Bridging the Fundamental Moral Divide on Health Care

Health Care Mayhem

The name of this blog is Popular Discourse, so perhaps it is appropriate to talk about the current state of public discourse around healthcare. Unless you have been living under a rock, you would know that following the resuscitation of the American Health Care Act (The GOP’s Obamacare replacement bill) and its subsequent passage in the House of Representatives, the Senate crafted (in much secrecy) its own bill. One that has been met with much outrage and a vociferous debate over the future of healthcare in this country.What is truly interesting about this public conservation is how, unlike many other political issues, where disagreement in driven primarily by difference in policy (how to accomplish certain goals, how to infer political priorities from broader shared values and how to weight those priorities), the health care debate is dominated by a profound disagreement on values. Nothing better showcases this phenomenon than the ideological clash between those who believe that healthcare is a right and those that believe healthcare is a privilege. The debate is characterized by participants angrily announcing their views at each other, asserting their respective claims. Both parties believe strongly in the indisputable rightness of their central claim, and in the incoherence of the other’s beliefs. So, what we’ve seen is a shouting match masquerading as a discussion: It’s conducted under the pretense of argument, it follows the communicative rituals and rules we use aiming to convince others, and we argue about health care as if there was an answer to this crucial political question that would appeal to the premises of both ideological factions. Though, if we’re honest with ourselves, we don’t actually expect that those who disagree with us will ever concede. We fail to recognize the central fact that, what makes this disagreement so fundamental, is that both sides are operating on completely different value systems.

A Theory of Fundamental Political Disagreements

It is this dynamic which prompted an incredibly poignant Huffington Post piece, aptly titled, “I Don’t Know How To Explain To You That You Should Care About Other People.” The article’s subtitle further captures the contours of our current healthcare debate, “Our disagreement is not merely political, but a fundamental divide on what it means to live in a society.” This is a stunning but accurate observation, one with which I agree strongly.

We each have been raised in different environments, and within different institutions. Moreover, we each have had certain values and moral attitudes instilled in us. We have internalized them and have invested these moral concepts with inherent emotional worth. They, in turn, shape the moral emotions we feel and our behavior towards others. When the author laments how she “doesn’t know to convince someone how to experience the basic human emotion of empathy,” she’s implicitly addressing how our internalized moral beliefs shape the literal contours of our world, the emotional phenomena we experience. However, simply because our account of moral emotions is subjectivist, does not mean we have to resign ourselves to an emotivist world of moral relativism. On the contrary, only by exploring the basis and structure of this philosophical disagreement can we actually have a serious conversation about what system of health care is desirable.  

To many, the idea that emotions are mutable and (somewhat) non-universal is alien. So it is probably worth it to flesh out this idea further, as it is central to my claim that our culture shapes our political values. As NPR’s Rebecca Hersher puts it, “emotions, the classic thinking goes, are innate, basic parts of our humanity. We are born with them, and when things happen to us, our emotions wash over us.” However, this view is flawed. We experience emotions as exogenous, we feel like  we have no control over. Sometimes we think of them as fixed reaction to a certain stimuli, yet as Professor Lisa Feldman Barrett puts it, in the same article, “But the problem with [the common wisdom] is that the data don’t support [it]. There’s a lot of evidence which challenges this view from every domain of science that’s ever studied it.” NPR’s phenomenal Invisibilia podcast expands upon this idea further, explaining that for every one of the complex emotions we’ve come to take as fixed in the West, there is a culture around the world which simply does not experience it. Additionally, there are emotions in other cultures which do not have Western equivalents. Parts of emotion are very clearly universal, but it is important to acknowledge how culturally and socially dependent they are. Man is both species and species-being.

This socially constructed character of emotion, and especially moral emotion, helps to articulate a theory of how fundamental political difference arise. Institutional and cultural differences lead to different moral emotions, attitudes, and behaviors and thus different philosophical views. This theory finds further support in the research of quasi-philosopher and social psychologist Jonathan Haidt. According to Haidt’s social intuitionism, moral emotions precede moral judgements, meaning that moral judgements are primarily intuitive and reasoning is often (and completely unconsciously) a retroactive rationalization of those intuitions. To quote his seminal article,  “The Emotional Dog and Its Rational Tail:A Social Intuitionist Approach to Moral Judgment.”:

“The cognitive revolution had opened up  new  ways  of  thinking  about  morality  and moral development, and it was surely an advance to  think  about  moral  judgment  as  a  form  of information processing. But times have changed. Now  we  know  (again)  that  most  of  cognition occurs automatically and outside of consciousness (Bargh & Chartrand, 1999) and that people  cannot  tell  us  how  they  really  reached  a judgment  (Nisbett  &  Wilson,  1977)…The time may be right, therefore, to take another look at Hume’s perverse thesis: that moral emotions and intuitions drive moral reasoning.”

Out of this moral theory, grew the Moral Foundations Theory, which aimed to, among other things, describe how social values and cultural differences drive political differences. In the Vox article, “Donald Trump supporters think about morality differently than other voters. Here’s how,” Haidt draws upon social psychology to explain how differences in regional culture determined support for different political candidates in the 2016 election. The results are illuminating and demonstrate how our particular cultures have a  direct bearing on our politics. This idea is supported by long-standing political science.  To quote one of my Comparative Political Systems textbooks, Thomas F Remington’s Politics in Russia, which puts it far better than I ever could:

“The patterns of behavior that influence how government operates are established through…channels of association…outside the government sphere…Citizens are less likely to cooperate in political cultures that harbor mistrust since they believe that combining for the common good is a sucker’s game…where people discount the common interest in favor of private benefit, government is likelier to be both more oppressive and more corrupt. Therefore in studying politics, we need to look both at people’s beliefs about government and at their expectations about social life more generally.”

I would claim that our moral beliefs about how to treat each other within our communities have a direct bearing on how we approach and think about political issues. It has special bearing on what teleological scheme we adopt (read: what goals we pursue). This, as many people will recognize, is pretty obvious. If you’ve been taught that it is good to help groups and individuals who have been marginalized, your politics will reflect it (you will feel bad when marginalized groups are mistreated). This is to suggest that the division we make between our mundane social interactions and politics, when we categorize them as different, is false.

This has a direct bearing on the specific issue of health care. Liberals and progressives believe that being a good person and member of society means having empathy for one another, caring for the disadvantaged, and striving for justice as fairness. While, on the other hand, conservatives (at least with regards to health care) privilege individual responsibility and autonomy, and thus believe that only negative rights deserve to be considered proper rights (à la Isaiah Berlin). As a consequence, liberals believe that it is prima facie unjust for someone to suffer because they could not afford health care. While, generally, conservative believe that health care ought to be treated like car insurance, that providing healthcare to the poor will engender lethargy and that the notion that health care is a right in anathema to the idea of ‘rights’ properly considered in the negative sense. These views are direct consequences of different starting positions.

Not All Values are Created Equal

Thus far I’ve advanced a theory of deep political disagreement: differences in culture and in upbringing result in differences in internalized moral emotions and attitudes. Which, in turn, have a direct bearing on the political values, we place a premium on. However, this definitely does not mean that we must surrender to the hopeless ennui of moral relativism. Certain cultural practices and social environments are better than others. For example, (and quite obviously) certain cultural norms have historically legitimized practices, which would be considered inhumane and horrendous by modern standards. Furthermore, I genuinely believe that we are best served by a society in which we have empathy for one another and community members strive for the common good. Not only does such an environment promote social trust and help facilitate collective action (and all the rewards we reap from that), insofar as we are embedded in dense social networks already, cultural practices which encourage social cooperation benefit all members of society; indeed, our welfare depends on both ourselves and on the structure of society as a whole.

Regardless of my personal views, we need to have this conversation over values, whether in the terms employed above or on different philosophical grounds. Simply acknowledging that we are divided as a nation, as a society, as an imagined community, does not help to fix that gap, one which grows every day. As detailed by Robert Putnam’s Our Kids, an incredible treatise on inequality among other topics, we have a tendency to to divide ourselves up socially and geographically into ideological tribes. As David Brooks, the conservative New York Times columnist, puts it, “America is a country in which privileged people suffer from their own characteristic forms of self-indulgence: the tendency to self-segregate.” We are becoming a less coherent nation, and to our detriment. But, perhaps acknowledging the deep roots of our philosophical polarization will help us resolve it, and help us have an honest conversation about what values we want our society to cherish and promote.

Disorganization in Trumplandia and Revisionist History with Professor Perry


Apparently, it is “Energy Week” at the White House. Another one of several themed weeks that have been instituted, despite their little substantive content.  Didn’t you know it was “Tech Week” last week, “Workforce Development Week” the week before, and “Infrastructure Week”, the one before that? Me neither.

The initiative, a misguided attempt to create order out of the chaos that perpetually emanates from the communications catastrophe that is the woefully disorganized Trump administration, has failed hilariously. So much so, that Politico dedicated an entire article to it. Unsurprisingly, the onus falls considerably on the President himself:

“White House officials acknowledge privately that their policy messages haven’t been able to compete with the flood of news about the Russia investigation — in part, because it’s nearly impossible to keep the president himself on message. Trump has continued to blast out missives about the Russia “witch hunt” and his myriad frustrations, including ongoing challenges to his travel ban, distracting from other events at the White House. The president talks about the Russia investigation more than any other topic, White House aides and advisers said.

Asked about potential themes for upcoming weeks, one senior Trump aide laughed and said, “Whatever he tweets.”

An ineffectual and disorderly communications process is representative of a broader trend at a White House overwhelmed by the demands of governance. For example, the early days of this administration have been defined by a phenomenally poor inter-agency coordination process (see this just today on the Syrian deterrence statement, and more criticisms here). An especially concerning phenomenon given that, while Trump flaunts his concern for foreign policy and justifies his radical policy agenda on specious national security grounds, coordination between disparate federal agencies and cabinet departments is central to U.S foreign policy process.

Furthermore, during the campaign, Trump leveraged his dubious business credentials to promise voters that he would replace an effete liberal elite drowning in bureaucracy and strangled by red tape, with business leadership from a businessman. Yet, the President has struggled to complete the first and most essential task of any administration: hiring the individuals who will actually form it.

According to a joint-project between the Washington Post and the Partnership for Public Service, of the 560 key executive branch positions that the President must fill, only 46 have gone through the final step of being confirmed by the Senate. Sure, staffing the administrative state is a difficult endeavor fraught with petty political squabbling, but Obama had already confirmed nearly four times that number by a similar point in his presidency. And before you blame partisan obstruction, note that while the average confirmation time per nominee has been higher for Trump’s picks, it is only slightly so (43 days per nominee compared to 34 days for Obama’s nominees). Moreover, Trump’s nominees have been genuinely terrible (Ahem! Betsy DeVos, Andrew Puzder) and have, as a result, accumulated the most “no” votes of any nominees of any President since America’s founding. Most importantly, however, the Senate cannot be blamed for the nominees that the President has yet to select. Trump has not, to this date, nominated nearly 400 (396, to be exact) of those 560 posts. With 70% of key posts (and 85% of top science posts) without even as much as a nominee, the responsibility lies unequivocally and entirely with the White House.

It is among this environment of chaos and disorganization, that “Energy Week” emerged early this week. Its Master of Ceremonies (or at the very least, it’s spokesperson) was none other than erstwhile presidential candidate and head-of-the-agency-he-once-forgot-he-wanted-to-eliminate Energy Secretary Rick Perry. During a White House press briefing and in statements to the press earlier this week, Perry alleged and advanced all sorts of bizarre claims regarding clean energy and the “America First” energy plan. But, the most strange was his suggestion that the Obama administration had repeatedly claimed that the American people would have to sacrifice American jobs and economic vitality to protect  the environment.

As the Washington Examiner reported:

“This week will also reaffirm our commitment to clean energy,” Perry said. “The binary choice between being pro-economy and pro-environment that was perpetuated by the Obama administration, it set up a false argument,” he said. “We can do good for both, and we will.”

What was most remarkable is how central Perry makes this claim to his argument and messaging. (Especially, given how how radical the administration’s plan is. But you probably didn’t need me to tell you that.)

However, when Perry claims that his plan recognizes that environmental protection and economic development are not mutually exclusive and specifically contrasts it to the Obama administration’s approach, I’m shocked. Not only because its mendacious with regards to the plan’s policy substance but also because the idea that ‘economic development and environmental protection are not mutually exclusive’, was the central message of the very same Obama-era approach to energy policy which Perry decries.

Don’t take it from me, take it from our 44th President himself.

From a speech to the United Nations in 2009:

For these are the nations that are already living with the unfolding effects of a warming planet – famine and drought; disappearing coastal villages and the conflict that arises from scarce resources. Their future is no longer a choice between a growing economy and a cleaner planet, because their survival depends on both. It will do little good to alleviate poverty if you can no longer harvest your crops or find drinkable water.

In a speech to Georgetown in 2013:

The old rules may say we can’t protect our environment and promote economic growth at the same time, but in America, we’ve always used new technologies — we’ve used science; we’ve used research and development and discovery to make the old rules obsolete.

[later on in the speech]

Convince those in power to reduce our carbon pollution.  Push your own communities to adopt smarter practices.  Invest.  Divest.  (Applause.)  Remind folks there’s no contradiction between a sound environment and strong economic growth.  And remind everyone who represents you at every level of government that sheltering future generations against the ravages of climate change is a prerequisite for your vote.

Again, in a speech in front of the UN in 2014:

So, all told, these advances have helped create jobs, grow our economy, and drive our carbon pollution to its lowest levels in nearly two decades — proving that there does not have to be a conflict between a sound environment and strong economic growth.

Once more, in a statement on the Paris Climate Agreement and the conclusion of the COP21 negotiations:

Now, skeptics said these [climate] actions would kill jobs.  Instead, we’ve seen the longest streak of private-sector job creation in our history.  We’ve driven our economic output to all-time highs while driving our carbon pollution down to its lowest level in nearly two decades.  And then, with our historic joint announcement with China last year, we showed it was possible to bridge the old divides between developed and developing nations that had stymied global progress for so long.

Or maybe in this speech in Hawaii last year:

So there’s no conflict between a healthy economy and a healthy planet.  And that’s why I’ve committed, along with Canada and Mexico, to get 50 percent of U.S. electricity from clean sources by 2025.  And with many of our biggest businesses switching to clean energy, I’m absolutely confident that we can meet that goal.

Or finally in this January 2017 Science article, written post-presidency:


The United States is showing that GHG mitigation need not conflict with economic growth. Rather, it can boost efficiency, productivity, and innovation.

Since 2008, the United States has experienced the first sustained period of rapid GHG emissions reductions and simultaneous economic growth on record. Specifically, CO2emissions from the energy sector fell by 9.5% from 2008 to 2015, while the economy grew by more than 10%. In this same period, the amount of energy consumed per dollar of real gross domestic product (GDP) fell by almost 11%, the amount of CO2 emitted per unit of energy consumed declined by 8%, and CO2 emitted per dollar of GDP declined by 18% (2).

The importance of this trend cannot be understated. This “decoupling” of energy sector emissions and economic growth should put to rest the argument that combatting climate change requires accepting lower growth or a lower standard of living.

I rest my case.

However, while this bizarre case of revisionist history perplexes and stuns, in the context of a disorganized and ineffectual communications process, it makes sense as a gaffe. Think of all the unfourtunate mistakes Spicer racked up during his press briefings earlier this year. And with Spicer still pulling double duty as Press Secretary and Acting Communications Director, following the departure of Mike Dubke, and with a communications staff populated by the likes of Sarah Huckabee Sanders, it’s perfectly reasonable to interpret this as a messaging failure. In many ways, it’s really silly messaging. It is a statement that is easily refutable and discarded. Insofar as you make it the crux of how you frame your clean energy plan, opponents quite literally can A) Agree with you B) Tout the statements Obama said above as well as the decoupling argument C) Turn your argument on yourself.

But ultimately, when the only two explanations for such a statement is ineptitude and untruthfulness (ok, granted this is politics), it truly reveals how disastrous the first few months of the Trump presidency have been. One would think that communications would be the strong suit of this President, one who does not really rely on policy expertise or a robust substantive agenda to win political points. So if the Trump administration cannot slap together a decent communications operation, what does that say about the administrates ability to make policy, to govern, or to fulfill the responsibility of the executive branch?