The word "poor" makes my friends uncomfortable. It brings to attention our obsession with having things, what I'll call Stuff Value. Second, it invokes a powerful myth – we can call it the Effort Myth – which says if we have stuff, we earned it through hard work and ingenuity. This implies if you don't have stuff, you were too lazy or stupid to get it. So when I say poor, and it gets you squirmy in your UGG boots, what I'm doing is making you conscious that you have stuff, and there are people who don't.
More importantly, I'm inviting you to entertain the forces in our country that have stacked the deck against certain groups of people. Forces like ZIP code, race and family support are a few examples that make sure the poor stay poor.
Just look at any social mobility data, like in Richard Wilkinson's TED talk. And look, I'm not upset about your UGG boots, except I think they look strange.
I'm upset that in 2013, we are haunted by Stuff Value and the Effort Myth. I'm upset that when my colleagues and I go out to practice medicine in a few years, we will come up against these forces and be unable to help our sickest patients. But there's hope. You, squirmy reader, are my hope.
Mike Johnston, a Colorado state senator, likes to say that "culture eats policy for breakfast." The Affordable Care Act (a.k.a. ACA or "Obamacare") is arguably the most famous recent policy in America. And culture is devouring it. According to Centers for Medicare and Medicaid Services (CMS) Census Data and a recent analysis by The New York Times, the ACA will leave roughly 600,000 of the most vulnerable men and women in our state without insurance.
The policy was conceived to cover the poor. Instead, due to a ubiquitous immaturity, it is disproportionately turning its back on black people and single mothers. Yes. I said it. Low-income black people will be negatively affected disproportionately. That's because in our country poverty of this kind disproportionately impacts black and Hispanic people. Same deal with single mothers. This is based on CMS Census data and confirmed by the Kaiser Family Foundation.
These are statistical correlations: careful there, squirmy reader, I didn't say causation. Now technically, this fallout in Georgia is precipitated by Georgia Republican Governor Nathan Deal's refusal to expand Medicaid. But from where I'm standing it doesn't matter. This might just be me, but I'm left thinking, why the hell didn't someone think of this? In Georgia, HealthSTAT, a student-run non-profit organization, and a consortium of groups under the banner of Cover Georgia, an advocate group trying to expand Medicaid to cover those uninsured by the ACA, are encouraging the governor to rethink his stance, like fellow Republican Governors in Ohio and Michigan. Cover Georgia is inviting us to change our culture, to reinvent the Stuff Value and the Effort Myth.
I'm not saying that people in society don't make bad decisions that lead them in the wrong direction. I'm not saying that if you're rich, you didn't earn it. I'm sure you worked hard, or likely your parents did. Again, Wilkinson's data suggests that in societies with little social mobility, your parents have a drastically high impact on your future income.
I'm saying the posture of our society has been one that rewards and punishes based on the Effort Myth and Stuff Value, when our better reason tells us this can't be so. We who are fortunate, born in this time and place to our relatively rich circumstances, must realize that we could have easily been an orphan child in Syria or Sudan.
In light of the outstanding impotence of our elected officials, it is incumbent upon "we, the people" who have something to do something. Even if all we have is the safety of a place to sleep and a sane mind, it's on us to gather our efforts in the redirection of Old Glory here. Our precious America, so distracted by shiny, new things. We thought we earned it. We didn't. We got lucky. And now it's time for us to turn our luck into grace.
Last month, hundreds gathered in the Atlanta Mission's Urban Garden for Lazarus Health Day. The mission of Lazarus, an Atlanta non-profit, is to build relationships with people with the intent of restoring dignity to those who have been disenfranchised and cut off from society. Health Day is just one of their projects. For seven years running, an interdisciplinary group of health professionals and students from across the state delivered care to the poor, offering a variety of services from rapid HIV tests to foot massages, to physical therapy and counseling.
This was a concerted effort to recognize and react to the massive inertia of injustice.
The medical students at Emory recently finished up their Poverty and Health Week (P&H Week). Hundreds of students from different disciplines came for seminars, workshops and networking events. Bright ideas forged in the creative environs of P&H Week will result in better care for the poor. One example is a mobile app developed by a team of government entities, non-profits, clinics and community stakeholders. The app will help you locate nearby resources in real time, for poor patients.
This is what it takes to break the Effort Myth and Stuff Value. This is how we change culture: doing things like Lazarus, joining causes like Cover Georgia, coming together for P&H Week and voting not on fringe issues but central issues. It will take us pouring our good fortune into efforts that create opportunities and provide grace to fix these cultural flaws.
Our sweet, young, confused America is a wayward teenager obsessed with Stuff. We've instituted laws like late night curfews – "Now listen America, you will care for your poor and uninsured!" No, it's time for America to grow up, grow out of the Effort Myth, grow out of adolescence and grow into grace.
A great poet of democracy, Walt Whitman, shared words on who We, the People might be:
Centre of equal daughters, equal sons,
All, all alike endear'd, grown, ungrown,
young or old,
Strong, ample, fair, enduring, capable, rich,
Perennial with the Earth, with Freedom,
Law and Love,
A grand, sane, towering, seated Mother,
Chair'd in the adamant of Time
Dave Mathews is a second-year medical school student from Atlanta, Ga.
Illustration by Max Cohen
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