Triage Culture: The Mideast, Wisconsin, and The NEA

by Arlene Goldbard

Triage is the process of culling and prioritizing patients to apportion medical treatment: those who will survive without treatment and those who will die regardless of treatment are given lower priority than those for whom care and attention will increase chances of survival. You need to practice triage in a field hospital, at the scene of a large accident, or in a crowded emergency room—wherever the need for care outstrips the supply.

But more and more, triage as a political philosophy is being practiced voluntarily, from the public squares of Tripoli to the streets of Madison, Wisconsin, to the offices of the National Endowment for The Arts (NEA). What works in a field hospital, where there are only so many doctors, so many beds and bottles of medicine, is being transferred to domains awash in surplus arrogance, in which the worst scarcities are compassion and wisdom.

In the medical domain, the process is systematized to prevent bias and self-interest from dominating: the triage nurse has nothing personal at stake; the guidelines are set according to a consensus of medical necessity; the goal is to help as many as possible. But the salient facts of triage politics are a stark contrast: someone with a hyperinflated sense of personal power feels authorized to decide who will get help and who will be expendable; and to blithely allow everyone else to suffer the consequences.

Everywhere I look, the people who have been declared expendable are refusing to lie down and die.

On Friday, when soldiers in the Bahraini capital fired at close range on protesters with hands in the air, chanting “peaceful, peaceful,” King Hamad bin Isa al-Khalifa’s version of triage was evident—preserving his own power would always take precedence over ordinary people’s lives—just as was Muammar el-Qaddafi’s on Monday when helicopter fire and trucks full of soldiers were unleashed to spill blood on the streets of Tripoli. Yet one by one, even high Libyan officials are deserting Qaddafi’s ship of state. When President Obama asked the Bahraini king to back off, changing the political equation, protesters were allowed to resume without being shot, but the king’s survival was still the paramount criterion. (Nicholas Kristof’s first-person account from Manama, Bahrain, is worth reading.)

Here in the U.S., thousands descended on Madison, Wisconsin (70,000 were reported to gather last Friday), to protest Governor Scott Walker’s move to eliminate collective-bargaining rights for many state workers’ unions. Walker unbalanced the state’s budget by pushing tax breaks for the corporate and financial elites to whom he owes allegiance, then used the shortfall as a club to blame and beat public employees. He appeared to have no doubt he could get away with it.

These tactics—the same package of deregulation, nonproductive investment, and tax breaks followed by scapegoating taxpayers for the deficit—created the national financial crisis. It is the financial equivalent of the old joke about the man who murders his parents, then begs the court to have mercy on a poor orphan.

Economist Paul Krugman put it very well in Sunday’s New York Times:

[W]hat’s happening in Wisconsin isn’t about the state budget, despite Mr. Walker’s pretense that he’s just trying to be fiscally responsible. It is, instead, about power. What Mr. Walker and his backers are trying to do is to make Wisconsin — and eventually, America — less of a functioning democracy and more of a third-world-style oligarchy. And that’s why anyone who believes that we need some counterweight to the political power of big money should be on the demonstrators’ side.

…Mr. Walker isn’t interested in making a deal. Partly that’s because he doesn’t want to share the sacrifice: even as he proclaims that Wisconsin faces a terrible fiscal crisis, he has been pushing through tax cuts that make the deficit worse. Mainly, however, he has made it clear that rather than bargaining with workers, he wants to end workers’ ability to bargain….

Why bust the unions? As I said, it has nothing to do with helping Wisconsin deal with its current fiscal crisis. Nor is it likely to help the state’s budget prospects even in the long run: contrary to what you may have heard, public-sector workers in Wisconsin and elsewhere are paid somewhat less than private-sector workers with comparable qualifications, so there’s not much room for further pay squeezes.

So it’s not about the budget; it’s about the power.

Cognitive linguist George Lakoff has published an essay exploring the underlying dynamic of the triage culture (though he doesn’t call it that). In “What Conservatives Really Want”, Lakoff describes how conservatives’ views are shaped by an underlying allegiance to top-down power:

Conservatives believe in individual responsibility alone, not social responsibility. They don’t think government should help its citizens. That is, they don’t think citizens should help each other. The part of government they want to cut is not the military (we have 174 bases around the world), not government subsidies to corporations, not the aspect of government that fits their worldview. They want to cut the part that helps people. Why? Because that violates individual responsibility.

It is well worth reading Lakoff’s piece in full as a pure explication of the triage culture. He continues to stress an underlying metaphor—the strict father family—as if it explained everything. But it’s easy to correct for that as you read, and his explication of clashing worldviews and their consequences is crystal-clear: the right-wing triage nurse standing with our notional national clipboard regards the body politic through a particular lens: if you are a loser in the marketplace, you didn’t try hard enough. You should accept your punishment. It will probably be good for you, but whether it is or not, it’s your problem, not mine. Why should government use my resources to protect you from the consequences of your own failures? Next!

I was really sorry to see National Endowment for the Arts Chair Rocco Landesman broadcast his personal commercial for the triage culture a few weeks ago. He told a theater conference that, “We’re overbuilt. There are too many theaters,” adding that “You can either increase demand or decrease supply. Demand is not going to increase. So it is time to think about decreasing supply.”

You’d think our top spokesperson for cultural development would be a little less inclined to accept defeat, but inside the beltway (which is to say inside the cramped discourse of small-p politics), it’s monumentally hard to resist drinking the Kool-aid that Lakoff describes, adopting the pretend vocabulary of budget-cutting and partaking of the gentlemen’s agreement not to acknowledge the drama of power that is actually unfolding. Following the triage trend, Landesman advocated giving fewer, larger grants. When people said that such a policy would only help the biggest grants-getters get bigger, he protested by citing Washington’s Arena Stage and its New Play Festival, which includes works by mid-size theaters.

Size isn’t everything, of course: when the triage culture has a grip on public officials, what suffers isn’t so much about size as about diversity, as about an idea of excellence that is bounded by certain cultural assumptions, one that tends to ignore work that disturbs the peace, or gives voice to divergent experience, or calls into question the entitlements of the privileged. In practical terms, when fewer, larger grants are given, women, people of color, rural artists are the categories that almost always lose. But even if we focus on size, Landesman’s notion of scale is skewed by his background in Broadway theater. Out here on Planet Earth, the Arena’s ability to command $135 million in capital funding for the new theater it opened last year suggests something largish, no? As does—to cite just one example among many—its $1 million-plus gift from the Mellon Foundation to establish a resident playwrights’ program.

The type of triage Landesman is proposing (without admitting that it is triage at all) allows a market framework to supplant the public interest in art. There is a romantic notion that market reality actually follows the law of supply and demand; and that it is somehow transferable to the distribution of social goods. Both points are absurd. On the one hand, compared to taxpayers’ subsidy to the oil industry, sports stadiums, the financial sector, agribusiness, and other sectors of our so-called market economy, public cultural funding amounts to a rounding error—a small tip for a very large dinner. If such enterprises were actually left to live or die by the law of supply and demand, things would look very, very different.

On the other hand, even the most primitive notion of the public interest must acknowledge that social goods—like education, care for the weakest and least protected, clean air and water, safe roads, culture, and so on—must be driven by other than market factors. In the cultural realm, the driving forces can include social inclusion, learning about each other through creative expression, balancing a distorted markeplace, promoting active creative participation, as well as supporting the creation of beauty and meaning and public access to that process. (Others of the countless reasons to support the public interest in art are discussed in “The Great Reframing,” the third part of my recent series on the cultural funding crisis.)

Unless you want to live in a triage culture, that is, one that sees markets as the universal metaphor and cutthroat competition as a state of grace. Thomas Hobbes described it best 350 years ago in Leviathan:

Whatsoever therefore is consequent to a time of war, where every man is enemy to every man, the same consequent to the time wherein men live without other security than what their own strength and their own invention shall furnish them withal. In such condition there is no place for industry, because the fruit thereof is uncertain: and consequently no culture of the earth; no navigation, nor use of the commodities that may be imported by sea; no commodious building; no instruments of moving and removing such things as require much force; no knowledge of the face of the earth; no account of time; no arts; no letters; no society; and which is worst of all, continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short.

Our human minds are subject to what cognitive scientists call “confirmation bias.” We typically seek evidence that confirms our existing beliefs. In an information-rich world, we almost always find it, regardless of how far-fetched those beliefs may be.

Given this proclivity, it is not easy to resist heaping up proof of our own rightness. But to do anything besides resist confirmation bias is foolish. Those convinced by their own propaganda are vulnerable: while they tell themselves soothing stories about deserving whatever good fortune has come their way, the world sneaks up on them. Wrap your mind around the trouble that Hosni Mubarak had believing Egyptians would cut him loose. As he began to barter with the nation—first dissolving the government, then pledging not to run in elections next autumn—he seemed sure of prevailing, then shocked to learn how wrong he had been.

Individuals in power are flattered, complimented, and courted with such unctuous persistence that it is almost impossible not to surrender to the delusion that one has earned adoration, rather than coerced it through punishment or reward. Hosni Mubarak’s astonishment at his rejection by the people he had dominated for decades is far more significant in the grand scheme of things than Rocco Landesman’s having absorbed enough obsequious flattery to convince himself that his brand of provocation is entertaining, or cute, or even somehow salubrious. But despite the vast gulf in power and motive, the traits their behaviors have in common are obvious: necessary humility eroded by position, a too-secure sense of entitlement to judge who is worthy and pronounce, and an inadequate grasp of the broad scope and sacred nature of a public trust.

This amazing version of Leonard Cohen’s “Who By Fire” features saxophonist Sonny Rollins. The song is based on a powerful Hebrew liturgical poem recited as part of the High Holy Days, Unattaneh Tokef, which states in stark terms the mystery of fate and the ultimate power of judgment: “[W]ho will live and who will die,” the sacred poem goes, “who will die at his predestined time and who before his time; who by water and who by fire, who by sword, who by beast, who by famine, who by thirst, who by storm, who by plague, who by strangulation, and who by stoning. Who will rest and who will wander, who will live in harmony and who will be harried, who will enjoy tranquility and who will suffer, who will be impoverished and who will be enriched, who will be degraded and who will be exalted.”

To this I add, who by the arrogance of power? Who by greed? Who by a heart that has forgotten compassion? Who by the lust for power at all costs? Who by a broken understanding of what it is to be human? As you listen, please allow the question to enter your mind: is society like a field hospital? Do you choose to live in a triage culture? And if you are tempted to answer yes, citing the illusion of necessity the right has so successfully imposed, consider this: would you choose it if you were the one with the checklist and clipboard? Would you still choose it if you were the one lying on the stretcher?

Everywhere I look, people are saying no to the triage culture. The right has been successful in masking its true nature through skillful use of frames and metaphors. Lakoff and Krugman are correct that allowing them to set the terms of debate in this country has been a recipe for self-defeat. Now we need to call it out for what it is, not a debate over budget and priorities, but a struggle to make democracy real.

You can visit Arlene Goldbard’s site at http://arlenegoldbard.com/