Compared to What?
When I applied to graduate school, I had to take the Miller Analogies Test. The MAT asks respondents to select one of several choices to complete comparative statements: Something like, “Right is to Wrong as Good is to (a) Evil (b) Dark (c) Dogs.” The best answer would be (a), but any of the choices might fit, and this item would effectively weed out cat people from graduate study.
My degree is in education. Do careers in public policy require the MAT? Because analogies matter. A leader who actually thinks that anything “dark” or “dog” is evil could promote a lot of suffering. Consider health care (as if you have a choice—check your inbox). The choices presented to us are extreme: “Health Care is to the Affordable Care Act as Civilization is to (1) Communism (2) Fascism (3) Lehman Brothers (4) Noah’s Ark.”
But what do we really want health care to resemble? One suggestion is that it should be a good retail operation. In that case, success would be something like a profitable auto parts store: Useful for everyone who has a car. Customers can spend whatever they want. The providers compete for the customers’ money. Of course, if you don’t have a car, there’s no reason to even be there, and that’s where the analogy breaks down. Everyone owns a body, whether we enjoy it or not, and it’s not like we can give it up and use a bicycle instead.
Or health insurance is like automobile insurance. Everyone has to have it, but you can get the required coverage from whomever you want. If your car is damaged, you and others involved will get at least some benefits. As it happens, I have recent first-hand experience in this area. The car is doing fine. The medical coverage will not be resolved for a long time. I’m good with medical coverage being like car insurance as long as the body work is taken care of as quickly as the quarter panel on our Subaru.
In terms of the MAT, partially correct analogies are wrong answers. Suppose health care is actually analogous to disaster relief? In that case, success would mean universal availability, or the whole society is vulnerable. If a disaster (say, a hurricane) hits a vulnerable population (say, in the Mississippi delta), overwhelming local capabilities, we expect a national institution like the Federal Emergency Management Agency to step in. We’re outraged if FEMA blows it, not so much because of the what happens to retail and insurance profits (although those suffer), but because disaster-response infrastructure is something everyone expects.
The disaster-response analogy is more accurate, but still incomplete. I believe universal health care is to functioning society as the levee is to the flood plain. If you don’t have it, you can’t live there. Sooner or later, you’ll be swept away. Sure; luck and wealth might give you the high ground. But the society itself will be gone or changed forever.
