Commentary: Democracy in a world without facts: A look at health care and guns
This article originally appeared in the St. Louis Beacon. - Some years ago at a scientific meeting in Sweden, a conversation with a local resident veered toward gun policy in the United States. You have tens of thousands of gun deaths annually, my companion intoned, and the trend is to make guns easier to access so more people can have them!
This was not a casual assertion that U.S. gun policy is imperfect. It was not an invitation to explore alternatives.
Instead, it was a “planetary” comment. As in what planet do you live on? As in how can a country that has seven times the gun death rate of Sweden and 41 times the rate of the United Kingdom seek salvation in additional guns? How can a country that has vastly more child gun accidents and teenage gun suicides than any other developed nation see solutions in more guns in more households so more toddlers and more teenagers can execute themselves or their play and school mates?
Similar considerations apply to the refrain “We have the best health care system in the world.” It’s not about agreeing or disagreeing. It’s about the planet. “If you really believe what you just said, please provide details of the planet you actually inhabit?”
I recalled these musings while reading a recent article about international comparisons of health care systems in the journal Health Affairs. The article concerned a survey of 20,045 randomly selected adults in 11 developed countries.
In most cost and access-related metrics evaluated, this nation, with “the best health care system in the world,” was last, usually by a country mile. Eighteen percent of U.S. respondents had no health insurance. But there were no equivalent data in other surveyed countries because universal health care is, well, universal in the rest of the developed world.
While cost-related access barriers ranged from 4 percent in the United Kingdom to 22 percent in the Netherlands, 37 percent reported such problems in the U.S. Annual out-of-pocket health expenses greater than $1,000 impacted from 2 percent to 25 percent of respondents, except in the U.S. where it was 41 percent. The same patterns applied to not filling prescriptions because of excessive cost. And the world’s best health care system yields lower life expectancies and higher infant and maternal mortality rates than most of its competitors.
My concern in presenting these examples is not primarily with the appropriateness of particular policies. It is instead with the viability of democracy when truth and facts become irrelevant components of political interaction. It’s with a culture in which Machiavellian distortion and cherry-picked misinformation are standard electoral fare; in which politics is a contact sport and ordinary citizens root viscerally for the home team, unified by the ethos that the other side is evil.
While Republicans command most of the market on planetary absurdities like death panels, Obama-is-a-Muslim fantasies, and the denial of evolution and climate change, bipartisanship is more evident in our myopic commitment to only seeing evidence that supports our beliefs.
For example, the United States has the world’s best medical technology and provides better access to specialists (but not primary care physicians) than most developed countries. I would rather suffer a weekend stroke in the U.S. than in, say, the United Kingdom, where weekend hospital staffs commonly lack specialists who can provide the best emergency therapies. If you are a Democrat who can barely acknowledge these realities, you aren’t really looking for truth or the best possible solutions. Our health care system is not all bad.
Democracy requires civil discourse and a foundation of accepted norms. The erosion of that foundation is dividing us into parallel universes with parallel sets of mutually exclusive perceptions.
The multifaceted limitations of our health-care system render it impossible to rationally perceive the world’s best, no matter what your political affiliation. But we don’t choose favorite football teams through deliberative processes. So rationality doesn’t apply.
There is doubt about the renewal of a soon-to-expire ban on plastic guns that can avoid metal detectors and proceed to our airplanes. Could there be a better illustration that something is missing from the communal vision that undergirds democracy?
It is exquisitely human to seek endorsements for our beliefs and preferences. But we have gone vastly too far when all that many of us hear from a bifurcated media, our acquaintances, our internet searches, is support for our beliefs and demonization of our opponents. When all the evidence routinely supports us, we enter a magical never land where the complex becomes simple and nuance is obsolete.
It’s an upside down world that reverses the logical order of intellectual discovery by beginning with conclusions and relocating the evidence in a self-serving bed of truthiness. With nothing to contradict our predilections, it’s one short step to “what planet do you inhabit” distortion. It is incompatible with democracy.
Ken Schechtman is a freelance writer and a professor at the Washington University School of Medicine.