Health Care Reform and Our Antipathy to Change

Writing in today's Washington Post about the problems of enacting health care reform, Michael Kinsley states: "Americans are in total agreement that the current situation is intolerable in all areas and that change -- big, immediate change -- is essential.  But as soon as change might actually happen -- as soon as we leave the abstract for the particular -- we panic."

Kinsley cannot seem to get his arms around why this is the case, beyond the obvious reason that there is serious disagreement over the details of reform.  The only explanation he can come up with is that we really don't want reform in the first place.  Not a very satisfying answer.

A more cogent response to the same conundrum is set forth by James Surowiecki in this week's New Yorker.  He agrees with Kinsley's thesis: "In theory, the public overwhelmingly supports reform ... [but] when it comes to actually making fundamental change, people go all wobbly."  Surowiecki argues that the public's skittishness about overhauling the system reflects the "deep-seated psycological biases that make people resistant to change."

We are all susceptible to the "endowment effect" -- we overvalue things that we own.  Thus, people who have health insurance will place a high value on it, even if it is flawed.

The endowment effect is compounded by the "status quo bias."  People are inclined to keep things the way they are.  Beyond inertia, Surowiecki suggests, we also seek to avoid loss.  The unknown is a scary place.  "Even people who aren't all that happy with the current system, then, are still likely to feel anxious about whatever will replace it."  (I recommend the article for examples of the studies underlying these conepts.)

The issues in health care reform are complex and emotions are running high.  It is useful to understand our hesistancy to embrace change when major shifts in policy are on the table and we all feel that we have something to gain or lose.

Words of Wisdom

I don't deserve this award, but I have arthritis and I don't deserve that either.
-- Jack Benny, Comedian