Repeal health care reform? The brain says no

Republican lawmakers are understandably chagrined over this week’s historic enactment of health care reform. After all, the legislation was passed and signed over their histrionics and without any constructive input from their side of the aisle, so they’re feeling irrelevant and impotent. That explains why they’re already making blustery threats to repeal this transformative piece of social law.

But it is just bluster. They won’t repeal the law—not for political reasons but for psychological reasons. Let me explain.

One of the cornerstone principles of cognitive psychology—the study of how we think—is the so-called default heuristic. The default heuristic, simply paraphrased, says that we won’t make the mental effort of choosing if we don’t have to. It’s much easier, cognitively, to punt, to go with the flow, to default to the status quo.

Here’s a famous example from the literature: About 28 percent of Americans are potential organ donors. That is, if they died tragically, their kidneys and heart would go to someone waiting for a transplant. In France, 99.9 percent of citizens are potential donors. Why would this be? Does altruism run in the French character? Is their moral training superior? Well, it’s actually much simpler: In most states in the U.S., the default position for organ donation is “no donation.” You must make the effort of deciding if you want to become a potential donor. In France it’s the opposite. Unless you make the effort to opt out, you are by default an organ donor. And it’s easier for the brain (French or American) not to trump policy. Thus it’s better to have kidney failure in Paris than in Washington, DC.

Why don’t people second-guess the status quo more often? Well, think about your typical day. You have a job to do, errands to run, perhaps you have a sick kid to worry about. Where does thinking about organ donation fit into those priorities? Plus, even if you do think about it and decide to assert yourself and become a donor, there’s the paperwork. Nobody is going to hand-deliver it to you. Maybe you’ll just watch TV instead.

You get the idea. Stress, fatigue, other demands—these are all what psychologists call cognitive load. Our brains do not have infinite capacity; indeed we have very limited processing capacity, which is why it’s so hard to juggle mental tasks. Our minds tire quickly, so we need to prioritize our mentally exhausting tasks. And not to put too fine a point on it, repealing the law of the land is probably not most people’s highest priority.

In psychological terms, as soon as President Obama signed the health care reform bill into law, it became the collective default position for millions of Americans—much like organ donor policy. There would have to be a compelling personal reason to spend time and effort on undoing the law—rather than, say, cooking a nice dinner or reading a good novel. Most Americans—except for a few vile and marginal tea-partyers—are going to forget about health care reform quickly. There are too many other things competing for limited energy.

Very few social programs are undone, and that’s because the brain’s default heuristic prefers consistency to waffling. Commentators are right to remind us of the brouhaha over Social Security when the idea was first broached. Opponents used the same hyperbole that tea-partyers are using today. But as soon as it became law over their objections, the energy dissipated as people returned to their workaday lives. And now, of course, it’s a default position that even Republicans consider sacred.