Poverty & Prophecy

Poverty & Prophecy

My wife and I have been listening to the Harry Potter books on Audible so I have been reminded of one of the key ideas from the series – the idea of the self-fulfilling prophecy. A prophecy is made about Harry Potter, the big bad guy, Voldemort, hears part of the prophecy and acts on it, ultimately fulfilling the prophecy and bringing about his own doom. The question, which is asked directly in the book, is whether any of the events of story would have happened if the prophecy had not been overheard. If the bad guy hadn’t been afraid of the prophecy to try to prevent it, would the prophecy have been meaningless?

This idea came back to me when thinking about a quote from Kathryn Edin and H. Luke Shaefer in their book $2.00 A Day. When I think about the poor and about the way they are treated, I often fall into a similar mindset as I do when I think about the prophecy from Harry Potter or any other story about a self-fulfilling prophecy. I find myself asking if the way we treat the poor effectively tells them they are not worthy and valuable, effectively creating a self-fulfilling prophecy that they realize. When we tell someone they are not good enough, not worth the time and attention of society, do they begin to believe it, and do they give up on themselves?
“Research shows that the intrusive treatment people typically receive at the welfare office can undermine their confidence in government and erode political participation,” write Edin and Shaefer. Their book shows that research on how people in poverty are treated finds that the treatment of poor people directly influences how they understand their position in society, how they understand whether they are supported, valued, and whether they should even try to participate in democracy to improve  their lives and fight for what they need to live better. Edin and Shaefer continue, “it stands to reason that this kind of treatment could also erode the very confidence that is so necessary for pulling yourself out of a $2-a-day poverty.”
This is where my ideas about self-fulfilling prophecies reconnects with poverty. Shaefer and Edin demonstrate that what we tell poor people becomes the reality they live within. We set up systems to aid the needy, but we treat them terribly when they seek to access such systems. We tell them they are not worthy, that they are failures, and that they don’t deserve the assistance legally provided. As a result, poor people believe they are not meant to participate in society, they may truly believe they are not good enough to improve their situation, and they may give up and accept that they are not deserving of a better life. The way we treat the poor effectively creates a prophecy that they live out, preventing them from meaningfully participating in our democracy, and limiting their chances of doing the things necessary to be seen as worthy of more help and assistance to escape deep poverty.
Guidance Toward High Value Care

Guidance Toward High Value Care

In his book The Elephant in the Brain, Robin Hanson explains that a lot of medical care and healthcare services are more about signaling than about the value they bring to the patient in terms of improved health and effective management or treatment of a given condition. Healthcare has a lot of signaling, showing others that we make enough money that we can go do something for our health, pushing others to get care to show how much we value having them be healthy, and giving us or others a chance to show how much we know and understand the human body. However, not a lot of what we push people toward really demonstrates that it adds a lot of value.

 

This is a problem that Dave Chase thinks is a big contributor to our nation’s healthcare woes in his book The Opioid Crisis Wake-Up Call. Chase is critical of unnecessary services and a medical system that pushes people toward care, without providing means to ensure that the care we push people toward is actually valuable. He recounts a conversation he had with Dr. Martin Sepulveda, “indiscriminate provision of health care services – absent efforts to help people understand how to use those services – leads to voracious appetites from both patients and providers for services that add little value but add a lot of cost to the individual, company, and society.”

 

When a child runs to their mother for a kiss on a bruised knee, the kiss doesn’t actually add any value in terms of helping heal the child’s bruise. But the care provided by the mother does signal her love for her child, signals to the child that they are valuable and important, and signals to others that the child has allies who will aid them during a time of need. The example is extreme, but if you look close enough, you will see some of the same aspects at play in many of our healthcare interactions.

 

Increasing access to healthcare without helping people understand what care they should seek, without helping people understand what options they really have, and without guidance toward high value care, means that we will use healthcare in a wasteful manner. Paying providers just by the number of procedures they do, and not by how much they help patients, encourages unnecessary medical procedures. Telling patients that if they value themselves they will go to the doctor every time they feel a little off will lead to patients overusing primary care. And pushing people to the emergency room every time they say they don’t feel well could crowd our ERs and delay care for those who really need it. The problem is difficult to solve, and I want to acknowledge that it is hard to know what care is really appropriate and what is wasteful signaling. That is the point that Chase makes. Without more transparency and clarity in the system, we won’t really know what medical services we should and should not pursue, and we (along with providers) will likely overindulge in high-signaling low-value care rather than medical treatments that are really useful and meaningful.

Early in a Career

I recently changed jobs, and a piece of advice that I revisited from Ryan Holiday in his book The Ego is the Enemy has come back to me at a perfect time. Holiday writes, “When someone gets his first job or joins a new organization, he’s often given this advice: Make other people look good and you will do well.”

 

Our tendency as successful young graduates, something Holiday addresses directly, is to want to prove ourselves. To prove that we were worthy of being hired over all the other candidates. To show that we are awesome and can handle the spotlight and the opportunity given to us. Our urge is to take on the biggest project, the most important client, and to do something truly impressive to show that we are great. The problem for us young people, is that we really don’t have much experience and what we learned in the classroom may not be directly applicable or up to date by the time we get into the swing of a job.

 

Holiday suggests that instead of being so focused on proving ourselves and trying to make a big impact by doing something visible and possibly beyond our ability, we should instead look to serve those who have already been in successful in their roles at our new organization. He writes, “It’s not about making someone look good. It’s about providing the support so that others can be good. … Clear the path for the people above you and you will eventually create a path for yourself.” The benefit to this strategy, according to Holiday, is that it puts you in a place and mindset where you are more focused on learning and growth than on individual achievement.

 

When you try to prove yourself early on, you risk doing too much, insulting others who can assist you on your journey, and failing to learn from the mistakes of others. When we make egotistical power grabs others will notice. If we allow our ambition to run faster than our skills and experience, we risk putting ourselves in places where we need assistance and need the buy in from those around us, and if we do this early in our career before we have  developed relationships and proven that we are deserving of help and assistance, we may find ourselves isolated. Helping others shows us where opportunities and trends lie, and it also builds allies for the future when we hit our own rough patches. Working to assist others early on doesn’t mean that we won’t have opportunities to do great and meaningful work, but rather that the work and effort we put in will align with the goals and objectives of others, helping the organization as a whole be more productive and effective, ultimately creating bigger wins and more success for us and others. We can still step up to take on big projects, but by making it about someone else and helping someone else succeed as opposed to making ourselves look worthy and impressive, we are likely to have more support and to have more guidance to make our success more likely.

Asking Questions While Coaching

In his book The Coaching Habit, Michael Bungay Stanier helps us see what makes a good coach. The key lesson that he shares with us is that a good coach does more listening than talking, something that seems to cut against our ideas of coaching in the United States. Good coaches, according to Bungay Stanier, don’t hog all of the speaking time. In the United States, our vision of a good coach is someone who has an anecdote for every situation with instructions and life lessons baked in. They are always talking, always telling everyone where their problem is and how to fix it. While this is the kind of coach we see in movies Bungay Stanier explains that this is not the kind of coach that we actually want and is not the kind of coach that will help us grow and improve. If we want to be good coaches, we need to learn that listening rather than advice and direction giving can be the most powerful tool in a coaches box, and that the standard vision of a coach is not as helpful as we may believe.

 

Bungay Stanier writes, “when you’re asking questions you might feel less certain about whether you’re being useful, the conversation can feel slower and you might feel like you’ve somewhat lost control of the conversation (and indeed you have. that’s called “empowering”). Put like that it doesn’t sound like a good offer.” I know for myself, whether I think about a sports coach, a business coach, or even a life coach, I picture some wise person who can tell me what to think and tell me what to look out for, but when I think about Bungay Stanier’s ideas of what a coach is (particularly a life or professional coach) I see a more impactful coach. A strong coach helps you discover solutions and approaches to challenges that work for you. They help you grow and develop by helping you learn,  become more self aware, and solidify your often tangled and jumbled thoughts.

 

Good coaches ask questions because it forces the person they are working with to think deeply and try to find their own answers. Giving advice is good and providing direction is helpful, but Bungay Stanier would argue that nudging an individual and asking them questions helps them grow in ways that simply telling them does not. When we respond to questions we think more deeply about our past, our goals, and what has or has not worked for us. We think about ways we could approach things differently or try new solutions. Telling someone something directly just gives them one point of view, and not necessarily the point of view that will help them the most based on their own history and experience. What listening and asking questions does is empower the other person to solve their own problems and learn more about themselves and the options at hand.