There is a psychological point to be made here too, about partisan motivated reasoning.  The results of the study are intuitive to most people who are not so ideological.  Of course increased access to health care leads to greater psychological and physical well-being for the insured as well as greater cost to society.  I have to admit that as a liberal, I'm tempted by arguments that the benefits of preventative medicine and reduced use of expensive emergency rooms means that increased health care for the poor will be essentially cost neutral.  While Obama touts improving health care access as a deficit reducing measure and liberal pundits minimize costs, the reality is likely that insuring everyone will cost significant money.  At the same time, arguments that state that medicaid doesn't improve poor people's health or that minimize the effect, seem psychologically motivated as well.  Indeed, the fairest summary of the results of the study would be this fairly obvious sounding ABC News headline which reads, "Medicaid makes poor healthier and states poorer". To add something to the numerous articles out there, I made the following graphs to summarize results:

People who received medicaid (in red) felt happier ("very happy" or "pretty happy" as opposed to "not too happy"), healthier, and less depressed (using this measure) than the control group (in blue).

People who received medicaid (in red) used more preventative services than control group (in blue) (yearly results for just women).

People who received medicaid (in red) used more medical services overall than control group (in blue), costing taxpayers more money, without any decrease in ER visits (yearly numbers, extrapolated from 6 month numbers in article - costs used per event in article, based on previous studies, are in parentheses).

Partisans will surely see it through partisan eyes, as one man's enormous gain in outcomes is another man's modest increase.  The National Review had a fairly detailed critique, but I can't help but feel that statements like "supporters must show not only that expanding coverage improves health but also that it does so at a lower cost to taxpayers than alternative policies" ring hollow unless advocates are forcefully pushing for those policies on the grounds of improving the health of the poor.  It has the same feel as liberal arguments that taxing the wealthy will actually stimulate the economy.  Both groups don't like to make tradeoffs, even obvious ones, but the reality is that expanding health coverage will both cost money and improve health.

Is it an unaffordable amount of money or a trivial amount?  The other neat thing about the study is that it actually translated health usage into actual dollars spent per year.  The control group still spent money on health care, which was presumably taken care of through existing services, charities, or emergency rooms.  The marginal cost of insuring the poor could be seen to be the difference between the experimental and control groups or the total cost of the experimental group.  Under medicaid, the government would pay all those costs, but there may be savings on what government is already spending on emergency room visits to public hospitals and other like societal costs.  In comparison, I found these links for the yearly cost of educating a child or incarcerating a prisoner in Oregon.

Yearly Cost

Of course, the above graph is perhaps misleading as there are far more school children than prisoners, so perhaps multiplying the total cost of care by the 213,000 medicaid eligible uninsured individuals or by the almost 650,000 total uninsured (numbers from statehealthfacts.org), and comparing it to the overall Oregon budget might put the cost of expanding coverage dramatically in context.  Below are yearly Oregon state budget items compared to extrapolated medicaid costs.  Note that the cost of insuring all uninsured is likely lower due to many uninsured being young working adults.  However, there is likely overhead and administrative costs to the program that are not taken into account as well, so perhaps this balances out.

Oregon Yearly Budget Items in Comparison to Potential Expanded Health Care Cost

I learned something from this exercise.  My liberal intuition was that expanding coverage to all the uninsured would not be that large a cost for a state.  In reality, it looks like expanding Medicaid in Oregon would be roughly equivalent to the entire budget of the Oregon University system or at least the community college system, depending on whether you count the entire cost of medicaid health care or just the marginal cost of increased usage.  Either way, it is a significant cost.  At the same time, providing health coverage to all the uninsured is not fiscally impossible.  It costs a fraction of the overall state budget and would cost a fraction of the Oregon health and human services budget.  Behind all the reactions to such studies is the attempt by both liberals and conservatives use motivated reasoning  to avoid a hard choice between a costly government program and failing to provide health care for our nation's poor.  There is a cost, in terms of money or well-being, to either position.

- Ravi Iyer

In case you haven't seen it, here is a summary:

The interesting thing to me of this story was a bit on the Daily Show where Wyatt Cenac points out that "in his defense, he's only lying about something that he believes in.  It's in service of a strongly held moral principle.  He's not lying to get out of jury duty or be boastful." (at about 1:10 in the below clip)

While the defense was intended to be comical, many might see Cenac's explanation as a truly mitigating circumstance.  Kyl likely believed what he was saying, given that an intentional lie would undoubtedly be revealed.  At some point in our lives, many of us also believe in something so much that our perceptions of reality are altered.  Many people do indeed believe that sometimes the ends justifies the means, and from our data, those people are actually more likely to be liberals (or libertarians).  One might argue that our incursion into Libya, for many, is a case where the ends (saving civilian lives, increasing freedom) justifies the means (violence).  In other examples, Democrats believe that the health care reform bill will improve access to health care, and also reduce the deficit.  Republicans believe that reducing taxes on the wealthy will actually increase revenue.  There are arguments to be made for either position, but an objective observer would probably believe neither of these claims and it seems likely that moral principles (Democrats believe in a social safety net & Republicans believe taxes on the wealthy are immoral) are shaping perceptions of reality, which is the definition of moral confabulation, when you believe in something so strongly, that you don't let objectivity get in your way.

- Ravi Iyer

ps. as if on queue, the Wall Street Journal published this perceptually skewed view of taxation, perhaps born out of their belief that higher taxes on the rich are immoral.  This article, by Jeffrey Sachs, details the correct math.  Of course, it is also possible that Sachs' view of the statistics is skewed by his own moral views.

There are some definite points to agree upon in her interview and the book.  She was clearly negatively impacted by those who somewhat forcefully put forth the opinion that she should adopt the positive psychology approach given her cancer diagnosis.  "The failure to think positively can weigh on a cancer patient like a second disease," she writes (p.43).  Some people believe that there is a connection between having a positive attitude and cancer outcomes and Ehrenreich goes on to dispute this.  A review of the literature on health and happiness is beyond the scope of this post and really should be beyond the scope of her book, let alone the few pages she devotes to serious study of it.  She is a journalist not a scholar and she touches on only a brief part of this immense literature, with a lack of depth that would never work in a scholarly setting.  Her book does not have the kind of literature review that really can get at complexities and she seems to have relied on "a list of articles...compiled for me by Seligman" rather than doing her own in-depth research.  She ignores a large literature on stress as having no relationship to happiness research and intermixes research on the effects of feeling happy on cancer vs. other health outcomes.  People who study cancer and positive illusions agree that "there is no evidence that positive illusions can cure cancer," but that is not the only health-happiness relationship worth studying.  Ehrenreich herself writes on p. 162 "The evidence that positive emotions can protect against coronary heart disease seems sturdier, although I am not in a position to evaluate it."  It certainly is more complex than "being positive"="being healthy".  But the health-happiness relationship is also not as simplistically non-existent as she represents in her media interviews, and she is possibly doing harm to others by representing the research as simplistically (the very charge she levels at others).

That being said, positive psychologists and those they inspire likely were doing harm to her and others like her.  On page 42 of her book (my hardcover edition), she writes that "without question there is a problem when positive thinking fails and the cancer spreads or eludes treatment.  Then the patient can only blame herself."  This is an important point that advocates of positivity should note.  It may work for some people, but it doesn't work for everyone and if someone wants to be grumpy because they have cancer, they should feel supported in those feelings, not attacked.  As Ehrenreich puts it, "She took it personally."  A more complex reading of the psychology literature would lead Ehrenreich and positive psychologists to the conclusion that acceptance of feelings (e.g. meditation) is important.  Perhaps some of the error lies in the idea that "positive psychology" is a separate discipline from psychology when in reality, there are no clear distinctions.

The fact that Ehrenreich is able to caricature positive psychology as "be positive" is unfortunate. It would be easy to place the blame on Ehrenreich for failing to dig much deeper than the works cited by Martin Seligman, who has his own detractors in academia.  But it is certainly true that positive psychology would do well to examine the ways that it can get it's findings out without being so easy to caricature.  How was Ehrenreich so easily able to dismiss the robust research on stress and health?  Perhaps because positive psychology overly focuses on activated emotions such as joy rather than deactivated emotions such as contentment?  Or perhaps positive psychology needs to incorporate previous research on stress and not pretend that it is a completely new discipline?

Ehrenreich seems to have a particular concern about synthetic happiness vs. real happiness, feeling as she states in her interview with Stewart, "I never believe delusion is ok."  In the personal realm, I have to side with positive psychologists as the evidence is overwhelming that circumstances matter less than we think in terms of our own happiness.  Human beings get used to things and those that don't are who we call clinically depressed.  Dan Gilbert puts in best in this video:

 However, even if synthetic happiness is the same as real happiness, there are kernels of wisdom in Ehrenreich's criticism.  Believing that one can synthesize money is different from changing one's perspective toward money (e.g. being grateful for the comforts we have) and some new age interpretations of positivity are a bit ahead of the curve of what can be called science.  It is true that people are attracted to happy people, wanting to be around them in business environments, which likely leads to a link between happiness and wealth.  Ehrenreich acknowledges this, but calls this a bias that needs to be corrected.  That seems more like an opinion, as I think it's reasonable for many to prefer the company of happy people, both in dating and in the workplace.  However, I can see how those who are naturally less positive might feel discriminated against or even feel like something is wrong with them as a result.

Positive psychology and spirituality is not for everybody.  Ehrenreich admits to being an atheist in her book (p.17 - "atheists pray in their foxholes").  I, on the other hand, often attend a new age church where the preacher was actually in The Secret.  Still, I have always been uncomfortable with the idea that people use spiritual principles to manifest wealth, as many at my church believe, and instead choose to interpret wealth as meaning the inner wealth that we all have.  Getting off the treadmill which says we constantly need more money is the key to wealth, not having more stuff.  That's my opinion, but  I don't feel particularly upset that others around me might feel something different.  If you watch Stewart's interview, you'll notice that he tries to frame positivity similarly saying that if it works for other people, why does Ehrenreich have a problem with it?  Ehrenreich doesn't give an inch.  The anger she feels for her cancer experience is palpable (and legible in her book).  Isn't it just as wrong to try to force everyone to be 'realistic' (put in quotes as one person's realism is another person's delusion) as it is to force everyone to be positive?  I often write about moral confabulation in this blog and I would hypothesize that Ehrenreich's moral outrage about positivity is somewhat more about her personal feelings than her research.  I say that not to dismiss her book, which gives voice to a very real sentiment shared by many, but rather to point out a very real hazard of the phenomenon of studying happiness.  Specifically, it can wound people when forced upon them and cause a great deal of psychological reactance.  Advocates of the science of studying happiness and the positive psychology approach to health maintenance would benefit from reading her book and learning about her perspective.  It's not the only perspective, but it's an important one to listen to.

Sarah Palin, in contrast to the Obama administration, believes that Jewish settlements in disputed territory should be allowed to expand.  She is very clear about this belief in her recent interview with Barbara Walters.  But does she understand the reason for these beliefs?  Consider the below statement...

"I believe that the Jewish settlements should be allowed to be expanded upon, because that population of Israel is, is going to grow. More and more Jewish people will be flocking to Israel in the days and weeks and months ahead."

In contrast, here is the view of the Prime Minister of Israel from this article:

"We do not intend to build any new settlements, but it wouldn't be fair to ban construction to meet the needs of natural growth or for there to be an outright construction ban," Netanyahu said.

"Natural growth" is the term Israel uses for expansion to accommodate population growth inside the boundaries of existing settlements.

Perhaps a minor point, as Palin has part of the story about population growth right, but her opinion about a mass immigration into Israel causing a need for settlement is at odds with the official government position, which stresses that the population which needs to be accommodated is growth from within.  It's possible that there is some immigration pressure, but it isn't an opinion that is generally put forth by supporters of settlers and if population growth were the real "because" in her stated opinion, then one might think she would be equally concerned about the population growth of the Arab population, which is growing at a far faster rate, and where those people will live.

The moral intuitionist perspective would hypothesize that she has a really strong intuitive support for Israeli settlers and that when pressed, she may have to confabulate logical reasons for this support.  If you want to see moral confabulation in action, fast forward to 4:20 in the below video.

 For the sake of balance, Palin's detractors are certainly capable of motivated reasoning (see this article by Andrew Sullivan) and moral judgment and I have to admit that I doubt my own immunity to such processes.  So maybe there really is lots of flocking going on and I'm just unaware of the validity of that argument.  Or maybe not...;)

A current hot topic in the news is this story of Keith Bardwell, a Louisiana justice of the peace who refused to marry an inter-racial couple.  His stated reason is that "my main concern is for the children", meaning that the children may not be accepted by either racial group.  Further, he claims that he is not a racist as proven by the fact that he regularly performs ceremonies for black couples in his house.

I obviously have never spoken to Mr. Bardwell, but I would speculate that his reasoning is a classic case of moral confabulation.  He believes that interracial marriage is wrong and he believes that the children would be hurt.  But I would contend that he believes the children would be hurt because he believes interracial marriage is wrong while he has confabulated a story with reversed causality, whereby he believes interracial marriage is wrong because the children would be hurt.  If there were no potential harm to children (for example, if the couple is sterile), would he marry the couple or would he spontaneously confabulate a new reason for being unable to marry them?  My guess would be the latter.

Is it possible to be both pro-peace and pro-Israel?  What part of this is simply the moral confabulation of believing that your side (liberal or conservative) is correct and that the other side MUST be unpatriotic?  Sometimes we might dislike the opposing viewpoint so much that we question not just their wisdom, but their motives.

To help answer this question, I analyzed some of our data from yourmorals.org to see how identification with one's country (measured using questions like "How much do you identify with (that is, feel a part of, feel love toward, have concern for)...people in my country?") is related to attitudes toward peace (measured using questions like "Peace brings out the best qualities in a society.") and attitudes toward war (measured using questions like "War is sometimes the best way to solve a conflict.").  It is worth noting that attitudes toward war and attitudes toward peace are not necessarily the same thing.  They are highly correlated (r=-.68) in our sample, but the correlation is not perfect (-1 or 1 would be a perfect correlation).

At first glance, it seems that being pro-peace might be incompatible with identifying with one's country.  Consider the below 2 graphs.  Attitudes toward peace aren't really related to patriotism.  Attitudes toward war are related to patriotism in that people who identify with their country more seem to be slightly more likely to be more sympathetic to the need for conflict.

Given that the distinction between pro-peace and anti-war is difficult, it is unsurprising that from the simple relationships, people are suspicious of people who are both pro-peace and patriotic.  However, these relationships are not large and there are many confounding variables, the most obvious of which are your political leanings.  Much research in political psychology concerns our motivated reasoning to support our political party's position on any given issue.  If we look within each political party, the relationship between being pro-peace and pro-country changes as shown in the below two graphs.

The confusing purple lines above are self-identified libertarians.  Let's deal with them later.

The main result if we look at everybody else is that we see that identification with one's country is actually associated with being pro-peace WITHIN each political group.  In contrast, in the first set of graphs, being pro-war was associated with identification with one's country when collapsing across all political groups. The results suggest that identification with country is independently associated with being pro-peace if we control for being liberal, conservative, or libertarian.  If we control for the variance associated with political ideology, it is not patriotic to be anti-war or pro-war.  It IS patriotic to be pro-peace....and the reason people who are pro-peace are characterized as not being patriotic is because the doves and the hawks reside on opposite sides of the partisan divide.  This partisan divide also predicts identification with country (conservativism correlates .29 with identification with country).  But if we take out the variance due to ideology, peace is indeed patriotic.

Put in the context of the political issue of the day, there is nothing so abnormal about being pro-peace and pro-Israel, but it is unsurprising that critics of J Street are unable to disentangle their partisan leanings from their opinions about the group given the simple pattern of what we see in society.  It is worth noting though that questioning the motives rather than the wisdom of the opposing position is not something that is limited to conservative groups like the Weekly Standard.  J Street characterizes the Weekly Standard's actions as "thuggish smear tactics", "swift boat" moves, and "unhinged" which is surely a caricature of their true motivations.  My advice to J Street would be to avoid such confrontational language as it only exacerbates the partisan divide and makes it more unlikely that others might actually see resonance in their pro-peace, pro-Israel stance.

There is one group for whom being pro-peace is more diagnostic, libertarians.  Libertarians make up 10-15% of the population according to recent surveys and 7% of our sample, but it is worth speculating about why group identification is so diagnostic of war and peace attitudes for this group.  Using Moral Foundations Theory, war and peace attitudes are predicted by both the ingroup/loyalty foundation and the harm/care foundation.  Similarly, patriotism and identification with one's country is a blend of concern about loyalty to one's group and care for those group members.  Libertarians score lower on the moral foundations questionnaire on both the ingroup and harm foundations.  My hypothesis would be that for libertarians, identification with country is more a function of group loyalty rather than care for other group members (see Ayn Rand's virtue of selfishness).  Indeed, the correlation between Moral Foundations Questionnaire-Ingroup scores and Identification with Country scores are higher for libertarians than for every other group (r=.56 for libertarians, .37 for conservatives and .38 for liberals).  I would speculate that the fact that libertarian patriotism is more loyalty than care based is the reason why libertarian patriotism is more highly related to pro-war/anti-peace attitudes.  More on libertarians to come as I'm working on a paper on libertarian psychology.

I don't think everything that liberals are saying about Bush is wrong, but disliking someone so much that you compare them to Hitler is a stretch, unless the person you are comparing them to is systematically setting up camps to kill millions of people. What part of what liberals say about conservatives is confabulated as well? Could denial of global warming be a type of moral confabulation?