Professor John McKnight:
Something sort of unusual, I think, has happened in the last maybe two generations. If you went back, let's say to the Second World War or shortly after the Second World War, before the Second World War and the Depression, right? You would see that there were a lot more relationships among people to support each other. That neighbor meant something more than the person who lived next door. That neighbor was a word that meant I have a special commitment to this person just the way "brother" symbolizes that, right?
And I remember I lived during the depression in a neighborhood, of working class to lower income neighborhood in...in Cincinnati. And at that time, about a third of the people were unemployed in the United States, imagine that, a third. We are very concerned now, and rightly so, that it's 9%, but there was a third and we didn't have anything like the kind of support programs that we have now Unemployment Comp or Social Security, any of those things, Medicaid.
So the question might be how did a third of the people survive? And we knew... know that they survived because of the mutual support of their relatives, friends, and neighbors. And my mother, for instance, the people next door, the husband, wife, two kids. He lost his job with the railroad, and so every evening, my mother would prepare dinner because my dad had a job, right, and she would prepare dinner for our family and at the same time enough for their family.
And so that's how they got their dinner, from their neighbor. And my mother wasn't unusual. This was going on all over because your neighbor, what would they do? And so you had mutual responsibility, right?
Now I think what's happened since then is that that sense that I care about my neighbor, I have responsibility to my neighbor has slowly declined. And it's declined because we've begun to substitute for mutual care something called service.
A service is something you pay for. Care you can't pay for. When I say, "I care for my neighbor, I care for my wife, I care for my father," that's a freely given commitment from the heart of one person to another. And I would never say, "I service my father." Service is not care. It is a paid activity, right, that is different than care.
My doctor I pay for a service called medical care, right? But my community is the place where their mutual care has most to do with my health. So what has happened, I think, over these two generations is people have begun to think they could buy what care used to provide, so that now, instead of the village raising a child, we outsource our children, and we pay people to raise them.
And then, incidentally, we have a... then we call that a youth problem. It's not a youth problem, that's a community problem. That's the problem of a village that doesn't raise its children. It's not... and it shows up in kids because you can't pay people. You can't have from day through night paid people taking care of your children and end up with children who are able, mutually responsible, who know what care and commitment to each other is because they haven't seen it in their own situation.
So more and more a great illusion, I think, has developed, and that is that systems, service systems can produce care. They can produce a university like the one I'm associated with, right? It can produce education, but it can't produce care. Care is a community relationship word, right?
But more and more of our institutions are stealing the word care, right? Think about it. Medicare. Medicare doesn't care. Medicare is a large bureaucracy that sends checks to doctors and people. Why would you call that care?
I got a letter recently from my insurance company, right? This is a letter that... where my address is printed by a machine that printed ten thousand other letters, right? And I open it up and I read it, and it says "Dear John," right? Now this...this is a machine that did that, you know.
And then in the second sentence, "We want you to know that we care about you." What a fantasy. What an illusion. They don't know me, right? [Laughs] If I don't help them make a profit, but they'll drop me in a minute, right? And... to think that we could become so misled that we would say that these systems are care providers, managed care, show that we've stolen the essence of community, our care for each other, and allowed the illusion, the joke that you could pay for care, and the systems that can't produce care, they use it because we're... we bought into the joke.
So that I think a lot of people think that managed care is perfectly reasonable. There is as much managed care as there are purple cows. Managed care. What care is is the thing that will never be managed, it is the freely given commitment from the heart of one person to another, and that above all can't be managed. It can be given, it can grow from connection. It can grow from knowing what a neighbor really is, right? But no system ever produced care.