Wednesday, August 12, 2009

communal discernment sucks (again)

As I'm writing my introductory material on interdisciplinary methodology and epistemology, I can't help but reflect on how basic the question of how we know what we know is. It sounds like one of those questions only total nerds would think about, because in real life, it doesn't matter, or there's no time to think about it. But the question is as pragmatic as it is philosophical. And it's the thing that's killing us right now in our health care "debate."

What do you know about the proposed health care reform? Where did you learn it from? What's your source, and how do you know they're trustworthy?

Because here's the thing, right. I'll visit, and read there that

"President Obama is committed to working with Congress to pass comprehensive health reform this year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans. The Administration believes that comprehensive health reform should:
  • Reduce long-term growth of health care costs for businesses and government
  • Protect families from bankruptcy or debt because of health care costs
  • Guarantee choice of doctors and health plans
  • Invest in prevention and wellness
  • Improve patient safety and quality of care
  • Assure affordable, quality health coverage for all Americans
  • Maintain coverage when you change or lose your job
  • End barriers to coverage for people with pre-existing medical conditions."
The issue of whether or not I think these things are worthy goals is one thing, sure. Of course. But the real issue, the one that is killing our communal discernment process as a country, is that of epistemic trust, or rather, the lack of it. When I read this information on the government's website, I trust that it accurately reflects the actual goals of the President and his administration. And it's only if you have that basic level of epistemic trust that you can begin debate about whether the stated goals are desirable. That debate isn't actually happening yet, because it seems to me that the larger, invisible problem of lack of trust is getting in the way. If you don't trust that these stated goals are the actual goals, if you think that somehow even though everything sounds nice that it probably isn't, that even though it says right there that Obama wants to "guarantee choice of doctors and plans" that what he really wants is to take away your doctor and assign a bureaucrat to shadow you for the rest of your life and literally stand between you and your doctor until the death panel comes for you in the form of Obama's secret army of Metal Ones, well...if you can't trust that what's being said is an honest reflection of the goals of the administration, then there's no point in debating what they're actually saying. And so, generally, we're not. We're not debating these stated goals.

This issue of epistemic trust is huge. When it's present, honest, productive exchange of ideas really can occur, because even if there's disagreement there's a common sense that all participants are honest, that they are representing themselves truthfully, and that you can trust what they say is what they mean. And this is precisely what we do not have right now.

That's the diagnosis. What's the solution?

Frankly, I'm at a loss. I don't know what could possibly fix this. But here's my attempt. Let's stop the shouting for a minute and just ask ourselves: is there a reason to distrust each other?

Is there a reason to distrust each other?

Is there a reason to trust each other?

Here's mine: we all live here. We all live here, and the laws that the representatives we've elected and empowered enact affect all of us. We all have a stake in this, and when we're talking about something as personal and basic and life-and-death as health care, we all have a huge stake in it. This seems to me to be reason to trust. Reason to assume that everyone has an interest in seeing this come out well. Reason to trust that it benefits everyone to sit down and list out what currently doesn't work about our system, and that it benefits everyone to brainstorm ways to fix it, and then talk about it until the best one of those ideas surfaces through the process of collective discernment. Or, as it is also known, democracy.


JJT said...

check this out:

Keith Brenton said...

It's when people stand to lose something that they stop trusting each other. When that "something" is money, the distrust grows intense - sometimes bordering paranoia. (Sometimes going right over the edge of it!)

Most folks have gotten used to losing money to health care providers and insurance companies. The health care providers and insurance companies are the ones who stand to lose (money) if the government steps in to say, "This is costing too much. Lighten up." So they (can afford to) start the (media commercial and organized town hall protest) rumors that we'll lose even more money, as well as our rights and freedoms of choice, if we let the government handle it.

I don't care where the change comes from, but things need to change - and for the better.

We could start by not having doctors and healthcare workers labor 24- and 36-hour shifts with catnaps rather than overlapping shifts and . That might improve the quality of healthcare and reduce the number of malpractice lawsuits. Maybe then we wouldn't feel obligated to pay doctors ten times as much as the average American laborer. It would help to reduce the cost of advanced medical education so that more people could pursue it.

But, you see, that scenario means that somebody stands to lose something ....

JJT said...


We don’t know whether or not some form of rationing would eventually take place if one of the pending bills were to become law. We would note, as does Obama, that denials of coverage are routine among private health insurance companies and under Medicare in our current system, and we asked McClusky [of the Family Research Council] about that. Why would such decisions about care be more objectionable under a public plan, for instance, than they are when Aetna or UnitedHealthcare denies coverage? "We find it more troubling when the federal government is doing it," he said. "It’s the 800-lb gorilla."

Lara said...

Amen and Amen. Very astute analysis. Thank you for that.

AM Kingsfield said...

whew! Some sane conversation on the topic!

We are only hearing the ranting of the minority. Let them rave. Their behavior is quite revealing.

Vasca said...

I'm reading as much as possible of the Health Care plan; hopefully our elected officials will do likewise. This is not something that should be rushed through.

We have a practicing physician in our family; he agrees something must be done to improve medical care but says there is no country in the world that can afford to furnish health care for all its' people.

It doesn't matter to me whether I'm in 'the majority' or 'the minority'; what does matter to me is what's happening to this country. I don't rant...I don't rave; I don't ridicule those who disagree w/my views. Each of us has a voice...we just need to rein in our anger and try understanding each other.

JJT said...

Vasca, that's exactly, exactly what we should be doing. And it seems to me that that is pretty much not happening. And both sides of this polarized (non)debate are crying foul. Not good.

Because crying foul means claiming the other guy is playing dirty and isn't being honest, and when you're doing that, you're not trying to understand. Now, I think there's some crazy, unsupportable, demonstrably false stuff floating around out there, like the phrase "death panels." But let's stop with the accusations of "crazy" (I did a sucky job of this in the post, I know, but I couldn't resist throwing in a reference to the Metal Ones, and it's all GKB's fault for sending me that SNL link that's turned into my blog's incessantly running gag) but try to figure out why what seems obviously nuts to me makes some kind of sense to some people, and what it is they're really expressing when they start talking about death panels.

As far as I can tell, the best way to interpret that is as an expression of a fear of loss of agency and control over these individual's own lives, in the most intimate dimension possible, their own bodies. I can see that contemplating this would be scary. So the response needs to address that actual concern--not waste time on arguing the wording of the proposed bill or whatever. Because that's not the real concern. The real concern persists, and it gets expressed variously, in terms of death panels and federally funded abortion and bureaucrats standing in between you and your doctor, etc., etc.

So, okay. But here's the point of communication breakdown, and that is, President Obama can address that real concern all day long, and so can all these representatives and senators from Congress, but if the attitude of their audience is "I can't believe what you say, you're lying and misrepresenting, I can't trust you," then it makes no difference. And this is where we're at. The people who have these really deep existential concerns about what health care reform are also people who don't trust what the people who are trying to design the reform are telling them about their goals and their methods for achieving them. And it doesn't allay fears to hear someone you don't trust try to reassure you there's nothing to be afraid of.

So what's the solution? The people who are trusted as information sources need to stop demonizing each other--and that's as true of MSNBC as it is of FoxNews at this point. And the people on both sides need to stop assuming that the other is obviously untrustworthy and start trying to understand. Listen.

Like you said.

Only much, much more longwindedly.