by Martha Quillen
I’m really concerned about American politics. Our public discourse has been divisive and immoderate for decades, but the citizenry never seemed as burned out, fed up and over it as some of my friends and acquaintances do now.
People tell me that our political process is broken and bankrupt, that it’s been bought and paid for, that it’s corrupt and irrelevant.
Others scathingly suggest that people who believe that their political views can matter – or should matter – are naïve and arrogant.
Yet even in the wake of such criticism, I continue to obsess over the growing gap between America’s rich and poor; the re-emergence of racism; the stratospheric cost of higher education; the paltry wages that hourly workers in rural Colorado generally make; and the incredible difference between the $70,000 or more per year that a nursing home costs and the $15,000 per year that a person over 85 has.*
Come to think of it, I guess I’m as disgruntled as my friends. But I don’t obsess about this stuff because I think our situation is hopeless. I obsess about it because I still think that man-made systems are fixable.
But that’s what many Americans don’t seem to believe any more. Whether the subject is climate change, campaign finance or the banking industry, citizens don’t seem to regard our problems as fixable.
Some of my acquaintances have given up on politics. Just let it go, they urge. Politics will make you crazy. But once you quit thinking about it, you’ll feel better. You and I can’t change the world, but this is America, where money matters – and there’s a surfeit of goods and enough for everyone, and things will be fine.
And it’s true: In America, things are good if you are lucky and of sound mind and body.
But everybody isn’t lucky and of sound mind and body, and a democratic society that blithely dismisses inequities and maintains that people deserve whatever happens to them is cruel and obstreperous.
So how did we get here?
Quite clearly by dividing into feuding factions, then ignoring, suppressing, ridiculing and shouting down a lot of voices, which is something Americans have been doing for several decades now.
Our political discourse has become an abomination: We know it, see it and feel it. But we can’t seem to change it. Instead, we complain about how our political opponents talk, our pundits exaggerate, and our politicians think.
But doing so merely escalates the problem. (I understand this because I excel at such futile escalations myself.)
In Salida, the modern tendency to campaign by bristling and battling has become disheartening – and baffling. This is a small town; you wouldn’t think we could find so many things to wrangle about. Yet every time one issue appears to be settled, the local paper features a new spate of infuriated letters about some new project and how those ignorant, uninformed, out-of-line, rude, selfish ….
Well, the complaints go on, and around, and back and forth.
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During the last two years, controversial issues have come and gone, waxed and waned, and surged, again and again, until the zingers have gotten so persistent that I feel as if I’m living in I Love Lucy mode:
“Ay, Caramba, Salida, can I not turn my back a single moment without you coming up with some new zany scheme to argue about?”
In my view, it’s important to read newspapers and stay informed and weigh in on issues, but my friends have a point. This sort of politicking gets us nowhere.
And if you had asked me last week, I would have told you that things were not looking good for America’s future.
Or Salida’s.
But then I read Being Mortal by Atul Gawande, an excellent, thoughtful and deeply philosophic book about problems in our health care industry, and it occurred to me that Americans are still innovative and insightful. And we are still resolving many of our problems, quietly and behind the scenes.
Gawande, a surgeon, readily admits that our health care industry is flawed, and that the nature of the medical culture he belongs to contributes to its problems. By education and tradition, medical professionals have been encouraged to regard saving people, longevity and safety as more important than a patient’s emotional well-being.
And thus the needs and desires of patients have frequently been neglected, especially the needs of the elderly.
Nursing homes maximize efficiency and ensure safety by confining patients to beds and wheelchairs. Many facilities discourage unsupervised exercise that could cause injury, and some impose strict diets and rigid visitation rules. Many house patients two to a room, thereby eliminating privacy. Such treatment can feel like imprisonment, and recent research shows that it not only makes patients miserable, it also hastens their decline.
But Gawande’s book is not about the system’s flaws, it is about strides and solutions that are changing our health care system for the better, including new and novel elder care programs, hospice and palliative care, and many sorts of assisted living.
New innovations and dedicated people have proven that patients fare better when they have a say over what happens to them. Apparently, people need the basic right to make their own choices in order to retain a sense of purpose and hope. Patients without any control over their lives trend toward depression and despondency, and the health care industry is starting to recognize that and respond.
There are inevitably setbacks and challenges involved when systemic change is attempted, but change is happening. There have been fundamental improvements in the way we treat the elderly, chronically ill and dying. And more changes and choices are evolving.
The most idyllic models Gawande cites are prone to backsliding, as is he. But that’s good news, because the push forward continues regardless, which proves that huge, monolithic systems can be fixed.
But what stands out in Gawande’s book is that these changes weren’t driven by fury, marches or uprisings. Nor were they initiated by hospitals that faced cutbacks or ruin if they didn’t do something. Nor by doctors who thought they’d be sued if they didn’t comply.
These reforms have been adopted because the medical establishment has gradually become convinced that they are right and good.
So now all we have to do is convince the rest of our society that the best medicine for what ails us is to make sure that citizens have some say in their treatment.
And that, of course, is the whole idea behind democracy.
* The $15,000 figure comes from Gawande’s book and is clearly based on the fact that most Americans over 80 have spent all of their savings and are living on Social Security. The $70,000 is based on a discussion I heard at a church breakfast yesterday, in which people were aghast at the $6,000 a month a friend of theirs was paying. (A quick online survey of nursing home costs showed that this figure was at the low end of average in Colorado; and assisted living facilities cost about half as much.) But when it comes to comparable averages, there are none. All sorts of facilities exist, and patients have different needs. However, it is agreed that most elderly people cannot foot the bill for full-time care, and that’s expected to get worse as the baby-boomers come of age, which is one of the reasons conservatives worry about “entitlements.”
Martha Quillen ages not so gracefully in Salida.
