Wednesday, July 22, 2009

Empathy, Taxes, Personal Responsibility, and Healthcare Reform

Two years ago I wrote a four-part blog post presenting answers the questions: Who is worthy of having adequate health insurance and high-value (safe, cost-effective) care; and what makes them deserving? And who, on the other hand, is unworthy; and what makes them undeserving? It includes debates with others about issues including free market forces, as well as government and individual responsibility, universal healthcare, taxation, smart economic growth, and problems with healthcare insurance. Here's the link

In January '08, we presented an in-depth analysis of the presidential candidates' healthcare proposals. The analysis included a discussion that compared (a) a publically funded universal healthcare program that included a private insurance to (b) a single-payer program (no private insurance) at Then we discussed whether it's necessary to increase taxes in order to fund a publically-funded universal healthcare system at The bottom line is that the Republicans' main focus appeared to be on minimizing taxes and making only minor changes to our current healthcare system, while the Democrats appeared more focused on providing some form of universal coverage (be it single payer or a hybrid system). The debate today seems to be along the same lines.

From a psychological perspective, here's how I see it:

Many fortunate people with plenty of money or a secure job with an excellent health plan do not want to pay more taxes nor to risk changing the coverage they believe benefits them; even if such changes may benefit many others who are suffering.

Some of those fortunate folks likely experience cognitive dissonance (i.e., are conflicted) when considering the plight of the millions of Americans who cannot afford adequate insurance and top quality care. Some may reduce this emotional discord/distress by believing that those less fortunate are somehow less deserving and should even be punished for having health problems. They may, for example, believe in the "moral hazard" myth, which states that providing adequate health insurance for all encourages risky and wasteful behavior by the insured persons since the cost of healthcare consumption is paid by someone else. So, they conclude that there ought to be considerable "skin in the game" (i.e., out of pocket expense to reduce consumption), which can have a devastating impact on the working poor and other struggling to make a living; see

Interestingly, one key thing absent from all this is EMPATHY (i.e., the ability to put oneself in the shoes of another). That is, it's much easier for many who are better off financially and health-wise to blame those who struggle and suffer for their own woes, than it is for them to feel others' pain and willingly pay increased taxes to help them. This is not surprising since:
  • Judge Sonia Sotomayor Supreme Court confirmation hearings in which empathy—the quality President Obama has proposed as a criterion for his judges—was considered a dirty word.
  • Many of the bankers, brokers, and others responsible for our economic collapse didn't feel empathy for those losing (or destined to lose) their homes while they profited.
  • Empathy is often absent in the health insurance industry as evidenced by insurance exec turned whistleblower Wendell Potter, who spoke out against health insurance industry at
Based on all this, I'm not at all surprised with the current opposition to universal healthcare—I'm saddened by it—but not surprised. After all, the "me generation" and their children are in power in the USA … and focusing on "me and mine" to the exclusion of others does not promote empathy (or compassion). This bodes very poorly for the future of our civilization, btw!

I'm not without hope, however. President Obama appears to be pushing strongly for change in a direction that will help level the playing field and improve the lives of those who suffer. Increased taxes from the more fortunate to help the less fortunate cannot be avoided, imo. So, we can expect pushback from those lacking empathy.

In my next post, I have a contentious debate with people working in the health insurance industry.
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