Health care and emotions – the politics of preaching
By Dena T. Smith
Since his inauguration, President Obama has used just about every forum possible to stress the need for health care reform. We’ve heard the pragmatic arguments: in the current system, we spend too much money on treatment rather than focusing on preventative care or that all the power is in the hands of private interests inflates costs. And we’ve also heard plenty of opposition to government intervention from the right. Two Tuesdays ago, I wrote about the need for the president and health care reformers to frame changes to the system in a way that people would feel motivated to create and/or support reform. I discussed what role altruism could have in this process (click here to go to the post). To re-cap, in the framework of classic theories of altruistic behavior, if people are to support an overhaul of the American health care system (as a helping behavior), they have to feel compelled to act and that the costs of the act would need to be minimal compared to the benefits of change. In other words, wanting to help combined with a bit of self-interest are the necessary cocktail. In the last few weeks, especially given the failure of the pragmatic (generally economic) approaches in convincing both congress and the public to change the system, the President and his team of health care reformers have locked in on emotions more intensely than ever before. One way in which they hope to activate people’s emotional responses is by swaying religious leaders to publicly emphasize the values of their respective faiths that might potentially push congregants to support government intervention in and alterations to the health care system.
The New York Times describes this as situating health care reform as “a core ethical and moral obligation,” (NY Times) Specifically, last week, Mr. Obama addressed thousands of American religious leaders. For instance, it has been reported that he telephoned about one thousand Rabbis, as the High Holy days approach. A major tenet of Judaism is the notion of social justice, which includes helping those less fortunate, those who are struggling, those who are in need – as a moral obligation. These themes will surely be addressed in temples accross the country in the coming month, when attendance is at its peak for the year and the President reportedly asked these Rabbis to address the need for health care reform at the same time. For those who hear these sermons, then, the benefit of reform is heightened, as a respected religious leader has endorsed its benefits. Additionally, the identity of individuals who attend religious services is generally tied to their religious background. Because of this, guilt and even dissonance from acting in a manner incongruous with the beliefs of one’s Rabbi or other religious leader, would be heightened, if congregants do not support the reforms that both their religious leader and, by implication, their religion seems to support. In other words, if the President can convince religious leaders to publicly support health care reform, the odds of congregants supporting the process also increases; people are exposed to the need for change, feel as though it’s a good/the right thing to do and also open the door to experiencing dissonance if they act in a manner that is in opposition to how they imagine their religious leader and fellow temple (or church or mosque) members would. Dissonance theory suggests that people alter their cognitions and/or behavior in order not to experience the unpleasantness and even torment of acting in a way that is in conflict with their attitudes. Further, this line of thinking suggests that the more salient an attitude is (i.e. someone’s religious values that dictate taking care of those less fortunate – especially when a religious leader is clear about the connection between health care and altruism), the more conflict they would feel if, say, they did not support the democratic party’s push for health care reform.
The question, however, is whether blurring the boundaries between politics and religion will push people to feel increased motivation towards health care reform or, on the other hand, to feel as though it’s a political invasion on their private moral beliefs and customs. If people see this as an emotional issue, this strategy could be quite successful as in the case of support for the Iraq war, as argued by Pagano and Huo (see link below). Emotions are very powerful factors in our support (or lack thereof) for political endeavors. However, if people feel intruded upon or as if their places of worship have been invaded by political pandering, this could all go terribly wrong.
Obama Calls Health Plan a Moral Obligation
The Role of Moral Emotions in Predicting Support for Political Actions in Post-War Iraq
Good post. Altruism is indeed a very handy thing for politicians to be selling: they can offer people the feeling of being altruistic without the attendant costs, so it isn’t really altruism in a strict sense but it feels like it to the voter.
It makes me think of the difference between “Live Aid” and “Live 8”. In the first Bob Geldof urged people to give their own money to starving Africans, in the second he urged them to ask their governments to take money from their citizens to send to starving Africans.
I agree – it’s sort of false altruism or maybe even imagined altruism. Of course, there is some question about whether a pure form of altruism exists at all. I feel that health care is a good case for getting to the root of how people make decisions about helping others. It is obviously more complicated than this, but it raises interesting social psychological questions.
Thanks for the insight/connection to Geldof – interesting to think about.
Very interesting and thought-provoking post. Thanks also to the commenter about the difference between Live Aid and Live 8. What doesn’t get discussed enough is whether forced altruism through the government is moral. The government is made up of politicans and bureaucrats who have no skin in the game, other than pleasing their voters, if they even care about that. They are just re-restributing money to those they wish to favor. What are the long-term consequences of changing the current health care system? Will it cause it to collapse in ten or 20 years? How moral is that? Is it moral to saddle our descendants with enormous debt? Health care is expensive, no matter how you pay for it. As more research, equipment, treatments and options become available, it will get more expensive. Who is going to pay for those?
Elsewhere, other systems are struggling. The head of the Canadian Medical Association said this month that the Candaian system is imploding.
As people are saddled with higher and higher taxes, there is less incentive to work or to grow businesses, as you see in France right now with ten percent of employment and with 25 percent of French national income going to pensions and health care. Are they paying for research, or are Americans subsidizing them? In France, taxes keep rising to cover this expense, and employment levels keep dropping.
Most people are not afraid they can’t pay for routine care. They are afraid of a major illness wiping them out. We should address that, rather than taking over the whole system. The government started on this path of employment-based benefits by a wage freeze in the 1940s, so that companies sweetened their pot with insurance benefits, which were allowed by the government. In those days, medicine couldn’t do much anyway. Now everyone who has job-connected health insurance is held hostage to their job, particularly as they get older and start to develop those nasty pre-existing conditions. Another unintended consequence of government intervention.
I believe if we do anything it should be as you said abovea: “To re-cap, in the framework of classic theories of altruistic behavior, if people are to support an overhaul of the American health care system (as a helping behavior), they have to feel compelled to act and that the costs of the act would need to be minimal compared to the benefits of change.” And we need to look to see what will happen in 20 years!
I also found your acticle though-provoking. I had not heard of President Obama’s plan to delve into the dangerous realm of religion. I personally think it is a very poor choice but I cannot say I’m surprised since he has staked a large portion of his success/failure upon forcing this down the American People’s throats. I certainly agree with Catherine. I have friends in Canada and France and cousins in London. They all talk about how horrid their health-care is. One of my friend’s mother from Canada was effectively killed by the program since she was told she desperately needed a Kidney, however she was too far down the ‘wait-list’ and passed waiting.
I find it amazing how much politicians from both ends of the spectrum are willing to twist/bend/re-invent the truth to meet their agendas. Heathcare is just one more issue. With all of the leftists out there who despise anything religious such as the ‘pledge of allegiance’ (cough) I have no doubt there will be some backlash. That is assuming this story would get any coverage though and the chances of that if it is unfavorable to Obama are zero-to-none.
Thanks for your comments. I have to respectfully disagree with some of these statements. When I wrote about altruism and claimed “if people are to support an overhaul of the American health care system (as a helping behavior), they have to feel compelled to act and that the costs of the act would need to be minimal compared to the benefits of change,” I was intending to show how changes to the health care system would need to be framed in order to be successful. I did not intend to suggest that the drawbacks outweigh the benefits. What I did intend to show was the difficulty in getting people to act in altruistic ways.
This discussion that we are now entering, however, extends well beyond altruism. We are now back into the realm of pragmatism, which is not all together separate from how Americans feel about health care as a right versus a privilege, but does take us in a slightly different direction. In terms of people’s fear of not having coverage – it may be true that people do not fear being afraid to pay for routine illness (though I’d like to see stats on this), but the larger issue is that major illness is at all-time highs in the US (things like diabetes, cancer, heart disease) in part because people don’t seek preventative care because it is expensive and even those who are insured are pushed away from routine visits to GP’s because their coverage doesn’t deem it necessary.
Catherine, you say “Now everyone who has job-connected health insurance is held hostage to their job, particularly as they get older and start to develop those nasty pre-existing conditions. Another unintended consequence of government intervention.” I agree with the first statement but I believe this to be a consequence of lack of government intervention and private insurance companies doing as they please. This would be my argument FOR government intervention. If insurance wasn’t employer-based, people would not be held hostage to their jobs for insurance purposes and pre-existing conditions would no longer be an excuse not to pay for care. The recent proposals that went through congress focused on ways to eliminate this loophole so claims won’t be denied as frequently.
In terms of waiting for care. I agree, it is horrendous that people have to wait for organ transplants and it’s devastating that people die because of this. But the same thing happens in the US – our transplant lists are miles long as well. And our insurance companies often won’t pay for people’s transplants for a variety of reasons – and even if we had an abundance of organs, it doesn’t do us much good to have available organs if no one’s going to pay for the surgery to transplant them. It would bankrupt the average person to pay for an organ transplant.
I can’t argue with either of you – we don’t know what will happen with our system. And we can easily point to flaws in the systems of other countries. But leaving our system as is or only addressing cases of severe illness is not going to solve the problem of lack of general care and the corruption that comes from the pharmaceutical world and the various other private enterprise that control who has the option of getting care.
One thing we do know is that the system, as it is, is costing us exorbitant amounts of money (as individuals and at the governmental level) each year. And those of us with insurance pay the price for the unpaid hospital bills of those without it. When our hospital bills are overpriced, it’s because the private hospitals want to make their money back for the thousands of people who default on their bills at every hospital, every year because they simply cannot pay. Our having to face the issue of being ruled out of treatment because of pre-exiting conditions and denied coverage in other ways is mostly because private insurance companies exist in the first place. Additionally, true Universal Health Care is not even being proposed in the US at this point. In my opinion, the government intervention that is being proposed is nothing like the systems in the UK or France or Canada. The president is not proposing to buy up the hospitals, doctors, drug companies, etc. In the end, if insurance and drug companies remain private, we will never really have a universal system. Allowing people to buy into a government option and putting some restrictions on what insurance companies can and can’t do would make the average American’s life easier, but it won’t solve all the health care problems. However, if we leave things as they are, this country is going to drown in our own health care debt – both those of us who have insurance and those of us who do not…unless we happen to be in the wealthiest 1% of the population that does not need to worry about such things.
Finally, we are talking about our basic feelings about people’s rights to care. Regardless of the economic drawbacks and the unknown of shifting the system, people in this country die and live lesser lives because of lack of care. We can worry about our children facing national debt because of shifting the system (and I do not make light of this) but we must also worry about them facing debt because no one can afford to pay the price for care. For instance, what’s going to happen to them as the unemployment rate stays at all-time highs, fewer companies even offer jobs with benefits and the cost of care continues to rise.
Hi Dena (DMouz here):
Excellent post, good for you. Very timely and I really like your perspective on this important issue.
Unfortunately, it seems as though altruism is often at odds with pragmatism in the whole debate about health care. I agree that the “what’s in it for me” factor is important because altruism alone won’t do it, especially for the incredibly small but powerful segment of the population who is not affected by uninsurance or underinsurance (either personally or through family/friends).
On a separate note, I was not aware of Obama’s angling towards the religious leaders and I’m not sure how I feel about it. My gutshot reaction is that religion has no place in this battle. I think religion is too often used as a tool of social control. I generally favor the separation of church and state. However, I think – in light of the last failure of health care reform –
Obama is doing everything he can to make this happen. Look how long it took us to recover from the last failed reform, after all. Obama reached out and will allow the religious leaders to do their research and decide how relay the message to their congregations, if at all. I think this is the most appropriate way to navigate the two (supposedly separate) terrains.
Unfortunately, despite the supposed separation of church and state, this is probably the only feasible way to appeal to the altruistic side of Americans, which I think scholars agree has been dwindling over time. The recession has also encouraged this type of individualistic thinking.
I am totally in favor of public insurance. The truth is that we spend more on health care than any other industrialized nation, but our health care outcomes (life expectancy, satisfaction with care, etc) do not match the dollars we spend. It’s time for us to think outside of the box. With fewer and fewer companies offering employer-sponsored coverage (coupled with the high unemployment rate and the decline of the lifelong career with one company), we need to realize that employer-based coverage is no longer the panacea to address this crisis. The only real solution is an overhaul… regardless of whatever outcome you choose to focus on, what we are doing has not been working. Offering a public insurance option will end the triumphant rule of the private companies (who can decide who and how to cover people) up to this point.
Sorry, totally rambling post….
The health care debate is awash in emotions and politics. It seems a very risky move to appeal to religion and risk the pandering argument. However, this comes on the heals of eight years of pandering/emotional appeals, and challenges to the separation of state and religion. Perhaps the norm of separation of church and state is shifting, and separation is becoming less absolute. The outcome of the health care debate might be very revealing indeed.
Thanks for a thought provoking post.
Keri