[This post was written by UCSD Sociology Graduate Student Jeff Lundy. Previously, Jeff posted here about Why Everyone Younger Than You Is Spoiled, drawing on his insights into the problems of amateur accounting for inflation and cultural and technological change. Today's post is about the current debate on healthcare and the role of expertise and skepticism in public debates. For a related point, check out this recent Daily Show clip on the media's disastrous role in the current healthcare debate.]
The Paradox of American Skepticism
The current healthcare debate is, without a doubt, a source of ire for many liberals. The White House finally has a savvy, liberal President. Democrats finally have a strong, filibuster-proof majority in Congress. The need for healthcare reform is pressing and has been for quite some time. Before the election, many Americans seemed extremely interested in the plans of candidate Obama. And yet, with all forces seemingly faced in the right direction, the irritating question remains: why is there so much trouble in making this healthcare reform happen?
I have to admit I was surprised by the depth of resistance that emerged against reforming our health system. Protesters were taking to the streets and town halls before there was even a definitive plan to rail against. (On a side note, isn’t it weird to think of conservative protesters? It seems like an oxymoron. I guess we live in strange times). Clearly, selling healthcare reform is much harder than I (and probably many other liberals) had previously thought; and this is a very irritating fact.
Now, there are one-million things I could say about the healthcare debate. I’ve read CBO reports, CDC reports, not-for-profit non-partisan reports, etc. However, this resistance to healthcare so surprised me that it got me thinking about something deeper than the debate about healthcare and the battle between liberals and conservatives. I thought to myself: why is it that Americans would resist changing a system that is so patently bad? Furthermore, why are so many Americans immediately apprehensive about changing the system? And what’s more: if they are so apprehensive about changing the system, why don’t these same Americans do any kind of research to figure out the facts on the matter?
These final thoughts brought me to a paradox about the American public. On the one hand, a large number of Americans are extremely skeptical of government policies, when one considers “skepticism” in the conventional sense – i.e. automatically mistrusting any plan that is proposed. On the other hand, however, Americans also seem extremely un-skeptical when one considers skepticism in the “scientific” sense – i.e. demanding empiricism and well-reasoned thought be applied to any proposition.
That I think this is a paradox probably has to do with me being an ivory-tower academic. And yet, I know that for myself (and many of my friends), my first impulse is to do research whenever I hear some heated debate that I don’t know much about. I take this to extremes sometimes (I recently did a semi-extensive literature search on college football); but yet, the impulse is fundamental. I need to know the facts on the matter. However, I don’t sense this impulse is fundamental for most of my fellow citizens.
And this leads me to a great concern. My impulse to research facts has led me to recognize that almost everyone talking about an important issue is grossly wrong. Even your common “experts” and “pundits” generally seem to know only about 50% of the facts about any pressing matter. The healthcare debate is no exception.
For instance, I’ve heard from liberals that the current state of healthcare could be fixed by removing company profits. However, the best estimates of company profits reveal that they are likely ~1% of the total GDP spent on healthcare. This estimation process is really complicated, and there are lots of counterarguments that could be raised, but the main point remains: profits are nowhere near the main source of our problem (at least in a straightforward sense). The same troubled reasoning goes for the conservatives’ favorite argument about “tort reform.” If we enacted these “reforms,” we would only reduce our health expenditures by at most 2%. And you only get that number if you take the most grossly unrealistic estimate of the impact of tort reform (i.e. if we strip consumers of every right to good treatment they currently enjoy). Numbers can be backed up with CBO reports, if you want to double-check.
The real source of the growth in healthcare spending is not one of these easy, naïve answers. It probably has a lot to do with the current state of medicine, which is centered on complicated treatments, instead of preventions or cures. The problem is multiplied by our society’s increasing insistence that everyone live as long as they can, while being given the absolute best treatment (a noble goal – but one which I think most people haven’t truly thought through to its fullest consequences).
However, I digress. The point of this post is not to disseminate the best thoughts on the healthcare debate; the more fundamental question I hope to ask is: why don’t most people realize how far off they are from understanding the sum total of this problem? Why don’t people know how much they don’t know (and how much “science” as a whole doesn’t know) about healthcare, and other important topics? How can we get more people to do some research whenever they feel the impulse to be angry about something?
This is an honest question. I honestly don’t understand this situation; but if we could figure out why this is happening I believe we’d open up the possibility for some major changes. For instance, I believe that most of the healthcare debate would be solved if everyone just understood the best facts we have on the matter.
I imagine some of this lack of inquisitiveness comes from people mis-estimating the amount of information needed to form a strong opinion. Maybe some of this lack of curiosity is caused by our education system focusing on facts and less on processing information. There are certainly many contributing factors.
I don’t think that the answer to why people aren’t more “scientifically” skeptical is that they are too stupid. People far less informed than current-day Americans have been tough-minded and inquisitive when facing challenges. I also don’t think it’s simply that people don’t have time to think through matters, or that they don’t have the necessary skills to evaluate the complex information needed to have a strong opinion. These may be reasons for why people are lacking in a strong opinion, but they can’t explain why so many people hold bad opinions.
So now I end this post with an appeal to anyone who finds him- or herself reading it: Fill me in. Let me know every idea you have on this subject. Set an ivory-tower intellectual straight and put his feet on the ground. Tell me your thoughts on why people can be so angry, misinformed, and also undesirous of better information, all at the same time.
October 15, 2009 at 6:18 pm |
“I thought to myself: why is it that Americans would resist changing a system that is so patently bad?”
Because for a lot of us, it’s not “patently bad” at all. In fact, for a lot of us, it’s great.
Check your premises.
October 15, 2009 at 11:41 pm |
To a non-American, the whole thing seems really bizarre. It makes no sense in economic/efficiency terms. It makes no sense in moral terms. It just makes no sense at all. I am sure that along with others, it makes me really appreciate the public systems we have in every other developed country.
Perhaps the answer to Jeff’s question lies in what Gore Vidal said in a different context recently: Americans are “the worst-educated people in the First World. They don’t have any thoughts, they have emotional responses, which good advertisers know how to provoke.”
(http://women.timesonline.co.uk/tol/life_and_style/women/the_way_we_live/article6854221.ece)
@ DON: The strange thing is that it appears that those for whom it is patently not ‘great’ are often the same ones opposing reform.
October 16, 2009 at 9:27 am |
Great exploration of an important topic, one I’ve thought about many times without attempting to really take it apart.
I think it really comes down to the distinction between skepticism and cynicism. Their supposed optimism notwithstanding, Americans harbor a deep cynicism about the political domain. That is, they doubt generally the possibility of public policy to change the way things are. There is widespread ignorance of both the real and potential role of policy in all aspects of society– witness Sarah Palin’s comments about Fannie Mae and Freddie Mac being “taken over” by the government.
The irony– or the paradox, as you call it– is that this cynicism co-exists with an anemic sense of skepticism about political claims. We have the worst of both worlds: a dogmatic distrust of the very notion of social progress, and a blithe acceptance of the wildest claims, including (perhaps especially) the most cynical.
So there is no paradox in the fact that the fate of the nation depends upon the simultaneous cultivation of a robust intellectual skepticism and an idealistic political imagination. In the words of Alexander Hamilton, “Those who stand for nothing will fall for anything.”
October 16, 2009 at 10:49 am |
These are all great comments. I’m glad people are responding, because as I said in the post, this isn’t just posturing on my part — I really am befuddled by how this can happen.
@Don: Selfishness is an interesting argument. Keeping in mind that many people have no direct interest in reform might help to understand why many people aren’t asking a lot of questions.
However, I also have to agree with Ben; there’s too many people who might benefit from healthcare reform (likely the majority, in fact) to make sense of the opposition to healthcare reform. Also, being selfish doesn’t exactly explain why people don’t do more research to bolster their opinion on healthcare. Even a selfish person who currently holds good insurance might be curious about the effects of reform; or at least might want to bolster their position against reform with some stronger facts.
@Ben: I think, somewhat, you must be right about Americans’ lack of education. In particular, I think that Americans might suffer from schools that not only deny them good skills-training (e.g. the ability to do long-division), but that also deny them higher-order training in critical thinking (e.g. what kinds of arguments should I trust?).
@Thomas: I agree that cynicism is the right word for the kind of skepticism I call “colloquial” in the post. And you put your finger on the paradox – people are cynical about government policies at the same time they demonstrate an apparent optimism about the quality of information they receive from various non-governmental sources.
In a final comment, I’ve also struck upon another interesting possibility for Americans’ lack of concern with finding facts. It occurs to me that religion may be a culprit here — at least in the form of the Christian ethos that currently permeates Americans’ thinking. Many people seem resigned to the fact that their lives are “not of this world” and that they ultimately only have to do certain incantations in order to get into heaven (where it apparently won’t matter that they completely destroyed the Earth they left behind). Consider responses to the following link:
http://answers.yahoo.com/question/index?qid=20061217145637AA10o3E
October 17, 2009 at 12:34 pm |
Three arguments:
It’s a matter of “rational ignorance.” Staying abreast of the facts is easy for us ivory tower eggheads, but most people have better things to do. The cost of acquiring and sorting all the information outweights the benefit of being informed given that you have marginal influence of the legislative process.
Bryan Caplan came of with the idea of “rational irrationality.” On an individual level, your opinion doesn’t matter so you can induldge in “irrational” behavior (voting for Obama because Michelle is a smokin’ hot babe or opposing free trade because you think Mexicans will steal your job). In the aggregate though, these irrationalities add up and lead to irrational outcomes.
I read a Daniel Boorstin book years ago that argued for American exceptionalism. The American theory of government is not to have a theory. That stuff is for Europeans. Just show me what works and what doesn’t work.
Hope that helps.
October 17, 2009 at 9:08 pm |
But there seems to be no rationality (however defined) at all on the conservative side. It’s hard to find a rational argument against reform. Instead it is an emotional, visceral, response. Which does seem to point to something much deeper in the culture. Which is very interesting.
Why is that Americans are so deeply suspicious (indeed frightened) of government when it comes to things which are clearly public goods. Things which are commonly present in every other developed country and clearly not problematic. And yet not so when it comes to things like military and policing/imprisonment. And, of course, public education. Why is public education OK and not everything else?
The strange thing is that the low level of government in the provision of infrastructure distorts markets and makes them much less functional than they are in other countries. For instance, the lack of public health care reduces the dynamism of the broader capitalist economy – people can’t afford to risk leaving a job with a big corporate for a start-up or small business because of the risk of losing health care. So competition, which is so fundamentally important to a market economy, is greatly reduced. The dysfunctional private infrastrucutre of things like telecommunications and electricity and transport have significant impacts throughout the economy.
In other societies it seems there is little interest in whether something is provided by the state or the market, so long as it is provided well. Sometimes that is publicly and sometimes that is privately. It is pragmatic rather than ideological. Yet many Americans would seem to prefer to go without something than have it publicly provided. This is contrary to what Josh argues – ‘just show me what works’. Clearly public health care works better for most people on an individual level, and for the broader economy.
And there is a sense in which the apparently democratic institutions – such as the election of all sorts of public officials who would be appointed anywhere else (like the attorney general for instance), and the dependence on private money for campaign financing etc actually diminishes the real level of democratic accountability and increases corruption.
And there is a deep fear of state bureaucracy, yet a nonchalance about corporate bureaucracy. Whoever provides your health care will do it bureaucratically. But at least if it is public you have recourse. Much more responsive to citizens than a corporate is to consumers. No government could get away with the outrages committed by American insurance companies.
It’s a fascinating paradox and I would love to understand it. But I am unconvinced by Josh’s explanation, and really doubt that any variant of rational action is going to persuade me. After all, it is cultural thing, and it is unique to one society.
Any other explanations?
October 17, 2009 at 11:17 pm |
Ben: I think you need to check your premises too. Healthcare is not clearly a public good. It’s not clear that “reform” still improve the situation. It’s not clearly unproblematic in other countries.
I’m not going to argue either way, but if you can sit there and honestly tell me that you can’t see a single rational argument against the proposed reforms then I have trouble believing that you would be open to any argument at all.
October 21, 2009 at 10:53 pm |
I am not claiming that there are no rational arguments against the specific proposed reforms. But this is quite a different thing to opposing reform per se. And it is that visceral opposition to reform, which the original post was about, which seems to me to be emotional and not rational, that interests me. And it also seems uniquely American. Can you imagine a protest movement like that in any other country? I have never heard of one. So it’s a very interesting case study in culture.
In any case, for those interested in the general topic of health care, I’d recommend listening to the last two episodes of NPR’s ‘This American Life’. They do a good job at examining the impacts and sources of the growth in health care costs. Some of the statistics are pretty jaw-dropping.
October 22, 2009 at 12:48 pm |
I’m apparently not the first person to be so struck by the opposition to healthcare reform that it made them question Americans’ reasoning skills:
http://www.huffingtonpost.com/bill-maher/new-rule-smart-president_b_253996.html
October 22, 2009 at 10:48 pm |
There is also a very interesting podcast (still available, though probably not for long, at the link below) on the political history of health care in the US. Who knew, for instance, that Obama’s program was based on Nixon’s?
http://www.abc.net.au/rn/rearvision/stories/2009/2658096.htm
October 23, 2009 at 12:56 pm |
Jeff, Ben et. al,
It is something deep within the culture.
From a very early age we are being mis-educated by corporate advertising into a cult of consumerism with capitalism as its core religion. Because socialism is viewed as anathema to capitalism it is portrayed as something akin to Satanism.
American are also rational, but our distrust of government is rooted in false premises that are pushed on us from the majority of media outlets. Generally the arguments against government are:
The government can’t do anything right,
The government is wasteful.
Private companies will find ways to make services profitable.
Socialism would mean the government would take control of each persons options.
Socializing means we would pay more taxes and we are taxed enough already
If you look at these in a critical way, they fall apart.
“The government can’t do anything right, ”
NASA does a lot of things right and heave been the driving force behind innovation over several decades.
The state wildlife management departments have, by managing hunting , setting quotas , and controlling when game animals may be hunted, have brought mane once endangered species back from the brink of extinction.
“The government is wasteful”
In general, news reports of fraud and waste in government procumbent, along with research grants that are made to sound frivolous are cited as proof of this concept, Things like $80,000 toilet seats, or $500 harmers are blamed on government incompetence, but the private contractors fraudulent behavior in charging so much for theses items is deemed as legitimate.
“Private companies will find ways to make services profitable.”
Many of the government services cannot be provided at a profit. with the same level of quality. Think what it would be like if the police department was run by private corporations. In two well known cases of privatization, the quality of service greatly decreased in order to make a profit.
In one case, a private corporation that took over the operation of several county jails cut costs by turning off the heat during the winter in one jail and feeding kibbels (dry dog food) to the prisoners in several of jails.
In another case, a private contractor that got control of the water services in a south American city raised rates to over half of the average income and outlawed the population to use wells or rainwater for watering their crops. Aparently they made a profit by taking away human rights.
In a third, less publicized case a large corporation that manages parking lots, took over the parking management (including meter reading, ticketing, and fines in several major cities. After many complaints from citizens who could document their claims against the company for fraudulent billing, the company was banned from at least two major cities.
“Socialism would mean the government would take control of each persons options.”
In the case of health care reform, we are not reforming health care, but how it is paid for.In our current system, the insurance companies determine if you need non-life threatening services (according their own definition of what is life-threatening) based entirely on financial cost-benefit analysis that can be summed up as “Will the cost of this procedure be more than we can make on this person over the remainder of his life?”
“Socializing means we would pay more taxes and we are taxed enough already”
If you work for someone else, take time to calculate how much you annual insurance premiums are. make sure you include any part paid by the employer as well. The compare that to your total tax and FICA withheld.
You would be trading a private tax for a public one. This would not bankrupt the private insurer,
In 2005, on major health insurer made 33 billion in revenue but claimed a profit margin of only 2.5 percent.
However, in the same year, their top paid 200 executives received bonuses that totaled almost 7 percent of the revenues. this was considered part of the employee payroll expense and were not part of the profit.