Thursday, December 9, 2010

Middle Ground

I’ve often heard the phrase, “If you’re young and you’re not a liberal, you have no heart; and if you’re old and you’re not a conservative, you have no brain.” And I do believe there’s a certain amount of truth to it. One of the reasons I chose Emergency Medicine as a career was that I liked the “White Hat” part of it all…I was the one guy who would take care of anyone at anytime. The Stetson has been solied, however, by years of reality, and so I have begun to morph from what I like to call the Hard Rock Café of Medicine…Love All, Serve All…to a more nuanced view that while there are both people we absolutely need to help and some totally beyond redemption, that personal responsibility is on the wane, and that nobody quite understands the concept of an “emergency,” in general people earn what they get out of life. That’s why I’ve become increasingly fascinated by pundits and politicians, as well as ordinary citizens, who are able to state with metaphysical certitude (thank you, John McLaughlin) that the solution to our social ills is to either throw handfuls of money at more government programs to positively impact more people or to slash every entitlement program out there and let people fend for themselves. They find no room for compromise in between. I have no idea what world they’re living in.

(If you and I are “ordinary” citizens, it’s important to note the policymakers and pundits are not “extraordinary” because, like Superman, they possess “powers and abilities beyond those of mortal men.” Instead, I like to think of them as extraordinary in a Twilight Zone sort of way, as “not like us” but resembling extraterrestrial fully willing to devour the heart and soul of their fellow humans while quoting “To Serve Mankind.” IT’S A COOKBOOK!)

So here’s what I think I’ve figured out. It’s really easy to be an extreme liberal if you live well and don’t see the poor, the abused, and the homeless. It’s easy to see them as the victims of racism, xenophobia, substance abuse, and rampant capitalistic greed. And it is equally easy to be a radical conservative under the same circumstances, except now you see them as abandoning the work ethic that built America for an entitlement mentality and draining the fiscal and cultural life from the land. What they know of the social ills of this land they know mostly from clever statisticians and reinforcing media, supplemented by “listening tours” and the occasional goodwill visit. Both sides are perfectly willing to manipulate the dispossessed as political tools and voting blocks to advance their own agendas. And after their obligatory daytime hours spent in tearful condemnation of or strident fury against the system, they go home to nice neighborhoods, full larders, kids in good schools with every chance to go to college, health coverage, and paid vacations.

The whole thing seems a little hypocritical to me, and I say this fully aware that I’m one of the ones who’s not worrying about my next meal. But if I don’t know how to live in poverty, at least I see it every day. Sometimes I’m sympathetic with what I see, and want to do all I can to help someone; sometimes it makes me furious, and I’m equally enthused about wanting to tell another that they’re abusing the system and they can expect no further handouts from me. But at least I know something of which I speak, and I have some “stake in the game,” as it were. Improving these social ills makes my working life easier. But when problems get fixed, politicians and pundits are out of work, and special interests cease to wield power. So it’s in everyone’s interest to keep the system going exactly as it is. Everyone’s, of course, except those in true need, and those rare individuals in public life actually interested in making positive change.

So what’s really out there? Based on my totally unscientific observational study of the socioeconomic needs of people who drop through the ED. About a third of folks are truly in distress and need all the help we can provide. A third are abusing the system. A final third really have no clue where they fit in and are just trying to get by the best that they can. And as a result of these observations, I have come to believe that our system does often entitle people to services that are undoubtedly excessive, but also places significant roadblocks in the way of those who truly need additional help.

I fully recognize that this subtlety…also known as reality…goes against the current “sound bite” dialogue we’ve come to expect in our public policy debates. And we accept that lack of substance, because these issues are hard to think about and even harder to solve, and if Americans have been trained to do anything in the media age it’s it avoid independent thought. Which is clearly one thing we excel at.

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