Hot Thought

Psychology meets philosophy: knowledge, reality, morality, meaning

Is Healthcare like Broccoli?

How to Evaluate Analogies

Some critics of U.S. President Obama’s healthcare plan have argued that requiring people to buy health insurance is as illegitimate as requiring them to eat broccoli. A psychological theory of analogy clarifies where this reasoning goes wrong.

In the debate leading up to the recent U.S. Supreme Court decision about Obamacare, Justice Scalia raised the question of whether forcing people to buy health insurance is like forcing them to eat broccoli. Such analogical reasoning is common in politics and many other spheres of human life, but it is not easy to figure out when analogies are being used well or poorly. One way to evaluate analogies is to use the psychological theory of analogical thinking that Keith Holyoak and I developed in our book Mental Leaps. We proposed that analogies need to satisfy three constraints: meaning, structure, and purpose. Analogical inference tries to apply information from a source analog (broccoli) to make inferences about a target analog (healthcare).

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The meaning constraint says that analogies should try to map elements with similar meanings. On the surface, broccoli isn’t much like health insurance, as one is a vegetable and the other is a social practice. On the other hand, both the source and target analogs in this case use the same concepts of government and requiring, so there is at least some meaning similarity between the source and target analogs.

The structure constraint says that analogies should try to preserve relational structure, which the broccoli analogy does well: the government requiring purchase of broccoli has the same relational structure as the government requiring purchase of health insurance.

Finally, the purpose constraint says that all analogies are intended to accomplish goals and should be assessed with how well they accomplish those goals. Justice Scalia’s use of the broccoli/health insurance analogy was intended to accomplish his goal of minimizing the involvement of government in people’s lives.

This raises the philosophical question of what goals are relevant to government policy. For some Americans, freedom is the only goal that matters, so that any kind of interference with individuals such as requiring people to buy health insurance is illegitimate. But the U.S. is the only prosperous country in the world that does not provide some kind of universal health coverage. Other countries, such as my home Canada, have judged that health care is a fundamental human need that the government has a responsibility to satisfy, like clean water. If the goals of government policy are to meet a range of human needs, not just freedom, then the broccoli/healthcare analogy fares poorly on the purpose constraint.

Following the American debates about healthcare, I’ve been amazed by the lies told about the Canadian system. Canada has had universal health insurance for decades, and people are generally very happy with it. The most right-wing politician would never dare to propose abolishing it. Canada spends far less per person on health care than the U. S., yet life expectancy is substantially higher: 81.48 years in Canada versus 78.49 in the US, which ranks 50th in the world according to the Central Intelligence Agency. Canadians don’t have to buy health insurance, which is provided by the government and paid for by employers and general tax revenues. People rarely have to worry about  pre-existing conditions, bankruptcy resulting from medical expenses, or loss of health coverage from changing jobs. This doesn’t mean that Canada is a socialist country, as most of the economy continues to operate on a free enterprise basis. It just means that Canadians have chosen a health care system intended to meet fundamental human needs.

In sum, the broccoli/healthcare analogy does well on the structure constraint, ok on the meaning constraint, but abysmally on the purpose constraint where it ignores the appropriate goals of political action.

Paul Thagard is Professor of Philosophy at the University of Waterloo and author of The Brain and the Meaning of Life.

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