The President's Mind; or How to Persuade Barack Obama

Yesterday's New York Times ran a front page story on health care costs that told us more about our president than it did about the topic. "President Obama," correspondent Robert Pear began, "recently summoned aides to the Oval Office to discuss a magazine article investigating why the border town of McAllen, Tex., was the country's most expensive place for health care."

Turns out Obama didn't stop there. Everyone at the White House decided they had to read the article; Obama cited it in a meeting with two dozen Democratic senators; one of them, Ron Wyden (an expert on health care) claimed Obama "came into the meeting with that article having affected his thinking dramatically."

My sweetie happily shouted across the table at breakfast, "That's the New Yorker article I was telling you about! You need to read it." Not surprisingly, it's now the most popular essay on the site. It's an interesting piece, but, for now, I want to set aside its topic. This essay clearly persuaded the president to listen. So, what rhetorical strategies characterize this piece? What persuades Barack Obama? Of course, we can't know for sure, but here are several non-mutually exclusive options.

First, the essay uses a residues structure. This is a bit of an old-fashioned term I use to refer to a form of inductive structure that follows the advice of Sherlock Holmes: "How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?" Atul Gawande, the author (a physician, writer, and professor--the sort of insider/outsider source Obama likely respects) wants to find out why McAllen Texas has the highest health care costs in the nation. He considers and eliminates a series of options before reaching the conclusion that we possess a system that pays doctors as individuals for the quantity of their work. So, at least some individual docs will order as many tests as they can to make as much money as they can and, if that becomes the norm in an area, that area will be far more expensive than other areas. Hence, McAllen, Texas.

An inductive structure engages the reader by heightening suspense (that's why mystery novelists use it) and inducing participation. You work with the author as the two of you consider possible answers. Are people in McAllen less healthy than other Americans? Is that the reason? No. It also closely resembles the empirical method of modernity; rather than beginning with a conclusion and discerning reasons for it, one looks at a series of cases to discover the pattern. Now the orator usually knows where s/he is going from the get-go, but the inductive structure recreates, streamlines, and makes formally appealing the discovery process, like the way a true crime novel recreates reality. Finally, it tends to work better than other options with a reluctant or hostile audience that may not be willing to consider the improbable at the start, but realizes it's the only option at the end. 

Our president does not like didactic orators. No, he does not. He likes to think through problems, he wishes to participate in the process, he wants to be engaged, and if you want to engage him, you better include him. Through induction.

Second, Gawande lionizes information and education. He goes to the Mayo Clinic in Rochester, MN (the most rational people in the world live in MN, or so I've been told. Sadly, their Senate election seems to prove otherwise.). Mayo created a system in which 1) all monies are pooled and everyone receives a salary, so no one has a "commission incentive" for ordering tests; 2) patient welfare, and not profit, is the institutional goal and; 3) teamwork is the means to achieve that end. Everyone meets regularly and passes along information to each other. No lone wolf docs.

In a larger sense, that model infuses the piece. The essay is an enactment of it. If everyone knows how the larger system works, and what the best practices are, then everyone will behave better and put those practices to work. Sure, there are docs abusing the system for pay, but that's not because they're nasty, evil, money-grubbing vultures. It's because the current health insurance system rewards them for it and because the occasional bad apple establishes a precedent (a bad person becomes, he notes, the equivalent of an "anchor tenant" in a mall). People are generally good and they will reform, if you provide them with the information and education they deserve. Like this article.

Our president is a John Dewey liberal. Perhaps it's no accident that Dewey worked at the University of Chicago; how long does an ethos linger at a place? This essay is filled with the markers of pragmatic reason: cases, options, analysis, statistical evidence, "reality-based" argument. It reflects both a faith in empirical reason and in human nature. It is, in fact, the sort of thing that John Kennedy would have loved.  

Yet Obama has updated it. Austin Goolsbee is a key advisor, from a school of thought variously labeled social economics, behavioral economics, or, from the book, Freakonomics. These economists have discovered, gasp, that social factors often affect economic choices. People operate by rules of thumb rather than strict logic. So, if one bad doc takes hold in an area, his practices will grow, etc. It's a bit like the famous qwerty effect. If we create new, postive qwerties, we can recreate a better health care system.

Again, however, the rhetorical appeal of Freakonomics rests in the new, the unusual, the refusal to take reality as a given, but rather to dig beneath the surface for the "real reason," much like an inductive structure leads you to the however improbable. Our president likes the novel explanation that is somehow rooted in the quotidian.

Finally, there's the love of analogy. Analogies, theorists tell us, connect the unfamiliar to the familar, thereby clarifying the unknown or persuading us to adopt it. Some go so far as to argue we think by comparison, constantly collating old situations so as to compare them to the new. Analogies put forth a scheme of interpretation--here's how you should think about this. So, if this situation is like that other one, that's how you should treat it.

This essay has two big analogies. As I mentioned earlier, bad practice or a bad doc is thought of like an anchor tenant in a mall. Anchors play a major role in determining community norms. This is, of course, an analogy within an analogy. Gawande also has an extended analogy: "Providing health care is like building a house." In each case, the analogy becomes a scheme of interpretation, a new or novel way to look at a situation.

I suspect those who are persuaded by analogies love connections; they like to see how one thing resembles another and how the world itself is a series of interconnected forces. That, I also suspect, describes our president.

So, he's a liberal in the tradition of John Dewey, one who thinks information and education matters enormously, one who believes that a presdient should discover reality before seeking to change it, one who is comfortable with complexity, who likes connections, who wants to think along with you, who is likely impatient with an argument that doesn't include him. He also thinks people are reasonable, but not in the classic logical sense--they use rules of thumb, community norms affect them, stuff happens. Yet they will change if one can craft reasonable explanations. And he likes the striking, the new, the unusual, the sharper explanation. 

So, the moral? Sometimes, it's helpful to examine not what a president does, but how he learns.   

Comments

[CA]

One presumes this would have been a much shorter, less interesting, not to mention angrier post if the president doing the "larnin'" had been W...

[JM]

I'm just pleasantly surprised to learn that Obama reads the New Yorker. I've now started to try to figure out which cartoons he shows Michelle. Or wonder if we'll ever see his name as a finalist in the caption contest.

In any case, the sentence Gawande wrote along the lines of "this is an empirical, not an ideological, problem" seems aimed squarely at Obama.

[oratoricalanimal]

Yep, noticed that sentence as well, JM. I think the excuse note he wrote for that little girl in Green Bay just might be his cartoon caption.