Problems and Purpose

LXS 400 was led by the Tribu Foundation, in consultation with the Center for Deliberative Democracy at Stanford University. During March 2020, a random sample of 514 Chileans convened to deliberate on two of the main themes prioritized in the national consultation promoted by the Chilean Association of Municipalities in December 2019: pensions and healthcare. The participants of this Deliberative Poll were selected using a random lottery mechanism, conducted by the University of Chile, after mailing roughly 25,000 letters to homes throughout Chile. Participants received balanced briefing materials prior to the event, which were reviewed by a cross-party advisory committee to ensure the information remained balanced and accurate. The delegates gathered online using the Stanford Platform for Online Deliberation for 3-days, where they met and spoke with fellow citizens about the issues in question and engaged in dialogue with experts and policymakers based on questions developed in their small groups. Participants were not asked to reach any consensus or decision; rather, the event was presented as an opportunity for participants to understand the issues at hand and to weigh competing arguments on all sides. This overview examines the quantitative changes in preferences among participants—collected using questionnaires before and after deliberation—for those policy proposals. The results of this deliberation were not only more informed citizens, but also citizens with a better sense of their personal and political opinions on these issues. Furthermore, the quantitative results of this deliberation were taken by members of the Senate’s Committee on Challenges of the Future, Science, Technology, and Innovation as a key input to draft legislation on the issues.

Participant Recruitment and Selection

The process of forming the deliberative sample began with mailing roughly 25,000 letters to homes throughout Chile, based on guidance from the Microdata Center and the “randomness beacon” tool from the Applied Cryptography and Cybersecurity Laboratory of the University of Chile, as well as census information. Ultimately, using a random lottery selection mechanism, 514 people from all regions of Chile were participated in the deliberation process. Of this group, 50.99% were women, and the average age of the group was 40.57 years, with 32.88% of participants between 18 and 29 years old, 39.1% between 30 and 49 years old, and 28.02% over 50 years old. Participants also displayed considerable diversity of political affiliation. Among those who listed a political identity, 8.8% considered themselves ‘Right,’ 20.7% considered themselves ‘Center Right,’ 24.5% considered themselves ‘Center,’ 20.9% considered themselves ‘Center Left,’ 3.1% considered themselves ‘Left,’ and 17.5% considered themselves ‘Independent.’

Methods and Tools Used

Most citizens most of the time are not well informed about public policy issues. As such, most polls provide a snapshot of the public’s impressions when they are operating off of little information—mostly sound bites and headlines. By contrast, Deliberative Polling addresses the question: how would the views of the public change on policy issues if they could learn about these issues under good conditions? Those good conditions include exposure to balanced briefing materials containing relevant facts and arguments from both sides, deliberation in small groups of peers with trained moderators, the opportunity to hear from and ask questions of panels of diverse policy experts, and the opportunity to register their opinions in confidential questionnaires. Representative samples—in terms of both demographics and political affiliation—of the population are selected to participate in these Deliberative Polls, allowing statistical inferences to be made about how the views of the whole population would change if they too could deliberate. Thus, Deliberative Polls provide a glimpse of what an informed populace would want from their government, without the cost and effort of engaging an entire population. To date, Deliberative Polls have been conducted more than 100 times and in more than 30 countries and jurisdictions across the world by the Center for Deliberative Democracy at Stanford University and partner organizations.

What Went On: Process, Interaction, and Participation

The event spanned three days from Friday, March 5 through Sunday, March 7. Deliberation on Friday and Saturday focused on pensions, while deliberation on Sunday focused on healthcare. Saturday and Sunday were split into two three-hour long segments; Friday’s deliberation was contained within a single three-hour segment. During each segment, participants deliberated the policy proposals in small groups using the Stanford Platform for Online Deliberation for an hour and a half, then enjoyed a ten minute break before an hour and twenty minute-long plenary session featuring competing experts and policymakers. At the plenary sessions, participants had the opportunity to ask experts questions about the proposals that each group crafted during their deliberation.

Influence, Outcomes, and Effects

Pensions

Participants discussed three types of proposals surrounding pension policy: structural reforms to the current pension system, parametric reforms that can be made in any pension system, and parametric reforms that can be made within the current system. Nearly all the proposals were highly contentious and garnered middling levels of support among participants.

First, regarding structural reforms to the current pension system, participants were divided as to whether payroll taxes ought to be increased to increase pensions. The percentage of participants who supported that proposal declined after deliberation from 71.0% to 59.3%, with the proposal’s mean rating declining from 7.037 to 6.329 out of 10 (P=0.001). Notably, while support for this proposal decreased by just 1.3% among male participants after deliberation, it decreased by 21.4% among female participants. If payroll taxes were to be increased, participants were broadly opposed to giving the full amount to individual pension accounts, with percentage support for that proposal decreasing from 62.7% to 36.2% and mean rating decreasing from 6.613 points to 4.565 points out of 10 after deliberation (P<0.001). Deliberators were divided on whether to give the full amount to the Common Saving Fund, garnering support from 42.9% of participants post-deliberation and a mean rating of 5.071 points (P=0.118). Participants were far more amenable to giving half of the hypothetical payroll tax increase to the Common Saving Fund and half to individual accounts with this proposal receiving support from 53.4% of participants after deliberation, although the mean rating fell by 0.591 points to 5.620 points after deliberation (P=0.008).

The proposal that the entire current pension system be replaced with a PAYGO system was supported by a plurality of participants, although support fell by 11.1 points and the mean rating fell significantly by 0.954 points (P<0.001) after deliberation. By contrast, there was widespread support for the proposal that “All branches of the Chilean military and the police should have the same pension system that the civilian have,” which received support from 85.8% of participants before deliberation and 86.5% after deliberation.

Next, participants discussed seven parametric reforms that can be made in any system. Nearly all participants expressed support for proposals designed to protect the Chilean elderly population. The proposal to “Create a subsidy to increase the pension of elders that need the assistance of a caregiver” was supported by 89.0% of participants post-deliberation, and the proposal to “Create a subsidy for people within the household who take care of the dependent old age population” was supported by 86.8% of participants post-deliberation. By contrast, the proposal to gradually increase the retirement age was met with majority opposition, which did not change significantly (P=0.981) after deliberation.

In general, support was comparatively low for proposals with the intended goal of greater gender equity in pension policy. Support for the proposal to “Increase the payroll tax to finance a subsidy directed to woman that allows equal pensions between males and females at the same conditions” plummeted from 79.0% to 43.4% after deliberation, while support for the proposal to “Gradually increase the pension age for women until it is the same as for men” dropped from 43.6% to 36.5% after deliberation. While female and male participants began with similar levels of support for both proposals, after deliberation, their stances diverged with women’s support for the two proposals declining substantially more than men’s.

Finally, participants rounded out their discussion of pension policy by deliberating on a number of parametric reforms that can be made within the current pension system. Participants’ opinions varied on the extent to which workers ought to exercise power in the pension system. Support for the proposal that “affiliated workers should have a vote in selecting the directors of the Pension Fund Administrator Board” declined 13.4% after deliberation, moving from an overwhelming 82.1% to a milder majority of 68.7%. Similarly, support for the proposal that “affiliated workers in the pension fund should select members on the boards of the firms in which the AFP invests” fell from 67.4% to 52.5%.

Regarding AFP fees, participants were generally unified in their support for the proposals. Overall support for whether such fees ought to depend on the profits AFP offers to savers remained high, with 70.8% of participants favoring it after deliberation—although the mean rating declined significantly by 0.643 points (P=0.004). On the proposal that “When the AFP contracts third party firms to invest on their behalf, their fees should be paid by the AFP and not the workers” (20), support (94.3%) remained incredibly high after deliberation—the mean rating did not change significantly (P=0.114)—and was championed by 89.3% or more of participants of all political identities.

On the subject of providing for socioeconomically disadvantaged Chileans, a majority of participants agreed that one million pesos ought to be put in every newborn child’s individual account and that a basic pension of 200k pesos ought to be created for the poorest 80% of the population, though support for the latter proposal declined from 83.9% of participants to 72.3% after deliberation, with its mean rating dropping from 8.369 points to 6.780 points (P<0.001). If such a basic pension were created, participants strongly opposed its financing with an increase of VAT, which received support from 10.0% of participants and a mean rating of 1.429 points after deliberation (P=0.020).

Health

The deliberation on health policy asked participants to consider proposals to improve Chile’s health system on issues such as rare diseases, mental health, and access to prescription drugs, as well as proposals on comprehensive reforms to Chile’s health system. In general, the majority of participants overwhelmingly agreed with the proposals before deliberation took place. The second questionnaire, however, shows a decrease in support for many of the proposals following deliberation.

Among the proposals to improve the health system with regard to specific issues, the largest declines in support came from proposals to increase taxes or premiums in order to finance reforms. When asked if participants agree or disagree with the proposal to “Increase taxes and payroll taxes to guarantee access, funding, treatment and care for rare diseases”, 80.0% of participants initially agreed. After deliberation, only 48.4% agreed with the proposal. Similarly, the percentage of participants who agreed with the proposal to “Increase taxes to fund a national plan for the training of specialists” declined from 60.0% before deliberation to 27.7% afterwards, with support dropping sharply across the political spectrum. The only proposal in this section for which participants did not agree either before or after the deliberation was “That FONASA and ISAPRES are funded separately for the treatment and care of rare diseases”. Opposition increased from 54.0% to 63.5% after deliberation while support declined from 32.5% to 23.6%.

Proposals that focused on increased government oversight received support from the majority of participants, though support declined over the course of the deliberation. 84.4% of participants agreed with the proposal to “Fix a minimum and maximum price of a prescription drug” post-deliberation, down from 91.7% before deliberation. The proposal to “Create a Primary Health System regulator that oversees the results of the local governments on health outcomes” saw support decrease from 91.8% to 66.2% post-deliberation. Participants were less supportive of the proposal to “Replace the current healthcare providers that depend on the local governments with local entities that depend on the Health Ministry”, with 55.5% of participants agreeing with the proposal post-deliberation.

Next, participants discussed proposals on comprehensive reforms to the health system. Once again, a majority of participants agreed with the proposals, although support decreased among all of them following deliberation. The proposal to replace the current health system with a single insurer for everyone dropped from 88.6% of participants who agreed to 79.5%. Similarly, the proposal to “Create a basic plan of minimal healthcare services at a fixed price that ISAPRES and FONASA should offer” received support from 71.3% of participants, down from 92.9% before deliberation.

Participants were most unified in their support for eliminating pre-existing conditions in ISAPRES plans and including healthcare as a right in the constitution, which 89.0% and 94.1% of participants supported post-deliberation, respectively. Participants were most opposed to the proposal that “FONASA should compete with ISAPRES, offer insurance plans with the same services and without the ability to select their clients”, with 52.1% of participant support post-deliberation.

Analysis and Lessons Learned

Values and Ideals

At the end of each survey, participants were asked to consider their “values” without discussion of specific policies. They rated ten statements, including: “A society is just if it takes care of those who are poor and needy,” “The state should make sure that healthcare made provided for the whole population through taxation,” and “Current workers should contribute in solidarity to the pensions of the retirees,” on whether they agreed, disagreed, or felt neutral. The Briefing Materials, which focused on the policy proposals, did not discuss any of these values, but these values were implicitly and at times, explicitly, discussed by the participants in the deliberations.

Six out of ten of these statements exhibited meaningful shifts in opinion, defined here as a change of 5% or more in the portion of participants who answered ‘Agree,’ ‘Disagree,’ or ‘Neutral’ after deliberation. The support for three statements concerning the state’s duty to support needy citizens decreased somewhat after deliberation. For example, the percentage of participants who rated the statement “Government should take care of pensions for poorest citizens” as ‘important’ declined from 71.8% to 57.3%, while the percentage of participants who rated the statement “A society is just if it takes care of those who are poor and needy” as ‘important’ declined from 89.5% to 78.7%, with its mean rating falling from 8.832 to 8.1941 (P<0.001). Despite these trends; however, strong consensus held among participants that government assistance, particularly in managing healthcare costs, is necessary. The statement “Through their own effort, every person must finance their own healthcare”, already unpopular, became even less favorable after deliberation. It plummeted 0.550 mean rating points from a 3.576 to a 3.026 rating (P=0.004), garnering support from just 11.7% of participants.

Knowledge Gains

Participants were asked several factual questions to determine their knowledge of the Chilean healthcare and pension systems.

With regards to the healthcare system, before deliberation, when asked, “Approximately what percentage of the Chilean population is enrolled in the FONASA system?” 72.9% of participants correctly answered “About 70%”. After deliberation, that share increased by 12.1% to 85.0% of all participants. Participants were also asked “In the public health system, what is the ratio of physicians for every 10,000 patients?”. After deliberation, 90.1% of participants answered correctly “About 7%” — an increase of 4.4% from before deliberation. And, finally, 80.5% of participants answered correctly “About 10%”when asked “What percentage of your income is designated for health insurance? — an increase of 6.0% compared to before deliberation.

With regards to the pension system, participants were asked, “How many funds are available to choose to invest your money?” After deliberation, 84.9% of participants answered correctly “5” — an increase of 12.8% from before deliberation. Participants were also asked, “What is the minimum monthly pension payment?”. After deliberation, 77.5% of participants answered correctly “Around 160,000 pesos” —an increase of 23.2% from before deliberation.

Overall, a majority of participants answered each of the knowledge questions correctly before deliberation and that share only increased after deliberation. The average increase in knowledge scores was significant in all cases (P<0.001, P=0.041, P=0.034, P<0.001, P<0.001, respectively).

Ranking Priorities

Since all the proposals were rated on the same 0 to 10 scale, the final positions on the scale can be viewed as a relative ranking of considered judgments about their relative priorities. Table 1 and Table 2 show the relative rankings of the pension and health policy proposals, respectively, before and after deliberation. The ranks for Time 1 (before deliberation) and Time 2 (after deliberation) are listed (in the columns T1 Rank and T2 Rank) and the means before and after deliberation are shown along with the opinion changes and their significance. Chart 1 and Chart 2 show these same changes in rank order graphically for pensions and health policy proposals, respectively.

The deliberation on pension policy yielded several substantial changes in policy priorities, although many of the highest-ranked proposals before deliberation remained so post-deliberation. Some of these proposals suggest a focus on reforming the AFP. For example, the proposal that “When the AFP contract third party firms invest on their behalf, the fees of them should be paid by the AFP and not the workers” (20) was the number 1 priority both before and after deliberation. Similarly, the proposal to “Create an excess profits tax to the AFP” (21), was the 5th highest-rated proposal after deliberation, down from number 3. The proposal that “affiliated workers should have a vote in selecting the directors of the Pension Fund Administrator Board” remained the 7th highest-rated proposal both before and after deliberation, and the proposal that “fees that the AFP charges for their services depends on the profits that they offer to the savers” rose from the 10th highest-rated proposal pre-deliberation to number 8. Other top-ranked proposals include creating a subsidy to support both elders that need the assistance of a caregiver, which fell from the number 2 priority to number 3, and a subsidy for the people who care for the dependent old age population, which rose from the number 5 priority to number 4. Participants also indicated a focus on supporting socioeconomically disadvantaged Chileans. The proposal to “Create a basic pension of 200k pesos for the poorest 80% of the population” remained the 6th highest priority, and the proposal to “Give every newborn child one million pesos to their individual account, improving future pensions” rose from the number 11 priority to number 9.

The proposals with the most drastic changes in ranking fell into the middle or lower end of the priority rankings after deliberation. Many addressed an increase in payroll taxes. The proposals with the largest drops in priority were to “Increase the payroll tax to finance a subsidy directed to women, that allows to equalize pensions between males and females at the same conditions”, which fell from the 13th priority to the 21st, and that “If payroll taxes are increased how strongly do you oppose or support giving the full amount to the individual account”, which fell from the 15th priority to the 20th. The proposals that increased the most in rankings were that “If payroll taxes are increased how strongly do you oppose or support giving half of the increase to the common fund and half to the individual account”, which rose from the 18th position to the 13th, and that “If payroll taxes are increased how strongly do you oppose or support giving the full amount to the common saving fund”, which rose from the number 22 priority to number 17.

Deliberations on health proposals also led to several significant changes in priority rankings. The largest changes in rankings came from the proposal to “Create a Primary Health System regulator that oversees the results of the local governments on health outcomes”, which dropped from the 5th highest-rated proposal to the 10th, as well as the proposal to “Create a basic plan of minimal healthcare services at a fixed price that ISAPRE and FONASA should offer, which fell from the number 4 priority to number 8. Notably, however, the proposal to “Include into the constitution healthcare as a right” remained the highest-ranked proposal both before and after deliberation.

Many of the highest-ranking health proposals post-deliberation suggest a focus on greater nation-wide standardization of pharmaceuticals and insurance. Included in the top priorities is the proposal to create a state-owned pharmaceutical company (33), which rose from the number 7 priority to number 4; the proposal to “Fix a minimum and a maximum price of prescription drugs”, which was the 5th priority post-deliberation, down from number 3; and the proposal to “Replace the current system for one with a single insurer for all persons, leaving the ISAPRES as a complementary alternative”, which rose from the number 9 priority to number 6. However, the rankings also showed less of a focus on shifting certain areas of healthcare away from local government to the national government. The proposal to “Replace the current healthcare providers that depend on local governments with local entities that depend on the Health Ministry” was only the number 12 priority after deliberation, and the proposal to “Increase taxes to fund a national plan for the training of specialists” remained the 15th highest-rated proposal both before and after deliberation.

Proposals to expand the scope of medical treatment saw various responses following deliberation. While the proposal to “Fund services and care for mental health problems, as is done for physical problems” remained the 2nd-highest ranked proposal both before and after deliberation, and the proposal to “Eliminate pre-existing conditions in ISAPRE plans and make them offer similar plans, prices, services and coverage” rose from the number 6 priority to number 3, there was much less focus on the proposal to “Increase taxes and payroll taxes to finance guaranteed access, funding, treatment and care for rare diseases”, which fell from the 11th priority to the 14th. Furthermore, the lowest-ranking proposal both before and after deliberation was “That FONASA and ISAPRES are funded separately without polling the treatment and care for rare diseases”.

It is notable that despite the relative shifts in priority rankings, all proposals on health and most proposals on pensions saw a decrease in mean ratings over the course of deliberation. Thus, an increase in ranking from pre-deliberation to post-deliberation does not necessarily signify greater support for a given proposal after deliberation.

References

Taken directly from https://drive.google.com/file/d/1Vt5XaTk2MW9M_VBN2oztK2nxYZdckl89/view