When you practice medicine, you see a lot of really strange things. One of the most vexing medical phenomena that doctors encounter is the autoimmune disorder, which, is in essence, the body attacking itself. It is a condition where the body literally doesn’t recognize its own tissue as “self”.
President Donald J. Trump is sworn in as the 45th President of the United States, and there is something disturbingly akin to an autoimmune disorder raging in America’s “body” politic.
This analogy, while not news shattering in and of itself, has been haunting me.
Perhaps it’s because I am a public health physician who has been trained to see the community itself as “the patient,” and to work to anticipate and prevent illness rather than just treating individuals after they get sick. So I know how dangerous autoimmune diseases are in medicine and health. And similarly, I think any self-destructive or divisive political climate is really dangerously unhealthy to our society.
Also, since the election, I’ve been troubled and probably for the first time in my life, I feel we may be past the point of no return as a “Great Society.” I really hope that’s not case. I hope we’re not heading into Nazi Germany in 1933, but I feel like there is such a profound difference of perspective in red and blue America, that it’s not easy to see how those two perspectives can be bridged. We are beginning to not recognize each other as “self” – similarly situated Americans.
On the right, we heard rallying cries to “drain the swamp” from Trump’s base of “working class whites” and others, who were fed up with politics as usual. On the left, we watched progressives and “poor communities of color” push back against the fear, racism, and misogyny generated by Trump’s campaign. But who really wins (and loses) when these groups are pitted against each other?
Medically-speaking, this is the kind of zero-sum game that decimates the human body when an autoimmune disorder rages. The working class has imploded within itself. And let’s be clear, whether framed as “working-class whites” or “poor people of color,” for the most part both groups are working people, only divided by a racial shell game. In fact, according to the Bureau of Labor Statistics, most of the people living under the federal poverty level (approx. 85%) actually work, at least part-time.
So working class people of all backgrounds are experiencing an unprecedented loss of opportunity. And that opportunity is in every domain of human endeavor, from health and housing, to jobs and education. This has declined for everybody. We’ve turned on ourselves in this autoimmune kind of way not recognizing that we’re all suffering from the same phenomenon. Leading up to this election, all of these levers of opportunity have been pulled against the working class and we’ve (yet again) been divided along color lines of red and blue, black and white.
So what’s the prescription that can calm it all down and get people talking to each other?
For me, one of the first steps is recognizing that racial, ideological, and class polarization is really just a symptom of this “disease” and that it’s really corporate power that has pulled the rug out from underneath us all.
What’s the prescription? In the same way, I, as a physician, might use steroids to calm infections in the body, today we must use something we already have access to: the American social compact.
We must fully take up those ideals outlined by our founding fathers that each one of us are heirs to universal and inalienable rights as Americans, regardless of class, race, or national origin. We must hold up that promise in the Declaration of Independence that the powers of the government are derived from the people themselves. We all are entitled to a government that produces a livable wage, affordable housing and health care, paid sick time, educational opportunities and more.
We must build up our body politic against divisive “antibodies” that seek to divide and conquer by appealing to fear and ignorance.
We must seize inherent opportunities from the parts of Obamacare Trump wants to retain, such as coverage for people with pre-existing conditions and coverage for children under 26.
We must hold Trump’s feet to the fire for the parts proposed in his healthcare plan that could dismantle any part of the social compact. For example, currently 31 states – including Vice President Pence’s Indiana – have expanded Medicaid coverage to 9 million additional people under Obamacare. So will there be a republican voter revolt at the ballot box in 2018 if Trump’s new plan cancels this order? And what about Medicare? We are now hearing rumblings about privatizing Medicare and perhaps even Social Security, two central pillars of the American social compact. This is autoimmunity run amok. Only we, the people, can prevent the irreversible damage to the precious tissue of our body politic.
We must learn to have inclusive, “purple conversations,” wherein we both challenge this new administration by strongly repudiating the racism, xenophobia, and misogyny associated with its leader while remaining open enough to understand the real pain of parts of his constituency, and look for any shared opportunities that lift all boats.
Finally, just as in treating an autoimmune disease, the prescription here must be multi-pronged (read: bi-partisan), anti-inflammatory, and focused on saving and healing the whole patient, which in this case, is all of us, America itself.
Dr. Tony Iton is Senior Vice President for Healthy Communities at The California Endowment.