Choosing Ends vs Means

Yes, I’m a bit obsessed with the Trolley Problem, because in it a whole mess of Bad Things converge in a uniquely clear way. Further, it seems to me the Trolley Problem is a clear example of what I was getting on about that, somehow, was brought to the attention of and earned the scorn of some Reddit folks. Yet further, Mike Flynn posted about how poorly the Democratic Party is forming and attempting to make its points regarding the so-called Affordable Care Act, which, as is so often the case with obsessions, brought the Trolley Problem back to mind. Because it’s all related. No, really!

Funny ol’ world, innit?

So, first, at the post linked above, the esteemed TOF gives an example of what really qualifies as not only fake news, but really inept political maneuvering:

Recently, for example, the Democratic Party was shocked, shocked we tell you, to learn that the Republican Party intended to follow through on its promise to dismantle the Affordable [sic] Care Act. The skyrocketing insurance costs in premiums and deductibles consequent to this act was one of the factors leading to the narrow defeat of its perceived heir and champion, Mrs. Clinton, in the recent election, although this has not been much mentioned. So the Democrats in Congress held a photo op announcing their intention to oppose this opposition. So far, so good. This is the normal procedure — sic et non — pioneered in the medieval world.

This was their opposition:

One immediately senses the overall ineptness that led the Party to its losses of Congressional seats, state legislatures, governorships, and now the presidency itself. Their sound-bite fails on two levels: the visceral and the rational.

The slogan “Make America Sick Again”, TOF asserts, fails on a visceral level, since, among other things, it’s not even clear who or what is being blamed until one (not likely) reads the fine print.  Further, the slogan makes no sense: neither the ACA nor its repeal will cause or fail to cause any sickness. The ACA is all about who *pays* for *care* of sickness.

Read the whole thing. While I agree with all this, I think there’s another level, and it has to do with what the ACA is in the minds of the audience: is it merely one among many government (and private sector!) programs designed to help defray and control the costs of medical care? Or is it Wonderful Healthcare for Everyone at Very Little Cost (or WHEVLC)? In other words, is support for the specific laws, regulations, and bureaucracies set up in the actual 1,990 page, 363,086 word bill itself, or is support based on the belief that the ACA is the same as WHEVLC?

I think the answer is obvious: those who supported the bill stated, almost without exception (that I can think of at the moment) that they were favoring WHEVLC. There were practically no popular discussions of specific provisions by those who favored the bill except for touting the Big Three of Pre-existing conditions(1), kids stay on parents’ insurance until they’re 48 or so (I may be off a little, something like that) and subsidies for people too poor to buy insurance. The other 1,900+ pages? Not talked about much.

Meanwhile, almost all opposition to the bill focused on details and mechanics. The most pertinent detail was the express need to pass the bill to see what was in it. That seems somewhat dubious, but it makes complete sense: the supporters of the ACA really didn’t care about how the worker’s paradise WHEVLC worked mechanically, because they were voting for WHEVLC, not the details. Problems, if any, would get ironed out in a few years, then everybody in America could walk into glistening medical facilities any time they needed to, get top notch care from caring professionals for anything that ailed them, and walk out confident the bill would be taken care of! Who could possibly oppose that?

Basically (and of course there are exceptions) one side viewed the decision to be between two ends: the then-current health care system, and WHEVLC; the other saw the decision as picking means: does the ACA make things better?  As I commented on Mr. Flynn’s blog:

One must assume the ends are known, because decisions are made, in the modern world, by choosing between ends. The Pragmatists, starting with Pierce, want to make the ends justify the means, so they habitually assume they know the outcomes and are deciding on them. A Pragmatist of the John Dewey species would be lost at sea if one were to demand moral decisions be made on principles, because, practically, the ends are unknown in any but very trivial cases. This is a Forbidden Thought.

Thus, the “Trolley Problem” is used as an example of moral decision making: a fantastic set of assumptions where all the crucial pieces are assumed to be known with certainty so that only the ends – 1 guy dies or 5 guys die – is considered relevant.

A real example of a moral decision might be: You promised to love, honor, serve and be faithful to your wife, but this morning you found out you didn’t like her anymore. What do you do?

No ends in sight. But that sort of question wouldn’t be very popular, less so the answer. So we assume, instead, that we know the ends *for sure* so that we can be Good People and chose Wonderful Healthcare for Everybody at Very Little Cost (WHEVLC, let’s say). And then make up whatever numbers and stories we need to help us feel good about it. In such a moral world, those who don’t like the ACA don’t want WHEVLC = what evil, evil people! The idea that there’s a difference between choosing ACA and getting WHEVLC cannot be entertained.

Back to the inane slogan. What seems to be happening to me is that the Democrats have decided, consciously or not, to abandon trying to convince the ‘undecided’ voters, in this case, those who may have become disenchanted with the ACA over the past 6 years. This slogan is perfect for the die-hard fans: it parodies Trump’s hateful (to them) campaign slogan, and hangs all the *inevitable* evil to come from failing to love WHEVLC on Trump’s shoulders. And the people who hate poor people and women – you know, people who would dare ask how this WHEVLC voodoo is supposed to work – well, they are, what is the word? Oh, yes, contemptible! Oops, meant Deplorable! That’s it!

On some level, I wonder if the current core of the Democratic Party believes people’s minds can be changed by argument or information. I suspect not. Therefore, a ‘better’ slogan might not be possible.

Finally, if one of those Reddit readers were to wander by, I ask: Did you ever hear about the trolley problem in school? How was it presented? Was a vigorous counterargument proposed and championed? More generally, was the possibility that moral decisions simply cannot be based on ends seriously discussed?  I suspect, but do not know, that Pragmatism is taught, more or less unconsciously, and that objections – fatal objections – to it are simply not seriously discussed. Well?

If this post isn’t enough, check here for further dissection.

  1. In insurance-land, that pre-existing conditions clause invites what is called ‘adverse selection’. In general, it means that buyers have information sellers don’t. People are more likely to buy insurance if they’re sure or think it likely they’ll need it. If I buy lots of life insurance because I know that the Mafia has a contract out on me, but don’t relay that information to the life insurance salesman, that’s adverse selection. That pre-existing conditions coverage clause codifies adverse selection – the seller must at least pretend they don’t know about your heart troubles, etc. Thus, the wisest, if not most moral, path is to buy insurance when you need it, say, right before you go into the hospital for surgery you’ve known about needing for years. Further, if you are young and healthy, it’s only a small risk that you’ll be hit with something bad before you have a chance to buy insurance for it. The premiums of healthy people who don’t make many big claims help keep costs down for sick people who do. This means sellers of insurance must take into account 1) having healthy people not contribute to the system (This reality is recognized – a little  – by penalizing those who don’t buy insurance. Then it’s just math: is the penalty or the insurance cheaper?) and 2) having to cover expensive treatment for people who only contribute a few payments into the system while taking large amounts out. Ultimately, this means prices have to go up – for everybody. Hmmm – did they? Every sane businessman and economist predicted they would.

Author: Joseph Moore

Enough with the smarty-pants Dante quote. Just some opinionated blogger dude.

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