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Dispatches from a Life-Long Government Employee and Conservative
One of the common themes on the right is that the government cannot do anything right, that government programs are wasteful and that they always provide poor services. There are many examples to point at, such as the VA, Public Schools, and the like. The general attitude is that government workers are lazy, have poor attitudes, and are generally no good.
I would like offer a counter to the conservative write off of all government workers and programs. This is not to say there are not many things that need to be trimmed. It is to say that blanket statements might not be accurate. Let me start with what my organization does.
I work for the government, in a taxed-based organization. I have been there my whole career of a quarter century. Six weeks out of college, I was working as a House Parent, helping men with significant developmental disabilities (mental retardation for the non-politically correct). That was my start. Now, I am the CEO.
Our Agency is one of 26 in the State of Georgia that provides safety net coverage for individuals with Behavioral Health challenges and Developmental Disabilities. We have a broad spectrum of services, ranging from outpatient therapy and psychiatric services, to 24 acute inpatient beds for mental health crisis and detox from substances. We have case managers who serve clients in the community, a supportive living program to help individuals live in the community, group homes, residential treatment programs, and we are the contractor for mental health services in the Cobb Adult Detention Center. That is “jail”, and by the way, we serve 600 people a month there, with our staff of 8, including an MD and Advanced Practice Nurse (APRN). That makes the Cobb Adult Detention Center the largest mental health facility in Cobb County, just like the jail in your community.
We are supported through State Funding, Medicaid, and a touch of Medicare. The population we serve, only around 15 percent of our population have Medicaid, 5 percent Medicare, and the remaining 80 percent are uninsured. Less than 1% have some other insurance. Of course, they cannot pay out of pocket, so the state lets us treat them on a sliding fee scale, that goes all the way up to 100 percent.
Despite what most people think about government salaries, we are underfunded. We do not have access to the State of Georgia’s pension program (and even if we did, 30 years for 30 percent of your top two years of salary is nothing to write home about; Georgia started reducing its pension plans in 1982). There is a national nursing shortage, and I cannot hire any nurses at the rates I can afford to pay, much less attract the top talent. $9/hour is not a lot of money to pay for a Client Support Worker to help care for someone with a developmental disability who cannot attend to their own Adult Daily Living Skills (this means they need help wiping their bottoms). I have seen my staff go years without COLA raises, while teachers, who work nine months of the year and get raises because they are more visible and popular.
Now, most of the staff who do work for me are dedicated, caring people, who have a mission in their hearts, God bless them. They are dedicated to making the lives of the least of the least, as good as they can be. This is hard work, and it can easily burn anyone out. If you stop caring it is time to go, but caring can be hard work some days.
So, when I see attacks on all government workers, I admit, I take it personally. These are attacks on the hard-working employees, some of whom make less than the people working at McDonalds, some of whom get hit by clients, some of whom go out into bug infested homes, or under bridges to serve our clients. These are attacks on the very people whom I am charged to serve. Our clients who nobody wants to help. Or clients who nobody wants living next to them. Without the meager laws on the books against bias, my residential clients would have no place to live.
I have seen a pastor for a church stand up and rail against land we bought from a previous mental health hospital to serve teenagers with drugs problems. I have seen our organization sued, because the city condemned that same land to block our use of it and the banks now wanted their money back. I have seen city inspectors have to be reminded that state and federal law allowed us to ignore zoning and place our clients into housing so they can live in the community. I have seen people in recovery, unable to rent an apartment because of a decade-old felony. I have heard otherwise compassionate people condemn the mentally ill, as lesser people. It is not unusual for me to hear fellow conservatives treat addiction as nothing more than an issue of willpower, or a failing of moral character.
Why do I mention all that? What my government agency does, the private sector has no will to provide. There is no money to be made on treating chronic conditions of individuals with no money, much less providing things like case management and supportive employment and supportive housing. Further, there is not enough private money applied to these areas. Mental illness and, to an even greater degree, substance addiction are still seen as moral failings (see above). Our culture in no way is ready to support the people we serve. With the utter destruction of the family, there is no one to support them. And this is not just single mom’s, but intact families who can no longer manger their loved one, who have been burned too often, or make it the problem of the State. our culture shuns these modern-day untouchables. They have no voice, no lobby, no money. They are the least of the least.
There are some things the government must do. Even if charity could, in theory, meet this need, the sad fact is that it shows no interest and likely wouldn’t until after several of our clients are in the morgue. Today, people are fine to donate for kids with cancer, but adult men who cannot control their drinking? Forget it. Remember, the pastor of a church did not want a treatment facility near their place of worship. If government organizations like mine do not exist, America will treat an increasing number in the justice system, which is an expensive way to treat them, money wise. It is even more expensive in the damage done to their lives.
Published in Politics
I’d prefer state by state funding to national programs. But given that, I’d probably still think “the grass is greener on the other side” and more localization was possible.
Certainly, larger organizations are capable of greater financial investments… which is as true of larger families and religious communities as it is of government agencies. Our current government programs seem to have reached a point at which our good wishes have stretched beyond our resources… even to the point of ignoring financial limits entirely. Public safety net expenditures grow even as the money to pay for them declines along with changes in demography and a shrinking workforce.
Not sure how well I addressed your comment, but I’m going to duck out of this conversation for a while. Too many big questions in a day makes my mind turn to mush!
The Feds take too much money at present to let the states do it. State taxes need to be higher and Federal ones lower. However, with the Feds out of it, some states would need to support others. I am not sure the best way to work that.
Thanks guys.
Well, one more thing. I just thought of a way to explain the “moral” challenge of addiction.
It’s similar to the role of personal initiative in physical recovery from surgery or physical training. There are good patients and bad patients.
It’s not like treating a virus or other disease because it’s not a simple matter of taking medication or balancing chemicals. The patient needs a strong will to push through pain and exhaustion. A lot of effort is needed and there’s frequent temptation to give up.
The role of helpers is not just to treat a problem but to motivate the patient. Cooperation is necessary from the patient, as well as factors beyond anyone’s control (and so we pray).
So to resist identification of addiction as a “disease” (though “physical disorder” is accurate enough) is not to dismiss addiction as a purely moral failing. Rather, it is to recognize the will as vital to correction.
And though addiction ends in a sort of slavery with the brain growing to “need” the unhealthy input, it begins by consent. That might speak more to prevention than recovery. Shame can be oppressive, but it is not wholly unhealthy.
Regarding government employees: I have worked in a University hospital and at the VA across the street. So I can compare and contrast. Any large organization has employees that can be divided into the cream at the top, the “average” middle people and the need-to-be-fired dregs at the bottom that can’t be easily fired due to rules and regs. Government bureaucracies attract few of the cream, less of the middle and a whole lot of the dregs. That drags the whole organization down.
Re: #91: Aaron, I was thinking in terms of assessment of need very locally, filling need-administering locally/regionally; funding regionally/statewide…as locally as possible.
Yeah, the reaction government always bad is way too reflexive. While big government bureaucracies tends to be inefficient, some things require government management. Big business can be just as bureaucratic, and in many cases there is no real competition, so big business bureaucracy can be just as non-responsive to consumer needs. I admire your work Bryan. Thanks for sharing.
Most chronic illnesses need much of what you point out we need for addiction.
People don’t choose to become ill. Nobody catches addiction like he catches flu.
Moral questions can wait, ’til something is stabilized; Christ let that ‘woman with a reputation’ touch Him…Let’s be careful of an uniquely conservative malady…
Eh… what do we call illness, then, that we suspect could have been avoided by a different choice of lifestyle?
Mind you, we’re not always right in our suspicions – we know lifestyle choices are a risk factor for stuff like diabetes and heart disease, but nobody but God knows whether those specific individuals who succumbed could have avoided the outcome by just being “X amount more disciplined” in their health-habits, or whether their being “punished” by illness is what they “deserve”.
Why do some alcoholics die of old age before they die of liver failure, while others are sentenced to death by comparatively minor overindulgence?
Still, a person with a cat allergy who chooses to have cats is choosing to make himself ill. People catch STDs. People smoke, then die of lung conditions blamed on smoking. Patients let themselves succumb to iatrogenic conditions when they could have refused… People can never be certain, but often have good reason to believe, that they’ve brought “lifestyle diseases” down upon themselves. Is there no choice involved?
Choice being involved doesn’t mean awful chance is not involved. The moral agony is often that it takes both: another choice may have avoided it, better luck may have avoided it, but all you know is you didn’t avoid it, and here you are.
Most chronic illnesses are not like the flu. Oh sure, there are horrible, uncurable diseases you can pick up from bug bites, however they are not what most people mean. Most people mean high blood pressure, heart disease, diabeties, etc. These are all things that let’s face it, are better if people manage their behavior better.
I have seen MRI’s and PET scans of non-alcoholic teenaged brains that look the same as alcoholic brains. They are just waiting for that first taste. Nobody chooses to become an addict. Nobody. Some people can drink and binge and be fine. 1 in 10, more or less, cannot. Their brains are wired differently from the get go, as best as we can tell. Now, if you smoke a substance that is a stimulant, it will make you an addict. The rates are 100%. Snort cocaine, and you have about a 30% addiction rate. Such is life.
If we take the approach to addiction is still to make it the fault of the addict. We might take the same point of view with hypertension? Maybe the person is a bit overweight, so did they “choose” their problem? Maybe if they did not eat so much, their heart would be better off? Do we ignore their back pain and just say “lose weight?”.
I like to ask people think about their BMI. Mine, is 27, which is Overweight (25–29.9). I drive this point home with anyone who wants to see addiction as just a choice. Most Americans have a complex relationship with food. Drugs hit the dopamine system much more powerfully.
People have lots of behaviors that are not good for their bodies or minds. If what we do is castigate them, they will not get help. It is odd that as a culture that sees a relapse of cancer as part of the illness, but a relapse on drugs as a failure. What we know is that the addicted brain’s amygdala will light up in response to drug cues, even after years of sobriety. It is amazing. With Mental Illness and Substance Abuse, as a culture, we demand better behavior control from people who’s organ for behavior control is impaired. It is, to some degree, demanding someone with MS dance to strengthen their muscles, and if they don’t, they are not trying hard enough.
This reinforces my point that private money will never meet the need to treat addiction.
When did I propose rejection of addicts? When did I condemn them? Christ offered forgiveness but demanded sinners repent and seek the good. Likewise, psychologists can’t expect reform without first securing regret and want of self-improvement.
Every former addict I know changed because he hated what he had become and found someone to become better for. The cure begins with shame and ends in pursuit of love. On the other hand, the continued addicts I know project their failures onto others and waste away in self-pity.
We do addicts no favors by denying that their challenges are first and foremost challenges of the will. That is not a judgment upon them.
And compassion demands we suffer with the person here. Passion meant to suffer. The Passion of The Christ. Compassion means to suffer with. I cannot do that, if I sit in judgement as well. Maybe the Lord can, but I cannot. I find judgment of others drives forth mercy and grace from my heart. That does not mean I give up judgment of reality. I will not give a lot of cash to someone struggling with addiction. I will also remember they are a human being in great pain.
And do doctors not give such advise? Do they not emphasize that losing weight, eating better, and exercising are at least as important as medication to securing heart health?
That’s all I’m getting at. Y’all keep trying to make this about blame. I’m talking about responsibility in the process of recovery. Recovery isn’t helped by tip-toeing around the need for lifestyle changes.
Aaron, the line between ‘encouraging’ the taking of responsibility and assigning blame is a fine one…Vigilance is paramount. We need to model both responsibility and humility.
I don’t disagree with any of that. In fact, I agreed when I said:
You replied with:
This implies, Aaron, that you do not see addiction like other illnesses, that it is different. It is shown in your response here:
You are comparing addiction to a sin.
I hope this helps see how your statements come across.
One thing it seems Bryan is getting at is, of course physicians do this, but they don’t tell their patients “because it’s likely you may have been able to avoid this, it’s not a disease”.
One reason I’ve avoided party drugs and large amounts of alcohol is because I have evidence that I might be uniquely impaired by overindulgence. There are… things not right… with me and my family members that probably make self-medication extra-tempting as well as extra-stupid. Should those not-right things be called a disease? Some of them could be. But whether that label “disease” is right or not, many of the behavioral consequences are the same as preventing or managing a chronic disease one’s family seems especially susceptible to.
Responsibility in the process of recovery is necessary for disease and injury, too. And whatever we think, yeah, the social meaning of, “you’re not sick, just ____” is often blame, not just encouraging responsibility (for as you yourself have pointed out, a lot of helping people recover from what are uncontroversially diseases is encouraging them to take responsibility for whatever their problem is for the rest of their lives).
Some people probably do find it easier to manage recovery by telling themselves “it’s not a disease”. Others may find owning up to what they have to do to stay “well” easier if they can tell themselves “it’s a disease, and now I have to learn to manage it”. I’m not an expert, and it strikes me that either strategy could work, meaning labeling something a “disease” need not be about abdicating responsibility, which seems to be your worry.
My adult daughter is an alcoholic and one of my two adult sons is a drug addict. I agree that their recovery is a matter of the will, but I believe there is something in their physical make-up that makes it harder for them than it is for me to use alcohol moderately. One of those elements is bipolar disorder. It means my daughter’s brain is working differently than mine and making it much harder for her to live without alcohol than it is for me.
I agree that her 2+ years of sobriety are due to her will (she still attends at least 5 AA meetings each week), but I cannot know how hard it is for her to initiate and continue in that sobriety.
When people say that alcoholism is a disease, I take it to mean that alcoholics are dealing with physical conditions that the rest of us don’t have to deal with.
Two of my closest friends were meth addicts. There was some kind of horrible depression that drove them to that drug. The depression surely wasn’t a choice.
Basically yes.
And undesirable or dysfunctional physical conditions at that. After all, Olympic athletes must be extremely dedicated to maintaining themselves in an unusual physical condition, too, but their exceptional conditions are considered exceptionally good, not exceptionally bad :-)
I also was a Gov employee (26 years, now retired). I take exception to your opening. We don’t say Gov can’t do ANYTHING right. We say, over and over, that they can’t do EVERYTHING right. My apologies if this was covered already in the comments, I did not read them all, but I could tell you HORROR stories about my own little experience in a safety related field in the United States Government. I am talking about unsafe people that could NOT be fired. Those people making the good workers work twice as hard watching them while doing their own job. Then on a less dangerous thread I could tell you of the massive abuse of power that my own little part of government foisted upon the tax payers, hiring friends who came in, collected a salary (while collecting retirement), then spent the day reading the paper with his feet on his desk. I am not a total anti-gov type, but I am of the group that cannot understand the total hands up (don’t shoot) feeling that gov should just get as much money as they can con the public out of with no oversight whatsoever.
It sounds like a rough job. It does not really match my experience with what I do. However, there are many conservatives, (and people have admitted this in the comments), who own up to the idea that there is not anything government can do right. I am guilty of thinking that sometimes too.
I’m not so sure. People catch the flu by exposure to infectious fluids. Numerous mechanisms impact the chance of catching it, and how severely, from a strong immune system or artificial prophylactics on one end to genetic predisposition or compromised immune system on the other end. No exposure, no flu. Any exposure, >0% chance of a flu, with a spectrum of possible effects.
So it is with addictive substances. No exposure, no addiction. Any exposure, non-zero chance of addiction and a spectrum of dependency reactions. All impacted by genetics, environment, and adaptive behaviors. For some drugs with some people, the only volition involved is the very first sample.
The only thing I expect from an addict is an admission they have a problem. All else might just be too much for them. And for some, it’s not all that different from the stoic avoidance of doctors and hospitals.
Even this can be really hard.
Oh, yes. Which is why it generally requires some form of “rock bottom” event to prompt it. Unfortunately, “rock bottom” is personal, and might be “dead in a gutter” for some. But without the admission, all of the societal tools are coercive. I’ve just enough libertarian in me to want self-destructive behavior to be destructive. Only if the addict’s behavior extends to risking others would I bring on the coercion. And this approach, with the public misery of such a case, serves to remind society to teach the consequences of addictive substances, whether they’re legal or not.
I have different expectations for those unable to (reliably) reason about their situation, as coercion is inevitable. The dismantling of State institutions for the mentally handicapped, driven both by budget cutters on the right and bleeding hearts on the left, ought to be reversed.
Amen
Drugs and Men you can’t forget men.
@bryangstephens You may find something here–certainly a good laugh somewhere in it–that may be of use to you in your CEO role. Do read it to the end, or skim it, then read the ending. :)