Review: The Dawn of Everything

The Dawn of Everything: A New History of Humanity by David Graeber

My rating: 4 of 5 stars

Social theory is largely a game of make-believe in which we pretend, just for the sake of argument, that there’s just one thing going on…

This is a difficult book to review. Not only is it long and extremely ambitious, it is also a beguiling mixture of strengths and weaknesses that are difficult to untangle. To begin with, this book is not, as its title promises, a history of humanity; and considering that the book only examines the past 10,000 years, it is also not about the dawn of humanity, much less everything. Really, this book has a far more focused purpose: to dismantle the standard narrative of how humans went from hunter-gatherers to urban-dwelling agriculturalists.

The standard narrative—as found in many popular books, from Steven Pinker to Jared Diamond to Yuval Noah Harari—goes something like this: In the beginning, humans were all hunter-gatherers, living in small groups, taking only what they needed from their environments. Only the most rudimentary technologies were employed; yet there was no war, no poverty, no oppression, no office jobs, no television commercials, no taxes, no bureaucracy, no robo-calls—in short, it was a simple time.

Now, depending on whether you follow Rousseau or Hobbes, you may differ as to whether you consider such a state of affairs a paradise or a slaughterhouse, and thus you may think that the switch to city life was a fall from grace or a stairway to heaven. But both camps agree that agriculture implies hierarchy, since the extra resources freed up some members of the group to do things other than just gather food; and once there was specialization, there had to be people to coordinate the specialists—in a word, leaders, middle-managers, and bureaucrats. Thus, the egalitarian band of hunter-gatherers eventually became the walled city controlled by an oligarchy, or the great empire ruled by a monarchy, or the insurance office run by the regional manager.

The simplest way to characterize this book is that it is a long refutation of this narrative. The authors do this by citing counter-example after counter-example from the archaeological record. This is where the book is most entertaining, as a great many of these archaeological anecdotes are both surprising and fascinating. By citing this evidence, the authors attempt to show, first, that hunter-gatherers did not all have the roaming lifestyle or the total lack of social structure that is often projected onto them. Elaborate burials and, most conspicuously, large stone monuments paint quite a different story of our ancestors.

The authors go on to show that the transition to farming was not sudden, nor did it immediately lead to dramatic social changes. Many communities, they aver, practiced a kind of limited farming for centuries before they became full-time agriculturalists. Furthermore, there is no necessary connection between the switch to city life and the rise of hierarchy, or the rise of empires and the invention of bureaucracy. In a nutshell, the authors contend that the main characteristics of the modern state—centralized leadership, a monopoly on violence, an administration to carry out laws, and so on—are a kind of constellation of social features, all of which have diverse and, often, quite unrelated origins, and which only came together to form the modern state gradually. To put the matter most succinctly, then, our world of nation states was not the inevitable outcome of a deterministic process.

Now, summarizing the book in the above manner is not exactly fair. The central thesis of the book is all too often in the background, and the reader is instead swimming through a sea of examples and ideas, struggling to spot land. This is both a vice and a virtue, since many of these observations, arguments, and examples—though leading off in a thousand directions from the central path—are quite intriguing. Still, it does often feel as though the authors are trying to take on the entire world, criticizing everything from the naming of epochs in archaeological literature to the academic treatment of feminist theories of prehistory. Interesting, yes, but a little distracting.

How to evaluate the book, then? As an attack on a commonly held myth of how humans went from agriculturalists to urbanites, it is successful. At the very least, the authors convince us that prehistory is an awful lot more complex and compelling than the simple, linear narratives we often project onto it. Nevertheless, I found myself wondering to what extent this myth predominates in the academic community. After all, the direct targets of the authors’ criticism are popular writers, whose specialty is not even prehistory (Pinker, Diamond, etc.). When academia is mentioned, the authors portray researchers as so hopelessly specialized, or so beholden to prejudices, as to be unable to see the big picture. Is that true? Regardless, I do think this book has a lot to offer the interested layperson, at least. It is a successful popularization of archaeology.

Yet it would be remiss of me not to mention the obvious political motivations of the authors. Both of them anarchists, this book can be read as one long justification of their beliefs. It is as if they are saying, “See? Humans don’t have to life in states, with huge bureaucracies and oppressive hierarchies!” But I do not think this was necessarily a good rhetorical strategy for promoting their philosophy. For one, when we are considering what we should do now, today, in a sense it does not matter whether humans lived in this or that place, at this or that time, in an approximately anarchist manner. History is not destiny. What is more, the societies the authors discuss are so totally unlike our own—in terms of scale, technology, and accumulated history—that it does not seem particularly relevant, anyway. (I am not, you understand, arguing against anarchism here, only the rather heavy-handed role their sympathies played in the writing of the book.)

While somewhat overbearing, disorganized, and not altogether convincing, as a corrective to many other popular accounts of human history, this book is valuable indeed.

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Review: A Splendid Exchange

A Splendid Exchange: How Trade Shaped the World from Prehistory to Today by William J. Bernstein

My rating: 4 of 5 stars

Five or six years ago, a Christmas mix-up resulted in my brother receiving two copies of this book. Not knowing what to do with one, he simply gave it to me. In so doing, however, he disobeyed Adam Smith’s doctrine that humanity has a natural instinct to truck and barter. Clearly, a rational animal would have used it to exchange for something he himself lacked, like cinnamon or frankincense or some textiles. What a wasted opportunity.

This book is part history of, and part homage to, trade. Four hundred pages is not nearly enough space to give such an expansive topic exhaustive coverage. But Bernstein does manage to pack quite a lot of interesting tidbits into his narrative. What most struck me was how central trade has been to human history. It has caused wars of invasion, spurred on colonialism, motivated the great journeys of “discovery,” helped to spread epidemic diseases, and stimulated newer forms of economic organization. In short, the urge to turn a profit has helped to join together every corner of the world—leading to many wonderful things and quite a few atrocities, too.

After reviewing this thrilling history, Bernstein ends by examining the old conflict between free trade and protectionism—or, more concretely, low tariffs or high tariffs. It is an interesting question. Low tariffs provide a small but tangible benefit to the general populace in the form of cheaper goods; but they do so at the expense of workers displaced by competition from abroad (and vice versa with high tariffs). So what is more important, knocking off a few cents from something bought by millions or allowing a few thousand people to keep their job? The traditional answer is that the government should keep tariffs low, and “bribe” those displaced with additional support in the form of welfare and job retraining. But in practice most workers are left to fend for themselves, which can eventually create political instability if resentment grows too widespread.

Another question has to do with the development of an economy. High tariffs can be used to shield domestic industries from foreign competition, allowing them to grow to the point that they can effectively compete. But high tariffs can also preserve inefficient companies and obsolete technologies, putting a country at a long-term disadvantage. Orthodox economic logic always favors free trade, but the evidence is mixed. According to Bernstein, several studies actually found a positive correlation between high tariffs and economic growth in the 19th century. Still, Bernstein comes down in favor of free trade, not because it offers an economic miracle (he says its benefits are overstated), but because it helps to foster bonds between potential enemies. But, if you ask me, when a nation is dependent on another (and potentially weaker) country for its resources, this can easily become a powerful source of conflict.

Now, if you don’t mind, I am going to disobey Adam Smith myself and donate this book to a library.

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Review: Capital in the Twenty-First Century

Capital in the Twenty-First Century by Thomas Piketty

My rating: 4 of 5 stars

In any case, truly democratic debate cannot proceed without reliable statistics.

For such a hefty book, so full of charts and case studies, the contents of Capital in the Twenty-First Century can be summarized with surprising brevity. Here it goes:

For as long as we have reliable records, market economies have produced huge disparities in income and wealth. The simple reason for this is that private wealth has consistently grown several times faster than the economy; furthermore, the bigger your fortune, the faster it grows. As a result, in the 18th and 19th centuries, inequality was high and consistently grew: most of the population owned nothing or close to nothing, and a small propertied class accumulated vast generational wealth. This trend was only reversed by the cataclysms of the 20th century—the World Wars and Great Depression—as well as the resultant government policies, such as social security and progressive taxes. But all signs indicate that the general pattern is re-emerging, and we are reverting to levels of inequality not seen since the Belle Epoque.

This is a relatively simple story, but Piketty goes to great lengths to prove it. Indeed, the value of this book consists in its wealth of data rather than any seismic theoretical insights. Piketty is an artist on graph paper; and with a few simple dots and lines he cuts to the heart of the matter. The large time scales help us to see things invisible in the present moment. For example, while some economists have thought that the ratio of income going to labor and capital was quite stable, Piketty shows that it fluctuates through time and space. Seen in this way, the economy ceases to be a static entity following fixed rules, but something all too human—responding to government policy, cultural developments, and historical accidents.

Given the title of this book, comparisons to Marx are inevitable. Piketty himself begins with a short historical overview of the thinkers he considers his predecessors, with Marx given due credit. Piketty even concurs with the basic Marxian logic—that capitalism inevitably leads to a crisis of accumulation, with the capitalists siphoning off more and more resources until none are left for the rest of the population (with revolution inevitable). If we have avoided such a crisis, says Piketty, it is because Marx based his analysis on a static economy, not a growing one. The twentieth century was exceptional, not only because of its many calamities, but also because it saw enormous rates of economic growth, which also helped to offset the basic logic of capitalist accumulation. Growth rates have significantly slowed in this century.

In summarizing Piketty this way, I fear that I am not doing justice to his appeal. This book is at its most enjoyable when Piketty is at his most empirical—when he is taking the reader through historical trends and case studies. This is extremely refreshing in an economist. I often complain that economics, as a discipline, is needlessly theoretical, getting lost in abstruse debates about how certain variables affect one another, rather than focusing on observable data. Piketty explicitly rejects this style of economics, and puts forward his own method of historical research. This has many advantages. For one, it makes the book far easier to understand, since Piketty’s point is always grounded in a set of facts. What is more, this way of doing economics can be integrated with other disciplines, like history or sociology, rather than existing apart in its own theoretical realm. For example, Piketty often has occasion to bring up the novels of Jane Austen and Honoré de Balzac to illustrate his points.

Well, if Piketty is even approximately correct, then we are left in a rather uncomfortable situation. As Piketty repeatedly notes, vast inequality leads to political instability and the undermining of democratic government, as the super-wealthy are able to accumulate ever-larger influence. So what should we do about it? Here, the difference in temperament between Marx and Piketty is especially apparent. Instead of advocating for any kind of revolution, Piketty puts forward the decidedly wonkish solution of a global tax on wealth. The proposed tax would be progressive (only significantly taxing large fortunes) and would extend throughout the world, so that the rich could not simply hide their money in tax havens. Yet as Piketty himself notes, this solution is nearly as utopian as the Proletariat Revolution, so I am not sure where that leaves us.

As much as I enjoyed and appreciated this book, nowadays it is somewhat difficult to see why it became so wildly popular and influential. This had more to do with the historical moment in which it was published than the book itself, I suspect. The world was still reeling from the shock of the 2008 crash, and the public was just coming to grips with the scale and ramifications of inequality. Specifically, while most people tend to think of inequality in terms of income—partly, because most people do not have much wealth to speak of—Piketty’s emphasis on wealth, specifically generational wealth, added another dimension to the debate. Piketty evidently succeeded in getting his message across, since I did not find anything in this book shocking. Now we all know about inequality.

While I am no economist, it does seem clear to me that Piketty’s argument has several weak points. For one, his narrow focus on income and wealth distributions lead him to ignore other important factors—most notably, for me, unemployment rates. Further, the major inequality that Piketty identifies—that wealth grows faster than the economy, or r > g—could have used more theoretical elaboration. I wonder: How can private wealth grow so much faster than the economy, if it is a major component of the economy? At one point, Piketty argues that the super rich can afford to hire the best investors and financial consultants; but from what I understand, professional investors do not, on the whole, outperform index funds (which grow along with the economy). Clearly, there is much for professional economists to argue about here.

Whatever its flaws, Capital in the Twenty-First Century is an ambitious and compelling book that made a lasting and valuable contribution to political debate. Piketty may be no Marx; but for a man who loves charts and graphs, he is oddly compelling.

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Review: The Deficit Myth

The Deficit Myth: Modern Monetary Theory and the Birth of the People’s Economy by Stephanie Kelton

My rating: 3 of 5 stars

Deficits can be used for good or evil.

Robert Skidelsky, in his enormous biography of Keynes, remarks that economics today occupies the same situation as theology did in the Middle Ages—as a complex a priori logic that can be used to reach any number of contradictory conclusions. The more I read in the subject, the more I agree with him. To be taken seriously in politics means being able to use this logic. And yet, despite the seemingly scientific nature of this language, we seem hardly better able to pinpoint the nature of economic reality than the scholastics were able to count the angels.

I am exaggerating, of course. But I am a little distressed to find that, according to Stephanie Kelton, most economists and politicians—who already disagree with one another—are still fundamentally wrong about money, taxes, fiscal policy, and government debt. Here is another perspective to add to the mix: Modern Monetary Theory, or MMT.

Kelton begins the book by taking a page right out of David Graeber’s history of debt. Money was not invented, as so often supposed, to solve the problems of a barter economy. Instead, money and taxes go hand in hand. The argument goes like this: If you introduce a currency into a fully functioning credit economy (where people just keep track of what is owed to one another), then there is little reason why people would adopt it. But if you institute a tax payable only in this currency, and threaten punishment for non-payment, then suddenly everyone must find a way to acquire the new currency, and this means doing some work for the state.

In other words, governments introduced taxes, not to collect money (which it was producing anyway) but to compel work. And Kelton argues that this is still true today: that governments do not depend on taxes. She uses the example of a scorekeeper in a board game. The scorekeeper adds and subtracts points for other players, but they are never in need of points for themselves. Points are simply willed into existence whenever needed. Kelton argues that the US government (and other governments with what she calls “monetary sovereignty”) is in essentially the same position with regard to the US dollar. Since we use a fiat currency, any number of dollars can be willed into existence. Thus, the government does not depend on tax revenue, any more than a scorekeeper must subtract points from other players in order to stay afloat. In short, we do not have to worry about the deficit, since government debt is nothing like the debt you or I may have.

Does that mean that the government can just spend infinite money? No, Kelton says: though the deficit is not a problem, inflation may be. Too much government spending may lead to too many dollars chasing too few resources, which can cause prices to rise. Does that mean that taxes are unnecessary? Also no, according to Kelton, since, apart from compelling work, taxes perform at least two important functions. First, they remove money from circulating, thus decreasing inflationary pressure; and second, they reduce inequality, which leads to a healthier society. Yet if the government cannot spend infinitely, and if we still do need to tax, then what are we doing wrong?

To answer that, Kelton next turns her attention to unemployment. Kelton notes that unemployment is built into our economy, largely via the policies of the Federal Reserve. The Fed aims for an arbitrary level of unemployment (say, 3%) which it considers the “natural” rate. Going below this natural rate would, it is feared, cause inflation to kick in, since demand would outpace supply. But this “natural” rate is little more than a guess, Kelton argues. Even when unemployment has been very low in recent years, inflation has remained low. Indeed, in this argument Kelton seems to have been prescient, since just in August the Fed decided to change its policy of lifting interest rates once employment hits a certain level, thus paving the way for more sustained employment growth.

But Kelton has a fairly dim view of the prospects of using monetary policy to govern the economy. Instead, she thinks that unemployment should be directly eliminated using a Federal Jobs Guarantee. This is the main policy proposal of the book, and Kelton spends a good deal of time selling it. The advantages are compelling. Most obviously, unemployment is bad for people and communities, so it would be highly desirable to get rid of it. And a jobs guarantee would give workers more bargaining power, since the wage floor would rise (the jobs would pay a living wage) and the threat of losing work and health insurance would be eliminated.

Still, I admit that I was not convinced. For one, even according to MMT’s own premises, the huge increase in aggregate demand—caused by increased federal spending, eliminating unemployment, and increasing wages across the board—could cause inflation. Kelton does not really address this potential pitfall.

On a more practical level, I also have trouble imagining the logistics. Kelton describes a program that can employ anyone, anywhere, in socially meaningful jobs. But there is not necessarily the right amount of meaningful work in any given location, nor do the unemployed necessarily have the skills necessary to do this work (and re-training has its limits). I think that a substantial amount of make-work is inevitable in such a scheme. Furthermore, I can hardly contemplate the enormous bureaucracy that would be needed to administer such a program. It seems there would be just as many people making jobs as people needing jobs made for them.

The job guarantee’s major policy rival, universal basic income (UBI), has none of these practical challenges (though of course it could cause inflation, too), since it is merely paid via the IRS. Admittedly, jobs do provide social and psychological benefits that an income does not. But Kelton does not discuss UBI at all, which I thought disappointing.

At this point, the reader may be forgiven for wondering what is so new about MMT. After all, Paul Krugman—an orthodox Keynesian economist critical of MMT—has been writing for years about the mistake of thinking of the federal budget like a household budget, and the desirability of federal deficits in times of recession. The difference, so far as I understand it, brings us into dangerously wonky territory. Krugman avers that when we near full employment, a large deficit may require higher interest rates in order to avoid inflation. Kelton counters that our assumptions that low interest rates boost spending, and higher interest rates constrict spending, are actually incorrect. In other words, Krugman thinks that monetary policy can partly compensate for fiscal policy, while Kelton thinks that monetary policy is not particularly useful.

I have little to add to this, other than to remark that I can never understand why these disputes—like theology—always take the form of high theoretical debates from first principles. It strikes me that the impact of monetary policy is an empirical question that could be answered with a careful look at the historical record. But what do I know?

Well, I have done my best to elucidate this sacred mystery, but I ought to evaluate the book. Like many readers, I found the writing in this book extremely grating. The tone was somewhere between a salesperson and a televangelist—promising instant enlightenment and easy solutions—which immediately put me on edge. In fairness, when Kelton is not selling MMT but explaining it, the book can be quite fascinating. But Kelton’s insistence on treating MMT as blindingly true, and its enemies as either blinkered traditionalists or deceptive politicians, was not charming or effective. And the amount of repetition could even be condescending. By the time I reached the end, I really could not stand to hear another iteration of the central tenets of MMT. I got it the first couple times.

Whatever the flaws of the book, and whether or not MMT is an accurate picture of how the economy works, it at least makes you think about how the deficit is treated in public discourse. Anyone who reads the news cannot help but notice that the swelling deficit is only invoked when we have to pay for, say, healthcare or infrastructure; but, somehow, when tax cuts to the wealthy or defense spending are on the table, nobody seems to worry. Even if the deficit presents more of a problem than Kelton believes, it is obvious that, if anything is worth going into debt for, it is programs that benefit the public, rather than bombs or yachts. I hope that followers of Keynes, MMT, Thomas Aquinas, and William of Ockham can at least agree with that.

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Review: Lost Worlds of South America

Lost Worlds of South America by Edwin Barnhart

My rating: 4 of 5 stars

This is the last installment (well, really, the first, but I did it backwards) in Barnhart’s lecture series on Pre-Columbian archaeology. They are all quite excellent and greatly enlightening. Throughout the series, I was constantly surprised—both at the material, and at my own ignorance of the material.

You see, I was raised in the United States, where some material on Pre-Columbian cultures was on the syllabus. Not only that, but I studied anthropology and archaeology in university. So I assumed that I would have at least a fair impression of what was going on in the Americas before Columbus.

But I had only the faintest notion. I did not know, for example, that some of the oldest stone structures on earth can be found in South America. Nor did I know that these ancient peoples also made the world’s oldest mummies. Now, mummies and stone huts may not seem very important to you, but their very early appearance underlies the surprisingly early presence of humans in the Americas. For a long time it was thought that humans crossed the Bering Strait after the end of the last ice age, around 11,000 years ago. Many recent findings have dramatically pushed back the date of these first humans, however; and most mysteriously, the oldest finds are in South America.

In high school I was taught about the Inca. But I did not realize that the Inca Empire occupied only a small part of this long history. Nor did I know anything at all about the other historical cultures that preceded the Inca—the Moche, the Chavín, or the Norte Chico, just to name a few. Of the Inca, I knew little more than that they were conquered by Pizarro and built Machu Picchu. That they built earth-quake resistant buildings, an enormous system of roads, and even (possibly) a writing system (quipu) in the form of knots—all this had either been either forgotten or never learned.

In short, I would encourage all Americans to get better acquainted with these ancient peoples. Most of us know, on some level, that the land had been occupied before Europeans arrived. But it is difficult to wrap your mind around the scale of what was lost. These lectures are an excellent place to start. By carefully examining the archaeological record, Barnhart brings this lost world—at least partially—back to life. And as he constantly reminds us, there is still much left to learn.

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Review: Debt

Debt: The First 5,000 Years by David Graeber

My rating: 4 of 5 stars

For a very long time, the intellectual consensus has been that we can no longer ask Great Questions. Increasingly, it’s looking like we have no other choice.

Three years ago, I went on vacation in the north of Spain, to the city of A Coruña. There, perched on the jagged rocks below the Roman lighthouse, I read Oswald Spengler’s Decline of the West. The crashing sound of ocean waves just seemed an appropriate accompaniment to Spengler’s grandiose attempt to analyze all of human history.

At it happened, I ended up reading David Graeber’s Debt in the exact same circumstances. And perhaps this coincidence highlighted the odd similarities between Graeber’s book and Spengler’s. On the surface, the two men are quite radically opposed: Spengler is mystical, conservative, and mainly preoccupied with ‘high culture,’ while Graeber is conversational, leftist, and usually focused on more humdrum human affairs. But both The Decline of the West and Debt are sweeping scholarly exercises which attempt to completely alter our view of history. As a consequence, the books have similar merits—a large perspective, unusual connections, an original angle—while suffering from the same basic weakness: the attempt to strap history into a Procrustean bed.

But I am getting ahead of myself, as I should explain what this book is about. Graeber set out to write about debt, partly as a response to the 2008 financial crash, but also to respond to a certain moral confusion he noticed in the general culture. This is the notion that one always ought to ‘pay one’s debts.’ Most of us, I suspect, would agree that this is the right and proper thing to do. But there are many cases in which debt can be morally questionable. Consider a man who had an unexpected heart attack and was taken to a hospital out of his insurance network, or a young student who took out college loans but then had to drop out because her father had a heart attack, or a family who had agreed to a predatory mortgage for a house that the bank knew they could not afford, or a poor country forced to adopt austerity policies by the IMF in order to pay their debts richer countries—in any of these cases, is it moral to pay one’s debts?

As Graeber points out, standard economic theory does not hold that all debts must be repaid. Rather, both the lender and the debtor enter into an arrangement with a certain amount of risk. The loan is, in a sense, an investment like buying stock, and may or may not yield money according to the fortunes of the debtor. But this is not how we typically treat debt. Bolstered by our moral sense that debts should be paid, we accept a moral lopsidedness in the relationship, giving lenders quite extraordinary powers (garnishing wages, confiscating property) to extract money from debtors. Yet Graeber is not an economist, and does not want to restore a balance to the arrangement. Rather, he is disturbed by the very concept of debt. For what sets debt apart from an obligation is that it can be precisely quantified. This means debts require a system of money.

This leads Graeber to examine the origins of money, which for me was easily the strongest section of the book. Most economist textbooks explain money by pointing out that money solves the problem of a double coincidence of wants. That is, if I have some extra boots, and I would like to trade them for some beer, it is quite possible the brewer already has all the boots he needs. But if I can sell the boots for money, and the brewer accepts cash payments, then we are in business. The problem with this story is that there is no historical evidence that such a thing happened. Indeed, this hypothetical situation is rather bizarre—essentially taking a world very much like our own, and then removing the money.

Instead, it appears from the historical record that credit systems developed before actual money. These could be formal or quite informal. As an example of the latter, imagine you are living in a small village. One day, you see your neighbor wearing a nice pair of boots, and you ask if he has any extras. He does, and offers them to you as a gift. Next month, you make a big brew of beer and then give him a jug of it, offering it as a gift. The key is that, using such a credit system, you effectively get around the double coincidence of wants, since there is a very good chance that you will eventually have something your neighbor wants, and vice versa. This is just one informal example of how such a credit system could work with ‘virtual money.’ Graeber, being an anthropologist, is full of fun examples of exchange practices from around the world, all of which fly in the face of our idealized notions of purely economic transactions.

After quite effectively demolishing what Graeber calls the ‘myth of barter,’ he embarks on a grand tour of history. And here is where the book fell off the rails for me. Now, this is not to say I did not enjoy the ride: Graeber is an engaging writer and is full of fascinating factoids and radical notions. But I was constantly bugged by the sensation that either I was misunderstanding Graeber, or that he was not proving what he thought he was proving. To give you a smattering of Graeber’s points, he argues that the use of coinage influenced ancient Greek philosophers’ concepts of matter, that religions emphasizing selfless charity arose in reactions to markets emphasizing selfish acquisition, that our notions of property derive through Roman law from slavery, that money was actually introduced by kings who used it to debt-finance wars, and that the Spanish conquistadores were driven to commit such atrocities because they were in debt.

As you can see, that is an awful lot of material to cover; and this is just a sample. Each of these arguments is, in my opinion, quite interesting (if not always convincing). But, again, I was always unsure as to the larger point that Graeber was trying to make. On the one hand, Graeber seemed to be saying that money and debt are inextricably bound up in an ugly history of violence; but on the other, Graeber demonstrates that debt financing is a remarkably old and persistent practice, and is partly responsible for what we (pretentiously) call ‘civilization.’ At the end of the book, Graeber states that his purpose was to give his readers a wider taste of what is possible, so that we can reimagine our society. However, one of Graeber’s main insights is that history is cyclical: alternating from periods of hard money (like precious metals) and virtual money (like IOUs and fiat currency)—though both of these systems involve debt. If anything, then, this book left me with the impression that debt is an inescapable part of life.

Allow me, if you please, to mention one of my pet peeves here. Graeber is a big fan of etymologies. This book is peppered with words and their unexpected origins, which Graeber often uses as evidence in his arguments. In my opinion, this is a very lazy and unconvincing way of arguing. Do not misunderstand me: I like a good etymology as much as anyone. But the fact that a word once meant one thing and now means another does not, in my opinion, prove that these two concepts are somehow secretly connected. I would have much preferred more detailed examinations of historical evidence; but Graeber actually goes out of his way in the afterward to criticize historians for being overly empirical. This is not a message I can get behind.

But enough of that. I am sorry to be writing even a moderately critical review in the wake of Graeber’s tragic passing. For all of this book’s (perceived) faults, I am very glad to have read it. Like Spengler, Graeber had a mind full of fire, and was always letting off sparks in every direction. He was, in advertising parlance, an idea man; and this book is full of bold new ways of seeing our past and present. And even if Graeber’s grand theories about society and history do not, ultimately, pan out, one can say of Graeber what Walter Pater said of aesthetic theorists:

Many writers have been made by writers on art and poetry to define beauty in the abstract, and express it in the most general terms, to find a universal formula for it. The value of these attempts has most often been in the suggestive and penetrating things said by the way.

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Review: Good Economics for Hard Times

Good Economics for Hard Times: Better Answers to Our Biggest Problems by Abhijit V. Banerjee

My rating: 4 of 5 stars

Economics is too important to be left to economists.

After listening to a series of lectures on introductory economics, I was struck by the degree to which the basic logic of supply and demand was used to make sweeping pronouncements about human behavior and economic policy. The lecturer, starting from the premise that supply and demand is inexorable, would rule out certain policies as working against the market, while promoting those he considered ‘market-friendly.’ But rarely did he stop to actually examine a case study to see how these theories played out, leaving me with the impression of a wholly a priori logic.

The central thrust of this book is that a priori logic cannot be trusted. The economy is complex and unpredictable, so the best way to understand it is through historical case studies and randomized control trials. The authors find that, when we examine the economy in such a way, many of our intuitions about how the it works or will respond to certain policies are wrong. Indeed, though this could hardly be called a revolutionary book—its tone is engaging but mostly academic—the two authors, Banerjee and Duflo, reach quite heterodox conclusions.

One basic economic argument used against permissive immigration policies is that the increased supply of cheap labor will inevitably drive down wages, thus hurting native workers. The logic is simple but it does not hold up under the evidence. In case study after case study, immigration is shown to be either economically neutral or beneficial to native workers. Indeed, ironically—and contrary to what Trump and his ilk may say—low-skill immigrants are better for native workers than highly skilled ones, because they often take jobs that native workers do not want—jobs requiring little communication and much labor. Native workers may even benefit by being promoted to managerial roles. A multilingual immigrant doctor actually competes more directly with native workers than a monolingual immigrant fruit picker.

Perhaps you can see that the above supply and demand argument against immigration is simplistic, since immigrants, apart from increasing the labor supply, also increase demand for goods. Indeed, most professional economists are decidedly in favor of migration. Workers have much to gain from moving to where their skills will be most highly rewarded; and businesses would gain from having good workers. But here the economists’ logic is shown to have its own flaw. Real workers are actually quite averse to migration. Banerjee and Duflo show that, even when a better job may just require move from the country to the city, most will simply not go. There is a large amount of inertia built into real people’s lives—the pull of family, friends, and familiarity—which works against even obviously beneficial moves.

This is not the only way that the real economy is (in economic parlance) ‘sticky.’ Though economists imagine a world of workers ready to move and re-train, of companies willing to fire and hire, banks that drop bad investments and jump on promising new ones, firms willing to relocate to new countries with cheaper labor, new businesses popping up and inefficient ones disappearing—in a word, a dynamic world governed by shifting supply and demand—the real world is consistently stickier than this logic suggests. This seems particularly true in the developing world—the authors’ main area of study—where they found that efficient and inefficient businesses coexisted, where bad-selling product lines were retained, where banks merely rubber stamped loan applications from existing clients, and where people do not migrate for work, or even take the work that is available locally.

Inhabitants of planet earth will likely not be surprised by all this. But the upshot, the authors argue, is that free trade does not deliver all that it promises. Now, the logic of free trade is simple and compelling, grounded in the law of Comparative Advantage put forward by David Ricardo. Simply put, this law states that we all will benefit from trade, since we can all specialize in what we are comparatively better at doing.

But the logic has not exactly played out as hoped. Though touted as a way of propelling developing nations out of poverty, in practice free trade policies have a mixed record. The authors use the example of India, which transitioned from a highly-regulated economy with high tariffs to a free market with low tariffs in the 1990s. The result of this transition was hardly the economic wonder that some economists could have predicted. In many places, wages actually went down rather than up, and in subsequent years much of the economic growth has simply gone to the country’s rich. This is not to say that the results of economic liberalization were all bad, only that it was hardly the panacea that free-market advocates promised.

The consequences for rich nations, like the United States, have also been mixed. While most economic transitions involve winners and losers, the shock of free trade has benefited those who were already ‘winning,’ and hurt those who were already ‘losing.’ In other words, while the big cities full of college-educated workers have grown richer, the arrival of cheap goods—mostly from China—has ravaged many blue-collar communities.

Admittedly, the theory of Comparative Advantage does predict that free trade will temporarily hurt some workers who are forced to compete with cheaper goods from abroad. But the belief in economic adaptability (not to mention the political will to help assuage the problem) was overly optimistic.

Even when jobs disappear, workers do not move. Many simply go on disability and leave the workforce entirely. In short, workers are sticky. Not only that, but the United States has been very bad at redistributing the gains of free trade in the form of worker retraining and extended unemployment. No wonder that many in the country are skeptical of the benefits. However, the authors are careful to note that the solution to this problem is not to impose new tariffs on China. This will only create further economic harm in other sectors (like agriculture) without remedying the harm already done. What is needed, the authors argue, are generous government programs to either re-train displaced workers, or to subsidize industries that are being driven out of business.

This leads us to the longest and most theoretical chapter in this book, that on growth. The argument is fairly dry but the conclusion the authors reach is striking: we do not know what makes economies grow. The greatest years of economic growth were between the end of WWII and the 1970s. This was also a time dominated by Keynesian economics, which led many to give Keynes the credit for this economic miracle. But the magic wore off with the coming of stagflation, which the Keynesian seemed powerless to stave off. This crisis brought the managed economy into discredit, and ushered in the neoliberal revolution, where deregulation, lower taxation, and free trade were seen as the best tools to rejuvenate the economy. Unfortunately, that did not work, either, and growth has never picked up to pre 1970s levels.

Instead, what has grown since the neoliberal turn has been inequality. Rather than stimulate the economy into mad activity, these policies have merely directed what modest economic growth there has been to the much-maligned top 1%. And their political influence has grown right along with their fortunes, which only reinforces the government’s tendency to embrace these sorts of ‘business-friendly’ policies.

As usual, the economic logic used to argue in favor of these policies—that lower taxes on the rich will spur greater activity—is supported by a priori logic rather than actual evidence. But the evidence does not bear it out. People work just as hard whether they are being taxed at 30% or 70%, or not at all, as demonstrated by a series of tax holidays in Switzerland. The notion that high salaries reflect employee value (which supply and demand would predict) is also not supported, as demonstrated by the remarkably high wages paid to those who manage stock portfolios, which consistently underperform against index funds—meaning that the wages are essentially a rent for holding onto money. (And since the high salaries in finance influence salary negotiations in other industries, this increases salaries across the board.)

A strange picture emerges from all this, a picture of an economic policy—at least in the United States—that is entirely divorced from reality. We wring our hands about immigration at a time when immigration is not going up, and even though immigrants pose no credible economic or cultural threat. We argue about tariffs but not about how to actually help those hurt by free trade policies. We cut taxes and deregulate businesses in the name of growth that never appears. Meanwhile, automation is likely to make many of these problems that much worse, and we persist in putting off any action related to the looming climate crisis.

The current pandemic—and concomitant economic crisis—has only put this magical thinking into high relief. Perhaps the best thing to call it is free-market fundamentalism: the belief that the economy, acting on its own, will sort out all of our problems—from poverty to pandemic—without any government aid. Strangely, it is a faith held most ardently by those who see the least evidence for it: people who have been hit by the economic dislocation of free trade. Indeed, at just the time when inequality is rising, we have embraced a kind of social Darwinism that treats the economic pecking order as a perfect reflection of personal merit. This mentality, resting upon the assumption of an imagined economic mobility (which is even lower in the US than in the European Union), justifies both extreme poverty and extreme wealth, since both are ‘deserved.’ To the extent that anyone is held responsible for the situations, it is either outsiders like immigrants or minorities, or the government—not the wealthy.

As Manny has suggested, the situation is rather reminiscent of the USSR in its final years. In both cases we have an economic philosophy based on a priori logic rather than evidence, and believed on the same grounds. As this philosophy fails to deliver, the country’s elites still do not publicly renounce it, but instead only increase their displays of fervor. Rather, entirely irrelevant factors—immigrants, minorities, nefarious citizens—are used to explain the lack of prosperity. Meanwhile, the rich line their already deep pockets while spouting the old egalitarian slogans. The result is a society gripped by nihilism, wherein the old ideals become barely-disguised lies by corrupt and incompetent leaders, and anger and hopelessness descend upon a country that senses it is going in the wrong direction but does not understand why.

This may seem rather hyperbolic. But when you consider how bad things have gotten in the United States in the short time since the publication of this book, when it was already quite bad, then perhaps you can see the justification.

If our economic logic is often misguided, and our policies either useless or worse, what do the authors suggest? Here is where I thought that the book was mostly lacking. Banerjee and Duflo are extremely heterodox when criticizing conventional economics, but are not nearly so bold in proposing solutions. Their general point, however, is that we ought to shift our focus away from trying to grow the economy—since we do not know how to do that anyway—and towards most justly distributing the resources we have now. High tax rates on the rich will help curb inequality without reducing effective incentives. Coordinated efforts between countries can help to reduce tax dodging, and enforcing anti-trust legislation will help curb corporate power.

The authors have a fairly nuanced view of basic income. They think that basic income schemes work well in developing countries, where the poorest are mostly working a variety of temporary or seasonal jobs. But they do not think UBI would work in developed countries, because people have come to rely on jobs not only for income but for structure and even meaning in their lives. In studies, people who stop working do not tend to increase time socializing, or volunteering, or on hobbies; instead, most people end up just watching a lot of television—which does not increase happiness or well-being. This is why the authors prefer significantly stronger unemployment support—helping workers to retrain and relocate.

This seemed somewhat timid to me. But perhaps it is misguided to seek bold, sweeping solutions from authors who insist on hewing to trial, experiment, and evidence. Hard-headed economists, the authors do not promise miracles. Yet if you are looking for a probing and insightful look at many of our current economic woes—now only exacerbated by the coronavirus recession—then this book is quite an excellent place to start. The most pressing point is that our economical problems have political solutions. As usual, the only thing we need is the political will to start acting.

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Review: Evicted

Evicted: Poverty and Profit in the American City by Matthew Desmond

My rating: 5 of 5 stars

Eviction is a cause, not just a condition, of poverty.

Yesterday, on July 24, the federal moratorium on evictions—protecting about 12 million renters—ended; and many state-level moratoriums will conclude soon as well. Enhanced unemployment benefits, which gave households an extra $600 per month, will terminate this month, too, meaning that families will lose income at just the moment they are vulnerable to eviction. Meanwhile, as the virus rages on, so does massive unemployment. It seems likely, then, that the United States is on the cusp of a huge wave of evictions. Under these circumstances, I thought it was a good time to read this book.

This is an urban ethnography written about the lives of the desperately poor as they struggle to find stable housing. Matthew Desmond lived for months in a trailer park and then in the inner city, following people around, taking notes and photographs, recording conversations, conducting interviews, and carrying out large surveys. In many ethnographies—especially since the postmodern turn—the author has striven to include herself in the narrative, emphasizing the subjectivity of the process. But Desmond has effaced himself from this book, and has instead written a kind of nonfiction novel of eight families undergoing eviction.

The first thing that strikes the reader is that Desmond is an excellent writer. The narration is gripping from the beginning—dramatic, vivid, and even occasionally poetic—meaning that my first reaction was emotional rather than intellectual. Wrenching pity for the people caught up in this cycle of poverty alternated, at times, with light disapproval at seemingly self-destructive behavior, which disappeared into outrage at the landlords profiting from this situation, and then incredulity that such things can be allowed to go on in a supposedly advanced nation. Often, I found it hard to take in, and had to put the book down to take a breath:

[Crystal] had been born prematurely on a spring day in 1990 shortly after her pregnant mother was stabbed eleven times in the back during a robbery—the attack had induced labor. Both mother and daughter survived. It was not the first time Crystal’s mother had been stabbed. For as far back as she could remember, Crystal’s father had beat her mother. He smoked crack and so did her mother and so did her mother’s mother.

But if this book were merely a collection of such stories, it would be little more than poverty voyeurism. This book has quite an important point to make, though, and that is how eviction is not only a consequence of poverty, but one of its major causes.

Any account of housing instability needs to begin with the fact that most people who qualify for housing aid to not get it—3 out of 4 receive no aide whatsoever. This leaves them at the mercy of the private housing market, which has seen steadily rising rents for years, at a time when wages are stagnant. Though it is normally recommended to pay no more than 30% of your wages in rent, the subjects of this book paid far, far more—in some cases, over 90%. This has serious consequences. Most obviously, if you are paying so much of your income in rent, it is impossible to save, and often even to pay basic expenses. What is more, this means that virtually any unforeseen expense—repairs, medical problems, or a funeral—can make a renter fall behind.

Once behind, it is extremely difficult for a renter to catch up. This effectively puts them at the mercy of the landlord. Even if the house is in disrepair and violates safety codes, missing rent means that the renter can be evicted on short notice. As Desmond describes, some landlords are willing to be lax—at least for a time—and cut deals with tenants. But for many who fall behind, the sheriff will soon be knocking on their door, along with a team of movers, giving the tenants a stark choice: to have their things left on the curb, or put into storage (where they need to pay extortionate fees in order to keep it from being trashed). Most evictees do not have housing lined up, and many end up in homeless shelters.

In a market where buyers are desperate and sellers are relatively scarce, there is little incentive for landlords to reduce prices, or even to make basic repairs of their properties. As Desmond explains, it is often more profitable for landlords to evict late-paying tenants and contract new ones than to make their properties livable. The tenants in these pages put up with rats, roaches, broken walls, smashed windows, clogged plumbing, sagging ceilings, to give just a short list. Desmond himself did not have hot water during his stay at the trailer park, despite paying rent on time, repeatedly asking the landlord, and even informing them that he was writing a book about life in a trailer park.

Eviction is not a rare occurrence—there are well over one million per year in the United States—and it is also not merely a private tragedy. Unsurprisingly, evictions concentrate in poor neighborhoods; and when residence in an area is unstable, it makes it an even less desirable place to life. As Jane Jacobs pointed out, neighborhoods are not primarily made safe by patrolling police, but by the constant presence of people on the street, people with a sense of ownership of the neighborhood. Ejecting residents obviously erodes this possibility—and not only in the area where people are evicted from, but also in the areas they unwillingly move to—which makes the city generally less safe.

Eviction is also not colorblind. Just as black men are disproportionately locked up, Desmond found that black women are disproportionately thrown out. And when you consider that having either a conviction or an eviction record can disqualify you from public housing, and can legally be used to screen potential renters by private landlords, you can see that this disadvantage is compounded. The white families in these pages certainly did not have an easy time finding and maintaining housing, but the black families were significantly worse off. Desmond followed one white couple who managed to find a place despite both of them having eviction and felony records, and one of them an outstanding warrant!

It is crucial to remember that housing instability is not merely the byproduct of individuals navigating private markets. The government is not only culpable for being a bystander to suffering citizens, but for propping up this very situation. Just as government force—in the guise of police officers and prisons—has been used to deal with the social fallout of disappearing jobs, so has government force—in the form of eviction courts, sheriffs, movers, public eviction records, and homelessness shelters—been used to deal with the disappearance of affordable housing. Without this government backing, the situation could not exist.

In many cases Desmond documented, government workers actually encouraged landlords to evict their tenants. Since many properties do not meet building codes, virtually any government attention—whether from the police, the fire department, an ambulance, or social services—can motivate a landlord to eject a tenant. What is more, if too many 911 calls come from an address, the property is labeled a ‘nuisance property,’ and landlords are forced by the police to ‘take action’—usually through an eviction. Even victims of domestic abuse are often evicted, one reason that many victims do not contact the police.

If we can agree that this situation is unconscionable, then of course we must do something to change it. But what? One solution is rent control: establish maximum prices that landlords can legally charge. This can have some quite negative unintended consequences, however. For one, if low-income housing ceases to be profitable, then there is no incentive to create more. This leads to shortage. But what about simply giving people more money, such as by raising the minimum wage or a basic income scheme? The problem with this strategy is that rising rents can easily offset income gains.

One fairly easy, short-term solution would be to provide defendants in civil courts with public defenders. Currently, in the United States, only defendants in criminal courts have such a right, though many other nations also provide legal counsel in civil cases. At the moment, most people do not even show up for their eviction hearings; the majority who show up do not have a lawyer, and most of them lose the case. Legal counsel can profoundly change the odds of evictees. And it is worth noting that, though hiring lawyers is expensive, cycling people through homelessness shelters is even more so—and this does not even take into account the other forms of economic disruption caused by eviction, such as job loss (quite common when people lose their home).

Another solution, popular in the past, has been to build public housing. This has several obvious problems, too. For one, as happened in NYC, vibrant and affordable neighborhoods were bulldozed to make way for enormous housing projects. What is more, the design of public housing projects was ill-conceived: enormous high-rises with parks in between. By isolating the poor into these buildings—with no shops or other services nearby, and few good communal spaces—the projects became dangerous and dysfunctional.

It is possible that smarter public housing could play an important role in the housing crisis. If apartments are scattered through the city, rather than concentrated, and integrated with shops, restaurants, and other businesses, then it is much less likely that they will become dangerous. An added benefit to cheap public housing is that they exert a downward pressure on the housing market, since private apartments must compete with them. However, the housing shortage is so acute that public housing alone is unlikely to be enough; it would require too much building.

This is why Matthew Desmond advocates housing vouchers. These vouchers basically pick up the tab for renters, covering anything above 30% of their income. However, there is an obvious problem with such a scheme: landlords are incentivized to overcharge for their properties, since the money is guaranteed. Indeed, according to Desmond, this often happens, which leads to a lot of wasted taxpayer money. Clearly, some mechanism is necessary to establish reasonable prices. But the voucher scheme does have the great advantage of scalability: they can be distributed quickly and widely.

Such a program would not be cheap. And in the United States, welfare programs tend to be politically divisive, since in our individualistic culture we prefer to hold the poor responsible for their own poverty. This mindset runs very deep. Desmond even records a preacher who, after giving a sermon about the importance of charity, refused to help a homeless woman so that she could learn her lesson. And certainly many of the people in this book did make bad, self-destructive choices. But as Desmond points out—and as psychological studies have shown—living in poverty actively erodes people’s ability to choose wisely and to think in the long term. Furthermore, many behaviors which seem irrational to middle-class onlookers are actually sensible adaptations to poverty.

The other important point to consider is that those of us lucky enough not to live in poverty are also benefiting from government policies. The federal government subsidizes mortgages—a policy that mainly benefits people with six-figure incomes. The capital gains exception means that homeowners who sell their house do not have to include much of that money in their income, and thus are not taxed. Indeed, the United States loses far more in tax revenue through these kinds of tax breaks than it spends in housing aid for the poor. This fits into a common pattern in American life: that those least in need of help are those most likely to receive it (and vice versa, of course).

As I hope you can see, this is a gripping and important book. The reader comes away with both an intellectual and a visceral understanding of housing insecurity. There are some things that I wish Desmond included—most notably, what economic trends drove this change—but, on balance, I do not think anyone could have written a better book on this topic. Now, as we face the prospect of mass evictions in the wake of the coronavirus pandemic, perhaps we will summon the political will to do something about the problem.

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Review: When Work Disappears

When Work Disappears: The World of the New Urban Poor by William Julius Wilson

My rating: 4 of 5 stars

It is just as indefensible to treat inner-city residents as superheroes who are able to overcome racist oppression as it is to view them as helpless victims.

This book is remarkable to read now, as it documents a phenomenon that has only grown more widespread in the years since its publication. William Julius Wilson set his sights on understanding the causes and effects of urban poverty, particularly as it afflicted the black community.

The process Wilson identifies will be familiar to most Americans now: As factories close and industry decamps, well-paying jobs for people without college degrees dry up. The disappearance of decent work causes a kind of domino effect. Those who can move out, do so, leaving only the most disadvantaged to stay. Little by little, the community starts to crumble. Families fall apart as people—particularly fathers—are unable to support their children. Drug use and drug dealing become widespread in a community with few legitimate employment opportunities.

Meanwhile, the government provides little support for the people trapped in this situation. The chronically underfunded schools did not provide a ladder out of poverty. The lack of public transportation means that people who do not own cars have little opportunity to find work elsewhere. Mothers are forced to choose between staying on welfare, facing stigma and losing a sense of autonomy, or taking minimum-wage work and losing health insurance—for themselves and their children. Instead of providing drug counseling and addiction support, the primary response is to incarcerate drug offenders in large numbers, which only further debilitates the community and makes family life even more difficult.

By now, this basic process has played out in many parts of America. But before it affected rural whites, it hit urban African Americans. And here is where the country’s racial attitude became a major factor. For the public response to this suffering was not sympathetic; rather, people worried about “thugs” and “super predators,” making American streets unsafe—people so dangerous that they could not be helped, only locked away. The public pointed the finger at “welfare queens” and accused poor mothers of milking the system to live a life of ease. In other words, as is so often the case in the United States, we blamed the poor for living in poverty.

As Wilson, a distinguished sociologist, is at pains to show, the key factor in this process is the disappearance of jobs. When there is no opportunity to make a decent living, a community suffers. Nowadays such a thesis is hardly controversial. Indeed, we have seen it play out in many parts of the country. But at the time, it was a vital point to make, since the public discourse insistently framed the problem as a kind of moral failing on the part of the poor. Either that, or some sort of negative cultural attribute was blamed. And, of course, all of this was racially coded. But as more and more communities succumb to this process, the explanations relying on personal responsibility or cultural traits seems less and less plausible. This is a structural problem.

This is not to say that Wilson is against using culture as an explanation. To the contrary, in the first part of this book, where he relies on surveys and interviews performed by his team, he notes how living in such an environment can cause adaptations that are maladaptive elsewhere. This can become a self-reinforcing cycle, since negative stereotypes are sometimes borne out, and used to further stigmatize the community. One of the most fascinating sections are a series of interviews with employers in the area, many of whom give excuses and justifications for not wanting to hire black employees, particularly males. But even more striking is that most of Wilson’s respondents endorsed the basic American value system of individualism and personal responsibility. Those on welfare did not relish a life of ease, but longed for work that could support themselves and their children.

The second part of this book looks at larger trends and solutions. Wilson notes that the sort of urban poverty widespread in American cities is virtually nonexistent in Europe, and credits the strong safety net there. His own proposals for improving the lives of the urban poor are familiar by now—universal healthcare, improved infrastructure, more funding for education—but they do not seem much closer to reality now than in 1996, when this book was published. We can start moving in direction at any time. All that is lacking is the political will.

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Review: Priced Out

Priced Out: The Economic and Ethical Costs of American Health Care by Uwe Reinhardt

My rating: 4 of 5 stars

Mantras about the virtues of markets are no substitute for serious ethical convictions.

There are a great many things for Americans to feel embarrassed about. Depending on your politics, you may bemoan the rise of identity politics and the snowflake culture predominating on college campuses; or perhaps you rage against racist policing or our lax gun laws. But I think that, as Americans, we can all come together and feel a deep and lasting shame over our health care system—specifically, how we finance it. According to Reinhardt, our system is so bad that it is routinely invoked in international conferences as a kind of boogey man, an example of what to avoid. And after reading this book, it is easy to see why.

I did not suspect that our system was quite so bad until I left the country. But, in retrospect, the evidence was quite apparent. Virtually all of my friends have expressed anxiety about their health care at some point—high premiums, high deductibles, or simply no health insurance at all. I have seen family members spend weeks negotiating with insurance companies for payment of their medicines (and even after the insurance chips in, the cost is still breathtaking). Meanwhile, in my five years here, I have yet to hear a single Spaniard express anxiety over how they will pay for a medicine or a medical procedure. Here, as in most of Europe, this type of anxiety is quite uncommon.

The U.S. system fails on many different fronts. Most simply, there is coverage. Millions of Americans have no coverage, and millions more have inadequate coverage (such as many of my friends, whose deductibles are so high that they may as well not have insurance). Second is cost. Both medical procedures and medicines are significantly more expensive in the United States. For example, the drug Xarelto (for blood clots) costs $101 in Spain, $292 in the U.S. The average cost of an appendectomy is $2,003 in Spain, $15,930 in America. A third failure— closely related to cost—is waste. Our byzantine payment system requires doctors and hospitals to spend great amounts of time and money communicating with insurance companies, which of course costs money, which of course gets transferred to the consumer.

But most fundamental failure is a failure of ethics. Or perhaps it is better to say a lack of ethical vision. As Reinhardt explains, while much of the debate on health care in America concerns itself with technicalities—risk pools, risk exposure, whether premiums should be actuarially fair or community-rated, etc.—this debate conceals the fact that we have yet to come to a consensus on the moral foundations of health care. Most of the world’s developed nations have established their systems on the presumption that health care is a social good. In the United States, on the other hand, we are sort of muddled, at times treating health care as if it is a commodity, and yet unwilling to face up to the implications of that choice—such as letting poor people die without treatment.

Aside from the ethical issues involved, health care has many features that make it unlike a typical commodity, and thus poorly governed by supply-and-demand. If I want to buy a car, for example, typically I am not in a great rush to do so. I can shop around, test-drive cars, compare prices across companies and locations, and read reviews. I can even decide that I do not want to buy a car after all, and instead buy a train pass. All of this contributes to control the price of cars, and incentivizes car companies to give us the best value for our money.

None of this is the case in our health care system. The demand is non-negotiable and, very often, time-sensitive. Furthermore, most patients lack the knowledge needed to evaluate what procedures or tests are justified or not, so oftentimes we cannot even be fully aware of our own ‘demand.’ Besides that, we have no ability to compare prices or to compare treatment efficacy. And even if we are careful to go to a hospital in our insurance network, there may be doctors ‘out of network’ working there, leading to the ugly phenomenon of surprise medical bills.

Added together, it is as if the car salesman blindfolded me, put a gun to my head, told me I had to choose a car in five minutes, while he was the only source of information about what car I needed (and medical bills can be quite as expensive as cars!). This is the position of the American “consumer” of healthcare.

My own brief experience with emergency medical care highlights the situation. The only time that I have ever been taken to an emergency room, I was unconscious. I woke up after being transported by the ambulance. Luckily, I was quickly discharged, and I also had insurance. But even though my insurance covered the hospital bill, it did not cover the ambulance, which I had to pay out of pocket. Again, I was lucky, since I was able to afford it. Many cannot, however, and have the experience of waking up from an accident, an injury, or an operation in debt. How can you be an intelligent consumer when you are unconscious?

The helplessness of the consumer creates a perverse incentive in our system. There is little downward pressure on prices. Instead, what results is a kind of arms race between health care providers and insurers. Insurers are incentivized to put up as many barriers as possible to paying out, which requires doctors and hospitals to invest ever-more resources into their billing departments, which of course only increases the cost to the patient. In many hospitals, there are more billing clerks than hospital beds; and when you realize that these billing clerks have their own counterparts in the insurance companies, you can get some idea of the enormous bloat created by our financing system.

I think there is a particular irony to this situation, since our American insistence on market values has created a labyrinthine network of incomprehensible rules, endless paperwork, and legions of bureaucrats—the very thing that capitalist principles were supposed to eliminate. Indeed, ironies abound in our system. For example, we endlessly discuss the affordability of government programs, while the tax incentives for employment-based insurance (which costs the federal and state governments an annual $300 billion in foregone revenues) is never mentioned. What is more, while the insurance mandates of Obamacare were roundly criticized as forcing the healthy to subsidize the unhealthy, as Reinhardt points out, the exact same thing occurs in insurance-based healthcare. And as a final irony:

It is fair to ask why, if socialized medicine is so bad, Americans for almost a century now have preserved precisely that construct for their military Veterans, and, indeed, why the latter are so defensive and protective of that socialized medicine system.

After reading this review, you may be excused for thinking that this book is a fiery manifesto about the evils of the system. Far from it. Uwe Reinhardt was a prominent economist and much of this book consists of tables and graphs. The writing is, if anything, on the dry side, and the tone is one of intellectual criticism rather than passionate outrage. Yet, strangely, this is why I found the book so effective. It is one thing for an arm-swinging socialist to condemn the evils of the system, but quite another for a calm economist to go through the data, point by point, and explain how it all works and how it compares with other countries’ performance.

You may also be excused for thinking that, given all this, Reinhardt would be an advocate for a single-payer system in the United States. After all, he was one of the architects of Taiwan’s single-payer system, which costs about 6% of the country’s GDP. (For comparison, America’s system costs us 17% of GDP!) But Reinhardt thinks that such a system would not work on American soil. For one, the libertarian streak in our culture runs too deep for such a system to be broadly acceptable. More importantly, however, Reinhardt thinks that our campaign finance system is so corrupt that the health care lobby would be able to exert a heavy influence on the government, thus canceling the benefit.

He instead advocates for an ‘all-payer’ system. The idea is to consolidate the market power of consumers by having standard prices set either by the government, or by associations of care providers and insurers. This would, at the very least, avoid the wild price variability that can be found in even a single city in the United States. It also helps to bring costs down, as demonstrated in Maryland, which has had an all-payer system for quite a while. Japan’s system is also established on this principle, and spends far less money per capita on its health care system, despite having a significantly older population than the United States.

In normal times, I was not exactly optimistic about the prospect of reforming out broken health care system. But in the wake of this pandemic, it does seem as if major reforms might not only be possible, but inevitable. Employment-based insurance makes little sense if people lose their jobs during a major health crisis, as has already happened to many millions of Americans. And high unemployment may persist for some time. What is more, a major health crisis, resulting in many thousands of additional hospital stays, will put pressure on private insurance firms and lead to a significant rise in insurance premiums. Basically, higher-risk patients create higher cost, and a pandemic puts far more people into the high-risk category. The greater strain on an already teetering system may be the proverbial straw on the camel’s back. We shall see.

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