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Is Income Inequality Making the “Anonymous” Problem Even Worse?

At the start of 2017, we looked hard at income inequality and, over the course of the year, the idea of treating certain people as “anonymous.” Yet we know the idea of engagement is much easier than engaging on a personal level. When people are anonymous to us, they can be ignored, feared, pitied, or even attacked. The anonymous seem to deserve our worst.

One factor that causes people to be anonymous is income inequality. This is true in financial services — the wealthy have private banking, the poor have check-cashing and cash advance services. It’s true in retail where the wealthy use personal shoppers and the poor, Goodwill and discount stores. It’s true even in food — the wealthy have Whole Foods and the poor must deal with “food deserts.”

I’ve spent some time pondering two recent articles in The New York Times that focus on the massive gulf in income inequality in America, and how that inequality manifests itself in healthcare. The first article — “What the Rich Won’t Tell You” — focuses on the widening gulf between the merely wealthy (versus the super-rich) and the average wage earner. The second article — “Can Prep Schools Fight the Class War?” — explores how the next generation is affected by the widening gulf and how one organization has drawn a line in the sand. There are important implications for all of us, as individuals, but also real implications for the health care system as it relates to “tiered” healthcare, access, and continued problems with the price consumers pay for healthcare.

Let’s look at the First article “What the Rich Won’t Tell You.” The author sets up the issue this way:

“Yet we believe that wealthy people seek visibility because those we see are, by definition, visible. In contrast, the people I spoke with expressed a deep ambivalence about identifying as affluent. Rather than brag about their money or show it off, they kept quiet about their advantages. They described themselves as “normal” people who worked hard and spent prudently, distancing themselves from common stereotypes of the wealthy as ostentatious, selfish, snobby, and entitled. Ultimately, their accounts illuminate a moral stigma of privilege. The ways these wealthy New Yorkers identify and avoid moral stigma not because we should feel sorry for uncomfortable rich people, but because they tell us something about how economic inequality is hidden, justified, and maintained in American life.

The top 10% of earners now garner more than 50% of income nationally, and the top 1% over 20% [NOTE: this is for income, the top 1% control a far larger percentage of the nation’s wealth]. It is not surprising, then, that that the people I talked with wanted to distance themselves from the increasingly vilified category of the 1%. But their unease with acknowledging their privilege also grows out of a decades-long shift in the composition of the wealthy. During most of the 20th century, the upper class was a homogenous community. Nearly all white and Protestant, the top families belonged to the same exclusive clubs, were listed in the social register, educated their children at the same elite institutions.

This class has been diversified, thanks largely to the opening of elite education to people with different ethnic and religious backgrounds starting after World War II, and to the more recent rise of astronomical compensation in finance. At the same time, the rise of finance and related fields means that many of the wealthiest are the “working rich,” not the “leisure class.” The quasi-aristocracy of the WASP upper class has been replaced by a “meritocracy” of a more varied elite. Wealthy people must appear to be worthy of their privilege for that privilege to be seen as legitimate. Being worthy means working hard, as we might expect. But being worthy also means spending money wisely….there is a deep tension at the heart of the American dream. While pursuing wealth is unequivocally desired, having wealth is not simple and straightforward. Our ideas about egalitarianism make even the beneficiaries of inequality uncomfortable with it. And it is hard to know what they, as individuals, can do to change things.”

We have to acknowledge that this is a fascinating (and scary) dynamic. The gulf between the top 10% of wage earners and the rest of American society widens by the day. Yet the gap between the top 1% and the rest of the wealthy is also widening. This has led to all sorts of bad social dynamics, tensions, and resentment. It has led to the most class-charged American society any of us have experienced in our lifetimes, and it’s hard to see how it will get better for our children.

That leads us to the second article — “Can Prep Schools Fight the Class War?”

“In recent years, and most obviously since the rise of Black Lives Matter, private schools around the city have taken concerted care to recruit minority students, to introduce curriculums and conversation about racial understanding in lower grades, to seek diversity consultants and to promote inclusion around gender. At the same time, ostentatious displays of wealth and entitlement that can dominate a school’s ecosystem have gone too often unchallenged. At the end of last month, however, John Allman, head of school at Trinity (one of the most prestigious schools in NYC), wrote a letter to the parent body meant to shake up the existing order.

Invoking the country’s current state of chaos, he wrote of a sense of alienation among students at the school — regardless of race, class, and privilege — that stood apart from the larger political and social crises besieging us. He blamed, in large part, “consumerist families that treat teachers and the school in entirely instrumental ways, seeking to use us exclusively to advance the child’s narrow self-interest. He called for a dismantling of “this default understanding of Trinity as a credentialing factory,” warning that without it, students would merely ascend to “a comfortable perch atop a cognitive elite that is self-serving, callous, and spiritually barren.” Without a shift in ethos toward greater commitments to the common good, toward social justice and activism, he said in the letter. “I am afraid we are, for a majority of our students, just a very, very expensive finishing school.”

Radically rethinking a school’s culture involves not only getting parents and children to alter a deeply ingrained mind-set and executing pedagogical changes, huge projects in themselves, but also ensuring that the families admitted are in tune with these values. This requires an ability to determine what sort of parents seek admission to your school solely so that their children can sit atop a cognitive elite and suggest to them that they might be happier elsewhere. This is not easy, but it is important for institutions that continue to groom the people who seem to keep running the world.”

Wow. If today’s American society is incredibly class-segregated and waiting to explode, how will it help if the current crop of high school students ascend to “a comfortable perch atop a cognitive elite that is self-serving, callous, and spiritually barren?” Don’t we face the real risk of a society irreparably divided by class (even more than race), and unable to understand one another and empathize with people different from us? Doesn’t this class divide ultimately contribute to the problem we explored over the last few months, where huge numbers of people are “anonymous” to us?

If anonymous is the enemy of engagement, widening income inequality and the gulf between the classes is exacerbating the problem. I worry about this for my kids, as I know many of us do. I want my kids to have a diverse friend group, a sense of responsibility for those who are less fortunate, and a love for people regardless of their wealth. I want them to see people as people, not as assets. I am inspired by the words of my middle son’s football coach who told the team, “we want to love people and use things, instead of loving things and using people.” There is great wisdom in these words.

I worry about this for our communities, too, which are often divided in ways that affect culture but also access to healthcare. And I worry about this for the future of healthcare, which is so sensitive to the policy and regulatory environment in an increasingly divided America and a federal government (executive and legislative branches, at least) that defies understanding.

I consider what income inequality means for myself, my own choices, and the way I see people and the way I’m seen. Yet I also consider what it means for our clients and the marketing strategies we design for them. Healthcare marketing is responsible for connecting with the entire community — rich and poor (and super-rich), business owners and homeless, sick and healthy, every group of people. And hospital marketing in particular can appeal to the “angels of our better nature,” helping people to see how they can live better, more productive, healthier lives. Healthcare organizations are uniquely positioned to engage with people — individuals at moments of great joy and sadness, but also all the moments that matter in between. We can be leaders in moving past anonymous to engagement. We can look past class and wealth and engage people as people, even when those factors are key in segmentation and targeting.

That doesn’t mean marketing is a “public service” or we ignore the business realities that keep the doors open and quality care possible at hospitals, clinics, and physician offices. Marketing has the same role in healthcare as every other industry — attracting customers to meet business goals. Marketing is responsible for driving profitable business, which is even more critical as payments for Medicare, Medicaid, and the uninsured fall shorter and shorter of covering costs. In healthcare, the right marketing means the right payor mix, the right insurance coverage, the ability to cover personal financial responsibility. That’s a reality.

Yet how we engage with people, how we treat them, is always important. The truth we all know, deep in our hearts and souls, is that we treat people differently when we know them — what they like and don’t like, what they care about and how to connect with them. None of us wants to be on “a comfortable perch atop a cognitive elite that is self-serving, callous, and spiritually barren.” That’s true even if we want to be cognitively elite or wealthy (not bad goals per-se). Anonymous is the enemy of engagement, yet we can decide to engage. We can decide to break the antiquated rules of healthcare marketing communication to really engage with people, to know them, to connect with them on a personal level. And that will benefit your organization and the healthcare system as a whole.

February 8, 2018
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