Why I’m liberal-ish

Like Mr. Kain, I also found Will Wilkinson’s essay on how conservatives, liberals and libertarians view the role of outside forces vs personal agency in a person’s success very interesting.  Wilkinson opens with this quote:

Harmon (2010a) built on these works by testing their conclusions against six U.S. public opinion polls. Secondary analysis found consistent and strong relationships. Conservatives and Republicans overwhelmingly attributed poverty to the personal failings of the poor themselves (lazy, drunk, etc.) while Democrats and liberals consistently offered social explanations like poor schools and lousy jobs for poverty. Later he looked at the inverse question, the reasons respondents give for others obtaining wealth (2010b). Generally he found that Democrats and liberals attributed wealth to connections or being born into a wealthy family, while Republicans and conservatives declared wealth comes from hard work.

Obviously there’s a lot of generalization in this quote.  All but the most hard-hearted conservative must concede that the circumstances of one’s birth and upbringing play some role in one’s future success, and even the most bleeding-hearted liberal has to admit that personal choice and motivation can amplify the affects of social factors.  Most of us would cite a combination of factors when trying to explain the origins of poverty in the United States.

My own feelings on the subject fall somewhere in the middle, and are informed in large part by working with economically depressed patient populations for many years in many settings.  On the one hand, I can see how being raised in poverty (particularly after many generations) can make escape into a more prosperous life seem dauntingly difficult, if not impossible.  At my last job, many of my patients came from a working class that had seen its jobs evaporate as the industries that had supported the state’s economy all went overseas.  The prospects for many of them were bleak.  That said, time after time after time I would see patients or their families make truly awful choices that only compounded the desperation of their circumstances.  Manageable illnesses flared because of missed appointments, or utility bills went unpaid until the power was about to be shut off, which led to calls pleading with our office to contact the company and state an urgent medical need for the power to stay on.

What crystallizes the question for me is my son, affectionately referred to here as The Monkey.

Our bright, inquisitive and rambunctious son was born to a birth mother who recognized that she did not have the resources to provide the kind of life she would want for him, and chose to place him with a family who did.  My husband and I are, of course, indescribably grateful for her choice, which allowed us to become the family we are today.  That choice was, I’ll wager, the single greatest determining factor in his future financial success.  Maybe he would have found a way into better circumstances for himself (he is a deeply awesome child), but his chances of avoiding lifelong poverty dramatically improved with one choice made on his behalf.  Same kid, same native intelligence and intrinsic qualities, vastly different financial outcomes.

This has little to do with what kick-ass parents the Better Half and I try to be.  It has everything to do with the advantages we have at our disposal.  Some of these are the results of personal choices, but many are the results of our own upbringings.  Both of us have completed grad school, and have stable careers with lots of professional connections.  This confers all manner of benefits beyond just having a decent amount of money to spend on raising the little guy.

For example, my employer has invested a great deal in having me at my job.  I generate a lot of revenue for my practice.  Replacing me would be tedious, time-consuming and expensive.  It is in everyone’s interests to accommodate the occasional request for days off should my son get sick.  I don’t have to be worried about getting fired.  I don’t have to worry about loss of wages.  I don’t have to weigh the option of sending him to school sick because I can’t afford the alternatives.  The same cannot be said for unskilled workers, who are all too easily replaced, and who can’t afford a day’s pay to stay home with an ill child.

I was also raised in a home where a premium was placed on my education, and there was never any doubt that I would go to college.  I know how to write a decent college essay.  I know the kinds of classes my kid should choose to prepare for college.  I have lots and lots of friends in many different professions who can offer advice and mentoring for whatever career he might choose.  The same cannot be said for most children born into poverty, who have few people to offer them the guidance to a more prosperous future.

Branching off a bit, anyone who hasn’t read Burt’s fantastic post from early this year on class in America should do so now.  It is brilliant, and well worth your time.  He writes:

What all of this demonstrates to me is that wealth and affluence are different things. There are those who do not need to work, those who do need to work, those who lack the ability to work. But one’s degree of poverty or affluence is a variable independent of one’s ability or need to work for a living. My observation is that there are three classes of people – those who do not need to work for a living because of their association with (although not necessarily personal possession of) capital; those who exchange their labor for money in order to survive; and those who get what they need to live by way of governmental entitlements. This is a continuum, not a stratification. One might have access to capital but still either need or want to work for a living in order to secure cash flow. One might have a background of life “in the welfare system” but genuinely seek real employment.

As I mentioned above, my little guy is bright.  We try to provide an environment that allows this to flourish, but he’s clearly got a decent amount of native intelligence.  In the kind of life we live, and hope he pursues himself, there is a clear relationship between intelligence, academic achievement and later career success.  There are plenty of smart people who operate in within the entitlement system who know how to create a relatively comfortable life for themselves.  Who’s to say in which direction he were to apply himself were he raised in an environment where the correlation between intelligence and career success was not nearly so clear.

It’s easy to view people who live their life entirely within the “welfare system” and see them as cheats, taking advantage of supports that were meant to provide the means of last resort for desperate people.  As I’ve seen plenty of times, there are lots of folks willing to manipulate the system.  I can understand (and to a great degree share) conservatives’ anger at this manipulation, which seems under-acknowledged among liberals to me.    But it’s also important to remember that people learn the lessons that surround them, and if generation after generation have viewed their prospects for generating their own capital as sharply limited then it’s easy for me to see how that viewpoint is absorbed by their children. The nearest analogy I can think of is thin people who find it easy to turn down sweets or fun to hit the gym, and so they assume overweight people are that way simply because they lack the strength of will to change.  Countless people who have struggled with being overweight have said (and I believe them) that it’s really not that easy.  I have no doubt it’s very difficult for children raised in poverty to see themselves escaping it, and much easier to learn how to operate within the system in which they are raised.

All of this is to say that, for all the manipulation that occurs within the entitlement system, my own alignment tends toward liberalism.  I believe it is in our collective best interests to provide a good education, reliable healthcare and good nutrition to all the bright, inquisitive and rambunctious children who, through an accident of birth, would otherwise have little access to them.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Good stuff. I’m not really sure liberals don’t think people mooch off the welfare system. The issue is more often conservatives making blanket accusations that all such people are lazy and corrupt. I have a visceral reaction to the “moochers” and “takers” randian crap that oozes out of the mouths of lots of conservatives.

    Most people who get some for of public assistance don’t stay on it forever. If there is a problem its with a subset of the people on assistance who are stuck in generational poverty. I’ve worked with lots of people on public assistance. Some, but not most, of them were on for their entire adult lives.Well those people had serious chronic mental illness’s like schizophrenia and were incapable of working. The other part about people stuck in multi-generation poverty is not just how they have learned to use the system or have been made helpless ( which i think is way overblown) but they lack the actual concrete resources most of us have like helpful supportive family.. I just lent some money to a friend ( well my ex wife). She is not stuck in “the system” but has some other odd circumstances that lead her to need some help to restart her life. Lots of people don’t have that which is a huge barrier to success. Most of us needed plenty of help to launch and re-launch ourselves.

  2. I agree totally. We should have both recognition that we are handed an unequal lot at birth (and let’s include talent as an arbitrarily distributed good), as well as a healthy respect for the dangers of creating a dependency – but that the former is more important to address.

    This post also reminds me again that my husband is an impressive guy. Born in lower-middle class home where his relatives did not go to college, no one particularly expected him to go to college or were able to provide him with intellectual stimulation or financial resources. He’s gotten himself through college and grad school. I forget sometime how impressive he is because of how unimpressed he is with himself.

  3. The first place I lived when I moved away from my home city/state was a really run-down sort of place. I’d say that more than half of those who lived there were on public assistance. The perplexing part of it was that even this microcosm, you had all sorts of people. This includes the groups of people talked about here as well as another one: those who could work, did work from time to time, but constantly blew it. They would go to work stoned. They’d quit a job because they couldn’t get the right day off. I’m uncomfortable saying that they were “manipulating the system” because that implies a degree of forethought that I think was absent. They were getting by in a system that had perverse rewards. In a tighter system, I think many of them would have gotten their act together.

    But not all of them. Therein lies the rub. How do you develop a system that doesn’t enable those of my neighbors that would be enabled, without making things impossible for the others? It’s simply not a matter of people being victims of circumstance or of being grand manipulators-of-the-system or somebody being one or the other.

    If I had to attribute it to anything, it would be the sense that a lot of people believe that their actions do not matter. They get fired, they get by anyway. They go to work and do everything right, they’re still working a low-wage and often unpleasant job. And since they often screw up before getting that raise or promotion, they’re stuck thinking they’re never going to get ahead. Not coincidentally, they seem to come from environments where people didn’t. I don’t begin to know how you compensate for that.

    The main cure I saw for it while I was out there was Mormonism. And that’s a solution with problems all their own.

    • How do you develop a system that doesn’t enable those of my neighbors that would be enabled, without making things impossible for the others?

      I have similar questions about how to keep people from using the emergency department inappropriately.

      • I don’t think its possible to invent a system that can’t be scammed or manipulated. I think it’s more important how many people the system helps up then how many try to scam.

        • Bingo. As a liberal, I’m well aware that there are going to be people who screw with their taxes to get some extra cash back on their EITC, that people will cheat to get an extra fifty bucks of foot stamps, and that people will cheat so they can extend their unemployment for another six weeks. But, I’ll take those losses for the pluses they bring for the rest of the population, especially since we waste more in subsidies and tax breaks than a million welfare cheats could steal from the back of a truck.

        • I am human, so I respond with a certain amount of negativity at the injustice of people getting something for nothing when they are capable of something. But, you know, I take a step back and realize that in the greater scheme of things, the paltry amount of my tax dollars that go to helping them isn’t that big of a deal. Besides, a lot of the neighbors I had, I considered friends.

          What is a bigger deal, to me, though, is the effect it has on the people themselves and those around them. Again, I’m not talking about the scammers, but rather (for lack of a better term) the enabled. The people who have been enabled to get by rather than build an actual life. I am not interested in seeing the 20 year olds I lived with turning into the 40 year olds I lived with. Not because of my tax dollars, but because I believe they deserve better and the system is allowing them to sell themselves short.

          I think it far too simplistic to say “we shouldn’t worry about those working the system as long as it’s helping people” just as it is too simplistic to say that we should focus entirely on abuse prevention at the expense of helping those who need it. Offer too much, and people who can and should be productive members of society won’t become such. Offer too little, well we know what happens. Helping those in need and encouraging those who can work and take on responsibilities to do so both matter.

          Even if taking care of my former neighbors were free, it would still be bad for society as a whole to let those who are capable of more simply coast. A lot of what I saw there wasn’t helping anybody, including and especially the recipients. This doesn’t mean I am in favor of tearing down what safety net we have. It does make me cautious with regard to making coasting too comfortable. Because, not only would those I saw coasting continue to do so, but people who are presently productive members of society might opt out as well, to their detriment and the detriment of those around them.

          That’s why it is a matter of competing priorities to me. And not a conflict I see a simple way out of.

        • What did the Midwest do after that great flood in the 1990’s? They fixed the fucking system. No more flooding (basically. this year has been wetter than any, and we’ve seen a bit).

          I should do a piece on “it’s not welfare, except it IS” — looking at disaster relief, and how it’s abused.

      • With regard to emergency rooms, what is your biggest concern? The resources consumed or the financial position it puts hospitals in?

      • Just a quick suggestion: find ways to process people who are chronic abusers into a “supervised, but 3 hots and a cot” system (where you have a nurse who can get them back to the emergency room if they need it, but otherwise provide what they really Want, without clogging up the real emergency room).

        • I am 100% in support of this type of “assistance” but I also understand that there is a visceral opposition to the idea of giving a chronic abuser a place to kill themselves (however slowly).

          • … chronic abuser of the emergency room, not of drugs. Give the crowd what they want, and they’ll stay the hell out of more expensive places.
            This doesn’t fix the chronic abusers of drugs/those that get drugs through The Medical System. That’s best fixed by giving doctors limited access to “what the person has been prescribed in the past year” (so that you can catch the guy getting the same prescription four days in a row, for something that sells for $10 a pill on the street).

      • “Why I’m Liberal-ish…”

        Dr. Saunders—as if you had a choice! It’s called DRD-4. Those dopamine receptor genes can wreak havoc on sexuality and also strongly tilt your political views in the leftward direction.

        Good news though, Doctor. As luck would have it, I just happen to do a little bit of neurosurgery on the side and would be more than happy to turn you into a Conservative–and it’s on the house. A very minor procedure, just a little flip of the scalpel and you’ll be hauling tea for the Tea Partiers from one coast to the other! I will be extremely careful. You know what they say about brain surgery–one little slip of the scalpel, and there goes 10 years of piano lessons!

        Good day, sir. Please don’t delete this. Can I not engage in any conversations around here? I actually think we can be good friends, Doctor. I’m certainly willing to try.

        • I’m leaving this comment up, since at least it’s vaguely on-topic and not addressed to people who haven’t even commented on this thread. A little insulting, perhaps, but at least vaguely on-topic.

          If all of your comments were similarly germane to the topic of the various threads, I’d let them stand. But they’re not, so away they go.

          • Okay, Dr. Saunders, that’s a deal! I sincerely appreciate you not giving the comments the heave-ho, and will in the future make every effort to make sure comments are strongly connected to the topic.

            That being said, while this would certainly be in the running for one of the “most stupid” question, I think I’m still on-topic, so here goes: just for the purpose of this discussion, if a woman, let’s say, Ann Coulter, learns she indeed is bearing a child that has the “Liberal” gene–granted, in Ms. Coulter’s case, such news would probably cause immediate, fatal, cardiac arrest or prompt her to leap from the tallest building–but in any case, what if she demanded to have an abortion bases solely on the fact she didn’t want to give Liberals one more vote or give the population at large one more Liberal. Would that necessarily be worse than aborting a child for medical reasons, or as another form of birth control, or the financial hardship caused by having a child at this time in her life? I’m well-aware of the DRD-4 gene not automatically turning a child into an Abbie Hoffman or a Jerry Rubin–maybe just a John Kerry, but I’m sure you get the gist of the point I’m trying to make.

            I have a great case for your other post but will have to do it later. I sincerely hope this is sufficiently on-target, Doctor. And again, my gratitude for being such a gentleman. I know there are times when it’s probably not at all easy. so I very much appreciate this kind gesture of yours.

          • Dr. Saunders, the previous comment of mine was in response, and directed to JG New.

            Does that automatically mean it is within the parameters of the topic of discussion? I’m trying.

        • “I just happen to do a little bit of neurosurgery on the side and would be more than happy to turn you into a Conservative …. A very minor procedure, just a little flip of the scalpel and you’ll be hauling tea for the Tea Partiers from one coast to the other! ”

          It’s called a prefrontal lobotomy

          • “It’s called a prefrontal lobotomy”

            Well how do you like that. Another neurosurgeon amongst the League. Just be glad you weren’t born into the Kennedy family. An assertive personality had the old man, Joseph Kennedy, ordering a prefrontal lobotomy for his precious child, Rosemary Kennedy, resulting in complete and total incapacitation. Oh, she was 23.

            I’ll certainly keep you in mind, JG New, should I find myself down in the dumps. In the meantime, should you need to talk to me, just ask for R.P. McMurphy at the Oregon State Hospital. Thanks.

          • I’d rather have a bottle in front of me than a prefrontal lobotomy.

  4. I believe it is in our collective best interests to provide a good education, reliable healthcare and good nutrition to all the bright, inquisitive and rambunctious children who, through an accident of birth, would otherwise have little access to them.

    That is probably true. The issues are free riders and the finity of resources. The way to thread those problems (at least, that we’ve come up with) is to provide those resources at minimal levels and to require payment for those resources at supra-minimal levels. Public school is there for everyone, but if you want a really good education, you need to move to a good neighborhood or pay for private school. Food stamps, WIC, and AFDC make sure that there is food to go around, but most people cannot afford more than the basics with those; good food costs real money. (When I consider the issue, I worry that bad economic and nutritional choices are made with the entitlement vouchers, too.)

    A Panglossian might argue that this is the best of all possible worlds; there is minimal provision for all and incentive for all to do better. I think that the phenomenon that you are discussing, and which I hinted at this January, is a significant obstacle to that. Generational transmission of the class cues regarding how sustenance is derived produces both skill sets and ethics corresponding to what has come before — and as Will most pointedly demonstrates from his own examples, those skill sets and ethics may include an ethic that improvement in one’s own circumstance is not typically possible. That is a significant part of the cycle that would need adjusting for things to materially change.

  5. I was going on to write a post about how free riders are only a part of the problem with assistance, that the bigger problem is hindering achievement more broadly – only to find Will Truman had done so, very eloquently. I’ll just say, me too!

  6. 1) Up until the middle of the 1990’s, most of the people on welfare were rural, not urban. That is essentially us subsidizing farming and rural living in general. Is that a good thing?
    2) It’s been my general impression that most people on welfare have “sidelines” wherein they make money. This is supported by the idea that you can’t live in Manhattan on welfare — the money just isn’t there. So you get a lot of people inside the Underground Economy.
    Does this jive with others’ experiences?

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