The Price of Everything (10 page)

Nonetheless, Obama’s political tactics made sense in the face of accusations from American conservatives that the government wanted to take over the decision of who lived and who died. The president got a foretaste of the opposition’s tactics when a White House proposal to study the relative effectiveness of new drugs and therapies, to decide which were most worthwhile, drew a furious reaction. An editorial in the
Washington Times
compared the proposal to a program called Aktion T-4 put in place in Nazi Germany to euthanize elderly people with incurable diseases, critically disabled children, and other unproductive types.

The rhetoric was effective because it tapped into the belief that life is priceless, that when it comes to matters of life and death we should spare no expense. As Joy Hardy, the wife of a British cancer victim who was temporarily denied Sutent by the NHS, said: “Everybody should be allowed to have as much life as they can.” This belief has burdened the United States with a uniquely inefficient health-care system. In 2009 health care consumed 18 percent of the nation’s income. And without any mechanism to ensure cost-effectiveness, it could swallow more than a fifth of the economy by 2020. Yet all this spending does not buy better health.

Somehow Americans have a lower life expectancy at birth than the Japanese, French, Spanish, Swiss, Australians, Icelanders, Swedes, Italians, Canadians, Finns, Norwegians, Austrians, Belgians, Germans, Greeks, Koreans, Dutch, Portuguese, New Zealanders, Luxembourgeois, Irish, British, and Danes. We achieve this while spending, collectively, much more on health care than any of them: about $6,714 a year for every American. In Japan, by contrast, health-related expenditures amount to about $2,600 per head, and in Portugal to only $2,000. What’s more, allocating health care by patients’ ability to pay rather than an analysis of the costs and benefits of treatment ensures that the American distribution of health, and life, is as inequitable as one can get in the industrial world. More than half of Americans who earn less than the average income report not being able to get needed health care due to its cost. This compares to fewer than 10 percent of the British or the Dutch.

Americans are inveigled by a powerful mirage: that markets don’t ration. In 2007, the Congressional Budget Office issued a report about how the nation might bring spiraling health-care costs under control by measuring the cost-effectiveness of medical treatments, as several other countries do. The report warned that putting a price on life might be politically tricky in the United States. “Many people find the notion uncomfortable if not objectionable,” noted the CBO, incompatible with “the sentiment that no expense should be spared to extend a patient’s life.” The invisible hand of the market is as ruthless in denying health care to the needy as the most coldhearted central planner. Our unwillingness to acknowledge life’s price does not mean it doesn’t have one.

ONE OF MEXICO’S
most famous cultural exports, alongside mariachi bands and drunken spring break in Cancún, is the 1979 telenovela titled
Los Ricos También Lloran
, or
The Rich Also Weep.
Dubbed into two dozen languages, the epic soap opera’s tale of the trials and tribulations of a lovely young heiress, Mariana, captivated millions of viewers in more than a hundred countries.

The show was exported to China and Saudi Arabia. It gave Russia a first taste of capitalist pop culture, drawing an audience of 100 million after making its debut there in May of 1992, shortly after the demise of the Soviet Union. President Boris Yeltsin was a fan. According to the Russian newspaper
Pravda,
soldiers from Abkhazia and Georgia would reach a tacit truce during showtimes in order to watch the show.

The telenovela’s plotline is of byzantine complexity. Mariana, the heroine, is ejected from the family ranch by an evil stepmother. A wealthy benefactor takes her in. The benefactor’s handsome son woos her. Her love for the young man is thwarted by a rival, consummated, tested by jealousy. Somehow—don’t ask—Mariana decides to give their baby son, Beto, to a woman who sells lottery tickets. Only after she encounters Beto years later and prevents his father from shooting him will she be happy.

Despite the idiosyncratic plot twists, and the actors clad in bell-bottoms, the telenovela appealed to millions because it tapped into a romantic archetype, that of the helpless heroine who falls into the lap of luxury yet cannot find happiness until she finds true love. Its message—though delivered in a style of high camp—resonates across time around the world: we may think wealth provides happiness, but they are unrelated.

The point had been made over a century earlier by the philosopher Arthur Schopenhauer, who argued that “money is human happiness in the abstract; he, then, who is no longer capable of enjoying human happiness in the concrete devotes himself utterly to money.”

In March of 1968, three months before he was shot to death, Robert Kennedy delivered a scathing critique of the nation’s fixation on economic growth: “Gross National Product counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for the people who break them. It counts the destruction of the redwood and the loss of our natural wonder in chaotic sprawl,” he said.

“Yet the gross national product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile.”

This age-old conviction is undergoing a bit of a revival. As people around the world struggled with the fallout from the global financial crisis and a worldwide recession, the sense that there is something wrong with our unbridled pursuit of material riches coalesced among some policy makers into a belief that nations should pursue something other than economic growth. Our narrow drive to maximize GDP, many seem to believe, brings only disaster.

In 2008, as the French economy slipped toward recession, French president Nicolas Sarkozy drafted two Nobel Prize-winning economists, Amartya Sen and Joseph Stiglitz, and the domestic economist Jean-Paul Fitoussi, to prepare a report on how to better measure people’s socioeconomic progress. “The time is right for our measurement system to shift emphasis from measuring economic production to measuring people’s well-being,” the report concluded. Government, it suggested, should supplement standard economic data with other information, including citizens’ sense of happiness with their lives.

The tiny Buddhist kingdom of Bhutan, high in the Himalayas, has stretched the idea further—devising a quantity it calls “gross national happiness,” which it plans to use to evaluate policies and keep track of the country’s well-being. King Jigme Singye Wangchuck coined the term in 1972, but it became a reality only after he abdicated thirty-six years later, when Bhutan had its first-ever democratic election, and the Bhutanese approved a new constitution that established the world’s first GNH index.

The index has six dozen variables, grouped into nine dimensions—including psychological well-being and community vitality, ecology, good governance, and time use. And it sets values to behaviors. People score happiness points if they pray and meditate often and understand their family, and lose points if they feel selfish. Yet more isn’t necessarily better. Playing Langthab, for instance, a game in which opponents head-butt each other into submission, is assumed to make Bhutanese happy. But it is enough to play it once or twice a month. Playing more doesn’t increase the happiness stock. Similarly, money adds to happiness—but only up to 70,597 ngultrum—or about $1,550—per household per year.

 

 

YET DESPITE ITS
growing popularity, the belief that money has little or nothing to do with happiness is misleading. Like Schopenhauer’s musings and Mariana’s troubles, the sweeping rhetoric about the emptiness of material wealth supports a dubious proposition that the pursuit of economic progress is somehow a waste of time because it does not deliver what is most important in life. Despite the skepticism about run-of-the-mill economic growth, despite the angry denunciations of materialism, it is usually better to have a big gross domestic product than a small one. Just ask one of the more than 3 billion people—half the world’s population—how happy they are making do with less than $2.50 a day.

In fact, surveys find that richer people tend to be happier than poorer people. That’s because money provides many of the things that improve people’s lot. Richer countries are generally healthier and have lower child mortality and higher life expectancy. They tend to have cleaner environments, and their citizens often have more education and less physically demanding and more interesting jobs. Richer people usually have more leisure time, travel more, and have more money to enjoy the arts. Money helps people overcome constraints and take control over their lives. Whatever Kennedy said, gross national product does allow for the health of our kids.

Researchers in Britain found that an extra £125,000 a year increased people’s sense of satisfaction with their lives by one point on a scale of one to seven. A study in Australia pored through surveys to understand how people’s feelings of happiness responded to life’s events. It found that a windfall of $16,500 to $24,500 provided more or less the same boost to happiness as getting married. Losing between $178,300 and $187,600 generated the same level of unhappiness as that caused by the death of a child. A Gallup survey in 2009 found that 30 percent of Americans earning less than $24,000 a year had received a diagnosis of depression, compared with only 13 percent of Americans making $60,000 or more. Happiness can be bought for a price.

There is a problem with the enthusiasm for replacing GDP with a measure of happiness. Who gets to define what makes people happy? Would it be the very same governments that would benefit if the indicator found a happy citizenry? For instance, media reports from Bhutan suggest the Bhutanese have lost interest in Langthab and other traditional sports. They are nonetheless included among the fonts of happiness. Bhutan is a fairly authoritarian nation. The government banned television until 1999. In 1989 it made it mandatory for all Bhutanese to speak Dzongkha in public places. In 1985, it passed a new citizenship law that redefined ethnic Nepalese in southern Bhutan who couldn’t prove they had arrived by 1958 as nonnationals, and subsequently expelled about 100,000 of them. It has nice things, like 72 percent forest cover and few tourists. But it also has a lot of female infanticide and feticide and a lopsided sex ratio of 89.2 females per 100 males. More democratic regimes might have problems defining the attributes of happiness. While Bhutan may be a happy nation, this probably has less to do with the many dimensions of their index than with their material wealth. In 1980, Bhutan’s GDP per person was 10 percent higher than India’s. Today it is 75 percent higher. In 2009, as the rest of the world slumped, Bhutan grew 6.9 percent. In 2008 the Bhutanese economy grew by a fifth. Like other countries around the world, it has grown happier as it has grown richer.

The World Values Survey, a set of polls performed around the world over the past twenty years, found that the happiest country in the world is rich Denmark. The least happy is poor Zimbabwe. The 2006 Gallup World Poll asked adults in 132 countries to rank their satisfaction with life on a scale of zero to ten. The citizens of Togo, whose gross domestic product per person is only $832, ranked their satisfaction at just above three. Americans, fifty-five times as rich, put their happiness at seven.

Happiness is a slippery concept, a bundle of meanings with no precise, stable definition. Lots of thinkers have taken a shot at it. “Happiness is when what you think, what you say, and what you do are in harmony,” proposed Gandhi. Abraham Lincoln argued “most people are about as happy as they make up their minds to be.” Snoopy, the beagle-philosopher in
Peanuts,
took what was to my mind the most precise stab at the underlying epistemological problem. “My life has no purpose, no direction, no aim, no meaning, and yet I’m happy. I can’t figure it out. What am I doing right?”