else quite has the same impact.

Paul Rand: And why do you think that is just because they can see the the role and the impact of what the work is doing and it's tangible to them.

Harold Pollack: I think it's tangible it's rigorous. It's it's more transparent or at least it seems that way to people. And you know, if you're say a big foundation in Chicago you are inundated with wonderful people who are very passionate about the interventions that they want you to support and they will come into your, you know, your big conference room and you'll be sitting on a coffee table and they will have someone who has an amazing human story who benefited from that and that's that's your appointment from 10 to 11 then from 11 to 12 there's the next organization that comes in with their in their intervention. And and you're saying, who am I going to support, I can't support everybody. When someone comes in and says I have a rigorous scientific trial and here's what we found funders say, Wow, that gives me a tool that is very helpful. Now there's a lot of challenges one can make to this perspective and there's a lot of limitations in this approach. But you can't do a randomized trial of a lot of things and a randomized trial has its own limitations. But that rigor is very valuable and I think the world is increasingly demanding both a rigorous randomized trial and also not only the trial now they've even gone a step beyond that they're saying I want your trial to be designed in a way that you can explain to us what the mechanisms were that made this intervention successful and for which people. The world is demanding a higher and higher standard of careful implementation and documentation and real scientific depth. And I think that is that makes me very encouraged that the marketplace and public policy and philanthropy is really asking us to raise our game and to really show that what we what we're doing is working and to really be able to explain why it's working.

Paul Rand: Remember Pollack's index card. Item number nine. The last item on the list. That caused the most controversy among financial experts. It says "promote social insurance programs to help people when things go wrong". This last piece of advice has been a driving force in all of Pollock's work.

Harold Pollack: I do think that there is a basic sense in America that we have to take care of each other.

Paul Rand: Is that increasing or decreasing or you think it's just inherent and it staying the same.

Harold Pollack: Well I think there's a battle that's going on about that. In some ways, I think we have been forced to confront these questions in a very basic way because the society is changing so dramatically it's changing geographically as we see tremendous inequalities between the wealthy coastal cities and some of the rural areas. We're changing demographically as the population of younger people is much more substantially nonwhite than the population of older people. And this has caused tremendous social tension. We're challenged because the rising cost of health care is just a profound burden on the economy.

Paul Rand: Just like finances and crime, Pollack sees the cost of our health care as an issue that's both central to people's lives and too complex for them to control. And as a member of the Center for Health Administration studies in Chicago he's working to find ways to better understand and improve it. But things aren't always so easy when you're trying to tackle what's been famously called one of the most complicated issues in America.

Harold Pollack: If you look out to 2030, 2040, 2050, we have a big problem. We have a problem with long-term care, we have a problem with Medicare costs, we have a problem of how we're going to finance pharmaceutical innovation without tremendously increasing costs. And we have to somehow have a more disciplined health care system.

Paul Rand: All the technological advances creating more new opportunities to save lives and spend money.

Harold Pollack: Absolutely and we're doing all of those things. I think across the political spectrum, we really don't want to face that issue with the seriousness that it that it deserves. I think conservatives have to face the fact that that greater government control over prices is probably essential to discipline the health care system and we're going to eventually do that. And if conservatives want to ensure that the that the market mechanisms that have tremendous value are part of that process, they ahve to figure out ways to to combine those things and progressives also have to have to acknowledge that. I think if you believe in things like the single payer system you have to think of a way that we can raise substantially greater government revenues in a way that that would not damage the economy.

Paul Rand: In regards to health care and in single payer especially given the clear current political environment where are some of your thoughts going. What's getting better, what's getting worse? What's looming?

Harold Pollack: Some things that are getting better. I think that ironically the effort to repeal the Affordable Care Act ratified the public consensus around the idea of universal coverage, that's not the same as single payer.

Paul Rand: What's that difference between universal and single payer.

Harold Pollack: So the idea behind universal coverage is that every American should have health insurance that genuinely works if you get really sick. Okay. And that no one should lose their house because they they get cancer, no one should be charged more money for insurance because they have a preexisting condition, and no one should be denied care for that reason. One way to achieve that aspiration would be if we had sort of Medicare for All single-payer system. That's only one way to do it. If you look at the countries of Western Europe that have universal coverage, some of them are like England or Canada where they really have a single payer system but some of them are more like the Netherlands or Switzerland or Germany where they have things that look a little bit more like the Affordable Care Act's exchanges. You can have private insurance in the mix, you could have non-profit insurers in the mix, you don't necessarily have to have one government payer that does everything but you do have to have this element where where everyone is protected. People of low income are subsidized, people who are sick are subsidized. And we have some way some national policy that ensures that everyone is covered and that the coverage is adequate if you really need it.

Paul Rand: As we've watched year after year is not a uncomplicated subject. Can you boil this down to put on an index card to get us so we can move on something here?

Harold Pollack: Well, no and I'll tell you why. Many of my friends who favor say single payer, say you know there are all these European countries that have a much simpler health care system that is much cheaper than the American system, that is more disciplined, that genuinely covers everyone and that's basically better than what we have. And in many ways. And what we should do, we should enact a system like that that kind of replaces the messy interest group politics and all the pathologies that we have right now in America. And you know they're right that a lot of these systems are better than the American system. But the problem is that any kind of single payer system that we create has to be the product of the very same goofy political system that produced what we have right now right. Right. So. So we would we would have to bake in a lot of the pathologies that we currently have in whatever is kind of achievable. So if we enacted something like a Sanders single payer style

Paul Rand: Bernie Sanders.

Harold Pollack: The revenue required to do that, even if we really really reduced health care expenditures at the national level, we would have to increase federal revenues by something on the order of doubling the federal income tax. And so the idea that we're going to jump to that in one fell swoop is just not going to do that right. But I do think that what we've learned over the past several years is that many Americans across the political spectrum believe that people who have the option to sign up for Medicare or Medicaid if that's what they want, that private insurance in many contexts does not work particularly well. I would say that the complexities and the all the political wrangling that's always going to be then we have to figure out how to navigate that successfully in a way that produces a better system than we have now. And one that's that's that's more humane and disciplined than we have now. But there's not going to be any simple way to get an index cards system that isn't an incredible set of compromises.

Paul Rand: Wonderful. You've been a terrific. Thank you for all of your thoughts your comments. We'll look forward to seeing what you continue to work on.

Harold Pollack: Thank you so much.