April 3, 2025 • 28 mins
Jay Chaudry and Lisa get philosophical about care. We acknowledge the multi-faceted nature of care as a main feature of the human experience. Beyond narratives that place care firmly on one side or the other of various binary descriptions, care is woven in many ways throughout our lives. What does this have to do with public policy? How might we change our advocacy if we view care as an important, key part of our humanity?
Read Jay's full article, "Beyond False Binaries in Care
New perspectives on the most fundamental of human activities" here: https://open.substack.com/pub/favorablethrivingconditions/p/beyond-false-binaries-in-care?r=mras5&utm_campaign=post&utm_medium=web&showWelcomeOnShare=false
Jay Chaudhary has the unique experience of simultaneously creating policy for and executing a successful state behavioral health strategy. During his five year tenure as Director of the Indiana Division of Mental Health and Addiction and Chair of the Indiana Behavioral Health Commission, Jay led a significant overhaul of Indiana’s behavioral health system, resulting in a significant jump in the state’s overall mental health rankings.
Jay has recently begun a new journey as Senior Fellow for Mental Health and Wellness at the Sagamore Institute, an Indianapolis, Indiana based research institution. Jay’s work at Sagamore focuses on continued advocacy for equitable behavioral health care access and exploration of strategies for improving overall community well-being.
Jay is an Aspen Institute Ascend Fellow and has received a number of accolades for his work, including being named a “20 Under 40” State Government Leader from the Council of State Governments and a ”Champion of Justice” by the Indiana Judges Association.
Become a supporter of this podcast: https://www.spreaker.com/podcast/love-doesn-t-pay-the-bills--5692861/support.
Read Jay's full article, "Beyond False Binaries in Care
New perspectives on the most fundamental of human activities" here: https://open.substack.com/pub/favorablethrivingconditions/p/beyond-false-binaries-in-care?r=mras5&utm_campaign=post&utm_medium=web&showWelcomeOnShare=false
Jay Chaudhary has the unique experience of simultaneously creating policy for and executing a successful state behavioral health strategy. During his five year tenure as Director of the Indiana Division of Mental Health and Addiction and Chair of the Indiana Behavioral Health Commission, Jay led a significant overhaul of Indiana’s behavioral health system, resulting in a significant jump in the state’s overall mental health rankings.
Jay has recently begun a new journey as Senior Fellow for Mental Health and Wellness at the Sagamore Institute, an Indianapolis, Indiana based research institution. Jay’s work at Sagamore focuses on continued advocacy for equitable behavioral health care access and exploration of strategies for improving overall community well-being.
Jay is an Aspen Institute Ascend Fellow and has received a number of accolades for his work, including being named a “20 Under 40” State Government Leader from the Council of State Governments and a ”Champion of Justice” by the Indiana Judges Association.
Become a supporter of this podcast: https://www.spreaker.com/podcast/love-doesn-t-pay-the-bills--5692861/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
[Music]
(00:11):
Welcome to Love Doesn't Pay the Bills.
I'm Lisa Chutey. I am a family caregiver.
My guest today is the senior fellow for Mental Health and Wellness at the Sagamore Institute,
where he focuses on continued advocacy for equitable-
Behavioral Health Care Access and Exploration of Strategies from Proving Overall Community Wellbeing.
(00:34):
He was the Director of the Indiana Division of Mental Health and Addiction
and Chair of the Indiana Behavioral Health Commission, where he led a significant
overhaul of Indiana's behavioral health system, resulting in a significant jump in the state's
overall mental health rankings, which is no small feat.
So thank you for that and welcome Jay Chaudhary.
(00:56):
I'm excited for this conversation. I saw an article that you wrote, which really touched me.
I did want to share it with the audience here.
And it's titled "Beyond False Binary's in Care."
And you start with describing a bit of your own parenting experience with your son
(01:19):
in particular moments you had. And would you describe that moment for us?
Sure. So now I have a 12-year-old and a 9-year-old of a son I'm talking about.
It was two at the time, so it's been almost a decade since this moment.
And we were talking before. I don't remember a lot of my children's early years.
(01:41):
I think that's a pretty common story, but this moment is just sort of burned into my brain.
So we had spent the whole day together and doing, what we were doing,
going around having some adventures. And my wife came home.
We were telling her about our day.
(02:04):
And he was recounting something that happened. And then he looked up at me and he just goes, right Daddy?
And the reason that's so profound is significant for me is it was the first time I really, really got the sense of this dynamic and reciprocal
and creative and alive relationship that I think a lot of people,
(02:33):
but since I come to associate with parenting, but I think before that stage and every parent has a different time and situation where this happens.
But before that stage, caring having is sort of like a series of tasks.
I mean, like so much joy and wonder, I think, also wrapped up in there.
But it is sort of like, okay, we got to get the nap and we got to change those diapers.
(02:55):
We got to make sure he's eating and got to make sure he's safe.
And let's celebrate these milestones when they occur, but the relationship aspect of it.
And this is something I've talked a lot with some of my male friends about his fathers.
I think this is something that this moment is really, really crucial and critical.
(03:16):
I think for a lot of fathers in particular, because we do have sort of a later start, right?
And I think it's just like from a purely physical standpoint of being caregivers of our children.
So, you know, it just was something I was reflecting on when I was thinking more about the concept of care.
(03:39):
Are there more personal experiences you'd like to share about any other family members or any other caregiving that you're connected to in a person?
My main caregiving experience is as a parent.
And so that's the lens to which I personally think of caregiving.
I have spent my entire career advocating for and working with caregivers of all stripes.
(04:07):
For example, I'm a lawyer by background.
I come myself a recovering lawyer in my early years.
I worked for in civil legal aid, which is the provision of pre-civil legal services to folks that can afford lawyers.
I had a lot of clients, probably more clients that were caregivers of non-children, frankly, than clients that weren't.
(04:30):
And helping them navigate the systems and seeing their experiences is something that I will never forget.
And I think really taught me a lot about how I wanted to approach the system if I ever got the chance to be in charge of any part of it.
I love that you're learning from the people that are most impacted and that's so important.
(04:51):
What do you mean in your article by false binaries?
What are some of the examples of the false binaries that we commonly apply to this kind of care work?
Yeah, and so I should mention that these reflections came during a seminar that I had the privilege of attending that was moderated by some pretty renowned and experts in the field and discussion of caregiving
(05:14):
and also attended by a lot of people who offered just incredible perspectives.
And so the article I wrote was a reaction to that seminar, so I want to make sure that I give credit to the high of mind for this part.
We talked a lot about how care is framed within these false binaries, both from the most granular level all the way up to policy.
(05:37):
And so we think of care as being sort of entirely altruistic and self-sacrificing or on the other end, we have the notion that care is a gift, that getting to care and a privilege you get to care for somebody else.
And there's elements of truth in both of those, but the truth is the experience of care is almost always something in between.
(05:59):
And so when you zoom out to a policy level, there's this, and you think about parenting, right?
There's this conversation about support for caregivers means daycare, right?
Or self-sacrificing daycare, which is really important.
A really important thing for parents who want to work outside of the home, but what about people that choose to stay?
(06:24):
That is something that we need to prioritize.
Right, which is a valid choice as well.
One of the moderators at that seminar you mentioned, Alyssa Strauss has been on this podcast, so love, I love that.
And she's all about expanding our view of care.
(06:45):
And I appreciate that you're taking that up and that we're here to continue that conversation.
I think that certain experiences that we have can be so varied all in one experience even.
And caregiving is one of those that, yes, yeah, it can be really, really difficult.
It can be a slog of tasks like you kind of talked about the early stages of having a new baby and it can be just this wonderful opportunity to grow as a human and to understand what we are all about as humans to form relationships and give meaning to life.
(07:26):
And all of those sorts of things so it can be a privilege, it can be an opportunity.
So, yes, all of that is true.
Are there other false binaries that you would want to specifically kind of point out that we tend to?
Yeah, and so there's one that I don't know so you call it a binary, but I think it's a misconception.
(07:49):
But I didn't include the article, but I've been thinking about a lot recently and this is not sort of my framing.
This is the framing of a writer.
Namely a sergeant, are you familiar with her?
So she has a she has a book coming out and she's been kind of talking.
We've had some articles written about about this notion of rethinking the idea of dependence, right?
(08:12):
I think that word has a really, you know, has a really negative connotation like it's bad to be dependent on other people, but the truth is like dependence is sort of what makes us human, right?
Like the fact that we exist, right?
Is is is is in contravertible proof that someone cared for us and that we were dependent on somebody.
(08:40):
And and you see this all the time and this is sort of zooming out to the policy landscape, right?
You see this all the time in conversations about social welfare programs, right?
Like the idea is that like the point of social welfare programs is to foster self-sufficiency and independence.
That's a common thing you see in community meetings or in in philanthropic meetings or or any sort of situation where we're talking about offering people help.
(09:06):
The that there's this notion that like the help is that receiving and needing help is the temporary space and that self-sufficiency and independence is the actual natural ideal state of human beings.
And I really would love to see us kind of flip that on its head and understand that like we are inherently dependent on other people on institutions, on, you know, families, communities, whatever it is.
(09:33):
Like there is an other there every part of our life of a good life has elements of dependence in it.
So I think that independence dependence, I guess it is kind of a false binary that I'd like to see us move past.
Yeah.
People talk about the term interdependence, which I think is more accurate and more something to strive for that we are a social animal.
(09:59):
And we're built to be that way and we're built to live with and for each other and in groups and cares certainly part of that.
Yeah, absolutely.
And I think that you know it's there's one thing I've been struggling with is you know I've come from like the you know really, really nuts and bolts world of state policy right where why are we talking about these lofty notions?
(10:27):
Why are we even having philosophical conversations, you know, let's just talk about like the dollars and cents and nuts and bolts of everything.
But I do think like these the ways we think about care really impact the way policies are implemented.
Right. So I think about the idea of you know if if you think about care is this thing that's like sort of altruistic and self sacrificing, you know it leads you as a policy maker to think that well maybe government shouldn't play a role.
(10:54):
I mean there's examples of a lot of politicians that will come out and straight up say like I don't think it's the government's job to pay for raising other people's children for them right.
And then so a lot of people and a lot of smart strategic people and sort of a counter to that have said well, you know that may be true but like it.
Look it's really important to pay for care especially child care because it helps people enter the workforce right so there's just like a this like purely economic argument.
(11:23):
For care you know and it's something you see across the board right you see you see that as an argument for all kinds of social programs that this is really at the end of the day.
A workforce issue but the truth is.
You know as no look and then that's true like that I want to make sure we realize that there are social and economic benefits to more robust investment and care infrastructure.
(11:51):
But what one of our seminar myrers pointed out is like that results in what he calls minimal minimum viable care right this idea that.
This framing results in sort of like just enough care for just enough caregivers to ensure people enter the workforce and stay there and that results in this like this story which I'm sure you've heard and people have heard all the time of like yeah these resources are out there.
(12:18):
Yes they're affordable but like just barely and yes they're accessible but only if you are able to like juggle you know four or five different.
You know stream funding streams and and vendors and you're able to really really devote like a large part of your mental bandwidth.
Yeah to a ranging care when you say resources you mean in terms of like public supports.
(12:44):
For families yeah so I would argue that these supports are very often not available because like you point out sometimes there is so much.
And so many limitations on on qualifying for them and they are so limited in scope that in a practical sense a lot of families can't fit.
(13:19):
Themselves into the program can't really make that program work for their particular situation and.
Yeah I love what you just said there about about families having to fit themselves in the program because I think that's fundamentally where we get a lot of these things backwards is you know we we developed these programs and these funding streams and and then there are very sort of like one size fits all approach and you know if families can't figure out how to take advantage of them it requires almost like a whole shit wholesale reshuff laying.
(13:57):
Kind of values and priorities and like moving people further and further away from like what they want their life to be just in order to access to have something workable like yeah yeah yeah exactly we're going to take a break now please stay right here and we'll be right back.
(14:20):
Thank you for sticking around we continue our conversation and you know I still kind of reflexively like to defend my my my former colleagues who I think almost again not necessarily the politicians but like the people administering these systems I think we're we're in our kind of doing their best.
And then a situation of I would argue artificial scarcity right like like there is you know no real scarcity here other than workforce but you know I think there is a lot of artificial scarcity that's created by just kind of like persistent and decades long under funding of these systems right and so.
(15:01):
What you have is people like my former colleagues of the state or her saying look we have we have the demand for.
Five hundred million dollars of worth of care but we have two hundred million dollars worth of care to provide and how do you you know actually that in a way that you know do you give.
This is a metaphor there always you know kind of struck me is kind of gross but I think it's also it's also it's also helpful is you know do you do provide steak dinners for you know a small amount of people or do you provide kind of like.
(15:34):
Warm over chicken and tuna dinners for a lot more people and there's no right answer to that but I think it's also important to remember that like for a lot of people.
Running these systems it is sometimes an impossible choice well yeah and I think the reason it's an impossible choice is because.
As a whole.
What we've done is to give like a hundred steak dinners to one person instead you know.
(16:02):
And making sure that that that person gets to keep their hundred steak dinners instead of spreading them out and I think you know to to to kind of put it in that analogy that's that's really what I think is happening and I think that the more you do that the more you have.
You drive up people's needs and you have in people in situations that ultimately are going to require more care because they weren't able to take care of themselves at key points they didn't have resources they needed at key points and then they get into some situation in some way shape or form that.
(16:41):
And it leads to another person being disabled or you know maybe the caregiver or leads to emergency kinds of situations that are very expensive to care for and certainly you know we do care about crises like that people jump in in crises we have emergency rooms required to treat people to stabilize and we it's very expensive to wait until people get into those crises.
(17:10):
This is an incredible stat from Indiana so we we put a lot of work in time into implementing mobile.
Right which is a response to mental health crises that's not law enforcement services.
Yeah.
Let go out of the community and there was a police officer that testified at the reason legislative hearing that since this has been implemented in his town burglaries are down 36% and criminal mischief calls are down like 40%.
(17:39):
So like not not this is not just having an impact on you know the people that are that are receiving these services it's having an impact on overall quality of life and I think the exact same argument can it should be made for care more broadly like this is not just that that's what I mean by this not just being an economic issue this is a that it is an economic issue but it's also like a fundamental quality of life issue.
(18:05):
It's by treating the issues earlier and well that people might have had you prevent harm to other people you prevent the need for for some more extensive interventions and and keep people in the best position to lead their lives fully and contribute as much as they can I think that's yeah it's so true but the problem then is that like the are the incentives don't line up to.
(18:34):
To follow that very true statement to let's logical conclusion right because like the incentive if if we take what we are saying is true and I think we both do.
Then it would seem to be a no brainer to invest for the long term and to like you know put a lot of time and money and resources into prevention but the problem is is we live in such a short term world right like whether you're talking about the business world where like the next.
(19:03):
All that matters or if you look at state budgets at most you're looking out two years right federally federally we govern from continuing resolution the continuing resolution right and so there's no incentive or or framework or thought to what about 10 to 15 years from now when when a lot of the things we're talking about will eventually bear fruit so that's in the that maybe a bit of an aside but I think it's actually really important about like you know why.
(19:32):
We don't have the things that folks like you were in the field know are just common sense.
Jay how would we make that sort of long term planning more feasible and more incentivized.
Yeah of course it's it's a literally billions of dollar question that there's no easy answers to and it's one thing that I think a lot of folks are.
(19:53):
Are looking at I don't have any easy answers what I can tell you is you know some lessons from the so our systems change every so Indiana which I think we're pretty profound like I and you know maybe they could be modified and use for different for different and so.
The most important thing right is understanding that it's the systems that matter right too often like we get really really caught up in trying to blame people right like it's the fault of this politician or this agency or.
(20:30):
This provider or this person receiving care or whatever and like what we don't understand is that we are all reacting to broken systems right and so like.
The less we can point individual fingers the better we can and understand like people are reacting to broken systems that's kind of like lesson number one less number two which I think is like so so so so important it kind of is an off shoot a number one.
(20:52):
Is we need we need alignment right like there's the world of advocacy is this like.
You know to people on the outside it looks like it's the seat on ice happy family but you go even like one layer deeper than then then the surface and you realize it's this like raging for inferno battles between like these different groups with like these like slightly different interests right like in in the care world you have like the self advocates and the home health organizations and the.
(21:26):
And then the providers and like all of them have like slightly different interests and they don't align with each other everybody's just like let me take care of my own little piece of the pie in Indiana we were able to call like a little bit of a truce right on that.
I get not perfectly enough for a long time but just long enough to like have some long term thinking kind of like make its way into the system so that's what I yeah.
(21:52):
I would say that kind of those kind of splits would probably be people responding to the broken system and the false sense of resource scarcity that the false false sense of lack and absolutely yeah yeah.
Yeah right because in a scare system what's the first thing you do you think about how can I get mine right and it's look it's really hard it took kind of a perfect storm of things to happen in Indiana for us to be able to make that happen and got people to gather.
(22:27):
Yeah I would argue that though you know that this is where there is an opportunity in crisis like we are in a crisis of care right in right now in in our country and really the world probably but I know more about our country.
And that's care across the lifespan right that's everything from early early childhood care all the way to elder care and everything in between.
(22:49):
And the way this normally works in states is every single type of care gets its own little spotlight for a moment and then policy makers and politicians kind of move on.
Yeah like check that's done but it's like.
We take care of the home health aids like let's move on to you know child care let them okay check we.
(23:13):
Add little subsidies for child care let's move on to disability.
Yeah it's like this and it's but nothing ever really it's fixed because number one you're drawing from the same pool of people right like and that's that's kind of like fundamental like we.
We talk about professional care like you're drawing from the largely the same pool of people to do the work and so you're almost like like you're almost like.
(23:35):
Pulling apart like like like and so we have to think about this holistic link and we simply like.
I was playing around with like a martial plan framing I don't love it because it's so militaristic but like some sort of like.
Framework that says like hey this is like arguably the crisis of our time right.
And it's going to require this kind of comprehensive holistic all levels of society type of solution.
(24:01):
And I think is a really good place to start and there's some folks kind of calling for that a little bit but I think those calls need to be louder and more frequent.
Yeah I would certainly agree with you and you know it's interesting you talked about you know people are responding to broken systems at politicians.
(24:22):
Advocates all of the people in power as well I didn't you don't usually think about it that way on their behalf as an individual family member I can certainly.
You know look at the ways that that I know I respond to broken systems or or have a hard time because systems are broken.
(24:43):
But to think that actually some of the people in power are responding to broken systems as well and doing the best they know how to do in in a broken system.
How do we also how do we acknowledge that and you know talk about getting away from binaries how do we how do we acknowledge that being true and also hold people accountable who are in a position of power like.
(25:05):
Yeah, you know like question and there's there's I mean there's some rabbit holes we go to I can you could go down the whole like campaign finance you know rabbit hole of like you know maybe the problem is money in politics you can go down the whole like.
You know you can you can make both sides of the argument on things like terminal midst and career politician you can talk about how social media is completely fractured and fragmented any notion of like a police of politics.
(25:32):
You know and all of those are rich conversations that you know maybe for for for for a different time would would be great to have but you sticking to care.
I think there's a there's a potentially potent message buried somewhere in all of these different conversations because cares something.
(25:53):
That impacts everybody right like the alley I was used is the opioid crisis right so like forever you know drugs or something that happened to other people right and look there was there was a huge element of like structural racism behind that that that you point
also sort of the prevailing view of like well drugs happen over there but then when it started spreading to you know the sons and daughters and nieces and nephews of rich and powerful people all of a sudden everything flipped right all the sudden addiction was rightly treated as like a brain disease and something that required compassion and and solutions and evidence and science and it was a good change right but what it took
(26:38):
was that little spark of empathy created by personal experience and the advantage if you will for care is that like everybody cares and everybody is cared for.
And if there's a way to kind of galvanize that inherent empathy into a political movement that's what it's going to take and and I again I don't know if it's if it's possible or likely or probable but I do think that we do have the
(27:07):
empathy aspect going for us. I think that's a really great place to land on and great thought to leave it with is there anything else that you feel like we're really missing from the conversation.
No this is fun thank you for inviting me. Yeah thank you and maybe we'll do it again sometime I appreciate you and your work and your writing there will be links in the show notes.
(27:34):
This is love doesn't pay the bills I'm Lisa Chuty if you appreciate the podcast is tell a friend.
[Music]
[Music]
(00:11):
Welcome to Love Doesn't Pay the Bills.
I'm Lisa Chutey. I am a family caregiver.
My guest today is the senior fellow for Mental Health and Wellness at the Sagamore Institute,
where he focuses on continued advocacy for equitable-
Behavioral Health Care Access and Exploration of Strategies from Proving Overall Community Wellbeing.
(00:34):
He was the Director of the Indiana Division of Mental Health and Addiction
and Chair of the Indiana Behavioral Health Commission, where he led a significant
overhaul of Indiana's behavioral health system, resulting in a significant jump in the state's
overall mental health rankings, which is no small feat.
So thank you for that and welcome Jay Chaudhary.
(00:56):
I'm excited for this conversation. I saw an article that you wrote, which really touched me.
I did want to share it with the audience here.
And it's titled "Beyond False Binary's in Care."
And you start with describing a bit of your own parenting experience with your son
(01:19):
in particular moments you had. And would you describe that moment for us?
Sure. So now I have a 12-year-old and a 9-year-old of a son I'm talking about.
It was two at the time, so it's been almost a decade since this moment.
And we were talking before. I don't remember a lot of my children's early years.
(01:41):
I think that's a pretty common story, but this moment is just sort of burned into my brain.
So we had spent the whole day together and doing, what we were doing,
going around having some adventures. And my wife came home.
We were telling her about our day.
(02:04):
And he was recounting something that happened. And then he looked up at me and he just goes, right Daddy?
And the reason that's so profound is significant for me is it was the first time I really, really got the sense of this dynamic and reciprocal
and creative and alive relationship that I think a lot of people,
(02:33):
but since I come to associate with parenting, but I think before that stage and every parent has a different time and situation where this happens.
But before that stage, caring having is sort of like a series of tasks.
I mean, like so much joy and wonder, I think, also wrapped up in there.
But it is sort of like, okay, we got to get the nap and we got to change those diapers.
(02:55):
We got to make sure he's eating and got to make sure he's safe.
And let's celebrate these milestones when they occur, but the relationship aspect of it.
And this is something I've talked a lot with some of my male friends about his fathers.
I think this is something that this moment is really, really crucial and critical.
(03:16):
I think for a lot of fathers in particular, because we do have sort of a later start, right?
And I think it's just like from a purely physical standpoint of being caregivers of our children.
So, you know, it just was something I was reflecting on when I was thinking more about the concept of care.
(03:39):
Are there more personal experiences you'd like to share about any other family members or any other caregiving that you're connected to in a person?
My main caregiving experience is as a parent.
And so that's the lens to which I personally think of caregiving.
I have spent my entire career advocating for and working with caregivers of all stripes.
(04:07):
For example, I'm a lawyer by background.
I come myself a recovering lawyer in my early years.
I worked for in civil legal aid, which is the provision of pre-civil legal services to folks that can afford lawyers.
I had a lot of clients, probably more clients that were caregivers of non-children, frankly, than clients that weren't.
(04:30):
And helping them navigate the systems and seeing their experiences is something that I will never forget.
And I think really taught me a lot about how I wanted to approach the system if I ever got the chance to be in charge of any part of it.
I love that you're learning from the people that are most impacted and that's so important.
(04:51):
What do you mean in your article by false binaries?
What are some of the examples of the false binaries that we commonly apply to this kind of care work?
Yeah, and so I should mention that these reflections came during a seminar that I had the privilege of attending that was moderated by some pretty renowned and experts in the field and discussion of caregiving
(05:14):
and also attended by a lot of people who offered just incredible perspectives.
And so the article I wrote was a reaction to that seminar, so I want to make sure that I give credit to the high of mind for this part.
We talked a lot about how care is framed within these false binaries, both from the most granular level all the way up to policy.
(05:37):
And so we think of care as being sort of entirely altruistic and self-sacrificing or on the other end, we have the notion that care is a gift, that getting to care and a privilege you get to care for somebody else.
And there's elements of truth in both of those, but the truth is the experience of care is almost always something in between.
(05:59):
And so when you zoom out to a policy level, there's this, and you think about parenting, right?
There's this conversation about support for caregivers means daycare, right?
Or self-sacrificing daycare, which is really important.
A really important thing for parents who want to work outside of the home, but what about people that choose to stay?
(06:24):
That is something that we need to prioritize.
Right, which is a valid choice as well.
One of the moderators at that seminar you mentioned, Alyssa Strauss has been on this podcast, so love, I love that.
And she's all about expanding our view of care.
(06:45):
And I appreciate that you're taking that up and that we're here to continue that conversation.
I think that certain experiences that we have can be so varied all in one experience even.
And caregiving is one of those that, yes, yeah, it can be really, really difficult.
It can be a slog of tasks like you kind of talked about the early stages of having a new baby and it can be just this wonderful opportunity to grow as a human and to understand what we are all about as humans to form relationships and give meaning to life.
(07:26):
And all of those sorts of things so it can be a privilege, it can be an opportunity.
So, yes, all of that is true.
Are there other false binaries that you would want to specifically kind of point out that we tend to?
Yeah, and so there's one that I don't know so you call it a binary, but I think it's a misconception.
(07:49):
But I didn't include the article, but I've been thinking about a lot recently and this is not sort of my framing.
This is the framing of a writer.
Namely a sergeant, are you familiar with her?
So she has a she has a book coming out and she's been kind of talking.
We've had some articles written about about this notion of rethinking the idea of dependence, right?
(08:12):
I think that word has a really, you know, has a really negative connotation like it's bad to be dependent on other people, but the truth is like dependence is sort of what makes us human, right?
Like the fact that we exist, right?
Is is is is in contravertible proof that someone cared for us and that we were dependent on somebody.
(08:40):
And and you see this all the time and this is sort of zooming out to the policy landscape, right?
You see this all the time in conversations about social welfare programs, right?
Like the idea is that like the point of social welfare programs is to foster self-sufficiency and independence.
That's a common thing you see in community meetings or in in philanthropic meetings or or any sort of situation where we're talking about offering people help.
(09:06):
The that there's this notion that like the help is that receiving and needing help is the temporary space and that self-sufficiency and independence is the actual natural ideal state of human beings.
And I really would love to see us kind of flip that on its head and understand that like we are inherently dependent on other people on institutions, on, you know, families, communities, whatever it is.
(09:33):
Like there is an other there every part of our life of a good life has elements of dependence in it.
So I think that independence dependence, I guess it is kind of a false binary that I'd like to see us move past.
Yeah.
People talk about the term interdependence, which I think is more accurate and more something to strive for that we are a social animal.
(09:59):
And we're built to be that way and we're built to live with and for each other and in groups and cares certainly part of that.
Yeah, absolutely.
And I think that you know it's there's one thing I've been struggling with is you know I've come from like the you know really, really nuts and bolts world of state policy right where why are we talking about these lofty notions?
(10:27):
Why are we even having philosophical conversations, you know, let's just talk about like the dollars and cents and nuts and bolts of everything.
But I do think like these the ways we think about care really impact the way policies are implemented.
Right. So I think about the idea of you know if if you think about care is this thing that's like sort of altruistic and self sacrificing, you know it leads you as a policy maker to think that well maybe government shouldn't play a role.
(10:54):
I mean there's examples of a lot of politicians that will come out and straight up say like I don't think it's the government's job to pay for raising other people's children for them right.
And then so a lot of people and a lot of smart strategic people and sort of a counter to that have said well, you know that may be true but like it.
Look it's really important to pay for care especially child care because it helps people enter the workforce right so there's just like a this like purely economic argument.
(11:23):
For care you know and it's something you see across the board right you see you see that as an argument for all kinds of social programs that this is really at the end of the day.
A workforce issue but the truth is.
You know as no look and then that's true like that I want to make sure we realize that there are social and economic benefits to more robust investment and care infrastructure.
(11:51):
But what one of our seminar myrers pointed out is like that results in what he calls minimal minimum viable care right this idea that.
This framing results in sort of like just enough care for just enough caregivers to ensure people enter the workforce and stay there and that results in this like this story which I'm sure you've heard and people have heard all the time of like yeah these resources are out there.
(12:18):
Yes they're affordable but like just barely and yes they're accessible but only if you are able to like juggle you know four or five different.
You know stream funding streams and and vendors and you're able to really really devote like a large part of your mental bandwidth.
Yeah to a ranging care when you say resources you mean in terms of like public supports.
(12:44):
For families yeah so I would argue that these supports are very often not available because like you point out sometimes there is so much.
And so many limitations on on qualifying for them and they are so limited in scope that in a practical sense a lot of families can't fit.
(13:19):
Themselves into the program can't really make that program work for their particular situation and.
Yeah I love what you just said there about about families having to fit themselves in the program because I think that's fundamentally where we get a lot of these things backwards is you know we we developed these programs and these funding streams and and then there are very sort of like one size fits all approach and you know if families can't figure out how to take advantage of them it requires almost like a whole shit wholesale reshuff laying.
(13:57):
Kind of values and priorities and like moving people further and further away from like what they want their life to be just in order to access to have something workable like yeah yeah yeah exactly we're going to take a break now please stay right here and we'll be right back.
(14:20):
Thank you for sticking around we continue our conversation and you know I still kind of reflexively like to defend my my my former colleagues who I think almost again not necessarily the politicians but like the people administering these systems I think we're we're in our kind of doing their best.
And then a situation of I would argue artificial scarcity right like like there is you know no real scarcity here other than workforce but you know I think there is a lot of artificial scarcity that's created by just kind of like persistent and decades long under funding of these systems right and so.
(15:01):
What you have is people like my former colleagues of the state or her saying look we have we have the demand for.
Five hundred million dollars of worth of care but we have two hundred million dollars worth of care to provide and how do you you know actually that in a way that you know do you give.
This is a metaphor there always you know kind of struck me is kind of gross but I think it's also it's also it's also helpful is you know do you do provide steak dinners for you know a small amount of people or do you provide kind of like.
(15:34):
Warm over chicken and tuna dinners for a lot more people and there's no right answer to that but I think it's also important to remember that like for a lot of people.
Running these systems it is sometimes an impossible choice well yeah and I think the reason it's an impossible choice is because.
As a whole.
What we've done is to give like a hundred steak dinners to one person instead you know.
(16:02):
And making sure that that that person gets to keep their hundred steak dinners instead of spreading them out and I think you know to to to kind of put it in that analogy that's that's really what I think is happening and I think that the more you do that the more you have.
You drive up people's needs and you have in people in situations that ultimately are going to require more care because they weren't able to take care of themselves at key points they didn't have resources they needed at key points and then they get into some situation in some way shape or form that.
(16:41):
And it leads to another person being disabled or you know maybe the caregiver or leads to emergency kinds of situations that are very expensive to care for and certainly you know we do care about crises like that people jump in in crises we have emergency rooms required to treat people to stabilize and we it's very expensive to wait until people get into those crises.
(17:10):
This is an incredible stat from Indiana so we we put a lot of work in time into implementing mobile.
Right which is a response to mental health crises that's not law enforcement services.
Yeah.
Let go out of the community and there was a police officer that testified at the reason legislative hearing that since this has been implemented in his town burglaries are down 36% and criminal mischief calls are down like 40%.
(17:39):
So like not not this is not just having an impact on you know the people that are that are receiving these services it's having an impact on overall quality of life and I think the exact same argument can it should be made for care more broadly like this is not just that that's what I mean by this not just being an economic issue this is a that it is an economic issue but it's also like a fundamental quality of life issue.
(18:05):
It's by treating the issues earlier and well that people might have had you prevent harm to other people you prevent the need for for some more extensive interventions and and keep people in the best position to lead their lives fully and contribute as much as they can I think that's yeah it's so true but the problem then is that like the are the incentives don't line up to.
(18:34):
To follow that very true statement to let's logical conclusion right because like the incentive if if we take what we are saying is true and I think we both do.
Then it would seem to be a no brainer to invest for the long term and to like you know put a lot of time and money and resources into prevention but the problem is is we live in such a short term world right like whether you're talking about the business world where like the next.
(19:03):
All that matters or if you look at state budgets at most you're looking out two years right federally federally we govern from continuing resolution the continuing resolution right and so there's no incentive or or framework or thought to what about 10 to 15 years from now when when a lot of the things we're talking about will eventually bear fruit so that's in the that maybe a bit of an aside but I think it's actually really important about like you know why.
(19:32):
We don't have the things that folks like you were in the field know are just common sense.
Jay how would we make that sort of long term planning more feasible and more incentivized.
Yeah of course it's it's a literally billions of dollar question that there's no easy answers to and it's one thing that I think a lot of folks are.
(19:53):
Are looking at I don't have any easy answers what I can tell you is you know some lessons from the so our systems change every so Indiana which I think we're pretty profound like I and you know maybe they could be modified and use for different for different and so.
The most important thing right is understanding that it's the systems that matter right too often like we get really really caught up in trying to blame people right like it's the fault of this politician or this agency or.
(20:30):
This provider or this person receiving care or whatever and like what we don't understand is that we are all reacting to broken systems right and so like.
The less we can point individual fingers the better we can and understand like people are reacting to broken systems that's kind of like lesson number one less number two which I think is like so so so so important it kind of is an off shoot a number one.
(20:52):
Is we need we need alignment right like there's the world of advocacy is this like.
You know to people on the outside it looks like it's the seat on ice happy family but you go even like one layer deeper than then then the surface and you realize it's this like raging for inferno battles between like these different groups with like these like slightly different interests right like in in the care world you have like the self advocates and the home health organizations and the.
(21:26):
And then the providers and like all of them have like slightly different interests and they don't align with each other everybody's just like let me take care of my own little piece of the pie in Indiana we were able to call like a little bit of a truce right on that.
I get not perfectly enough for a long time but just long enough to like have some long term thinking kind of like make its way into the system so that's what I yeah.
(21:52):
I would say that kind of those kind of splits would probably be people responding to the broken system and the false sense of resource scarcity that the false false sense of lack and absolutely yeah yeah.
Yeah right because in a scare system what's the first thing you do you think about how can I get mine right and it's look it's really hard it took kind of a perfect storm of things to happen in Indiana for us to be able to make that happen and got people to gather.
(22:27):
Yeah I would argue that though you know that this is where there is an opportunity in crisis like we are in a crisis of care right in right now in in our country and really the world probably but I know more about our country.
And that's care across the lifespan right that's everything from early early childhood care all the way to elder care and everything in between.
(22:49):
And the way this normally works in states is every single type of care gets its own little spotlight for a moment and then policy makers and politicians kind of move on.
Yeah like check that's done but it's like.
We take care of the home health aids like let's move on to you know child care let them okay check we.
(23:13):
Add little subsidies for child care let's move on to disability.
Yeah it's like this and it's but nothing ever really it's fixed because number one you're drawing from the same pool of people right like and that's that's kind of like fundamental like we.
We talk about professional care like you're drawing from the largely the same pool of people to do the work and so you're almost like like you're almost like.
(23:35):
Pulling apart like like like and so we have to think about this holistic link and we simply like.
I was playing around with like a martial plan framing I don't love it because it's so militaristic but like some sort of like.
Framework that says like hey this is like arguably the crisis of our time right.
And it's going to require this kind of comprehensive holistic all levels of society type of solution.
(24:01):
And I think is a really good place to start and there's some folks kind of calling for that a little bit but I think those calls need to be louder and more frequent.
Yeah I would certainly agree with you and you know it's interesting you talked about you know people are responding to broken systems at politicians.
(24:22):
Advocates all of the people in power as well I didn't you don't usually think about it that way on their behalf as an individual family member I can certainly.
You know look at the ways that that I know I respond to broken systems or or have a hard time because systems are broken.
(24:43):
But to think that actually some of the people in power are responding to broken systems as well and doing the best they know how to do in in a broken system.
How do we also how do we acknowledge that and you know talk about getting away from binaries how do we how do we acknowledge that being true and also hold people accountable who are in a position of power like.
(25:05):
Yeah, you know like question and there's there's I mean there's some rabbit holes we go to I can you could go down the whole like campaign finance you know rabbit hole of like you know maybe the problem is money in politics you can go down the whole like.
You know you can you can make both sides of the argument on things like terminal midst and career politician you can talk about how social media is completely fractured and fragmented any notion of like a police of politics.
(25:32):
You know and all of those are rich conversations that you know maybe for for for for a different time would would be great to have but you sticking to care.
I think there's a there's a potentially potent message buried somewhere in all of these different conversations because cares something.
(25:53):
That impacts everybody right like the alley I was used is the opioid crisis right so like forever you know drugs or something that happened to other people right and look there was there was a huge element of like structural racism behind that that that you point
also sort of the prevailing view of like well drugs happen over there but then when it started spreading to you know the sons and daughters and nieces and nephews of rich and powerful people all of a sudden everything flipped right all the sudden addiction was rightly treated as like a brain disease and something that required compassion and and solutions and evidence and science and it was a good change right but what it took
(26:38):
was that little spark of empathy created by personal experience and the advantage if you will for care is that like everybody cares and everybody is cared for.
And if there's a way to kind of galvanize that inherent empathy into a political movement that's what it's going to take and and I again I don't know if it's if it's possible or likely or probable but I do think that we do have the
(27:07):
empathy aspect going for us. I think that's a really great place to land on and great thought to leave it with is there anything else that you feel like we're really missing from the conversation.
No this is fun thank you for inviting me. Yeah thank you and maybe we'll do it again sometime I appreciate you and your work and your writing there will be links in the show notes.
(27:34):
This is love doesn't pay the bills I'm Lisa Chuty if you appreciate the podcast is tell a friend.
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