Thursday, March 16, 2017.
“Norman Rockwell Visits a Country Doctor” by Norman Rockwell, 1943. Via WikiArt.
This is the second part of what I expect will be a three-part series. Follow the link to read Part One, The Sorrows of Young Lance Mannion and the Republican Health Care Act.
Start with the given.
Just about everything Republican politicians say is in service to the Rich Corporatists who own them. Much of what they say is to disguise the fact that they are serving the Rich Corporatists who own them, from their voters and from themselves---they say a lot of things that are meant to assure themselves they’re good people for doing the People no good. And almost all the rest they say is to reassure their racist voters that they---the voters and the politicians---aren’t racist but even if they are it’s ok because those people are nothing but lazy bums and thieves except for the ones who are drug addicts, drug dealers, murderers, and rapists.
Thus the Republican health care plan which is basically a giant tax cut for the rich, a boondoggle for the worst of the insurance industry, and a means of punishing those people for having the temerity to be poor and get sick and need government help to stay alive.
But all of what they say is said out of the very human tendency to form opinions and hold beliefs based on the assumption that they know everything they need to know to form those opinions, that they’ve learned the hard truths about life from experience, and that their experience is typical. In short, their thinking like everybody else’s is based on ignorance, vanity, and narrow self-interest, all of it frosted over by the self-flattering, complacent certainty that we’re thoughtful, decent, intelligent, and rational people who see the world for what it is and call it the way it the way we see it.
Once we think something’s the case, it’s very hard to get us to unthink it.
Don’t bother us with evidence to the contrary. We have all the evidence we need. If we don’t, we find it in a glance. Inside our own heads or right there, right then, in front of our own eyes, which amounts to the same thing, considering our tendency to see things as we expect to see them and as we need to see them as we want to see them, our vision directed by our biases and prejudices, wishes and desires, informed by memories we edit in the very act of remembering---that is, by what’s already inside our heads.
We are our own first, favorite, and most reliable source for news and information about how the world works and what it all means.
“Look. There it is. That one story on CNN, the experience of a friend of a friend of a friend, what just happened at the grocery store, what I remember doing to get my life back on track when I was twenty and had just flunked out of school confirms I’m right. So get out of my face with your ‘facts’ and your ‘science’ and your ‘fake news’! I know what I know and that’s all I need to know!”
But of course we don’t know...or don’t know enough. And we don’t even know we don’t know so we certainly don’t know what we don’t know.
Our memory is suspect, our store of personal knowledge insufficient, our experience limited, our level of expertise probably nowhere near what it needs to be, our capacity for self-deception boundless, our own thinking mysterious, and our self-awareness laughable.
“Here, clearly,” Michael Lewis writes in The Undoing Project, his new book about a pair of psychologists who in the 1960s and 70s studied the way people assessed risk and reached decisions and came to what were at the time some surprising conclusions, chief among them that people don’t think rationally, “was another source of error: not just that people don’t know what they don’t know, but that they don’t bother to factor their ignorance into their judgments.”But what else do we have to go on?
Day in and day out, as we go about the business of keeping our lives relatively together and moving forward on an even keel, this works out ok. We do what seems best and hope for the best, asking ourselves, What’s the worst that can happen? While trying not to think about the worst that could happen.
But it’s a problem. It causes us to get in the way of our own thinking when we need to think the most practically and clear-headedly and to not even know we’re doing it.
The water heater’s shot. Do I need to buy a new one or can I just get this one fixed? What’s wrong with it? How do I know? Should I call in a plumber or will a handyman be able to handle it? Which one should I call? I can ask a friend, ask a neighbor, check with the owner of our local hardware store, he’s pretty knowledgeable about these things. Maybe I can just go online, watch a few videos on YouTube? Or just say the heck with it and head over to Lowes and let the sales rep talk me into whatever. But what’s the best way to pay for it? Can I pay for it? Can the sales rep be trusted? Is the plumber or the handyman the owner of the hardware store recommend reliable? Will he show up? When? Whose advice should I take? Which of my own internal arguments should I listen to? What should I do?
I have to do what seems best and hope for the best. What’s the worst that could happen? I go a few more days without hot water? I’m out a couple hundred more bucks than I would have been if I’d made another, smarter decision, whatever that might have been?
But suppose the situation’s more urgent, suppose someone’s immediate health and well-being are at stake, suppose the decision’s far more complicated and the consequences of a wrong decision far more severe? Suppose, say, Mrs M wakes up one morning two days before Christmas with a tightness in her chest and feeling it’s hard to breathe? She’s had a cold for a few days running, maybe it’s just that her cold has gotten into her chest. Or maybe it’s pneumonia? Or maybe it’s her heart! The doctor’s office opens in an hour. Should we wait and drive up there? Or should we go straight to the hospital? Is there time? Maybe it’s best to call 911 and get the paramedics here right away, let them decide.
Which is what we did.
The doctor at the ER diagnosed the flu.
Mrs M would have been fine if we’d waited a half hour and gone to our doctor’s. We did go to the doctor’s that afternoon. She’d had an appointment for a checkup already scheduled. Our doctor agreed with the doctor at the emergency room.
Here’s the thing.
That decision was easier for us than deciding how to deal with the hot water heater, because we had a key question already answered for us: how were we going to pay for it? We weren’t. Not all of it, at any rate. Not even near all of it. Our insurance covered it---the ambulance, the ER, the tests they did there, the doctor’s fees, whatever they charged us for whatever incidentals hospitals routinely tack onto your bill that you didn’t even know existed to be charged for. The co-pays were nothing to sneeze at. (Ha! A little medical humor there. Just keeping things light. You’re welcome.) But the fact is we were lucky in having the insurance we have. We didn’t have to worry about whether or not it would cover the trip to the hospital. We didn’t have to decide on the spot which hosptial. We didn’t have to make our own medical diagnosis that would have been influenced by our having to make a financial decision at the same time, which is what Republicans want more of us to have to do in order to keep down everybody’s medical costs in order to keep down their taxes.
You might remember that back in December a Republican Congressman from Michigan named Bill Huizenga boasted---seriously. He was boasting. He thought he was being a great dad!---about how he had let his son’s broken arm go unlooked at overnight in order to save himself the cost of a possibly unnecessary trip to the emergency room. Huizenga did some on the spot doctoring. He diagnosed a sprain, splintered his son’s arm himself, and sent him to bed to sleep it off. His son didn’t. And in the morning they went to the doctor. Yep. Broken. Other parents having made that same judgment call and finding out how wrong they were would be overcome with guilt. Not Huizenga. He insisted he did the right thing. What’s more, he insisted that that’s the way every family should handle decisions about their health care.
From Talking Points Memo:
"When it [comes to] those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don't have a cost difference, you'll make different decisions," he said.
He offered the example to explain his view that health care consumers should shoulder more of the financial responsibilities, instead of the current health system, which he said "continue[s] to squeeze providers."
"We have to be responsible, or have a part of the responsibility for what's going on," he said, while advocating for health savings accounts, a common GOP proposal.
"Way too often, people pull out their insurance card and they say 'I don't know the difference or cost between an X-ray or an MRI or CT Scan.' I might make a little different decision if I did know [what] some of those costs were and those costs came back to me," he said.
Thoughts like that didn’t even cross our minds. They didn’t have to, because we were able to do what Huizenga thinks we ought not have been able to do, pull out our insurance card. What’s more, if we had had to think that way we wouldn’t have known what to think. I’ve had three MRIs on my back in the past four years, all leading up to my surgery. I have no idea what their actual cost was because our insurance covered it. No copay! And I’m lucky I didn’t have to worry about that because I would not have been able to make an informed decision about whether or not I really needed them. I left that to my surgeon. I left it up to him to decide whether or not I should have the surgery. I’d have been a fool not to have. What did I know about stenois of the spine except that it was painful and debilitating and was getting worse? I could---and did---do some research, in order to make a reasonably informed decision to leave the decision up to the guy who went to med school, but if I was capable of truly understanding my condition I’d have become a doctor myself.
But this is a basis of the Republican health care plan, that everybody’s smart enough to play doctor.
This is stupid enough when you’re making decisions affecting your own health.
But we’re expected to make decisions affecting everybody else’s by way of who we vote for to send to Congress to make decisions and pass laws about health care policy.
It’s fundamental to democracy that the People are presumed to be intelligent, informed, and rational. It’s a basic quality of human nature that they generally aren’t.
When you think about it, it’s crazy, leaving the governance of a nation of 300 million people spread out across a vast continent and out into the far reaches of the Pacific Ocean and living and working in a global economy up to individuals who don’t know what they don’t know but think they know all they need to know, who form opinions and make judgments based on what’s going on inside their own heads without understanding how it got there or even what all is in there and how it's influencing their thinking.
For decades, the divide between Democrats and Republicans has been increasing along this line: what to do about the fact that the world is growing more and more complicated and complex and therefore more and more beyond individual understanding. Democrats believe the way to deal with it is more education plus a greater reliance on facts and figures gathered and analyzed and put to use by experts. Republicans have generally responded by denying that the world is complex or complicated. It is what you think it is, which is what it always was. Not only can folks understand it just by looking out their own windows, as it were, hardly need to bother---they know pretty much all they need to know already. Not only do they not need experts to tell them what’s what, there really aren’t any such things as experts. What there are are bunches of overeducated elitists working toward their own self-interested ends and in the process telling the rest of us what’s in our best interest, as if we’re a bunch of idiots incapable of figuring that out for ourselves. Experts, in short, are con artists who take us all for fools.
You thought I was going to say Donald Trump, didn’t you?
Nope. I’ll get to him. Right now, Jason Chaffetz.
End of Chapter Two.