Health Care Reform Law and the Struggle between Mind and Heart

Charles M. Blow documents that President Obama's sales job for the health care reform law has so far resulted in his lowest approval ratings on health care (34%) since taking office. Blow writes that: "This underscores the current fight for the soul of this country. It's not just a tug of war between left and right. It's a struggle between the mind and the heart, between evidence and emotions, between reason and anger, between what we know and what we believe."

Blow goes on to contrast Obama's language that emphasizes what people know or should know with Rush Limbaugh's language that speaks to his followers about the belief that Obama is bad for America. (http://ow.ly/1uLJe)

The paradox of the Internet is that it allows all of us unlimited access to both knowledge and "a staggering amount of untruth." Fact-checking websites like Snopes, PolitiFact.com, and FactCheck.org try to counter what Google CEO Eric E. Schmidt calls "a cesspool." David and Barbara Mikkelson of Snopes know that "rumors are a great source of comfort for people" during uncertain times. Their experience also supports the basic tenet of behavioral economics that people reject nuance and facts that dispute what they sincerely believe to be true. Mrs. Mikkelson states, "When you're looking at truth versus gossip, truth doesn't stand a chance."

Gossip is not just gossip. How else can one explain a long New York Times article on the rising stars of gossip blogs? (http://ow.ly/1uLmw) Anthropologists and sociologists have begun to take gossip seriously enough to split into two camps: the functionalist school sees a useful tool for enforcing social rules and maintaining group solidarity, and the other group sees a hostile endeavor by individuals to selfishly advance their own interests. One scholar has noted that: "The gossip did serve to reinforce the teachers' group solidarity, but in this case it was also a form of warfare that brought everyone down. It was reminiscent of the old saying that gossip is a three-pronged tongue: it can hurt the speaker and the listener, as well as the target." (http://ow.ly/1uLpG)

It is this last point that worries me about the current health care reform debate. It seems to me that unless we understand that both facts and beliefs are important, we may hurt our entire national community of health care providers and patients. Atul Gawande reminds us of how Medicare in 1965 faced a year of nearly crippling rearguard attacks that included an attempted boycott by the Ohio Medical Association and reluctance to integrate Southern hospitals. Gawande ends his article by writing:

"That's the one truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success. We are the ones to determine whether costs are controlled and health care improves – which is to say, whether reform survives and resistance is defeated." (http://ow.ly/1uLto)

Why do people believe things that just aren't true. Susan A. Clancy, a post-doctoral fellow in psychology at Harvard, provides some answers in her fascinating book Abducted: How People Come to Believe They Were Kidnapped by Aliens. People's mental health can benefit when they create a coherent narrative for their lives, and as Donald Spence explored in Narrative Truth and Historical Truth it does not matter if our narrative truths are really true. What matters is that the story gives meaning to our lives. "Our personal stories are inextricably linked to our needs, goals, and desires." (http://ow.ly/1uLxE)

"Science demands reason, argument, rigorous standards of evidence and of honesty Absolute certainty will always elude us. Nothing is ever known for sure, and there are no sacred truths." Clancy believes those who believe they have been abducted want sacred truths and so they create a narrative that gives them meaning and contact with the divine. Clancy also introduces us to Brendan Maher's Irish Fact: "a fact-like statement that while not actually true is demanded by the flow of the narrative." Recent scientific understanding of memory and false beliefs all point to the human tendency to "choose from countless ways to reframe, reconceptualize, and understand our past." (http://ow.ly/1uLxE)

America is the land of opportunity and of opportunists, the land where people travel constantly, the land of immigrants where social class does not hold you back, and the land of the rugged individualist where personal ambition trumps community. And according to Lewis Hyde America is the apotheosis of the trickster. Coyote, Hermes, Mercury, Prometheus, Raven, and Legba are examples of this "mythic embodiment of ambiguity and ambivalence, doubleness and duplicity, contradiction and paradox." (http://ow.ly/1uLDQ) Let's face it, we don't always like to be held to strict honesty and truth, and the trickster is found and honored in almost all human cultures.

When Krishna was a child his mother Yasoda left the house and told him not to steal the household butter. As soon as she was gone, he eats the butter. When she returns, the child covered with butter replies, "I wasn't stealing butter; there were ants in the butter jars and I was simply trying to keep them out." He also points out that since everything in the house belongs to them he did not really steal the butter. Yasoda laughs because she is charmed by her cunning and shameless child. (http://ow.ly/1uLDQ)

In Greek philosophy, Parmenides declares that "Cretans are always liars." Since Parmenides himself was a Cretan, "the sentence plus its speaker make a befuddlement, an aporia, an inky sea." (http://ow.ly/1uLDQ)

Okay, I have almost lost you all by now. But, what if Ron Paul, Rush Limbaugh, Sarah Palin, and Bill O'Reilly are so convincing to so many people because they are seen as tricksters. In a time of uncertainty and economic instability, people want to believe in something. People need to create a narrative that makes sense to them and makes them feel better. Trying to change such people's minds with simple facts will simply not work. Confidence men have always found favor historically in the USA.

The last word goes to Sharon 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." (http://www.newsweek.com/id/213625) and (http://www.newsweek.com/id/212131).

Originally posted on the ICSI Health Care Blog.