LETTERS FROM THE GLOBAL PROVINCE
Please Lord, Some Benign and Salutary Neglect, Global Province Letter, 11 September 2013
Who strive - you don't know how the others strive
To paint a little thing like that you smeared
Carelessly passing with your robes afloat,-
Yet do much less, so much less, Someone says,
(I know his name, no matter) - so much less!
Well, less is more, Lucrezia.
-- Robert Browning, Andrea del Sarto
Daniel Patrick Moynihan. For the life of us, we cannot tell you why we have not memorialized the late Senator Moynihan in the Gods, Heroes & Legends division of the Global Province. He served his country long and well, did not in any way ape the ciphers who have peopled the Senate for the last 50 years, and inundated us with good humor and a fair amount of erudition.
A Democrat, he was facile enough and sensible enough to work on both sides of the aisle. In fact, under none other than Richard Nixon, he issued his famous prescription for which we most remember him. In 1970, Moynihan wrote a memo to President Nixon saying, "The time may have come when the issue of race could benefit from a period of 'benign neglect.' The subject has been too much talked about. The forum has been too much taken over to hysterics, paranoids, and boodlers on all sides. We need a period in which Negro progress continues and racial rhetoric fades."[1 He was not advocating that Government neglect minorities, only that often the poor and disadvantaged are helped more when one turns off the bombast.
Salutary Neglect. In the present day, cutting off flagrant speechifying is not enough. We need salutary neglect, but a 21st century variety. Originally it described the light-handed enforcement of Parliamentary law in the American colonies of the 18th century. In the present day, we require less-doing-of-practically-anything by all the institutions of society, not just government:
Salutary neglect is a term used in the American history, referring to an unofficial and long-lasting 17th- & 18th-century British policy of avoiding strict enforcement of parliamentary laws, meant to keep the American colonies obedient to England.
The term comes from Edmund Burke's "Speech for the Conciliation with the Colonies" given in the House of Commons March 22, 1775:
"That I know that the colonies in general owe little or nothing to any care of ours, and that they are not squeezed into this happy form by the constraints of watchful and suspicious government, but that, through a wise and salutary neglect, a generous nature has been suffered to take her own way to perfection; when I reflect upon these effects, when I see how profitable they have been to us, I feel all the pride of power sink, and all presumption in the wisdom of human contrivances melt, and die away within me." (Burke p. 186)Prime Minister Robert Walpole stated that "If no restrictions were placed on the colonies, they would flourish".[1] This policy, which lasted from about 1607 to 1763, allowed the enforcement of trade relations laws to be lenient. Walpole did not believe in enforcing the Navigation Acts, established under Oliver Cromwell and Charles II and designed to force the colonists to trade only with England, Scotland, and Wales, the constituent countries of the British homeland as well as Ireland, then in personal union with Kingdom of Great Britain, as part of the larger economic strategy of mercantilism. Successive British governments ended this non-enforcement policy through new laws such as the Stamp Act and Sugar Act, causing tensions within the colonies.
Dying Peacefully. Some 50 years ago we heard a senior hospital official pose a vexing question to a very respected cancer researcher. “You know these patients are dying. Why don’t you just let them go as painlessly as possible? Why are you cutting them up at the last, even if it gives you insight into their affliction?” The thought was that scientists and medical bureaucrats should leave well enough alone.
We learn that “about a quarter of Medicare’s $550 billion annual budget pays for medical treatment in the last year of life. Almost a third of Medicare patients have surgery in their last year of life, and nearly one in five in their last month of life. In their last years of life, one-third to one-half of Medicare patients spend time in an intensive care unit, where 10 days of futile flailing can cost as much as $323,000. Medical overtreatment costs the U.S. health care system as estimated $158 billion to $226 billion a year.”
In “A Full Life to the End,” we learn that these costs don’t need to be and that the living death many end-of-life patients endure does not have to be. In fact, one could suggest that the Hippocratic oath and several tenets of religious faith are violated as doctors poke away at patients on their last legs. The mother of the author of this article—Katy Butler—died right:
My mother died shortly before her 85th birthday, in a quiet hospital room in Connecticut. One of my brothers was down the hall, calling me in California to say, too late, that it was time to jump on a plane. We were not a perfect family. She did not die a perfect death. But she died a "good-enough" death, thanks to choices she made earlier that seemed brutal at the time.
She slept in her own bed until the night before she died. She was lucid and conscious to the end. She avoided what most fear and many ultimately suffer: dying mute, unconscious and "plugged into machines" in intensive care; or feeling the electric jolt of a cardiac defibrillator during a futile cardiopulmonary resuscitation; or dying demented in a nursing home. She died well because she was willing to die too soon rather than too late.
Valerie Butler died in her own bed, not in the clutches of horrific, unnecessary, degrading healthcare. Our healthcare system is amuck, perhaps because we are relentlessly doing the wrong stuff. The Dartmouth Atlas of Healthcare, by implication, has revealed that a huge amount of what we do in the name of medicine is not justified by the results. But even this wonderful continuing body of research does not begin to deal with the economic drain, the patient suffering, and the moral breakdown such waste visits upon America. In other words, we need to stop doing what the high potentates of medicine believe to be their solemn duty.
Cellphone Disaster. Likewise, many other products and services offered to Americans are flawed and hugely expensive, and visit collateral damage on the rest of the economy. A favorite example of ours is the cellphone and cellphone systems, which are essentially dominated by two and one-half unregulated monopolies that offer expensive phones, outrageous usage charges, poor reception, and frequent breakdowns.
We ourselves recently bought an Apple iPhone on a Saturday morning but returned it early Sunday morning. Its small screen turned texting into a nightmare. And its address book feature not only did not capture all the numbers on our previous phone but it invaded, without our permission, our computer address book. It was too expensive and too unstable. Dare we say it? The revered iPhone and the Androids and the rest of the digital contraptions foisted on the American public are simply lousy products.
On prior occasions, we have noted that one of our employees could call home to Indiana from Germany more cheaply than he could call from the American South. In other words, it is near impossible to make a decent call from all parts of the United States at a reasonable cost, a situation that is only compounded by the lack of, not the presence of, government control in the cellphone industry. The phones meanwhile are littered with functions we don’t need and did not ask for, so that the monopoly providers can pump up their sales, not so we can make a decent phone call. Meanwhile there are two basic operating systems for the U.S. cellphone service industry, one of which is out of kilter with standards operating in the rest of the world. We are blessed with fragile, expensive cellphones that not only cost too much but also add to the cost of doing business in these United States.
In several sectors, not just cellphones, but in banking, computers and computer software, automobiles, etc., we need to stop impregnating our products and services with useless functions and extreme fragility so that we may live a little better. This very tendency, this eagerness to charge us the moon for inherently and systematically flawed products, was the subject of our previous essay, “Systems on the Edge of a Nervous Breakdown.” In other words, we need to stop building products and services that leveraged buyout artists and Wall Street bankers adore—products with flashy outsides that are hollow at the core and so, suck the consumer dry.
Big Problems and Little Matters. We had a long breakfast the other morning with the engaging and societally aware Tom Davenport who is one of the leaders in America of putting data, large masses of data, to work in order to solve the most complex problems of business and society. We had previously noted that Mr. Davenport is on the right issue—little old America has become a society of huge numbers and we need to learn how to deal with humongous batches of stuff. Whether we are dealing with car traffic or malaria epidemics, we need to get our arms around skillions of bits of data if we are to be in control of our destiny.
As we and Mr. Davenport ate our toast, we bemoaned the fact that the quants have put big numbers to work on small matters, not tackling the giant sort of questions that will determine whether America can take a leap forward into the future. Ay, there’s the rub. Whether we are talking about healthcare, or telecommunications, or transportation, all the brainpower is being devoted to small trivialities, putting aside the big stuff. That is why, indeed, we most need to stop doing many things, lots of things. Otherwise we will never get to the big stuff.
In sum, in 2013, less is more, and more is a lot less. In healthcare we are littered with useless, sometimes harmful, procedures. Our cellphones are caked with a raft of functions, but don’t offer cheap, reliable calls. With cellphones and other products, we are busy generating at top speed progressive iterations of products and services that were fundamentally flawed at inception. Can we just do the few things that count well?
P.S. This brings to mind our favorite oxymoron—Microsoft Works!
P.P.S. The wonderful Hippocratic Oath, if observed, would bind each physician to do no harm. Likewise, if we applied it to our own lives, it would cause us not to foster products and services that drain the life out of our community.
P.P.P.S. “She should have died hereafter;
There would have been a time for such a word.
To-morrow, and to-morrow, and to-morrow,
Creeps in this petty pace from day to day
To the last syllable of recorded time,
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.-----Macbeth.
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