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Mar. 24 2010 - 3:43 pm | 1,395 views | 1 recommendation | 11 comments

Repeal health care reform? The brain says no

Republican lawmakers are understandably chagrined over this week’s historic enactment of health care reform. After all, the legislation was passed and signed over their histrionics and without any constructive input from their side of the aisle, so they’re feeling irrelevant and impotent. That explains why they’re already making blustery threats to repeal this transformative piece of social law.

But it is just bluster. They won’t repeal the law—not for political reasons but for psychological reasons. Let me explain.

One of the cornerstone principles of cognitive psychology—the study of how we think—is the so-called default heuristic. The default heuristic, simply paraphrased, says that we won’t make the mental effort of choosing if we don’t have to. It’s much easier, cognitively, to punt, to go with the flow, to default to the status quo.

Here’s a famous example from the literature: About 28 percent of Americans are potential organ donors. That is, if they died tragically, their kidneys and heart would go to someone waiting for a transplant. In France, 99.9 percent of citizens are potential donors. Why would this be? Does altruism run in the French character? Is their moral training superior? Well, it’s actually much simpler: In most states in the U.S., the default position for organ donation is “no donation.” You must make the effort of deciding if you want to become a potential donor. In France it’s the opposite. Unless you make the effort to opt out, you are by default an organ donor. And it’s easier for the brain (French or American) not to trump policy. Thus it’s better to have kidney failure in Paris than in Washington, DC.

Why don’t people second-guess the status quo more often? Well, think about your typical day. You have a job to do, errands to run, perhaps you have a sick kid to worry about. Where does thinking about organ donation fit into those priorities? Plus, even if you do think about it and decide to assert yourself and become a donor, there’s the paperwork. Nobody is going to hand-deliver it to you. Maybe you’ll just watch TV instead.

You get the idea. Stress, fatigue, other demands—these are all what psychologists call cognitive load. Our brains do not have infinite capacity; indeed we have very limited processing capacity, which is why it’s so hard to juggle mental tasks. Our minds tire quickly, so we need to prioritize our mentally exhausting tasks. And not to put too fine a point on it, repealing the law of the land is probably not most people’s highest priority.

In psychological terms, as soon as President Obama signed the health care reform bill into law, it became the collective default position for millions of Americans—much like organ donor policy. There would have to be a compelling personal reason to spend time and effort on undoing the law—rather than, say, cooking a nice dinner or reading a good novel. Most Americans—except for a few vile and marginal tea-partyers—are going to forget about health care reform quickly. There are too many other things competing for limited energy.

Very few social programs are undone, and that’s because the brain’s default heuristic prefers consistency to waffling. Commentators are right to remind us of the brouhaha over Social Security when the idea was first broached. Opponents used the same hyperbole that tea-partyers are using today. But as soon as it became law over their objections, the energy dissipated as people returned to their workaday lives. And now, of course, it’s a default position that even Republicans consider sacred.


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  1. collapse expand

    Nicely done. In 8 paragraphs you’ve described the dynamics of Washington, DC. 5 stars! Bravo!

    Looking forward to the next one.

  2. collapse expand

    Inertia is also one of the foundational principles of behavioral economics. I think the anti-health care team was aware of the science; that’s why they fought the health care bill so desperately. Now they are just using the repeal efforts to raise funds. I’m sure they realize that the next two weeks are their best opportunity to scare their base into opening their wallets.

  3. collapse expand

    The health care law just passed has numerous poorly designed features and conditions that will take effect soon. These will continually remind citizens why the law isn’t proper reform at all, but merely the same old dysfunctional health care expanded with higher costs, higher taxes, higher debt and more regulation.

    • collapse expand

      Eh, possibly. But to go with what Mr. Herbert is talking about here, look at how easy it was for American’s to let themselves be drug down by the system before this reform was put in. 70,000 bankruptcies a year due to insurance (or lack thereof) that will hopefully be undone by this. 45,000 deaths a year that will hopefully be the same. Rising rates by annual clockwork, etc, and the people put up with those for how long because, well, that’s the way it worked and American Idol was on. Obviously the mass may rise again, but it will probably take a while now that this has been voted in. If people could tolerate the pre-reform methods as long as they could before doing something about it, how long do you think it will take them to build up steam over fighting against this reform now that it has happened and less lives are being ruined? It’s going to take at least a couple election cycles by my reconing.

      In response to another comment. See in context »
      • collapse expand

        This is the same rhetoric that has been used in the past for other socialized countries which now ration care. Canada allows a certain number of x-rays yearly and Great Britain has a cap on how long you are allowed to sit in an ambulance before you’re waiting on a curb for medical attention. Government has a perfect track record for ruining everything it is involved in; social security, post office, etc.

        In response to another comment. See in context »
  4. collapse expand

    Psychologically speaking, my default reaction should have been clicking to the next website instead of creating a user account and logging in. As we all know checking a box at the DMV is the same as health care debate. Perhaps the debate will continue because they were elected to represent the people and it is their job. With Mr. Herbert logic, nothing would ever get done, including health care reform, simply because it’s easier to go home and read a book.

  5. collapse expand

    Mr. Herbert,

    I do not disagree about your argument about “default heuristics” except that it has be understood within its limits. People will indeed default to social policy, when all of the choices are more or less equal. Becoming an organ donor is no more work or trouble or benefit than not, after all, you are dead when it becomes effective. It is not like people are going die in car crash, have their organs harvested, and then say “Oh, I did not like that, next time I will make a different choice”. There is no positive or negative feed-back in the system.

    When the choices are not of approximately equal effect, and people experience either positive or negative effects and they get subsequent chances to make a similar decision, then “default heuristic” does not work as well. If as a result of this bill, people who vote have higher taxes, they may vote differently next time and elect different representatives who change the social policy default. This is a negative feed-back loop. Conversely, if people who vote have positive experiences as a result this bill’s passage, they can get medical coverage when they could not before and at a better price, well, there is a positive feed-back loop. If the balance of positive outweighs the negative, then the “default” remains.

    After all, 150 years ago, slavery was the “default” social policy. Yet we do not have slavery any more. If “default heuristics” were as powerful as you make it seem, we would still be living in trees.

  6. collapse expand

    I re-read the article and appreciate your attention. Thank you. Good points in the article however, I believe the status quo in this legislation requires a lot of people to act (act or be fined). So wouldn’t default heuristic support that if people have to do something anyway, there is a chance that they may just take an opposing action(e.g., call there representative and say stop making me buy something, it hurts)?

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    About Me

    I've been a Washington, DC-based science writer for many years, specializing in psychology and human behavior. I currently write a blog for the Association for Psychological Science called "We're Only Human," and am also a regular contributor to Newsweek.com and Scientific American Mind. Crown will be publishing my book, On Second Thought: Outsmarting Your Mind's Hard-Wired Habits, in September. I am an old-school journalist embracing the world of new media. I'm on Facebook and Twitter. I believe that every news story--whether it's about money or politics or crime or love or health-- is in large part about psychology and the quirks of the human mind. When I am not writing, I am hanging out at Westside Club, riding my bicycle, listening to music and/or cooking for family and friends.

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    For more insights into the quirks of human nature, visit my “We’re Only Human” blog. Selections from the blog also appear regularly in the magazine Scientific American Mind and at the website Newsweek.com.