What, Me Worry?

Gawande and Williams

What, Me Worry?

Gawande and Williams

What, Me Worry?
An email conversation about the news of the day.
March 17 1999 2:47 PM

Gawande and Williams

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The Dow is making me very nervous. I don't know crapola about money. So I suppose I should sit back in happy ignorance watching the savings I've started setting aside in a mutual fund continue its tumorous growth. But I am a worrier by nature. Ten thousand just seems awfully high. And all those pieces in recent weeks by smart people like James Surowiecki, Joseph Nocera, and John Kenneth Galbraith arguing that the market is dangerously out of whack with the earnings potential of companies have only worsened my vertigo. I looked up the Glassman and Hassett article in which they argue that price-to-earnings ratios of 100--four times higher than current levels--would be perfectly reasonable. It didn't make me feel any better. I have no idea whether their argument makes any sense. Nonetheless, all that talk about how "our model" indicates a much higher "comfort zone" for investors sounded a little too much like pseudoscience. I'm not ready to start stuffing cash under my mattress yet, though.

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The schism between the economy's winners and losers is as troubling to me as it is to you. And underlying the growing disparity in incomes seems to me to be two big problems: 1) Marriage is worsening income disparities, since the well-off marry the well-off. 2) The current economy places a high premium on skill; yet no matter what we do, nearly half of our youth won't get a college education. Have you seen any possible solutions--short of forcing lawyers to marry their household help and doctors to marry starving artists?

I know you want to talk about Gore's poll numbers. But even though I've done plenty of time as a campaign flunky, I just can't get all that excited about numbers almost two years in advance of the election. But I am deeply worried that Gore could be to Clinton what Bush was to Reagan. He'll have to start exuding magic, giving us that up-and-coming feeling. And he'll have to convince us he's got that vision thing. The "livable world" agenda doesn't seem quite up to it yet. But then neither does Governor Bush's compassionate conservatism. The polls aside, I think Gore still has the upper hand. There will be ways and opportunities to make him look more presidential. But I still would like to see more evidence that he has the deal-making, confidence-boosting, nation-rallying skill it will take to tackle some of our up-and-coming problems--like trying to reduce that income disparity or fix Social Security and Medicare or limit the damage from an imploding nuclear Russia. Are you ready to see any of these candidates as up to the task? Myself, I think it's just too early.

On the moralism matter, I think there are lots and lots of ways that doubts can creep in about the quality of a surgeon's work. But lying and covering up about a sexual affair on the side would not be high on that list. I have no doubts that a special prosecutor could press surgeons I know into a similar position that Clinton dug himself into. That wouldn't stop me from getting surgery from them. There's an interesting problem at work here. We want to assume that presidents and editors and surgeons and all kinds of other folks don't have outside events that can interfere with their work. But divorces, financial troubles, crummy days, flu viruses, and lots of other things do interfere to some extent. I suppose that's scary, but I don't think there's much we can do about it except in extreme instances without becoming truly inhumane.

Dubiously yours,

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Atul

Atul Gawande has written about medicine for The New Yorker and Slate, is a surgical resident in Boston, and is a fellow at the Harvard School of Public Health. Marjorie Williams is a contributing editor at Vanity Fair.