A Case Study in Critical Thinking: The Medical Care Reform Debate



  • The Wikipedia entry for Critical Thinking defines it as purposeful and reflective judgment about what to believe or do in response to arguments for a particular course of action, especially determining whether there is adequate justification to accept the conclusion as true. Critical thinking gives due consideration to the evidence, the context of judgment, the relevant criteria for making the judgment well, the applicable methods or techniques for forming the judgment, and the applicable theoretical constructs for understanding the nature of the problem and the question at hand. Critical thinking employs not only logic but broad intellectual criteria such as clarity, credibility, accuracy, precision, relevance, depth, breadth, significance and fairness.
  • Engineering Duty Officers need to develop critical thinking skills to be effective proponents of particular courses of action they propose and to critically assess proposed courses of action proposed by others. They greater the skill you have in logically and critically evaluating arguments, the better your ability to convince others to accept the validity of your own arguments.
  • Most people are not born with a noteworthy effectiveness at critical thinking and critical thinking is a skill that can be improved with study and practice. Two of my favorite books on the topic are:


The Case Study Ground Rules


As an intellectual exercise, I am going to suggest some questions to consider tailored to medical care reform. You should try to answer these questions on your own first before consulting the file I have created that provides some of my suggested additional information (not answers, really). The point of this blog post is not to convince you to adopt my opinion about the merit of reform proposals. The purpose is to suggest the kinds of questions Engineering Duty Officers should ask if someone comes to them to propose solutions to any complex problem. The benefit of this approach is that it focuses on data and logic and does not resort to impugning the motives of those for or against various proposals. Before reading any further, write down what questions you think are pertinent if you were the only one deciding what to do about US medical care reform (political issues aside). Then read further to compare your questions with those I suggest.


Basic Critical Thinking Questions (for any topic)


1. What are the issues and the conclusion?


2. What are the reasons?


3. What words or phrases are ambiguous?


4. What are the value conflicts and assumptions?


5. Are there any fallacies in the reasoning?


6. How good is the evidence?


7. Are there rival causes?


8. Are the statistics deceptive?


9. What significant information is omitted?


10. What reasonable conclusions are possible?


Critical Thinking Questions Tailored to Medical Care Reform


  • How big and complex is the medical care delivery system in the United States?
  • What are the major issues of contention?
  • What problem(s) is the government trying to fix?
  • Are those the most important problems (or the right places to start) with US Medical Care? What do others think?
  • Do other countries have similar problems with growth of medical care costs and coverage? What actions have they taken? What results did they get?
  • How “bad” are the problems? What is their impact?
  • Is there anything unique about medical care/insurance that makes it different from most other services consumers use?
  • What are the economic considerations of rationing/consumption/scarcity fundamentals that may be relevant?
  • How does anyone (government or private industry) make enough money in medical care premiums to offset the cost?
  • What process was used to determine the identified problems and proposed policy changes are the “right” ones and the highest priorities?
  • What are the appropriate measures of national medical care effectiveness, satisfaction, and quality?
  • What policy changes are being proposed to address the problems? What evidence is there that the proposed changes will actually have the desired affect and limited unintended consequences?
  • The most significant government run medical care program prior to this was the initiation of Medicaid. What were the projections for that program and how valid, with the benefit of history now, were they accurate/valid and why?
  • Are there any fallacies in the reasoning? (looking for signs of weak arguments)
  • If current medical care reform proposals can be characterized as top down, what other options are available to reform medical care in the United States?
  • What are the pros/cons of a bipartisan approach?
  • What happened the last time the government tried to reform medical care? What is different now?


As noted above, think through your own answers to these questions based on what you have read or think, possibly writing them down in advance to avoid the “knew it all along” bias. As an intellectual exercise (yes, I regularly do things like this to hone my own critical thinking skills), I have placed information related to each one of these questions in a separate file (available at this link).

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