Peter Ubel

American presidents have been trying to reform our health care system since at least the Nixon era, but with only limited success. Past reform efforts have failed for many reasons. For starters, the U.S. health care system is complex, with the medical industry making up almost 1/6 of our economy. But perhaps the biggest obstacle to reform is a psychological one: thoughts of health-care reform too often trigger images of putting for bogey instead of putting for par.

I am referring to the psychological power of loss aversion, a phenomenon that behavioral economists have been studying for several decades now. Most of us, you see, seek to avoid losses with greater fervor than we seek to achieve equal gains. If given a 50-50 chance of either winning or losing $100, we decline. The $100 loss looms larger than the $100 gain. For similar reasons, most people express greater interest in surgical procedures that carry 90% survival rates than in ones that carry 10% mortality rates, even though these procedures are identical. Thinking about mortality triggers loss aversion. This week we even learned that loss aversion influences putting behavior among professional golfers. When putting to avoid a bogey, golfers are more aggressive than when putting for birdie, and consequently are more likely to make their putts. Few things are more motivating than the desire to avoid losses.

Which brings us back to health care reform. When President Clinton attempted an overhaul of our health care system in the 90′s, his administration correctly recognized the need to control health care costs. Without cost containment, they knew it would be impossible to expand health care insurance to the millions of people who lacked such coverage. So the Clinton administration looked for ways to increase the number of Americans enrolled in managed care plans, which at that time had achieved some success in controlling health care expenditures.

The problem with the Clinton approach was that it made Americans feel like they were losing their traditional health care. Managed care was infamous for saying no — for denying people health care services and for limiting their choice of doctors. By taking things away from people, managed care triggered loss aversion. Consequently, the American public never supported Clinton’s reform efforts.

The Obama administration is steeped with people knowledgeable about behavioral economics, who hope to keep the public from slipping into a state of loss aversion. Not surprisingly, then, the administration has enthusiastically embraced research out of Dartmouth University, demonstrating huge regional variations in medical expenditures that have not been accompanied by any variation in health care quality. According to this research, some cities in the US spend twice as much per capita on health care as other cities without experiencing any discernible improvement in health.

Obama’s people hope that Americans will perceive health care reform as a win-win opportunity, with lower health care costs through the elimination of waste and inefficiency, accompanied by more stable and secure health care coverage. But even if the administration succeeds in assuaging the fears of the general public, they face a much stiffer challenge with the health care industry. Any success they have in controlling health care costs will, after all, create losers. If we spend less money on health care in the US, then someone in the health care industry is going to take a financial hit. One person’s waste is another person’s income.

No surprise, then, that both the insurance industry and the AMA have begun pushing back against elements of the Obama plan. These groups stand to lose money under health care reform. Hospitals are likely to lose money too, as are drug companies, medical device companies, and other powerful parts of our vast health care industry. All of these groups will be motivated to fight health care reform.

The Obama administration has made a point of distinguishing its behavioral approach to economics from the more traditional approach embraced by the Bush administration. Ironically, though, it is the Bush administration that understood how to pass health care reform without triggering loss aversion. When George W. Bush decided to push for a Medicare drug plan, he recognized that the pharmaceutical industry would wield its powerful lobbying strength against his efforts if they feared a loss of income. So he crafted a plan that benefited the drug industry. Politicians on the left criticized these concessions to industry, but it is hard to imagine the drug plan passing without such concessions.

Obama should draw a lesson from his predecessor. If he causes the health care industry to perceive his health plan as a threat to their incomes, his plan will face stiff resistance. For health care reform to succeed, people in the health care industry need to keep making exorbitant sums of money for awhile. Over time, the government can gradually ratchet down health care costs. But initially, Obama needs to reduce the number of people who perceive health care reform as a loss.

The cost will be steep. But the alternative will be more costly. We cannot afford to make reform feel like a health care bogey.

Peter Ubel is author of Free Market Madness: Why Human Nature Is at Odds with Economics — and Why It Matters (Harvard Business Press, 2009), and Director of the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan.

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Last summer, New York City made a great stride toward promoting public health, by requiring chain restaurants to prominently publish calorie counts alongside their menus. This type of regulation holds the promise of improving people’s eating habits, without restricting their freedom to order whatever they want.

Theoretically, this new regulation should help consumers make better choices: they should eat fewer big Macs and more Asian chicken salads. Indeed, proponents of free markets, who normally oppose government regulation, should celebrate New York City’s new policy, because, by requiring restaurants to inform consumers about their purchases, the city has moved the restaurant business closer to Adam Smith’s ideal of a free market-one where savvy and educated consumers choose among available goods based on their cost and benefits.

As a physician who conducts research in behavioral economics, however, I am concerned that this policy won’t accomplish its goals, because it should be simple for restaurants to make their offerings attractive to even the most calorie conscious consumer.

How will they do this? By creating new items on the menu that make everything else look healthy by comparison.

When people evaluate consumer goods, they usually need some context in which to judge relevant attributes of competing products. What counts as an expensive DVD player? Best way for me to tell is by looking at other DVD players. And what counts as a low-calorie meal? Easiest way to tell is to see how many calories are in other meals.

If I was a restaurant owner and wanted to keep selling a popular high calorie sandwich to New Yorkers, I would place two new items on my menu, each with 50% more calories than the old sandwich. Maybe add on a couple slices of bacon, or a fried egg . . . anything Homer Simpson would like on his sandwich.

I expect that very few customers would thrill at the idea of these new “heart attacks on a bun.” Most will recoil. But that’s ok, because my goal would not be to attract customers to these new sandwiches. Instead I would use these new sandwiches to make my old ones look better. You see, my customer’s eyes will soon wander toward other items on the menu, and what used to be the highest calorie sandwiches will now look like veritable health-food snacks!

I have no idea whether any restaurants will employ this psychological technique. I do know that companies often make high-priced products, deluxe car models for example, in large part to sell their midrange products.

More importantly, my example highlights the kind of unconscious behaviors that could reduce the impact of New York City’s new regulations.

I hope that I am wrong, and that restaurant goers begin eating more healthfully in response to the calorie information now available to them. But if they don’t, I expect New York City will need to go further, to persuade people to eat better food.

Helping consumers make good choices often means we need to do more than simply inform them.

To read my other blogs, and to learn about my book Free Market Madness: Why Human Nature is at Odds with Economics-and Why it Matters , check out my website at: http://www.peterubel.com/.

View original post and comments at Scientocracy

With jobs disappearing faster than a major league fastball, the public is understandably irate at the damage that greed has wrought upon our economy. Financiers destroy their companies, and our retirement portfolios, and then complain when their bonuses are less than 7 figures.

The greedy behavior in recent headlines has not been limited to Wall Street. Last fall, for example, Congress uncovered the shocking details of Dr. Charles Nemeroff, Chair of psychiatry at Emory University, who had made almost $3 million in consulting fees from the same drug companies whose products he was prescribing. More disturbingly, he was responsible for evaluating these same drugs in federally funded research trials. Then in November, we learned that renowned Harvard psychiatrist, Joseph Biederman, had received hundreds of thousands of dollars from Johnson & Johnson, a company which made medications that, not by coincidence, treated the same childhood psychiatric illnesses that Biederman had become famous for publicizing to doctors.

With all of these disturbing stories, it is natural to attribute our current economic problems to excesses of greed.

Greed is indeed a prominent theme in many recent headlines, but it doesn’t explain what has been happening. Greed is a reliable constant in human affairs. Attributing the current situation to greed is like attributing someone’s headache to the fact that they have a brain. The real explanation lies not with greed, but with our failure to deal with conflicts of interest.

Conflicts of interest have played a central role in many of the disasters that have befallen our economy in recent decades. Enron and other corporate debacles a decade ago were aided and abetted by accounting firms that were providing consulting services to the same companies they were auditing, creating a situation in which the right-hand was expected to raise the alarm about financial practices being suggested or condoned by the left hand. The dot-com crisis was similarly aided by stock analysts who provided buy recommendations for companies whose stock their firms were underwriting. And now in the most recent debacle, it has emerged that credit rating agencies, entrusted to identify risky finances, were aggressively drumming up business from the same lenders whose credit they were rating.

As highlighted by publicity over the payoffs to psychiatrists, conflicts of interest have also contributed significantly to another less acute but equally serious problem plaguing our economy: the ever-intensifying problem of skyrocketing health care expenditures. Despite numerous calls for change, pharmaceutical companies continue to shower physicians with gifts, and an increasing proportion of medical school faculty obtain an increasingly large proportion of their income from industry. (Disclosure: I am an academic physician, but I have made a practice of staying independent from industry funding. That independence has come easily, given that most companies have no interest in a primary care physician who studies decision making and ethics!) As a result, the newest and most expensive interventions are enthusiastically embraced by the medical community, often before their safety and effectiveness have been firmly established.

In the face of economic turmoil, it is tempting to look for greedy villains. By the time there are villains to punish, however, it’s usually too late to fix the problem. Shooting the fox won’t restore chickens to the hen house. Instead, we need regulations to reign in the pernicious effects of conflicts of interest.

How can we do this? Beyond calls to punish perpetrators, the most common response is to call for greater disclosure of conflicts. Medical journals and medical schools, for example, have largely tried to address conflicts of interest by requiring physicians to disclose their outside income. However, disclosures are not a solution. For starters, people often don’t report their conflicts. Nemeroff famously failed to report the majority of his $3 million in consulting fees. More importantly, disclosure can cause outsiders to drop their guard – when a physician readily admits working with a drug company, other people mistakenly assume that he must therefore be being forthright about his research results.

The only way to reduce the effects of conflicts of interest is to reduce the conflicts themselves. Auditors and bond raters shouldn’t be hired by, or provide other services to, the companies they are rating. Stock analysts shouldn’t be allowed to provide buy recommendations on stocks their firm underwrite. Physicians shouldn’t be allowed to accept gifts from pharmaceutical companies.

As Obama continues to implement policies meant to avert future economic disasters, it will be essential for his administration to take a hard look at regulating the conflicts of interest that pervade our economy. Only by doing so can we get our economy back on track, and prevent another precipitous derailment.

Note: I am joined in today’s post by George Loewenstein, Herbert A. Simon Professor of Economics and Psychology at Carnegie Mellon University.

To read more of my blogs, and to learn more about my new book, Free Market Madness, check out my personal website: http://www.peterubel.com

View original post and comments at Scientocracy

The key to good policymaking is to understand human nature.

Want to increase how much money people save? You better know what they will do if you change the tax code. Want to reduce the threat of terrorism? All the security in the world won’t suffice if you don’t, at the same time, find ways to confront the behavioral forces that lead people to commit acts of terror. Want to make health care affordable to all? Policy won’t achieve this goal unless policymakers understand the ways doctors and patients make decisions about what healthcare services to use.

In my new blog — Scientocracy — I plan to explore important policy debates through the lens of human behavior. I intend to not only show why psychological science is relevant to a whole range of policy debates, but to also imagine what policies might look like if they were better aligned with human nature.

Who am I to write such a blog?

I am a physician at the University of Michigan, with undergraduate training in philosophy, and without a single psychology course to my credit. Not promising, I know. But actually, after sitting in on a behavioral economics class at Carnegie Mellon University 15 years ago, I have spent the majority of my professional career studying how people make health care decisions — how patients choose between, say, chemotherapy and radiation; how surgeons decide whether a patient is a good candidate for liver transplants; and how policymakers decide whether a new drug brings enough health benefits to justify its staggering price.

Through my research, I have learned a lot about the irrational and unconscious forces that drive people’s decisions. And I have seen what can happen when leaders implement policies that ignore these forces.

The one constant in my professional career, besides practicing medicine, has been my focus on decision-making and policy. For example, my first book, Pricing Life, was published as part of a series on bioethics, but the book deals as much with moral psychology as it does with philosophy.

And my newly released book, Free-Market Madness: Why Human Nature Is at Odds with Economics — and Why It Matters, is a critique of libertarian extremists who believe that most of society’s problems (obesity, crime, drug use…) can be solved by deregulation. I show why such free-market evangelism is at odds with human nature, and why psychologically informed policies — ones that recognize both the rational and irrational side of human nature — would rein in the excesses of free markets to account for human imperfection.

When I talk about Scientocracy, then, I’m not talking about a world ruled by behavioral scientists, or any other kind of scientists. Instead, I am imagining a government of the people, but informed by scientists. A world where people don’t argue endlessly about whether educational vouchers will improve schools, whether gun control will reduce crime, or whether health savings accounts can lower health care expenditures,… but one instead where science has a chance to show us whether vouchers, gun control laws, and health savings accounts work and, if so, under what conditions.

As a new President assumes leadership in the United States, I hope to add to the chorus of voices calling for government policies that are informed by a solid scientific understanding of human nature, in all its wonderful messiness.

To learn more about me or my new book, Free Market Madness, check out my website: http://www.peterubel.com/ .

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“With luck, Ted Kennedy will be dead soon.”

She uttered these words two minutes after expressing hope that the nation would rally behind Obama. A lifelong Republican, she had voted for McCain. I expect she harbored concerned about Obama’s terrorist pals and his anti-American pastor. But with Obama now newly elected as president, she was already beginning to forget what she used to find so terrifying about him. As an American, and as someone who worried about the stiff challenges facing our country, she had no choice but to wish him well. To hope for Obama to fail would, after all, be to hope for America to fail.

But Ted Kennedy — that was a whole other matter. Out of nowhere, in what had otherwise been a pleasant conversation, she brought up his name. “Did you know,” she asked, “that he never graduated from law school?” I didn’t actually. “Did you know how wild he was when he first became a senator?” she asked. I had heard a bit about that, but wasn’t that, like, 40 years ago? “I hope he dies soon. I really do,” she said.

I was dumbfounded. Home for the holidays, I had known that I would be surrounded by ardent Republicans from both sides of the family. My children, you see, have four Republican grandparents and a slew of Republican aunts and uncles. Politically speaking, I think of myself as a flaming moderate, but both sides of my family think of me as a pinko — for not supporting our initial invasion of Iraq; for questioning the wonders of the free market (horror of horrors: I even have a book out now called Free Market Madness!)

But while I expected to hear people complain about how liberals are ruining America, I did not expect to hear anyone call for the death of an ailing senator. This sentiment was so raw, so primal, it flabbergasted me. What had Ted Kennedy done lately to deserve such vitriol? Had his passionate pursuit of universal health care earned him such enmity?

No. None of the complaints she uttered concerned any recent aspect of Kennedy’s life. (I’m leaving her identity unnamed, but I want to clarify that the person I’m writing about was neither an aunt nor grandmother of my children.) In her 70s, she was clearly stuck in the 60s.

I’ve drawn a lesson from this conversation, about the challenges Obama will face trying to bring our country together. The 60′s may have happened forty years ago, but the cultural battles begun back then have not completely run their course. Many elderly conservatives still hate democrats with great passion. And though they find it hard to direct that hatred toward Obama, they have plenty of other people to direct their hatred towards.

And direct this hatred they will! Psychologists have long known that when people’s world views are threatened, they grasp for ways to affirm their beliefs. A recent study published in the prestigious journal Psychological Science reveals the strange depths to which we humans will plunge to affirm our beliefs.

In stage one of the study, a research assistant asked participants to fill out a questionnaire. The research assistant was a moderately attractive blonde haired young woman in a scarf. I mention this not because I’m sexist, but because her physical appearance is important for the study. You see, the research assistant headed off to the file cabinet to get a copy of the survey, and in doing so, switched places with another moderately attractive blonde haired young woman wearing an identical sweater and scarf. The two research assistants shared moderate similarities in their appearance, but anybody looking at the two of them at the same time could easily tell them apart.

However, the research participants weren’t looking at the two at the same time and comparing them. They were in a situation where they expected that they were interacting with a single research assistant. And when the second research assistant came back with a copy of the survey, most of them didn’t realize that this was a different person. Instead, something felt wrong about the situation. Their world view had been challenged. They assumed they were doing a simple survey in a comfortable setting, but instead found themselves feeling acutely uncomfortable for reasons they couldn’t quite grasp.

That’s when stage two of the study takes place. In this stage, the participants filled out the survey, which presented them with a hypothetical report about the arrest of a prostitute. Participants were asked to play the role of a judge and determine proper bail for this woman.

The research participants — still feeling all these negative emotions, still knowing that something in their view of the world wasn’t fitting together correctly — slapped a huge bail on the hypothetical prostitute, a dollar amount significantly greater than the value chosen by a control group who had not experienced the surreptitious switching of their research coordinator’s identity.

When people’s world views are threatened, they look for ways to confirm other parts of their world view, often with vigor. When they cannot detest Obama, therefore, they revisit the sins of Ted Kennedy’s youth with righteous vengeance.

Many Republicans are feeling quite threatened right now. The validity of their world view has been questioned, by events and also by the majority of American voters. We can all hope that Obama will be able to unite people across this partisan divide. But we should be prepared for many ardent Republicans to respond to these threats by looking for fresh targets.

There are many reasons we can hope that Ted Kennedy will overcome his brain tumor and live a long time. But now there is a new reason to hope for this — the longer he lives, the more he can soak up Republican ire, and reduce the chance that Republicans will redirect their negative emotions toward our new president.

For more information on my book, Free Market Madness, check out my website at http://www.peterubel.com/.

View original post and comments at Huffington Post

If President-elect Obama wants to know the challenges he can expect to contend with in his first 100 days of office, his “honeymoon period,” he need look no further than the state of Michigan.

I’m not talking about what he can learn from Michigan about unemployment, where we are #1!

I’m not talking about lessons he can learn from Michigan about relations with the Middle East, given the large population in Michigan who originate from that part of the world.

I’m not talking about any of these things. Instead, I’m talkin’ football…Wolverine football, and the pressures that come to those who take on new leadership positions in a world saturated with 24/7 media.

The University of Michigan football team brought in a new leader this year, Rich Rodriguez from West Virginia, with expectations that this innovative coach would turn our good football team back into a great one, one that would regularly compete for national championships.

The parallels between the situations facing Rodriguez and Obama are impressive. Like Rodriguez, Obama will come to his new leadership position amidst expectations that he will return the United States back into the world’s premier super power.

Both Rodriguez and Obama face a flat world. The globalized economy is going to be a huge challenge for Obama, with no single country able to dominate the world’s economy any more. Similarly, the flattening of the college football world is a challenge for Rodriguez, a world in which formally dominant programs like Nebraska and Notre Dame find themselves struggling to keep up with the increasing number of colleges investing huge money in their football programs.

Both Rodriguez and Obama must also contend with a vicious 24/7 news cycle that feeds on controversy and that promotes impatience. ESPN and CNN need material to fill up time. Talk radio stations–covering sports or politics–have lots of time to kill too, and consequently don’t pause for a moment to absorb new information before pronouncing something a success or failure–how could he have chosen so and so as starting QB or as head of the Justice Department!?

Is it possible for a leader to thrive in this environment? And to survive, do they have to experience immediate success?

Recent experience in Michigan suggests that success doesn’t have to be immediate. Rodriguez had a horrible first season at Michigan. Unprecedentedly horrible. The Wolverines lost to their arch rival, Ohio State, for the umpteenth time in a row, broke their record of successive years in a bowl game, and even lost to the University of Toledo. (Toledo!)

The 24/7 media should have chewed Rodriguez up and spit him out by now, based on the way they’ve dealt with other people who don’t garner immediate success. But by and large, they haven’t. And it’s illuminating to think of why they’ve laid off so far, and ponder how that might payoff for Obama when he becomes President.

You see, everyone knew that Rodriguez did not inherit a team ready to fit into his new scheme. He didn’t inherit a quarterback compatible with his offensive system. (Heck, he didn’t inherit a quarterback compatible with any division 1 team’s system.) To make matters worse, he inherited only one returning starter on the entire offense. Defense looked like it would be Michigan’s strength, but how strong can a defense be when it is exhausted by the end of the first quarter, getting no chance to rest because of the ineptitude of its offense?

We Michiganders (yep, that’s what we’re called) knew things would get worse before they got better. So far we have been willing to give Rodriguez a chance to demonstrate what he can do when he has had time to implement his new system, with people he has recruited.

I don’t know how long Rodriguez can continue to struggle before people start calling for his head. Another 3-win season and many Wolverine fans will thirst for blood. But show fans some progress, and they’ll wait at least one more year.

Like Rodriguez, Obama has a few returning players–Gates at defense, and those nine folks over at the Supreme Court–but he’ll be bringing in a new team, ready to make dramatic changes from the Bush Administration. And he will inherit insanely difficult challenges. People know that things are broken now, and won’t be fixed overnight. They even expect things to get worse before they get better. This is all to Obama’s advantage.

Let’s hope the hunger of our 24/7 media, and the insatiable appetite of the blogosphere, doesn’t lead too quickly to calls for Obama’s head when things don’t turn around in 100 days.

So far Rich Rodriguez has survived the rigors of the passionate Wolverine fan base. He has managed people’s expectations, while doing everything in his power to turn things around.

Let’s hope Obama can continue to manage the public’s expectations of what he will accomplish in his first term as president.

Although the challenges Obama faces tower over those facing Rodriguez, Obama does have one thing in his favor: unlike Rodriguez, he doesn’t have to compete again in Ohio for four more years.

View original post and comments at Huffington Post

Last week, I had the pleasure of participating in what the World Economic Forum founder, Klaus Schwab, described as the planet’s largest brainstorming session. Approximately 700 leading thinkers (and me, too) converged upon Dubai to discuss the greatest economic challenges facing the world, from the current economic crisis to future crises. People from 6 continents came together, people from government, academia and business, to discuss these events. And yet one man dominated the event, a man who wasn’t even there.

That man was Barack Obama.

Obama did not address the convention. And while several prominent Obama advisers were in attendance, most were not (being busy working on the transition) and no one there attended in any official Obamoid capacity.

Yet, Obama was omnipresent, mentioned explicitly in almost every official conference presentation. When the leader of Dubai addressed the convention, his first words were directed to Obama. Obama was explicitly discussed in thousands of casual conversations. Indeed, every non-American I spoke with wanted to talk about Obama, often congratulating me for his recent election victory.

But it was Obama’s implicit presence that I found most remarkable. On the final day of the meeting, you see, all of us met in a general session and listened to seven people who had been asked to summarize the ideas generated over the previous two days. These summaries were often distressing. We conference participants had been charged, after all, with outlining the biggest problems facing the world, and we had no problem finding some major problems to discuss.

Foremost on many people’s minds, of course, was the current economic crisis, which most agreed could be the worst crisis in decades. But as serious as this crisis is, it was viewed by most attendees as a temporary problem, overshadowed in the long run by some much more serious and potentially permanent threats — threats of water shortages, soil destruction, food deprivation, global warming, over population…all of these problems causing serious political unrest. Pretty distressing stuff.

To make matters worse, we all recognized that the solutions to our current economic crisis are the very kinds of things that will exacerbate our long-term problems. Most efforts to overcome the financial crisis are focused on getting the global economy growing again. When economies grow, so too do CO2 emissions and deforestation efforts and water usage.

While most of us at the World Economic Forum agreed that governments need to take strong measures to avert a global economic crash, we also felt that the world is in trouble if economic success continues to depend on unsustainable growth.

That is why Obama loomed so large over the meeting. Because the challenges facing the world need a leader prepared to tackle such vast problems. And over the last decade, the world hasn’t had such a leader. I don’t mean to denigrate the great leadership from people we’ve seen like Al Gore, in bringing attention to global warming, or even more recently to Gordon Brown, for designing some sensible first steps in responding to the economic crisis.

But let’s face it, the world still looks to the president of the United States for global leadership. And based on what I saw in Dubai, the world now awaits for Barack Obama to take office and lead the way. The economic crisis has provided further evidence of just how small our planet is, how interconnected we all are. We live in a time where neither the economy nor the environment are local, where the US can’t afford to put “Country First” without regard to global challenges.

When it meets in Davos, the World Economic Forum is famous for its celebrities, with Bono and Sharon Stone and Angelina Jolie, among others, putting their fame to work on behalf of important world causes. The recent World Economic Forum in Dubai, however, was devoid of such celebrities. It was attended, instead, primarily by academics like me. Ironic then, that a man mocked by John McCain for being a celebrity dominated the event anyway, without even having to leave his Chicago home.

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Here in the final stretch of the presidential campaign, things are getting even uglier, with the other side lobbing misleading verbal attacks while our side tries to remain above the fray. With this kind of negativity and distortion, it is hard to imagine the winning candidate being able to pull the country back together.

But perhaps my experience last weekend at my eight year old’s soccer game illustrates a way for all of us to put the campaign back into perspective.

My boy plays on a travel team stacked with fast and aggressive players who usually win, racing past the other team to any open balls. Ahead 4-1, they were still scrambling after the ball, trying to out-muscle the other team.

The ball trickled toward the sideline, and one of our players leaned into an opponent to get the ball. Parents of the other team waited for the referee to call a foul, but she let them play on. Outraged at this injustice, the parents began complaining among themselves about how rough our team was, how they were pushing all the time, and how the referee never seem to call fouls on our kids. They quickly decided that we were benefiting from home field advantage.

Armed with this “knowledge,” they found themselves in a competitive lather. Each time two boys fought for the ball, they were convinced that it was our kids who initiated the contact, and our referee who was allowing such inappropriate aggression. Caught up in the emotions of the moment, they began verbally abusing the referee, screaming that she was blind, biased, and didn’t belong on the field. When that didn’t work, a couple of the dads began yelling to their kids, instructing them to push our kids down.

When they called upon one of their kids to push my kid, I must admit to feeling a strong urge to beat the crap out of the two most egregious fathers. But the urge was only fleeting, mainly because I had two pieces of information that helped me to see the situation that day more clearly than the other parents.

First, I’d managed to strike up a conversation with the referee at halftime, and learned that she was a high school freshman from the same town as our opponents. She wasn’t a hired gun, favoring our team. She was a 14-year-old, struggling to figure out where to draw the line in a game between two groups of intense eight year old boys.

Which brings me to my second piece of information — having studied human behavior for the better part of my professional life, I knew that these parents were making an honest mistake. They were unconsciously viewing the game through distorted lenses. Studies have consistently shown that people have a very difficult time observing partisan contests with objective eyes. That’s why in a game between the Eagles and the Cowboys, Eagles fans will invariably believe, passionately, that the officials are biased in favor of Dallas, even pointing to specific plays that demonstrate clear evidence of such bias. Cowboy fans, of course, will believe that the officials are biased in favor of the Eagles.

I actually reflected on this phenomenon as two of the players leaned into each other that day, neither player initiating the contact, and neither player getting the better of the exchange. The opposing parents erupted in a flurry of catcalls and accusations upon witnessing this battle. They were honestly enraged, but the source of their rage, the circumstances that prompted their anger, were entering their consciousness only after being distorted by this powerful psychological lens.

It was easy at that moment to see this strange crowd as emblematic of the current presidential election. My son’s team is centered in Ann Arbor, a reliably Democratic community. Our parents were sitting calmly on the sidelines, muttering under their breath about the insane parents standing 20 feet to our right. The opposing team is from a solidly Republican city just south of Ann Arbor. And they sounded to us like the kind of angry crowds we’ve heard about who scream epithets at McCain/Palin rallies.

But how would we Ann Arbor parents have reacted of our team was behind 4-1 in a physical game like this? I’d like to think we would remain calm, like the presidential candidate favored in our community. However, there is lots of reason to believe we would have seen the game differently, viewing the aggression as more one-sided than it was.

The McCain campaign is trailing badly in the polls. Is it any surprise that McCain supporters are calling foul so aggressively at rallies? Is it any surprise that they believe that it is Obama who was the first one to go negative in the campaign? Is it any wonder that they are convinced that it is Obama who is putting his campaign ahead of the country’s best interests?

We citizens are currently standing on the sidelines observing two presidential campaigns caught up in an aggressive battle. We are all convinced that the media is biased against our candidate, just like those parents were convinced that the 14-year-old referee was taking sides.

When our psychological biases cause us to scream at our eight-year-old boys to maim other people’s eight-year-old boys, it can not come as a surprise that we exchange nasty words with each other when caught up in an intense and important political campaign.

But the campaign will soon be over, and the elbow throwing will cease. Maybe then we will all realize that this campaign wasn’t a game, and that we are all, as Americans, rooting for the same team.

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Despite Barack Obama’s recent surge in the polls, much could change between now and election day. While it looks like this election will be decided by the economy, unexpected events could dramatically change the campaign narrative. Terrorists could conduct an attack inside the US. Obama, despite his two years of steady poise, could say something really stupid between now and November, that would cause independent voters to flee.

But one thing is certain: this presidential campaign, like all recent campaigns, will not be decided by the candidates’ health care proposals.

The US health care system is a bigger threat to the American population than terrorism ever was. As horrific and evil as were the attacks on 9/11, and as much as we needed to mobilize our troops to depose the Taliban from Afghanistan, the more than 3000 people who died on 9/11 are dwarfed in numbers by the tens of thousands of people who die, needlessly, because they have no health insurance.

Ask people what they are worried about, and health care usually sits near the top of their list. Almost 50 million people in the US have no health insurance, people who have to decide whether that gash really requires stitches, or whether that heartburn is a mere stomach problem or sign, instead, of a potentially fatal heart attack. A similarly vast number of people have too little health insurance to cover the basic health needs. Consequently, they hover in economic peril, one serious illness away from bankruptcy.

To make matters worse, persistently rising health care costs threaten our global competitiveness, handcuffing US industries with huge expenses. This health care inflation also adds to state and federal budget problems.

Yet despite this dire situation, health care doesn’t win elections, because health care problems never feel as immediate as other threats. When the Dow Jones plummets 800 points, people understandably worry. They can see their life’s savings dwindling, and their hopes of early retirement evaporating. When a student conducts a school massacre, everyone is caught up in the terrible drama, with their view of gun control quickly rising up their list of concerns: gun control advocates will feel even more passionately than before the massacre that we need to restrict gun ownership, while gun control opponents will become even more convinced that the whole situation could have been averted if more of the teachers were packing.

There is no aspect of the health care crisis that has the immediacy of a bank foreclosure, a terrorist attack, or even a verbal gaffe from one of the candidates. Our health care crisis fails to win elections in part because it doesn’t feel like a crisis to enough people. It also fails because it is hard for candidates to come up with a simple solution to such a complicated mess, and therefore any solution a candidate puts forth is easily caricaturized and criticized.

Both candidates have proposed ways they think will improve our health care system. I feel strongly that Obama’s approach, even in its preliminary form, is far superior to McCain’s. But that probably won’t matter on election day. Ultimately this campaign will be won over other issues.

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Barack Obama would like the next two debates to be about the economy. John McCain would like them to be about anything but the economy, preferably with plenty of discussion of 60′s radicals and crazy preachers.

McCain won’t get his way, of course. We will hear discussions of the bailout, taxes, health care and the like, with Obama eloquently explaining the failed Bush-McCain approach to these issues, while McCain tries to paint Obama as an out-of-touch, tax-and-spend liberal.

But what will it take for Obama to win the debates? The best answer I’ve heard to this question comes from a man who has been an irritant to Obama supporters for many months now, a man whose advice I approach with great caution, out of fear that he is setting a trap for the candidate. The man is Bill Clinton, and the advice is this: to win the presidency, it is less important to make people like you than to convince people that you like them.

The man who “feels our pain,” famously biting his lower lip, knows how to project empathy. Obama did not display this talent in the first debate. He did an excellent job of portraying competence and knowledge, and of appearing calm and presidential in the middle of a financial crisis, a strong contrast to McCain’s erratic behavior during the same period.

But the campaign is getting dirty now. Sarah Palin is accusing Obama of pallin’ around with terrorists. We can expect some unofficial interest group to start cranking out ads with you-know-who God d@#$ing America. McCain and company will try to scare people away from Obama.

To dampen these fears, Obama needs to show people that he cares for them. How best to do that? He needs to reveal his heart without coming off as a phony. If he starts biting his lower lip, we are in trouble. If he pulls out one of those tired old campaign stories and expects us to feel his empathy — “why just the other day in Toledo, I spoke with Betsy Wilkerson, a single mother blah blah,” — well, been there, slept through that.

Obama needs to tell us about people who he truly loves deeply, and about how he wants to help the same people. When he talks about his love of America, and therefore his love of the American people, he should talk about how our great country helps people very close to him achieve their own version of the American dream. Does anyone who he loves rely on Medicare? Let’s hear how that person would be affected by McCain’s policies.

Most undecided voters won’t be voting with their heads; they won’t be calculating tax rates, health-care deductibles, and federal budget deficits and seeing which candidate comes out on top. Instead, they will be voting with their guts. And if they can’t trust a candidate, they won’t vote for him.

The image of Barack Obama palling around with terrorists won’t stick in people’s minds if they see his caring side on display Tuesday night, and if they see how his head for policy details works together with his heartfelt desire to help the many people he loves.

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