In Honor of Today's Health Care Summit

Morton Kondracke has a piece in today's Roll Call that argues for "incremental" reform of U.S. health care policy. I offer it in the spirit of "getting there from here," a la Atul Gawande, on the occasion of today's events at Blair House.

Actually, there's another thoughtful piece on health care policy in today's Roll Call. Written by Rep. Darrell Issa (R-Calif.), it's on tort reform. Together, the two columns serve to remind us that the states often have served as useful laboratories for policy reform in the United States.

Friending the Lonely Crowd

I have discovered to my chagrin that the Glenn Fellows--or some portion of them, anyway--are aware of my dalliance with Facebook. I put it this way because I don’t entirely approve of Facebook, and I almost never use it to report my own random activities or idle ruminations (I have a blog for that). Frankly, I find Facebook useful mainly as a means of unobtrusive parental surveillance, the efficacy of which is inversely related to my level of overt activity. At one point, my children had to approve my request to “friend” them. In doing so they must have known that they were devaluing the currency, but at this point I suspect they have forgotten that their old man is lurking in the shadows.

One oft-lamented feature of Facebook is its habit of using “friend” as a verb, and that is only one of the ways in which Facebook has corrupted the language. Even more objectionable, in my view, is when the site declares that So-and-So has updated “their” Facebook profile. This infelicity no doubt stems from the engineering challenge inherent in recognizing a distinction between male and female Facebook members, English lacking as it does a neutered version of the singular personal pronouns “his” and “her.” Perhaps it’s time to borrow from Finnish its versatile, trans-gendered, third-person pronoun, hän.

It was in Finland, in fact, that I first encountered Facebook. Oulu, the home of the university where I taught as a Fulbrighter in 2006, is a city of about 110,000 souls in what is known as Finland’s Silicon Valley. (In the late 1980s, when perestroika was in full swing and Mikhail Gorbachev visited Finland, he caused a sensation by electing to visit a Nokia factory in Oulu instead of the Lenin Museum in Tampere.)

I created my own Facebook account because I thought it would be rude to resist the overtures of my students at the University of Oulu. Over time, I noticed that many of my Finnish “friends” were migrating to LinkedIn, another social networking Web site designed more explicitly to serve professional purposes, and another place for yours truly to lurk.

Perhaps because I was introduced to social networking overseas, I was unaware that Facebook was founded as recently as 2004, and that it began as an extracurricular and strictly intramural activity at Harvard University. This I learned from a recent issue of The New York Review of Books, which features an insightful article by Charles Petersen, who argues that the secret to Facebook’s success lies in the way that it exploits the dynamics of social stratification.

In his explication of Facebook’s “snob appeal,” Petersen refers to the concept of “position taking” associated with the French sociologist Pierre Bourdieu. It has to do with the branding and marketing of self, to wit: “When Facebook had been limited to a few elite schools, listing Beethoven among one’s ‘favorite music’ could easily stand as a statement of aesthetic discovery. This was due to that other salutary fiction of an elite meritocratic education: that class distinctions disappear, to be replaced by pure judgment and analytic reason.” To me this has the ring of truth. It also is reminiscent of a classic work of sociology that, these days, is more often cited than read. I refer to David Riesman’s The Lonely Crowd (New Haven: Yale University Press, 1950), the most popular work of modern sociology--1.4 million copies sold--ever.

The Lonely Crowd attempts to demonstrate that large, impersonal societal forces tend to call forth certain character traits or personality types. In medieval times, a relatively stable and static society favored pious and traditional individuals. The industrial age, by contrast, was all about production and destruction. Its “self-made” men were driven by internalized values; Riesman refers to them as “inner-directed.” In an age of consumption, by contrast, it is appropriate for individuals to look outside themselves when they engage in “position taking.” These “other-directed” souls become masters of the art of exchanging tastes with their peers, though that condemns them to being forever buffeted by the fickle winds of fashion. If inner-directed people have gyroscopes that govern their movements, other-directed people are propelled by highly sensitive radar systems. That’s why they join Facebook, and then maybe they worry about what inadequacies they are revealing in the process.

That the young David Riesman served as law clerk to Mr. Justice Brandeis, the obsessive collector of facts that would usher in a meritocratic age, is probably no coincidence. That The Lonely Crowd touched a nerve in the American psyche is a testament to the power of Riesman’s analytical skills. The popularity of social networking sites such as Facebook also may be a measure of the insecurity that other-directed people feel about their “position taking,” and of what another great sociologist, Robert Nisbet, called the “quest for community.” Then again, come to think of it, this may have nothing whatever to do with the American political culture, but rather, with the small-d democratic soul wherever it may be found--and an extremely egalitarian version of it is to be found in Finland, as matter of fact. But that’s another story.

Health Care as the New Social Security

Diane Auer Jones is a scientist with a long and distinguished record of public service. She graduated summa cum laude from Salisbury University and earned a Masters degree in biology with a minor in chemistry from the University of Maryland Baltimore County.

Ms. Jones has held positions with the government, both as a career civil servant and as a political appointee. She has served as a program officer with the National Science Foundation. She has worked on the Hill as a professional staff member for the Research Subcommittee of the U.S. House of Representatives Committee on Science. From 2003 to 2005, she served as Princeton University’s Director of Government Affairs, but then was called back to public service as Deputy to the Associate Director for Science in the White House Office of Science and Technology Policy. Later, she was nominated to be Assistant Secretary for Postsecondary Education and was confirmed by the Senate on August 1, 2007.

Currently, she is the president and CEO of the Washington Campus, “a non-profit organization dedicated to educating current and future business leaders about the federal policy-making process, the impact of policy decisions on business strategy and success, and the ways in which business and community leaders can effectively and ethically influence policy decisions to support healthy communities and a robust national and global economy.”

Ms. Jones is one of the most interesting people you will ever meet. Through The Chronicle of Higher Education, she maintains a fascinating blog. There, she has written about living with her husband on an old boat that is moored on a city-owned dock in Washington harbor.

Here, she has written extensively and very movingly about child-rearing and home-schooling.

And she has written very thoughtfully about how health care reform, should it come to pass, could prove to be another government Ponzi scheme. That will be the subject of her presentation at our next policy salon, scheduled for Tuesday, February 23, at 6:30 in our WISH classroom at 239 Massachusetts Avenue, N.W.

To prepare, the Glenn Fellows are reading a 2007 Congressional Research Service comparative study of health care spending in some thirty OECD countries.

They also will have read Atul Gawande’s oft-quoted article from the January 26, 2009, issue of The New Yorker.

Readers who are really interested in this subject might also want to look at this piece, by Jerome Groopman in The New York Review of Books.

Glenn Fellows at Embassy of Finland

A Diplomat's Progress--Book Review

Next Tuesday evening’s speaker in the Glenn School/WISH policy salon is Henry Precht, a retired American diplomat. Mr. Precht was born in Savannah, Georgia, and educated at Emory University. He joined the foreign service in 1961 and served in U.S. embassies in Rome, Mauritius, Iran, and Egypt. He was the Department of State’s Desk Officer for Iran during the revolution and hostage crisis when the Shah was overthrown, and he was deputy ambassador in Cairo when Anwar Sadat was assassinated. His nomination by President Jimmy Carter to the post of U.S. ambassador to Mauritania was vetoed by Senator Jesse Helms.

After leaving the foreign service, Mr. Precht served as president of the World Affairs Council in Cleveland, Ohio, where he also taught at Case Western Reserve University. A few years ago, he published a work of fiction called A Diplomat’s Progress, a series of vignettes about a State Department official named Harry Prentice. It is an engaging work that reveals, as one reviewer has put it, the “grittier side of embassy life with a wry sense of humor and a bit of an edge.” To the extent that the work is autobiographical, A Diplomat’s Progress is rather remarkable.

For one thing, the “grittier” aspects of diplomacy are portrayed “warts and all.” In one of the vignettes, the young Harry Prentice and his wife attend a dinner party at the home of the foreign minister of Mauritius, during which the lecherous host assaults the drunken daughter of the Japanese ambassador. In a vignette set in Egypt, the protagonist must tend to a dead body and a great deal of drug money. In “Caviar and Kurds,” he unwittingly leads the Shah’s secret police to an underground freedom fighter named Hassan, whom Prentice finds hanging from a lamppost the next day. In this account of embassy life, no good deed goes unpunished.

Most remarkable as an autobiography—and surely it must be regarded as partly that, in spite of the veneer of fiction—is the book’s unflattering portrait of its protagonist. Throughout A Diplomat’s Progress, Harry Prentice’s diplomatic efforts are undone by either his naivete or his cynicism. Typically, the reader is given a glimpse of a career diplomat preoccupied, not with the national interest, as one might suppose, but rather, with his own career advancement. At one point, for instance, Prentice seems to have been the unwitting accomplice of a Palestinian terrorist. What does he do about it? He gets up on the middle of the night to compose a somewhat Bardachian “balance sheet of possible courses of action.” There appear to be two:

First, the natural inclination of every Foreign Service Officer: Do nothing. Wait on events and react as necessary and as seems prudent at the time. . . . Alternatively, I could report my suspicions to the police. Playing it straight and admitting wrong might be partially redeeming. The key word was “partially.” The embassy surely would be informed and handle my future as if it had no value. The same with the Israeli authorities. I had to face it: Only I really cared about my future, not any American or Israeli career-building bureaucrat.

During his posting to Cairo, Prentice is asked to interview a Sheikh who might have been in a position to influence the extremists holding a number of American hostages in Beirut. Prentice’s efforts fail. “But never mind,” seems to sum up his reaction. “I could only hope that someone—the ambassador or an unknown friend in the department—would make an excellent report of my performance for my file.” The adventure, he concludes, “just might be a turning point—upward—in my career.” On the basis of the evidence provided by the author, the judgment handed down by Prentice’s first wife seems just: He has “a pretty good soul, even though sometime it seems quite lost in the bureaucratic maze.”

I intend to adopt A Diplomat’s Progress as required reading for the spring 2010 seminar in public policy making. And I will hope that the author will join us at another policy salon to talk about his admirable work of fiction.

Muddling Through Snowmageddon

You may have heard that the capital of the free world and weather wimpiness closed down this week due to a succession of paralyzing snowstorms. One notable exception was the Glenn School's Washington office at 239 Massachusetts Avenue, N.E., where the Glenn Fellows gathered for their weekly seminar while the worst of Wednesday's blizzard howled outside. As a result, the Washington Academic Internship Program might be the only enterprise in town that is not severely behind in its work (though we did have to cancel a policy salon and a scheduled guest speaker).

So, here is a shout-out to an intrepid class of Fellows who made the trek from their townhouse on Constitution Avenue, and to program coordinator Laura Allen, who lives a few blocks away on Jenkins Hill. Our little triumph in the face of adversity was also made possible by the fact that your faithful blogger checked into a nearby hotel the night before.

After class, I headed to my home in Alexandria without much of a plan as to how I was going to get there. As I walked past Union Station, I noticed there was not a single cab in the taxi stand out front--not a good sign, it seemed to me. Then I learned that Metro was operating only underground, which meant that the Yellow Line bridge across the Potomac and the Blue Line tracks through Arlington Cemetery were both out of service. The only way of getting to Virginia was to take the Orange Line, which burrows under the river at Rosslyn. So that's what I did, and I rode it all the way to Ballston. After working my cell phone in the lobby of the nearby Arlington Hilton, I was able to connect with an entrepreneurial cabbie who agreed to pick me up in his 4-wheel drive SUV. He dropped me at my front door a little while later. Total elapsed time: three and a half hours.

The highlight of my adventure in improvised commuting occurred right at the beginning, while plowing into the teeth of blinding wind gusts and feeling--thanks to my suitcase, backpack, and laptop computer--like an overloaded pack mule. While trudging down the middle of Massachusetts Avenue, I encountered what I thought might be one of Washington's legions of homeless men. He looked up as we passed each other, then abruptly stopped. "THE Ohio State University," he cried out, reminding me of my headgear (pictured above). "Go Bucks," I replied through a hearty chuckle. And then, we went our separate ways.

The Brief against Brandeis

There is no denying that the long-lived Louis D. Brandeis (1856-1941) was an American treasure. The son of Eastern European Jewish immigrants, he graduated at age 20 with the highest GPA in the history of Harvard Law School. He made his reputation as a Progressive lawyer and as a leader of the worldwide Zionist movement. In 1916, he was nominated for a seat on the United States Supreme Court by President Woodrow Wilson.

The definitive biography of Justice Brandeis has just been published. The work of Melvin I. Urofsky of Virginia Commonwealth University, the 955-page tome is getting rave reviews. One, written by Anthony Lewis, recently appeared in The New York Review of Books. Brandeis, according to Lewis,

was intensely interested in facts. His law clerks did research on facts as much as law. When the Court considered a case on presidential appointment power that involved the 1867 Tenure of Office Act, Brandeis had his law clerk, James M. Landis (who became the dean of Harvard Law School), go over the Senate journals of 1867 to see what the views of the times were. Landis spent months in the Library of Congress reading the journals page by page.

Brandeis even tried to get Justice Holmes, who read philosophy in the original Greek, to take more interest in facts. He urged Holmes to spend the summer break reading up on working conditions and visiting the textile mills in Lawrence, Massachusetts. A year later Holmes wrote Harold Laski that “in consideration of my age and moral infirmities, [Brandeis] absolved me from facts for the vacation and allowed me my customary sport with ideas.”

Brandeis’s obsession with facts continues to reverberate through American law and politics. Consider, for example, what Wikipedia has to say about the term “Brandeis brief,” which refers to

a pioneering legal brief that was the first in United States legal history to rely not on pure legal theory, but also on analysis of factual data. It is named after the litigator Louis Brandeis, who collected empirical data from hundreds of sources in the 1908 case Muller v. Oregon. The Brandeis Brief changed the direction of the Supreme Court and of U.S. law. The Brandeis Brief became the model for future Supreme Court presentations in cases affecting the health or welfare of classes of individuals. This model was later successfully used in Brown v. Board of Education to demonstrate the harmful psychological effects of segregated education on African-American children.

This week members of the Winter 2010 class of Glenn Fellows are reading essays and court cases organized around the theme of fact-finding and its jurisprudential consequences. As they read these materials, my hope is that they will perform a little thought experiment by asking themselves about the facts that the Court recognized in Muller, Brown, and Roe v. Wade, and whether it would have been wiser for the Court to base its rulings on strictly legal grounds, rather than conducting fact-finding expeditions.

In Brown, for example, the Supreme Court had the option of resurrecting Justice Harlan’s stirring dissent in Plessy v. Ferguson, which would have meant striking down school segregation on the grounds that “our constitution is color-blind,” rather than on the less substantial grounds that segregated schools inflict psychological damage upon African-American children. Likewise, in Roe v. Wade, there were a number of precedents that the Court, rather than wrestling with the question of fetal viability and formulating a national “right of privacy,” might have used to finesse the issue of abortion by declaring that public health is a matter that the Constitution, through the Tenth Amendment, reserves to the states. I hope the Fellows will ask themselves, in short, whether the Brandeis brief, so well intentioned, has inflicted a great deal of legal and political harm in the century since Muller v. Oregon.