Charity and Entitlement



I am a believer in charity. I write off about 15% of my gross yearly as free care to patients who have no insurance and no ability to pay a medical bill. My wife and I give almost 10% of our after tax income to various charities, mainly food banks and home building organizations as well as several religious charities.

I believe that charity is good for the soul. I am not a religious man, as I’ve discussed in other posts. But I think that the spirit is enriched by actions that promote life and wellbeing in others and in ourselves. And contrary to what many people seem to believe these days, charity is good for the recipient as well as the giver.

There is a school of thought that seems to believe that charity somehow belittles the recipient; that it is a humiliating experience and that it represents some sort of feel-good power trip for the person giving the charity.

I think the opposite is true. When you give to someone with no expectation of any return you are making an exchange of values. You are recognizing in that person an inherent value that you wish to acknowledge. If I help you out with money or material support, I am in essence saying to you, ‘I believe in you. I believe you have worth and potential and wish to see that developed or continued.’

For the recipient, a charitable assist can be uplifting and affirming. You may be down and out, beset by trouble or overwhelmed by circumstances, but another person has seen your trouble and thinks that you are worthy of help; someone believes in your potential enough to put material backing behind kind words of encouragement. It can be a tremendous boost to hope and morale – an affirmation that you still have worth and someone else believes in that worth.

Gratitude is tied into this exchange. Gratitude is not a demeaning or fawning emotion meant to stroke the feelings of the chartable giver. It is rather a subtle but powerful motivator for the recipient. If someone has acknowledged your value in a material way, there is an implied obligation to do your best to improve as a result. Sometimes it may mean repaying the favor. More commonly it is a ‘pay it forward’ obligation. I am grateful to many key individuals in my life who have helped me through tough times. I can’t repay them in kind, but I can emulate them in my dealings with others.

Contrast that to an entitlement. Those who believe in the big government solution to individual problems affirm that we all are entitled by dint of our birth to a certain level of material support. You don’t have to earn it, you are entitled to it. It is paid free of any obligation to repay or pass on to others. In this system, there is no acknowledgement of value. You are just getting your due. In fact, if you don’t get it, you are being deprived of a right and should feel resentful. You are not a person of value, you are just another citizen collecting what is owed to you.

I believe this sort of entitlement philosophy is damaging to the soul. It robs people of their dignity and their individuality. You become just another case number. Your check arrives anonymously in the mail and you have no obligation to do anything but cash it. There is no mutual recognition of value, no opportunity for gratitude. Just take your check and keep the line moving, next case!

I see this in my practice every day. We see all comers, but expect a token level of payment from everyone. The uninsured or self-pay patient pays a ten dollar ‘down payment’ on their appointment. If surgery is recommended, we work out a payment plan that fits their budget. There is no insistence on a huge amount up front, but we expect regular payment on the balance, or at least regular communication. One of my favorite patients paid off his surgery bill with rolls of quarters from his small vending machine company. Every month he would deliver two rolls of quarters. It took him several years and we offered after a while to write off the rest of his bill, but he insisted on paying in full.

Contrast that to the AHCCCS patients I see. (AHCCCS is Arizona’s form of Medicaid) They regularly fight my staff over paying the token $1 fee the state asks us to collect for each visit. They cancel or miss appointment far more often. They are more demanding of immediate scheduling and complain the loudest if we run late. They are entitled to the best care other peoples money can by and by God they’re going to make sure they get it.

The entitlement culture is not just corrosive to those who are on the dole. It cheapens us all. How many times have you passed a homeless person and wondered why ‘someone’ doesn’t do something to help him. Entitlements have allowed us all to abdicate our responsibilities to each other. Society or the government or some other big nameless organization is expected to help those in need. The problems are too big for individuals. They need big expensive solutions.

But in fact, that is a cop-out. It’s hard to look someone in the eye and offer help. It’s hard to know what sort of help to offer or how much is enough. Better to leave it to ‘experts’. That is the abdication that most of us choose.

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