I think that a lot of insight can be gained into the ongoing discussions about health-care reform from an old joke:
In the late 18th century, a young English lord approached a beautiful woman at a party. He said, "Madam, I have been looking at you from across the room. I am quite rich and am prepared to offer you a fine estate, ten thousand pounds a year, and a stable full of horses. Would you consider marrying me?"
The woman blushed and replied, "I most certainly would!"
The lord then said, "Can I take you to my bed tonight for ten pounds?"
The woman turned scarlet, slapped him, and said "I am shocked, what sort of woman do you take me for?"
To which the lord replied, "I believe we have established that, now we are haggling over the price."
So what does that have to do with health care?
As this joke highlights, there is a moral rule that we do not trade money for sexual favors. That is, sex is not supposed to be something that has a price. The Psychologist Jonathan Baron calls these protected values. A protected value is one that a person does not want to violate at any cost. Indeed, asking someone to consider an economic tradeoff for a protected value leads to a reaction of moral outrage.
As the initial offer from the lord makes clear, though, we are constantly making monetary tradeoffs for things. As long as the situation is set up more subtly than a direct payment for a violation of a protected value, then we are happy to consider the value of our supposedly "protected" values.
Julie Irwin and Jonathan Baron demonstrated this point in a 2001 paper in Organizational Behavior and Human Decision Processes. They found people who stated that they had a protected value for saving the environment. Consistent with this value, they rated themselves as unwilling to purchase a product made from wood cut from a rainforest. In another task, though participants with protected values stated how much they would be willing to pay for a variety of desks that had many different features. Some of those desks were made from wood cut from the rainforest. In this case, people certainly gave a lower price for desks with the rainforest wood than for those made from other materials, but they gave a price. That is, they made clear that there was some price that they would ultimately be willing to pay for this desk.
The idea here is that the protected value has the biggest influence on people's attitudes when people are focused primarily on that value. When the value is placed into a broader context it tends to become one factor among many that affects people's choices. Then, we can and do consider monetary tradeoffs for that value.
Now to health care.
There are many possible protected values that people might have about health care legislation. Some want universal health care coverage. Others want the United States to avoid laws that smack of socialism. For those who want universal health care coverage, the threat that this goal will not be realized leads to strong reactions. Likewise, the many people who have attended town hall meetings and shouted down politicians are having a moral reaction to the possible creation of a big government project.
At the same time, political decisions are always being made to cut taxes or to spend money on government programs in which the ultimate outcome affects the protected values that people hold. Recent polls suggest that older voters are strongly opposed to health-care legislation that would provide universal coverage, because they are opposed to an increase in the size of government. Yet most of these voters are already covered by Medicare, which is a monumental government program. Because this program has been a line item in the budget for many years, it is no longer treated as a potential violation of a protected value.
So, it is important to recognize why different ways of stating the same position can lead to very different reactions. The world is a complex place, and there are lots of values that we hold dear. When we are asked a question about just one of those values, we are likely to treat a violation of that value with outrage. However, when we place our values into a broader context, we tend recognize that tradeoffs are often required. We can then negotiate these tradeoffs with reasoned discussion rather than violent argument.
