The Online Resource for Massachusetts Poverty Law Advocates

Health Care

How Unconscious Fear Of Death May Skew Your Judgment — In Life And 2016 Politics

CommonHealth (WBUR) - Fri, 03/11/2016 - 2:09pm

(Simeon Muller/

It’s “the worm at the core” of your life: the knowledge that you will die. And who can blame you if you assiduously push the worm to the back of your mind, right?

But then along come three experimental psychologists who cook up all kinds of crafty tests to analyze exactly what the worm is doing to you. They take Ernest Becker’s 1973 classic, “The Denial of Death,” and go all empirical with it, gathering actual data on how fear of death seems to affect people, from romance and shopping to war and, yes, 2016 politics.

So even though you may not want to look death in the face, you might want to peek at what the psychologists found in their research spanning hundreds of studies over 25 years. Because really, even though you may need your denial to get through the day, it’s arguably insane to spend a life pretending away its central fact. At the very least, you can try to understand what all that denial is doing to you.

Skidmore College professor Sheldon Solomon, co-author of the team’s new book, “The Worm At The Core: On The Role of Death In Life,” spoke recently at Boston’s Museum of Science, and I damped down my own denial and asked him about mortality.

A taste of what he said: “Whenever people are reminded of death, they love people who share their beliefs and they hate people who are different. They sit closer to people who share their beliefs and they sit further away from anyone who looks different. And if we give people in a laboratory setting an opportunity to physically harm someone who’s different, after people are reminded of their mortality they become much more hostile and vicious.”

Here’s our conversation, lightly edited:

How would you summarize your central idea?

What we would say, in a proverbial nutshell, is that one way of thinking about what makes human beings unique is the fact that while we share with all forms of life a basic inclination toward self-preservation, we are arguably unique because of our big forebrain, which gives us the capacity to think abstractly and symbolically, to dwell on the past and anticipate the future.

And because of that we’re smart enough to realize that like all living things, we will someday die; that we could die at any time, for reasons we cannot anticipate or control; and that like it or not, we’re animals, breathing pieces of defecating meat, no more significant or enduring than lizards or potatoes.

And our claim is — and this is based on Ernest Becker, who won a Pulitzer Prize for his book, “The Denial of Death” — that if that’s all we thought about, ‘I’m gonna die! I could walk outside and get hit by a comet! I’m a cold cut with an attitude!’ then we wouldn’t be able to stand up in the morning. We’d just be quivering blobs of biological protoplasm cowering under our beds.

And what we believe, following Becker, is that the way that human beings come to terms with the potentially debilitating existential terror that’s engendered by the awareness of death is to embed ourselves in culturally constructed beliefs about the nature of reality — what the anthropologists call culture.

Prof. Sheldon Solomon speaks at Boston’s Museum of Science. (Courtesy of David Rabkin/Museum of Science)

What culture does is to give us a sense that life is meaningful and that we’re valuable. It tells us where we came from, it tells us what we’re supposed to do while we’re alive. It gives us some hope of immortality in the hereafter, either literally — through the heavens, the afterlives and souls of all the world’s great religions — or symbolically: We may know we’re not going to be here forever but we’re still comforted by the fact that some vestige of of our existence will persist nevertheless — perhaps by having children, or by amassing great fortunes, or by doing something noteworthy in the arts or sciences.

And so the argument is that what makes us unique is that we know that we will someday die, and this gives rise to potentially paralyzing terror that we reduce by believing that we’re people of value in a world of meaning. And whether we’re aware of it or not — and most of the times we’re not — everything that we do, for the most part, is in the service of maintaining a sense that life has meaning and that we have value in order to reduce death anxiety.

So that fear of death is insidiously affecting our behavior all the time…

Absolutely. Because otherwise this might be right but trite. If it were obvious, then maybe we would all know this and be talking about it. But I think what makes these ideas both subtle as well as potentially profound — and profoundly interesting — is that the argument is that most of us don’t think about death all that much. And the reason is that we’re comfortably ensconced in a cultural worldview that is sufficient to allow us to stand up every day.

But your team’s work picks apart what those effects are experimentally.

That’s correct. Ernest Becker won a Pulitzer Prize for “The Denial of Death” and these are all his ideas. And people just said, ‘Well, this is shocking nonsense.’ Or, ‘This is interesting but speculative and can’t be tested.’ So 35 years ago, right out of graduate school — we’re experimental social psychologists, my buddies Jeff Greenberg, Tom Pyszczynski and I — we said, ‘Well, why can’t we try and test these ideas?’

The very first study we did was with municipal court judges in Tucson, Arizona. We divided them randomly into two groups. And we just told the judges we wanted them to look at a typical court case and assign bond for an alleged prostitute. What we did was to randomly divide the judges into two groups, where one of them was reminded of their mortality by answering two open-ended questions: Just describe your thoughts and feelings about your own death. And: Jot down what you think will happen to you physically when you die.

Then, a few minutes later, we showed them paperwork associated with a court case for prostitution, the most common crime in Tucson at the time, and we said, ‘Hey, what bond would you set?’

Now in the control condition, where the judges were not asked to think about their mortality, they set an average bond of $50. That’s good because that was the average bond for that crime at the time. That was baseline.

But when they were asked about their mortality first, they set a bond that was nine times higher — $455. And what’s amazing are two things: One is that judges are supposedly trained to administer the law evenly and rationally. And secondly, when we told the judges what we were doing they all said, ‘No way your stupid little questionnaire could have had any effect on my behavior.’

And this was the first of now more than a thousand studies where we and other researchers provide death reminders — sometimes with a little questionnaire, sometimes we stop people in front of a funeral parlor or 100 meters to either side, sometimes we’re even more subtle and we bring people in and have them read stuff on a computer while we flash the word death so fast, 28 milliseconds, that nobody even sees it.

And yet whenever people are reminded of death, they love people who share their beliefs and they hate people who are different. They sit closer to people who share their beliefs and they sit further away from anyone who looks different. And if we give people in a laboratory setting an opportunity to physically harm someone who’s different, after people are reminded of their mortality they become much more hostile and vicious.

Across all those studies, what’s the order of magnitude of the change?

In most of our studies, we’re just concerned with more or less. In the case of the judge studies, the magnitude was profound: It was nine times as much. Then we did another study where we wanted to show that death reminders do not just foster punitive reactions. So we had the subjects think about death or not, and then showed them a little newspaper article about a citizen behaving heroically by thwarting a bank robbery. And then we said, ‘Well, how much monetary reward would you give that person?’ And people reminded of death said they’d give the person three times as much. So sometimes these effects are both profound and considerable.

When we talk about the effects of death reminders on political preferences — I’ll give you another example that i think is quite astonishing:

Just prior to the events of Sept. 11, President George W. Bush had the lowest approval rating of any standing president. Three weeks later, he had the highest approval rating, and this was across political lines. Even 80 percent of Democrats were enthusiastic about President Bush. And we got to thinking about this, because Max Weber, a German sociologist at the beginning of the 20th century, said that in times of historical upheaval — when people are understandably quite uncomfortable to the point of feeling existentially threatened — this is a fertile substrate for the emergence of what he called charismatic leaders.

We all know the term ‘charismatic leader’ but most of us don’t know that Weber was the one who coined it. And Weber said a charismatic leader is somebody who is imbued by their followers, or imbues themselves, with this kind of supernatural, larger-than-life kind of aura, often proclaiming that they’ve been chosen by God to rid the world of evil. And this is precisely what President Bush said in the aftermath of Sept. 11. A couple of days later he said, ‘We will rid the world of evildoers.’ And then in a cover story in Time magazine in October of 2001, he said he thought God had chosen him to lead the country during these perilous times.

So we did 10 or 12 experiments — they’re very simple. We just went to different places in America and we randomly divided people into groups. Some were reminded of their mortality, while some were reminded of unpleasant but not fatal things, like students failing an exam or being in pain and going to the dentist and having to have a root canal. And then we just asked them: What do you think about President Bush and his policies in Iraq?

We were frankly astonished, because Americans in a benign state of mind, in a control condition, were not enthusiastic about President Bush and his policies in Iraq. But death reminders consistently increased his popularity. The most glaring example of that was a study that we did five weeks before the 2004 election. It was at Rutgers University with American citizens who were registered to vote and intended to vote. We randomly divided them into two piles: half were reminded of their mortality, the other half of something unpleasant, and then we just basically said, ‘Who do you intend to vote for in the election five weeks from now? Secret ballot, we’re not asking you to tell us.’

What we found was astonishing because in the control condition, the respondents said they intended to vote for Sen. [John] Kerry by a four-to-one margin. However, the people who were reminded of their mortality said they intended to vote for President Bush by an almost three-to-one margin. To me, these are gargantuan effects.

The point that we made at the time was: We’re not proposing that anyone who supported Bush was necessarily doing so for defensive reasons. On the other hand, well, there were millions of people who voted in that election and surely some of them were undecided up to the point where they actually walked into the voting booth. And just like the judges, the participants in this experiment said to us: ‘No way your stupid questionnaire influenced how I was going to vote.’

I think this has ominous implications for democracy regardless of one’s political predilections. I think here’s one thing conservatives and liberals should agree on, and that is that elections, abstractly and ideally, should be decided by people making rational deliberations based on a command of the facts. And as you know, there’s not much evidence of that in the current run-up to the 2016 elections.

Which leads us to: How do those Bush and 9/11 findings make you see what’s going on on right now?

We see eerie historical parallels. We haven’t had anything of the magnitude of 9/11. However, we have had the Paris attacks, we had the San Bernardino shootings, we’ve got Syria melting down, the entire Mideast is unstable and there are droves of people making their way to Europe. We began to get interested this summer when Donald Trump became a most unlikely serious contender for the Republican nomination by proclaiming that he’s going to build a big wall and that he’s going to ‘bomb the s— out of ISIS’ — those were his exact words — and that he’s going to make America great again.

To us, this really harkened back to Weber’s conception of a charismatic leader, so we did a study in September and October in Staten Island, where once again we asked some people to think about their mortality and other people to think about something unpleasant. And we found the same thing as in our 2004 President Bush studies, and that is that in response to a death reminder, people reported being more supportive of Mr. Trump and more willing to vote for him.

By what measure? 

This was just more or less. We just wanted to see whether death reminders made a difference. Now that raises the very practical question of well, how much of a difference? And we were frankly just wanting to wait to see who would become the actual nominee. It seems to us that regardless of who ultimately will run for president that there will be no shortage of reminders of death in a rather thinly veiled effort to engage existential concerns to override rational cogitations.

Once again, I want to emphasize that we do not have a partisan stake. We all have strong feelings as citizens, but our main concern here is to just make people aware of how profound a difference even fleeting and indirect reminders of death can have. When Donald Trump or other candidates mention immigration or mention terrorism, whether they’re aware of it or not, what we believe they’re doing is to indirectly conjure up intimations of mortality.

But isn’t it just fear-mongering, not necessarily about mortality?

No, because every time in our experiments when we compare death reminders to other grotesquely fear-provoking stimuli, it’s death that matters. Sometimes we say to people, ‘You’re going to have a root canal with no anesthetic.’ Sometimes we say, ‘Imagine you’ve been in a car accident and you have to to have a limb amputated.’ Sometimes we say, ‘Imagine you’re giving a speech in public and you get sick and projectile-vomit on the audience and you’re humiliated.’ None of those things produce the effects that subtle death reminders do. And so on those grounds what we argue is that death is the motherlode of all fears.

If you wanted to help people be more rational about this, what would that sound like?

More From CommonHealth:

It would have to start very early in education. I think it would have to be non-denominational, in terms of not selecting any person or issue. In general, people just need to know that subtle, even unconscious death reminders can radically skew everything from their political preferences to the way they take care of themselves or don’t take care of themselves with respect to health-related behaviors.

We’re all human, myself included, I’m told by some. After Sept. 11 when I was standing there, late that day, as far south as I could get toward the former World Trade Center, I was no different from a lot of Americans. I was saying, ‘We gotta kill somebody!’ And I had to stop myself and say, ‘Wow, wait a minute, I am an ambulatory example of everything we have studied as psychologists.’

By not disqualifying ourselves from being prone to these processes, I think this goes a long way. I don’t think any kind of pontificatory behavior that appears to be patronizing and condescending — to the effect of ‘Oh, this is what you’re doing’ — will help. Better to say, ‘This is what we all do,’ and to get people to agree that this is non-optimal. And then we can get to the particular applications of this phenomenon in the hopes of making some headway.

Categories: Health Care

Mass. Small Business Owners Dropping Health Coverage That’s Become Unaffordable

CommonHealth (WBUR) - Fri, 03/11/2016 - 5:41am

Ryan Cook wanted to help. The office manager at his small Raynham real estate office needed health insurance; her husband had lost his job and with it, the family’s coverage.

So Cook looked into adding the woman and her family to his self-employed plan. “And I was seeing prices at about $1,800 a month. That cost was ridiculous, quite frankly,” said Cook, president of FCRG, Inc.

Ridiculous, but not a complete surprise, as Cook’s own premiums have increased 50 percent in the last three years.

His office manager tried another option. She applied for subsidized coverage through the state Health Connector and was told she qualified. Her monthly contribution would be $250 a month.

“It just made no sense at that point for me to provide that benefit to my employee,” Cook said.

Cook says many small business owners he talks to at Chamber of Commerce luncheons and other meetings are struggling to stay competitive with larger firms when it comes to benefits.

“The one that everyone is choking on is the cost of health care,” Cook said. “They’d love to be able to offer it but it just becomes so cost prohibitive to the business that you can’t do it.”

Jon Hurst, president of the Retailers Association of Massachusetts, says his members, which have an average of 10 employees, have seen premiums rise in the range of 12 percent every year for the last decade.

“A 12 percent increase in already-high health insurance premiums, coupled with rising rents, rising payrolls and, frankly, sales that are flat or down at the level of inflation, well, that doesn’t work economically — something’s going to give,” Hurst said.

Small business rates approved for April 1 offer no relief. The base, or starting point for premiums, will rise anywhere from 0.4 percent at Tufts Health Public Plans to 32.3 percent at Harvard Pilgrim Health Care. The average base rate increase is 7 percent — many times the projected rate of inflation.

“Premiums reflect the cost of medical care,” said Eric Linzer, senior vice president at the Massachusetts Association of Health Plans. “What we’re seeing is a combination of rising prescription drug costs, care delivered in some of the highest-priced settings, and there are significant costs associated with the Affordable Care Act (ACA) that have increased premiums.”

Hurst says many small businesses have tried all the solutions brokers suggest, like offering coverage with high deductibles or increasing employee co-pays. Some of the larger small businesses are moving to self-insured coverage, where a company is responsible for the medical expenses incurred by its employees.

“Or maybe try to get their employees to be insured elsewhere if they are very small,” Hurst said.

There are several changes that may have made it easier for workers to move from a company plan to MassHealth (Medicaid) or subsidized coverage through the Health Connector.

For one thing, making that transition is now allowed. Before passage of the ACA, Massachusetts residents who had access to insurance through work could not enroll in subsidized plans. But the ACA lifted that restriction and Massachusetts followed suit in 2014.

Second, many small businesses no longer face a penalty for failing to provide insurance. A state fee of $295 per worker for firms with 11 or more employees ended in 2013. The state employer penalty for small businesses is scheduled to be replaced this year by a federal fine that applies to some companies with more than 50 workers. Cook, the real estate president, says some companies are splitting in two so that they stay under the 50-worker threshold and avoid the fines.

Bill Vernon, Massachusetts director for the National Federation of Independent Business, says members who drop coverage do so because they can no longer afford it. Employees typically switch to a spouse’s health plan, buy coverage on their own or, most commonly, enroll in MassHealth or a subsidized ConnectorCare plan.

“People are insured,” Vernon said. “What we see here, I think, is the shift as to who is paying and how it’s being paid.”

It’s not clear how big of a shift is underway. Raw numbers from the state Division of Insurance (DOI) show at least a 30 percent drop in small business coverage between 2007 and 2014.

Fewer Small Business Employers Offering Coverage:

Click to enlarge: This table shows the number of Massachusetts small business employers offering coverage between 2007 and 2014. (Courtesy Bob Carey, with Division of Insurance data)

Fewer Employees Covered By Small Business Plans:

Click to enlarge: This table shows the number of people covered by a small business insurance plan between 2007 and 2014. (Courtesy Bob Carey, with Division of Insurance data)

Bob Carey, a health care consultant who was part of the team that launched the Connector, pulled the above DOI numbers after noticing a recent one-year drop in small business coverage rates.

The small business insurance filings for April 2016 show the number of workers covered by an employer plan has dropped another 5 percent.

Changes in state and federal insurance law may explain some of the drop. People who are self-employed used to be counted as small businesses, but are now tallied in the individual market. More DOI data compiled by Carey shows 27,517 people who might be in this category. Then, some small businesses may have grown and moved into the larger employer category. And some firms, as Hurst said, have started self-insuring and would not be captured in the DOI figures.

But still, it looks like something is happening in the small business market.

“I think folks in this market assumed that the small group market, which is 50 or fewer employees, had remained relatively stable,” Carey said. “But in fact we see that there’s been an annual decline in both the number of people covered and the number of employers who offer coverage.”

DOI doesn’t see the numbers that way.

“The apparent decline over that timeframe cannot definitively be attributed to small employers not offering employees health insurance plans,” said Chris Goetcheus, spokesman for the Office of Consumer Affairs. “These employers may have found alternative means to negotiate coverage in the large employer group, which DOI does not regulate.”

The most recent survey of employer coverage might seem to support that idea. It shows that 76 percent of Massachusetts employers offered health insurance between 2011 and 2014, a rate that’s significantly higher than the national average of 55 percent.

But Aron Boros — who directs the Center for Health Information and Analysis, the agency that produced that survey — says the overall steady rate masks some subtle changes.

“We do see, over the last year, a trend where fewer members are receiving their coverage in that small group market,” Boros said. “We see premiums increasing in that small group market at a more volatile and higher rate than in other sectors.”

Boros says he can’t tell exactly where employees of small businesses go for insurance if the company ends coverage. Some of the numbers he’s looking at don’t add up. Private plans say they are covering about the same number of people, the state’s uninsured rate was consistent last year at 3.6 percent, and yet enrollment in MassHealth and subsidized ConnectorCare is up.

“There’s a little bit of an open mystery in these enrollment figures,” Boros said.

There’s no question this mystery is putting enormous pressure on the state budget. MassHealth grew to just over 2 million residents 15 months ago. That’s one-third of the state’s population. The Baker administration reviewed eligibility and the number dropped to about 1.8 million — still a quarter of all the men, women and children in Massachusetts. State Health and Human Services Secretary Marylou Sudders says she’s not making a direct link between a decline in employer coverage and an increase in the state rolls yet, but is watching the insurance numbers closely.

“Massachusetts health reform law is based on all of us having shared responsibility,” Sudders said. “As we go forward we need to be certain that our employers, our individuals and our insurers are all part of that conversation so that we can continue to have 97, almost 100 percent of folks in Massachusetts have health care coverage.”

Many small businesses say they hope to be part of that conversation, but they’re struggling. The idea that employers would take their share of responsibility for expanding coverage was premised on the pledge that health insurance would be affordable. For many small businesses it is not.

“The costs are getting crazy for us,” said Tom Erb, president of Electric Time Co. in Medfield, where premiums rose 22 percent this year. “For a family plan, my cost per employee is $5 to $6 an hour.”

Erb says he doesn’t feel like he can drop health insurance and still attract good employees.

Besides, he said, “I don’t know what the options are, kick everyone out and throw them to the Connector?” It’s not something Erb wants to do.

“This is a harbinger for the rest of the country,” consultant Carey said. “We had, and we still have, more small employers offering coverage than almost any place in the country, but we’ve seen a decline, and I think you’ll see that play out in other states as health reform and people realize that there are other coverage options.”

Categories: Health Care


Subscribe to Mass Legal Services aggregator - Health Care