Is Being Ignorant Better Than Being Stupid?

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!
  ~ Sparky

Stupid Is As Stupid Does

If you haven’t heard or read about the recent uncovering of remarks made by Jonathan Gruber in relation to the crafting and passage of the Affordable Care Act (i.e., ObamaCare: pub patrons will note I rarely use that term even though I have largely supported it), then it is most likely because you are stupid. Yes, sorry, but that’s the sad reality of affairs according to intelligentsia types like Professor Gruber.

Aaron Blake writing in the Washington Post yesterday argued effectively that Gruber’s remarks will likely have little effect on any legislative initiatives to fully repeal the ACA. And as Kevin Drum pointed out in MotherJones, while Gruber’s choice of wording may have been very poor, he is right in noting that most of the electorate knows very little about public healthcare policy – if that’s what Gruber indeed meant. To me, stupid implies the inability to learn. I think Gruber may have accurately depicted an electorate that is disinterested in and/or unwilling to learn. Even still, I question how someone supposedly so smart could be so stupid.

Whatever term might best describe the initial benchmark of the electorate’s understanding of healthcare delivery, policy and regulations back in 2010, it has certainly advanced substantially from then. I’d like to think I’ve contributed a smidgeon since I started this blog in May of 2012. Whether the ACA is repealed, amended or dismantled one line at a time (parish the thought – I read the whole damn thing) healthcare public policy debate between January 2015 and the November elections of 2016 promises to be as energized, contentious and fraught with misinformation and misunderstanding as ever.

And knowing that, I am hoping to take the PolicyPub to a higher level next year. I am hoping to invite guest bloggers representing differing perspectives and backgrounds. Through my firm’s recent strategic alliance with Healthcare Lighthouse we are exploring ways to collaborate on sharing of healthcare public policy knowledge and information in ways that bring real value to organizations involved in healthcare. I am hoping to reenergize our free private discussion group where healthcare public policy is debated based on the merits of ideas and beliefs, and not sound bytes and news clippings.

To accomplish this I am going to need help. I am going to need to find others who share my passion for wanting to learn, understand and share their knowledge on the inner workings of healthcare public policy – and more importantly, the impact of that policy on patients and provider organizations. If you know of anyone who would be interested in adding to the discussion, please have them contact me.

I would like to commit myself in 2015 to proving how wrong Mr. Gruber is: not only is our electorate not stupid – but neither by implication are they willing to allow college professors to determine the future of our healthcare delivery system while they sit back and accept what’s given to them.

Cheers,
  ~ Sparky

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