Skin In The Game

I.

One of the most interesting responses I got to my post supporting the junior doctors strike was by Salem, who said that this situation was (ethically) little different than that around adjunct professors, who also become overworked and miserable trying to break into a high-status profession. Salem very kindly didn’t directly accuse me of hypocrisy, but maybe he should have.

While I sympathize with adjuncts’ terrible conditions, my natural instinct is to say feedback mechanisms should keep doing their work. You can probably trace the argument- imagine a simplified toy model where the only two jobs are professor and salesperson, and being a professor is fun and high-status but being a salesperson is boring and low-status. Everyone will become a professor, and this will decrease the demand for professors and increase the demand for salespeople until the employers involved change their policies accordingly. Eventually it will stabilize where the nonmonetary advantages of being a professor are perfectly compensated by the monetary advantages of being a salesperson. If professors are getting paid shockingly little, it means the system is sending a signal that the nonmonetary advantages of being a professor are shockingly high, or else why would people keep trying? If we demand that professors get paid more, then we’re letting them keep all their nonmonetary advantages over salespeople but demanding they have monetary advantages as well. It destroys the system’s incentives to have people go into less fun but nevertheless necessary fields.

All of this makes perfect sense in the adjunct case. So why do I feel so differently in the doctor case?

Maybe for personal reasons. When I was in college, my two dueling career plans were doctor and philosophy professor. I brought this up with my professors, who universally told me not to go into academia. They told me that it was grueling, thankless, and for the vast majority of people involved doomed to failure, and that they couldn’t in good conscience advise me to try it. I listened to their advice and became a doctor instead. It might not have quite the I-can’t-believe-they’re-paying-me-to-do-this amazingness of debating metaethics all day, but I still love it and it has much better career prospects.

So I guess you could argue that one reason I have less sympathy for adjuncts is that letting them achieve their goal would be a kick in the face to Past-Scott, who made what he considered the sober choice and went into a better-paying profession. If it turns out all I had to do was hang on a few years, and then the government would decree that people who got paid to argue about metaethics had to have career prospects as good as doctors’, then I was a huge chump to try to do things the hard way. Maybe it’s that fear of chumpness that makes it harder to sympathize.

And maybe the reason I feel such solidarity with doctors is that it’s not supposed to be a profession you go into knowing you have no hope. Healing the sick is a lot more practical and socially-subsidizable an activity than pondering Truth; it seems like the sort of thing it should be easy to get paid for. Here in America, this is the conventional wisdom: make it into medicine, and you’re promised a pretty good career. So maybe my solidarity with British doctors is a big cultural misunderstanding. Maybe, coming from America, I’ve absorbed a social promise that doctors will be treated well (which is true in America), but in Britain those doctors go into medical school knowing 100% that their lives will be unbearable and their compensation miniscule. Maybe they do it anyway because for them medicine is as much of an I-can’t-believe-they’re-paying-me-to-do-this as philosophy is to me.

Suppose somebody tells me that before going to medical school, every doctor in the British Isles has to sign a Waiver Of Appreciation Of Consequences, which spells out in excruciating detail all of the horrible things about a medical career. It says exactly how many 100 hour weeks they’ll be expected to work, exactly how many 36-hour shifts they’ll take, does its best to give them an idea how much senior doctors will abuse them. Maybe there’s even a video portion that has interviews with disgruntled current doctors describing in explicit detail all the worst things that have happened to them. Maybe they even have to shadow current junior doctors, work 36 hour shifts themselves even though they can’t do any procedures yet, just so that they can never claim that they didn’t understand on an experiential level what a 36-hour shift means. Suppose the government (unlike in the real world) does this 100% fairly and accurately, and then they stick to it – ie as bad as things are, they never get any worse than the video promised. And suppose that after all of this, representatives from Private Industry come in to discuss their options for non-medical jobs, and explain how conditions in these jobs will probably be much better. If a medical student signs this waiver, completes their training, graduates, hates their job, and demands better pay and conditions, can we have any sympathy for them?

(I’m talking about a hypothetical world here. In the real world, we have to consider that lots of people didn’t know what they were going into, and the thing they were going into keeps getting worse than they were led to expect. This is purely a Least Convenient Possible World argument here.)

The first argument we might use is that instead of focusing on the virtue of the employee, we should focus on the problems with society. That is, who cares whether the doctor made a good choice or not? Society still owes people decent jobs and working conditions. I think I reject this argument. There are some decent jobs attainable by the sorts of people who could become doctors (this is not true for everyone, but it’s pretty true of the people who could become doctors), and not every alternative has to be great for everybody. Suppose there are many entry-level gardening jobs available, but I become a skyscraper-window-washer. Then I complain because I am afraid of heights, and I want special accomodations for this. When you say “maybe you should try a different line of work”, I say “stop making this about my virtue and start focusing on the problems with society such that it can’t give everyone decent conditions.” It’s not a very sympathetic argument. Society is totally allowed to have jobs that not everybody would enjoy as long as it gives everybody a wide range of options.

(one might argue that nobody could possibly enjoy being a junior doctor, but weirdly enough this is false. There are some people who love it. I usually assume these people are on cocaine, but maybe some of them aren’t.)

The second argument we might use is that instead of focusing on the virtue of the employee, we should focus on distortions in the economy. Who decided to have a medical career consist of ten to twenty years of misery followed by an elusive opportunity to get a really nice job with great pay and hours? Isn’t part of the problem that hospitals aren’t competing for junior doctors? Can we oppose dualization of the labor force as just a generally bad idea? I think this argument is right, but I also think there’s still a lingering question of “Okay, but since we do have this terrible industry with bad incentives, should we feel sympathy for people who voluntarily place themselves right in the middle of it?”

The third argument we might use is that we sometimes need to save people from their terrible decisions. Just as we ban people from permanently selling themselves into slavery, no matter how aware they are of the consequences when they make the deal, so maybe we should assume that signing the Waiver Of Appreciation of Consequences is an irrational decision motivated by time discounting and that people’s future selves ought to be freed from the tyranny of their past selves’ poor judgment. There’s definitely some truth to this, but it’s also a little too close to the policies of the BETA-MEALR Party for comfort. And doesn’t this ignore that doctors aren’t slaves, and can leave the medical profession any time they want? Even if there are some reasons they can’t (difficulty finding other jobs, sunk cost effects) wouldn’t it be less distortionary to smooth their path to non-medical careers than to try to reform medicine?

All of this makes sense. And yet as a psychiatrist, I constantly have people come into my office saying their jobs are making them suicidal. You would think somebody would leave a job before it makes them suicidal, but this doesn’t always happen (the same is true of relationships, by the way). My suggestions that maybe they find a different job or boyfriend tend to fall on deaf ears.

I think one big reason I am so much more sympathetic to doctors than adjuncts is that I know them and have worked with them and I can see a reality – both a real reality and an emotional reality – that makes the model look kind of weak and threadbare.

II.

A few years ago I rented a house. In the rental contract, it said “tenant must have their own rental insurance to cover damages to the property”. I reminded my landlord that rental insurance mostly just covers damages to the renter’s stuff, and that the landlord usually has a separate property insurance to cover damages to the property, and that the way he was doing it might not even be legal. He just said yes it was and I had better get the rental insurance. I made a mental note to get the rental insurance and then got distracted by everything else in life and never got around to it.

A few years later, a pipe burst and the house flooded. The damage was assessed at way more than I had the ability to pay. I told the landlord he had better fix it, and the landlord told me I had better get my rental insurance to fix it for me – ie, the rental insurance I had forgotten to get.

There followed a gigantic disaster. I asked some lawyers whether the landlord was legally required to insure his own property, and they gave me vague and conflicting answers, then all agreed that even if he was it would cost more money than I had to fight the case in court. I ended up on the verge of breakdown. The landlord was clearly deliberately stonewalling me, trying to make it as hard as possible for me to figure out what was going on in the hopes that I gave in and gave him the money I didn’t have. Eventually, after several months’ of living out of a friend’s spare room while I tried to get the fate of the house sorted out, we settled out of court for a big fraction of my life’s savings.

(I later got some evidence that the landlord did have the property insured and was running some kind of insurance scam trying to get the money out of both me and his insurance, but that’s a different story and I’m still not sure either way)

The reason I bring this up was that for the duration of the crisis, and to a lesser degree even to the present, I was utterly convinced that the government had an obligation to make sure landlords insure their properties. Offering a contract where the tenant was responsible for insuring the property? Totally unacceptable. Maybe even a human rights violation. What’s the new phrase people are using these days? “A denial of your right to exist”? Even so.

It’s easy to craft the argument where I’m in the wrong. Different landlords should be allowed to experiment with different arrangements as long as their terms are clearly listed in their contracts and the other contracting party agrees to them. I signed the contract then failed to do what the contract said, and clearly I needed to pay the penalty. We can imagine some nanny-state laws that might ameliorate that – for example, if a contract says a tenant must purchase insurance, it’s the landlord’s responsibility to make sure the insurance was actually purchased – but the arguments for implementing these laws are on really shaky ground.

And all I’m saying is that in the middle of this crisis, I had no sympathy for any of this. In the middle of this crisis, my thought was that I had worked really hard for years to get a little bit of money saved up, I was going to lose all of it for some burst pipe that wasn’t my fault, this was cosmically unfair, somebody needed to do something about it, the landlord was a big company that probably had millions of dollars, and somebody needed to do something about this right now.

III.

An article by Freddie deBoer in this month’s Current Affairs proposes “Journalistic Self-Outsourcing”. DeBoer notes that lots of journalists and intellectuals suggest that protectionism and other anti-globalization policies are immoral. For example, Zack Beauchamp of Vox calls Bernie Sanders’ skepticism of free trade “screwing the global poor”; Brad deLong calls the same “a call to keep China a society of poor subsistence rice farmers as long as possible – keep them poor, barefoot, uneducated, and by no means allow them to work at any of the high-value manufacturing occupations we want to keep in the United States.”

DeBoer has a few things to say about how we should take money away from the rich in a way that can help both poor Americans and poor Chinese, but he quickly transitions into the barb he clearly relishes: if Beauchamp and DeLong are so in favor of poor Chinese people, how come they haven’t outsourced their jobs? They both earn quite a bit of money, and China must have some decent journalists and economists who would love to telecommute to well-paid American positions. Are DeLong and Beauchamp hypocrites for not arranging to expedite the transition of their jobs to Chinese people?

One argument in their favor: they’re currently living in a relatively globalized world, their employers must have the option of replacing them with Chinese people, but both of them still have jobs. This suggests that maybe journalism and economics aren’t as replaceable as deBoer thinks. Beauchamp might be able to retort “As soon as Vox finds a Chinese journalist who’s as good as I am they’re welcome to hire him/her, but until then I can stay on, secure in the consistency of my principles.” Presumably he can say this without fear, since the subtleties of being in touch with the pulse of the American people and writing English-language articles would elude most lower-class Chinese.

But this lets them off too easily for purely contingent reasons. Even granting that they can’t be replaced with Chinese people right away, are they forced to will their replacement with Chinese people, deep in their hearts? Should Beauchamp go into work every morning asking his boss whether he’s found a suitable Chinese person to replace him with yet, and be disappointed every time his boss says no?

Again, there’s a contingent argument otherwise. If you’re really pro-globalization, you might believe that it’s impossible for the Chinese to take all our jobs, in the same way that the Luddite Fallacy says it’s impossible for robots to take all our jobs. The more Chinese take manufacturing jobs, the more Americans will have lots of money which will encourage new service jobs that the Chinese can’t easily take. If this is Beauchamp’s argument, he could say that we should globalize all the jobs that can be globalized, including his if possible, and then he will just move to an unglobalizable job. Since his job hasn’t been globalized yet, maybe he’s already in an unglobalizable job, so people should just stop bothering him.

But this is still too contingent. Let’s least convenient possible world again, and suppose that economists determine that there are permanent negative effects on American jobs from Chinese globalization, those effects disproportionately go to the poorest Americans, and no new unglobalizable jobs arise to restore cosmic balance. Now does Beauchamp have to will his own replacement?

Okay, argument from the other side: suppose a 1980s version of Beauchamp is writing an article against apartheid in South Africa. The South African whites argue that if apartheid ends, they’ll be competing for jobs against much poorer blacks and so their quality of life will go way down. They say that if Beauchamp really wants to end apartheid, he himself should give up his journalist position to a South African black who will take it for a few dollars a day.

I’m both very convinced that the right thing to do in that situation would be to fight apartheid, and also convinced that the South Africans would be right about the personal jab – the median American journalist who pushed the fight wouldn’t want his job taken over by Zulus willing to work for lower wages. When I put myself in that situation, and imagine myself being undercut by foreigners willing to practice medicine for almost nothing, I’m pretty pissed off about the idea too.

So maybe we should just let the journalist keep being a hypocrite. Journalists are pretty privileged people, and if we call journalists hypocrites every time they stand up for the less privileged without giving up all their own privilege, we’ll probably just end up with journalists who stop standing up for the less privileged.

IV.

Consider two contradictory arguments.

The first says that people who experience a problem have unique insight into it, and people who don’t experience it debate it from a position of ignorance or callousness. Thus a rich person can say “The poor don’t need help because they can pull themselves up by their own bootstraps”, but a poor person knows this is harder than it sounds. There’s a really boring sense of this in which the poor person may know specific facts the rich person is missing – for example, the rich person might falsely think welfare is much more generous than it is. But then a rich person who’s read a lot of books on poverty might claim to have a better perspective than the poor person, since she would likely know more about the welfare system. The more interesting claim is that there’s a sort of near-mode-vs-far-mode thing going on here, where things that are easy to dismiss in the abstract become a lot more relevant in the concrete. A really good example of this is Hitchens’ waterboarding – he said he thought it was an acceptable interrogation technique, some people offered to waterboard him to see if he changed his mind, and he quickly did. I’m fascinated by this incident because it’s hard for me to understand, in a Mary’s Room style sense, what he learned from the experience. He must have already known it was very unpleasant – otherwise why would you even support it as useful for interrogation? But somehow there’s a difference between having someone explain to you that waterboarding is horrible, and undergoing it yourself. Just so with everything else. Under this view, the only people we should trust to tell us whether junior doctors get treated fairly are junior doctors; the only people we should trust to tell us whether globalization is acceptable are people whose own jobs are on the line.

The second says that people with skin in the game are the last people we should be trusting. Who do you trust to tell you how many subsidies the government should give the oil companies? Some economist in the budget watchdog organization who calculates exactly what the costs and benefits are? Or an oil company CEO who says “Trust me, we need lots and lots of money”? Under this argument, everyone has access to logic and reason, people detached from the situation are able to use it, and people within the situation are (perhaps excusably) motivated by self-interest. We can perhaps understand the fears of the white South African who thinks he’ll lose his job and end up bankrupt, but it’s our job as dispassionate external observers to notice that his concerns are outweighed by the concerns of other people whom his self-interest makes him unable to understand. And the last person you want giving you a sober cost-benefit analysis of torture is the person who is being waterboarded – everyone knows a waterboarding victim will say anything at all to make it stop!

The second argument obviously has its uses, but I’m fascinated by the first. In the few cases where I have direct experience with it, it seems to bring knowledge beyond just “this is really bad”. In fact, the anti-junior-doctor argument seems resistant to just learning medicine is worse than you thought – if anything, medicine being very bad makes the argument stronger, since it means the doctor should be extra quick to listen to feedback and go into a different career. But somehow experience with doctors has made me much more reluctant to believe that argument. In the same way, one could imagine Hitchens saying “Yes, this waterboarding is really unpleasant – good thing that means it’ll be really easy to make the terrorists want to talk” – but that wasn’t the conclusion he drew from it.

I guess the thing I’m not sure about is – does personal experience/”skin in the game” reduce fully to factual propositions? Does a factory worker have an advantage over a journalist in understanding globalization just because he knows that being laid off is really bad, and that it’s harder to get a new job than a journalist thinks – two things we would expect any journalist worth their salt to already know about? Or is there some hard-to-communicate knowledge that’s neither factual nor just a cover for “the secret hard-to-communicate knowledge that I am selfish and want a system that benefits me rather than other people”?

Awkwardly, my far mode says that there isn’t and my near mode says that there is.