Random Thoughts from a Restless Mind

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine. An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists.

Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting. Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least.

A just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled. Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work.

We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

“Enjoy the weekend off; you deserve it.” How many times have you heard something like that? “They need to give you X; you deserve it.” Statements like that confuse me. What does it mean to deserve something? In a roomful of people how does one determine who deserves what? “He got what he deserved.” Says who?

I like accuracy in my language, at least when considering prose as opposed to poetry or koan. The concept of earning something is much more comfortable for me, much easier for me to get my head around. Whereas there’s a real sense of entitlement in the concept of “deserve”, coupled with a whiff of helplessness in that one must be granted the state of deserving by another, to earn something is a little more like math. 2 + 2 = 4. If you do this you have earned that. This week I earned my days off by doing well at my day job, leaving few to no loose ends that required weekend tying. I earned my keep, if you will, earned the ability to take 2 days away from what provides me income. At every encounter along the way I worked to the best of my ability to earn the respect and trust of those who purchase my particular skill.

Do I deserve any of that? Well, that’s where the idea of entitlement comes in, hand in hand with the subservience inherent in the fact that someone else gets to make that call. If you ask me, not only did I deserve all of that, but there should have been more! What I did should have earned me more of all of that. There’s a fine line between “deserve” and “earn” it turns out, even for one such as I who understands the difference. In certain circumstances the hand of others, seen or unseen, pulls on strings that determine whether you do, indeed, receive that which you have earned.

As Scar so famously said: “Life’s not fairrrrrrr.”

There’s the rub. Fairness. Is what you’ve earned fair? It’s maddening, isn’t it? Even if you forswear all sense of deserving this or that in favor of earning whatever you are still at risk of falling for the fairness trap. The reality as far as I can see is that, on balance, we all get pretty much both what we’ve earned and what we deserve; it kinda all evens out in the end. What makes it difficult is that at any one time there may be a disconnect in one particular place where you think you’ve earned it–whatever it might be–and yet it’s not coming your way. No way around it, that’s really hard. Unfair, even.

The lesson here, I think, is that pretty much everything in life is to be earned. Food, shelter, clothing. Respect. Trust. We have within us only the ability to go about our best in order to earn any and all of these. To put it another way, our best good-faith effort is all we have to contribute to the equation; acknowledging that it is on us to earn these things is in itself a demonstration of good faith, a repudiation of entitlement, and a clear statement to all that what we receive in the end cannot be justified by some outside agent declaring that “we got what we deserved.”

We deserve to be loved. Everything else we deserve only the opportunity to earn.