As we construct the stories by which we understand reality, we tend to romanticize people when they’re generalized.  In healthcare, for instance, patients are “people who need help,” and we have a set of emotions and moral ideas associated with them as a concept.

The problem is people need all sorts of kinds of help, in different degrees and of different natures.  The help one person needs could be help with whatever personality trait it is that leads them to abuse the healthcare system.  When we zoom in to the individual person or the particular situation, the romanticism can evaporate.

A person with a lifetime of collected individuals and particulars, like Michael Morse, can gain a very unromantic impression of “people who need help.”  Looking back at his time as an EMS, he writes that he didn’t expect to learn that “mildly Ill people, younger than [him] would call 911, lay in bed until [they] arrived, allow others to physically carry them from their homes and then wait for 8 hours crammed into an overcrowded emergency room with other mildly Ill people.”

This wasn’t all patients, of course, but it was some, and they have to be included in our de-romanticized idea of who uses these services when we have public policy debates about them.  Writes Morse:

But the most unbelievable thing is nobody has the courage to reign in the waste, abuse and frivolity that plagues EMS, not the politicians, not the Fire Departments or their unions, not the ambulance companies, the hospitals, the doctors or even the medics on the street.

I’m not sure courage is the problem.  As Morse goes on to note, the participants all profit from the situation.  A lack of reasonable standards also covers them on the other side, because nobody is to blame if the intention is to help everybody and “the system” just can’t accommodate them.  It’s not the people to whom we’ve assigned the task of managing the system, because they just want to help, and they’ve told us they need more and more.  It’s the fault of the taxpayers or corporations or whatever bogeyman we want to focus on for not supplying what is needed.

These are the incentives that inevitably arise when we declare goods and services to be “rights” and separate the recipient from the payer.  For some reason, when rights are things that we are permitted to do, we easily understand that they can be abused, but when rights are things that we are entitled to be given, we romanticize away the possibility of abusing the gift.

Featured image by Adhy Savala on Unsplash.