Sunday, July 26, 2009

Changing minds

I don't think you can change people's minds by just telling them they're wrong, or by comparing the costs and benefits of two alternatives, without taking into account their values. After all, you're picking the benefits--you may have excluded something important to them, because it's not important to you. Or maybe it's even something you see as an evil. There's a lot of unexpressed assumptions in most arguments I've read.

You might be able to do it (change their minds) by showing how your proposal is in accord with their values. I'm sure you can do it by changing their values, if you can manage that.

One person told me I changed their mind by presenting information they already had in a different way, which I suppose can be called perspective. (I wouldn't call it framing. I think framing has a deserved bad reputation--it's like push advertising. "If only we choose the right vocabulary we can get those dimwits to make the right decision!")

I learned a long time ago that most people learn best (most easily and most thoroughly) when they learn something themselves. Facts you can just tell, I mean drawing conclusions and figuring out problems. They keep the knowledge, they incorporate it into their worldview, when they work it out on their own rather than being told the solution. That was a hard truth for me: I like to tell people things. I like being the one that knows! And I like being helpful. But when I discovered the best help I could be would be to step back and let them figure things out, I started doing that as a first step in helping.

So, this started out being about the United States moving toward some kind of government-provided health care for all (citizens? persons within our borders?) using tax dollars. I haven't paid much attention-I'm not willing to pay the price of trying to affect this process, so the details are useless to me until it's in place in whatever form it ultimately takes. But what keeps catching my attention is the underlying struggle between two approaches to the problems of life: one, where we (as individuals) decide that this problem is best solved as a community, and agree to impose the costs of a solution on all of us (some voluntarily, some through coercion) by using government as a tool to provide that solution; and two, where we (as individuals) decide that this problem is best left in individual hands and to individual judgement about individual solutions, which also imposes some costs on everyone, just different costs.

People in all kinds of political associations (or lack of them) in all kinds of positions on all kinds of problems have this decision somewhere in the basis of their approach. And they decide it differently depending on the problem. What I rarely see is argument addressing this decision, this core choice about what solutions to try and how to make those solutions happen. Instead in the health care debate I've read mostly comparisons of the costs: if we stay with our current system X people pay Y cost, and if we move to government-mediated health care A people will pay B cost. Then the other side picks apart your cost analysis (which can always be done) and you've moved nobody from one position to another.

I think it's possible to move this decision one way or another by looking at values instead of costs. I know, I know--my friends in favor of single payer or a national health service will say that the other side doesn't care about poor people because the other side discounts societal effects on choice, and my other friends in favor of private health care will say the first side doesn't care about encouraging self-reliance and growth (of all kinds: intellectual, economic, research) because the other side thinks it's worthwhile to take away the fruits of personal labor to pay for other people's bad judgement.

I think it would be more useful to admit that one set of people thinks giving the government control of my health care is worth it because only government is big enough to provide care for everyone, and medical care is important enough to do it this way, and our current system is failing a lot of people. And that another set of people thinks giving the government control of my health care means imposing the worst of government bureaucracy on decisions that are very personal, that emotions matter to health care decisions and don't matter to government rules, and that every time I cede power over my life to the government I become more vulnerable to human mistake, human corruption, and clerical error. I think both sets of people would benefit from examining what governments in the United States do well and what they really get wrong; our culture is important to this discussion, more important than how other countries' health care systems work.

I don't think that conversation is taking place.

6 comments:

Charlie Stross said...

Speaking as a Brit, who is used to a National Health Service, the framing mistake is in assuming a single payer national health system is one in which the government gets to dole out healthcare.

Over there, the NHS is emphatically not part of the government; it's more like the Post Office. It's in public ownership and it gets funding and oversight from government, but it's a separate institution, and if politicians try to get their hands dirty tinkering with the details of how healthcare is provided and who gets it, the howls of rage (from the users -- people like me) shake the corridors of power. Because it's an institution with such a big user base (less than 10% of the UK population bother with private medical insurance, and even then it's usually just a top-up that is useful for things like elective/cosmetic surgery that the NHS doesn't provide), it has enormous clout; even Margaret Thatcher didn't dare go near it.

Kai Jones said...

Your experience as a peever seems to have gotten in the way of actually reading my post, wherein I make the point that framing itself is a mistake, that the culture of the United States differs enough from other countries with successful government-provided health care (whether that is through payment only or actual provision of services) to make it important to examine where *our* governmental structures succeed and fail, and that the best way to make it work here if we're going to have it (payment only or provision of services) will depend on our social structure.

Charlie Stross said...

Well yes, you're clearly right up to a pount -- but here's the rub: you seem to be assuming that there can be a consensus about what government does right or wrong. I suspect the differing US cultural attitudes about government intervention, good or bad, also masks a profound disagreement about the purpose of government, or indeed its desirability. And how you get past that -- well, it's a profound problem. National healthcare systems only work if they have a broad platform of consent; if the core idea of government intervention in healthcare isn't agreed upon, then it doesn't matter what the means of delivery is -- a bunch of folks will be trying to tear it down.

(I suspect social security and the Great Society programs may be the best example to look at.)

Kai Jones said...

I think there are some areas where there will be agreement about what the government does *well*, not right or wrong. Government is a tool of a particular kind, and like a hammer, not always appropriate to the problem at hand and yet also a tempting filter for all possible solutions.

If you're right about consensus being necessary but not sufficient for government health care, I doubt we'll manage to get it here. None of the arguments I've heard or seen in favor of it address the very real problems opponents are focused on. It's not quite to the stage of "you're evil or stupid if you don't agree with me" that bothered me so during the Bush years, but seems to be approaching that low level of discourse.

Stef said...

(wandering in belatedly)

Most of the discussion I see around who should pay for and have access to what health care is precisely around the values that you aren't seeing discussed. I wonder what the differences are in where we are seeing the discussions.

I know that many folks in the fat activist community are fearful that the government will try to balance the health care budget on our backs, but currently many of us can't get health insurance or health care at all.

Kai Jones said...

Stef: I don't see anybody exploring the questions, just two sets of people who've already decided which one they favor, and the arguments they marshal to their causes don't address the issue of what government does well and what safeguards might we build in against the things government does poorly.

I think government does very poorly when it interacts with a lot of personal choices. Taking kids away from parents, while something we really need and want to do, almost never works out well; it might work out better than leaving them there would have, but we haven't been willing to build the kind of system that would ensure it works out better. Legislation around mentally ill people has prevented the old problems around choice and autonomy (problems mostly suffered by those who were or were accused of being mentally ill) while creating new ones suffered more evenly across society (I see a lot of mentally ill people downtown, and I really wish I didn't have to share the streets with them when they're having severe problems dealing with reality and conforming at least somewhat to social expectations for public behavior).

In fact when I look at the history of government interacting with personal choice I see a whole lot of taking away something that wasn't working great and completely failing to replace it with something better.

Of course there are exceptions: making abortion legal, making sex-differentiated hiring and home-buying/rental behavior illegal, etc. I don't have the knowledge or methodology to examine why some things work better than others, but I want that information badly.