Creative Altruism

For me, possibly the greatest moment in American history came when George Washington declined to serve a third term as President and retired to Mt. Vernon.  At that time, he was held in such reverence that many proclaimed he should be declared king for life.  With his altruistic refusal to let that happen, he established once and for all the democratic nature of the American republic, and ensured the legacy of peaceful transition of office needed for its continuance.   He was following the example of Cincinnatus, the Roman farmer general, who, after heroically defending Rome from invasion, refused further office and retired to his farm, guaranteeing the rule of civil over military government for his and future generations.  A Society of the Cincinnati, composed of descendants of Revolutionary War officers,  exists to this day in Washington, D.C. to further the ideals of both Washington and Cincinnatus.

And they, of course, were probably following the even more ancient example of Solon, the great Athenian statesman, who, when asked to write a Constitution for the new Athenian democratic city state, included as its final clause, that on its passage he, Solon, should be exiled for life from Athens.  He truly could be termed the father of democracy.  History has many such acts of creative and heroic altruism, evidence that altruism can, in fact, change the world for the better.   A few, like those I’ve mentioned, loom large and are remembered.  Most are smaller, often forgotten acts that creatively open doors to subsequent history without calling attention to the actors themselves. One of those forgotten moments may be occurring in southern Europe now.

In Spain and elsewhere, the Washington Post reports, the Euro crisis is being met with the emergence of alternative economies, in which “hours” are traded for purchase of goods and services by those who, in many cases, have no Euros for currency but plenty of time.  Banks have established accounts for what the Spanish call “turutas” and businesses are buying and selling them for their goods and services. In places like Barcelona, thousands use them, and they are emerging as an alternative currency. They represent the role of currency purely as a medium of exchange, and are imperfect at best as a store of value.  But they fill the enormous vacuum left by the financiers and corporations who have focused solely on money’s role as a store of value and ceased treating it as it was originally created to be, a non-cumbersome medium of exchange for goods and services.  They buffer ordinary people from the worst ravages of the crisis.  They represent a statement by the Occupy and other related movements that alternatives exist to an oppressive economy dominated by financial interests alone, and may be a harbinger of steps to come in the economic paradigm shift.  And they may even call financiers’ attention to their own derelictions.

It takes altruism for a business person to purchase goods with Euros and sell them for turutas.  It takes altruism for a bank to set up accounts for deposit of Turutas and not Euros.  Not the kind of grand altruism of a Washington or Cincinnatus, but possibly historic nonetheless.  Perhaps this moment will pass, leaving only a quickly forgotten ripple.  But we may be witnesses to a moment when “business as usual” steps aside for the entrance of a new way.

Curing the Cost of Health Care

Back in 2005, I had surgery for my arthritic back.  The surgeon was skillful, and the recovery, according to the doctor who lives next door, the smoothest he had ever witnessed.  In its execution, it was the kind of medical event in which American medicine can take justified pride.  Then I began getting copies of the bills sent for the surgery to Medicare and my insurance company.  While I had no out-of-pocket expense for the surgery, I was horrified.  The surgeon had sent a bill for $10,000, and was paid $2,000. Frankly, considering the skill he evidenced and the office overhead he supported, I thought the payment well justified and would have found a payment even of about $5,000 reasonable.  Then the hospital sent Medicare a bill for $25,000, of which all but a co-pay of $15 was paid by Medicare, with the private insurance picking up the $15.  Part of the bill was for legitimate hospital costs – operating room, room and board, nursing care, etc. – amounting to $9,000.  Though steep for two days of hospital care, I could pity the hospital a little and grudgingly swallow the costs.  But $16,000 of the cost was for a 2-inch titanium rod and two titanium screws inserted into my back.  I was appalled.  My son, an avid bicycler, commented that an entire titanium bike costs about $3,000. Excuses were made that custom tooling was expensive, health required exacting precision, etc., etc. They would have been valid even fifty years ago, but in an age of robotics and sub-atomic precision, they simply represented excuses for inefficiency. What had caused this charge, and what could be done about it?

The answers of course were greed and the legislated inability of Medicare to control charges by medical device makers.  While Medicare is allowed to squeeze excess out of doctors’ bills, often to the detriment of the patient, it is not allowed to regulate effectively either hospital charges or device manufacturers.  That in turn causes costs to be incurred somewhat akin to the $2,000 toilet seat charges the Pentagon faces from contractors.  The result is a tragedy for Medicare, which is blamed for costs it is not permitted to regulate. But the real tragedy is for American medicine and the American people.

In the Washington Post this morning, Matt Miller writes the first frank account of this issue I have seen.  Miller writes that we are debating Medicare in a bubble, “impervious to global benchmarks that suggest our efficiency ambitions are far too timid.”  We blame Medicare for escalating costs when the real villain is the entrenched inefficiency, and greed, of the private health care sector.  Other countries’ health systems deliver more effective health care than the U.S. at far lower per-capita costs.  The traditional excuse that our high health costs result from the superlative character of our health system just doesn’t fly. Internationally, we do not rank even in the top five of national systems for effectiveness, in terms of things like infant mortality, availability of coverage, etc.  Yet the most effective systems deliver health at a far lower percent of national GDP than ours does, with a more elaborate national administration, i.e., they are far more efficient despite having a higher governmental overhead. Our percent of GDP spent on health care is about 18, while OECD countries average 8 percent and Singapore, with similar effectiveness scores to ours, spends 4 percent.

 It turns out that the top national health systems in terms of effectiveness, none of which is the U.S., use a great variety of approaches, from all private providers as in Switzerland or Japan to all public single payer systems as in several European systems, but share one trait in common: all insist that no profit be made from the treatment of those who are ill.  Yet profiting from illness is at the heart (or lack thereof) of the American pharmaceutical and medical device manufacturing industries.  It turns out that the American insistence on private, unregulated costs of medical goods, pharmaceuticals and services is itself the illness we need to treat.  As Miller notes, we have given a license to inefficiency and excessive profits at the expense of the individual citizen.  A step toward a cure would be to provide for regulation of device and pharmaceutical costs by Medicare.

We celebrate the virtues of a free market, while forgetting that the market for esoteric goods and services to individuals who don’t understand them yet must have them cannot by definition be free.  Free markets imply perfect information and freedom of choice.  Our health services markets fail us constantly, with more neurosurgeons in Boston than in all England and whole rural counties without obstetricians, with 50 million uninsured, and with $16,000 2-inch rods about which the ultimate consumer has no choice.  Then we blame the messenger, Medicare, for exorbitant costs over which it has no control.  Health services are not luxury items like yachts, where we might sometimes pay willingly for old fashioned, handmade ornaments. Other countries have already shown us alternative ways to do things right.  It’s time we lifted our eyes beyond our ideology and looked to the future of effective and efficiently provided medicine.

Common History

Back when Lyndon Johnson was first elected to the senate, his victory margin was, as I recall, about 87 highly mysterious votes that had turned up in a previously uncounted ballot box; he was quickly dubbed, and admiringly known, in Texas as Landslide Lyndon.  Folks up north thought of the event as the acme of crooked politics, and were suspicious of Johnson thereafter.  Texans knew better.  He had lost his previous run for the senate by around the same margin because of another mysterious ballot box turned up in a recount by cohorts of a West Texas political boss who was an arch rival of Johnson.  The feeling in Texas was that a turnabout was fair play.  What on the east coast was a violation of basic fair election rules was, in Texas, part of the ongoing election process.  I think of that sometimes when I’m following the European Debt crisis.

A friend of mine who often visits Germany, and has continuing conversations with friends there, tells me that his German friends see the continuing Euro mess as a straightforward matter, “There are rules, and you follow them.”  My southern European friends see things differently.  To them, Greece, and other southern European countries were systematically squeezed by northern European banks like Deutsche Bank, operating a lot like the U.S. banks that made no-questions-asked loans and then rapidly foreclosed in the run-up to the U.S. financial crisis.  Then Greece sought under the table assistance from Goldman Sachs (who better than they to know how to rig an intricate financial deal?) to stave off Deutsche Bank.  But Sachs had rigged the deal so that Greece suddenly found themselves several billion more in debt to Sachs than they had expected, more than their treasury could bear.  Greece had been caught in a pincer movement between two great white sharks.  So they adopted the classic southern “ok, now I can’t pay, what do you do?” approach, which set off the cascading events of the European debt crisis.  In other words, the crisis was set off by the loose financial practices of northern European banks, so why should southern Europe unilaterally suffer for it?

It’s now being generally recognized as a culture clash between northern and southern European values, but of course, other layers of the problem make it even more complex.  There’s also the growing suspicion on the part of southern Europeans that Germany’s long-term goal is to obtain a political hegemony over all Europe by financial extortion based on the strength of the German economy, a sort of economic Fourth Reich.  That makes countries like France or Britain less than eager to support Germany’s proposals.  All Europe is sliding into recession because southern Europe’s economies are being leached away by excessive debt loads, while German manufacturers face loss of customers for their markets by the very austerity German financiers seek to impose.  Germany itself begins to show internal policy conflicts.  German policy makers show increasing signs of wanting to help other European countries in need, but continuing reluctance to honor such divergent values.  It becomes increasingly obvious that economics alone has no solution for problems originally described in purely economic terms.

While many issues must be resolved to find solutions to Europe’s problems, one of the most interesting ones is never mentioned.  Solving the crisis will involve some degree of unequal sacrifice.  A perception of such sacrifice with a willingness to proceed requires altruism, but in turn, such altruism involves a sense of group identity.  A big reason why differences in political values between Connecticut and Texas, as well as other large cultural differences, never come to a head is that both share highly mobile populations and a crowded common history.  Texans frequently live in New England and New Englanders in Texas.  They both know what it’s like to live in the other place.  Just as important, they share common heritages, from the War of 1812, celebrated this year in both places, through to rocket probes on Mars.  "We Americans" is a common phrase.  Differences loom far smaller than commonalities.

I have never heard the phrase "We Europeans" from the lips of a European.  In Europe, Germans remain intensely German, and Spaniards Spanish.  In Italy, Florentines remain suspicious of Neapolitans.  And I have never heard a European discuss the common history of, for instance, Germany and Spain.  Each place has an exciting and memorable history, but a European history is a compendium of the histories of European countries, not a history of all together.  One never gets a sense of shared hardships overcome, shared triumphs, shared places of pilgrimage.  A European history is needed that reminds people of their common heritages and values, not their differences.  It is there: the era of the Holy Roman Empire, for example, had a more cross-national nature than anything in Europe today.  Charles Martel at Tours and the Venetian Fleet at Lepanto won great battles on behalf of all Europe.  Common memories and common heroes should abound.  But instead, European countries today compete, often bitterly, between each other for the European championship in soccer and blame each other for their problems..  No such competition and no such bitterness occurs between states in the U.S.  Until they can recognize a unity that goes far beyond a common currency, Europeans will never succeed in sharing a healthy common economy.

The Human Interest

Years ago, in a commencement address at American University, President John F. Kennedy stated, “While we proceed to safeguard our national interests, let us also safeguard human interests.”  A noble sentiment indeed, but one that seems forgotten in this 21^st century fashion of unenlightened self interest.  It deserves notice that JFK did not raise the interests of humanity while ignoring national interest, but assumed instead that they can share common values and goals.  We especially seem to have forgotten that.  Time after time, we discount human goals and values obvious to the rest of the world as,”not in the national interest.”  There is a new principle of international law, embedded in the Law of the Sea Treaty (which of course the U.S. has as yet refused to accept) called "the common heritage of mankind" principle, which holds that all nations are bound to honor and hold in trust for future generations places such as sea beds, great historical sites, etc., that are the common property of humanity.  It, too, is a noble sentiment, well worth honoring.  But it has become fashionable among some conservatives to discount any values “not invented here” as suspicious attempts to Europeanize America, as though only those values not found in other nations can be truly American.  As I walked through flower-filled public spaces in Canada this summer remembering the colorless and joyless public streets common in the U.S. (“flowers – what a waste of money!”), I thought what a tragedy for the human spirit that attitude can become.

It is an old problem, written large in this new age of mass slaughters, globalized finance, an international struggle against terrorism and planetary climate change.  It’s said that we drive on the right side of the road and use the fork in the right hand in America because, following the Revolution, we didn’t want to be like the British.  De Tocqueville noted the problem in the 1840’s.  David McCullough, in The Greater Journey, an account of Americans in Paris in the 19^th century, quotes a conversation between two Chicagoans at the Paris International Exposition of 1900 (site of the first presentation of the internal combustion engine, electric turbines, and now-priceless works of art, the fair was regarded by most as the grandest world fair ever held until that time):  First Chicagoan, “Well, it’s not as good as the Chicago Fair of 1876”; Second Chicagoan, “I knew that before I came.”  Some of us just haven’t changed.  But the world has.

Written large, the problem transforms from comedy into tragedy. My country’s skies are bluer than the oceans.  But other lands have skies as blue as mine.  So states one of the great hymns, based on the melody of Sibelius’s Finlandia.  We all share one planet, and a common humanity.  Yet we devote the equivalent of the entire corn crop of Iowa each year to corn syrup for soft drinks, while humanity around the world starves for lack of ability to pay the inflated food prices that result.  We cheerfully count arms sales to other countries that enable the mass slaughters as part of our world’s largest GNP.   We proclaim the world superiority of our educational and medical systems while we slide further and further down the international scales of effectiveness.  And in terms of climate change, we fiddle while the rest of the world (including us) burns.

Eugene Robinson, in the Washington Post, notes that the science of climate change is now confirmed to the point that previously skeptical scientists have reversed their positions, scientists previously cautious in describing the evidence are announcing that they had been significantly underestimating its effects, and a strong world consensus has emerged regarding the seriousness of the problem.  Other countries “get it.”  Yet in this country, Gallup polls show that public recognition of climate change and its consequences has actually declined, from 60 percent in 2007 down to 44 percent in 2011.  In the face of the hottest July in the hottest year on record, severe drought in Australia and emerging drought in our own Midwest, torrential rains in Russia, and floods covering one-third of Manila, many of us grit our teeth, square our jaws and hang on to full scale denial.  Robinson terms it the “You can’t pin it on our SUVs” view.

It’s time for the interests of humanity to come forward again as part of our legitimate public policy agenda.  Robinson suggests that global climate change should be part of the discussion in this current election, and I would agree with him.  I would also add subjects like the effect of our domestic policies on world poverty, and our national contribution to world violence.  We as a nation known for its impact on world affairs cannot disregard the effects of our actions on the common interests of all the world.  We cannot claim greatness without practicing it.

The Price of Liberty

When I absolutely have to wear a tie at this time of year, which I’m glad is rarely, I like, if possible, to whip out an old Snoopy tie of mine.  Snoopy, you recall, is the beagle in the Peanuts comic strip who is truly the blithe spirit among a horde of often over-wrought kids (a little book, The Gospel According to Peanuts, provides a theological interpretation, which is my lame excuse for wearing the tie to church, that Snoopy represents the Holy Spirit trying to lighten up a bunch of overly striving Earnest Christians.) My Snoopy tie shows him in swimming trunks traipsing across the beach, whistling and wearing sun glasses; on the back of the tie it says, “My body may be at work but my mind is on vacation.” I’m just returned from an orgy of vacationing, including short trips to Canada and to Chautauqua, New York, sandwiched in between two separate weeks at the beach; my mind is still back there somewhere, whistling and hiding from me. Eventually, it’s bound to show up.

Meanwhile, I’ve been catching up on old opinion columns, and in the process found a few that as usual make a mishmash of the difference between Liberty and Freedom (one of the most common vices among all of us.)  One was in a column by Robert Samuelson, which reflected on the current crisis in capitalism in a serious way that deserves consideration. First, we all need to keep in mind that Freedom is the absence of all external constraints, while Liberty is the absence from the constraints of arbitrary or despotic government.  That difference is important.  Freedom is the fervent desire of every teenager; Liberty is the mature desire of adults to live together in an orderly society that recognizes and respects the needs of the individual while providing ground rules that enable all to live and work together peaceably and happily.  Freedom implies no obligations on anyone’s part; Liberty implies reasonable and non-arbitrary mutual obligations on the part of all of us.  Freedom implies the State of Nature in which we are all equally unconstrained and vulnerable; Liberty implies the Social Contract.

Samuelson writes in two different columns about democracy and about capitalism in a way that is subtly contradictory.  In one, about the bitter political strife in this election year, he writes that Americans are torn between their love of freedom and their love for equality to the point that it constitutes the great divide between conservative and liberal thought.  He cites de Tocqueville as a source of his belief that we seek equality because of our innate greed, and that egalitarianism will eventually win.  In the other, about the crisis of capitalism, he acknowledges that the implicit bargain that capitalism makes in exchange for the freedom of its profit making is that large returns on investments will be reinvested in ways of benefit to all, and that the bargain is being broken when companies just hang on to profits without reinvesting them productively.  He recognizes that lack of reinvestment is a big factor in the current recession, to the detriment of all.

Samuelson is right when he talks about our individual greed dragging us down, but wrong to forget that we are social animals, tied together by bonds of empathy and mutual accommodation.  Biology tells us that has been the key to our success as a species.  Even a small child knows instinctively what’s fair and what’s not.  Samuelson seems not to recognize that what he characterizes as greedy egalitarianism in us is that small child shouting, “That’s not fair!”  The violators in this case are the one-percenters and the corporations who are not doing their part in keeping our society going.  Paying taxes, reinvesting, refraining from price gouging, responsible treatment of employees, all are fundamental ethical practices required for a free society.  Miss Manners, in an article years ago in the American Scholar, commented that the enactment of a law represented the failure of an ethic.  Regulations are the consequence of unethical behaviors.  If businesses desire less regulation, then the key first step for them is to become models of ethical practice. The price of Liberty is not just eternal vigilance, it’s also responsible participation.