Homeless people in Portland are abundant. One of my local cafes has a large population of homeless who hang out outside of it.
I’ve struggled with my response when a homeless person petitions me for money. For various reasons, I have decided to say no. On the rare occasion when I carry cash and it feels right then I hand out money.
I came across a discussion by an economist who was talking about poverty and the distribution of money. This post is about poverty and the accumulation of wealth.
Poverty is Default
We think of poverty as a plight. A homeless guy once told me that he had been down on his luck which he blamed for being homeless.
His assessment was inaccurate. Money doesn’t start out in your bank account. You aren’t showered with money and employers aren’t lining up to assign you a job. It takes a lot of work to direct funds into your account.
Once you have the money you have to go about securing it – keeping it.
Building wealth requires continued diligence. It takes time and most forces pull you down towards poverty.
You’re not assigned housing, good health, a close community from birth. These all have to be meticulously collected, curated, and executed.
We take this for granted as physicians because we have already secured high paying jobs. With medicine being as rigorous as it is, there is a physician shortage that allows us to wake up and show up to work.
Keeping a Job
Keeping a job is fucking hard. Arriving to work on time, meeting performance requirements, behaving professionally, and avoiding trouble at work require specific skill and diligence.
In fact, I wasn’t able to keep my job and I consider myself a hard worker. I worked for nearly a decade at Kaiser Permanente, and in the end I resigned due to problems I created myself. I slipped one time, one little thing, and that’s all it took.
Mental health disorders are ubiquitous in a highly structured society. Financial and work stress take their toll on citizens. We stigmatize mental health and chalk up to weakness or inability to cope.
Many of my colleagues hide their depression. They willingly suffer in order to keep their jobs. They carry on practicing medicine, 100% defeated, hoping to escape it all during retirement.
Some can successfully suffer silently and others succumb to depression, anxiety, insomnia, and mental breakdowns.
We don’t look at addiction as a disease in this society, it’s considered mostly an irresponsible life decision. Even some physicians have a hard time accepting addiction as a disease.
The kind of addiction that’s incompatible with employment is hard to treat. It’s much easier to ignore it politically because such individuals don’t have much of a united voice.
But damn near anyone can be at risk for addiction. I don’t think there is any immunity to it. If you’re wealthy then you can get help. But your record will be tarnished and employment after such a diagnosis will be hard.
It’s perfectly fine to pity the person who lives on the streets. To feel sorry for the unemployed, homeless person who lives in poverty.
It’s also necessary to recognize how much hard work it takes to not be in poverty. To maintain a job. To not succumb to addiction, to hide the mental health issues from medical boards and employers.
It’s hard to kiss the ass of your staff. To say ‘yessum to your boss. Flying under the radar and enduring sexism or racism at work are a few of the skills needed to rise out of poverty. One little mistake and you’ll be right in there with the rest of the poor.
Frailty of Wealth
I look at my position in life and it is in fact a very frail one. All I need to do is miss a bill payment, get arrested, develop a drug habit, not reply to a letter or email, not show up for a medical board investigation, make one subtle mistake on a medical chart – I’d be fucked.
I’m retired with very few responsibilities but nothing about this life is simple. It takes a lot of orchestrating to be a productive individual in a highly structured society.
It’s even harder when you’re employed full-time. Add on top of that several layers of complexity when you have dependents.
Rising Out of Poverty
It takes foresight, planning, sacrifice, and hard work to get out of poverty.
If you’re living on the street then you need to first enter mainstream society. This means handing all the bureaucracy that comes with being a tax payer.
What you don’t have to do homeless is pay bills on time, deal with licensing boards, file income taxes, coordinate work with household errands, traffic, package deliveries, and healthcare appointments.
Many of us have decided to take on this challenge because we’d rather not be poor. It’s something that has to be maintained until the day you die unless you are lucky enough to have someone else paying your way through life.
Some claim that they want to be wealthy, they say they want to be financially secure but judging by their actions, it’s low on their priority list.
Ask a poor person if they want to be poor. Fuck no, they want to be rich or at least get by on a decent income. But will they keep their rental apartment clean? Will they avoid being rowdy late into the night? Will they avoid the police? Pay bills on time? Show up to work diligently?
Staying out of Poverty
My parents earned a decent amount of income and lived well. But they couldn’t hang on to their money. They lost their house and could no longer afford paying for my out-of-state tuition. My dad lost his car and his business, one after the other.
They were well-to-do and gradually they lost it all. All the things they did right didn’t matter much. It takes only one wrong move to bring the whole structure down.
No matter how wealthy you are, the norm is poverty. The constant gravitational pull is down towards poverty. Entropy ensures that wealth, money, assets, and resources are constantly scattered.
Our efforts are focused on fighting financial entropy and keeping our wealth in one location, preserving the value of that wealth, and making that wealth grow. Finally, we’ll want to spend down from that wealth without exhausting it prematurely.
Employed as Physicians
The hard part of medicine isn’t the clinical part, it’s not performing a surgery or piecing together symptoms to come up with a diagnosis. It’s dealing with difficult people in a very tightly structured profession. It’s avoiding mistakes that could end our careers or put it at risk, otherwise.
Friends ask us to diagnose them. Family asks us for prescriptions. Patients don’t tell us the whole story. Some are out to score opioids. Making a mistake is inevitable no matter how brilliant and careful you are. Making it through all these obstacles takes a shit-ton of hard work and focus.
Perception of Poverty
It’s one thing to be impoverished in a country without social safety nets and without basic infrastructure. In these countries the poor have to sift through gutters and beg for money on the street.
In the US you can be poor and as long as you are a functional individual without physical or emotional handicaps, you can enjoy damn near everything that a rich person can enjoy.
A poor person in the US has access to high-speed internet at the libraries. They can get free or low-cost personal communication devices. They can get free health insurance and get treatment by the same high-caliber doctors who treat patients at UCLA or Harvard healthcare systems.
Housing subsidies are available though they likely won’t stay in a downtown high-rise. They can furnish they apartment with high quality donated items. In fact, the same items that I shop for at thrift stores are available for donation to low income individuals.
They can take advantage of food subsidies and shop at the same grocery stores that I shop at.
They can get free education at both private and public institutions.
They can breathe the same quality air as myself. Drink the same tap water that I drink and exercise in the same parks as myself.
I live in poverty – according to others – doing so intentionally and loving the shit out of it.
I don’t own a car.
I buy used clothes.
I live in a tiny studio.
I have a pay-as-you-go cell plan.
I don’t own a TV.
I don’t take regular vacations.
I don’t have an A/C.
I clean with vinegar and baking soda.
I don’t have a microwave.
I cook most of my meals at home.
I make my own deodorant.
I use mason jars at home instead of cups.
I don’t believe I’m living in poverty. Some even feel a little sorry for me. It’s all perspective.
Intentional poverty isn’t the same as being homeless or having mental health problems or addiction disorders which person from holding down a job.
But intentional poverty has a survival advantage. The odds are stacked against us to hang on to wealth and to remain high earners for several decades successfully.
By living intentionally poor I am giving myself a distinct advantage. I am forgoing all the headaches and hard work needed to live a rich life and taking advantage of the perks that come with having fewer responsibilities.
In the US even the lowest standard of living is fairly high-quality. It’s worth taking advantage of if you don’t need a BMW or a mansion to feel comfortable in life.
The majority of physicians are willing to work very hard in order to afford a more luxurious lifestyle. Not out of greed but because we think that we must try to rise way above others. As if that’s the only way to enjoy life. It might stem from the pity that we have for the poor.
Medical professionals are suffering, no doubt about it. The work is hard when done full-time and many are burnt out. But giving it up and living intentionally poor is out of the question for most clinicians.
When you live an expensive lifestyle then you need more money saved and invested in order to afford that lifestyle passively, as in, when you retire. Most of us must eventually live off of investments. Few will be able to work full-time until they drop.
To have more saved and invested you have to work full-time longer. You have to take on the risk of practicing medicine longer. You also have to take on more market risk to ensure that your investments will support your wealthier lifestyle which you’ve gotten accustomed to.