California Dreaming?

A Case Study in the American Malaise.

So just what is wrong with America? Of course, there are those who think nothing is wrong; who over the past 10 years have been the beneficiaries of the greatest redistribution of wealth--to the already wealthy-- that has ever occurred in the history of the Republic. But there are those whose experience has been different and who have faced the reality of an increasingly elusive and withering American Dream.

What does this have to do with healthcare? The answer is: a lot. One of the fundamental determinants of the health of the country’s population is not the number of physicians or even the money spent (US spends more than 17% of GDP, far more than any other country, and gets at best variable and mediocre results), no, the biggest determinant of overall health is distribution of wealth. Where there are gross disparities in income and wealth, there are predictably gross disparities in health outcomes and health status as well.

Sometimes it takes an artist, a bona fide writer (unlike me) to truly shed light on things as they are. I recently received an essay from a friend and Silicon Valley writer, Gary Garvin, who puts it far better than just about anything I’ve read. The link to his full essay, “Gloriously Pointless”, can be found at http:// rggblog.wordpress.com. Particularly poignant to me is his observation about how much money has flowed through Silicon Valley without leaving any enduring legacy of community improvement for people like Mr.Garvin, his family and the students he teaches in the community college system of California. Here’s an excerpt from Mr. Garvin’s essay:

‘One of the factors that has shaped my life and which has gotten progressively worse is the hassle of going from A to B, the stalls, the noise, the urgent, massive crowding. The freeway was rough everywhere, with cracks and patches and asphalt warps, reminders we might be living on borrowed time. Still, the scenery was pleasant once we put the Silicon Valley sprawl behind us, the bare, softly rolling hills, fully green from winter rain, soothing and sensual. Yet the hills would turn dead brown in the coming rainless summer, as they always do, and it was hard not to think of grass fires, the Oakland fire, mud slides, and earthquakes, the faults beneath the smooth veneer of the California landscape.

Traffic, of course, is not a big deal and it is much worse elsewhere. We get used to it and put this irritation aside. It would be madness not to do so. Earthquakes seldom are a big deal either, and most who have lived here long enough don’t pay much attention. We learn to roll with the punches—this is what defines the California character—yet after thirty years I still haven’t settled in, and each time I feel a tremor, something inside me slips a bit.

I wonder what else we have inured ourselves to, with what effects.

I am worn out and dispirited, for personal reasons I won’t bore anyone with. I will, however, look outside. Part of the problem, mine and ours, as with freeways, is the size and complexity of the facilities and institutions that determine the course of our day-to-day lives, the distance, separation, and simplifications—and chaos—these can cause. But I haven’t heard much discussion about issues of scale, and our solutions tend to larger schemes.

An enormous amount of money has poured through Silicon Valley the last decades without beneficial effect on its environment or the quality of its life and culture. Now many of us are scrambling, and if we took the time to leave the freeways, we would find more of us are doing much worse. Yet all these years, prosperous and lean, the state has gone through a series of budget crises, the current one the worst. Services have been cut, the infrastructure left in varying states of disrepair. Public schools have endured perpetual hiring freezes and layoffs, and program cancellations and increases in teacher loads. Like earthquakes, budget shocks have become a permanent part of our economic climate. But that cannot be a problem of size, but of priorities, or of something else we have not looked at and factored in.

I have taught at seven schools, three of them with some reputation, and the experience has not been wholly rewarding. Faculty at all are competitive and contentious, the departments specialized and divided. Not only is there no mechanism in place to give support and recognize basic needs, the language does not exist to express them. The humanities can be less than human, and sometimes inhumane.

I am not alone. Many I know of my age, in teaching and in other professions, here and throughout the country, are in the same shape and they voice similar concerns. Like me, they didn’t see it coming.’

So why doesn’t the money “stick”, or the culture cohere? Is it because taxes and cooperation are for suckers? Is it because the era and legacy of Ronald Reagan so thoroughly legitimized greed and the obsessive pursuit of self-interest that there is simply no thought paid to giving back or belonging to something larger than our own reflections? And the corollary question is: as a result of this spiral of social disintegration, have we totally lost our bearings and connection to any physical place or community? I fear that, ultimately, when this happens it is only one more small step to losing even more fundamental human qualities such as compassion and caring. How often in the past three decades have we heard those who are less fortunate callously dismissed as mere “losers”? Are we becoming a nation of a few haves and many losers?

So ask yourself: Is this the America I’ve always believed in? If not, where do we go from here? I think many of us would agree that the current path is not one we would care to continue on to its logical terminus. Not only our health but our very survival as a civil society depends on changing course. Are we up to it? Do we have the moral strength and political courage? In many ways, a health care system is an indicator of so much more. It is really nothing less than a reflection of how we chose to live and what we hold dear.