Sunday, February 09, 2014

A tribal battle over health insurance portability

In 1990, linguist Deborah Tannen made a splash with You Just Don't Understand, a study suggesting that men and women speak fundamentally different languages, informed by different values, and so often talk past each other.

Psychologist Jonathan Haidt has demonstrated something similar with liberals and conservatives: they march to different moral drummers and so make very different ethical judgments about what government and community owe to the individual and vice versa. In a 2012 op-ed, Haidt described liberal and conservative value schemes as different tribal affinities defined by different sacred objects -- for liberals, "formerly victimized groups," for conservatives, "God and country." The villains are all symmetric: elite oppression vs. intrusive and redistributive government. More on Haidt's schema below.

I thought of Haidt's contrasting value systems while reading a Washington Post profile of two people who have left jobs because the ACA made health insurance outside the workplace available to them.
One, a 56 year-old woman whose job changed abruptly and unpleasantly, left to full-time babysit her 5 year-old granddaughter. She's paying about $500 a month with subsidy for an exchange plan covering herself and her husband.  The other, a 44 year-old, "left a full-time job in New York making $88,000 a year plus benefits to help his nephew, a cancer survivor, start a social media and video-gaming site for other teens with the disease." He's working essentially for free and getting health insurance for $170 per month after enduring a period in which he couldn't afford needed cholesterol medication.*

Here's the reaction of one of the country's most prominent conservative healthcare wonks, a former CBO director who's been a relentless critic of the ACA:
“What the White House wants you to think is, if a person chooses to make less income, they must be doing something that makes them better off,” said former Congressional Budget Office director Douglas Holtz-Eakin, now president of the American Action Forum, a conservative policy group. “What conservatives would have you ask is, is it an appropriate use of someone else’s money to put you in that position to choose?”
That is a perfect snapshot of the conservative national narrative as sketched by Haidt.  Hold on a few moments, as the liberal narrative comes first:
A good way to follow the sacredness is to listen to the stories that each tribe tells about itself and the larger nation. The Notre Dame sociologist Christian Smith once summarized the moral narrative told by the American left like this: “Once upon a time, the vast majority” of people suffered in societies that were “unjust, unhealthy, repressive and oppressive.” These societies were “reprehensible because of their deep-rooted inequality, exploitation and irrational traditionalism — all of which made life very unfair, unpleasant and short. But the noble human aspiration for autonomy, equality and prosperity struggled mightily against the forces of misery and oppression and eventually succeeded in establishing modern, liberal, democratic, capitalist, welfare societies.” Despite our progress, “there is much work to be done to dismantle the powerful vestiges of inequality, exploitation and repression.” This struggle, as Smith put it, “is the one mission truly worth dedicating one’s life to achieving.”

This is a heroic liberation narrative. For the American left, African-Americans, women and other victimized groups are the sacred objects at the center of the story. As liberals circle around these groups, they bond together and gain a sense of righteous common purpose.

Contrast that narrative with one that Ronald Reagan developed in the 1970s and ’80s for conservatism. The clinical psychologist Drew Westen summarized the Reagan narrative like this: “Once upon a time, America was a shining beacon. Then liberals came along and erected an enormous federal bureaucracy that handcuffed the invisible hand of the free market. They subverted our traditional American values and opposed God and faith at every step of the way.” For example, “instead of requiring that people work for a living, they siphoned money from hard-working Americans and gave it to Cadillac-driving drug addicts and welfare queens.” Instead of the “traditional American values of family, fidelity and personal responsibility, they preached promiscuity, premarital sex and the gay lifestyle” and instead of “projecting strength to those who would do evil around the world, they cut military budgets, disrespected our soldiers in uniform and burned our flag.” In response, “Americans decided to take their country back from those who sought to undermine it.”
So Haidt has Holtz-Eakin's number, which is no diss on Holtz-Eakin. Haidt's colleague Smith, whom he cites above, has my number.  The tribal moral portraits are on point.  The value systems Haidt sketches out really do illuminate our political battles.

On the liberal side, I think sometimes of an injunction from freelance journalist and I think Afghanistan native Josh Shahryar, which I'm going to have to paraphrase from memory: don't confuse your indignation on behalf of the disadvantaged (in response to conservative policies/pronouncements) with actual concern for them. There is, one would hope, usually a relationship, but it gets attenuated in political and rhetorical combat.

* Is the medication needed? My family has me trying to work through diet after bobmbarding me with lit about possible dangers of statins and alleged lack of evidence that lowering cholesterol numbers reduces risk of heart disease.

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