Are Amateurs “Sufficient”?

This is a slightly different vantage than usual on the question of “what might suffice”?  But it is definitely about sufficiency.

St. George, Maine Volunteer Fire and Ambulance Association sealI spent a good portion of the weekend at a conference for Emergency Medicine Providers (aka EMTs).  In Maine, most EMTs are professional, but quite a few smaller squads also include volunteers.  When I got my license, which was less than two years ago, our entire squad in St. George was comprised of volunteers.  And that’s a big part of why I joined. Plus, the service was free to people who needed to use it.  I loved the idea of neighbors being so fully present for one another in a time of crisis.  I loved that people didn’t have to worry that they couldn’t afford help.  Loved that when help came through the door, it might even have a familiar face.

This is changing quickly.  Partly, it is that folks want a paramedic on call 24/7, and it’s hard to do that for free.  Partly, though, and this is the crux of what I want to explore here, it’s that it is getting harder to get and maintain a license.  My course was 130 hours, plus two final exams.  Apparently, it used to be about half that long.  And to remain licensed, I need to get continuing ed units, which is a big part of why I spent my weekend at the conference.  I can get a bunch of them here on topics that are relevant.  And since our squad is a volunteer squad, getting them in clusters like this is a real help–as we don’t have many opportunities for continuing ed credits at “work.”  Sure, we can go to other people’s events, but part of the issue here in Maine is that we are a geographically widely dispersed population.  It takes a lot of time to get to, participate in, and get home from training at other stations.

And here’s the thing:  of course we should be well trained.  But I feel compelled to point out that this increased emphasis on professionalization is happening AT EXACTLY THE SAME TIME that healthcare in the US is in a horrible spending spiral, and is wildly unaffordable, and is spotty in the service it can provide in rural areas.  I have to wonder why the group that licenses EMTs is making it harder to get and maintain a license in such a moment.

I don’t think it’s a conspiracy or evil intention.  My best guess is it’s a fundamental lack of forethought.  While the notion of professionalizing such service is laudable, the down-sides are potentially dire for the very folks who are meant to be served by increasingly well-trained medical folk.  Which is where the whole issue of sufficiency comes in.  The pretty-darn well trained amateur model was working.  A model with well-paid and well-trained professionals can also certainly work.  But is it necessary?  Was the other truly insufficient?  And on what grounds?   That’s the heart of it:  what are the criteria that are being brought to bear that make a system that celebrated community caring for each other suddenly deeply inadequate?

The old model was very much about good will, about neighbors helping each other for free.  And as the fine folks at Freakonomics have amply demonstrated, paying someone just a little to do something that they used to do for free (plus the satisfaction of a deed well done) does not work.  Just as paying people to donate blood actually leads to a decline in the number of donors, paying a token to folks to be on the EMT roll does not work very well.  When people lose the ‘feel good’ factor, they either want to be paid well or to not do it.  And going from an all or mostly volunteer squad to a mostly paid squad significantly increases costs.  Which then get passed on to patients, who have to pay for the service.  And what was once an inspiring instance of community self-sufficiency becomes a commodified service within a capitalist framework.

For now, I’ll keep up my license, as I wait to see if the local efforts to develop a Community Health Program take off, but I can already read the writing on the wall.  Even if my town cherishes volunteers, at the state level, they’re just not that into us.

Systems Theory, in Surround-Sound

My afternoon was book-ended by watching the healthcare summit streamed onto the home page of the New York Times (thank you, NYT!).  In the middle, though, I was having a great conversation with a friend and colleague who is currently working on building an environmental art program at Unity College in Maine.

One of things we were puzzling through was how to help people learn about systems theory.  Not necessarily in a formal sense (although that would certainly be great), but at least in a way that helps them to appreciate the intricate interconnections among species or actions or bodies of thought, as well as the relationship between those entities and the environments in which they arise.  Systems theory is integral to environmental education, and is increasingly important for understanding the fine arts and for arts education.

But as powerful a tool as systems thinking is, it can be surprisingly difficult to teach.  At first glance, this makes no sense.  We live in a world of natural and social systems.  And we humans have evolved to be remarkably adept at reading the world in order to survive.  Yet, we are apparently not always particularly adroit at appreciating the relationships between elements at two or more remove from one another, or at understanding the ways that feedback loops build upon one another, or the role of sensitive dependence in a system, or the importance of emergent phenomena.

I suppose it could be that we are still very short term thinkers—great at sussing out immediate danger or pleasure, but not so great at discerning the larger picture.  That approach certainly affords immediate survival advantages, and those are, well, essential.  But if one looks at the parallels between systems theory and a range of indigenous belief systems, it’s clear that plenty of other systems also emphasize holistic approaches, emergence, and profound interconnectivity.  In a paper on systems theory that they delivered in 1999, James J. Kay and Jason A. Foster, both then at the University of Waterloo, argued for an explanation that resonates with my colleague’s observation that her (predominantly American) students struggle with these concepts.  They proposed that students have such a hard time with systems theory because it runs counter to the implicit and explicit beliefs that undergird Western science.  “Generally,” they wrote, “these behaviours [emergence, self-organization, etc.] are not intuitive to students, as they do not conform to the Newtonian linear causality mode of reasoning that is a cornerstone of our culture” (5).  And, they point out, even students who are not well-versed in the sciences have absorbed the beliefs about cause and effect that shaped Western science for the first few hundred years.

Which brings me to the health care debate part of my afternoon.  As you likely know, there are a host of disagreements between Democrats and Republicans about health care reform.  One that was stressed this afternoon was between incremental versus comprehensive reform.  Basically, the Democratic position was that the ills of our current health care system are so intertwined that to effect change requires tackling everything at once.  And the Republican position was that such an approach is foolhardy and that we’d be fiscally and socially wiser to move in a step-by-step fashion.  This one sentence summary ignores some important ideological differences, but it highlights a difference that isn’t getting any coverage in the traditional media, and that I bet isn’t going to get any attention:  if we set aside the specific content of the argument for a moment (hard as that may be) this is, in part, a conflict between a Newtonian vision and a Systems theory view.  The Republicans proffer a Newtonian view, one that emphasizes straightforward cause and effect links and linear relationships.  The Democrats present a systems view that acknowledges feedback loops and complexity.

I have opinions about which position is wiser in this case.  But much more important than what I might think is whether or not the people who are living inside the U.S. health care system, and who are ostensibly voting for the kind of system we should adopt, have the tools to understand both positions.  If, as Kay and Foster claim, it is hard for people to learn systems thinking, then that implies many, many people don’t have the tools to evaluate the two positions on their own merits.  Without an understanding of feedback loops, the Democrats’ insistence on insuring more people as a means of reducing individual insurance costs very likely won’t make sense.

As a citizen, this realization frightened me.

But as a thinker, I found this moment of crystallization kind of amazing.   Naturally, that made me want to share this sense that systems theory itself was the thread that bound my superficially discrete afternoon experiences (because that’s kinda cool), and that divergent ideas about systems theory are part—quite possibly a rather large part—of the health care impasse (because who knew!?).  Yet I could not help but wonder:  does the health care summit really belong on this blog?  If I write about it, am I being political instead of artistic and environmental?  Asking the questions in that way forced me to realize that excluding these observations would deny the importance of systems thinking.  I would be creating artificial barriers between one arena of thinking and living and another.  It might be convenient, but it would force me to disregard a host of subtle interpenetrations that shape not simply an afternoon but a life.

Or, as I not-so-secretly believe, not a life, but life.