In a recent podcast interview with Ezra Klein, Michigan Senate candidate Dr. Abdul El-Sayed was trying to explain what motivates his sense of mission to try to expand access to healthcare in this country. He told the story of a former patient of his—a woman struggling with homelessness and substance abuse—whom he encountered in the emergency room.
After ordering the usual round of tests and treatment, he said he tried to convince her to stay in the hospital system for rehab. He prepared a whole treatment plan for her, and the hospital would have covered it. She refused these multiple offers of help, however, and left, claiming that her daughter was picking her up.
Shortly thereafter, he says, he saw her again. She was back, homeless and prone, on the same subway floor where she'd been living before.
As Klein points out, this was an odd story to choose to illustrate his thesis, since it doesn't really prove that the healthcare system specifically failed this woman. She had access to medical care, according to this telling. Indeed, the medical system offered her multiple rounds of free treatment, and she refused.
There's no evidence she would avail herself any more willingly of a universal single-payer health insurance program, if it existed.
Instead of proving anything about the the medical system, then (and lord knows there are plenty of better examples one could have found of ways it has failed people or denied them care—unwillingly, in other cases), this story illustrates a quite different and less readily solvable challenge of modern life:
In any modern metropolis, we are constantly passing by people in the same position as the woman Dr. El-Sayed saw on the subway floor. People, really, in the same position as the man who fell among the robbers in the Parable of the Good Samaritan. And we don't know what we are supposed to do about it. It becomes harder still to know how to respond when the person does not ask for help; or even refuses help that is offered.
It is a feature of life in any great modern city that one walks past on any given day people lying flat at a bus stop, people talking to themselves in paranoid rambles, people asking for money. Yesterday, I took my headphones out for a moment because a man lying on a bench outside was hacking out his lungs. Eventually, he quieted down and seemed to be okay. I kept walking uneasily. Was there something else I should have done?
A few months back, I was visiting a friend in New Haven. To his credit, he heard a voice that I might not have noticed. A man was apparently calling to us from a vacant lot. He had fallen and broken his leg while trying to climb over a fence into an abandoned gas station. We called the paramedics, who arrived shortly thereafter.
What felt so unusual—maybe even gratifying—about this Good Samaritan experience—was that the man had a specific request, and we knew how we could help him for once.
A friend of mine who lives in the Bay Area says for the same reason that he would love to meet a panhandler for a change. It's relatively easy to hand people a dollar bill. The homeless and desperate people he sees on the street, by contrast, are more likely to be unconscious than to ask for money.
My friend is always talking about how he wishes we had an established etiquette for what we are supposed to do in these situations. If you walk by a fellow human being lying stretched out on the ground in front of you, shouldn't you rush over to check their pulse and make sure they're okay? Shouldn't you call a paramedic? Unless they're just asleep and want to be left alone?
Most of us think we wouldn't just abandon the man who had been beaten by the robbers and dropped on the side of the road in the story. But how many of us do exactly that every day? We see unhoused people all around us. And we think: "maybe they don't want us pestering them." And who knows—in many cases, that could well be true. As the woman in Dr. El-Sayed's story tells him, when he offers rehab treatment: "Don't tell me what to do; you're not better than me."
As early as 1946 (in an essay that ends by quoting the entirety of the Good Samaritan story), Dwight Macdonald was already noticing that any walk through a major city confronts one with a whole series of these impossible moral dilemmas. "A style of behaviour which refuses to recognize the human existence of others has grown up of necessity," he writes. He observes that people in his era, as they walked past someone lying "in the gutter, badly hurt and only half conscious," would relieve their conscience by thinking to themselves that the man "must be drunk."
This is the all-purpose "formula by which, in the city, one denies human recognition," Macdonald writes—just as today, we often think to ourselves: "must be on drugs."
If we really get alarmed, of course, we sometimes call the authorities. "The policeman," writes Macdonald, "is the only person in a big city who is professionally required to see people as people, to break the shell of apartness that encases each human being." As Macdonald adds: "When people are forced to see others as human beings, they make contact vicariously through the police. What a 'style' of communal relations!"
Macdonald would doubtless be shocked by how much worse this problem has grown in the decades since he wrote, particularly since de-institutionalization in the 1980s left thousands of people dealing with various forms of mental illness to fend for themselves on city streets.
As Eric Hobsbawm described the effects of this policy in his Age of Extremes, "[I]n the cities of the West there no longer was a community to care for them. There was no kin. Nobody knew them. There were only the streets of cities like New York filled with homeless beggars with plastic bags who gestured and talked to themselves. If they were lucky or unlucky [...] they eventually moved from the hospitals that had expelled them to the jails which, in the USA, became the main receptacle of the social problems of American society[.]"
This dystopian feature of urban living now seems so "normal" to us we often don't even realize how much it would have shocked our own great grandparents. It turns out people can get used to anything. As Arthur Koestler writes in his book The Lotus and the Robot, about his postwar travels in Asia, he was appalled during his first visit to India by the fact that in walking through any street he was forced to step over innumerable naked and hungry human beings. He had survived war and fled across the entire European Continent to escape Hitler's armies—but never had he seen poverty and desperation like this.
And yet, he writes, "After another week, I took the huddled corpses for granted and no longer saw them—just as I was no longer aware of the beggars, cripples, and legless deformities [...]"
That is what has happened to us as well. We don't even see or notice the people we may pass on any given stroll through a major prosperous city who are prone on the ground, unconscious—possibly dead, for all we know. We have learned not to see them.
Of course, sometimes we do notice them (especially if they cough or stir). We even feel a bit guilty of course. But we nonetheless hurry along past them, knowing we can savor our guilt at our leisure once we are safely back home, and even think a bit better of ourselves for feeling so guilty.
We are like the driver in one of Bertolt Brecht's most haunting poems—who passes by a "ragged" hitchhiker and coldly tells his other passengers that they have no room to take him—even though they all know there is actually plenty of room in the back seat.
We had gone some distance further, a day’s march perhaps, Brecht writes,
When I suddenly took fright at this voice of mine
This behaviour of mine and this
Whole world. (Kuhn/Constantine trans.)
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