A pack a day for 30 years.
Why are you on disability?
For my smokin'
Do you drink sir?
No.
Fast forward in the interview...
Who is your doctor?
Dr. Rollinghills
I don't know Dr Rollinghills. Is he from around here?
No, he is from Wayawayfromhere
What are you doing in Happy Town?
I'm here for alchohol rehab.
But, you just told me you don't drink.
Blank stare
You may want to disagree with me on this one, But I'm convinced a very large population of our country are consumers, not because they want to be, but because they have to be.
No class of folk is immune from this race towards the consumption junction. For anyone trying to flame me with comments like I'm a jerk or I'm racist or sexist, get over yourselves. The only class of people I'm talking about are the net consumers in life.
You see, there are two main classes of people in this world. Those who produce. And those who consume. Everything else is just noise. Productive members of society are those with a desire to To serve others. They are the net producers that subsidize the large and growing pool of net consumers in our country. Leeches, whos sole desire is to live off the fruits of others. To be served by others. The question is not whether you are working or not. The question is whether you want to work or not. Why do some feel so ashamed at accepting a hand out while others view it as their God given right to take away from others?
Perfect example. At a local pool this weekend we had our rented inner tube stolen off our chairs. That's a consumer at work. We took our other innertube back to the storage station at the end of the day-->Producer. Others left theirs for someone else to put a way-->consumer. How does one become a consumer vs a producer? Is it nature or is it nurture. I'm convinced it's both. The hardware is your genes. The sequence of guanines and cytosines that make up your DNA. They determine your hardwiring. The neuron complex of your brain. This is your hardrive.
Your genetic make up can change and can be strongly influenced by social and economic factors (the software). Up and down regulating genes by eating fatty foods or smoking yer cigarettes. The association between nature and nurture is undeniable. The two go hand in hand. But the question remains, does your original genetic make up affect the outcome? I believe it does. Just as your genetic make up determines the size of your feet or the color of your hair. I believe there are genes at work that determine whether we will be motivated towards producing or consuming. Genes that can be mutated onto the opposing team either spontaneously, or through the gentle nudge of a loving or abusing father. A glass of milk or a crack pipe. But genes none the less. To believe otherwise would be myopic.
So the question is, does everyone's hardware start out the same at birth? Does every brain of every human that ever lived start with the same potential to become a lifelong producer or a lifelong consumer? I don't think so. You have in-utero stress from diet to alcohol to drugs to stress of the physical and emotional type. These can all affect the hardwiring of baby. That's in addition to the genetically determined hardwiring that mommy and daddy bring to the table.
To believe that every brain at conception is created equal is to believe that everyone has the same shoe size or the same size belly. We can comfortably say that Johnny is big boned and that's why he's forty pounds over weight. That his parents are big and that it runs in the family.
Why is it hard to believe that Johnny's brain has a higher consumption ratio because his parents do as well? Now I know that thin people are born into fat families and fat people are born into thin families. Just as producers arise out of consuming families and consumers arise out of producing families. In my experience with people, I just don't see that as the norm. Producers surround themselves with producers and consumers surround themselves with consumers. And that crosses all sexes, races and cultures.
If in fact we want to believe that everyone has an equal opportunity to produce or consume, then we must believe that all brains are created equal. And that is simply not the case. Whether it's alchohol and drugs during pregnancy, or a spontaneous mutation along the way or simply the baseline genetic make up--the sequence of guanine and cytosine that fortells the destiny. If we want to believe that everyone is capable of consuming or producting equally by virtue of free will, then we have to believe that all intrinsic capabilities are created equal. That all brains are created equal. That all brains, put in the same social surroundings, will thrive equally.
I don't believe that for a moment. Just like I don't believe putting everyone into an olympic training program will make them gold medalists. Brains are different because of genetic and social factors. To ignore the contribution that genetics play in determining net consumer or producer status would be silly. Different brains are hardwired differently. And the software (education) you install will only work if that harddrive is functioning. I think, for what ever reason, the harddrive of life long consumers are wired differently than producers. They have to be.
If you believe that, then what do we do about it? Do we try and create equality in a genetically impossible attempt to make all people created equal? Or do we accept producers and consumers as genetically assissted events and work around the political and economic implications of inequality. If all people are not created equal, then why do we try so hard to make it happen?
Perhaps, turning our country into the nanny state it has become is necessary to save the millions of consumers who are genetically inclined not to care about anyone but themselves. Perhaps we are fighting natural selection by supporting a genetic trait whos weakness requires the support of others to survive. Instead of only the fittest surviving, we are encouraging the consumer traits to thrive with our craddle to grave support. Perhaps we have to. For the sake of compassion. Funding consumers at every turn to survive in a capitalistic land built by producers. Perhaps we don't have a choice. As a compassionate society. If someone is born into producer or consumer status, perhaps we should stop trying so hard to bring turn them into something they are not and accept that they are genetic consumers and we must take care of them for the sake of compassion and fighting the forces of Darwin.
An interesting observation I see in the hospital. A far larger percentage of my old folks are producers than consumers. A far larger percentage of my young folks are consumers than producers. Why do you suppose that is? Perhaps a productive life is a longer life. Perhaps a consuming life leads to an early demise. I don't know how to explain it. But an interesting observation none the less.
Chew on that for a while.
Yeah Yeah, so what was the answer to the Deformed Hand Pic?
ReplyDeleteProducers surround themselves with producers and consumers surround themselves with consumers.
ReplyDeleteYes, and the Producer population designates some of their group to go forth and 'take care' of the Consumers for a fare Wage. This may be done for moral reasons or to prevent widespread unrest and revolution, or the hope* that some of the Consumers will transfer into the Producer population.
A large part of health care, especially hospital-based health care, is just such an agreement. Physicians, nurses, social workers, teachers, etc. are the designees put onto the front line, let's call them the Servers.
Hedge fund managers, CEO's Fortune 500 companies, politicians, bankers, captains of industry, etc, known as the Owners, are happy to have us do their bidding in order to 'manage the problem.' They allow a mutually acceptable Wage to 'care' for the consumers.
At first we start out motivated and positive about the work of helping the masses, hoping* to make a difference, perhaps unaware of the implicit social bargain that has been made. After years of residency and medical practice, the realization comes that the constant onslaught of Consumers will never end. The Wage once seemed generous, but now the Wage, any Wage, is insufficient for the soul-sapping, mind-numbing and often physically-draining task at hand.
The Owners continue to remind us Servers of the rising Cost and this Cost cannot be maintained and therefore must be cut. The MRI Costs $2,000, the hospital bill Costs $10,000, the doctors' fees Cost too much. The Cost of the Servers is bankrupting our nation.
The Owners try to convince us Servers that we are in fact Owners too and that we should welcome this Wage cut, because somehow we benefit as well.
The Owners try to convince the Servers that the Producers are a problem, in fact, The Problem.
Soon the Servers are pitted against the Consumers, bad attitudes develop. The political leadership of the Owners cuts the Wage and the Servers nod and think, well, that's only fair, after all the Cost is too high, right.
The Owners fail to divulge to the Servers what the Actual Cost is. The MRI that Costs $2,000? Well, most of that Cost is really transfer from one Owner to another. The Owner of the MRI transfers Cost to the Owner of the company that makes the MRI. Much of the Cost is then written off, especially the part paid to Servers, and the Actual Cost is a fraction of the Cost.
The best part is that even the Actual Cost is paid for with taxes, mostly payroll taxes and other regressive taxes. The Owners are not paid Wages with regressive taxes, instead they take capital gains which are a preferred form of compensation with preferred tax treatment.
The heat rises between the Servers and the Consumers as the Servers get paid less and less Wage to care for more and more Consumers.
[To be contuned.]
*Hope is fool's game.
Brilliant! Both the post and the comments. I'm addicted to so many of these medical blogs because it gives me hope that there are still rational people out there.
ReplyDelete...because it gives me hope that there are still rational people out there.
ReplyDeleteTo reiterate, hope is a fool's game.
You need to revisit that statement about old people being producers and not consumers. Seems to me that observation is correct. That generation HAD to produce because there wasn't any "social safety net" back then.
ReplyDeleteSo that begs the question....is the genetic predisposition to consume...triggered with the knowledge of "the safety net"?
What would happen if that safety net was..poof...gone.
I would like to let loose with a maniacal laugh...but I'm at work....
Steve
That has to be one of the most cynical, judgmental, not to mention oversimplified rants I have ever read.
ReplyDeleteDino. You'll have to explain
ReplyDeleteA bit cynical with this one :)
ReplyDeleteConsumers may have a personality such that they cannot come to peace with what living in modern society forces them to be. They may work in a repetitive, rote job that literally sucks the life out of them, and doesn't pay very well either. Then when they are off work, they feel like they are owed something. And who are we to say they aren't?
No one is disputing that genes influence personality and behavior. But consider that "production" may be a learned skill. Why do we make our kids mow the lawn and take out the trash? Why is it sometimes so difficult to instill the value of contribution in a teenager or young adult, even if they were raised in an upper class family?
Well it's simple. It is not readily apparent in modern society that contribution is necessary for survival. In pre-modern human society, children would be conditioned from birth to realize that the only route to survival is interdependence with other members of your tribe. For a teen age child living in such a small community, it would be so OBVIOUS that work needs to be done, they would just learn how to produce.
In modern society though, the necessity of contributing to one's society is obscured by the media, larger culture of product consumption, and just the overall nature of our system of living. To a young person, the necessity of contribution is NOT readily apparent to them because all work is abstracted and currency is used. Mom and dad simply go to the bank and "get money" out of it. When I was a young child, I initially assumed money was free, you just had to go to the ATM and get it.
It is not simply a matter of producer/consumer as a result of society/genes. You have to look at how our current society obscures the natural process of learning how to produce. Even to the point that some people never learn it.
For a classic read on producers and consumers turn to Ayn Rand's Atlas Shrugged. I am sure that Happy and many of the readers of this blog have read it already.
ReplyDeleteOhio oncologist beat me too it: I wasn't sure if I was reading the blog or Atlas Shrugged. I agree that it's a combination of genetics and environment. However, I would argue that you place far too much weight on the genetic vs. environmental component here. A kid raised on coke in his baby bottle at bed time and big macs further along in life doesn't have a chance in hell of avoiding CV risk as an adult unless he's got some pretty kickass genetics. However, place that "consumer" into an environment where he's raised by producers (ie proper diet, educated on diet), I imagine that you'll notice a much more substantial change in the "producer" direction than if you compared a kid with composted genetics versus one with Grade A genetics. You can't use the tools you're born with unless you're taught how to use them.
ReplyDeleteOn another note, hilarious-yet-informative blog. You are slowly killing my desire to be an IM PCP, but hopefully I can continue to hold out. In 5 years, when I'm actually out of residency, hopefully the medicare debacle will be smoldering and reimbursements will be on the rise. Until then, I will sleep with my rabbit's foot under my foot and dream with RVUs in the 40s dancing through my little head. That is all.
Ohio Onc. I've heard of Ayn Rand but I've never read any of her stuff. I don't have a clue what she writes about.
ReplyDelete0.75. I am here to inform others of the current reality. The fact is, it's the government that is destroying med students desires everywhere.
ReplyDeleteShorter Atlas Shrugged: Man has a fundamental right to build railroads and if you have a problem with that then you are a thankless, godless communist.
ReplyDeleteHH, before the gummint stepped in to pay doctors to treat the indigent, remuneration for health care workers was often in the form of chickens and bushels of soybeans.
Happy,
ReplyDeletePick up a copy of Atlas Shrugged - you'll enjoy it. It is long, but worth it. I won't go into the criticism here, but there are many and I agree with some. A really interesting tid bit about Atlas Shrugged is that the CEO of BBT (a bank out of NC) has been offering million dollar grants to buisness schools with the proviso that the include Atlas Shrugged in the cirriculum. The schools that have accepted this offer have come under fire (UNC-Charlotte is an axample). I think this tells you something about the book and the nature of politcal and other discourse in this country. If you don't agree with the collectice wisdom (read "politcally correct" wisdom) then you are a racist, sexist or some of "ist." The wrost insult, though is probably that you are a "greedy capitalist."
HH, I totally agree with you. I'm just poking fun as you kicked me out of my ignorant bubble of bliss. When I'm trying to float above my bottom line, have no fear, I will not be cursing your name but that of the bureaucrat who's foot is pushing my financial head below water. Looking forward to your future posts.
ReplyDelete