Here is my take on observations over 60+ years.
Like it or not, the plights and misfortunes of others do effect us all as a society. Yes, some people do bring upon themselves the problems they endure, but ultimately we all, directly or indirectly, pay a price. Many, however, are born into circumstances that don’t allow them the opportunities to learn how to make the life choices that will provide benefits well into old age.
It is a start-at-the-bottom solution.
If everyone receives sex education, has access to birth control, and is educated in the responsibilities of sexual activity and parenthood, there would be fewer abortions and fewer children born to those who cannot afford them, have no idea how to care for them, or who have mental and emotional issues that prohibit them from being responsible parents. Not to mention there would be fewer Medicaid costs for such births and all the subsequent medical expenses for those children.
If students receive decent, consistent mental and physical health education starting in elementary school or earlier, they would be better able to deal with the challenges of life — either their lives as children in a dysfunctional, possibly abusive, family or their lives as adults. If these children receive regular physical examinations and mental health evaluations, there would be less of a drain on Medicaid in the future to deal with drug abuse, sexual diseases, pregnancies, unhealthy diets, accidents due to reckless behavior, and poor life choices, in general.
We, society as a whole, pay the price no matter what. Wouldn’t it be better to pay for the care, education and services at a young age so those children mature to be responsible, productive adults adding value back into our communities?
Leaving the bulk of societal responsibilities to states or local governments is inefficient and grossly prejudicial. Rural areas, small towns, and the poorer states simply cannot provide the necessary services and education needed for a populace to be physically and mentally healthy. Even now, with whatever little federal help is available, those areas still cannot meet the need. Without federal help they would provide no services at all. I live in a city that is surrounded by poor, rural areas and towns. My city has an overabundance of medical services — including, two major hospitals and countless smaller health facilities. The rural areas are terribly short on doctors, dentists, nurses, medical clinics, psychologists, and mental health facilities. Residents of those areas either travel twenty, thirty or more miles to my city or they go without. There is no mass transit here. The elderly and those who are physically and mentally handicapped and who cannot drive and have no family members to provide transportation either have to pay someone to provide transportation, a cost most cannot afford, or they go without the services they need.
Time and again it has been proven that providing health care for people is cheaper and more effective than paying for them to get services at emergency rooms — services which are then paid for through taxes. Had those people received proper care early on their illnesses would not become serious enough to require trips to the emergency room, and they would not be causing backlogs in the ER that slow down the immediate care needed for true emergencies, such as unexpected occurrences and accidents that cannot be predicted or planned for.
One of the biggest arguments against local or state responsibility for all, or most social needs, is that our population is mobile. Rarely do people spend their lives in one community. We move, all the time. How confusing and inefficient would it be for your health care and other services to change every time you moved? Perhaps the idea that “we take care of our own” worked back in pioneer days, but no longer. Even our smaller communities experience frequent changes in population. And, that too, makes the “take care of your neighbor” idea impractical. Because we are so mobile, we often don’t even know our neighbors, much less feel that we can ask them for help or feel the responsibility to provide help to a neighbor we don’t know. And, many people don’t even feel safe asking for help because they don’t know or are not well acquainted with their neighbors. With social media now, you could find your personal problems plastered all over Facebook by the neighbor to whom you turned for help. Remember, licensed personnel and facilities must abide by privacy laws that mean nothing to an indiscreet neighbor.
I came from an educated, middle-class family. Both of my parents were raised in or near large cities. My father moved us to the country when I was in elementary school. I was raised in a very rural area. Most in our community lived at poverty level. Every day I noticed the differences between myself and my family and other kids and their families. I saw the differences in our diets and health, in our ability to evaluate and tackle problems, in our ability to understand complex matters, in our appreciation of education, in our opportunities for the future. There was little public aid back then, if any. People who were struggling, down on their luck, sick, injured, or just overwhelmed with life had to depend on family, neighbors and churches. But, their families, neighbors, and churches were also poor. Help was limited. One cannot give what one does not have. People died because they did not receive the assistance they needed. I look at my life now and the lives of people my age who stayed in that area, and I see the negative effects of their childhoods etched on their faces. Most of their lives have been needlessly difficult. Just a little preventative education and mental/health care would have led to them being healthier, happier, and more productive people.
I am not saying that all the problems lie in the rural areas. Certainly there are large areas in cities that are poorer and more disadvantaged than the rural areas. And, in cities the problems are compounded by the inhumanity we often see in crowded populations. Some metropolitan areas are steeped in crime, domestic and sexual abuse, incarceration, and other serious problems. These poor metropolitan communities also struggle to provide the services necessary for a healthy populace.
I work with a woman whose teenaged son was diagnosed with serious mental health problems after committing a crime. She and her husband were Republicans, always against tax increases, followed the “pull yourself up by your bootstraps” philosophy — until they couldn’t. Even with excellent health insurance provided by their employers, they struggled to find the help necessary for their son. Our state is not known for its social services and certainly known less for its mental health services. Even in a city overflowing with doctors and medical facilities, the parents discovered mental health clinics were few and those that exist have back-logs of cases. Even getting appointments with private mental health counselors was difficult. These parents are educated and have well-paying jobs that give them access to the court and health systems that others don’t have. Even so, they were overwhelmed with the tangle of services, most of which were inadequate. Trying to coordinate different services from the state, the federal government, the county, the city and their private practitioners was confounding, time-consuming, expensive, and exhausting. Fortunately, they had vacation time to use for all the running around and coordinating that was necessary, but if they didn’t have jobs with good benefits, they could not have obtained what little help they did get for their son. Mental health care is a perfect example of how unorganized and uncentralized services fail. Most mental health care comes from the state level. If your state, like mine, doesn’t care, you don’t have many options if you can’t afford private care. My friend and her husband were good parents, provided excellent care for their children and still their son was hit with an unexpected, catastrophic illness. I cannot imagine what their situation would have been like if they were poor, uneducated, disadvantaged, unemployed, or had health issues of their own. My friend has a distant family member in another state with mental illness. That state has excellent mental health facilities and services. The experience of that person’s family was and is completely different. Whereas my friend has to hobble together services from a multitude of places just to receive basic help for her son, her family in the other state was able to get all the help they needed from one agency and they paid very little out of pocket. My friend’s son is now an adult and still struggles with his illness. He has to live in a shoddy apartment in a crime-ridden area because those are the only apartments that will rent to him. Her relative in the other state resides in a comfortable facility that not only provides mental and physical health care, but also education and employment opportunities. He lives a productive life and rarely has recurrences of mental illness episodes. If mental health services were centralized and equal in all areas of our country, my friend’s son would have the same quality of life and the same opportunities to give back to society as his relative does. Both of these young men are, in reality, financial drains on society, but one receives excellent care and is able to work, pay taxes and give back, and the other, not so much. And, both, had they not received any help or less help, would be incarcerated, and incarceration is a greater financial drain. So, which is better — sufficient centralized help paid for by taxes that allows someone with mental illness to stabilize and be productive or incarceration, also paid for by taxes, that will certainly make the person’s mental illness worse and lead to further problems in the future? If we invest in health and mental services, fewer people will be in jail, or on the streets committing crimes, or homeless.
Lastly, I want to address this statement of yours, Larry:
“I think most people have a measure of compassion, but empathy must be nurtured on a personal level and it must not be coerced or mandated.”
That statement is one of the best arguments for federal involvement. Thank you for providing it, Larry.
Many people do not have empathy and never will. Perhaps, their DNA lacks an empathy gene, if that is possible, perhaps their parents had no empathy so could not teach it to their children, perhaps their life experiences erased whatever empathy they had as children. I know many people who would proclaim they are good, decent citizens, but they have no empathy for others outside their immediate families. Even those who are well-off financially, have an “us against them” attitude. I have a sister like that. She is a fabulous mother and grandmother and wife, but she won’t open her purse-strings for anyone else. She has no empathy, and I don’t know why, but that’s the way she is. Because so many individuals lack empathy, it is impractical to think that members of a community will willingly reach out to others in need, especially if it means giving up their money. They won’t do it because they have no empathy. That is why they must contribute to the general upkeep and well-being of our society through taxes. Expecting your community to help out when needed might work if everyone in the community contributed. They won’t — they never have. Look at any church or public service club, the members usually represent a very tiny portion of the community and within those organizations, a very few members do most of the work or provide most of the support. Is that fair? The same people do most of the work and donate most of the money over and over again. I have seen it in every organization I’ve ever joined. Many people will not do their fair share, even though they can.
