Thornton Holding Court.jpg

Thornton Hall

The Revolution Will Be Kuhnian.

Is This Ideology?

Another example for our ongoing discussion of the use of the word "ideology" in current American English comes from a NYT article--Looking At Costs And Risks, Many Forgo Insurance--about people who chose to remain uninsured even though affordable insurance and subsidies were available in state exchanges during the open enrollment period that ended March 31. 

To be sure, some of those who chose not to sign up were motivated by ideological opposition to Mr. Obama, to the law’s mandate that they buy insurance, or to both. And for many others, confusion and lack of understanding, including about whether they could get financial help buying coverage, were the overriding reasons.

Is the following statement even coherent?

"To be sure, some of those who chose not to sign up were motivated by ideological opposition to Mr. Obama..."

Can one be ideologically opposed to a person? Not in the United States. We have a strong norm against ideologies such as racism or nativism that are opposed to humans qua humans. 


What is the evidence that there are uninsured people who choose to be such because they believe the Federal government may not legitimately require individuals to purchase insurance?

But a New York Times/CBS News poll of uninsured people in December found that of those who did not plan to get coverage, half said that cost was the main reason. Nearly three in 10 said they objected to the government’s requiring it, while about one in 10 said they felt they did not need it.

This outdated poll is propped up by the story of one of these people, Tammy Williams from Washington State:

Tammy Williams of Bothell, Wash., based her decision to opt out partly on philosophical resistance to the law.

“The government comes into our life and makes these decisions for us without even asking us,” said Ms. Williams, 56. “It just makes me want to rebel.”

Ms. Williams, who earns less than $40,000 a year at a small marketing firm in Seattle, said she did not want to hand over what little discretionary money she had after rent and other living expenses to an insurance company. She has been uninsured since moving a year ago from Ohio, where she had a job with health benefits.

She qualified for a subsidy to help buy coverage through Washington’s marketplace, but said that she still would have had to pay around $135 a month for the least expensive plan, with a $6,000 deductible that she said made it unfeasible.

“I am opting out,” she said on the last day of the enrollment period, adding that she might instead buy dental coverage outside the marketplace to take care of a chipped crown and a cavity.

This small glimpse into the mind of someone ideologically opposed to the ACA is actually the picture of a person who would have participated but for the scary high deductible, a person who, moreover, demonstrates exactly why we need the mandate (that she "opposed") by confessing that she plans to game the system by waiting to buy dental insurance until she has plans to get a pre-existing cavity taken care of!

But it's worse than that. The NYT makes no effort to check if the fear of high deductibles is valid, and examining that point reveals a classic false balance piece. 

These folks are presented as rationally choosing to pay a $95 penalty rather than, eg, $135 a month for a $6000 deductible plan. But that's not a fair description of the facts. The deductible involved does not apply to check-ups, routine OB-GYN care, care for chronic diseases, and even many prescription medicines. By law, there isn't even a co-pay. The care doesn't  cost $6000! It costs $Zero!

The Kaiser Family Foundation explains here:

All new plans must cover some defined preventive services with no copayment by the consumer and without having to meet the deductible first. Those include some vaccinations, mammograms and other cancer screenings, contraception, including birth control pills, and periodic physicals. But prevention services do not include treatment for an  illness, such as the flu. Charges could also apply if, during a preventive care visit, the patient is also treated for a medical condition or a minor injury. In addition to doctor visits and preventive care, some plans may also offer limited coverage for some prescription drugs.

But there's still more that the reporter doesn't seem to understand, again from Kaiser:

Under the law, the maximum amount a consumer with single coverage will pay out-of-pocket in 2014 will generally be $6,350 while a family could pay up to $12,700. Those totals include copayments and deductibles, but not premiums, and they apply only to plans that are not grandfathered under the law.

So the article should say: 

In Washington State, two cups of coffee a day will run you about $120 a month. For fifteen more dollars, Tammy Williams of Bothell could have a bronze health insurance plan under the ACA. Ms. Williams, 56, is generally healthy meaning that every medical service she expects to need in 2014 be 100% free, with no co-pay and no deductible. Even if she needed additional care, the plan would cap her total out of pocket costs at $6350. 

In an interview, Ms. Williams revealed she would likely sign up if she understood the facts. She claims to object to the ACA on principle, but when questioned, she reveals that her decision was dictated by the cost of the plan, a cost she clearly failed to understand. 

At the end of the day, ideology, as it's used here, means "based on an incorrect analysis of the likely costs involved." Does that sound like the kind of thing that goes in the same box with nationalism and Marxism?

Reality, Bias, And The Asymmetry of Motivated Reasoning

Lying By Synonym

Lying By Synonym