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America’s unfortunate decline into post-familialism highlights the need for a new era of public service.

As I sit here listening to the endless debates on why the sequester will destroy/help us and whose fault it is and why things are so bad, I am forced to contemplate fundamental changes in the American culture which got us to this point. It is not simply a red state/ blue state thing. It is not just the rich being demonized by the poor. There is a fundamental shift – a splintering – taking place in both culture and tradition in the once united America.

Mine was the generation of the post-war baby boom of the 40’s. Everyone in my neighborhood had been in the service or had supported the war effort. Every parent had been through the Depression. They had heard Roosevelt’s fireside chats, the attack on Pearl Harbor – indeed the death of Roosevelt himself – and they had heard it together. The Roman phrase “pro bono publico” was, if not stated, a fully understood concept. They were the generation that knew they had both rights and obligations to their country. They knew that we all had to pull together, and that it would only work if an educated populace participated in this governmental experiment. Today we have no such unity. The narcissism and detachment of the intelligentsia renders them incapable of social contracts. Everyone’s got rights; few have responsibilities. And we don’t understand why we’re going to hell in a hand basket.

One sphere where America’s cultural shift away from rights and responsibility can be seen is in the decline of the family structure. While this might seem far afield, the change in how Americans view family changes core assumptions we need to practice emergency medicine. We can no longer depend on a family to fill in the gaps with a patient. We can no longer rely on that grandmother or grandfather to look over children, watching to see if they worsen. It can no longer be assumed that there is a family structure to help with our elderly. For as long as humans have lived in family units, we’ve depended on a certain amount of sacrifice in taking care of our own. But that is changing.

To better understand the sobering shift in family assumptions, I recommend a new work by Joel Kotkin, entitled The Rise Of Post-Familialism: Humanities Future? In a straightforward manner, Kotkin reviews the lightning speed with which the Western world has abandoned concepts which have sustained us over the millennia. Here are a smattering of facts that Kotkin uses to build his case. The number of women who are childless at age forty has doubled in the last thirty years from 10 percent to 20 percent. Thirty percent of German couples plan on having no children. Interestingly, survey data showed that half of German men say they can live full and happy lives without children. (So much for happy daddy syndrome.) In Asia, many of the same trends are being seen. A third of Japanese men age forty are unwed. For the first time in our history, half of the Asian countries have birth rates below replacement levels and two-thirds of Western and Eastern Europe have birthrates below 1.8 children per woman. Russians are on pace to have a population in 2030 that is 20 million less than it is today.

So what does this mean for us as a people, and as physicians? Families and clans no longer serve as our central organizing feature, which have historically functioned to care for the sick and the elderly in society. The great paradox of modernity is that when we get richer, we decide to have fewer children but more luxury goods. We have truly decided to trade tots for toys (i.e. possessions). Better to have surrounded ourselves with goodies than to minister to the needs of our young, let alone care for our growing number of old. A society that is increasingly single and childless is likely to be more concerned with serving current needs than addressing the needs of the next generation. We are becoming the ‘now’ culture, which suppresses our responsibility to our past (i.e. our parents), grandparents and undermines our responsibility to our future. Is it okay to run the country into debt without asking who’s going to pay the bill? It depends on who you are serving with your decisions.

The cohesiveness of our family structure is an essential part of the cultural dialogue, but it is merely a structure on which we must build a shared moral base. If you think the public schools of today are going to give your children a value structure, you are fundamentally wrong. If you believe that there is no shared moral base, then getting caught is the only real crime your kid can commit. But character is what you do when nobody’s looking. No degree from Yale can make up for a lack of character.

It will surprise none of my usual readers that I hereby offer a “modest” proposal which will attack not only the debt crisis but force us to ask broader questions about this shift in the demographic base. The words “financial crisis” and “college cost crisis” and “care crisis for the elderly” all seem to run together at once. We are lacking in manpower and resources for reasons which we don’t fully understand. I propose the reinstatement of the draft. Men, women, rich, poor, black, yellow, white; everybody goes. This could be a path to citizenship for illegal aliens and a way out for nonviolent youthful offenders. Take everybody. No excuses, no nothing. The Israelis do it; we can do it.

Just as during the Second World War, which united the country, have everyone participate where they feel they can best contribute (what a concept!) for the society. Some will go into the military as always, and such service is noble and needed; but it will be their choice. Most can be used for other purposes. To care for the infirm, and care for children. To restore the land and rebuild cities. Detroit has 60,000 properties that need to be leveled so that the land can be returned to other use. America’s national forests need work. I challenge you to find a community that does not need help. The young, strong and unskilled are always needed in a society.

This period will be followed with a month-for-month matching of school-for-service as a new GI bill emerges, allowing people to head to trade schools, junior colleges or universities. The rising cost of education is essentially shutting many people out of their path to the American dream. Let’s develop a path that we can all relate to.

The single most productive bill to come out of the Second World War was that which sent our GI’s into training. It built the basis of a stronger society and we can do this again. By the way, by then I presume those who have come out of several years of service to their country would be better students and no doubt better citizens. They would have a real experience base with which to understand the needs of others. They would be more willing to participate in the shared experience of governing the country. In this culture, our children who are becoming young adults should be viewed as our wall, our fortress against the consuming abyss of death. In them we have a future. Without them we have nothing.

In infants veritas est

In children there is truth

 

Comments   

# Long Time E.D. Doc 2013-04-10 02:46
Those damn kids! (Greg Henry channeling Andy Rooney...?)As GH rants I too reflect back on the good ole days, mainly of how GH was once relevant and insightful, not to mention far less cliche. Oh wait, I didn't mean to interupt his "contemplation on fundamental changes to America."
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# Ira Sender 2013-04-26 07:49
I'll go you one better, Greg. Since many of our generation have never done a bit of service for their country (with a few notable exceptions like Mark Plaster), how about as a prerequisite to collecting medicare we are obliged to put in 2 years of service. Granted we might not be able to go through boot camp, but many sixty-five year olds have a good bit of knowledge and could still could provide some type of volunteer service to their country. It doesn't matter when you do the service, young or old, but it would be a prerequisite to obtaining Medicare.
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# Chuck Henrichs MD FACEP 2013-04-29 02:53
Being 'forced to contemplate fundamental changes in the American culture' may have a pompous ring to some, but I would not consider such an exercise irrelevant. While the concept of some form of mandatory work or service may rankle certain political sensibilities, the observations leading to the notion do not lack insight. Dr. Henry knows if his proposal is meant to be taken literally (I suspect perhaps so) or is to be taken ironically as was the 'modest proposal' Jonathan Swift made for the infants of the poor. By the way, Swift published his essay anonymously, just as Long Time E.D. Doc posted.
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