Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Our value judgments are often psychologically frail

Peter Ubel, MD
Policy
September 23, 2014
Share
Tweet
Share

In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to almost every other developed country.

Suppose you were fixing the U.S. health care system and realized that increasing access to care would make it harder to control costs. Which of the three aims would you make your priority? I asked this question to a couple groups of people. One group came out strongly in favor of access, the other in favor of cost control. Can you guess who these two groups of people were?

I asked a group of undergrads at Duke to make the same guess. These undergraduates were taking my health policy course, and with that background were able to make some good guesses. Those prioritizing access: Some thought it might be a rural population with limited access to subspecialists. Others thought it might be a poor population with little access to health insurance. Those prioritizing costs: Some thought these might be fiscal conservatives, others thought they were large employers trying to hold down the cost of employee benefits. These were all really good guesses. Only one problem with them.

They are all wrong, very wrong. Instead, the two groups of people were the very same students who were taking my course. On the first day of class, you see, I had given them a writing assignment explaining why one of these three goals ought to be a priority for any reform of the U.S. health care system. But I did not allow them to choose which goal to defend. Instead, I required some students to defend the idea that costs ought to be the priority, and required other students to defend access to care. Several weeks later, at the end of a quiz, I asked the same students to indicate which of the three aims they would prioritize if they were in charge of the U.S. health system.

Their opinions in the fourth week of the semester were strongly influenced by the aims I had arbitrarily assigned them to defend in the first week.

Health care systems are complicated. When it comes to laptop computers, we can plausibly hope for low cost, high quality goods that meet most people’s needs. These three aims are even more achievable for a basic necessity like food. We can expect high quality, cheap food that everyone has access to. But health care markets are much more complicated than the markets for computers and food. In fact, health care markets often force us to make impossible choices.

Do we offer that new hepatitis C drug — at $90,000 per patient — to everyone who might benefit from it? Or would such a policy bankrupt us? No easy answer. It comes down to a difficult value judgment.

As it turns out, our value judgments are often psychologically frail. That’s what my first-week writing assignment had such a profound effect on student values. The writing assignment did not run in the face of a long held view. In fact, that first week of class was probably the first time most of these students had given a second of thought to the trade-off between health care access and cost. But soon after they wrote their essays, their values began to solidify. That is a scary phenomenon. Once people begin to take hold of a moral position, they are anchored to that view, raising questions about their ability to objectively weigh the moral trade-off as they learn more about the topic.

Rather than fear this moral anchoring, I have chosen to utilize it. First, by taking advantage of the phenomenon in my teaching. I think a good way to open people’s minds is to show them how easily their minds become closed.

Second, I keep this phenomenon in mind when espousing my own opinions. I am humbled by the knowledge that my own opinions are shaped by unconscious biases.

If more of us acknowledge the psychological forces that influence our values, maybe we would be less caustic in confronting people whose moral and political views differ from our own.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Prev

What does this retired doctor miss about medicine?

September 23, 2014 Kevin 3
…
Next

Employer-sponsored primary care: An explanation

September 23, 2014 Kevin 0
…

ADVERTISEMENT

Tagged as: Public Health & Policy

Post navigation

< Previous Post
What does this retired doctor miss about medicine?
Next Post >
Employer-sponsored primary care: An explanation

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Policy

  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The child within: a grown woman’s quiet grief

      Dr. Damane Zehra | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The child within: a grown woman’s quiet grief

      Dr. Damane Zehra | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Our value judgments are often psychologically frail
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...