Powerful Dilemma
The current issue of The New Yorker includes the latest of Malcolm Gladwell's insightful essays. This one, entitled "Million-Dollar Murray" explores the underlying dynamics of three disparate, but structurally-similar, problems: homelessness, police brutality and automobile emissions. What do these three areas have in common? Gladwell contends that rather than being distributed in a statistically normal fashion (hence, yielding a bell-shaped curve), these three phenomena show a "power-law" distribution (and yield a hockey-stick shaped curve).
In by-now-familiar fashion, Gladwell tells the story of Murray, a homeless man from Reno. The "million-dollar" part of the story's title refers to the cost of medical services provided to this affable chonic alcoholic who repeatedly collapsed on Reno's streets for 15 years, often ending up in the one of the city's two downtown emergency rooms for detox and medical care. In 1990, homelessness investigator Dennis Culhane found that a relatively small percentage (fewer than 10% and closer to 1%) of Philadelphia's homeless population, like Murray, accounted for an extraordinary portion of the city's indigent care expenditures.
Gladwell goes on to chronicle the Los Angeles Police Department's findings that allegations of excessive force against 44 police officers accounted for a similarly skewed percentage of all reported infractions. And, data gathered in Denver suggests that identifying and fixing 25,000 seriously polluting vehicles, rather than systematically testing more than 1 million, would reduce the city's emissions by 35 to 40 percent.
Well, if we can pinpoint the sources of these problems so clearly, why don't we fix them? Ah, there's the dilemma. Fixing them means taking action that violates our fundamental American beliefs. Here's a quote from the piece:
Power-law resolutions have little appeal to the right, because they involve special treatment for people who do not deserve special treatment; and they have little appeal to the lift, because their emphasis on efficiency over fairness suggests the cold number-crunching of Chicago-school cost-benefit analysis.
I have plenty of personal experience in the issues that Gladwell raises. Throughout the 1970s and mid-80s I worked at Allegheny East MH/MR, a community mental health center serving Pittsburgh's eastern suburbs. The center's first Executive Director was Ray Webb, a human service visionary who never stopped thinking about ways to provide help to needy people. There were no sacred cows for Ray. If there were better ways to deliver more services with the meager budgets he was able to get each year, he'd try them. As a result of the kind of analyses Gladwell highlights in his article, we found that a relatively few chronically mentally ill individuals accounted for a huge portion of our inpatient budget every year. We called them the "Fortune 100" because they were the 100 people who cost us a fortune every year. If we could keep those people out of the hospital, we could provide more services for others in need in our community.
So, we undertook an intensive "case management" approach to monitoring these 100 people, making sure they were in residential programs, taking their medication, attending day programs. Very special treatment. And, it worked...for a while.
Then, the Reagan Revolution began, and funding for community mental health was slashed. As Gladwell puts it in his article, we decided that we'd rather "manage" the problem than fix it. When the community mental health system collapsed, the homeless problem exploded. The burden was shifted from the relatively inexpensive outpatient public mental health system to the much more expensive law enforcement and hospital-based healthcare systems, where we continue to "manage" the problem to this day.
Like Ronald Reagan said in his first inaugural address, "government is not the solution to the problem, government is the problem." In this case, truer words were never spoken.
Read the article. It's very thought provoking.
Spot on. Genuine. Well put.
Thank you.
Posted by: Reverend Charlene WT Mann (ULC) | February 11, 2006 at 09:01 PM