One of the most appealing arguments for government health insurance is the perception that it’s “a sure thing.”  No matter how powerful reputational incentives are, a private health insurance might go out of business, or fall into the hands of a myopic CEO.  With government health insurance, on the other hand, you know that you’re covered, right?

This is a prime example of what psychologists call a pseudocertainty effect.  Tversky and Kahneman originally explained it using two hypotheticals (my paraphrase):

Hypothetical #1: You play a two-stage game.  There is a 75% chance that the game ends in stage 1 and you win nothing.  However, if you make it to stage 2, you get to choose between \$30 with certainty, or an 80% of \$45.

Hypothetical #2: You choose between a 25% chance of \$30 or a 20% chance of \$45.

Most people take the first choice in Hypothetical #1, and the second choice in Hypothetical #2, even though they are mathematically identical.  T&K’s explanation: Hypothetical #1 looks better due to a “pseudocertainty effect.”  People are misled by the fact that the P(A|B)=1, even though B itself is far from certain.

What does this have to do with health care?  Well, government health care is a sure thing conditional on (a) getting high-quality care for (b) a treatable ailment (c) in a timely manner (d) without getting a secondary infection… etc.  In other words, like private health care, government health care isn’t a sure thing at all.

Now you could object, “It’s not about a pseudocertainty effect.  It’s about a higher likelihood of good health with government health insurance.”  If you go down that route, however, you’ve opened yourself up to a barrage of tough questions.  What evidence is there that government health insurance raises life expectancy – or any other major measure of health?  Even if it does, is the extra cost worth it?  As Tversky and Kahneman showed, people will pay a lot to go from near-certainty to perfect certainty.  They’re far less eager to pay an arm and a leg to go from a 45.3% chance of living to 80 to a 45.5% chance living to 80.

My point: While “certainty” is of the most appealing arguments for government health insurance, it’s silly.  But if proponents stop using it, it’s going to be a lot harder to win over public opinion.  It’s a choice between persuasion and honesty.  Take your pick.