Mark D. White
Apparently, according to a recent AP article by Carla K. Johnson, present in both the House and Senate health care reform bills is a program in which
workers at participating companies would be automatically enrolled - critics say "tricked into" enrolling - unless they opted out. People would see a deduction for the program from their paychecks - estimates range from $160 to $240 a month - unless they signed a form or clicked a box saying they wanted to keep the money.
This idea can be traced most directly to Nudge: Improving Decisions About Health, Wealth, and Happiness, the bestselling book by Cass Sunstein and Richard Thaler, in which the authors recommend that governments and businesses rearrange options and design default choices to (in Thaler's words from the AP article) "try to help people make decisions without telling them what they have to do."
However, as I explain in my chapter in the forthcoming book, Essays on Philosophy, Politics & Economics: Integration & Common Research Projects, edited by Christi Favor, Gerald Gaus, and Julian Lamont, when governments or businesses act to "nudge" people to make choices, these nudges unavoidably help people make decisions the policymakers want them to make, not the decisions the people want to make themselves.
That is exactly what this long-term care proposal does--by automically enrolling people in the plan, the policymakers are assuming people want to be in the plan (or should want to be in the plan, according to the policymakers), and they use people's cognitive imperfections to put them in the plan. They claim that people are too shortsighted, lazy, or prone to procrastition to sign up for the plan themselves, so they take advantage of this behavioral quirk, counting on people to be too shortsighted, lazy, or prone to procrastination to opt out of the plan. And if this component of the reform bills passes, you can bet that the policymakers will claim success by pointing the number of people who did not opt out. But this does not prove that this reflects their true choice, preference, or well-being, but just that people acted as the policymakers predicted to the plan they designed, which reflects their preferences, not (necessarily) the employees'.
(For more on my opinions regarding Nudge, besides the book chapter linked above, see this blog exchange in which I posted an unpublished op-ed.)