Wednesday, July 8, 2009

Notes From Underground: How Do We Like Our Poor?

Posted by Tracy Moore on Wed, Jul 8, 2009 at 11:04 AM

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Thinking about healthcare issues in the abstract makes my eyes bleed, so if you want sophisticated waxing on healthcare reform and policy, stop reading now! But a recent conversation with a local healthcare professional gave me pause. I was talking to a women's health nurse practitioner working at a women's healthcare clinic in town. I asked how the job was going. She said the bulk of her clients were on TennCare, but that she also saw immigrants and unemployed women who had no insurance at all. She'd noticed something curious: The immigrant women were extremely grateful to have any care at all. The unemployed women--sometimes middle-aged execs who'd recently been laid off from well-paying jobs but were no longer carrying COBRA--were also extremely grateful to have any care at all. Both groups happily paid for their own care based on a sliding pay scale. It was many of the unemployed women on TennCare--those who paid nothing for the visit--who seemed the most entitled and demanding. "They want the best care, all the extra attention," she said. (I'm paraphrasing from memory.) Initial reaction: "Really?" I said. "They're not grateful?" It got me thinking about the presumptions we have about the poor, and the notion that they ought to be grateful for handouts. Those of us who have to pay for our insurance would be grateful to have it for free if we suddenly lost it. But I think there's something psychologically to holding that card in your hand. Free or not, the TennCare member is enrolled in a system that promises them coverage, so they can rightly expect to get the full benefits of that program. They want the annual checkups and medication and attention and the extra tests. They've got the card; the lady next to them doesn't. They went through the system and did the paperwork. (I'm not even talking about or implying that anyone in these cases is necessarily bilking the system, although we know that does happen.) They can expect the care. And when we expect something, we're more likely to ensure we get it. But really I'm just talking about the stigma of poverty. We're a country built on a poor-but-proud mentality in some ways. The poor can earn respect by working hard and with dignity, we seem to say. Expecting handouts is generally looked on with derision. It's almost as if we want to see the kind of grace we think should come with being on the receiving end of that benevolent hand of government charity. All our cultural signals back that up. Shows like Extreme Makeover: Home Edition show needy family after needy family sobbing with joy that anyone would be so kind as to swoop into their lives and solve their problems. That's the viewer payoff: They're poor, and now they have this dream house, and they're super humbled by it. We like our poor humble. If the family took one look at their shiny new home and rolled their eyes and said, "Geez, it's about time," it probably wouldn't have the same punch. Watching the citizens of other countries discuss their universal healthcare, no one ever comes off so much as grateful for the coverage, merely matter-of-fact about their right to receive it. But that's not America. Also, I've been poor--no health insurance, food stamps, trailer parks, the works. Being poor used to seem to mean enduring a very public acknowledgement of your predicament, at least in the small towns and public school systems I went through. Credit was harder to come by, so it was much more difficult to pose as middle class. (Though I've lived in Section 8 housing where everyone else seemed to pay $12 bucks a month in rent but always had really nice electronics.) And this was still a generation who didn't have a fancy swipey thing for food stamps that just looks like a credit card from a distance. You had to paste those suckers onto a little booklet and whip it out in line while everyone looked. And that free lunch program meant you had to pull out your card and have it filled in punch-hole style by the cafeteria lady, while, again, everyone else paid with cash and looked on and tried to figure out where your particular family went wrong. So you learned to act really grateful. It seemed to bring less scorn. I probably just sound like a whiny asshole: Man, back in the day when I was really poor, you had to really act poor, and now poor people don't have to act poor at all! I'm certainly not arguing that poor folks ought to grovel and tear up every time they catch a break--there's enough shame already there, especially with so many people already blaming them for their misfortunes. But I am intrigued by the assumptions that informed my very simple and immediate head-scratch at this woman's comments about some of her patients--and I'm usually your classic bleeding heart when it comes to most social programs. So what's worse? Those women not being grateful, or me thinking they should be?

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I probably just sound like a whiny asshole: Man, back in the day when I was really poor, you had to really act poor, and now poor people don't have to act poor at all!

Well, you beat me to it. I wouldn't have called you an asshole, though.

So what's worse? Those women not being grateful, or me thinking they should be?

Neither, really. Who do they owe gratitude to? Someone on tenncare probably feels entitled because they are. They're covered by tenncare. They pay taxes. I'm unclear on what sort of gratitude your healthcare professional friend is expecting. She gets paid, too. A person on tenncare could perhaps feel gratitude towards the society they live in that finds it worth erecting a social safety net for them (dysfunction though it may be) using taxpayer money (including their own).
I think perhaps your friend is also confusing "gratitude" for "relief" in the immigrants and recently unemployed. These are people who are in a scary murky grey area of our healthcare system, where they've lost some of the security they formerly enjoyed, and their benefits/lifestyle are in flux.
I don't see where gratitude should play into this at all.

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Posted by Chris Wage on 07/08/2009 at 11:27 AM

Orwell's The Road to Wigan Pier (as well as Down and Out in Paris and London is great on the subject of middle-class sanctimony vs the abjection of the poor.
Moralization about poverty is one of the nastiest parts of our culture, and it allows politicians to get away with all kinds of cruelty. Hell, the unemployment debate last year was a great example: there are actually monsters out there (a lot of them) who feel that unemployment is a moral issue, that people drawing unemployment insurance compensation (which they PAID for through taxes on payroll) are somehow freeloaders, etc.
It's desperately scummy business. Unfortunately the only cure seems to be for the pricks who criminalize and moralize about poverty to fall victim to poverty themselves. Just thinking about it doesn't seem to be Christian enough for them.

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Posted by The OG DG on 07/08/2009 at 11:40 AM

Oh lord, I could go on about this for ages and still make no sense at the end of it. The gist of what I believe is that healthcare should be viewed as a right and not a privilege. A trip to Greece or a nice cut of meat – privilege. A dose of antibiotics or a cancer screening should be available to all and at reasonable prices. I don’t (and won’t) pretend to know how to fix the obviously broken system, but my conscience tells me that what’s going on now for millions of people is ridiculous, and to leave things as they are is short-sighted, lazy, and morally repugnant.
I think the “grateful poor” archetype is one that is as old as altruism itself. No one wants to do something nice for those in need and have them spit in your face, but at the same time, how much awed amazement at the kindness of strangers is expected? It can be gross, uncomfortable, and raises the possibility that the provider was perhaps disingenuous in his or her desire to help the poor.
But then again – so what if it’s disingenuous? Someone got food when they were hungry or a pap smear or a fancy Xtrme Home Makever or whatever. I don’t know, human nature, blah blah blah. Maybe we could take the poors and train them in the ways of leeching and snake oil so they don’t sully our fine hospitals with their grinding poverty and bare humanity in the first place.

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Posted by Ashley on 07/08/2009 at 11:56 AM

"They've got the card; the lady next to them doesn't. They went through the system and did the paperwork."
So TennCare recipients' resentment of those who didn't follow the rules is understandable but when legal immigrant or other citizens question benefits for illegals, that reflects some deep evil on their part?

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Posted by Mark Rogers on 07/08/2009 at 12:34 PM

I think anybody should be grateful for free medical care, Mark, no matter what the circumstances. And I wouldn't give poor people -- nor anyone else -- a break for acting like ingrates about it. But I also don't begrudge anyone -- illegal or legal -- for getting help these days. It's damn hard out there. I'm happy that at least someone has a hand reaching toward them.

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Posted by Pete Kotz on 07/08/2009 at 1:20 PM

Half of this country believes that if you are poor its entirely your own fault. No health insurance as a result? Your fault. Want health insurance? Work harder & get a better job because I won't help you.
Its a most perverted intertwining of Smith & Darwin - and most who believe it will never see the world otherwise.

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Posted by TobintheGnome on 07/08/2009 at 1:37 PM

Mr. Kotz,
I could not agree with you more. My point was that it seems inconsistent to write sympathetically about one group's resentment of others who do not play by the rules while demonizing others who make similar arguments.
Perhaps if the discussion were about the quantifiable public policy benefits of expanded health care instead of an illusory 'Right' to health care, we could actually have a productive dialogue.

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Posted by Mark Rogers on 07/08/2009 at 1:41 PM

Hooray for Tobin! You win the award for the most lucid depiction of the shit I have been reading and hearing for a long long time. In 2 paragraphs no less.
One last detail to the picture you painted: Most of those that embrace that sentiment, at least from an I-40 perspective (and their bumper stickers), are piss poor themselves and mighty right proud of it too!?
"Work harder & get a better job because I won't help you. "
That's compassionate conservatism, innit it?
Bush/Cheney 04!

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Posted by mIKES on 07/08/2009 at 2:09 PM

Tobin,
You may well be right that many people feel that way although I think you are dramatically overstating the numbers. But the question that follows is why this is so? Americans are the most generous people in the world in terms of private charity. A large number of Americans participate in activities within thier communities that make a real difference in the lives of the poor. Why then should your observation be true?

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Posted by Mark Rogers on 07/08/2009 at 2:22 PM

I hear what you're saying, Mark, but Pith will never really have many rules of consistency. A lot of people write here, and they all have different opinions. House rules are that you get to say what you want. I don't think Tracy, for example, has ever written anything about illegals. But I can see why a reader might expect her opinions to be consistent with someone else's, just because they come from the same source.
We did have a pretty good discussion of health care last week, where the readers -- and I believe you were among them -- were far more eloquent than we were.

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Posted by Pete Kotz on 07/08/2009 at 2:32 PM

Mr. Kotz,
Thanks for your reply.
I was not clear in my initial comment that I was not so much focused on the author as readers out there that would agree with the article and then go out and demonize opponents of illegal immigration for holding a similar position.

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Posted by Mark Rogers on 07/08/2009 at 2:57 PM

Ah, now I understand, Mark. My apologies. Now I'm getting your point, and a worthy one it is.

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Posted by Pete Kotz on 07/08/2009 at 3:27 PM

I have heard ministers say from the pulpit it's not a sin to be rich, but I have never heard one say it's not a sin to be poor. Maybe they think it's not necessary, but all too many "Christians" seem to believe being poor is a bigger sin than even the big two.
I think when anyone makes the blanket statement your health care worker does, they clearly started with a point of view and then accepted all experience that reinforced it and suppressed what didn't. However, some people react to the contempt they feel from those serving them with hostility and demands to assert what little power they can muster in a low power situation.

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Posted by Sabo Pike on 07/08/2009 at 10:07 PM
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