“Something is terribly wrong”
Earlier this year, the world learned that Dr. Paul Farmer died unexpectedly in his sleep at age 62.
Responses to his death have poured out from across the planet. More than once, I’ve read a piece grieving the loss of Paul Farmer and heard echos of Jesus’ disciples in the writings on Farmer’s absolutely clear moral philosophy, his miracles, and personal vows to carry on his spirit to the ends of the earth.
To me, Paul Farmer was inspirational for his moral clarity in a world that accepts suffering as an intractable problem. He flipped the prevailing conventional wisdom on its head - rather than doing the best we can for the poor with limited resources, we must marshal all the resources we need to serve the poor - and made the impossible seem obvious. As a young adult, I found his perspective both fresh and deeply familiar, articulating wisps of ideas floating in my childhood mind.
Who gets the best?
One cornerstone of Farmer’s philosophy that resonated with me was the concept of “preferential option for the poor,” which draws from Latin American Catholic liberation theology. “O for the P” insists that the poorest among us should get the best.
Our world stratifies society so that the richest accumulate the best of everything: the most comfortable homes, the nicest neighborhoods, the best schools, the most luxurious cars, the finest service. And it’s gotten worse over time as companies have learned to “price discriminate” their way to maximum profits: the best seats on the airplane, the shortest lines at the airport, the fastest passes at Disney World, and more can all be bought. On a recent trip to the grocery store, I saw three different types of blueberries: regular, organic, and the most expensive: “sweetest batch.” Even nature’s fruit isn’t safe from price-maximizing productization.
Healthcare in the U.S. is no exception. The rich have most of their costs covered by health insurance and have access to the best doctors and nicest hospitals. The poor don’t get insured at all, or if they’re lucky, get limited health insurance that too few doctors accept and are treated as burdensome or incompetent by healthcare institutions.
Yet, as Paul Farmer put it simply, “Any serious examination of epidemic disease has always shown that microbes also make a preferential option for the poor...” Doesn’t it just make sense, he asks, for us to organize our efforts around providing the best healthcare to the poorest?
How can we deliver the best?
The second idea I’ve carried with me for over a decade is the notion of accompaniment - the act of walking side by side with people on the journey toward healing. It sounds simple, but most of our institutions, programs, and services are not set up this way at all. They come encrusted with power dynamics inherent in charity, philanthropy, and international development aid. They are designed for scale and operational standardization, not for individual humans. They are hungry for a measurable endpoint to demonstrate success, not for a longitudinal relationship with unclear duration. I have personally built institutions, programs, and services like this, recognizing how hard it is to build a different way. But I’m working to shift my thinking from wanting to donate or volunteer more to considering how I can be a citizen servant to communities around me.
What to do next
Over a decade ago, I had the opportunity to serve Partners In Health, working on PIH Engage, a project to organize communities across the country to fundraise and advocate for global health. I was glad to work at the organization that had inspired me to get into healthcare and enjoyed being surrounded by a patchwork team united by a passion for better health globally.
As I move into the next season of life, I can feel the force field of rationalization closing in: the incentives of healthcare institutions, governments, and individuals are too misaligned; there just isn’t enough money in Medicaid to serve people adequately; it’s too hard to change policy, and regulations are overly complicated anyway; I’m cynical about for-profit companies encroaching into the space, but safety net institutions are shouldering an impossible burden with too few resources.
Yet Paul Farmer’s passing has stirred my inner disciple to rewind to the time when pragmatic solidarity - moving beyond compassion to action - just felt like the only obvious way.
“It’s not just about the acknowledging the suffering of others. It is also about asking the question, “how much of this suffering is premature or even unnecessary and what might we do collectively to lessen it?””