Adam Blatner

Listening to National Public Radio on 7/17/09, they talk about the initiative to promote junior colleges. While in many ways this is meritorious—we need more trade schools and less emphasis on university-level education for everyone—, nevertheless, I was struck by the theme of the commitment to remedial work, attending to emotional needs, and the like. Whoa: The problem here is how much, because the lack of motivation varies in intensity from slight—a little encouragement will do the trick, ignite the passion—to intense. In such cases, for a variety of reasons, remediation attempts generally fail. Many attend because of pressures from others, but have little intrinsic desire to do college work. Some are motivated were they in more apprentice, doing-type roles, but again, aren’t even “junior college” material. Nor is this merely a matter of intelligence, though in some cases that is so. There are people going to college who have no ability or skill even for junior college work. If retention is an ultimate goal, for some this is an asymptotic limit. That term refers to something like the speed of light or perfection. It means that for all practical purposes, there are some goals toward which  one make unlimited amounts of effort. In the case of college retention, this would involve payments to various professionals, materials, administrators, and the like. For those lacking skill and or motivation, no amount will work.

Nor does this concern confine itself to the problem of retention in colleges. I have similar questions about the goal of rehabilitation for addictions or substance abuse. The problem involves those who relapse, who don’t take sufficient responsibility to do their part to stay sober. Back to the college scene, there are those who do little for themselves.

A third category is the frontiers of healthcare, keeping extreme premature babies alive, or heroically extending the biological lives of elders or sick people at the extremities of illness. What if one person out of a hundred may be saved with an expense of ten million dollars per person? Shall the energies be expended for all hundred? And what quality of life is meant by “saved”—?

This problem also partakes of the general social tendency towards entitlement and victimization. States of inadequate strength of character become re-framed as being a victim of disease, and this is profoundly wrong, misleading. The problem is not so much that of blame as the awareness that it is okay to speak about giving up on people! If I am helping X and X doesn’t do enough to make use of my help, how much am I obliged to keep helping, or trying to help? A minute, a day, a month, a year, ten years? How many relapses should I permit before I am morally permitted to withdraw my efforts?  These are matters not just of personal morality but of community policy.

The problem of certain diseases or disabilities having asymptotic limits is emotionally touchy. The problem, to say again, is that the amount of money, personnel, and effort thrown at a given problem rises exponentially in proportion to the severity of the problem. When do we dare say, “Sorry, it’s just too much. We can’t afford it.”

The challenge here is to the natural tendency to empathize and rescue. This can function from our more immature “child” ego state rather freely—no limits are recognized. It partakes of our inner child’s wanting unlimited nurturing without having to do anything to earn it. But the adult part of ourselves is coming to recognize in this era that resources are limited and that indeed there are many nice things to do that in effect we cannot afford to do. It’s time to include that reality-testing function in our public policy.

The most current example of the politics of health care is telling: It’s obvious everyone wants more and wants not to pay more. No one wants to really say or be confronted with the realization that you can’t have more without paying for it. The fantasy is that there is “fat,” “inefficiency,” and the like in the system that can be managed so that we could conceivably get more and not have to pay more. Will no one have the courage to stand up to the media and the public for pandering to this grossly childish and irrational mixture of expectation and entitlement?