Selfish care

Last week I saw the great Gatsby, a movie directed by Baz Luhrmann and starring Leonardo DiCaprio. I wrote last week that the World Health Assembly is bombastic, but this movie over tops the Assembly easily. Mr Gatsby holds staggeringly sumptuous parties in his mansion. The 1920s come alive in the movie with all-singing and all-dancing effects, and with Jay-Z's audacious music. Digital panoramas of New York make you dizzy. Fortunately, the story is less complex and easy to follow. Mr Gatsby was years ago in love with Daisy who now lives just across the bay from Gatsby, with her boorish wealthy husband Tom. Gatsby left her many years ago to first make a fortune with illegal deals in the prohibition years so that they would be rich before they started to live.

The parties he now organises are nothing more than an attempt to win her back, but she never shows up. After arranging a meeting through Daisy's cousin Nick, who happens to live next to him, he finally meets her again and a competition follows between the two lovers. But that is maybe not most important. What the movie is really about is that getting rich first is not always the right strategy. And that over-consumption, selfishness and low moral standards do not make you happy in the end.

The individualization and demoralization of the 1920s is perhaps the very start of the trend in the second part of the 20th century that is still continuing today. This week in Herald Tribune there was a great article by David Brook: "What our words tell us". The Google database that contains 5,2 mln books between 1500 en 2008 gives some interesting insights. Researchers looked at how frequently words were used between 1960 and 2008 and discovered the same two main trends. First, individualism has increased as was shown by the increased use of words and phrases such as personalised, preferences, self, standout, unique, 'I come first' and 'I can do it myself'. On the other side of the coin there was a much lower use of words like community, collective, share, united and common good. The second trend, demoralization is also on the rise, reflected by the decreased use of words like virtue, decency, conscience, honesty, patience, compassion, courage, bravery, faith and wisdom. The word humility was even 52% less used.

Brook himself identifies a third trend, governalization and I think he is right. I am sometimes surprised how often our politicians are in the news and how much importance is attached to what they say and do. Politics and media are more connected than ever before.

The overall story according to Brook is that over the last 50 years society became more individualistic and less morally aware. This led to social breakdowns which government tried to address, sometimes successfully and sometimes impotently. And perhaps the government could be smaller when the social fabric of society was more tightly knit.

For long-term care we also had and still have to cope with these trends, both in the Netherlands and probably also increasingly world wide. People have become more individualistic and rely less on their family and social networks. The government has stepped in with big schemes and now provides or finances much long-term care to people. The government is judged by the people on the ability to deliver and care has become a right rather than a shared responsibility. The public sector and those delivering the care also have to face people that are attaching less value to morals. In less kind words, people who are probably less decent, honest and modest when using care.

In the Netherlands we will attempt to reverse the trends by delivering less public services and by asking people to rely more on their social networks when they get old. I mentioned that in previous blogs. We also try to increase their moral standards, among others by asking them to report on inefficiencies in the care system (last week an internet based reporting point was opened). Not so much much by focusing on dishonest behaviour, but rather by together addressing inefficiencies in the care sector. However, much is of course related to 'careless' acts.

And what can we learn from the movie? Well, Gatsby did not get his love again. He was killed by the guy whose wife he killed by reckless driving with his sports car after a binge in New York. At the end Nick tells him that 'You can’t repeat the past, old sport'. We will see whether in Holland we can at least change the past, when it comes to long-term care.