Tuesday, July 18, 2006

Poverty, Consumption and the Pursuit of Happiness

The other day, while helping a patient put together an application for a social service program, we went over some monthly bills which she had brought to my office to include as documentation of her expenses. Other than her subsidized rent, her monthly bills included a cell phone, a land-line, cable TV, and monthly payments on leased furniture. She has no credit cards (and those who do pay extortionate interest rates!), but the interest and fees she pays for her leased furniture more than makes up for her lack of a Visa or MasterCard.

I often forget that many of my patients actually lease their furniture and large-screen TVs from local leasing companies. I'm genuinely shocked at the size of some of my patients' television screens and the excessively massive furniture (all black with fake gold and chrome plating) which crowds their apartments and homes. I was also shocked a few years ago when I realized the enormous amounts of money which is spent on the leasing of such home furnishings.

While perusing my patient's lease agreement, I could see that a mediocre dining-room set with four chairs, retailing at around $600, was going to cost this woman on a fixed income more than $1300 by the time she finished the payments over several years. Add to this mix the great risk which she runs of having the items reposessed if she happens to become ill, get hospitalized, or otherwise miss a monthly payment, thus forfeiting all of the money which she has already paid on said furnishings. This type of exploitation (and poor judgement) makes my blood boil.

After she left my office, I spent some time pondering the reasons behind such behavior and consumption. I had asked her why she leased under such horrible and exploitative terms rather than simply saving up money and purchasing a dining room set outright for much less money, and she could not necessarily answer me in a way that explained her actions. What I surmised from her answer is that "this is what is done" and she didn't necessarily have the skills to do anything differently. I was perplexed, but was (and am) undaunted in my determination to more fully understand.

From my solid middle-class perspective, it's relatively easy to not see the other side, to turn a blind eye to the eagerness of those less fortunate to rise up, or to at least have surroundings which make one feel more comfortable and on a par with others. Don't so many of us strive for more? I told myself to look deeply at the circumstance of a disabled person with multiple illnesses, perhaps a history of emotional trauma, and generations of poverty and struggle. That person watches TV, takes in thousands of commercials and advertisements enticing him or her towards a better life of conspicuous consumption, and numerous television shows and movies portray beautiful people in beautiful surroundings enjoying comfortable furniture, the latest technology, the most chic of homes, and the latest and greatest gadgets and toys. Cinderella stories---in the form of "American Idol" and "The Apprentice", for example---demonstrate that ordinary people can transform their lives and reap the benefits of fame and wealth almost overnight. The economically disadvantaged watch these shows with zeal, look around at their homes, and are determined to bring some semblance of that wealth into their own living rooms and bedrooms.

Is this a fair theory? Are they victims of the free market and the media's relentless presentation of the contentment which consumption might deliver? Do they, in their desire for a more comfortable life, miss an opportunity to reexamine how they wish to spend the little money with which they manage their lives? And when they complain that they don't have the $1 co-payment for their antihypertensive medication (and believe that they should not have a government-mandated co-payment in the first place), is it fair to remind them how much they pay for cable and their dining room set? Is it really my place to use that moment to instill a new way of looking at consumption, economics, and priorities? Am I right to suggest that they downgrade their cable to the $60 package so that they have $15 for medication co-pays each month? My jury is out.

Reflecting on these questions, I examine my own life and financial state and the choices which I make. Do these choices point towards a desire to have more, to live in a way which my income and level of education do not necessarily reflect? Do I also make choices which some would find suspect vis-a-vis the realities of my situation? Do I even have the right to question others' motivations in this regard?

We all strive for happiness and comfort, and in a consumer culture that happiness and comfort is often reflected in our purchasing habits. I feel strongly that I cannot properly address this issue with any substantive acumen in this post, as it would take a great deal of research, reading, and contemplation to get to the heart of this very complicated socioeconomic issue. The bottom line is that I see individuals with whom I interact on a regular basis make choices which may be deleterious to them economically, and which, in my opinion, are based on artificial desires created by suits on Wall Street who decide in boardrooms what the next gimmick may be which they will peddle to the poor masses as those mega-corporations behind these "objects of desire" seek ever-expanding profitability and market control.

Although this may seem far from healthcare-related, economic health and savvy financial planning are actually integrally entwined with health, healthcare, and self-care. An individual's priorities might dictate how often an individual refills prescriptions, how important they feel it is to spend a dollar on the bus ride to a doctor's appointment, or whether they choose between a cable upgrade or fresh vegetables. Consumerism drives our culture and economy (and our healthcare system), and our patients are often pawns in a game which they perhaps are unware even exists. Or perhaps they willingly play that game, openly acknowledging that they desperately want what the purveyors of consumer goods offer so willingly. It is a conundrum of a dizzying order, one with which I struggle, and one which certainly impacts my patients' health---and my sanity.

The next time a patient tells me that they can't afford a dollar for a medication prescribed by their doctor, my response will be colored by these thoughts which I have pondered here, unfortunately never having reached a satisfactory conclusion from which to draw a pearl of wisdom and insight.

The pursuit of happiness, did you say? Yes, and that pursuit may very well take some to Wal-Mart to buy cheap goods made in sweatshops, whether I like it or not. It may also make a woman who can barely afford her rent choose to lease a dining room set for $1000 which she does not have.

This is an exercise in tolerance, in understanding, of confronting internalized classism, and of coming to terms with aspects of our society which drive me to the brink.

May all beings be happy. May all beings be free from suffering. May I be more understanding and compassionate. And while we're at it, may all beings in need find an extra thousand dollars in their bank account on the day they need it most.
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