Clause 61: The Pushback Blog

Because ideas have consequences

Ignorance, Sin and Health Care

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There was an interesting posting on LinkedIn this week, that began thus:

By now, everyone has formed opinions of the Affordable Care Act (ACA). Ironically, the strongest opinions seem to come from people that know the least about it. Our research indicates that the best predictor of a favorable opinion is not a person’s age, gender, race, education, income, or even whether he/she is uninsured: what matters most is whether they voted for Mitt Romney in the last Presidential election.
—  Dana Goldman, “Where Obamacare Went Wrong (Or Did It?)

Dr. Goldman is on the faculty at USC. He is the director of the of the Leonard D. Schaeffer Center for Health Policy and Economics at the USC Price School of Policy, Planning, and Development.

It’s an odd juxtaposition in the paragraph; apparently, there is a linkage between knowing the least about the act and having voted for Mitt Romney. Well, let’s not live in ignorance here; we’ll just go download the Patient Protection and Affordable Care Act and, good citizens as we are, read the thing ourselves.

Holy buckets! It’s 906 pages! And here is just one excerpt:

SEC. 1139B. ADULT HEALTH QUALITY MEASURES.

(a) DEVELOPMENT OF CORE SET OF HEALTH CARE QUALITY MEASURES FOR ADULTS ELIGIBLE FOR BENEFITS UNDER MEDICAID.

The Secretary shall identify and publish a recommended core set of adult health quality measures for Medicaid eligible adults in the same manner as the Secretary identifies and publishes a core set of child health quality measures under section 1139A, including with respect to identifying and publishing existing adult health quality measures that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time, that may be applicable to Medicaid eligible adults.

So even if you do read through all 906 pages, you still are not sufficiently informed; this or subsequent administrations have ample discretion to fill in the blanks. As is often the case, the legislation delegates most of the details to government entities who are not accountable to voters. Even after reading it, you wouldn’t be done; you would still need to catch up with the Health Care and Education Reconciliation Act of 2010, and also look up all the legislation that these acts amend to find out what was changed.

Enough with the ACA. The real issue here is our being underinformed, and what that means.

Ignorance

Dr. Goldman’s position is not an isolated occurrence, but a instance of a common pattern that can readily be observed. To many people, their policy objectives are noble and good, and people who object to them are lacking in knowledge. “If you only knew enough, you would agree with me.”

I have been in church groups with people who have said variations of the statement, “Love, and do what thou wilt.” (From Augustine of Hippo, On the First Epistle of John). However, how do we know that what we will is the right thing to do? There would appear to be a lack of humility here; an unawareness that well-informed and loving people also go wrong.

Sin

The Christian doctrinal tradition is spelled out most effectively by St. Paul:

We know that the law is spiritual; but I am unspiritual, sold as a slave to sin. I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me. For I know that good itself does not dwell in me, that is, in my sinful nature. For I have the desire to do what is good, but I cannot carry it out. For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it.

So I find this law at work: Although I want to do good, evil is right there with me. For in my inner being I delight in God’s law; but I see another law at work in me, waging war against the law of my mind and making me a prisoner of the law of sin at work within me. What a wretched man I am! Who will rescue me from this body that is subject to death? Thanks be to God, who delivers me through Jesus Christ our Lord!
— Romans 7:14-25, New International Version

There is a very unpleasant tendency in contemporary America to equate sin with ignorance. The whole idea of well-meaning people like us going astray causes discomfort. I have been in liturgical churches that skip over the Rite of Contrition. I am very dissatisfied when this occurs in a service I attend. I know that I make mistakes every week, in what I have done or left undone, and I want to ask forgiveness for them.

It takes more than knowledge to avoid sin. Not only is it necessary to know what is right, but one must have the will to act on the knowledge. And, even then, one can find that the knowledge was imperfect; that what appeared to be a correct course of action was not so.

Does this mean that I must not advocate my point of view? Not at all. However, it does mean that others who don’t see issues as I do are not necessarily ill-informed or ignorant. Our politics would be less shrill and polarized if everyone would bring a little humility into the public square with them. Anyone who disagrees with me is not stupid, evil or crazy just by the fact of their disagreeing.

Specialists

Another aspect of Dr. Goldman’s viewpoint is that he is a specialist, whose job it is to understand the legislation and its policy effects. He gets paid to read all 906 pages of the ACA (or, more likely, have some grad student read it and summarize it to him); the rest of us would have to read it in our free time. Nevertheless, the legislation affects our lives, and we as citizens do not surrender our obligations to form judgments and act on them to specialists.

I am confident that Dr. Goldman could demonstrate that his grasp of details of the ACA and other current legislation exceeds most of ours, but what would that prove? We do not abdicate our rights as citizens to give or withhold our consent to the legislation as a result, or to act on that decision by voting or petitioning our elected representatives for redress. We are going to form judgments and take actions based on them, however much we know about the subject matter. To do otherwise is to surrender to a dictatorship of detail.

If specialists want to influence public opinion, the burden falls to them to explain their position to us in terms we can understand and sell us on the merits of the changes they want to introduces. The default is to leave things alone. In the medical field, this is summarized as, “First, do no harm.” The principle that changes have to be justified and ought not to be made if they cannot is the centerpiece of conservatism. It contrasts with the expansive viewpoint that says that change out to be made if a minority believe that they can make the world better and they need not bother selling the rest of us on the correctness of their beliefs.

There is an arrogance that comes with specialization, a belief that those who don’t have the specialized knowledge should just give way to those who do. It is not limited to those with doctorates; plenty of IT people, building tradespersons and auto mechanics have it as well. As citizens, from whose consent power is derived, we cannot condone this arrogance. Health care policy is too important to leave to the professionals.

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Written by srojak

October 11, 2013 at 11:40 pm

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