The One Ring

Remember, how in The Lord of the Rings, all the action centers on the One Ring of Power that controls all the others?  Frodo, the protagonist, must battle the evil Sauron to prevent Sauron from obtaining it and thereby becoming Master of Middle Earth.  Frodo succeeds by entering Sauron’s evil kingdom (smog covered and about as ugly as 19^th century England or the Ruhr at the height of the industrial revolution) and casting the ring back into the fiery volcano from which it was originally forged.  It’s possibly the only hero’s quest in which the hero wins by destroying the treasure he started out with.  We need another Frodo now.

Middle Earth is of course all of us (or at least 99 percent of us), and the part most in danger of being overrun by Sauron these days is Europe.  In the quest for the One Currency that will rule all others, the lives of millions are being ruined (Greece), countries are threatened with breaking apart (Spain now, possibly Italy later), governments destabilized (The Netherlands), and all Europe is covered with the growing smog of uncertainty.   But it goes well beyond the Euro issue.  Bonn and Goldman Sachs and economics departments everywhere long ago accepted “economic determinism”, Marx’s view that economics itself is the one ring that controls all others; but in their vision, that economics is limited essentially to the relations between goods and services that we call a market.  Financiers and economists seek to enact their vision as a laissez-faire free market capitalism that controls all things, yet is responsible only for their own prosperity.    In defense of “economic principles”, austerity regimens are imposed that blight the continent.  People die so that they may have bonuses.

Marx never shared the financiers’ vision, for he claimed to be a student of Aristotle, and Aristotle knew better.  It was Aristotle who coined the term that we know as “economics” (he also coined the term “middle class” and to him it was a designation of honor); Aristotle’s economics was the art of managing a household.  In it, he included both the relations between people and the relations between goods (that we call markets.)  Of the two, people and goods, people deserved the higher consideration, and their relations involved far more than finances.  One doesn’t discard a sick child because the price of medicine cuts into profits.

Capitalism proved long ago that, used wisely, it can contribute mightily to prosperity.  But so also can health, good education, a sense of community, respect for the needs of fellow citizens, and all those other things that together create our mutual “household.”  Capitalism is a useful tool that can have many variations and contribute strongly to the health of society, or to its detriment.  It is the vision of free-market capitalism as The One Ring which must be possessed that generates the blight on all our relationships.  In Lord of the Rings, Nazguls are wraiths on horseback, bound to Sauron’s service, who once were men, overwhelmed by their own greedy quest for the one ring that controls all others.  Some of our financial leaders need to look in the mirror.
Europe’s leadership needs to recognize that healing the EU involves far more than only the health of markets.  Some already do, but far too few.  The Germans, in particular, still remain caught up in the view that only market issues matter.  Considering the damage that view has already wrought, they have a more rather than lesser obligation to other European nations to contribute to the healing.  If you break it, you own it.  Yes, the markets need to be worked on, but so do many other things.  Germany should be in Spain and Greece today, providing relief services and finding ways to alleviate the suffering before winter sets in.  They need also to work together with other European nations to find a modus vivendi which does not require all countries to follow the rules of German markets.  That may require abandonment or modification of the role of the Euro as counterproductive to real European union.  The motto of the EU is United in Diversity; that needs to be practiced.  Otherwise, this period will be remembered mainly as the third misguided attempt in the last century by Germany to control the destiny of Europe at other nations’ expense.

The Disposition of the Heart

In the 1740’s, tensions between Europe and the Moslem world were at their usual high level.  The final Crusade was less than 500 years in the past, a European fleet had turned back a Turkish invasion at Lepanto only 170 years before, and the Turkish army had besieged Vienna 80 years ago.  Sea warfare continued the ages-old struggle, and the new nation soon to rise, America, would fight its first battles after independence against the pirates of Tripoli.  In the midst of all this, a devout lady wrote to John Wesley, founder of Methodism, inquiring earnestly whether it was true that all Moslems went automatically to hell, a common belief at the time.  Wesley’s response to her was one of history’s great statements about inter-faith, and inter-cultural, understanding: “Of the judgments of God, I cannot speak.  But this I know, that God looks not to the clarity of the mind, but to the disposition of the heart.”

This is, in a way, our biggest challenge these days in dealing with Iran.  The statements of someone like Ahmadinejad strike us as at best irrational, and possibly the ravings of a monster seeking our destruction. He is speaking the political cant of a culture so different from ours, and with such a history of strained relations, that a common clarity of the mind seems impossible to reach.  We must seek, like God, to penetrate past that to an understanding of the disposition of not just his, but the heart of a people.  For while diplomatic exchanges are between individuals, wars are between peoples.  The insincerity he exudes when disclaiming any attempt at nuclear weaponry may or may not represent how the Iranian people will actually behave.  Real dangers of nuclear proliferation must be avoided, but so also must be “daggers of the mind” that arise out of cultural misunderstanding.

Beyond peoples, our enemy here is the widening gap in progress and modernization between ours and the developing world.  While we struggle over iphones, they struggle to bring electricity to isolated villages.  Nuclear power to us is a kind of luxury, easily turned to weaponry.  To Iran, it may be a necessity, both for bringing electricity to those villages and as a barrier against the invasions (from Iraq) and the interventions (from us) they have experienced within their lifetimes.   As the technology gaps widen, the cultural gaps widen even more.  We must seek past the cultural misunderstanding to understand each other as people. 

That is at the heart of the need for less inflammatory language, and less drawing of lines in the sand.  President Obama is right in his stout support for the right of free speech, even when it is obnoxious and blasphemous.  But that right must be exercised and that speech must be spoken, and understood, responsibly, with awareness of the cultural differences that impede understanding.  Censorship cannot be imposed, but self-censorship must be encouraged.  The right of free speech must not be construed as an invitation to the use of derogatory language.  The struggle against extremism must continue, but each side must focus as much on the extremists of their own nation as on the extremists from elsewhere. To do otherwise invites escalation into war.

The War of Three Turnips

Hard times test friendships.  That was never more the case than in Chicago, where a liberal mayor and the teachers union are going to court over their inability to agree on teachers’ contract terms.  On the face of it, each has right on their side, and that of course is the problem.  Sometimes, two rights can create a wrong.  The press is, during this election cycle particularly, trying to make a federal case of a local issue.  In a way, they too are both right and wrong.  It’s become a mishmash of traded claims, challenges and obfuscations.  That the principal victims are the school children is obvious; the opponents are all, in their way, good guys, but the villains remain lurking behind the curtains.  As I write, the good guys have agreed on at least a temporary truce (it still may not hold) for the benefit of the children, but the villains remain unidentified.  Long term solutions will require their being fingerprinted and brought to justice.

The Chicago conflict, narrowly considered, is centered on two main issues.  First, the teachers are being asked to work longer hours with no increase in pay, and refuse to do so.  Second, the teachers refuse to be evaluated, and paid, and risk tenure, based on student performance when they believe many factors in that performance are beyond their control as teachers.  The school system’s, and city’s, goal obviously is to improve performance in a period of extremely tight finance at no additional cost.  A longer school day would most likely benefit the kids, but, as my mother would say, money is tight and you can’t squeeze blood out of a turnip.  The teachers’ goal is to be treated fairly.  They too are struggling in a tight economy, and some may be “moonlighting” or at least babysitting while their spouse works two jobs; they also are turnips.  Anyone who has been married to, or has children who are teachers knows that teachers’ workloads extend beyond the classroom.  There are undoubtedly also some “process” issues involving dominance struggles between city leaders and union officials, but they are common to all negotiations, and skilled negotiators get past them.

The first issue is one of fair compensation for increased workload; the villain of course is our own desire to get something for nothing.  We want the best for our kids, but are unwilling to pay for it, especially in tight times.  We are the third turnip in this war.  The taxpayer reluctance to properly fund education means both mayor and teachers are strapped for funds.  Times will undoubtedly improve, and so must taxpayer willingness to pay fairly for necessary services, but in the meantime other ways must be sought.  The teachers are being asked, in effect, to work required unpaid overtime.  A narrow solution commonly used by other types of organizations in such situations is payment of compensatory time, creating a balance for each teacher of “unpaid” hours which can, in future years, be converted into personal leave or vacation time or longevity calculations at retirement.  The “really real” villain is our tendency to load onto the school system the unpaid burden of correcting problems from outside the system. A wise old boss of mine maintained that the need for "overtime" usually indicated some deeper problem.  In schools, too long a day may simply compensate for too short a school year, or a need to compensate for out-of-control deficiencies. A longer school year would probably be a better goal than a longer day, but that too would cost money the taxpayer is unwilling to pay, or politicians to ask for. But it is a goal this country needs to work toward. Our current school year is a vestige of a rural past this nation can no longer afford.

  It so happens that the same villain, along with summer, social inequality and absolute testing standards, complete the gang behind the second Chicago issue, that of fair evaluation, pay and security of teachers. And an already recognized educational innovation is available to generate a solution. Studies have shown that much of the difference in grade-level performance of public school students arises because children from more affluent homes continue to advance during the summer while the schools are out, through camps, summer courses, etc., that poorer children cannot afford.  A major grade-level attainment gap between rich and poor children in high-school is actually the product of the many summers when the well-off advanced while the poor slid back a little. Testing children at both the beginning and end of the school year reveals their actual progress during the school year, when the teacher is in fact a responsible party, which turns out to be much the same between rich and poor.  Other inequality factors intervene as well, like poorer nutrition, lack of home support, etc., but they are apt to be distributed fairly equally across a school district, or a large region within a metropolitan school district.  A teacher is much more likely to be fairly evaluated if the progress of students is measured against the average progress, measured at the beginning and end of the school year, of same grade-level students in the same school district.  A goal of increasing the average progress during the year of students in the class generates a workable standard for evaluating teacher performance.  It also clearly defines educational issues for the community that lie outside the control of the teacher and the school system.  That may in turn sensitize the taxpayer to where the real issues lie.  Chicago’s problems are not unique to Chicago. 

Crowded Theatres

During the Baltimore riots in 1968 following the assassination of Martin Luther King, Jr., destruction and looting were rampant throughout the downtown areas, police cordons were everywhere, and the scene generally was chaos. Throughout the riots, reporting in the newspapers and on radio and TV was strangely muted.  Afterwards, I asked an acquaintance who was a radio news reporter what had been going on; he told me that the media had voluntarily self-censored its reporting of the worst incidents to avoid making a bad scene worse.  So, to this day, some of the worst incidents go undocumented and unknown to the general public.  He could have claimed, as some media free-speech advocates do today in regard to the release of the blatantly anti-Muslim movie which set off the middle-eastern rioting, that freedom of expression required reporting everything.  But back then, even the New York Times reported only “all the news that’s fit to print.”

Most of the stridently (a pejorative, but it fits) free-speech advocates are in support of having no restrictions at all on the internet.  While there is some merit to their cause, there also is some excess.  They, mostly from the U.S., think like the teenager in terms of unrestricted freedom rather than responsible liberty.  They perhaps grossly understate the importance and the role of the internet in our current society.  Being from the U.S., they should know that one person’s freedom ends at the end of the other peoples’ nose, and that freedom of expression “does not include the right to shout ‘fire’ in the middle of a crowded theatre.”  Those are understandings of the responsibilities of liberty, not irresponsible freedom, established long ago by the U.S. Supreme Court. Freedom of expression does not include incitement to riot.  And evidence of damage to the other person’s nose includes, in the case of the anti-Islamic movie, dead bodies and burning buildings.  More recently, the Supreme Court ruled that you can not be required to serve as the conduit of another's expression.  In other words, freedom of expression includes the right not to express the views of another.

Nowadays, the internet is a crowded theatre for the whole world.  The days are past when the web was the private playhouse of the cognoscenti, and saying anything, no matter how outrageous, was speaking to a highly tolerant private audience.  Wildly variant values, deep misunderstandings, and restless mobs roam the aisles.  We are far yet from generally acceptable norms of “community” behavior in the internet theatre that would legitimate governmental censorship, but far enough along to know that responsibility for consequences goes with expression.  The right not to express becomes even more important.  That is why the self-censorship of Google in restricting access to the movie from parts of the Middle East was appropriate, and might have not gone far enough.  The internet has grown up.  It’s time for some of its sponsors to do so as well.

Cheese Cake Medicine

You don’t expect to find a cure for soaring medical costs in a mass-market restaurant chain.  Yet that is where Atul Gawande, an American physician known for his expertise in reducing error and improving efficiency in surgery, went searching.  His quest, reported in the August 13 New Yorker magazine, demonstrates lateral thinking that is just the kind we need much more of these days. It also reveals a fundamental flaw in the standard medical practice model that needs correcting to keep good health within the reach of the average person.

Gawande’s search took him to the Cheese Cake Factory, a leader in the “casual dining” business through its use of automation and carefully engineered kitchen work processes in all of its  restaurants.  Each kitchen is precisely laid out to the same floor plan, chefs cook each dish to exacting specifications that are the same everywhere and time and motion management are ruling principles.  But the key is the kitchen manager, who inspects each dish before it goes to the customer, rates it, and ensures any flaws are corrected.  This is a “best practices” model that does not permit variations according to the idiosyncrasies of a chef – it may not reach the sublime heights of an Emeril Lagasse, but it ensures against burnt toast or overdone steak.   And it provides good, $15 entrees.

Gawande then examined emerging medical practices at places like Brigham and Women’s Hospital (BWH) in Boston.  At many large and busy hospitals, you may encounter a half-dozen different physicians giving conflicting diagnoses and instructions, tests may be unreported or ignored, quality of care by the staff irregular, etc., etc.  Gawande counted 63 different personnel involved in his mother’s care during a recent knee procedure.  The medical profession is following what is known as a traditional “craft” model.  Doctors are self-employed and view themselves as providing a unique product using techniques, methods and materials unique to them. Major improvements in treatment in the medical profession take, on average, more than 15 years to become wide spread.  The results of this system can be lovely, but they are error prone and expensive.  At BWH, in the orthopedic surgery department, they have begun using instead a “best practices” model for knee surgery.  Specified common steps are required for all anesthesias and post-operative regimens, acceptable surgical practices are spelled out, and medical devices must be from a list of the ten least expensive devices (studies have shown no real differences in effectiveness between knee devices varying widely in cost, but each doctor, until now, had their own “pet” device).  When doctors informed their suppliers of the “ten cheapest” requirement, the reductions in price were remarkable.

The results at BMH were revealing:  length of stay was reduced by a day, patients’ pain levels cut almost in half, and measures such as distance walked, stair-climbing ability, standing ability, etc., improved about 50 percent.   And just the reduced stay by itself saves an average of $2000 per patient.  The “best practices” approach is being tried in different specialty areas at hospitals across the country, and there, too, results can be startling.  At the University of Michigan Hospital, for example, standardized “best practices” in blood transfusion produced a reduction in need for transfusion of 31 percent and a reduction of costs of $200,000 per month.  “Mass-medicine” chains are beginning to emerge across the country.  But, as Gawande reports, the pace of change in medicine can be glacial.

Resistance to change stems in large part from the traditional “craft” view of the hospital as the physician’s “workshop”, where everything is done for the convenience of the physician, not the patient.  That can be seen daily at any hospital, where very ill patients are waked at 3am for tests, so that results may be ready for the physician when he arrives.  In the emerging model at its best, the hospital is viewed as “a temporary residence for frail and very ill people”, and all activity is oriented to providing for their best possible care.  We now are at a juncture in medicine somewhat like the emergence of factories replacing cottage industries during the Industrial Revolution.   Only 25 percent of physicians report themselves as self-employed anymore, and a growing number of hospital “chains” have their quality of performance monitored electronically at a distance.  Resentful employees sometimes are reluctant to accept standards they were never trained to honor.  At this stage, good things may be either gained or lost in the change process.  Better quality at lower cost is the goal.  But in the process, either patient care or health professional job satisfaction may be at risk, also.  One danger is that health entrepreneurs may turn lower costs into higher profit margins instead of gains for the patient.  In the early industrial revolution, fringe industrial zones where horrible work and living conditions prevailed were sometimes known as “hell’s kitchens.”  We can tolerate nothing like that for treatment of the ill.  Perhaps it is appropriate that ultramodern, well-managed kitchens producing fine products to exacting standards become our new model for medicine.

The Search for The Golden Middle Way

I have some favorite exotic words that I savor, lifted from other languages – words with magic in them, words that spark the imagination, words of charm and elegance, words of comfort and hope.  I, for example, like the French word “papillon”; it’s so much more charming than its English translation, “butterfly”, possibly because I don’t find it as common a term as a native French speaker might.  But my favorite word of all time would have to be “sophrosyne.”  It rolls off the tongue with such elegance, mingled with charm; but above all it contains such mysteries that understanding it is a life-long quest.  It is an old Greek word that is essentially untranslatable.  Or rather, its translation is a project that must be accomplished within each person, for it denotes not a thing, but an approach to living.  Plato describes it in his dialogue, Charmides.  It represents a healthy-minded way of life characterized by harmony, moderation and avoidance of unproductive extremes, and was perhaps the primary social goal of ancient Greece. It was first translated for me as “the golden middle way is best.”  The closest approach to a short translation might be to take the two phrases carved on the entrances of the temple of the Oracle of Delphi, “Know Thyself” and “Nothing to Excess”, and to stir them in your head until you get it right.  That’s been my goal all my adult life.

My yearning for sophrosyne was heartened recently by two reviews, one a really fine article on Sunday, September 2, by Stephen Pearlstein in the Washington Post, the other the final chapter in David Rothkopf’s book, Power, Inc.  That the paradigm shift in economics that I mutter about from time to time is well underway is evidenced by both.  They reveal through many sources a general perception by conservatives and liberals alike that American capitalism is severely ill, and requires substantial treatment for its restoration to health. They further reveal that the search is underway for some middle way to accomplish that.  The general recognition that other alternatives such as communism (itself an intellectual extreme of the 19^th century), will not resolve the issues shows a healthy-minded regard for realities that has sometimes been lacking in the past.

Pearlstein, in his review, focuses on a variety of diagnoses of the illness favored by different experts from right and left.  All seem to agree, for starters, that, in Pearlstein’s words, “A pure market economy is an ideological fantasy; even the freest markets operate in a framework of laws, infrastructure, institutions and informal norms of behavior in which government is heavily implicated.” In other words, all sides are beginning to reject the intellectual excesses of pure free market theory. The most extreme conservative, Edward Conard, a funder of Mitt Romney, argues that the illness is insufficient income inequality, while, at the other end of the spectrum, Nobel Laureate Joseph Stiglitz argues that the problem is an inequality gone wild that has led to governance by plutocracy.  Rather like the blind men and the elephant, various experts argue that the problem is too much promotion of business rather than the market itself (Luigi Zingales), or reliance on the performance of financial expectations rather than the product market itself (Roger Martin), or lack of adequate regulatory infrastructure (Jeffrey Sachs.), or lack of accounting for what Stiglitz calls social capital, Zingales calls civic capital, and Martin calls the civil foundation.

Rothkopf focuses not on the diseases of capitalism but on real world variations of capitalism that are being tried in countries around the world.  He makes a persuasive argument that American laissez-faire capitalism, itself a fossil of the 19^th century without the built-in  means to manage stateless supercitizens like multinational corporations, is unable as it stands to deal with the stresses of globalism, but that the real question is which form of capitalism can do better.  In addition to the American lightly regulated laissez-faire form, he posits four major competing models: Chinese state-managed capitalism, German and Scandinavian Eurocapitalism, Indian and Brazilian Democratic Development capitalism, and Singapore’s Entrepreneurial Small-market capitalism. Each country’s model has features tailored to its culture and stage of economic development; what they all have in common is a much larger role for government than that found in the U.S. 

Rothkopf’s vision is of a world in which government and business partner rather than compete.  Their missions can be to a large extent complementary, government to provide the “whole-person” needs of its citizenry, business to provide the goods and services sought by customers. Each has major goals and capacities the other simply cannot have. The 21^st century task is to find a new proper balance, and that will require abandonment of the ideological excess of the past.  The golden middle way is best.