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How GOP secrecy on the health bill plays into our psychological biases

Why it’s so hard to keep people talking about millions losing health care.

Senate Republicans are inching closer to a final draft of an Obamacare replacement bill. The American Health Care Act will likely result in loss of insurance for tens of millions of people, and could be the most impactful policy of the Trump era. But perhaps more concerning: There seems to be little coverage of, or interest in, the fate of this bill.

When the bill was introduced in the House in early March, media interest in it was astounding. On television, the words “Obamacare repeal” were repeated 2,000 to 3,000 times every day for two weeks — and it only got bigger from there, until the revised version of the bill eventually passed in May. In the past few weeks, those words were repeated just a few hundred times, and most of those instances were focused on the Congressional Budget Office’s analysis of the House’s bill, not the Senate’s deliberations.

From a political perspective, there may be a few reasons we’re tuning out. For one, the Trump-Russia saga has crowded out other storylines. But Senate Republicans have also been incredibly secretive about the bill — likely a lesson learned after their colleagues in the House created lots of drama on the road to passing their version. Lawmakers in the upper chamber have clamped down on any tidbits of information that could add to a narrative journalists and activists can latch onto.

Senate Republicans have learned that any amount of information on the process fuels interest and outrage — and the best way to tamp down on it is to keep it out of people’s minds. Republicans have said the 2016 election was a mandate to repeal Obamacare, yet the AHCA is polling quite poorly. So one way to get out from between a rock and a hard place is to hope people aren’t paying attention as the GOP passes an unpopular bill.

We also saw this phenomenon during the Trump-Russia investigation. After then-FBI Director James Comey’s first congressional testimony, interest in the storyline had died down, and had Trump left things alone, it might’ve continued to be a peripheral issue. Instead, Trump superpowered the story by firing Comey.

So why is it that we stop caring about these crucial things? As it turns out, there are several reasons news producers and consumers alike tune out these stories.

It comes down to basic psychological biases that make it hard to maintain a consistent level of concern and attention.

1) We’ve become numb to the story

Have you ever spent time at a zoo? If you have, you can recall when you first enter a building that houses animals — it smells horrible. But then gradually, as you start to marvel at the creatures inside, the odor passes out of your attention.

Something similar might be happening here with health care.

“We easily become used to the stimuli around us,” Nina Strohminger, a Duke University psychologist, explains in an email. “This goes for everything from the feeling of our feet in our shoes to our social circumstances. Usually, this tendency serves us well — it is more efficient to monitor changes to our environment than stasis. But this also means that we easily adjust to injustice.”

We also become desensitized when we’re confronted with a scary thing, but then the negative outcome doesn’t hit us immediately.

“It’s like if Godzilla showed up in the middle of San Francisco right now, and just sat there doing nothing,” says Troy Campbell, a behavioral scientist who studies consumer attention at the University of Oregon. “We have these things that come up, and they become threatening to us; they feel immediately threatening. But then if they don’t lead to a negative immediate consequence, they don’t actually feel threatening.”

Many stand to lose health care if the law passes. But it’s hard to feel that as an immediate threat. And especially hard for those who don't believe they stand to lose coverage.

2) We’re distracted by more compelling narratives

If the story of health care is like the story of Godzilla arriving in a city and sitting down, the Trump-Comey-Russia scandal is a story where Godzilla showed up and each week picks a fight with another monster in a different part of town. When Godzilla is upset at these other monsters, he tweets about them. Godzilla’s advisers furiously try to control the message. But there’s no stopping Godzilla.

The Trump-Comey-Russia story is more exciting. It has well-defined characters and interpersonal conflict.

Republican senators are now working on a draft of their version of the health care law in a secretive manner. There’s little actual news, little human drama or narrative to follow. Those stories without narrative are hard to write, and harder to read.

We’ve seen this play out before.

In the fall of 2013, University of Minnesota public health professor Sarah Gollust and colleagues tracked all of the local television news stories they could find about the implementation of the Affordable Care Act. That fall was when the main provision — the creation of insurance marketplaces and the expansion of Medicaid in many states — came into effect.

This was a major policy moment that impacted millions of Americans’ lives. Yet when people turned on their local news, they didn’t hear a discussion of how the policies worked. “The most common source of news for Americans provided little public health–relevant substance about the ACA during its early implementation,” Gollust’s paper concluded. They hear about the drama.

“The major frame that the news media used was the politics — who’s winning, who’s losing,” Gollust says.

Only 7 percent of 1,569 news stories analyzed in the study discussed the Medicaid expansion — a program that would bring free health care to millions. “There’s an allergy to covering [Medicaid],” she says.

Interest in it hardly ever spikes.

We’re drawn to the narrative of the Russia story. And when we’re so focused on one issue, we become blind to truly surprising things going on in the periphery. Psychology has an extremely illustrative experiment showing this: Participants are told to keep their eyes on a basketball as it gets tossed among players. Meanwhile, a man in a gorilla costume walks through the shot. Very few participants will notice the gorilla.

3) We have a hard time grappling with huge numbers of people

According to the Congressional Budget Office, the House version of the ACHA stands to push 23 million people off of health insurance — about half due to reductions in Medicaid programs. This is a huge number. And it should be hugely concerning.

But behavioral scientists have long understood that huge numbers aren’t always emotionally resonant. It’s called “psychic numbing,” and it’s mostly been studied in the context of genocide: Why is it that the world so often just looks on while thousands are slaughtered?

“Numbers fail to spark emotion or feeling and thus fail to motivate action,” Paul Slovic, the psychologist who pioneered this research, has written. “Numerical representations of human lives do not necessarily convey the importance of those lives.”

And the more lives at stake, ironically, the more abstract they feel to us.

The opposite of “psychic numbing” is the "identifiable victim effect.” Charities have long understood this concept: Images of singular victims are easier to empathize with than statistics or stories about large groups of people. This effect could, in part, explain why the image of one drowned Syrian boy in 2015 galvanized so much awareness of the refugee crisis.

This is a big reason why the Trump-Russia-Comey story is so much more compelling. It involves just a few well-defined, well-chronicled characters. It’s human drama — palace intrigue, political gamesmanship — that’s not abstract.

“You have 23 million people who stand to be affected by the appeal, but then you have a single character, Trump, that everyone can focus on,” Gollust says. “He’s a person; he’s in the limelight. Who do you focus on in the 23 million? There isn’t a single story.”