Losing Faith in Society or Individuals or Both?

As information and misinformation surrounding health care legislation continues to be front and center in American politics, many of my patients have begun to tell me what they think. Lately, I have had a string of patients tell me things like, "It is all about individual responsibility. If people weren't so fat, health care would be cheaper," but then they go on "those people always eat at McDonald's, never exercise, and use their food stamps to buy junk food and not fruits and vegetables. The government has enabled them to behave this way through continued subsidies and now we have to bail them out again."

It is an attractive argument. After all, we all know that not enough Americans exercise regularly and there certainly is a higher rate of obesity and major diseases (and therefore health costs) in poorer populations. But I have an uneasiness about accepting the rest of the argument because I have never been there. Through luck of birth, I grew up in a stable family which valued education. I was always safe and never had to worry about whether I would be shot while walking in my neighborhood. I always had food on the table (even though my mother admitted some months were harder than others). I have never had to work more than one job, and I never had to worry about losing that job if the city bus was late or never showed up. Compared to many, my life has been easy. So how can I possibly know what "they" are going through or understand why "they" make different decisions than I would.

The attractiveness of the "us" vs. "them" argument is that "we" are always in the right. The problem is that it quickly falls apart when challenged. Who are "we?" Or alternatively who are "they?" Are they just the poor, the sick, or the elderly? Are they just the ones who have made bad decisions? Perhaps they are just people who think and act differently than we do. Not surprisingly, we are all a "we" or a "they" depending on the perspective of the individual rendering the opinion.

Encouraging healthy behavior is great and it would likely save money, but moving the argument to an emotional one hinged on the deeper issues of society is a slippery slope. Such arguments cease to see individual people struggling to do their best in the midst of huge challenges and instead focus on bad outcomes--essentially throwing the baby out with the bathwater. I realize much of this emanates from the difficult balancing act any society faces between helping its most vulnerable citizens and maintaining the status quo. But I also know if I ever become one of "them," I hope there is some safety net in place to help me out in my time of need.

John

Comments

[Jean Antonucci]

Thanks for bringing this up Brady.
Many of my patients and many letters as I read indeed express the idea that if only people would do X- eat less/ eat different/exercise / find work/ then others would not have to support these freeloaders.BUt when these fat lazy illegal immigrants who eat badly and go on the dole turn out to be real people with real stories everything changes. I grew up safe and well fed too. But in my work I know the real stories of the folks struggling
I do not know what to do when I hear the us vs them argument Willie Nelson sings "it is the prayer of every man to know how freedom feels, isn;t there any love anymore living in the promised land."
This is a promised land.
HArd topic Thanks for opening discussion There but for the grace of god go you and I and all those others
JEan

[John Brady]

Rich,
Beautiful and eloquent. Thanks!
John

[Rich]

John,
Like you I was born into a family and time when my needs have always been met. I'm truly blessed, and although I work hard now, I was just lucky. I could have just as likely grown up in poverty and have to think constantly about day to day survival.
It's easy to blame the poor or addicted or unhealthy or overweight or... etc etc.. people for their lot in life. Doing so just lets one rationalize that they have no obligation to help others. "They deserve what they have or don't have". This rationalization helps someone ignore their obligation to helping others, especially the less fortunate. I know that most physicians chose to be doctors because they truly want to make a difference in others' lives. Many people of other professions are also motivated to help, I know that is true. I am hopeful that the lucky people will be the givers, and will be motivated to restore everyone's faith in our society. Cynicism is easy, sacrifice for others can be hard but so rewarding to all. One of my father's favorite sayings, which I repeat to myself often, is "Be the solution, not the problem". I hope everyone can take that attitude to heart so we can all be blessed.

[John Brady]

Brock,
The Kaiser Family Foundation has a side by side comparison of all the plans at http://www.kff.org/healthreform/sidebyside.cfm
Happy reading!!

[Brock]

I hear many rumors about what is and is not going to on with the Health Care Reform and what the changes mean. Where can I go to get (relatively) unbiased information on what all the different plans entail?

[Sofia]

John,
This argument is born out of frustration. I believe many individuals do believe a safety net is needed for those who truly have fallen upon hard times. What has clouded the issue is those that "take advantage" or feel they are "entitled" to such amenities. That sense of entitlement frustrates many patients who work hard and have played by the rules their entire lives and now feel threatened. This "us vs them" argument is exactly what the politicians want. We all need to focus on real solutions that can fix the problems in an inclusive manner. Haven't we had enough of political divisiveness?