Daniel McFadden

In the United States, individuals with disabilities and those aged ≥65 can supplement their Medicare with so-called stand-alone Medicare Part D prescription drug plans. Beneficiaries can switch their stand-alone prescription drug plans annually, but most do not. Indirect evidence has raised concerns that non-switchers do not even make plan comparisons (labeled “inattention”), but direct evidence is scarce. Therefore, we surveyed 439 beneficiaries of Medicare Part D plans from a nationally representative adult sample after the 2024 open-enrollment period. Overall, 53% self-reported making no comparisons. Of those who did not compare, 98% did not switch (vs 67% of those who did compare). Multinomial regressions revealed that beneficiaries who neither compared nor switched were more likely than switchers to report difficulties with comparing and switching, experiencing no plan-related discontinuation, changes, or dissatisfaction, not using advisors or the plan-finder website, and receiving potentially confusing mailings. Non-switchers who did compare were similar to switchers in reporting few difficulties and relying on advisors and the plan-finder website, but they were less likely than switchers to report plan-related changes, discontinuation, or dissatisfaction, while being more likely to report receiving mailings and having no college degree. We discuss insights for policy-making.

Stated preference elicitation methods collect data on consumers by “just asking” about tastes, perceptions, valuations, attitudes, motivations, life satisfactions, and/or intended choices. Choice-Based Conjoint (CBC) analysis asks subjects to make choices from hypothetical menus in experiments that are designed to mimic market experiences. Stated preference methods are controversial in economics, particularly for valuation of non-market goods, but CBC analysis is accepted and used widely in marketing and policy analysis. The promise of stated preference experiments is that they can provide deeper and broader data on the structure of consumer preferences than is obtainable from revealed market observations, with experimental control of the choice environment that circumvents the feedback found in real market equilibria. The risk is that they give pictures of consumers that do not predict real market behavior. It is important for both economists and non-economists to learn about the performance of stated preference elicitations and the conditions under which they can contribute to understanding consumer behavior and forecasting market demand. This monograph re-examines the discrete choice methods and stated preference elicitation procedures that are commonly used in CBC, and provides a guide to techniques for CBC data collection, model specification, estimation, and policy analysis. The aim is to clarify the domain of applicability and delineate the circumstances under which stated preference elicitations can provide reliable information on preferences.

William Shakespeare's Tragedy of King Richard III, written approximately in 1592, is the story of evil acts by the detested and misshapen hunchback, Richard, who plots to sow discontent among his brother, the King, and others, and has his brother murdered along with other wicked deeds in order to gain the throne. It opens with the line, “Now is the winter of our discontent” (p. 111, ed. Wright 1936). “The Winter of Our Discontent” is also the title of John Steinbeck's (1961) novel of a man who trades his moral convictions to reclaim lost family wealth. “Globalization and Its Discontents” is the title of Joseph Stiglitz's (2002) book that critiques rigid adherence by major economic institutions—such as the International Monetary Fund—to economic orthodoxy in the promotion of globalization. (JEL F6, D72, D3, O23, O24, L17, K33)

This chapter focuses on the new Medicare Part D prescription drug program. Participation in Medicare Part D requires individuals to make active enrollment and plan choice decisions. Active decisions are made initially when first enrolling in the program, and can be revisited periodically during the program's annual open enrollment periods. Whether consumers make wise choices at these decision points is of interest not only for the evaluation of this particular market, but for consumer-directed health care more generally. The chapter explores how people decided among the prescription drug plan options made available through Medicare Part D, based on their prior drug use, self-rated health, and other factors.