I've been following the threads on Ronald Reagan's legacy, and there's one Reagan quote that I keep noticing. It comes from Reagan's interview with Good Morning America on January 31, 1984: "What we have found in this country, and maybe we're more aware of it now, is one problem that we've had, even in the best of times, and that is the people who are sleeping on the grates, the homeless who are homeless, you might say, by choice." This comes off as a callous remark, but I can't really call it evil. It seems to me that it reflects a fundamental misunderstanding of the nature of mental illness.
This misunderstanding is not confined to those on the hard right. In a November 1999 interview with Playboy magazine, then Minnesota governor Jesse Ventura infamously said that he didn't read books by Ernest Hemingway, because the author had committed suicide. "I have seen too many people fight for their lives. I have no respect for anyone who would kill himself. If you're a feeble, weak-minded person to begin with, I don't have time for you."
Liberals aren't perfect either. They're just more subtle in their prejudices.
But getting back to Reagan and his disastrous policies. Let's be honest here. Mental health policy in this country has been a disaster for a long time, and the Democrats have been just as bad as the Republicans. It started with the Kennedy administration and was exacerbated by the creation of Medicaid in 1965 which shifted payment responsibility from the States to the Federal Government. (There had been an earlier shift from counties to states.) Medicaid specifically forbade payments to state mental hospitals. This encouraged deinstitutionalizatin without adequate community support, because many of the community mental health centers created by the Kennedy initiatives did not want to deal with the severely mentally ill.
There was a very interesting article about an upcoming California ballot initiative which goes into some of the history in that state. This is relevant, because many Californians still blame Reagan's cuts from the 60's for the state's current woes. Those let go in the 70's were severely ill, and no community system existed to support them.
For an interesting perspective on some of this history, you can watch a grand rounds lecture delivered at UCLA's Neuropsychiatric Institute on January 30, 2001 called "Mental Health Policy in Modern America.".
Note: You'll have to scroll down to get to the proper link.
So, Reagan's policies weren't exactly enlightened either as governor or president, but I'd bet that you'd find a lot of Democratic governors engaged in cost shifting when it looked like the Federal government would pick up the tab.
Likewise Democratic Congresses engaged in the same practice when they passed unfunded mandates. There's a reason that No Child Left Behind is so deeply ironic. It's yet one more reason why we need to come up with a comprehensive solution to universal health coverage.
