In the poem, Ode on a Distant Prospect of Eton College, Thomas Gray wrote that, "where ignorance is bliss, ’tis folly to be wise." He was referring to the unfettered ability of time to ultimately win any race against human pain and sorrow – and since that race is determined before it is run, why not walk and enjoy what you may. Or something like that.
Earlier this week renowned healthcare economist, Uwe Reinhardt, wrote an editorial for the Healthcare Blog: Rethinking the Gruber Controversy: Americans Aren’t Stupid, But They’re Often Ignorant – And Why. Reinhardt reminds us that stupid implies the inability to learn, whereas ignorance is lacking information and knowledge. And when it comes to most public policy, including healthcare policy, Reinhardt points out there is no lack of ignorance caused by four contributing considerations.
First, the social and economic analysis associated with most controversial policy involves complex and (too) often complicated approaches. Then secondly, special interests representing differing positions with respect to such policy usually seek to further complicate that analysis in order to gain popular support for their individual position. And then too, considerable cause for ignorance can be attributed to the general lack of individual interest in public policy. Reinhardt writes the third and fourth contributors represent some combination of individuals lacking time and/or interest (what does not impact us directly tends not to interest us).
Whatever and however the relative causes contribute to ignorance of public policy the political maelstrom surrounding the Affordable Care Act has certainly helped highlight that disconnect. And when it became publicized this fall that Jonathan Gruber had made the now infamous remark about the “stupidity of the American voter” the nature of that disconnect became politically contentious.
Even a fundamental understanding of the majority of that Act remains elusive to most. And nearly every stakeholder with a horse in the race if you will has relied upon that reality to exploit ignorance for the purpose of individual and/or public gain. This is the crux of Reinhardt’s article: that the inherent nature of our political system necessarily involves positioning policy in ways that belie known (or unknown and unintended) consequences negatively impacting various constituencies of those stakeholders.
For example, he believes that consumer driven healthcare is a veiled means of facilitating care rationing in a market economy; individual savings that receive preferential tax treatment in lieu of a defined purpose (e.g., FSAs and HSAs) are a means of regressive taxation; and tax preferences should really be considered tax expenditures that require direct or indirect subsidization through higher tax burdens on those not receiving those preferences (burden shifting).
Reinhardt ends the post with a passage from Alexis de Tocqueville’s Democracy in America. People all too often hear what they want to hear. When the choices of those individuals represent personal benefit to others – e.g., whether through a consumer choice to purchase or a vote to elect a candidate – there is the inherent incentive to tell them what they want to hear.
Reinhardt’s post reinforces what I wrote back in November about how I would like to see this modest little blog advance in 2015, and so I thought it was a fitting end to the year. Next year ought to be fascinating with a newly Republican-controlled Congress, a refusal-to-be lame duck President and a Supreme Court that again will have its objective temerity put on trial via a challenge to the Affordable Care Act.
Through it all, I hope to continue sharing with you that which reflects honesty, integrity and a steadfast commitment to always seek the truth – even when the truth is hard to hear.
Happy New Year!