THE PIMPLE ON ADONIS' NOSE
Some Thoughts on the Distribution of Educational Resources
in The United States Today
Robert Paul Wolff
Last summer, having finished the revisions for a new edition of a textbook on Introductory Philosophy and finding myself with enough money in my bank account for a brief overseas vacation, I asked an agent at the local Travel Bureau to find me someplace completely new, untraveled, and out of the way. He sifted through a dusty pile of brochures shoved to the back of a drawer and came up with the tiny Republic of Invertia, almost exactly half way around the world.
An island nation with a population of slightly more than four million, Invertia has no history, art, music, or natural landmarks of any note, and hence has been virtually ignored in the travel boom of the past twenty years. I agreed forthwith, and told him to book me as inexpensive a round‑trip flight as he could manage, together with reservations at what appeared, from the brochure, to be Invertia's sole tourist hotel. Three days later, I was on my way.
We touched down in the capital city of Invertia shortly after nine a.m., local time; by ten we were through customs, and at ten‑thirty, I had checked into my hotel, and realized that I had four days to fill and no idea what there was to do in Invertia.
Fortunately, the National Tourist Bureau, such as it was, occupied the building next to the hotel, so after a quick lunch, I presented myself at the information desk and asked the clerk what Invertia had to offer the interested tourist with several days on his hands.
"You must surely visit our national hospital, and also our national university," he said. "We in Invertia are enormously proud of both institutions, and no visitor to our island should fail to see them. I will telephone the Ministries of Health and Education and arrange the entire matter."
When I returned to my hotel at dinner time, I found a message from the Travel Agent. The next day at one in the afternoon, I would be given a tour of the leading hospital of Invertia. The following day, I would see the university.
As I came down to the lobby of my hotel on my second day in Invertia, promptly at one p.m., I found the Minister of Health herself waiting for me. Apparently visitors were rare enough to warrant the red carpet treatment no matter how unimportant they might be. We got into the official limousine at the curb, and set out for the National Invertian Center for Health, or NICH as the Minister referred to it.
Approaching the NICH, I was powerfully impressed by the size and elegance of the building, gleaming with marble facade and surrounded by carefully maintained lawns and gardens. Clearly, the government of Invertia put health care very high on its agenda. I assumed I would be driven to the rather imposing front entrance for an official tour, but instead the Minister directed the driver to pull up in front of the Emergency Room. As she explained to me, the ER was the heart of any hospital, and I would get the best possible idea of how Invertians handled their medical services by observing its activities for a while.
Walking through the automatic sliding doors into the Emergency Room of the Invertian National Hospital, I was struck immediately by how quiet, clean, and orderly everything was. My own experience of hospital emergency rooms -- not to mention the images from countless movies and television serials ‑ had led me to expect a busy, seemingly chaotic swirl of patients, nurses, and Interns, with weary family members slumped in chairs along the wall staring blankly at out‑of‑date magazines. Instead, I could easily have mistaken the ER for the reception area of a big law office or corporation.
For a moment, I simply stood and looked around, trying to adjust my perceptions to my expectations. Then the sliding doors opened again and two men came into the Emergency Room. The first was a man about my age, shabbily dressed and in obvious distress. He staggered more than walked into the ER, calling out in pain as he lurched toward the reception desk. "Please," he said in a gasping, feeble voice, "help me! I think I am having a heart attack!" With that he slumped to the ground, clutching his chest.
The second man was a tall, handsome youth ‑ a veritable Adonis ‑ who walked with an easy, athletic stride. He wore an elegant suit and tie, had smoothly tanned features, and appeared to me to be in perfect health. These impressions, I must admit, are somewhat reconstructed from subsequent reflection, because my attention was entirely seized by the poor man writhing on the floor.
As I stood there frozen, watching what seemed to be the last moments of a dying man, the ER erupted into movement. The attendant behind the reception desk spoke a few quick words into the phone at his elbow, and moments later the swinging doors flew open as an Intern hurried into the room pushing a wheel chair. I prayed that they would be in time to save the man on the floor, who was now straining for breath with great raking gasps.
To my astonishment, the Intern rushed past the stricken man and instead approached the young Adonis, whom he gently guided into the wheel chair. Then, solicitously settling a blanket about the young man's feet, he made a detour around the body on the floor, glancing at it somewhat irritatedly, and carefully pushed his new patient to the reception desk. As I watched, too horrified as yet even to speak, the man on the floor gave a last cry, and died.
Throughout these events, the Minister of Health stood beside me calm, unperturbed, a satisfied smile on her face as if to say, "Well, that is how things are done here. Isn't that splendid?" Meanwhile, the receiving attendant was taking the young man's medical history and inquiring as to his needs. Mesmerized, I drew closer to listen to the interview.
So far as I could make out, this was the first time he had ever found it necessary to seek medical assistance. What had brought him to the hospital was a small pimple on his nose, just to the right of center. He was greatly concerned that the pimple spoiled his otherwise exquisite profile, and he wanted to know whether there were specialists in the hospital who could remove it without leaving an unsightly scar.
As he said this, the Minister of Health, with a great air of self‑satisfaction, held up her hand, as though to say to me, "Watch this!" The attendant spoke again into the phone, and immediately a distinguished looking doctor appeared who introduced herself as a plastic surgeon. She assured the young man that every facility of the hospital would be put at his disposal, and she expressed herself as absolutely confident that her team could remove the pimple with no visible scar whatsoever. She had removed many such pimples, she said, and had never lost a patient. With that, the Intern rolled him through the swinging doors, and followed by the surgeon, he disappeared. A short while later, two orderlies brought in a large waste bin, pushed the dead body roughly into it, and exited again.
I was so appalled by what I had witnessed that I had trouble finding the words with which to give voice to my thoughts. During my first few hours in Invertia, I had felt quite comfortable and at home. The people all spoke English, and the manners, the facial expressions, even the body language of the men and women I had met seemed so much like those of my own home town of Amherst, Massachusetts that I had begun to believe that I understood the Invertians quite well indeed. Yet the utter incongruity of the reactions in the Emergency Room to the two men who had presented themselves as patients made me vertiginous.
Most mysterious of all was the obvious satisfaction with which the Minister of Health had observed the events. Her pride at the treatment of the young man's pimple, and her utter unconcern for the dead man, bespoke an attitude, a moral framework, a world view, so different from mine that I could scarcely imagine where to begin my questions.
"Well," she said, breaking into my troubled stream of thoughts, "now you have seen us at our very best. What do you think of the Invertian health care system? How does it compare with that of your own country?"
Very quietly, with great self‑control [for, truly, I feared that I had somehow stumbled into a madhouse, and could not anticipate what those around me might do next], I undertook to discover some explanation for what I had witnessed. "Let me start," I said, "with the man who died of a heart attack on the floor before us. Why did no one try to help him? Why wasn't he immediately taken into an examination room, given emergency treatment, put on oxygen, given drugs? Is your hospital not equipped to handle such cases?"
"Oh, we are more than adequately equipped to handle a heart attack, but what would have been the point? He was clearly close to death when he came through the doors of the ER."
"But with quick action, you might have saved him! He died at our feet!"
"Exactly," she said, as though I had proved her point. "Over a period of years, we have kept quite careful records of patients admitted while suffering massive heart attacks, and our experience shows that such patients have a very poor prognosis for recovery. A considerable number ‑ almost half, I believe ‑ actually die during our efforts to save them or shortly thereafter, and a majority of those who do live through the first days or weeks of treatment emerge from the hospital in something less than perfect health. Many need further medical treatment, a number have subsequent heart attacks, and taking all in all, the prospects of heart attack patients for full recovery and healthy, happy post‑attack lives are quite poor. So you see, it makes very little sense to devote our splendid medical resources here at NICH to treating what can only be considered marginal patients."
In order to grasp the utter callousness of this speech, you must understand that it was delivered not apologetically, or hesitantly, or with an embarrassed awareness of the inadequacies in the Invertian health system thereby revealed, but with a sort of self‑satisfied assurance, not to say smugness. The Minister of Health clearly was a woman supremely pleased with the performance of those under her command, and confident that I would share her pleasure once I understood the marvelous efficiency of NICH.
"Do you never treat anyone suffering from a heart attack?" I asked.
"Of course we do," she replied, "but only when we determine that the patient has a very good chance of complete recovery. Before we will admit a heart attack patient, we require an extensive physical examination, a complete medical history, and letters from the patient's previous physicians explaining why they believe that the patient's heart condition is not an accurate indication of his or her general health. If, in light of the entire medical dossier, we decide that the patient can reasonably be expected to recover from the heart condition quickly and live a long, healthy, productive life without further medical intervention, then we are quite prepared to make an exception. Indeed, our admitting attendants are specifically instructed to keep an eye out for promising patients who might in the ordinary course of events be overlooked because of apparently contra‑indicated previous conditions." This entire speech, you understand, delivered in that patronizing tone so often used by experts, especially medical experts, when explaining things to lay people who cannot be expected to grasp the most elementary matters.
"And the handsome young man with the pimple on his nose?" I asked. "He does not seem to have gone through an elaborate background check or a series of admissions tests."
"Quite true," she replied. "Ordinarily, any patient seeking admission to the hospital must go through the entire procedure of medical evaluation, but every so often, we see a patient who is obviously bursting with good health ‑ fit, vigorous, strikingly attractive. When such a patient comes along, needing only the very slightest medical adjustment to emerge in perfect condition, a patient with whom our chance of success is virtually 100%, we are prepared to waive the normal procedures and speed the admission process. That young man was one of the most promising patients I have ever seen. Our Cosmetic Surgery Department's success with superficial pimples is close to perfect. As soon as I saw him, I was sure he deserved admission to the hospital. When he is released, he will be an outstanding specimen of Invertian youth. I would hazard the guess that he will never need medical attention again."
I was struggling to find my bearings in what seemed more and more to be a Kafka‑esque hall of mirrors. "Let me be absolutely sure I understand what you are saying," I said, in one last effort to make sense out of this nightmare. "You operate this hospital on the general principle that patients will be admitted only if they have relatively minor ailments which you can be virtually sure of curing. When someone is desperately in need of medical attention, such as the man who died here only a few minutes ago, you deny it on the grounds that such people have a poor chance of being totally and completely cured. But when young Adonises or Venuses present themselves to have a pimple removed, a hang nail trimmed, or a slight headache treated symptomatically ‑ in short, when patients appear who do not need medical care in order to survive, but merely want it so as to become even healthier and more attractive than they already are, then you lavish the full resources of this magnificent modern hospital on them. Do I have that right?"
"Just so," she said. "I think you are now beginning to understand how the Invertian medical system works."
"But men and women are dying every day, some of whom could be saved by your hospital. And in return, all you get is the satisfaction of knowing that your healthiest, most attractive young men and women are pimple and hang nail free! How can you possibly justify devoting all your medical resources to such frivolous ends?"
Oh, dear," she replied, obviously distressed that I understood so little of what she had been saying. "I am afraid you have things quite upside down. If we were to do as you suggest, and admit to our hospital patients with heart attacks, cancer, internal injuries from automobile accidents, and heaven knows what else, we should be swamped! We might manage to handle a few, though it would mean turning away thoroughly qualified patients like that young man who was just admitted. But to let them all in would be impossible!
"Indeed," she went on, "we couldn't do it even if we wanted to. Our medical staff is not trained to deal with life‑threatening ailments, save for a handful of specialists in the Trauma Center. What would all our supremely well‑trained Plastic Surgeons, Podiatrists, and Dermatologists do to keep busy? Besides, we haven't the physical facilities to treat such patients. In this hospital, there are four entire wards of Plastic Surgery, each completely staffed and outfitted, including a Nasal Reconstruction center. But there are only two physicians with any experience of major heart ailments, and neither of them has the capacity to treat more than three or four patients at a time.
"All that is entirely secondary, however, for what is at stake here is a matter of fundamental principle. Invertian society has need of an elite core of superbly healthy men and women whose every last imperfection or blemish has been meticulously removed by the most modern techniques of medical science. In an ideal world, where there are infinite resources, we could, I suppose, build endless hospitals to treat those suffering from heart disease, cancer, severe internal injuries, and other life‑threatening physical problems. But resources very definitely are not infinite, and as I am sure you will recognize, it takes much more in the way of those resources to treat each dying patient than it does to correct the minor imperfections of healthy patients. When you consider that many of the really sick patients simply die despite our best efforts, you will concede that it would be utterly quixotic of us to turn our entire medical system upside down, all for the purpose of trying to save the lives of men and women who, even if they do live, will never play a set of competitive tennis, run a respectable marathon, or grace our city with their good looks."
I am a philosopher by profession, and argument is my stock in trade, but the image of that poor man dying in agony at my feet blotted out all thought of logical by‑play. I listened to the Minister's arguments with a heavier and heavier heart. When she had finished, I asked meekly whether we could leave, and without seeing anything more of the NICH, I returned to my hotel. The next day, I was slated to visit the university. I could not even imagine what I would find there. Nazi‑style experimentation on human subjects, perhaps. Lock‑step courses in Invertian ideology. A Department of Astrology and Dianetics.
I spent a troubled night.
The next afternoon, it was the Minister of Education who appeared at my hotel to conduct me on a tour of the Invertian National University. The Minister was a short, fat, energetic man who perspired freely in the warm midday sun. My mind was still filled with the images of that poor man, dying on the floor of the ER, utterly ignored by Doctors, Orderlies, and the Minister of Health herself. I am afraid I was only half listening as the Minister of Education poured out statistics on the way to the University. I did manage to gather that the University had a full complement of departments in the Arts, Humanities, Social Sciences, and Natural Sciences, as well as small but well‑staffed Law, Medical, Engineering, and Business Schools. Even before we arrived at the university, I began to feel more at home.
The Central Administration Building was a large, nondescript, functional structure ‑ the sort of building one could see on any of a thousand American campuses. After parking in a place especially reserved for the Minister's car, we entered and went first to the Student Admission Office. The Minister explained that this was the best place to get a feel for how the University operated.
The Admissions Office looked just like any college admissions office in America. There were wall racks with copies of application forms, class schedules, literature promoting one or another of the various degrees offered at the university. A bulletin board had sprouted with the usual hand‑printed notices of rooms to share, typing services, furniture for sale, secondhand textbooks. There were several Admissions Officers waiting to greet prospective students. All rather familiar and comforting, I thought to myself, especially after the disorienting visit to the hospital.
As I stood there with the Minister and his aide, looking about the large room, the door opened behind us and two young people walked in. First through the door was a neatly dressed young woman whose face and manner bespoke a quite attractive intelligence and self‑confidence. As she approached the desk of one of the Admissions Officers, I edged closer in order to overhear their conversation.
She introduced herself forthrightly, in a cultivated voice, and said that she wished to enter the university to pursue a degree in Mathematical Physics. She explained that she had a straight‑A grade record at her secondary school, had achieved perfect scores on the Invertian equivalent of the Scholastic Aptitude Test, and in fact had already published several original papers on a rather recondite branch of Mathematical Physics in Invertian and foreign journals. She was, she added, a champion swimmer and tennis player, and also had given public concerts as a pianist. In her spare time, she said, she worked with learning‑disabled children, and took inner‑city girls on nature walks. Needless to say, I was tremendously impressed. This was just the sort of outstanding student I had encountered at Harvard, Yale, Princeton, Swarthmore, and the other top colleges and universities in America. She had that pulled‑together look of someone who knows her own abilities, has worked hard to develop them, and has acquired thereby a justifiably high sense of self‑worth.
As she spoke, the Admissions Officer grew visibly more impatient, fidgeting with his pencil and rather ostentatiously leafing through some paperwork on his desk. When the young woman had finished, he looked up. "Well," he said, in a perfunctory tone of voice, "take an application form and fill it out. We will contact you if we can find room for you." With that, he dismissed her and turned his attention to the second applicant.
My first thought was that the young woman had stumbled on a small‑minded bureaucrat who resented young people manifestly more talented and accomplished than he. I had known a few such in America, even, I reflected, among the senior professoriate. Then too, it occurred to me that because there could be no question about her being admitted, he might simply have sent her off so that he could attend to more difficult cases. But as I stood there, wondering what might happen next in this topsy‑turvy country, I heard the young woman saying to an older couple who were apparently her parents, "I knew I wouldn't get in." The looks on their faces confirmed that she had would be denied admission to the university.
The Minister of Education had observed all this with apparent approval. Didn't he care that so supremely well‑qualified an applicant had been summarily turned away from the National University without so much as an interview? How on earth could he explain to the faculty of the university that the very best students were being denied admission? At that moment, the second potential student stepped up to the Admissions Officer's desk, and the Minister, with much the same gesture that his colleague had used the day before, motioned to me to watch how this applicant was treated.
Standing before the desk was a young man who, in every conceivable way, contrasted totally with the young woman who had just been so unaccountably sent packing. He was carelessly dressed, slouched rather than stood, and seemed bewildered by his surroundings, as though a university were entirely terra incognita to him. Well, I thought, they shan't waste too much time on him.
Even before the young man started to speak, the Admissions Officer's manner changed completely. He put down his pencil and visibly gave the applicant his complete attention. "How may I help you?" he asked solicitously, his voice friendly and inviting.
"I wanna go to school here," the young man said, in a manner both belligerent and insecure. "I don't have no high school diploma. I flunked out of 12th grade."
"Can you read?" the Admissions officer asked.
"Sure I can. Not books and stuff like that, but I can read the sports pages well enough to know which team's ahead."
"And how about writing. Have you ever written an essay of, say, three pages in length?"
The young man looked about suspiciously. "Say, what's the idea of the Third Degree? I just said I wanted to go to school here. I didn't say I wanted to be one of the teachers."
"Of course, of course," the Admissions Officer answered in a tone intended to calm the young man's anxieties. "We quite well understand. Would you wait just one moment?"
With that, he picked up the phone and said a few words too softly for the young man, or me, to hear. Almost at once, a door at the rear of the reception room opened, and a group of distinguished‑looking men and women entered, wearing full academic regalia, as though on their way to a Commencement. They gathered around the young man, took him gently in tow, and led him off through the rear door.
"What is going on?" I asked the Minister, who throughout these events had been teetering back and forth on his heels, hands in pockets, with a broad smile across his face. "Were those senior members of the faculty? What are they doing here in the Admissions Office? Where are they taking that young man? And why on earth was that extraordinary young woman denied admission to your university?"
The Minister was somewhat taken aback by this rush of questions, but he motioned me to a chair, and undertook to explain what I had just witnessed. He sat down in a chair opposite me and gave a tug at his vest, as though to settle himself for a lengthy discourse.
"Let us take your questions in reverse order," he began, "inasmuch as the young lady's case was dealt with before that of the young man. The young lady was denied admission to our university because she is highly intelligent, superbly well‑trained, already quite accomplished, and powerfully motivated to continue her studies."
At about this time, I began to wonder whether the Invertians really were speaking English. It certainly sounded as though they were speaking English. But perhaps, I thought, this is some curious dialect, derivative from English, in which certain of the key logical connectives have had their meaning reversed. Could this be an obscure linguistic rebellion against their former colonial rulers? The problem here was with the Minister's use of the word "because." The young lady had been denied admission to the university because she was intelligent, accomplished, and highly motivated. Did "because" in Invertian mean "in spite of?" Did "denied admission" perhaps mean "granted admission?" Or were the old sailor's yarns true about everything at the antipodes standing on its head. I decided to try a bit of dialectical give‑and‑take in an effort to get my bearings.
"You denied her admission because she is intelligent, accomplished, and highly motivated. But surely she is an absolutely certainty to do well at university. I would imagine the probability that she will graduate, indeed graduate with honors, is just about 100%."
"I'm glad you saw that," he replied, apparently pleased that I was catching on. "I thought perhaps, this being a somewhat unfamiliar setting, that you might not have recognized it as soon as we who are more practiced at the ins and outs of admissions. I was half‑sure before she even opened her mouth, and as soon as she said she had published original papers in Mathematical Physics, I knew there was no point in letting her in."
"But think how much she can profit from a university education," I protested, feeling as I did so that I was rapidly losing my grip on reality. "With her background and preparation, a university education will bring her to the very pitch of intellectual perfection. By the time she leaves, she will be virtually at the same level as your most senior faculty. And think what a delight it would be to them to have such a student in their courses. Why, they could present the very latest results of their own research for her consideration and critique, instead of plodding through the elements of basic Physics and Mathematics."
"Well," the Minister answered, "you have just made the case for rejecting her ‑ as good a case as I could have made myself. That young woman is already so well developed intellectually that she does not need what a university can offer. With or without our university resources, she will do well in life. Indeed, she is already capable of securing a position in one of our nuclear power plants, and with a bit of on‑the‑job training, she will be a productive and successful member of society. To spend our scarce education funds on her would be wasteful and inefficient."
"And that young man," I said, rather more belligerently than I intended, for I was growing very frustrated indeed. "You have admitted him to the university despite the fact that he can barely read and write. Judging from that flock of professors who shepherded him out of here, he will be getting the most expensive education Invertia has to offer. Yet I will bet my airfare home that he won't make it through four years of university education. Everything is against him! He needs remedial reading, remedial writing, no doubt remedial math as well. Out of every hundred such students you admit, you probably won't see more than fifteen of them on Commencement Day."
"Oh, I agree with everything you say," the Minister replied. "But what would you have us do? You saw him when he entered. Educationally speaking, if I may put it this way, he was in extremis when he walked in. If we had turned him away, I am absolutely confident that he would have died intellectually before too long. At this very moment, our team of professors is working with him, starting the painful, difficult process of developing his intellect, challenging his mind, helping him through the shame and self‑doubt of semi‑literacy. As you say, we lose quite a few young men and women like him, but we save quite a few too. Imagine the thrill we all feel when one of those young people, whose mind had all but ceased to function, begins to read, to write, to think, to argue, to question a world that has, until then, been closed to him or her."
I have to admit that I was beginning to feel just a trifle less sure of myself, but I decided to press on nevertheless.
"Look," I said, trying hard to find some common ground on which the Minister and I could achieve a meeting of the minds. "Your motives are no doubt admirable. I sympathize entirely with what you are trying to accomplish. But how on earth can you use a university faculty to do the most basic remedial education? Where do you find students able to take your advanced courses in literature, philosophy, physics, or chemistry? How can students like that young man even begin to handle the sophisticated intellectual materials presented in advanced seminars?"
"Our faculty are capable of helping the educationally most wounded of our students ‑ if I may put it that way ‑ because we have for some time now been recruiting faculty specifically for that purpose. We require that professors in every department be trained in what I might call educational emergency procedures. The handful of advanced courses we offer are quite adequately enrolled, but we take care to offer few enough of them so that there is no problem. All our facilities are designed to serve the needs of the educationally disadvantaged. We have even devised a system of icons to guide our poorer readers about in the library.
"As for the drop‑outs, of whom, as you suggest, there are many, you must not suppose that our efforts with them are wasted. Not every student who enters our university completes a degree or goes on to advanced study, but even those who are with us for only a semester or two have clearly benefited from the experience. Some who could barely read leave able, for the first time, really to enjoy a daily newspaper. Others have acquired numerical skills that will earn them more challenging and rewarding jobs. Most, I think, acquire some sense, however incomplete, of the life of the mind. And those with whom we completely fail ‑ whose minds die before we can save them ‑ well, they are the price we must pay for the chance to help so many others.
"We could restrict our university to that young lady and her sort. There aren't many quite that promising, but Invertia has its share of gifted young men and women. What would we accomplish, were we to do so? Our population would consist of a small number of superbly educated people whose already magnificent talents and abilities had been brought to the pitch of perfection by an expensive and exclusive education, and a large population of inadequately educated men and women whose lives are stunted, whose perspectives are narrowed, whose capacity for intelligent self‑government diminished, because we denied them admission to our university."
I was by now thoroughly confused. I felt an overwhelming need to make sense out of the experiences of the past two days, to place my visits to the NICH and to the Invertian National University into some sort of coherent framework. Somewhat desperately, I proposed a meeting at which the Ministers of Health and Education and I could talk informally. The Minister of Education immediately agreed, and assured me that it would be no trouble setting up such a meeting for the following day, which was to be my last in Invertia. With that, we returned to my hotel, and he left me until the next afternoon.
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.