Tag / inequality

by Elizabeth Stoker Bruenig

Inequality is a Moral Problem

When we talk about Christian ethics, a lot of the things we address seem to be chalked up to the vicissitudes of living in a ‘fallen’ world. What we mean by a ‘fallen’ world is a world which is no longer perfect, or a world that is infected with various kinds of lack. I think this mindset leads us to view the various problems we tackle as basically organic functions of the world outside of our control, and some of them are. Disaster relief, for example, is important; so is caring for the sick, and in many cases sickness is a thing that happens outside of anybody’s control.

It’s my sense that a good number of folks see poverty and inequality as a pair of those ‘fallen world’ realities, things that just arise inevitably and organically from the machinations of the impure world we live in. Among the Christians who view poverty and inequality this way, the following verse comes up pretty frequently:

“The poor you will always have with you, and you can help them any time you want. But you will not always have me.”

This is Mark 14:7, but Jesus appears to be referring to a similar phrase in Deuteronomy 15:11:

“There will always be poor people in the land. Therefore I command you to be openhanded toward your fellow Israelites who are poor and needy in your land.”

What I want to note about each of these verses is where God locates the action: in both verses, we have the establishment of the poor, and then in the following clause, an address of action. But who does God expect to act in order to redress the wrong of poverty? You.

Now this is really interesting. First, it’s a far cry from rightwing ‘get ‘em back on their feet’ ideologies which endlessly brainstorm about how to force the poor into being less poor. Secondly, it shuts down the typical whinging one hears about the worthy and unworthy poors, because it shifts the obligation for answering poverty onto the listener. But the most important thing it does, in my thought, is highlight the fact that poverty and inequality are decisions that we make.

But if the poor will always be with you, how can poverty and inequality be choices? Aren’t we doomed to suffer them?

Not exactly. What these verses tell us about the world we live in is that there will always be people with greater needs than others, but they don’t necessitate that those needs will remain unmet. Thus, even though some will have greater needs, it is our decision as to whether or not those needs will be met. Understanding that this is a decision shifts the moral debate: poverty isn’t a morally neutral status-quo type situation, but rather a signal that we have elected to create inequality while the onus is on us to do otherwise. Matt Bruenig puts it like this:

Once you understand what I am saying, you realize that the old leftist cliche is right: who gets what is purely a matter of political power. If the rich elites continue to run the show, it doesn’t matter what you do. The distribution will continue to favor them and income stagnation and inequality will never be whipped. Even if you make some strides against those things within the existing set of economic rules, they can use their power to change those rules to preserve the distribution they like. What ultimately matters for inequality is who has the power to control the levers of distribution management and what result they are aiming to produce. Everything else — technology, education, competition, and so on — is completely secondary.

The set-up of our distribution systems doesn’t create need (that is, there are those with greater and lesser needs) but it does dictate which needs are met and which aren’t, and that is purely a function of our choosing. Thus the election of a system that creates inequality is not only a serious practical problem (if you haven’t read the Spirit Level yet, go ahead and read it) but also a moral problem: it is the direct refusal of the actionable commandment God makes that we offer continuing support to our poor.

Consider Augustine, here, in sermon XXXV:

Did [the poor] bring anything into the world? No, not even the rich brought anything into the world. You found all here, you were born as naked as the poor. In both alike is the same bodily infirmity; the same infant crying, the same witness of our misery…Be you all of one mind in obeying the word of God. God made both the rich and the poor…The rich and the poor are born alike. You meet one another was you walk on the way together. Do not oppress, and do not defraud. The one has need, the other has plenty.

What’s remarkable here is the utter equality Augustine sees between the rich and poor in terms of inherent value. We can take Augustine one step further and value that inherent equality to the degree that we choose to uphold it: after all, we’re born alike, and since whatever comes next in terms of distribution is going to rely upon how we as a society elect to set up the rules of distribution, we have the opportunity to achieve a state closer to equality. Now, the equality we achieve hopefully won’t be the naked and screaming sort Augustine associates with infants, but it can be the sort that honors the equal dignity of all persons by meeting their needs.

So when we look at regressive measures as Christians — say, the proposed cuts to SNAP, or the opposition to healthcare plans like the ACA that would extend greater coverage to more people — remember that getting rid of or opposing policies that would make people less poor do not return us to a neutral status quo. Instead, when we oppose or eliminate policies that have reduced or could reduce poverty, we’re acting in moral error against the instructions of God, and we’re not ‘returning’, as it were, to a neutral state produced by the machinations of a fallen world, but to a morally negative state we’re choosing to produce in direct contradiction to God’s instructions. It’s decisions all the way down.

Maybe this has been quite drawn out for what is likely a simple point, but my purpose here is mainly to reiterate this: when we talk about poverty and inequality, we are talking about moral errors that we are guilty of. When God talks to us about poverty, he doesn’t harass the poor or try to force them into non-poorness; he addresses us, those who make the distributive decisions that allow poverty and inequality to proliferate. Any vision of handling poverty that does anything other than address the choices we as a society make about distribution are thus severely suspect.

 

by Elizabeth Stoker Bruenig

Justice is a Collective Virtue

Apologies if this post is both shorter and grouchier than the majority of my posts, but I have the flu. I know it’s that time of year for most of the anglophone world, so good luck to you all in staying well.

If you do happen to get the flu, though, and you get bored, you can always entertain yourself during your quarantine the way I do: trying to dig up the justifications Christians claim for supporting patently un-Christian politics.

One of the themes I run into again and again is the notion that there’s a sharp distinction between individual justice and collective justice. See ‘Tea Party for Christians‘, a website truly forged in hell, drawing that bright line here:

The U.S. Constitution was written to ensure and protect those rights for individuals (not the collective), placing the ultimate power in America with its people rather than its government (which merely represents the people). The Founders understood that we live in a fallen world and that granting politicians too much power would ultimately lead to the oppression of individuals under their authority. So the Founders wrote a Constitution that severely limited governmental power, spreading it across three branches, the states, and the people. This should be of the utmost importance to Christians, as God’s stance on oppression is clear…

Neat sleight of hand. See how they conflate the ‘collective’ with the ‘fallen’ world? Their suggestion is that: a) the rights of individuals are separable from the rights of the ‘collective’ (a word I guess they use since it sounds like something the Borg would use, though ‘group’ or ‘whole’ would serve just as well); and b) that the collective is suspect because people in general are corrupt and grouping them together empowers them to inflict their corruption upon others. This is usually the kind of nonsense rhetoric you find surrounding Tea Party/libertarian-minded moves like the recent cuts to SNAP and the rabid opposition to Obamacare, which would extend healthcare to many poor Americans. Of course, the slicing of SNAP and opposition to greater access to healthcare are both thoroughly un-Christian, and their rooting in the individualist notion of justice is only one reason why, which I’ll address here.

Because I’m not feeling well, I’ll spare you the prose. Here are the multitude of reasons this line of thought doesn’t work within the frame of Christian ethics:

1.) You are owed ‘rights’, speaking in Christian terms, as a member of the class ‘humanity.’ God has a special relationship with various classes of people, including specific nations and families. He also has a special relationship with ‘humanity’, which is a massive class of creatures separate, ethically, from other classes of creatures. So the Bible isn’t actually that interested in individual rights. This makes sense, as:

2.) Justice, in the Biblical sense, can’t even be conceived of in individual terms. Even with a conception like Augustine’s, in which the first step to justice is for a person to be rightly oriented toward God (thereby just within), a person having a just disposition has only that: a single just disposition. But justice in the world actually occurs when people engage with others in a just way. To inhabit a just world, people must not only maintain a just disposition, but must behave justly toward each other. Justice can only be understood in terms of equality, and equality can only be understood in terms of comparison, which can only take place among collectives, not individuals. So even the notion of ‘justice’ doesn’t make much sense in a frame in which the individual is the sole unit of moral interest, unless you buy a negative rights frame, in which case:

3.) Following that point, there’s no negative conception of justice that makes sense in a Christian framework. That is to say: it’s flatly un-Christian to say that ‘not’ doing something amounts to justice, so libertarian notions of justice occurring when we’re all following the non-aggression principle are ridiculous. This is for two reasons: first, Jesus distributes a variety of positive commandments in the NT; secondly, the very principle of individualism suggests a shrinking away from engagement with others, which Pope Francis addressed pretty well here:

We find Jesus’ wounds in carrying out works of mercy, giving to the body – the body – and also to the soul, but the body, I stress, of your wounded brother…Because he is hungry, because he is thirsty, because he is naked, because he is humiliated, because he is a slave, because he is in jail, because he is in hospital. Those are the wounds of Jesus today.

Francis’ warning is not to stop at welfare; that is, just because we have distributed to everyone their just due doesn’t mean we should consider our engagement with them finished. But your Tea Party and libertarian Christians actually take two steps back from that: they neither want to distribute everyone their just due nor to engage with them, or at least, there would be no moral imperative for them to in their system. Within the framework of Christianity, though, the imperative is there: this is just one more way that Christian ethics are fundamentally unsuited for compatibility with libertarian ethics. Augustine, of course, agrees, via the amazing Mary T. Clark:

Those who tend to call the contribution made to another’s basic need, by someone better off, a work of charity or liberality need to be reminded that the social function of private property in this case obliges them to a work that is directed toward the common good, and therefore a work of social justice, which obliges in charity. Since love is naturally a free act, there is a tendency to think of it as something untouched by obligation. By firmly grounding justice upon the motivation of love, however, Augustine teaches us that all the commandments of God require of us that which is most our own. And that is why the New Law is one of Love. “And Love is the fulfillment of the Law” (Romans XIII, 10.)

For the new law to be fulfilled and justice to be achieved through that law, we must reach out ceaselessly toward each other in love and aid, and must not stop at the meeting of basic needs, but must engage constantly as friends and neighbors. This is is the vision of the NT, and it’s a great one. It’s also one that is thoroughly averse to the anti-healthcare, anti-SNAP Republican/libertarian ethic of individualism and property-hoarding.

by Elizabeth Stoker Bruenig

Dispatch from the U.K.: Disability & the NHS

In my room at Cambridge I hang up  prints: the first shows three swans with black beaks drifting in a pale blue pond; the second compares two varietals of ripe wild peaches; the third depicts a blue-point Siamese cat sitting up with a quirked tail. Along my windowsill I line up my bud vases and mason jars and perfume bottles, and in each empty vessel I place flowers. When the sun comes through in the morning it glows in the glass and the petals and shines mellow color onto my far wall.

It’s tranquil. I like that sort of mood for a room. From my window I can see a small garden, and beyond it a row of buildings, and in one of them a woman sells flowers and tea early in the morning. Because my seizures are controlled, I can get up early to make it in time for some of the better cuts: marigolds, now, early season.

I was diagnosed with myoclonic epilepsy at fourteen. It’s an incurable condition: I have small, electric-shock-like muscle spasms many times a day, and occasionally have grand mal seizures. Most of my grand mal seizures happen early in the morning or late in the evening, and like most people with epilepsy, I can control my seizures with medication.

And things would be straightforward enough if the story ended there, but it doesn’t. Anti-epileptic drugs, or AEDs, are notoriously troublesome medications. They come along with terrible side effects (anything from losing massive swathes of skin to developing excruciating kidney stones) and often require an excessive amount of tinkering or ‘cycling’ to find the right therapeutic dose and/or combination of doses. If all that goes well, a person can have a shot at the peaceful life: morning walks, marigolds in bud vases, colored light on the far wall. But whether or not a person can actually have that, it turns out, depends largely on their income.

For one, epilepsy drugs are expensive, and have begun in recent years to skyrocket in price. After insurance, I still paid $380 for a 90-day supply of my medication in the States, and that was for an older and relatively inexpensive medication. While some can make use of generic medications, neurologists are often reluctant to prescribe generic drugs, the outrageously high cost of epilepsy medications has contributed to the sprouting of a number of epilepsy-oriented charities and funds aimed purely at assisting poor people in paying for medication. The Epilepsy Foundation of North Carolina reports that,

Epilepsy medications are expensive, often costing more than $1,000 a month. For those not covered by insurance or other programs, these costs are prohibitive. Most affected are the working poor.

These funds are undoubtedly helpful, but they’re only spottily available and often come with peculiar qualifiers. Thus on any online message board devoted to epilepsy medication, one can find sheepish requests for donations of unopened packets of drugs, supposing the sender has cycled onto a new medication. I’m not going to lie: I often find myself seriously considering shipping off a half-bottle of some AED with god-awful side effects hoping it’ll do more for another person than it did for me. It’s not a good idea, I know — this is why I refrain.

But if concerns about shipping medication to strangers in need are troubling, just imagine the anxiety of the person who would be willing to engage in such dangerous exchanges for little more than two weeks’ worth of relief from seizures. As the Epilepsy Foundation of North Carolina pointed out, the high price of seizure medications affects mainly the working poor; indeed, studies have shown that poor people are more likely to develop epilepsy in the first place, and are less likely to benefit from medication to the same degree their wealthier counterparts do. Unsurprisingly, given the compounding stress of paying for medication while simultaneously being rendered unable to work by lapses in treatment brought on by the sheer cost of medication, poor people with epilepsy suffer immense psychological distress. Stress can, unfortunately, trigger seizures: the cycle here is brutal, and the overlap of poverty and epilepsy particularly harsh:

PWHE [note: people with a history of epilepsy] in poverty were significantly more likely to report depression, feeling everything is an effort and having feelings of worthlessness in the past 30 days than the other three populations. But no differences were found between the two epilepsy populations in serious psychological distress and two questions on the K6 (nervous and restless). Ours findings suggest that feelings of anxiety are common among persons with epilepsy regardless of their poverty status. This could be explained by the nature of epilepsy as a chronic disease with episodic attacks (seizures).

Epilepsy does have a minefield-like quality: one never knows when tranquility is going to give way to sudden suffering. This is especially true when the stakes of time off work are high, or when one has dependents. Medication, of course, can lend a certain sense of peace, provided one has the resources to comfortably try different dosages and brands regardless of price.

Which is precisely what the NHS provides. For a run-of-the-mill prescription, a person will pay £7.85, or roughly $12.59. So if you’re ill with something treatable — swimmer’s ear, say, or pink eye, strep throat, any of those minor maladies — you’ll be slapping down less than thirteen bucks for your scrip here in the U.K. When I found this out, I was amazed: I’d be saving about $125 a month!

Of course, I was wrong. Why? Something called a medical exemption certificate. While most people using the NHS pay what Americans would imagine as a fairly low price for their prescriptions, people with certain medical conditions — epilepsy, diabetes, and thyroid disorders among them — don’t pay anything at all for their prescriptions. Which is to say: people with epilepsy in the United Kingdom get their epilepsy medications for free.

I wouldn’t have known about the MedEx if it hadn’t been for a friendly Brit who noticed my medical alert ID bracelet during a conversation about my new experience of the U.K. She explained that she had a thyroid condition and hadn’t ever paid for her medicine; she seemed to consider the idea sort of ludicrous, and from the matter-of-fact and half-effusive way she explained the medical exemption option to me, I determined she was rather proud of the NHS. She isn’t alone: about 61% of British people are quite satisfied with the work of the NHS, and with good reason.

In short, the NHS works. About 52% of people with epilepsy in the U.K. are seizure free. Figures are much more difficult to come by in the USA as there’s no single body interacting with all persons with epilepsy, and furthermore, not all persons with epilepsy can even access treatment in the States. But perhaps this small anecdote will speak for itself: on the NHS epilepsy help boards, nobody is requesting unused pills because they can’t afford their medicine. Studies across the board have suggested that the cost of epilepsy per person in the U.K. tends to be lower than the cost per person in the U.S.; I’m willing to bet that has to do with preventative care and the ease of access.

And then again, there may be something more to it yet. My sensibilities err toward the peaceful; I prefer the quiet, the serene. Cambridge is busy, but bucolic: for every bustling street, there’s a dark ridge of burgundy trees rising up over a misty stretch of green. Epilepsy, with its subtle threats and persistent burdens, is the sort of thin that generally disrupts these moments of peace, but with the NHS securing the cost of my medication (however it may change), I’m more at ease, which in turn eases the condition itself.

There is, of course, something more — something immaterial. It’s easy for me to understand why people stare at seizures; I know my muscle coordination is poor and that episodes are frightening to see. At times one can feel a little isolated. But all around me are those who through their participation in this country’s economy chip in, ever so slightly, toward the cost of my medication. The woman who leans across the counter beside me to buy a few bouquets of ranunculus goes away with an armful of fluttering red petals, and I’m aware of a slowly forming sense of gratitude.

I shift my bunch of marigolds down into a canvas bag. Thank you, I say.

The flower-seller says cheers.