Kent Bottles: How to Understand Our Acceptance of Lies, Distortions, and Myths About Health Care Reform
Any rational, well-informed person knows that the status quo of the American health care system is not financially sustainable, does not produce outcomes as good as other countries that spend a lot less money, does not give medical care access to about 50 million Americans, causes about 700,000 bankruptcies every year, and is a major cause of American companies struggling to be successful in an increasingly global economy. Any rational, well-informed American should be supporting comprehensive health care reform and should know that we must decrease per-capita cost of health care and increase the quality of care delivered.
And yet, many Americans are afraid of change. What is going on here?
The apparent irrationality of Americans when it comes to health care reform can be better understood if one examines recent neuroscience findings about inherent biases in human cognition.
James Surowiecki in a column titled Status-Quo Anxiety (http://www.newyorker.com/talk/financial/2009/08/31/090831ta_talk_surowiecki) compares our attitude toward health care reform to “St. Augustine’s take on chastity: Give it to us, Lord, but not yet.” Surowiecki describes two inherent biases in human cognition: the endowment effect and status quo bias.
The endowment effect makes humans overvalue things that they own. In a classic endowment effect experiment, half the subjects were given coffee mugs and asked how much they would sell them for and half the subjects were asked how much they would be willing to pay to buy an identical mug. Logically, one would think the two groups would value the mugs similarly, but the new owners of the mugs thought their possessions were worth twice as much as the others were willing to pay for it. Those of us who today have adequate health care insurance exhibit the endowment effect of not wanting to lose or devalue a valuable asset.
The status quo bias is a reflection of how much humans resist change of any kind. Many studies have shown that employees usually adopt the company’s default option for their 401k, and this bias is related to our feeling the pain of loss more deeply than the joy of gain. When we think about health care system reform we worry more about what we might lose than what we might gain. Paul Krugman writing about “How Did Economists Get It So Wrong” relates that economists like Raghuram Rajan and Robert Shiller issued warnings before the economic meltdown of late 2008. And yet, the Federal Reserve under Alan Greenspan ignored such advice because it challenged the status quo. When Rajan presented the opinion that the financial system was taking on potentially dangerous levels of risk, “he was mocked by almost all present.” (http://www.nytimes.com/2009/09/06/magazine/06Economic-t.html?_r=1&ref=magazine)
Sharon Begley in two articles in Newsweek explores a similar theme by looking at motivated reasoning, inferred justification, cognitive dissonance, confirmation, and other inherent biases (http://www.newsweek.com/id/213625/output/print) and (http://www.newsweek.com/id/212131/output/print).
Steven Hoffman in describing motivated reasoning in Newsweek says, “Rather than search rationally for information that either confirms or disconfirms a particular belief people actually seek out information that confirms what they already believe.” 59,934,814 Americans voted for John McCain for President and it should not be surprising that some of them use motivated reasoning to believe in death panels, insurance for illegal aliens, and requirements of federal funding of abortions. None of these three myths has been proposed and yet many Americans believe that is what Obama wants to do. And yet, believing in these myths would confirm some Americans’ belief that the wrong person is President.
Hoffman has also studied inferred justification, a sort of backward chain of reasoning. Starting with something one strongly believes in (Obama is a socialist who is leading the country in the wrong direction), one then works backward to find support for the belief: Obama wants to pull the plug on grandma or give government agents unlimited access to physician bank accounts. The fact that these two supporting data points are not true does not get in the way of their use for inferred justification.
When humans come across information that challenges pre-existing beliefs, the theory of cognitive dissonance predicts that they will try to relieve the resulting tension. People seek out confirming information, but ignore disconfirming information. Liberals can watch MSNBC and Conservatives can watch Fox News so that they are more likely to only encounter information and facts that confirm their existing beliefs about health care reform and other important issues of the day.
“In a world gone crazy, the impossible –even death panels – suddenly seems possible,” states Drew Westen, the author of The Political Brain. A lot has happened that makes the diagnosis of the world gone crazy plausible to some Americans who are very anxious and angry. The federal government has bailed out AIG, Fannie Mae, and many of the largest banks. General Motors and Chrysler have filed for bankruptcy. We have elected an African American president. Unemployment today stands at 9.7% and 6 million jobs have been lost. U.S. households have experienced a loss of $13 trillion in wealth over the last few years. The Chinese own most of America’s debt.
The last word goes to Begley in Newsweek: “Anyone who believed that the battle over health care reform would be waged on facts, logic, reason and concern for the less fortunate…probably also scoffed at Lyndon Johnson’s daisy ad. As politicians and strategists (at least the successful ones) have finally learned, appeals to emotion leave appeals to logic in the dust. And no emotion moves people more powerfully than fear.”