By Atul Gawande
New Yorker – November 21, 2016
How dependent are our fundamental values—values such as decency, reason, and compassion—on the fellow we’ve elected President? Maybe less than we imagine. To be sure, the country voted for a leader who lives by the opposite code—it will be a long and dark winter—but the signs are that voters were not rejecting these values. They were rejecting élites, out of fear and fury that, when it came to them, these values had been abandoned.
Nearly seventy per cent of working-age Americans lack a bachelor’s degree. Many of them saw an establishment of politicians, professors, and corporations that has failed to offer, or even to seem very interested in, a vision of the modern world that provides them with a meaningful place of respect and worth.
I grew up in Ohio, in a small town in the poorest county in the state, and talked after the election to Jim Young, a longtime family friend there. He’d spent thirty-five years at a local animal-feed manufacturer, working his way up from a feed bagger to a truck driver and, in his fifties, a manager, making thirteen dollars an hour. Along the way, the company was sold to ever-larger corporations, until an executive told him that the company was letting the older staff go (along with their health-care and pension costs). Jim found odd jobs to keep him going until he could claim his Social Security benefits.
In the end, Jim said, he didn’t vote. Last year, his son, who was born with spina bifida, died, at the age of thirty-three, after his case was mismanaged in the local emergency room. Jim has a daughter in her forties, who works at Walmart and still lives at home, and another daughter trying to raise three kids on her husband’s income as a maintenance man at a local foundry and her work at an insurance company. Jim lives in a world that doesn’t seem to care whether he and his family make it or not. And he couldn’t see what Hillary Clinton, Donald Trump, or any other politician had to offer that would change that.
But he still believes in our American ideals, and his worry, like mine, is that those now in national power will further betray them. Repealing Obamacare, which has provided coverage to twenty-two million people, including Jim’s family members; cutting safety-net programs; downgrading hard-won advances in civil liberties and civil rights—these things will make the lives of those left out only meaner and harder.
To a large extent, though, institutions closer to home are what secure and sustain our values. This is the time to strengthen those institutions, to better include the seventy per cent who have been forsaken. Our institutions of fair-minded journalism, of science and scholarship, and of the arts matter more now than ever. In municipalities and state governments, people are eager to work on the hard problems—whether it’s making sure that people don’t lose their home if they get sick, or that wages are lifted, or that the reality of climate change is addressed. Years before Obamacare, Massachusetts passed a health-reform law that covers ninety-seven per cent of its residents, and leaders of both parties have affirmed that they will work to maintain those policies regardless of what a Trump Administration does. Other states will follow this kind of example.
Then, there are the institutions even closer to our daily lives. Our hospitals and schools didn’t suddenly have Reaganite values in the eighties, or Clintonian ones in the nineties. They have evolved their own ethics, in keeping with American ideals. That’s why we physicians have resisted suggestions that we refuse to treat undocumented immigrants who come into the E.R., say, or that we not talk to parents about the safety of guns in the home. The helping professions will stand by their norms. The same goes for the typical workplace. Lord knows, there are disastrous, exploitative employers, but Trump, with his behavior toward women and others, would be an H.R. nightmare; in most offices, he wouldn’t last a month as an employee. For many Americans, the workplace has helped narrow the gap between our professed values and our everyday actions. “Stronger together” could probably have been the slogan of your last work retreat. It’s how we succeed.
As the new Administration turns to governing, the mismatch between its proffered solutions and our aspirations and ideals must be made apparent. Take health care. Eliminating Obamacare isn’t going to stop the unnerving rise in families’ health-care costs; it will worsen it. There are only two ways to assure people that if they get cancer or diabetes (or pregnant) they can afford the care they need: a single-payer system or a heavily regulated private one, with the kind of mandates, exchanges, and subsidies that Obama signed into law. The governor of Kentucky, Matt Bevin, was elected last year on a promise to dismantle Obamacare—only to stall when he found out that doing so would harm many of those who elected him. Republicans have talked of creating high-risk insurance pools and loosening state regulations, but neither tactic would do much to help the people who have been left out, like Jim Young’s family. If the G.O.P. sticks to its “repeal and replace” pledge, it will probably end Obama’s exchanges and subsidies, and embrace large Medicaid grants to the states—laying the groundwork, ironically, for single-payer government coverage.
Yes, those with bad or erratic judgment will make bad or erratic choices. But it’s through the smaller-scale institutions of our daily lives that we can most effectively check the consequences of such choices. The test is whether the gap between what we preach and what we practice shrinks or expands for the nation as a whole. Our job will be to hold those in power to account for that result, including the future of the seventy per cent—the left out and the left behind. Decency, reason, and compassion require no less.