A Bad Healthcare Analogy

“All it takes is a little time with the DMV to remind you why you don’t want the government to touch health care.”

-A friend’s away message

Anyone who has spent much time discussing things with me has probably been subjected to the analogy rant.  Often accompanied by gesticulations and a raised tone of voice, the rant mainly focuses on how often analogies are used to prove points, when in fact analogies have no force of proof whatsoever.  They are merely illustrative devices.  The original statement remains as true or false as it was before the analogy, and yet the case is often subsequently treated as closed.  However, there is a second danger to analogies, less inherent but more insidious.  The problem is simply that most analogies are bad.

A bad analogy suffers from the “apples and oranges” problem*:  it compares two things that are not comparable.  As a result, instead of illustrating, it misleads.  Instead of bolstering a true conclusion, it directs to a false conclusion—or, at the least, a logically unsound one.  Overly drastic analogies may reduce complex issues to sound bites in an attempt to make a nuanced problem appear open and shut through comparison to entities that everyone agrees are good or bad.  As a result, all discourse is cheapened and rhetorical tricks are elevated above substantive arguments.  The consequences are serious, which is why bad analogies should be stamped out wherever they occur.

Consider the above statement.  The context, of course, is the healthcare reform bill currently waiting to be resolved.  The House version of the bill includes a public option that would allow people to buy government-funded health insurance.  The statement attempts to prove (or rather, further support the conclusion the writer already considers to be foregone) that a government-run health insurance program could not be a good option because it would be as inefficient and frustrating as the DMV.  Since every licensed driver in the United States agrees that going to the DMV is a Dantesque punishment, the writer is attempting to tap into its self-evident awfulness to prove the public healthcare option to be equally inevitably awful.  Unfortunately, the analogy would only stand if the DMV and the public options were equivalent institutions, which they are not.

The statement attempts to compare a government-run institution with no private competition to a government-run institution introduced as a competitor to private institutions.  The fallaciousness of the comparison should be clear.  Institutions with no competition are in danger of becoming costly, unwieldy, and inefficient because customers are forced to patronize them whether they want to or not.  The DMV illustrates this problem (with the exception of cost; because the DMV has no need to turn a profit, a driver’s license is $64 and vanity plates are a modest $30 per year).  This would be equivalent to public health insurance introduced while simultaneously abolishing all private health insurance, but that is not the situation being discussed.  Ruling out the possibility that the writer is either ignorant of the content of the healthcare proposal or deliberately implying that the proposal is something it isn’t, we have a comparison between two things that simply aren’t similar enough to be meaningfully compared.  In other words, a bad analogy.

A valid comparison would have to compare the public healthcare option to another situation where a government institution provides the same services as private ones.  The post office and public universities are both good examples.  In both cases, we see in action the kind of competition the public healthcare option is designed to promote.  Both systems coexist comfortably with their private counterparts.  Public and private find different niches and audiences, but both are forced to maintain a reasonable level of performance— variously some combination of low prices, quick delivery, a good standard of education, and so on, depending on the institution—lest one lose out to the other.  The private sector’s better efficiency keeps the public sector from becoming excessively cumbersome, while the public sector’s lack of need for profits keeps the private sector from price gouging too badly (the exception is private colleges, where for some families price is no object).  Comparing the public healthcare option to an analogous system leads to the conclusion that it will be beneficial, not detrimental.

As a side note, the above illustration makes it obvious what is wrong with the DMV.  It has no private counterpart.  Both private and public options are necessary to create beneficial competition.  If a private company also offered valid driver’s licenses, DMV lines would be shorter and DMV employees would be forced to occasionally help people or else lose their customer base and, as a result, their jobs.  Eventually they might be able to take down the bulletproof plastic windows and the signs warning patrons not to threaten employees.  Under comparable circumstances, the DMV would perform more like the post office: well enough that there are circumstances when one would voluntarily choose the government option over the private one.

Even if one had to compare the public option to a public institution with no private competition, picking the DMV is overly fatalistic.  Other government-run institutions with no competition manage to do an acceptable job.  For instance, while it took me four trips and three months to get my California driver’s license, I got an updated Social Security card in less than an hour.  You can get a passport by mail, requiring a long wait but a minimum of hassle.  Picking the government facility with the worst reputation for inefficiency and bad service smacks of emotional appeal, harnessing the reader’s instinctive dislike of the DMV to create a negative impression of the public healthcare option instead of providing any substantive reason why the latter should be equally bad.

There is another minor reason why the comparison is invalid: it compares an institution that is actually run by the government (the DMV) with one that would only be funded by the government (healthcare).  The specific phrasing evokes the image of waiting at a hospital or doctor’s office as one waits at the DMV, but that situation would only make sense if the government were actually running all the hospitals.  In reality, hospitals would remain as they are now: about two-thirds nonprofit with the remaining third split between for-profit and public.  Hospital administration would remain the same.  The only change would be who was charged for services.  Of course, with funding come restrictions and with restrictions comes inefficiency, but the same problem exists with private insurance providers and, more to the point, it isn’t the same sort of inefficiency found in the DMV, where lack of accountability allows inefficiency to fester.  The same presumably goes for doctors’ offices; it seems unlikely that every private doctor’s office would be replaced with a government-run behemoth.  Even if the misleading is not deliberate, linguistic imprecision that gives an argument a false impression of validity is always highly suspect.

There is no reason to believe that the statement was made with bad faith, or indeed with any motivation other than a burst of frustration at the DMV.  Nevertheless, the DMV is not a health insurance provider and has no particular resemblance to one, public or private, existing or proposed, and even the most cursory amount of forethought should have revealed this.  Such a comparison is a perfect example of a bad analogy.  It uses one thing’s emotional context to apply connotations inappropriately to another thing, all in support of a conclusion that the writer was already sure of.   In the spirit of fostering intelligent debate, this analogy must be squelched.

—-

*This is an idiom, not an analogy.

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1 Comment

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One response to “A Bad Healthcare Analogy

  1. Joe Sullivan

    Bad analogies are bad only if a person is trying to create understanding. Most of the discussion about health care (and other political issues) seems like it is coming from people who aren’t interested in enlightenment. These days all issues boil down to whether they can be used to attack Obama and his “socialist agenda” or not. It is sad that politics has become a contest that opponents seek to win at all costs, rather than determining what is best for the country.

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