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.