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Houston, we have a problem

By Dr. Lucas Restrepo

Anosognosia is a curious problem. This morning, I asked a patient if he was blind, as he was colliding against the walls. He answered, “of course not.” His opinion didn’t change after failing repeatedly to count fingers or name objects placed in front of his face.

Rationalists have a high regard for graphs. The chart below shows that, consistently, more people live in poverty in Texas and Arizona than in the rest of the country. 

GraphIn 2009, 1/6 Texans and 1/5 Arizonans lived in poverty. Poverty is complex and resists simple explanations. However, poor governance perpetuates or exacerbates it. It’s curious that, where poverty is direst, politicians exhibit great affinity for exotic ideas, perhaps to deflect attention from real problems. While Texan politicians fantasize about secession, their Arizona counterparts want the police to detain anyone who looks Mexican. These extravagant distractions were handsomely rewarded by voters during mid-term elections. Escape-goat-hoarder cowboys also share a sordid fetishism for balancing budgets at any costs, and Medicaid and CHIP are on the dissection table.

Ezra Klein explains that “the underlying rationale is that sacrificing the health coverage of poor people would be a worthwhile move if it solves the state’s budget crisis.”

Reading this, my colleague Arthur Lavin commented: “can there be a more explicit, visual exhibit ofcruelty?” I posit that more than pitiless, the impetus to cut Medicaid is unintelligent. Let me explain. The word intelligent comes from the Latin expression intus legere, which literally means “to readwithin.” Of course, it is impossible to read if you turn your face away from things, or if you do not perceive things. The blind, those with anosognosia, and those feigning blindness, are destined to stumble on things they ignore.

Here’s the stumbling block: everybody gets sick, particularly the poor. Those who can’t pay for health care will receive medical attention, typically when their illness becomes harder to combat (and more expensive). Obviously, someone has to pay the bill.

That’s you and me. That’s right: when you disburse your premiums or co-pays, you exercise an involuntary ―and unintelligent― form of altruism, charitably helping health care institutions, public or private, compensate loses from the uninsured.

Humanists have a high esteem for art. The oil-on-canvas below, painted in 1887 by William Blandford Fletcher, is titled Evicted.

EvictedAdmirably, Evicted is a study of visual evasion and intersection. The evicted are stared at by the characters in the posterior plane, while the neighbors in parallel to the ousted avoid watching. The effect would be almost mathematical if it wasn’t by the immediacy of the girl’s eyes, looking straight at the spectator. Artists epitomized by the great Victor Hugo, departed from the traditional depiction of poverty, which was attributed to personal flaws or sins. Fletcher’s dignified portrayal of the dispossessed, with their unavoidable gaze, demand an explanation, and submit a striking indictment: there is something inherently inhumane and unacceptable about the eviction. It is precisely this sensibility that permitted the creation of the welfare state that defines our civilization, under the utilitarian premise that we all are vulnerable to the twists of fortune. Ironically, the contemporary failing of such sensibility is permitted by the success of the welfare state, which rendered poverty less conspicuous, removed from the eye of the comfortable.

“Physicians,” said Rudolf Virchow, “are the natural attorneys of the poor.” Here, I wish to vehemently denounce the irresponsibility, cruelty and lack of intelligence of those who wish to rip apart the safety net of our society by doing away with Medicaid.



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