

The policies sound good, and perhaps they would be, if not for the malignant intentions that motivate them.



As physicians, we have seen the numbers of uninsured and underinsured soar, costs skyrocket, and quality deteriorate. Meanwhile, doctors drown in a sea of bureaucracy.



Only single payer would eliminate the high corporate overhead, profits, and enormous inefficiencies...



The banality and sense of entitlement of rich students at Harvard left John H. Summers feeling his teaching had been degraded to little more than a service to prepare clients for monied careers.



Most of the students I encountered had already embraced the perspectives of the rich, the powerful and the unalienated, and they seemed to have done so with appalling ease.



One of my less affluent students, the son of a postman, asked me once for advice about a financial investment.... I told him what I thought about this recommendation; but only later, when I learnt how little he had to invest ($2,000 was his total savings), did I allow myself to think I understood the significance of his question. No amount of money may be permitted to lie idle if something may be got for nothing.



I recently received a form letter from Marcia Angell's socialist federation, "Physicians For A National Health Program," looking for support for government sponsored universal health care. It cited the usual reasons:Etc. Ok, valid if not hyperbolic points. But that's notshe wants single payer insurance.The stated reasons include reducing corporate profits. That's not a byproduct, or a necessary result, it is afor doing it.Another example I've used before. NPR was interviewing someone over a year ago about the high price of oil (ha!) and she asked the guy how to reduce the price, and he said he actually hoped the price would go higher, because it would curb use, decrease carbon emissions, force alternative energies to be explored, etc. Great. Her response, however was: oh, ok, and decreasing demand would be another way to hit oil companies where it hurts.Get it? That's where she was standing, lowering prices might be good for the consumer but she didn't bother to say that. What was on the tip of her tongue was the need to punish oil companies. This woman is not stupid, she's not unaware of the complexities of energy policy-- but where her mind went immediately was how we can hurt oil companies. It wasn't incidental, it was absolutely vital that this happen.In the British Times Higher Education is an article by a Harvard professor lamenting the decline of the American student. Here's the table of contents blurb:It laments the student privilege, grade inflation, consumerist attitudes, and the like. But that turns out to be only a minor gripe. What really got him:He goes on to describe and deride this perspective, but when he chooses to cite an example-- you expect him to say something like "they urinated on homeless people" or "voted for Bush"-- he chooses this:This Harvard professor is angry that the guy wanted to. Period. "Something for nothing." Do you understand?I suppose I shouldn't be surprised-- this nut was also angry that Harvard wouldn't let him teach a class he named, "Anarchist cultural criticism in America"-- but the main point is that this guy, the NPR interviewer, and Marcia Angell are certainly not the underprivileged. Their resentment against the system isn't supposed to be this visceral.That's why the social welfare angle is a red herring. It's not that they want better services for the underprivileged and hurting the rich is the byproduct; it's the opposite, hurting the rich is the emotional, primary motivator, and the rest is an intellectual posture that rationalizes this resentment. This is why it's dangerous. That's why you can't side with them even if you agree with their policies. Intention matters.Ex-Marcia these three may not be rich, but this amount of public hate and open vitriol are not expected in a properly functioning classless society.Which simply means it's not properly functioning. Nothing new there, except for this: it is properly functioning. What's not working is the perception.Summers is angry because he doesn't feel he could plug into the capitalist system, even though, obviously, he could if he tried-- the postman's son certainly is, with far less money or knowledge than the professor. So it's not the reality, it's the perception, but perception, confidence, is what this society is based on. Consequently, the system is failing.The analogy is a bank run. As long as people think the bank is solvent, then it actually is. But if enough peopleit isn't, then itbecomes insolvent.So the question that needs to be answered is, "what went wrong that ordinary Americans hate people they perceive to not be in their class?"From grade zero through college, you are told you belong to a class. Let's use the simple example of money: if you're an engineering student they'll tell you how to be an engineer, but no one anywhere tells you how to be aengineer. No one even tells you it is possible. If you go into the humanities, the expectation is you'll be "poor." Your future is defined by its limitations, not possibilities. "You won't starve, but you certainly aren't going to be rich." Really? Are we still in America? It seems to occur to no one to try to teach humanities students howto be poor.You're choosing a major and a lifetime social class. There's no fluidity-- they teach you, day one, pick your life slot. Good luck changing your mind in twenty years.I'm not saying they should explicitly teach you how to be rich-- I'm saying they shouldn't teach you to expect to be in a slot.Worse-- and I have seen no one anywhere make this observation, the most important one of all-- there is no generational perspective on advancement. At no point in K-16 is there even the subtlest suggestion that you should make something of yourselfNot as a byproduct, but as the actualof all this education. No: the whole thing is aboutCertainly people want their kids to do well, they put them in violin lessons, but what is missing is this explicit mantra: they need to go further than me. If you're a doctor reading this, answer honestly: you've mused about whether you want your kid to become a doctor or not, but do youthem to be more than that? Not equivalent-- e.g. lawyer-- but more? Are you raising them for more, or the same?Here's a word you will never hear taught as a goal: dynasty. No. What they teach you is feudalism: here's your fief, bring me homage.It's not totally the parents' fault: the entire system, education and onwards, has grossly diminished expectations of its people and encourages, necessitates a self-focused, ahistoric worldview. They want you to plug into the Matrix, and then die. When you do, return all your stuff, someone else will use it.If you think of psychiatry as Zoloft, you're missing its scope. Psychiatry and culture are the same. It backs it, it supports it, it helps set expectations and values. It was more obvious with Darwinism or Freudianism because those were clearly articulated theories you could put in a book; psychiatry is more nebulous, but it is no less powerful a cultural force. Here's its mission statement: "you are different. And we will try hard to get you back up to the level of almost normal, but, state of the art, that's about as good as we can get."But psychiatry doesn't just reduce expectations for humanity, it diverts attention away from real expectations, onto a pointless biologic outcome. If it really wanted to help, say, foster kids , it would say, "what are the ways we can actually change their lives? Options: we can send them to big orphanages with skill immersion programs; or we can spend a trillion dollars and give them all individual tutors/case managers to follow them every day, etc--" But since it can't have this complex debate, because it requires way too much money, it shifts the expectations to "managing symptoms."The classic counterargument to my position is: you may be right, but psychiatry is better than nothing.Yeah, so was your first husband. "Better than nothing" is almost always worse than "nothing." Defaulting to psychiatry legitimizes not pursuing actual solutions.The patient is bleeding, your solution is to mop up the bloody floor so it doesn't look as bad. How long will this work? At what point do you become so deluded by the system that you think the "real" solution is better mops?