In a few months, I will retire as Chair of the Board of Trustees of HelpAge International. I have already received an invitation on LinkedIn to enrol in an online class in AI and begin a new career, and another one promising lucrative opportunities in financial management.
When I was 65, I thought I could hang up my work boots, having served business corporations as an executive, a member of boards, and a consultant, for 44 years. Prime Minister Manmohan Singh put me back into harness to serve the country as a full-time member of India’s Planning Commission. In five insightful years in the cockpit of India’s national planning, I learned how economic evaluations have corrupted human values in government.
I thought I would finally retire and play golf when Narendra Modi became Prime Minister in 2014 and abolished the Planning Commission. My second attempt also failed. Trustees of HelpAge International (HAI) induced me to join them as Chair of their Board. HAI is engaged with the care of older persons around the world. Longevity has increased with improvements in standards of living and medical advances. There are more older persons who need care everywhere.
HAI is a very small NGO compared with international NGOs who are focused on the more popular causes, such as the care of children, women, and the environment. HAI finds it more difficult than them to attract donors and get the attention of policymakers for the cause of older persons. HAI needed a new strategy. Honestly, I was not as concerned at that time, as I am now, about the cause of older persons. I was intrigued by HAI’s strategic challenge.
In nine years as Board Chair, I learned about the care of older persons and geriatric medicine, and about caregiving in general. I plunged into the world of civil society organizations and non-profits, and their challenges in obtaining adequate financial support and in reforming their own governance. Corporate management concepts and business management methods have begun to sweep through governments and NGOs too. Business management consultants have become advisers to governments and NGOs, to “professionalize” their managements. Economic values are overtaking human values in governments and even in care providing organizations.
Business management is the art of efficiently exploiting resources—natural and human— to produce profit. By law, managers of business corporations are accountable to the stock owners of their corporations. Their responsibility to society lies within their conscience. In the world of professional management, when the voice of conscience conflicts with legal accountability, the latter is expected to prevail. Governments are accountable to citizens, especially to those with the least power and wealth. In government policy, the calculus of human values should prevail over the calculus of economic evaluations.
The paradigm of economic progress must be changed to care for aging populations and also to save the world from climate change. Economic exploitation must end. Human values must be put into the driving seats of governments and business organizations.
In my essay on a caring society, I mix policy with a little poetry and some philosophy. I explore the value of caregiving, and how it has been corrupted by economics.
I. POLICY
Money or Life
“Your money or your life!” demands the robber. Economists attribute monetary values to human lives to calculate the cost-benefits of public policies. Benyamin Applebaum explains how the monetary calculus of economics has taken over government policies, in The Economists' Hour: How the False Prophets of Free Markets Fractured Our Society (Little, Brown &Co, 2019). Monetary cost-benefit analysis overtook social values in the 20th century when economists from the Chicago school of economics began to steer government policies.
An evaluation of the monetary worth of a human life was inherent in the act of buying a slave. And as wage labour became more common in the early modern era, the value of a person was equated with the market value of a person’s output. By this measure, the worth of a man who has a formal education, with which he can earn more, is more than the worth of another who could not have the privilege of the same formal education. The life of a human being in a poor country is less valuable, in dollar terms, than the life of another born in a rich country. The life of an older person, with fewer years remaining to live and work, is less valuable to an economy than the life of a younger person.
In this monetary calculus, the value of the work of a woman caring for children (and elders) in the family is less valuable than the work of men (and women) who go out of their homes to earn money. Outside the home too, caregiving, which is not considered economically productive work, is less valued. Economic calculations drive women out of their homes to earn money, increase the size of the GDP, and gain social respect.
Pensions
Longevity is increasing everywhere with economic progress and medical advances. All countries are facing economic problems with the proportion of younger, “working age” people reducing, compared to older, “retired” persons. Changing demographics is resulting in fewer younger persons to earn and pay taxes for providing pensions to larger numbers of older persons. Perversely, at the same time, pressures to improve the productivity of the workforce and new technologies to replace humans at work are reducing the numbers of jobs for young people.
Governments are caught in a bind. They must create more employment and income earning opportunities for young people. Employers feel pressed to reduce the retirement age to move older persons out of the work force and make room for younger persons. Therefore, pensions must be provided for longer, and sooner, to older persons.
Milton Friedman (the iconic leader of the Chicago School of economics) influenced Margaret Thatcher in the UK and Ronald Reagan in the US to reduce the sizes of their governments and let the invisible hand of the market do its magic. “Government is not the solution. It is the problem,” Reagan declared. Chicago school economics spread around the world in the latter half of the 20th century. The Chicago School (and Friedman himself) forced the Chilean government, with the backing of the US government and corporations, to privatize Chile’s social security system. As Applebaum explains:
“The Chilean government does even less for the elderly. The social security system was privatized in the early 1980s.The architect, José Piñera, was a member of the second generation of Chilean free-market economists. The system requires Chilean workers to invest at least 10 percent of their salaries with private companies, which has helped to deepen financial markets and to fuel the expansion of the corporate sector. But this pension system does not provide adequate pensions. The result is a system that transfers wealth from the poor to the rich—exactly the opposite of the way that social security should work”.
The care-giving economy
Several trends have come together in the 21st century to reduce the numbers of jobs in large organizations and to increase the need for care-giving services.
· Digital technologies and AI are replacing human beings, in manufacturing, services, and even creative work
· With the numbers of older persons increasing, their care needs are increasing too
· Developing countries in which public healthcare services are not yet well-developed must build them now
· The need for therapeutic care of underemployed, and socially disengaged youth has increased. Enforced isolations during the Covid pandemic, with school closures, etc, created a further surge in this need
· More care-giving workers will be required in both developed and developing countries. This provides an opportunity to create employment, offsetting the decreasing jobs within industrial organizations.
However, wealth and income disparities will widen further with employment in caregiving because care-giving jobs are economically valued less and therefore underpaid. (The feminine/masculine dichotomy of caregiving versus productive work prevails).
Applebaum points out:
“If the iconic workplace of the mid-century was an automobile factory that lifted its workers into the middle class, the microcosm of the modern economy is a hospital staffed by a handful of highly paid physicians and a vast army of poorly paid support staff. One consequence is the startling resurgence of inequality.”
I was in a hospital in Delhi earlier this year to have my hip-joint replaced. The surgeon and his team were world-class. Even citizens of the US and UK come for surgeries at this hospital (and others in India) because they do not have to wait for months or pay much higher costs in their own countries. They can get the same standard of surgery in India at a fraction of the cost. I was out of the hospital in three days, and then walking around without a stick in two weeks. The surgeon and his team were excellent. Moreover, aftercare by nurses and attendants was abundant, caring, and professional. I made many friends amongst them. They had migrated from all parts of India to find work in Delhi. We talked about their old parents and others they had left behind; some showed me pictures. I also learned how little these professional caregivers are paid.
The values we live by
Philosopher Michael Sandel poses the moral dilemmas that modern market economies create, in What Money Can’t Buy: the Moral Limits of Markets. (Farrar, Strous, and Giroux, 2012). Applebaum also gives an example in The Economists Hour (ibid).
"An economist named Uri Gneezy persuaded six day-care centres (in Israel) to announce that parents who came late would be fined. He then compared the results with four centres that continued to operate on the honour system. What happened? Late pickups roughly doubled at centres that punished late arrivals: parents facing a fine were more likely to come late. Parents felt they could purchase a few extra minutes to spend at work or the market or the gym. They didn’t need to feel guilty because they had paid. And the shift in behaviour outlasted the policy: parents continued to come late even after the fines were eliminated. A social norm had been replaced by a transaction.”
There is an ethical difference between (1) feeling not guilty because you have paid someone and bought a convenience, and (2) feeling guilty because you have harmed another human being, even though you have compensated her with money. In Gneezy’s case-study, staff in the care centres, who have children and family of their own at home to care for, have been paid money to provide care for others. But their own families have been deprived of care.
Market economies enable people to earn money. They also create social inequities. In market economies GDP grows and family well-being reduces. Societal values change. Children grow up without learning the moral difference between what they should not expect to be paid for, such as caring for older persons who have provided for them, and the work they should expect to be paid for.
2. POETRY
Care, need and greed
The poet Robert Frost ends his poem, Two Tramps in Mud Time, with these verses:
“Nothing on either side was said,
They knew they had but to stay their stay
All their logic would fill my head:
As that I had no right to play
With what was another man’s work for gain.
My right might be love but theirs was need.
And where the two exist in twain
Theirs was the better right—agreed.
But yield who will to their separation.
My object in living is to unite
My avocation and my vocation
As my two eyes make one in sight.
Only where love and need are one,
And the work is play for mortal stakes,
Is the deed ever really done
For Heaven and the future’s sakes.”
Frost is cutting wood for the winter in his yard. He is cutting it himself because it makes him feel good about his life. Two men who need money make him feel guilty for doing the work and not letting them earn money.
Getting the work-life balance right has become a global problem. Even investment bankers, who seem to be working all the time, and earning a lot of money too, feel their life and work are out of balance. Many retire very young, with enough money for the rest of their lives. They don’t need pensions, they say: what they want is a meaningful way to live the rest of their lives.
Many come to me for advice. I ask them, “What do you care about most?” I have asked the same question to CEOs and business executives when I was a management consultant and was invited by them to help improve their organizations’ performance. I would ask them to shut their eyes and listen to their hearts before they replied.
Hardly any said they cared about making more money for themselves, or even about making more money for their corporations. They said they cared for their families most of all. When pushed further and asked what impact they would like their companies to make in the world, most would say they wanted to improve the lives of people. Though their hearts wanted to, they were required by law to produce results for their shareholders, to whom they were accountable, not their own hearts.
How much money do we need for what really matters?
Formal organizations separate work and life. Henry Ford is reputed to have lamented that when he wanted only pairs of hands in his factories, he was compelled to hire whole human beings with many needs and demands. The modern, technological solution is to replace humans with robots: they can do the work of human hands more efficiently. They don’t have feelings, and don’t complain or demand higher wages.
We work to live and live to work. Women labour, we say, to produce children. That is the natural way new lives come into the world. However, women are not as valuable workers as men in formal organizations, because women need biological time off to create life and then to care for their infant children. When a woman is paid to care for another woman’s children, as day care workers are, the care worker’s monetary earnings add to the GDP. As do the earnings of the richer woman in a higher paying job, who cannot afford the time to take care of her own children because “time is money” in the economy. Whereas their time could have provided care and love in their families when it was needed, both are working and earning.
As Michael Sandel says, there are some things that money cannot buy. Money can’t buy love.
3. SOME PHILOSOPHIC DOODLES
I or We
“Ubuntu”—I am because we are. (An African saying)
Healing by communities heals communities.
Geriatric medicine heals bodies. Caring communities heal us.
Your business or your life
Businesses run with economic evaluations; communities with human values. When an appliance designed for AC current is plugged into a DC power socket, it will blow up.
Who is best equipped to be a care provider? (Rate on a scale of 0 to 10)
(1) Business
(2) Government
(3) Community
Scientific intelligence
Francis Bacon’s folly.
Francis Bacon said science gives Man the power to control unruly Nature. Climate change has revealed again that Nature controls Man.
Renee Descartes’ error
Descartes said, “I think, therefore I am”. The truth is, “I am, therefore I think.”
When I don’t think, I discover who I really am.
Artificial intelligence
Artificial intelligence thinks but does not care.
Scientists creating artificial minds to replace human minds are on a fool’s errand.
The end of life’s journey
“Setting out on the journey
Wondering what to make of it
And who I will be?
Reaching the end
Feeling one with it.
A good life lived.”