10/19/2007 21:1

Talking More Rationally

"That's one of the issues," my friend remarked, "that I wish we could talk about more calmly and rationally." Not that my friend is especially noted for calm discussions of major social and political topics; I suppose he was speaking to himself even though he was addressing another member of the group we were with.

The issue at hand was federal legislation pertaining to a children's health program. How can anyone be opposed to children's health? They can, however, be opposed to a specific program. On the one hand, the proponents argue that too many children are not receiving care (or, at least, not adequate care), that this program has been successful, and that therefore it should be expanded to make health care available to more of the children who are presently not receiving adequate care. The opponents argue that the program has been successful at helping the children whom it was intended to help, expansion would put the government in the position of being more nearly a univeral health plan (albeit only for children), that the cost in dollars is too high (especially at a time when they want to spend large amounts on a small war), and that the cost in dollars is swamped by secondary social costs such as the diminution of private health coverage among middle-class parents.

There. Isn't that a calm rational discussion?

The conversation is not so calm in actual reality as my presentation suggests that it could be. Why not?

First, because there are other issues involved. Side arguments are raging about the level of health care which is adequate and about the appropriate involvement of the government in providing health care to citizens. Political and social philosophies clash over the rights, responsibilities, and performance of private health insurers.

Second, because we don't have reliable, objective data to support any position, and we haven't perfected a technique to balance large uncertainties.

Start with the question of what constitutes an adequate level of health care. Not only do we not have agreement on what that level should be, we also do not have clear measurements of what level of care is currently being offered. (Consider the health care you receive yourself. On what basis do you decide that the care is or is not adequate? Is your decision based on an objective, rational, and comprehensive set of data? Probably not.)

What are the social costs of expanding the program, or of maintaining current eligibility standards, or of reducing it, eliminating it, or replacing it?

Nobody knows for sure. But everybody seems to have an opinion.

The problem is that our opinions are dependent on the social and economic models that we use. If our economic model is correct, and if we make the change that is proposed, then it is likely that we will see such and such an effect. But if an alternative model is correct, the effects may well be different. What, in reality, are the advantages and disadvantages of government-run health plans, government-sponsored health plans, employer-sponsored health plans, consumer-purchased health plans?

Nobody knows for sure. We can't conduct controlled experiments on entire national populations, experiences are not immediately tranferable between different nations, and our theoretical understanding is still uncertain.

The debate is cast in terms of the specific proposed change to the law, but the disagreement is over broad views about how the world actually works. The heat of the argument is disproportionate to the specific question being debated because the real issue is much larger and because our rational understanding is not adequate to resolve that larger issue.

Sociology and economics are rapidly moving beyond observation and theorizing to the realm of experimentation and verification. There is hope that some of these larger questions will become tractable to rational debate. That should help to make calm and rational debate more possible.

Even so, we will still be debating. If we truly knew the benefits and costs of a federal health plan for selected children, and those of various alternatives, we would still need to debate which set of benefits and costs are most desirable.

This is the largest issue of all: What is most to be desired? How will we learn to debate that question?