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How to Cure Our Costly Addictions : In health care and welfare, we must build up self-reliance, not spew blame and bile.

November 15, 1994|DONELLA H. MEADOWS | Donella H. Meadows is an adjunct professor of environmental studies at Dartmouth College.

Talk radio while driving west on Oklahoma 51 just before the election. On comes the Republican candidate for governor: Some people are just bad and can't be fixed. There's a line, and when someone crosses it, there's no room for mercy. Put 'em in jail. Execute 'em.

Oklahoma folks call in: People will take any handout they can get. There are two kinds in the world, the self-reliant ones and the ones that live for handouts. Stop the handouts.

America's declining standard of living is spilling out in ugliness. We need someone to blame, someone we can feel superior to, even when we ourselves don't feel very high. The obvious targets are those who won't talk back, those who have been hurt most, those who don't look like us. It doesn't matter that there's no logic behind our blame or our prescriptions. Those folks can't be fixed, so let's preach at them. We won't pay for their schools, but we'll put out millions for their prisons.

The Republican Congress sweeps into office on this tide of bile. The mean mood is a national tragedy, because we do have broken people, families and communities, and they need real fixing, not spleen-venting simplicities.

Before they got vengeful, conservatives had some useful points to make about welfare. Government "help" is too often guilt-assuaging gesture. It creates layers of wasteful bureaucracy. Too much help of the wrong sort creates a culture of dependency that swamps our ability to provide.

We start with a real problem. The poor can't afford doctors, for example. Rather than ask why people are so poor or doctors are so expensive, we step in with a kindly government program. We'll subsidize health care.

That works for awhile. But it suppresses other solutions, especially those that might have been invented by people, communities, local organizations. And the subsidy does nothing to encourage health-care providers, with a huge government purse to dip into, to contain costs. Both the providers and the recipients of the program become addicts.

Addiction is a strong word, but an accurate one. We've gone for the quick fix that dulls the pain but allows the under-lying problems--poverty and bloated health-care costs--to get worse. So we spend more money, our drug of choice, to go on disguising symptoms. The money attracts more people into the system and keeps them there longer. It encourages health-care providers to make their services lavish, sometimes even corrupt. More and more money is needed, until the system breaks down in unaffordability and blame.

That's the conservative analysis, and it's right. But here's where the liberal analysis is right: It doesn't help to tell addicts to go cold turkey. There were good reasons why the poor were not able to solve their problems in the first place. After generations of addiction, those reasons have only deepened.

The kind of support the down-and-out need is the kind we have always refused them, the kind that would mean engaging with them not as objects of contempt, but as fellow human beings. The only answer to addiction is to build up the self-reliance of the addict. That takes time and understanding, not blame and bile. Not two years and you're off. Not passing the burden of health care around from government to employers to the poor themselves like a hot potato.

Any 12-step program can tell you that no addict is beyond fixing, that no one can fix anyone else and that no one can fix himself or herself alone. The recovering addict needs constant, tough support, relentless honesty and the surrender of personal will to some higher power, even if that higher power is no more than a group of other recovering addicts. That's a more complex, compassionate and proven formula than the simplistic conservative agenda--and it's not one that government can provide.

But government can encourage, with money, law and rhetoric, the people and organizations that do provide non-addictive, capacity-building support. It can stop the recriminations and the false choices, such as the choice between prevention and punishment, when we need both.

Whether the problem is health care or crime, welfare or teen pregnancy, drugs or urban blight, that problem cannot be solved while people live in desperation. This country is rich enough to end desperation; in fact its poverty is the main factor undercutting its richness. Ending poverty calls for humility, honesty, freedom from ideology and refusal to accept cruel simplicities about anyone's human potential. It requires listening to the wisdom and cutting the nonsense from both the right and the left.

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