Attention Conservation notice [w. apologies to Cosma Shalizi, from whom the phrase is stolen]: What follows is what in the newspaper business used to be called a thumbsucker — in this case, yet another way to see the GOP as not just wrong, but so steeped in an error of principle, of worldview, as to be irredeemable. It’s got a nice anecdote in it, lifted from someone else, but there’s no need to read on if you don’t like such stuff. Which last is, of course, a PGO of its own. See: I’m fractally unnecessary.
I don’t recall an election in which two such strikingly opposite visions not just of the United States, but of human nature, so clearly set the stakes. Let me get to part of what I see by some indirection:
I’ve been doing a lot of reading lately, with (thanks to the exceptional luxury of a sabbatical) much more to come. I’ve started out by trying to catch up on some of the political books I’ve missed recently — and I’ll probably have some thoughts to share about Christopher Hayes’ Twilight of the Elites before long. I just finished Michael Sandel’s What Money Can’t Buy too, though I found it perfectly interesting, but less compelling than Hayes’ book for a number f reasons. Still that’s a philosopher’s take on the same problem explored in the book that prompts this post, Virginia Sweet’s God’s Hotel.
Sweet’s work is a memoir of her doubled journey as a doctor at the last surviving American big city alms house, San Francisco’s Laguna Honda Hospital, and as a scholar trying to understand Hildegard von Bingen’s spiritual and practical approach to her form of medicine. Sweet’s book has been enthusiastically received, and I can see why, though it didn’t move me in quite the same way it seems to have for some others. It’s Sweet’s lack of struggle that gets me, I guess; there’s no doubt in my mind she did sweat and suffer over her 20 years caring for the poor, but in recollection the life unfolds with an easy rhythm, no matter how tumultuous the world around her might be.
That said, though, the core message of the book is that there is a profound difference between health care and medicine, and that we ignore the virtues of the art and practice of medicine at our great cost. As one of her reviewers notes, this is a subversive thought: Medicine is a craft, performed one-on-one, slowly…
…while health care is a commodity, something that can be abstracted and, in a sense, mass-produced:
Sweet doesn’t romanticize much, and she never suggests that she, her patients or anyone should trade modern medicine and its quantifying tools for Hildegard’s actual practice. But she makes the point a good historian of ideas should: one studies the past not to recreate it, but to understand what its thoughts meant to its thinkers — and then what meaning those same insights may have in the radically different time and place in which the historian lives. Use Hildegard as a tool to probe what the consequences may be if we commit ourselves to life within Mitt Romney’s vision of America.
In that frame, here’s just a brief passage, in which Sweet describes her even-tempered reaction to the consequences of an infestation of her hospital by the kind of consultants that Romney’s parent firm Bain produces:
Above all, the [consultants'] report said, they’d been amazed by the anachronistic presence of a head nurse on every one of the hospital’s thirty-eight wards. As far as they could tell, this head nurse did nothing but sit most of the day in her chair in the nursing station. She answered the phone, to be sure, and kept the charts tidy; now and again she when out and inspected a patient with one of her nurses. Also, she made coffee, kept the TV room and lounge neat, organized patients’ birthed parties and in general, did whatever needed to be done. It was a pleasant job [the consultants] observed, helpful, no doubt, but one hundred years after Frederic Taylor’s description of scientific management, and in a time of tightening health-care budgets, such a use of a skilled RN was excessive. They’d even seen one head nurse whose only task was knitting. That’s right, a head nurse who, as far as they could tell, spent all day in her chair at the head of her ward, doing nothing but knitting blankets and booties for her patients.
So their main recommendation was to change the nursing structure at Laguna Honda. The job of head nurse should be eliminated. Instead, a new nose manager position should be created, where each nurse manager would be responsible for two wards instead of one. She would no longer answer the phones, tidy the charts, or help out with patient care. Rather she would manage the staff…
It was a lesson in the inefficiency of efficiency. And the best way to explain is to tell you about the head nurse who knit….[hers] was a little-old-lady-ward, with thirty-six little old ladies — white-haired, tiny and old — and sure enough almost everyone one was wrapped in or had on her bed a hand-knit blanket; white and green, white and red, white and yellow. And there was the head nurse sitting in her chair at the nursing station, answering the phone, fussing with the charts, observing her charges, and knitting one of the few blankets remaining to be done.
I’ve thought a lot about those blankets since the disappearance of the head nurses and their well – run neighborhoods of wards. About what the blankets meant and what they signified. And here’s the thing: The blankets made me sit up and take notice. Made me pay attention. Marked out that head nurse as especially attentive, especially present, especially caring. It put me and everyone else on notice.
It’s not that the ladies for whom they were knitted appreciated them or even noticed them. Who did notice was — everyone else. Visiting family noticed. Looking down the center aisle, they saw two rows of little white-haired ladies — their mothers, great-aunts, and sisters — each lady bundled up in a bright, many-colored hand -knit blanket. They also saw that each had makeup on, and her hair done and her nails polished by the nurses who knew that, down at the end of the ward, was the head nurse, knitting. The Russian ambulance drivers noticed, when they rushed onto the ward to pick up one of the ladies…Even the doctors noticed. The blankets put us all on notice that this was a head nurse who cared.
…those blankets signified even more than attention and caring. The click of that head nurse’s knitting needles was the meditative click of — nothing more to be done. Although it had seemed to [the consultants] that the head nurse did nothing except knit, that nothing was, as the Tao says, what the Superior Man does when everything that was supposed to be done has been done.
We did get used to the new system eventually. The remaining staff learned to answer the phones, tidy the charts, talk to families, help the doctors, survey the ward and support one another at the same tim they were looking on the computer or filling out the forms that the new nurse managers created. But the new system had a cost. It was stressful. After the head nurses were cut in half, there were more illnesses and more sick days among the staff; there were more injuries more disabilities, and earlier retirements. Among the patients there war emore falls, more bedsores, more fights, and more tears. And this, in the broader scheme of things — even economics — is not efficient.
…The [consultants'] report taught me not only the lesson of the inefficiency of efficiency. It also taught me the lesson of the efficiency of inefficiency.
Because it wasn’t just the tasks of the head nurse that fell by the wayside with [the] recommendations. It wasn’t even their watchful re-creation of neighborhoods within the village of the hospital. It was the time they had, the unassigned time, that not only belonged to them but spread itself to all the staff — doctors included. That unassigned time, as inefficient as it seemed to be… turned out to be one of the secret ingredients of Laguna Honda. With the elimination of the head nurses, so economical on paper, some of that extra time was also eliminated, and with it, some of the mental space to focus and care. There was, I discovered, a connection between inefficiency and good care…
I don’t want to romanticize here, any more than Sweet does through her long narrative. To channel my inner Freud, sometimes the old ways of doing stuff really are outmoded. No one who has recently spent four years in academic administration needs to be reminded of that.
But Sweet’s point is one I’ve been thinking of more and more as each Bain vulture capitalism story makes its way in and out of the Look! Shiny! media narrative. Sweet mentions that the consultants who got rid of half of the head nurses shifted $2 million in the budget. They collected $200,000 for their recommendation — an agreed 10% bounty on all “savings” their study produced. They correctly determined an individual inefficiency, and missed, in Sweet’s account, the systemic advantages of what seemed to their analytical framework, their faith, to be an obviously flawed system.
And so it goes throughout the current GOP worldview. We know that the private sector is the GOP solution to (putative) problems in the public schools [paywall] by selecting the right measurement criteria. Bobby Jindal can determine the cost of libraries, but not the cost in money or possibility of their loss. The number wins; the uncertain future weighs for nought. The usual catchphrase for all this is privatizing profit and socializing risk — which is what the GOP seeks for social capital as much as the financial kind. Hence the stakes of this coming election.
But beyond that pretty familiar notion, what came to front-of-mind as I read Sweet’s story was the reminder, if any were needed that the basic worldview of the two sides in this election are not the same, for all the overlap of interest and elite corruption and all that the circular firing squads of the left can (sometimes accurately) describe. I said this was meta, and it is, and I should probably let y’all get back to your Saturdays. But behind the consultant’s technical apparatus is a vision of a world of individual action and reaction. Cut here, save the money, Profit!
Taken to the level of politics and national elections, it’s a vision (sic!) of a country best understood as an assemblage of 300 million individuals. Hence, among the adherents of this view, the furor over the suggestion that business folk had any help building their businesses.
If you think that such a view of the lack of connection between one person’s endeavor and the next is the way to educate a population, receive health care in a timely and useful fashion, to innovate, then the GOP is for you. If you think we live in society in which individuals gain freedom of opportunity and access to experience supported by the links between the lives of all those 300 million — if you inhabit reality, that is — then we need to destroy the current GOP root and branch, now and for the forseeable future.
Put another way: we need to recall that I didn’t build this blog…without the internet, without its readers, without…you get the idea. ;)
And that’s enough meandering. I’ve just finished my next, post-Sweet book in this orgy of reading, Elaine Pagels, Revelations. Interesting, culminating in a very good explanation of what from my perspective I read as the reason Isaac Newton so excoriated what he saw as the theft of Christ’s church by Athanasius, his imperial patrons and his allies. Not sure what to grab next. No matter. What a joy it is to read and read and read…
Images: Jan Steen, The Sick Woman, before 1679.
Max Liebermann, The Canning Factory, 1879.