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Politics, Medicaid & Sleights of Mind

Four years ago, I spoke at a scientific conference at the University of Colorado in Boulder and was followed on the program by a married…


Four years ago, I spoke at a scientific conference at the University of Colorado in Boulder and was followed on the program by a married couple doing path breaking work on “the neuroscience of magic.” Their presentation, which was very cool, came back to me yesterday at a quarterly meeting of the Kaiser Family Foundation board, whose equally expert and cool staff were updating the trustees on the unfolding story of Congressional efforts to “repeal and replace Obamacare.” Although I’m a member of the board, these thoughts are mine, not the foundation’s.

Since 1991 the Kaiser foundation, in the words of its president, Drew Altman, has been playing “a special role as a trusted source of information in a health care world dominated by vested interests.” KFF is now firmly established in health policy circles — and beyond — as the go-to source for judicious, non-partisan analysis of policy options in health care, for honest and fair reporting of findings, and for an unrelenting focus on the impact of decisions on Americans’ health and access to needed care, with especially meticulous attention to consequences for those who seldom find themselves “in the room where it happens.” In its policy work, the foundation carries those silenced voices into those closed rooms. Its multi-media programs, notably the ubiquitous (and editorially-independent) Kaiser Health News, carries out across the country compelling stories of what’s really happening to real people.

Kaiser’s Program on Medicaid and the Uninsured has long been a major effort, a fount of timely insight into the workings of the nation’s 52-year old health safety net on which millions have depended for support. Without it, many enrollees would, literally, have died. Medicaid is at the center of the epic battle to insert an “H” into the ACA, replacing the Democrats’ “Affordable Care Act” with what for now the Republicans are calling the “American Health Care Act”. Whatever shape the new law takes, if one passes, it seems unlikely to be known by the name of the current president who is little more than a convenient smokescreen for a massive Republican retrenchment from a longstanding social compact.

Hence our question: Magic and Medicaid?

Let’s start with the magic. What made the Boulder presentation so intriguing was that the two neuroscientists, Stephen Macknik and Susana Martinez-Conde, had persuaded some of the world’s great magicians to allow them to study techniques to trick the brain, to “hack” the brain, they said, explaining that magic depends on our hardwired brain processes of attention and awareness that “are hackable” by skilled tricksters. They named the subfield they were pioneering “neuromagic.”

The first chapter of their book, Sleights of Mind, closes with this summary:

“A good magician uses your mind’s own intrinsic properties against you in a form of mental jujitsu. By understanding how magicians hack our brains, we can better understand how the same cognitive tricks are at work in advertising strategy, business negotiations, and all varieties of interpersonal relations. When we understand how magic works in the mind of the spectator we will have unveiled the neural bases of consciousness itself.”

Consciousness itself. “The hard problem.” My curiosity about these matters was boosted during time I spent over the past five years as a member of another board, the Mind and Life Institute, founded some 30 years ago by the Dalai Lama and a Chilean neuroscientist, Francisco Varela. Their goal was to foster intellectual exchange between Eastern mind science and Western brain science.

That board took me to India twice and to several U.S. cities to participate in East-West dialogues hosted by the Dalai Lama. It took me also to the exploding literature on the workings of the human mind, which, as a rank amateur, I am barely beginning to sample. With the poet, Wallace Stevens, I can hope that “it is necessary to any originality to have the courage to be an amateur.” My equally superficial interest in training the mind through contemplative practice or mindfulness meditation, another discipline with roots in Buddhism, bears on the question we’re circling now about defenses we humans might be able to muster against the magicians’ — and the politicians’ — mental jujitsu moves. Staying focused is surely one, and I decided not to delete this winding paragraph mostly because it so aptly illustrates the propensity of the human mind — our “monkey mind” — to wander off. But I digress …

The current political cauldron in which we find ourselves seems to be exacerbating the attentional deficits to which Nicholas Carr, and others, have been drawing our attention, such as it is. Whether, and if so how, the Internet improves or diminishes our powers of attention and memory is an open question, but that it “changes the brain” is uncontroversial.

Now back to Medicaid. What came into sharp relief in the interchange around the Kaiser table, whose trustees bring extensive high-level government and media experience, were the very high table stakes for which the Congress is choosing to play its game of poker, with an eviscerated “Obamacare” as the ultimate prize, or so we are led to believe.

What’s at Stake” is a persistent theme on the Kaiser website, which describes key provisions of the Medicaid law and how current proposals would dramatically increase the number of uninsured Americans (by 23-million the Congressional Budget Office estimates), bringing the total number of uninsured to over 50-million people, many of whom are among the nation’s most vulnerable citizens.

The leaders of the Senate and the House are intent on rushing this through, skipping procedural checkoffs in the normal legislative process, including the usual conference to resolve differences between versions of the bills voted in the two chambers. The Republicans want a win and they want it now, so they can move on to tax reform. Pundits are starting to predict that they will pull this off. If they do, they will have “solved” the federal government’s fiscal health care problem by ”devolving” it to the states, to Governors who, with the so-called “flexibility” of this Trojan Horse, will have revenue budgets that will appear to have been struck by a meteorite. Drew Altman’s June 2 Axios essay, “What’s Really at Stake …,” plays out the scenario:

“The $834 billion cut in federal Medicaid spending in the American Health Care Act would kick off budget battles in the states that go way beyond Medicaid. We could see cuts to higher education, school funding, corrections, environmental protection or other state priorities — or new taxes, depending on the state. … Medicaid is the largest source of federal revenues states receive, and once the proposed reductions trickle down to state budgets, it won’t only be a Medicaid debate any longer.”

The proposed mechanism for shifting the costs and risks to the states is called a “per capita cap” on spending, the focus of much debate. Beyond that, though, something more profound is going on, without the kind of discussion a change of such magnitude warrants. The real intent is to change the fundamental structure of the nation’s largest entitlement program, and thereby undermine the very legitimacy of the notion that there are protections to which citizens of a civilized nation should be “entitled” — basic health care, a safe environment, a decent education, justice and fair play — collective protections for which the federal government should be held accountable.

From “neuromagic” we have concepts that may shed light on how we’re being duped: “frames, or “windows of space the magician creates to localize your attention,” and varieties of “misdirection,” such as an unexpected flying dove (a “big move”) that catches your eye and “covers the small move” of the magician reaching into a box to set up the next trick. Or “time misdirection” through which the magician makes his secret move when you think the trick hasn’t begun. Sleights of Mind contains dozens of similar examples, integrating them with both psychological and neuroscientific research.

In related work, distilled for general readers in Thinking Fast and Slow, Nobel laureate, Daniel Kahneman mines another rich vein of insight into how we fool ourselves, and Michael Lewis’s The Undoing Project is a riveting story of the scientific friendship behind that line of research. George Lakoff has long been framing and reframing political discourse from his perch as an expert in linguistic and cognitive neurosciences.

Once we penetrate the illusions clouding the Medicaid case, our attention turns to the states and the governors, especially those for whom the Medicaid caps on spending will be hardest to absorb. In its latest analysis, Kaiser has identified state-level “risk factors” and has grouped individual states by the risks they will face. All states will suffer, which means that, among politicians, it may be governors who will be first to feel the pain of this historic retrenchment from an ethic of care. That will likely be too late to stop the Congressional juggernaut, but one can hope that at least some Republican governors will become stronger voices for greater reason and moderation.

“Hope.” A word that carried multiple meanings in the recent Comey hearings. It may not be too much to hope that those of us who are looking for some light in these dark times might turn to the state and local levels, as many are doing, even as we continue to work for movement in the midterm Congressional elections.

And we might hope that Americans will begin to see the misdirections for what they are: the “big move” (like the sudden dove flight) is, in this case, the manufactured animus against a caricature of the enhancements to Medicaid that actually made “Obamacare” a progressive instrument of social cohesion. Not a perfect one, but a promising start. If we glance over there where the deceiver is hard at work, we will see the “small move,” the one that sets us up to be duped.

The real agenda is to starve government, starting with the underlying Medicaid program that has delivered on the American promise of social justice and mutual aid. For what? To build up the military, expand the nuclear arsenal, cut taxes for the super wealthy, eliminate regulations, shore up the failing carbon economy, strengthen corporate political influence, do deals with dictators, and continue to accumulate enough money and power to keep the plates spinning and the magic working.

Until we reintroduce some rudimentary checks and balances in the federal system, we are at the mercy of the sleights of hand that are making our minds spin. At times of instability, change can come quickly, though, as Teresa May learned to her dismay this past week.

Whatever may happen here, we would do well, in the meantime, to sustain our hope, keep our wits about us, maintain our equilibrium, and nurture the connections that bring us comfort and joy. Sounds like a job for mindfulness meditation. Off to my zafu.

Originally published at medium.com

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