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Wednesday, March 12, 2014


To day I conclude my essay, The Pimple on Adonis' Nose.  Tomorrow I shall tell you about its reception, and discuss some of the questions it raises.

On my last day in Invertia, I met as promised with the Minister of Health, the Minis­ter of Education, and members of their staffs.  We sat on the porch of my hotel, in the late summer sun, and talked for more than three hours. 

I spoke at length about my puzzlement and distress at what I had witnessed, both at NICH and at the university.  I told them I was appalled by the callous disregard of the man who had died in the ER of the hospital.  Invertians, I said, seemed to be friendly, sensitive, caring people, and yet the staff of the hospital exhibited no anger at what had happened.  I went on to talk about the mystifying events at the university, and confessed myself utterly unable to understand why the brilliant young student of Mathematical Physics had been summarily turned away while a barely literate young man, manifestly unready for universi­ty work, had been so solicitously received and admitted.

When I had finished, both Ministers sat quietly for a while, stunned, I think, by the vehemence of my remarks.  Finally, the Minister of Education made a gesture deferring to his colleague, and she began their reply.

She started with a question.

"Tell me," she said, "since you clearly find our Invertian medical policies so alien, how such things are managed in the United States.  Had we visited the Emergency Room of an American hospital, what would we have seen?"

" In the emergency room of any American hospital, "I replied, “the response to that desperately ill man who staggered into the ER of the NICH would be the same.  He would be given immediate emergency medical attention, and every effort would be made to keep him alive. Specialists would be called to the ER;  if necessary the patient would be hurried into an operating room;  the entire medical team ‑ specialists, residents, interns, nurses, technicians ‑ would work together to arrest the heart attack, stabilize the patient, and give him the best possible chance for survival. 

"If, at the same time, a healthy young man were to present himself with a pimple and ask for treatment, he would be told to wait until someone could see him.  In all likelihood, he would be sent packing with a warning not to waste the time of the ER with cosmetic problems and some sardonic advice about over‑the‑counter skin creams.  Were the doctors in the ER actually to examine him, they would quickly conclude that he was not in need of medical care, and he would be advised to go home.

"And how do these meticulously cared‑for patients fare?" the Minister of Health asked me.  "Do they all recover and go on to lead long healthy productive lives?"

"Of course not," I replied.  "Many of them die despite the best efforts of the hospital, and even those who do recover are required to follow a careful regimen of diet, exercise, and periodic check‑ups.  The point is that the American medical profession considers its job to be the saving and prolonging of life, not the cosmetic improvement of those who already enjoy excellent health." 

"And your educational system?" the Minister of Education asked, breaking into the discussion.  "Does it operate on these same principles?  Are the neediest attended to first, as in our Invertian university?  I was, I confess, very puzzled by your reaction to our admis­sions procedures, in light of the reports I had heard of your concern about the operation of our National Hospital."   At this point, I became aware of a certain uneasiness.  In retrospect, I realized it had been growing in a corner of my mind since my visit to the university the previous day, and my conversation there with the Minister of Education.  As I answered his question about the American higher educational system, I began to feel more and more that there was some sort of incompatibility between my reactions on the first and second days of my visit.  But all of this, as I say, became clear to me only in retrospect.  When the Minister asked me about American higher education, I plunged into my reply with great self‑confidence.

"To begin," I said, "I must explain that higher education in the United States is not under the unified control of the central government, as it is in so many European, Asian, and African nations, and as it appears to be here in Invertia.  There are, taking all in all, almost four  thousand institutions of higher education in America, including private universities and liberal arts colleges, state universities and colleges, community colleges, junior colleges, and so forth.  These institutions vary dramatically in size, in quality, in cost, in level of funding, and in mission.  Some are vocationally oriented; some were founded, and are still run, by religious sects;  some are devoted as much to research as to teaching; and others are entirely teaching institutions. 

"The very best colleges and universities have many times as many applicants as they have room for.  Their admissions policies are highly selective; such institutions spend hun­dreds of thousands of dollars a year processing applications, interviewing applicants, and making sure that they select the most qualified young men and women who wish to enter.  But there are also a considerable number of colleges that have trouble filling their class­rooms, and they, despite their best efforts to be selective, may be forced to admit students who are not a great deal more qualified than the young man we saw yesterday. 

"The system has serious defects, needless to say ‑ defects of which I am a harsh critic. Nevertheless, I really think it is fair to say that the overwhelming majority of professors, admissions personnel, and academic administrators genuinely seek to select, for their insti­tutions, applicants who are well‑prepared for higher education and capable of benefiting from the faculty assembled there. 

"Every one of those colleges and universities would be simply delighted to receive an application from that young woman whom your university rejected.  Indeed, if you will give me her name and address, I think I can guarantee to ar­range a full scholarship for her at any one of scores of outstanding institutions in the United States."

"So," said the Minister of Education, not as impressed as I might have hoped by this rather effulgent speech, "your answer is, no.  The American university system does not op­erate on the same principles as does our Invertian system.  If I may venture an observation, it would appear that you run your universities in just about exactly the manner that the Minister of Health here runs our hospitals."

"What on earth are you talking about?" I said, astonished by his remark, and stung by it as well.  "With all due respect to the Minister, who is, I recognize, a dedicated public  servant, your hospitals do cosmetic surgery on fundamentally healthy young men and wom­en while allowing heart attack victims to die on the floor of the Emergency Room.  What possible connection is there between that bizarre distortion of medical values and the way in which the American system of higher education operates?"

"Well," the Minister replied, in a patient, measured tone, as though explaining things to a child, "our medical system selects only the healthiest patients, on the basis of the prob­ability that they will respond positively to treatment and leave our hospital as close to phys­ical perfection as nature and medical science combined can make them.  We reject patients who are too sick, too weak, whose general physical condition is too poor, to make them promising candidates for treatment."

"Your university system selects students, by your own account, in exactly the same manner.  The closer a student is to being in perfect educational health, if I may speak in that fashion, the more eagerly your colleges and universities compete to enroll that student in their entering class.  You yourself told us that the young Invertian woman with the ex­traordinary preparation in theoretical physics and the arts could, without difficulty, secure a scholarship at any of your very best colleges or universities.  The young man we saw yester­day, on the other hand, was, educationally speaking, the equivalent of the heart attack vic­tim at the hospital.  He was desperately in need of immediate educational help if his mind was to have the slightest chance to survive.  So our most senior professors rushed to his side, and took him into the university, where they are already beginning the long process of remediation and development from which he may, I say may, emerge a reasonably well‑educated, independent, literate, thoughtful citizen.  Your colleges and universities, if I un­derstand you correctly, would shrink from such an applicant, admitting him only if forced to by a shortage of, as you put it, 'better qualified' candidates.

"Your colleges and universities are engaged, educationally speaking, in the removal of pimples from the faces of intellectually beautiful young people.  The only visible differ­ence between those young men and women on their first and last days of college, I would imagine, is a slightly higher sheen, a bit more of a glow of perfection.  Judging by what I have read of your most distinguished universities ‑ for, you see, we here in Invertia are aware of the rest of the world ‑ many of the young people who enter those ivied walls are so far advanced in their study of science, the arts, or society that they are better thought of as junior colleagues than as students.

"Is it not the proudest boast of such institutions that virtually all who enter their Freshman classes graduate with distinguished records, and go on to achieve great success in later years?  How does that differ from my colleague's claim that the Invertian medical sys­tem has produced a small but select cadre of beautiful people who are free of every blem­ish and in perfect physical health?  You are disturbed that this island of perfection is pur­chased at the price of a sea of physical neglect.  Your educational system accomplishes the very same result.  Your Harvards and Yales and Amhersts graduate perfect educational Adonises and Venuses, while all about them the minds of countless men and women are dying for lack of educational care."

 "You cannot expect Princeton or Chicago to admit students who cannot properly read or write," I protested.  "That is not their function.  They do not have the resources for the enormous task of remediation such an admissions policy would impose on them.  To set scholars of Renaissance poetry or Quantum Physics the task of teaching remedial writing or math would be an unconscionable waste of the extraordinary talent gathered in those cen­ters of learning.  Their job is to take the most promising, the brightest, the most talented young people in America, regardless of race, creed, gender, or national origin, and bring them to a pitch of intellectual excellence at which they will be able to extend the scholar­ship, the exploration of nature, the cherishing and elaboration of the arts beyond what previous generations have achieved."

"As for the absence, at your best institutions, of appropriate resources for remedia­tion," the Minister responded, "that is precisely, as I understand it, the point made by my colleague here with regard to the NICH.  The medical policies of Invertia being what they are, the NICH has over the years built up a world‑class cosmetic surgery department, while neglecting its coronary, oncology, and trauma departments.  Naturally, the NICH is not now well‑suited to treat heart attack victims.  If the policy were to be changed, it would no doubt take some time and even a good deal of money to convert the NICH into something resem­bling your Massachusetts General Hospital. 

"In exactly the same way, Harvard, having for more than a century labored hard to make itself the very model of a modern German university, would be ill‑prepared indeed to deal with an influx of genuinely needy students whose lack of skills and preparation de­mand immediate, high‑quality remediation.  No doubt, it would cost Harvard some time, and some money, to retool.  But just as you seem unwilling to accept such considerations as an excuse for allowing that poor man to die in the ER, so, in all consistency, you can hardly accept the existing structure of your institutions of higher education as an excuse for allow­ing potential students like that young man in our admissions office yesterday to die, educa­tionally speaking, outside the walls of your most distinguished colleges and universities."

"You are completely ignoring the enormous social benefits that flow from the grad­uates of our very best colleges and universities," I argued.  "It doesn't do Invertia as a whole any particular good to remove pimples from the faces of otherwise beautiful young people.  But that young woman, were she to receive the benefits of an advanced university educa­tion, could do more than merely hold down a job.  She might make discoveries that would lift all of Invertian society to a new height of material or intellectual well‑being."

"Let me consider the supposed benefits of a system of education designed to serve the least needy, or, as you would prefer to put it, the best prepared, applicants," the Minis­ter responded.  "Despite what I believe to be a vast exaggeration of the effects of elite uni­versity education on students who are already superbly well‑prepared, I am quite willing to grant that lavishing the most expensive resources on those who need them least results in some significant benefits that might otherwise fail to materialize.  But that hardly settles the question, for we must still ask, as your economists like to do, what the opportunity costs are of that educational policy.  What is foregone, what is lost, when scarce resources are con­centrated on the least needy, rather than being allocated to the neediest?

"Are you quite prepared to insist that the total well‑being of American society would diminish if some portion of the wealth devoted to the education of the best‑prepared stu­dents were redirected into programs for remedial help to the educationally neediest?  If the students gathered at Harvard, Yale, Berkeley, or Chicago were forced to attend the Univer­sity of Massachusetts, Dade County Community College, or Chico State, would the social loss thereby inflicted on American really be greater than the benefit resulting from bringing along to a higher level of educational accomplishment all those young men and women who are now simply excluded from the entire higher educational system?

"Perhaps you will say yes.  I don't know.  But has the thought ever crossed your mind?  Has it even occurred to the educational establishment in America to attempt a seri­ous confrontation with the question?  Would the president of Harvard consider such a question even relevant to his effort to actualize the biblical injunction that to those that hath shall it be given?"

"This is simply pointless," I burst out.  "You seem to have an answer ready to hand for every objection I raise.  Let us stop arguing.  You have been more than patient with a newcomer to your land, and this is, after all, my vacation!  Yet there is one final question I must ask."

"By all means," the Minister of Education replied, not at all put out by my excitable temperament.

"I will not quarrel with your educational policy," I said, " for all that it contradicts everything to which I have devoted my adult life.  But surely you can see, can you not, that there is an extraordinary difference between Invertia's method of allocating its educational budget and its method of allocating its medical budget. In the one case, you treat the healthiest and let the neediest fall by the wayside.  In the other, you lavish attention on the neediest, and force the ablest, best prepared to take whatever is left over.  And yet neither you, nor your colleague here, seems to feel the least sense of inconsistency, to experience the slightest mental cramp at this manifest contradiction.  How on earth do you explain this strange Invertian insensitivity?"

"Ah," the Minister responded with a smile, "that is a question you are as well equipped to answer as I, for in your country, exactly the same contradiction exists, for all that the incompatible policies are reversed.  If you can explain why, in five decades of university teaching, you have never felt the slightest discomfort at your country's settled practice of devoting lavish resources to the education of those least in need of them, while at the same time taking it for granted that your country's medical resources should be con­centrated on saving the lives of your least healthy fellow Americans, then perhaps you will be able to understand how we here in Invertia can live comfortably with the selfsame irra­tionality."

And with that, he and his colleague rose, shook my hand, and departed, leaving me, as you will imagine, sorely troubled.

In the first few hours after this last conversation, I began to think that our way of doing things in the United States was as utterly mad as the Invertian way.  I even spent some restless hours that night framing proposals for the reform of American higher educa­tion.

But the next day was bright and sunny, and I was eager to return home. I paid my hotel bill, thanked the man in the Travel Bureau for his help, and began the long trip home.  The closer the airplane brought me to the coast of North America, the less reasonable my feverish schemes for reform appeared to me, and the more I recovered my old sense of the essential rightness of the American way.  By the time I had landed at Logan Airport in Bos­ton, there to be greeted by my wife, I had entirely regained my senses, and was ready to treat my Invertian vacation as nothing more than a good story.

Which, I hope you will agree, I have done.

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