EDITOR’S NOTE: This essay is the second in a series about the plight of street people and how our system mishandles them.

The USA spends twice on healthcare what the next highest spender in the world does (with poor results). The healthcare industry is the largest employer in the USA. The USA incarcerates more people than the rest of the civilized world combined. Americans have more lawyers than the rest of the world combined, who bring with them the most legal risk (which sustains more lawyers). These gears work together, and Evangeline’s case is under the sum line of how they all factor into her pitiless, ineffectual, exorbitantly expensive outcome.

It’s expensive, not to mention useless, to endlessly jail her, and no interested voice has the power to say stop. It’s very expensive, not to mention inefficient, to hospitalize her when she needs food and shelter, and no interested voice has the power to say stop.

Evangeline would have some form of safety net anywhere in the world. No nation under any government fails to recognize that some people are too mentally ill to function. There is no theoretical libertarian paradise where people are so happily free that they are cured of mental illness (that mistake comes from the Scientologists).

It is trite to say, but the players (the jailers, the lawyers, the hospital-testers) in any status quo are players because they get what suits them. All-of-the-above get their bite at Evangeline. Yes, it’s the taxpayers who eat the waste, but she is the one who lives in a city with such a costly social safety net, which is forbidden her.

Here is a “navigator” organization that helps people through the bureaucratic maze/flow chart and into the shelter system. Imagine a person like Evangeline, who can barely keep the same thought in her head for five minutes straight, having her future depend on navigating her way through the maze (left for another post are the implications of building a system where failure to correctly fill out paperwork brings such consequences). So, Evangeline outmaneuvers our system and creates her own. Contrast using the navigator site with the ease of just asking a passerby to use their cell phone to call 911 for chest pain. It goes to the joke “I may be crazy, but I ain’t stupid.”

A small part of me admires her for giving the flowchart writing, maze-making bureaucrat her fat, middle finger. I never asked her (maybe next time I will) if she thinks any of this going to the ER is wrong in any way (I’ve had so much experience with various forms of this problem, and never have gotten a good answer). I bet she’ll say (or she should say): “it’s your system, I’m a powerless mote in it (Ok, she’d never use the word ‘mote’)”; “you play your part in it, I’ll play mine;” “a girl’s got to do what she has to do to survive;” “high civic consciousness is too much to ask of someone in respiratory failure, left out in the snow.” All of these quotes (except the last) are paraphrases of Russian refugees of the crazier Soviet system I talked to (back when I worked in Brighton Beach). Few people, crazy or sane, are defined, top-to-bottom ethicists. Libertarians would say it’s just us. How many is that? One year I went to a convention of the New York State branch of the Libertarian party that was held in the party room of a diner. Evangeline was not there.

So, the system grinds its machine on without change because it suits the status quo players that the jails and the emergency rooms are the only parts of our system with the adaptivity to take in someone without proper ID, stoned, drunk, ranting, agitated, deluded, etc (or smoking like a chimney). To get in a shelter, you can’t have any of these complications. But you can always go to jail, you can always go to the ER. It’s an open-ended, magically unlimited, system for incarceration and liability (which makes for an open checkbook for non-players). The result is the systems’ Zeus-like caprice. For the same behavior, if the police get Evangeline it’s the bad place, and if we medical people get her, it’s the good. It’s not just Evangeline. Zeus’s caprice has prevailed in the management of mental illness since we closed down the institutions (to be discussed in the next part of Evangeline’s series).

The status quo did not grow this way overnight, or naturally. It was lobbied for by the players over the last half century. The players being the state, the lawyers (a congressman is 68 times more likely than an average American to have practiced law), and the largest portion of the US economy. It’s the product of interested solutions that create these outcomes the way rivers are channeled by dams and canals.

Evangeline can be a log jam in that system, but to who? Not to the players who have the power to address the system’s shortcomings. She’d jam the system if you were sick and needed a clinician, or a clinician who needed a patience-battery recharge, or an individual writing their tax return. She’s a jam to most everyone, except she’s not a log jam for a lawyer who needs a new Porsche. To that player, she is an opportunity the same way meat at half price is to a grocer. A Nobel Prize in economics]7 was awarded proving government approaches regulation in the same entrepreneurial way. She’s nothing of a jam to the people who actually wrote the regulations regarding smoking, or how a patient’s mood must be stable to qualify for housing.

What happened when we tried to fix our healthcare system with Obamacare? The canal diggers and dam-makers, the holders, makers and molders of the status quo perpetuated the status quo. Barring a disrupter, the same players will guide our next attempt at reform. How will the same dams and canals change if we just send yet more water through them?

In breaking down all of the ample blame there is to go around, it always fascinates me how often most people, even most clinicians, blame Evangeline, a crazy lady fighting for her life, for using to her advantage the system, which seems equally crazy. We can try to blame the status quo, if you can “blame” an evolution. This does not satisfy either, because no part of the system made the problem, so no part can change it, and no part is responsible, thereby making everyone blameless even if the outcome is a highly blame-worthy gerbil wheel. Everyone is responsible for paying, but no interested individual is powered to say “no, i’s too much, and look at the bad outcome” (Whatayagonnado? Vote for Trump?).

What answers to Evangeline do libertarians offer?

First, she is a case study in the law of unintended consequences. Zero tolerance to smoking sounds nice, but in just her case, we might have spent a million unanticipated dollars on that fleeting bonbon of “nice.” Anytime you hear “zero tolerance” think “zero wisdom,” which must mean unlimited expense.

Second, she’s a prime example of how the agility of a charity might answer. Just let her be cared for, without trying to socially engineer her.

Third, she cannot remake her future, and become productive, even if her mental illness is managed, because of her criminal record. Jailing people should be a tool of last resort, yet we use it as a first. Take her case, and multiply it by hundreds of thousands more. None of these people will ever be productive contributors to our society because we have decided to jail them, and stunt their futures. There is a town in Belgium that has, for centuries, gently cared for the mentally ill in an empathetic way, successfully. A person looking to fix our mess, who is not driven by a status quo concern, might ask them for some pointers.

Fourth, there are alternatives, there are always alternatives, but leaving open a solution space to “see what happens” is the very opposite of what a state, or a bureaucracy does. They rarely use the trial-and-error approach that is the scientific method, which is the only way to truly find correct risk-benefit relationships. I’d guess most clinicians would say that in weighing the risks and benefits, Evangeline’s smoking is less of a menace to her than respiratory failure out in the snow. Ah, but the bureaucrat can say no. Just think about that: a clinician, at a state-of-the-art institution, in the medical Mecca that is New York City, can be told “no” by the very same institution that built a system crazier than its craziest patients.

Fifth, wealthy systems create options just through being wealthy: who is developing more anti-psychotic medications, Norway or North Korea?

Sixth, Libertarians are the only political system to truly embrace evolution. Not guided evolution, with the parameter of success the ability to bribe the state for rents. Uncurated revolution, subject only to the strictures of self-ownership and non-violence.

Eugene Darden Nicholas

About Eugene Darden Nicholas

Eugene Darden (Ed) Nicholas is from Flushing Queens, where he grew up sheltered from the hard world, learning the true things after graduating college and becoming a paramedic in Harlem. School continues to inform and entertain in all its true, Shakespearean glory. It's a lot of fun, really. In that career, dozens of people walk the earth now who would not be otherwise. (The number depends on how literally or figuratively you choose to add). He added a beloved wife to his little family, which is healthy. He is also well blessed in friends and colleagues.


Like this post?