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November 2009
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Cognitive Dissonance

America is suffering from a severe case of cognitive dissonance over health care. At a minimum it helps to explain the emotion and misinformation people seem to be harboring in regards to the current “debate” on health care. Cognitive dissonance is one of those apparently simple concepts that is both hard to translate and to understand. I should know having learned about it the hard way. When I was finishing my MBA, cognitive dissonance was a question on my comprehensive exam. One which the grading committee felt I had come up short in explaining. Fortunately it was not the only question.

I gained first-hand knowledge about cognitive dissonance early in my career working at Johnson & Johnson. My assignment was to expand usage of Johnson’s First Aid Cream. One of our concepts was to eliminate the sting that children experience when mom put on first aid cream. In a nutshell, this concept failed miserably because of cognitive dissonance. If there is not some sting it does not work. Over the years I have seen example after example where cognitive dissonance causes failure to what would appear to be a viable concept.

Depending upon who you ask we have been debating and discussing health care reform for some 40 years. Actually we are worse off today and the problem is getting bigger every day. Yet everyone I talk with, every article that I read suggests a common agreement that health care reform is an imperative that cannot be ignored. Why the failure to make progress? Could the answer be as simple as cognitive dissonance?

The answer to this question is not a simple yes because it is important to first determine the cause of the dissonance. In my opinion, that cause is confusing interrelated but also distinctly different issues, the quality and cost of health care delivery and how healthcare is paid for. One can be totally for the reform of health care from a quality and cost of care basis and be totally against changing how it is paid for. It is a classic case of the devil you know is better than the devil you do not know – a case of cognitive dissonance.

If you are lucky enough to have insurance, even if the premiums are extremely high, then the current system works just fine. The fact that your premiums are high because of all the people who cannot afford to pay or do not have insurance is a hidden cost seems to be easily ignored or rationalized. The fact that many medical providers are charging your insurance company for procedures they may or may not be performing so as to get the fees they require to stay in business seems to be accepted. If you do not have insurance and you go to an emergency room for treatment why would you want to change anything, the systems is working for you. This situation only begins to explain the conundrum and the cause of the dissonance.

So is this country facing a quality of care problem, a cost of care problem or a payment of care problem? Unfortunately the answer is yes and this is where the cognitive dissonance is formed. Explaining this issue to the American public with all of its diversity is a challenge to say the least. While it would be irresponsible to just leave it to Congress to work out a solution, it is equally irresponsible to model an “everyone wins” solution which ends up being no solution at all. It is not clear to me whether it is the White House or congressional leadership that has failed in finding a way to communicate the problem they are trying to solve or even if there is agreement to exactly what the problem is. Possibly if they understood the cognitive dissonance that is generated by the complexity of the situation they could come up with a solution.


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