My wife is once again fighting for her life following a leukemia relapse.  The type of cancer she has can be cured, but the treatments are expensive, the recoveries prolonged and difficult each often taking weeks of hospitalization, and the battle can sometimes go on for years.  Prior to the onset of this illness she was denied her own health insurance policy; the reason given was a history of tennis elbow and a benign cyst.  I was able to carry her under my personal policy; and a good thing too as after her cancer diagnosis in 2005 she was uninsurable.  Simply put, she had become an unacceptable financial risk to insurance corporations.

Over the five years following her diagnosis, the premium for my policy almost tripled (from about $7K/yr to near $20K/yr), well beyond the reach of many citizens.  Although I was informed the rate hikes had nothing to do with the expense of her illness, it made little sense that the negligible increase in my risk over that period justified such a substantial rate hike.  I had the financial means to keep the benefits in place and reduced the premium cost by taking some additional out-of-pocket expense.   The policy has served us well, but we witnessed first hand the rate increases that have priced some out of the market or forced them to settle for a lower level of benefit, e.g., a cap/defined amount of coverage.

We also lived with the uncertainty of whether she would remain insured should something happen to me as the primary policy holder.  That was, of course, until the United States joined every other Western democracy in guaranteeing her access to medical care by enacting The Patient Protection and Affordable Care Act of 2010.  There is really no doubt that her chances of winning this battle depend on her ability to remain insured.

My wife received many get-well cards from individuals wishing her a speedy and complete recovery.  Yet some of them would also be casting a vote in the upcoming election for a political party whose leadership has made the repeal the healthcare reform law a legislative priority (ref).  The Republican-controlled House has now voted more than 30 times to repeal the law.  Following the Supreme Court’s decision upholding its constitutionality, House Speaker Boehner stated that “This [law] has to be ripped out by its roots” and “We will not flinch from our resolve to make sure this law is repealed in its entirety” (ref).  Mitch McConnell has called the law “the single worst piece of legislation that’s been passed, certainly in modern times” and “We’ve got one last chance here to defeat Obamacare.  We can do it in the fall election” (ref).  Senator McConnell stated that he would use “reconciliation” to permit a simple majority to pass a repeal of the law in the Senate and has previously stated that it would be necessary to replace President Obama to prevent a presidential veto.   Should they be successful in carrying out their declared objective, the outcome potentially puts my wife’s survival at risk.

So, the two positions held by some of the individuals who have sent their well-wishes are in conflict; wishing her a complete recovery while advocating against her well-being by casting a vote for a legislative agenda that would once again make her uninsurable.  Such a conflict falls into the realm of ‘cognitive dissonance’.

Cognitive dissonance, first coined in the 1950’s by Leon Festinger, is the term used in modern psychology to describe the state of holding two or more conflicting ideas, beliefs, or values simultaneously (ref).  “In a state of dissonance people may sometimes feel surprise, dread, guilt, anger or embarrassment”, and are thus motivated “to reduce dissonance by altering existing cognitions, adding new ones to create a consistent belief system, or alternatively reducing the importance of any one of the dissonant elements.”  Some examples include The Fox and the Grapes by Aesop.  Although wanting the high hanging grapes but unable to think of a way to reach them, the fox ultimately reasons that the grapes aren’t worth eating – that they most likely are not ripe or are sour.   Another is a cigarette smoker who wants to live a long life but with the knowledge that smoking can cause illness and shorten his/her life.  To reduce dissonance the smoker can rationalize that the odds of getting ill are small or simply deny the evidence.  In short, one way that individuals reduce dissonance is to rationalize their way out of the conflict.

However, we enter dangerous territory when examining some of the reasoning that has been used to oppose extending health insurance coverage.  Individuals who would benefit from the law have been characterized as being a burden to the system, freeloaders looking for a handout.  In a previous article I described the steps leading to eliminationist behavior, one being the scapegoating of individuals, defining them as ‘cancers’ or ‘vermin’, that threaten the well-being and security of the state (ref). One of the more shameful displays of such opinion in the healthcare debate was caught on video where Tea Partiers mocked and scorned an individual afflicted with Parkinson’s Disease at a healthcare protest in 2010.  The individual was told that there were no handouts, that he needed to work for what he supported, one in the crowd mockingly tossed dollar bills at him, while another called out ‘communist’ (ref).  A look into the Parkinson’s Disease victim is provided here (ref).

And such beliefs were recently echoed by Republican presidential candidate Mitt Romney at a $50,000 per plate fundraiser: “Well, there are 47 percent of the people who will vote for the president no matter what.  All right?  There are 47 percent who are with him.  Who are dependent upon government, who believe that they are victims, who believe that government has a responsibility to care for them, who believe that they’re entitled to health care….you name it…So my job is not to worry about those people.  I’ll never convince them that they should take personal responsibility and care for their lives.” (ref)  (ref).  And the day following the disclosure of those statements, Mr. Romney ‘fully embraced’ the substance of those comments saying that ‘his views helped define the philosophical choice for voters in his campaign against President Obama’ (ref).

David Brooks rightly asked “who are these freeloaders?  Is it the Iraq war veteran who goes to the V.A.?  Is it the student getting a loan to go to college?  Is it the retiree on Social Security or Medicare?” (ref).  And it certainly doesn’t describe those like my wife.  She has faithfully paid her taxes that support by far the world’s largest military defense budget as well as the healthcare benefits of our elected officials who in turn would deny the same to her.  And she has given generously of her time to help the less fortunate in our society, having served on the boards of multiple not-for-profit organizations, leading numerous fundraising campaigns, and having been recognized by the governor of our state as Volunteer of the Year.

During my wife’s hospitalizations we had the opportunity to get up close and personal with some of these individuals who would not ‘take personal responsibility and care for their lives’.  There was the deadbeat who was trying to conserve his insurance benefits by not ordering a dinner tray.  My wife, unable to eat due to nausea, offered to donate her tray to him only to be told “He’s no longer with us”.  And there was the freeloader whose insurance denied a transplant.  He eventually lost his life while unsuccessfully trying to fundraise the required quarter of a million dollars.  And there was the moocher who contracted a life threatening and debilitating cancer after losing his job with only months left on his COBRA benefits.

And consider the inherent conflict in those who display the slogan “Support Our Troops” yet at the same time oppose healthcare reform.  After being willing to make the ultimate sacrifice to defend our freedom, our troops return to the country they defended that allows over 2000 veterans to die each year due to lack of access to essential care (ref).  Support our troops?

Supreme Court Justice Scalia’s argument about whether the government would next require us to buy broccoli is simply ludicrous and misses the point.  My wife wanted some of that broccoli before the cancer, but the store wouldn’t sell it to her.

Cognitive dissonance abounds.  But rather than defining our citizens in need of healthcare as moochers, wouldn’t a more reasonable way to resolve the dissonance be to join the rest of the civilized West in providing universal care?

But, seriously, don’t tell a gravely ill person that you wish them a complete recovery while at the same time advocating against their insurability.