An Illuminating Trip Outside the Santa Fe Bubble

By paulgibson51 on October 21, 2017 • ( 0 )

Today’s blog provides excerpts from an extraordinary New Yorker article comprised of interviews with a series of old high school friends of a doctor who returned home to rural Ohio…and they talked healthcare as a right…and much, much more. Trust me, everyone needs to read this to gain insight into the perspective of Trump supporters.Retake Our Democracy on KSFR. At 11am today, Roxanne and I are on KSFR 101.1 FM for a full hour conversation and to support the KSFR pledge drive. We are asking you to please listen in and give us a call at 428-1393 to make a donation and voice your support for KSFR and Retake Our Democracy.

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A Journey Outside the Santa Fe Bubble and To Find a Path to Common Ground

Thanks to my pal Mark Rudd for both the article on which this blog is based and for the short video at the end of the blog. How many times have I asked myself: “How do ‘these people’ vote for Trump?” or “Why can’t people understand why universal healthcare is so important and so just?” Well, Dr. Atul Gawande returned to his hometown in rural Ohio and this New Yorker article relates his conversations with a half-dozen friends. I highly recommend that you take 15-20 minutes to read this very important piece as it includes rich details about the lives of these friends, their economic situation and health conditions that provide an excellent context informing the comments you will find below. I was left with a far more nuanced understanding of how people could possibly vote for Trump, be willing to toss a healthcare system out the window and say ‘screw you’ to anyone with a BA. I will provide precious little narrative connections between a series of quotes of high school pals of Dr. Gawande. And while part way through, you just feel a sense of dread, a sense that reaching ‘these people’ is simply impossible, by the end, a path to common ground seems possible. My advice, click here, to read a truly worthwhile, well-written analysis of the divide over healthcare which clearly isn’t just about healthcare, but about two fundamentally different assumptions about the role of government. And after reading the full article and then come back here to watch the 2-minute video at the end of the post.

His friend Joe: “My personal opinion is that anytime the government steps in and says, ‘You must do this,’ it’s overstepping its boundaries,” Joe said. “A father, mother, two kids working their asses off—they’re making minimum wage and are barely getting by—I have no problem helping them. If I have someone who’s spent his whole life a drunk and a wastrel, no, I have no desire to help. That’s just the basics.”

His friend Tim who works at a water treatment plant: “People don’t think about their water, Tim said, but we can’t live without it. It is not a luxury; it’s a necessity of human existence. An essential function of government, therefore, is to insure that people have clean water. And that’s the way he sees health care. Joe wanted government to step back; Tim wanted government to step up. The divide seemed unbridgeable. Yet the concerns that came with each viewpoint were understandable.”

From the author: “Before I entered the field of public health, where it’s a given that health care is a right and not a privilege, I had grown up steeped in a set of core Midwestern beliefs: that you can’t get something for nothing, and that you should be reluctant to impose on others and, likewise, to be imposed upon. Here self-reliance is a totemic value. Athens, Ohio, is a place where people brew their own beer, shoot their own deer, fix their own cars (also grow their own weed, fight their own fights, get their own revenge). People here are survivors.”

From Arnold: “I think the goal should be security,” he said of health care. “Not just financial security but mental security—knowing that, no matter how bad things get, this [the cost of healthcare] shouldn’t be what you worry about. We don’t worry about the Fire Department, or the police. We don’t worry about the roads we travel on. And it’s not, like, ‘Here’s the traffic lane for the ones who did well and saved money, and you poor people, you have to drive over here.’ ” He went on, “Somebody I know said to me, ‘If we give everybody health care, it’ll be abused.’ I told her that’s a risk we take. The roads are abused. A lot of things are abused. It’s part of the deal.’”

From the author: “As he [Arnold] saw it, government existed to provide basic services like trash pickup, a sewer system, roadways, police and fire protection, schools, and health care. Do people have a right to trash pickup? It seemed odd to say so, and largely irrelevant. The key point was that these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down. And that’s what has happened with American health care.” This is a key distinction toward finding common ground. Rather than a privilege or a right, it was a collective effort to share the burden of meeting very basic community needs.

From Betsy, a school teacher: “The honors kids—the Hillary Clintons and Mitt Romneys of the school—sat at the top of the meritocratic heap, getting attention and encouragement. The kids with the greatest needs had special-education support. But, across America, the large mass of kids in the middle—the ones without money, book smarts, or athletic prowess—were outsiders in their own schools. Few others cared about what they felt or believed or experienced. They were the unspecial and unpromising, looked down upon by and almost completely separated from the college-bound crowd. Life was already understood to be a game of winners and losers; they were the designated losers, and they resented it. The most consistent message these students had received was that their lives were of less value than others’. Is it so surprising that some of them find satisfaction in a politics that says, essentially, Screw ’em all?”

The article sites Arlie Hochschild’s brilliant book of Strangers in Their Own Land where she utilizes an image of people standing in line to get their just rewards for working hard and seeing people cut in line in front of them, getting benefits without working for them.

From the author: “Our political debates seem to focus on what the rules should be for our place in line. Should the most highly educated get to move up to the front? The most talented? Does seniority matter? What about people whose ancestors were cheated and mistreated? The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains. America’s founders believed these possibilities to be fundamental. They held life, liberty, and the pursuit of happiness to be “unalienable rights” possessed equally by all members of their new nation. The terms of membership have had to be rewritten a few times since, sometimes in blood. But the aspiration has endured, even as what we need to fulfill it has changed.” The article examines how the vast majority of Americans love Medicare precisely because we all pay for it in taxes from birth, not knowing when or if medical crisis would strike but agreeing that there was the need to share the burden of protecting all of us. In these terms, people support government interventions, but when seen as a benefit doled out to some, especially if those people are viewed in any way as being ‘undeserving,’ support erodes.

The article includes a very apt citation from history. In the early 1800s tens of thousands of people died each year from small pox. And then a European quite by chance discovered a vaccine. Unfortunately the cost was outside the reach of most Americans. So, at Jefferson’s prompting, and with Madison’s unhesitating support, Congress passed the Vaccine Act of 1813 with virtually no opposition and tens of thousands of vaccines were distributed, saving thousands of lives. Unfortunately, in 1821 a mistake was made and a batch of small pox was sent to North Carolina instead of the vaccine and ten lives were lost. The resulting furor caused Congress to repeal the Vaccine Act and soon thereafter thousands of lives were again lost to small pox. Seeing their error, Congress reversed course and restored the Act. The point is, of course, that forms of socialized healthcare have been in place in our country for over 200 years. It is not some radical departure. And the other point is that as we develop new public policy, there will always be mistakes or short comings to learn from. But these need to be addressed without entirely disposing the policy advance.

From the author: “Two sets of values are in tension. We want to reward work, ingenuity, self-reliance. And we want to protect the weak and the vulnerable—not least because, over time, we all become the weak and vulnerable, unable to get by without the help of others. Finding the balance is not a matter of achieving policy perfection; whatever program we devise, some people will put in more and some will take out more. Progress ultimately depends on whether we can build and sustain the belief that collective action genuinely results in collective benefit. No policy will be possible otherwise.”

The human face of this kind of collective benefit is driven home from one final interview, a friend who had lived a life filled with drink, chicken wings and tobacco leading to a massive heart attack. Mark had been forced to insure with Obamacare before he had the attack and being under 60, surviving his heart attack left Mark with a huge pre-existing condition. Under Obamacare, he is still covered and still gainfully employed. So the key here is this: if we can craft a system that feels like from the start we are all chipping in to provide for our collective security, there is no line and no cutting. We all paid in; we all benefit as none of us know when a health emergency will arise. But in a civilized society, if you have a heart attack and survive, your first thought should be: I am alive, not how the hell will I ever pay for this?

And so today, we watch the GOP undermine Obamacare and Trump removes regulations insuring that insurance policies cover pre-existing conditions (sorry Mark, who voted for Trump) and enable insurers to offer bogus, low cost health policies, the equivalent of what happened in 1821 when the Vaccine Act was identified as less than perfect. And quite likely many of the individuals in this article will support this move. Our challenge is to listen to their voices, understand their perspective and have the kinds of conversations that Dr. Gawande had with his old classmates. A remarkable article.

Click here to read the entire New Yorker article and then to see in 2 minutes a video from Move.On that points a way to how to start a conversation with the kind of people captured in this story. It isn’t as compelling as the New Yorker article and I think someone needs to make a video of conversations with those folks.