The Unspoken Punchline...

 

The American promise—that you can be anything you want—is a mantra we internalize from childhood. It's the foundation of every commencement speech, the hopeful message on every career guidance poster. But what if the whole thing is a setup for a punchline? Comedian Chris Rock delivered it perfectly: "As long as they are hiring."

It’s a funny line, until it isn’t.  As someone who grew up in a blue-collar household, I found it to be a devastatingly accurate summary of the modern American condition. It captures the humor, the tragedy, and the stark reality all at once. For years, I have used Labor Day as a moment to reflect on the deterioration of the physician's work environment—a topic that, for those of us in the field, feels more hopeless with each passing year. But this year, I find myself thinking less about my own profession and more about the foundation on which it all rests: the simple, hard-won dignity of work itself.

My own trajectory began in a family of five children, where my father was a railroad fireman, then an engineer. In my earliest memories, he was a figure of physical toil, shoveling coal into steam locomotives. Then he became an engineer on diesel locomotives.  His schedule was chaotic, defined by the whims of the railroad's system. He would take a train 180 miles south, sleep on a station bench, and turn around the next day. We would often have to pick him up in some distant town, 30 or 40 miles away, a small sacrifice for a man who seemed to belong to his work more than to us.

The railroad was a union shop, governed by a ruthless seniority system. The most tenured engineers got their choice of routes and hours, leaving the newer men like my father with stretches of unemployment, even while he was still officially on the company's books. He hated the union dues and the men at the top who seemed to prosper without working very hard. He was, in a way, his own harshest critic, constantly engaged in home improvement projects that were more like feats of engineering than weekend hobbies. I remember a day when seven of his friends showed up to help bend a warped 16-foot plank of wood into a sill plate. The conversation, as they worked, was a symphony of railroad stories, a shared language of labor and hardship.

The values of that world were rarely spoken but deeply embedded. We were taught to mind our own business, which meant a steadfast refusal to gossip or, more importantly, to ever speak of what happened within the family. It was a kind of principled isolation. We were expected to work hard and to be rewarded for it, yet my family lived paycheck to paycheck. The meals were predictable, built from a half-pound of ground beef. Good grades were a given, but a future beyond high school was an unwritten page. Nobody in my family had ever gone to college. I ended up there on a football scholarship, and even then, in the early years of my studies, I tried to get a job on the railroad. The men who interviewed me knew my father's name, even though he had been gone for six years. I didn't get the job. It was one of the best things that ever happened to me.

 I look at that world now and see a profound contrast with the one we inhabit today. The honesty, the direct exchange of labor for value, seems to have been replaced by a system of ever-increasing abstraction and exploitation.

The promise of American capitalism—the idea that free-market competition drives innovation and success—feels more like a myth. We no longer buy products; we license them, signing up for a lifetime of monthly payments that invariably increase. There are minimal guarantees, but a large extended warrantee business where you can purchase one.  The company that employed my father, a place of hard work and honest wages, is now nothing but a ruin. In its place, we have a system where businesses compete not on the quality of their product, but on gimmicks designed to guarantee a perpetual revenue stream.

This is a world defined by stark, growing inequalities. The gap between the richest and everyone else has widened dramatically. Just in the past 10 years the number of billionaires and their net worth has doubled. Tax cuts for the wealthy, deregulation that degrades our environment—these are not accidental byproducts of the system but deliberate mechanisms for concentrating wealth. We see the rise of a managerial class that seems to exist solely to siphon value from the real producers of goods and services. The largest managed care company in the U.S. is a behemoth with a gross annual revenue that rivals the GDP of a small country. They produce nothing but profit, denying care to their subscribers while extracting billions from the system. It is a world where a billionaire, who surrounds himself with other billionaires, can convince working people he represents their interests.

The most unsettling change, however, is the erosion of fundamental values. The robber-baron mentality is back, with CEOs and corporations shamelessly pursuing power with no regard for the environment or the well-being of the working population. The truth itself has become a flexible commodity. It is now routine for a President to lie to and troll the American people, a new norm that has been embraced by those who claim to represent the very people who value honesty above all else. This particular form of ad hominem is most frequently used to attack the work done by other politicians and government workers.  Expertise is openly mocked, and the social contract with workers has been grossly violated.

Perhaps the most visceral example of this new ethos comes from a quote by a current director of the Office of Management and Budget. He stated, “We want the bureaucrats to be traumatically affected…We want them to not want to go to work because they are increasingly viewed as the villains.” He talked about starving them of funding and putting them "in trauma." As a man who grew up watching my father work, I cannot comprehend a world where a manager openly declares his desire to inflict trauma on his employees. Here is a novel concept – your employees are working hard enough already and most are struggling to get by.  The idea that a manager could view the very people who do the work—the civil servants who keep the country running—as villains is a profound moral failure.

 Labor Day was created to honor the accomplishments of the American worker. It was a recognition that we needed a social contract to ensure job security, a share in prosperity, and freedom from exploitation. In the last seven months, that progress has not just been halted; it has been violently reversed. The contempt for workers, the willful destruction of their professional and living environment, and the disregard for their security is palpable.

How can this possibly end well?

George Dawson, MD, DFAPA

References:

1:  Abelson R, Rosenbluth T.  Medicare Plan Would Let A.I. Companies Determine What Is Covered: [National Desk].  NYTimes, August 29, 2025  https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-healthcare.html

2:  Nehamas N.  DOGE Put Critical Social Security Data at Risk, Whistleblower Says.  New York Times.  August 26, 2025. https://www.nytimes.com/2025/08/26/us/politics/doge-social-security-data.html

3:  Wikipedia.  Mass federal lay-offs.  Accessed August 30, 2025. Link.

4:  Malakoff D. How Trump upended science. Science. 2025 May 8;388(6747):576-577. doi: 10.1126/science.ady7724. Epub 2025 May 8. PMID: 40339033.

“Many fear that in just 14 weeks, Trump has irreversibly damaged a scientific enterprise that took many decades to build, and has long made the U.S. the envy of the world”.

5:  Kaiser J. NIH under siege. Science. 2025 May 8;388(6747):578-580. doi: 10.1126/science.ady7725. Epub 2025 May 8. PMID: 40339032.

“The atmosphere is one of “chaos and fear and frustration and anger,” said a senior scientist with NIH’s intramural research program who, like others, spoke on condition of anonymity to protect themselves and others from retribution. This scientist added: “It’s this feeling of utter powerlessness and repeated insults.”

A former top NIH official who was forced out believes that’s the intent. “I think the plan is to sow as much chaos as possible. … I think they want a dispirited workforce at NIH so people will just say ‘to hell with it’ and leave.””

6:  Jacobs P.  Trump administration quashes NIH scientific integrity policy.  Science.  2025 April 3; https://www.science.org/content/article/trump-administration-quashes-nih-scientific-integrity-policy

7:   McNicholas C, Sanders S, Bivens J, Poydock M, Costa D. 100 ways Trump has hurt workers in his first 100 days.   April 25, 2025   https://www.epi.org/publication/100-days-100-ways-trump-hurt-workers/

8:  Greenhouse S.  ‘He’s brazenly anti-worker’: US marks the first Labor Day under Trump 2.0.  Advocates say Trump has hurt workers in many ways, often by cutting their pay or making their jobs more dangerous.  The Guardian.  September 1, 2025.  https://www.theguardian.com/us-news/2025/sep/01/labor-day-workers-trump

9:  Borosave RL, Steffens S.  Trump’s War on Workers. Buried beneath the bluster is a systematic assault on labor. Nation.  August 29, 2025.  https://www.thenation.com/article/politics/trumps-attack-workers-labor/

10:  Su J, West R, Stettner A.  Trump’s Department of Labor Continues Its Onslaught against Workers.  The Century Foundation.  July 22, 2025.  https://tcf.org/content/commentary/trumps-department-of-labor-continues-its-onslaught-against-workers/

 I truncated the references at this point.  Any Google search will show hundreds of references about how Trump has attacked and derided workers and degraded the work environment.  

Graphics Credit:

The background for the photo is a blueprint of railroad yards and the Chicago and Northwestern Railroad in my hometown.  If you look closely at the right lower corner you can see the turntable where locomotives were turned and directed into the roundhouse for repair.  This was posted by the Ashland Wisconsin Historical Society.  I still have vivid recollections of accompanying my father to this complex, the smell of diesel fuel, and the constant loud thrumming of the engines making everything else inaudible.