I was actually going to write a post today on the kinds of health care reform proposals that I would support, and that I believe a majority of Americans could get behind as well. (Perhaps tomorrow if I have the time.)
But in researching various proposals, it occurred to me that the problem with conservative critiques of Obamacare - at least from pop conservatives like Rush Limbaugh and professional scare mongers like Sarah Palin - is the logical fallacy of their “slippery slope” arguments, and the sheer impossibility of many of their most dire warnings about what will happen if we adopt Obamacare.
Don’t get me wrong (although I know many of you will). There are indeed legitimate slippery slope arguments that can be made about these proposals that meet the stringent test of being logically thought out, and buttressed by facts. Reasonable assumptions can be extrapolated from what the Democrats are proposing that aren’t so slippery that they fall off a cliff into the netherworld of nonsense.
But in truth, many of the worst slippery slope arguments being employed in this debate on the right are full of logical fallacies that assume too much, ignore alternative arguments to explain facts, and stretch logic and reason to the breaking point in order to present half baked notions of the future of American health care under what Democrats are proposing.
What makes a good or bad slippery slope argument? I like the Wikpedia entry that explains a valid slippery slope argument:
Modern usage includes a logically valid form, in which a minor action causes a significant impact through a long chain of logical relationships. Note that establishing this chain of logical implication (or quantifying the relevant probabilities) makes this form logically valid. The slippery slope argument is only a fallacy if such a chain is not established.
A slippery slope argument that evolves into logical fallacy can take many forms; to my mind, failing to rigorously test your own assumptions that define the argument itself is the easiest trap in which to fall. Essentially, trying to impose a false assumption invariably leads to a crumbling of the whole edifice.
Again, Wikpedia has a pretty good definition for those arguments that crumble into logical fallacies:
The heart of the slippery slope fallacy lies in abusing the intuitively appreciable transitivity of implication, claiming that A lead to B, B leads to C, C leads to D and so on, until one finally claims that A leads to Z. While this is formally valid when the premises are taken as a given, each of those contingencies needs to be factually established before the relevant conclusion can be drawn. Slippery slope fallacies occur when this is not done — an argument that supports the relevant premises is not fallacious and thus isn’t a slippery slope fallacy.
Often proponents of a “slippery slope” contention propose a long series of intermediate events as the mechanism of connection leading from A to B. The “camel’s nose” provides one example of this: once a camel has managed to place its nose within a tent, the rest of the camel will inevitably follow. In this sense the slippery slope resembles the genetic fallacy, but in reverse.
Let’s take Sarah Palin’s “Death Panels” statement as a perfect example of a slippery slope argument that degenerates into logical fallacy the moment one looks at it in a rational manner.
Palin doesn’t even bother with any intermediate steps; she goes from A directly to Z without so much as a logical assumption between them. Even those who support her statement admit that there is nothing that the Democrats are proposing that even remotely approaches some kind of board where individuals are sorted out based on how productive they are, or potentially can be. The fallacy of this thinking then, is that any incremental steps that could, in the end, lead to death panels are simply ignored and a kind of intuitive logic is employed to go directly from A to Z.
It is those incremental steps that are the key to the fallacy. In order to accept her statement, one would have to believe that no one would recognize anything untoward in these incremental steps to death panels (the “boiling frog” analogy), or that no one would attempt to change course and prevent the death panels from forming in the first place (a “momentum” argument that is easy to disprove).
Of course, Palin wasn’t making a logical slippery slope argument. That was not her intent. It was to polemecize the debate by throwing rhetorical bombs at Obamacare, hoping to rile up her supporters, and strike fear into seniors and others.
I find it amusing that many of those who seek to explain Palin’s argument go so far afield to justify her logic that they actually prove how patently ridiculous her statement was.
Let’s take the normally reasonable and objective William Jacobsen of Legal Insurrection who makes spaghetti of Palin’s arguments by stretching logic beyond reason:
These critics, however, didn’t take the time to find out to what Palin was referring when she used the term “level of productivity in society” as being the basis for determining access to medical care. If the critics, who hold themselves in the highest of intellectual esteem, had bothered to do something other than react, they would have realized that the approach to health care to which Palin was referring was none other than that espoused by key Obama health care adviser Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel).
The article in which Dr. Emanuel puts forth his approach is “Principles for Allocation of Scarce Medical Interventions,” published on January 31, 2009. A full copy is embedded below. Read it, particularly the section beginning at page 6 of the embed (page 428 in the original) at which Dr. Emanuel sets forth the principles of “The Complete Lives System.”
No doubt Rhambo II is nutty as a fruitcake. The question we have to ask is where in the alphabet between A and Z does Mr. Potential Death Panel Chief fit?
The next question is, whether Dr. Emanuel’s proposal bears any connection to current Democratic proposals. There is no single Democratic proposal at this point, only a series of proposals and concepts. To that extent, Palin’s comments properly are viewed as a warning shot not to move to Dr. Emanuel’s concept of health care rationing based on societal worth, rather than a critique of a specific bill ready for vote.
Certainly, no Democrat is proposing a “death panel,” or withholding care to the young or infirm. To say such a thing would be political suicide.
But one interesting concept which is central to the concepts being discussed is the creation of a panel of “experts” to make the politically unpopular decisions on allocating health care resources.
As Bill himself admits, the Democrats are not proposing a death panel and Mr. Death Panel doesn’t fit anywhere on the A to Z continuum because frankly, there are no A to Z dots to connect at the moment. There’s only a vague mention of a “panel of experts” who would not have anything to do with the “Complete Lives System” of allocating health care resources. Instead, the proposed Commission would make decisions on treatment options and, according to the letter from Obama to Congress that Bill quotes, “These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.”
Not a hint of a death panel. Not even a hint of a “complete lives” determinant for allocating health care resources. Bill is using one bogus slippery slope argument to support Palin’s equally curious polemic.
Sorry, but just because conservatives combine a genuine distrust of government with the real potential for unintended outcomes by using some valid slippery slope arguments about Obamacare, that doesn’t mean we can go off half cocked and, by sheer intuition rather than facts and logic, imagine the absolute worst nightmares about nationalized health care. All slippery slope arguments against Obamacare are not valid. And Palin’s might be the worst of the lot.
A possibly valid slippery slope argument about this “Medicare Payment Advisory Commission” is that it would result in a “one size fits all” treatment regimen for specific diseases. Instead of coming up with the best course of treatment for what ails you, in consultation with your doctor, a third person will be sitting in the room with you - your friendly, neighborhood government health bureaucrat from MedPac - who will have a specific outline of treatments and drugs that would be approved for payment by the government.
Currently, you can tailor your private insurance plan to cover those “unnecessary tests” that Obama is so concerned about. And, of course, the counterargument is that if you want those tests, you can always pay for them out of your own pocket.
But given what I believe to be a valid slippery slope for what Obamacare could eventually mean - a virtual end to private insurance and all but the richest Americans forced onto the government plan - we should be very concerned with any board or commission set up to make one size fits all decisions on treatment.
In fact, let’s examine the reasonable argument that, by moving steadily from A to Z, Obamacare will for all intents and purposes destroy the general health insurance industry and eventually mandate that almost all Americans join the government plan.
Lindsey Graham, in an interview with Ezra Klien, fills in some of the A to Z gaps:
My belief is that no private-sector entity can survive over a long period of time competing against the government. The public option will be written by politicians. It will be generous. Nobody in my business worries about the bottom line. Eventually, the public option will dominate the marketplace because the political forces in the public sector are different than the economic forces in the private sector. Eventually, the private sector will give way.
You know, we already have Medicaid and Medicare. The private sector covers the middle. If a public option becomes part of that mix, you’ll have the whole deal covered by the government. That’s why I’m against it. And what I’d like to do long-term is enhance the options available to the retirement community and reform Medicare.
Is it logical to assume that because private insurance companies are beholden to market forces and government is not, that eventually - unless government deliberately keeps its premiums high - these companies will simply be forced out of business because they can’t compete?
I believe the answer to that is a great big yes. The government already skews market forces in the health insurance industry because 6 out of every 10 dollars spent on health care in America is spent by government.
Graham’s argument has some holes (the boiling frog, remember?). Is it reasonable to assume that government wouldn’t lift a finger to save private insurance companies from going the way of the dinosaurs?
This is trickier because it would depend on who might be in power. Would Republicans risk the wrath of their base to bail out Prudential, or Allstate? Lots of little guys make a living selling insurance as independent agents. What would happen to them if that part of their business went up in flames?
If Democrats are in power - as I am assuming they will be given the fact that the GOP is prostrate right now and in such a shambles leadership-wise that it is probable the Dems will be in power for the foreseeable future - I think they have made their feelings clear about “greedy” insurance companies. Based on their attitude toward business in general and specifically, the insurance industry,I doubt whether Democrats would lift a finger to help insurance companies remain in the business of selling health care policies.
That is a reasonable assumption drawn from known facts. Attitudes and statements by the Democratic leadership about health insurance companies leads to the logical conclusion that their elimination would not be a catastrophic occurrence. Hence, no private insurance would mean virtually all Americans would be forced on to the government plan.
This is an example of a valid slippery slope argument. Will it really happen? Counterarguments similarly based on facts and logic must, by definition, refute the market forces that would be at work as well as statements made by liberals about evil insurance companies. I don’t think it can be done but anyone willing to try will get a hearing from me.
Unfortunately, too many conservatives use fantastical and illogical slippery slope arguments to posit the absolute worst outcomes for Obamacare. Old folks being forced into signing DNR orders and living wills based on the proposal that Medicare will be paying for doctors visits to discuss these options is a similarly nonsensical idea. To extrapolate people being “forced” to do anything remotely like signing their own “death warrants” just from this simple, common sense idea is beyond the pale of rational discourse. Those who advance the argument are not concerned about anything except ginning up fear among senior citizens over Obamacare.
Slippery slope arguments about rationing are a little different. It has been pointed out that there already is a form of rationing used by private insurance companies who routinely deny some treatments as too experimental or not necessary in their view. The question of how draconian it might get under Obamacare is, I believe, unanswerable at this time. Much depends on whatever ideas they eventually come up with to control costs. If it looks like they won’t do diddly, then a rationing regime will be absolutely necessary. How bad it could get just isn’t logically foreseeable at this time.
If we stick with those slippery slope arguments that are valid and discard the nonsensical ones, we can win this debate. But using logical fallacies and outright imaginary outcomes meant to scare people rather than make them think about the consequences of passing Obamacare only makes conservatives look like hysterics.
And that may be Sarah Palin’s brand of conservatism, but it’s not mine.