Monday, March 31, 2008

Poverty, the disabled and "personal responsibility"

Interesting article in the Sunday Globe:  The sting of poverty.  It's relevant for too many people I know with disabilities.  Here's a quote:

IMAGINE GETTING A bee sting; then imagine getting six more. You are now in a position to think about what it means to be poor, according to Charles Karelis, a philosopher and former president of Colgate University.

In the community of people dedicated to analyzing poverty, one of the sharpest debates is over why some poor people act in ways that ensure their continued indigence. Compared with the middle class or the wealthy, the poor are disproportionately likely to drop out of school, to have children while in their teens, to abuse drugs, to commit crimes, to not save when extra money comes their way, to not work.

To an economist, this is irrational behavior. It might make sense for a wealthy person to quit his job, or to eschew education or develop a costly drug habit. But a poor person, having little money, would seem to have the strongest incentive to subscribe to the Puritan work ethic, since each dollar earned would be worth more to him than to someone higher on the income scale. Social conservatives have tended to argue that poor people lack the smarts or willpower to make the right choices. Social liberals have countered by blaming racial prejudice and the crippling conditions of the ghetto for denying the poor any choice in their fate. Neoconservatives have argued that antipoverty programs themselves are to blame for essentially bribing people to stay poor.

Karelis, a professor at George Washington University, has a simpler but far more radical argument to make: traditional economics just doesn't apply to the poor. When we're poor, Karelis argues, our economic worldview is shaped by deprivation, and we see the world around us not in terms of goods to be consumed but as problems to be alleviated. This is where the bee stings come in: A person with one bee sting is highly motivated to get it treated. But a person with multiple bee stings does not have much incentive to get one sting treated, because the others will still throb. The more of a painful or undesirable thing one has (i.e. the poorer one is) the less likely one is to do anything about any one problem. Poverty is less a matter of having few goods than having lots of problems.

Substitute "health crises" for "stings" and you now know how it is for too many people with disabilities.

Consider this:  You have a normal life one day.  The next, perhaps a car accident.  Or even more likely, a visit to your doctor that brings bad news.  Or a phone call that tells you you need to discuss a medical test right now with family.  It may not even be yourself but maybe, your spouse or your child.

At first, you're in shock and going through the motions, but at least there are motions, things to do after the diagnosis, people to see, prescriptions to fill.  Family and friends are sympathetic and everyone promises to look after you.

For a little while.

Then life starts to set in.  You face an endless series of doctor visits, hospital stays, and the endless phone tags between you, your record-keepers, and your insurance company.

But it doesn't end there.

If you have a disability that restricts your mobility, there are more problems.  Perhaps you can't stay where you are.  Perhaps the insurance company won't pay for just one thing you need.  Then the bills come.  You have to move.  You can get Medicaid but not without spending down everything you worked for.

Even a "simple" condition like diabetes can unleash a long chain of consequences that can totally and completely upend your life.   A friend of mine entering college "got" Type 1 diabetes, and he has ADHD.  He left school and never came back.  One would think a diabetic could still go to school--and many do--but this really put him in a tailspin.  

I hear and know of too many stories of people with disabilities who become destitute, even when they were solid middle-class before their "event".

Life for such people is an endless series of "problems", as Karelis would put it.  I haven't read his book, but I would be very surprised if the problems of people with disabilities aren't mentioned at some point.

I have seen this first hand with my own life.  I've written before about my foster mom and her disabilities following her car accident.

When I was first brought into her family as a foster child in 1963, all of the adults in the family supported themselves.  My mom and her daughter lived on foster care payments and daycare, and my mom's son-in-law worked at Philson's, the shoe-supply factory in Blubber Hollow.  We were in rental housing, but not Section 8 so far as I know. 

At the end of my immediate family in 1994, when my mom died, all of the surviving adults (myself and mom) were on public assistance in public housing.

Part of our decline was due to macroeconomic changes (the loss of factory work and of the middle class) but a good amount of our decline was due to mom's car accident and ruptured disk that put her in a wheelchair in short order.

I was my mom's caregiver for the last three years of her life, so I know that routine all too well.  It is very easy to get behind when one problem comes right after another.

Even in my own life, I have had trouble keeping up when medical problems have to be dealt with.  When I was gradually losing my sight a year ago due to complications from my cataract implant, I was shocked when my housing unit failed inspection.  I had not been keeping up with cleaning at all.  I can only assume that I wasn't able to clean what I couldn't see, and couldn't see what I couldn't clean.  My problems crept up on me like cat's feet and I literally couldn't see them!

(Happy ending:  my sight was corrected and I managed to get my unit cleaned to everyone's satisfaction, not least my own.)

Karelis mentions the "self-discipline" myth so popular amongst politicians and professional moralists, that claims that if "people were only hard-working and personally responsible" they wouldn't be "poor".

I wish my late Catholic French-Canadian mom were here to rebut that argument.  In her absence, I'd like to tear that in pieces, but that will take another post.

Looking forward to reading the book.

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