Seven Pillars of Wisdom

Rating 2.5

T.E. Lawrence was an officer in the British army before and during WW1.  His story takes place in Arab states including what are now Egypt, Syria, Jordan, Iraq, Saudi Arabia, Turkey and others.  He is obviously a well-educated man, though his story-telling skills are typical of his era and therefore somewhat tedious and difficult for a 21st century reader accustomed to tweets and instant gratification.  

Despite the fact that his story was made into a movie (Lawrence of Arabia) and is probably quite a tale, I found that to read it was actually unrewarding.  The text is about 600 pages, though after 45 pages I gave up.   The book begins without a story.  He uses high-falutin prose to present his list of seemingly unconnected details, almost no character development, no hero, no villain, and no obvious goal. There are some mildly interesting facts about the culture and politics of the people in that part of the world, though these tidbits were not a sufficient reward to slog through such Victorian-style British text.   I presume that at some point the author settles down to tell an actual story, though my attention span could not stretch that far. 

The Blue Nile

by Alan Moorehead

Rating: 4.3

The Nile is the world’s longest river and is fed by its two main tributaries, the Blue Nile and the White Nile.  The Blue Nile is shorter though supplies over 80% of the water in the Nile.  Alan Moorehead writes an interesting and at times poetic story of the characters and events that comprise the search for the source of the blue Nile.  

Beginning with a Scotsman named James Bruce he details the many European characters who braved deserts, primitive and hostile natives, and brutally hot weather to to find the elusive source of this mighty river.  I read the book several months before writing this review, so I’ve forgotten many of the details.  However I do recall that it was a well-told story, very interesting, and at times poetic.  Moorehead seemed to have good historical perspective and sensitivity to many of the extraordinary events on the Nile during the late 18th and early 19th centuries.  He writes well, keep the story moving, providing just the right amount of detail and just the right amount of sharp-eyed observation.

His telling of Napoleon Bonaparte’s invasion of Egypt is excellent, as well as his story of the little-known Theodore, Emporer of Ethiopia (a most peculiar madman).  His depiction of the armed battle between Theodore’s army and the British army alone makes the book worthwhile, though there are many other episodes to keep the reader’s attention.    

The Fat Tail

by Ian Bremmer

Rating 3.8

Bremmer runs a firm specializing in analysis of business risks and opportunities for international companies.  His firm advises big companies on political and related issues they might face around the globe.  If you’re considering building a factory in Botswana, he’s the guy to go to for advice.

Bremmer has a wealth of knowledge and perspective on the realities and complexities of today’s global economy.  In this book he attempts to demonstrate how financial factors are just one of the many issues to consider in decisions of where to locate your business.   He cites numerous examples of the types of upheaval and threats faced by businesses everywhere.  In similar fashion to the book ‘Black Swan’, he points out that revolution, military coup, expropriation and other presumed outlier events actually occur far more frequently than imagined.  

The same can be said for stock returns, in which the so-called ‘normal curve’ envisioned by statistical theory is just that: a theory.  Reality shows that the tails of the curve, as measured by the 3rd moment of a population of data (kurtosis), exhibits far more occurrences than predicted by the normal curve.  To express this in the vernacular, shit happens way more than expected.

At the time of writing this review it’s been over a year since reading the book, so many details are fuzzy.  However I do recall that the information was worthwhile, though his writing skills a bit lacking.

Men to Match My Mountains

by Irving Stone

published 1987

rating: 4.2

Irving Stone tells the many stories that comprise the settling of what is now the western United States, primary in California, Colorado, Utah and Nevada.  He covers the period from shortly before the gold rush (1849) to  1900.

Stone assembles hundreds of episodes both large and small, from the humorous to the bloody, the tragic to the heroic.  Being born and raised in San Francisco and having lived in Colorado for the past 10 years made this book a bit more fun for me as I learned the source of many familiar names.  The movers and shakers of the early west had streets and other public places named in their memory.

As a historical review of an extended period and large geographical area, this is not a neat or tidy story with a hero, a goal, a struggle and an outcome.  Rather it is a mosaic of stories and events spread over decades, the result of which is realization of the manifest destiny.  

The early days in California are covered, with descriptions of the Californios, who were Mexican citizens when what is now the southwestern U.S. was owned by Mexico, and had been owned by Spain just a few decades earlier.  Mexico was not really interested in this territory, paid little attention to it and provided even fewer resources.  To reach this area traveling west required a truly life-threatening journey across hostile terrain inhabited by sometimes hostile Indians.  It was generally faster and safer to sail to Panama, cross that narrow land mass, then sail to California, or to sail all the way around Cape Horn.  

Monterey was the seat of government back then, until gold was discovered in 1848, and mining began in earnest in 1949, bringing fortune seekers of every kind from around the world.  This boom transformed San Francisco from a few sand dunes and tents into a thriving city in the 1850s.  A few years later gold and silver were discovered in Nevada, transforming that area into a temporary boom community, and a bit later in Colorado.

There is much coverage of the Mormon settlement of Utah and their conflicts with the rest of the U.S. over the issue of polygamy.  There were horrific violent episodes committed by both sides of this dispute, and it was not until 1896, some twenty years after the death of founder Brigham Young, that Utah finally realized its goal of statehood.  To achieve this privilege they had to relinquish their legal right to polygamy.

The number of interesting and noteworthy characters are too numerous for this short review, though here are some of the more memorable ones:  Collis Huntington was the one of the Big Four who owned the first transcontinental railroad (along with Charles Crocker, Leland Stanford and Mark Hopkins).   He was a shrewd, ruthless business man with not a shred of charitable impulse and hellbent on acquiring as much money and power as possible until the day he died.  He owned all California elected officials, most newspapers and many in the U.S. legislature.  The outrage over his pattern of monopolistic behaviour led to the rise of organized labor and eventually to the trust-busting Sherman Act in 1890.

Charles Crocker on the other hand was a hands-on visionary who would stop at nothing to actually build the railroad, working side by side with his imported Chinese laborers, pick in hand, for over a decade to overcome every imaginable obstacle in linking the east and west coast.   Some say the engineering and physical feat of this railroad is on par with the Great Wall of China.  

In Colorado there was H.A.W. Tabor, a genial, hapless business man who started with nothing yet became among the wealthiest in the world from acquiring stakes in silver mines.  He was as generous as he was lucky, though his sensible and conservative wife was profoundly unhappy with her husband’s wasteful spending, herself having no interest in the trappings of wealth.  He divorced her and married a young beauty named Baby Doe who bore him two daughters.  Baby Doe loved the furs and jewels and high life her husband provided.  As often happens, the wealth began to unravel.  So much silver was mined from the west in the mid-19th century that the country became over-supplied with this metal.  Congress de-monetized silver in 1873 and suddenly Tabor’s wealth plummeted.  He was forced to sell all of his holdings to pay debts and ended up living with his young wife and daughters in a small house for $35/month.  He died shortly thereafter of a burst appendix.  Most people assumed that the beautiful young Baby Doe would use her charms to attract another wealthy man, but she fooled them all.  She continued to raise her daughters, and tried to resurrect one of her late husband’s mines by actually digging it herself.  She spent 20 years in this effort and died poor.

The book is well-written and maintains a good pace.  These are important qualities for a story with no main character and in which we already know the ending.  Not exactly a page-turner, though still difficult to put down.  Overall, an interesting portrait of the countless struggles endured by those who built a civilization in the western U.S.

The Arabs

by David Lamb

Published 1987

Rating: 4.2

David Lamb, an American journalist who lived in and reported on the Middle East, writes a very readable description of Arab culture and politics, aimed at helping westerners to understand the several hundred million people know collectively as Arabs.  Lamb uses Cairo as his base during his four-year stay in the early 80’s.  He travels extensively through and reports on Lebanon, Israel, Syria, Jordan, Iraq, Saudi Arabia, Kuwait, Qatar, Oman, Tunisia, Libya, Sudan, and Morocco.  He meets and interviews political and intellectual leaders as well as average citizens to describe Arab culture and politics and to elaborate on the complexities of the Israeli-Palestinian conflict.

Lamb concludes his book by admonishing the United States for its lack of understanding of the many peoples that comprise the Arab world, and for painting these diverse peoples with one brush.  To make his point, he provides ample historical perspective, starting with ancient desert cultures, the traditions of Bedouin tribes, conquest by invading armies throughout the millennia, and of course the rise of Islam after the death of the prophet Mohammed in 632 AD.

Lamb begins his story in Cairo, which he characterizes as the heart and soul of the Arab world, and a place where the author spends much time.  He contrasts the dynamic Cairo of the early 20th century to the polluted and chaotic mega-city at the end of that century.  It is a story of a rapid decline from a thriving cultural and intellectual capital to a sprawling and desperately poor city of 8 million inhabitants.   Yet he maintains that Cairo in 1986 was still the intellectual capital of the Arab world in that no other country permitted such freedom of thought.  Most free-thinkers in the Arab world have long since moved to western countries.

Having read Napoleon’s accounts of Cairo from his invasion in 1798 and having visited Cairo myself in 2011, I was struck by the similarity of observations from the western perspective and ultimately how little has changed in two centuries.

Living in Cairo and having many local friends there, Lamb provides a view into the seeming contrasts of the city.  Trash piles up on the streets and city infrastructure is hopelessly inadequate or completely absent.  Traffic is pure anarchy, inside banks people cram toward the tellers rather than forming orderly queues.  Yet Egyptians maintain a fait accompli sense of life and are known for their good sense of humor.  Amazingly, despite the outward filth, the homes of even the most humble peasants are immaculate inside.  

Lamb traces the recent decline of Egypt to Nasser, who led the country from 1956 until his death in  1970.  Despite the fact that Arab culture is basically capitalistic (Mohamed and his wife were both business people), Nasser nationalized much of the country’s business and turned to socialism.  Nasser also set lofty goals of defeating Israel and of uniting the Arab world into a great monolithic culture.  

None of Nasser’s goals were realized.  In fact his policies accomplished quite the opposite of his goals.  Israel proved to be too formidable of an enemy and Egypt and its Arab neighbors proved unable to use their numbers and wealth to prevail in battle.  Plagued with infighting, untrained armies and sometimes conflicting agendas, they were the Goliath that could not slay David.  Lamb explains how the basic tenets of Islam - that Allah ultimately decides outcomes, the duty of the faithful is to pray 5 times daily and that the text of the Koran contains everything they need to know - actually discourages intellectual and material pursuits.  He outlines how this combination of Islam and socialism under Nasser combined to destroy wealth and create an impoverished, uneducated society.  He also describes to some extent how the clergy trumped university intellectuals to further impoverish Egyptian society and of course establish their own power base.  

Perhaps the most puzzling element in the middle east is the relationships between the Palestinians, Israel, Lebanon and the rest of the Arab world.  At one point in detailing the complexities of these relationships, Lamb characterizes the Palestinians as ‘the Arab’s Jews’.  By this he means that for most Arabs, the Palestinians are viewed in much the same way that Jews are viewed in many western countries.  That is to say that they are a) different, and b) successful, and therefore . . . c) resented and/or ostracized by the mainstream.   He describes Palestinians as more educated, more worldly, less religious, and more middle class than in most Arab countries.  When Israel invaded Lebanon in 1982, many muslims in Lebanon actually cheered the arrival of Israeli tanks because they felt that the Israelis would expel the Palestinians.   While many Arab states are outwardly pro-Palestinian and anti-Israel, none of these states actually want any of the Palestinians in their country.   With all of the extraordinary wealth of the Arab oil states, millions of Palestinians continue to live in poverty, right in the backyard of the wealthiest Arab nations.  

Lamb devotes a considerable number of pages to describing the tangle of interests that comprise middle eastern politics.  It is a hopelessly complex web of shifting priorities spanning the planet, and while it would be easy to cite numerous truths about national or factional interests, they would all be half-truths at best.  From this section of the book I am reminded of the response of Henry Kissinger in 1970 when one of his deputy secretaries excitedly suggested that he had a solution to the middle east peace problem.  Kissinger stopped the junior officer and said “there is no solution to the problem.  Our job is to manage the problem.”  Indeed, Lamb’s text on middle eastern politics portrays exactly what Kissinger described.  There are too many players who benefit from the various conflicts for there to be any notable chance of a lasting peace.  Almost every war, terrorist act, and government policy of oppression has a vested interest in the death and subjugation of one group for the benefit of another group.  Ego and money are always stubborn obstacles to peace.

Perhaps the longest lasting and bloodiest example of this concept was the Iran-Iraq war which lasted through most of the 1980’s.  This brutal conflict was really a battle of egos between Iraq’s Saddam Hussein and Iran’s Ayatollah Khomeini.  Iran had triple the population while Iraq had a better trained and equipped army.  Iran sent tens of thousands of pubescent boys to march through mine-fields, thus serving the dual purpose of clearing the fields and killing themselves in the process.   Iran equipped these boys with plastic keys that they were told were keys to heaven for their martyred souls.  Both sides had enough oil money to buy weapons from the United States and Soviet Union, and both sides had plenty of outsiders who were delighted to see these two adversaries waste their blood and treasure in a prolonged battle.  

After describing the hopelessly entangled politics of the region, Lamb shifts to the impact that oil has had on many Arab countries.  He notes that despite the vast wealth that has accumulated in the area, most Arabs are still very poor and uneducated (at least they were back in 1986).  Since this book was published much of that has changed, and education has gradually spread and many Arab governments have made concerted efforts to diversify their economies to reduce dependence on oil.  Most of the smaller Arab nations with oil realize the problem that they have not earned their wealth, so that when the oil runs out some day, they would revert to the poor desert tribes they once were.  To prevent such an outcome, some are trying to direct efforts to build a more sustainable society through education and diversification.

He notes that in Saudi Arabia, which is probably the most conservative and also wealthiest Arab country, the leadership would actually prefer to be more progressive, but the majority of their population is not ready for rapid change.  So Saudi culture modernizes at a seemingly glacial pace, as the fabulously wealthy and large royal family governs in much the same way they have for two hundred years, allowing every citizen access to their leaders to register virtually any complaint or request.  

Lamb concludes with a message for westerners that Arabs primarily want to be friendly with the United States yet feel a combination of hurt and anger at being rebuffed.  He describes the United States view as the simplistic belief that there are just two sides to conflict in the middle east, and that one side is good and the other side evil.   And he asserts that as long as the U.S. hold this view and refuses to educate itself about the varied interests of the many players in the Arab world, our policies are likely to fail.  His book then is one journalist’s attempt to enlighten us about the Arabs.  It’s a worthy effort.

The Insurgents

by Fred Kaplan

published 2013

rating: 3.9

This book traces the history U.S. military strategy regarding insurgencies, and in many cases, most notably Vietnam, the military’s lack of strategy.  The United States by the 1960’s had the most powerful military machine on earth and an ingrained culture of conventional warfare involving large numbers of soldiers and massive firepower.

This military strategy was a disaster in Vietnam, where the enemy played by very different rules.  After the failure in Vietnam, the very word ‘insurgency’ was forbidden in the U.S. military.  Non-conventional wars were frowned upon as something that real soldiers don’t bother with.   Yet a small but growing number of people both inside and outside the Pentagon were beginning to question this approach and to push for realistic policies to deal with the new world of warfare.  

The story is told with General David Petraeus as the central character.  Kaplan traces Petraeus’s career from West Point through all of his military accomplishments and finally his resignation as director of the CIA.  Petraeus was an exceptional student and officer, usually at or near the top of his class in everything, and very early discovered that the U.S. failure in Vietnam was really a failure to recognize the nature of their enemy.  

The U.S. military, having gained world dominance through its superior air and ground firepower, was strongly biased toward fighting conventional wars - the type where the side with the best and fastest weapons wins.  As a comedian once joked when Bush was president, ‘they just discovered oil on the moon, so Bush has ordered troops to invade.’

Through the study of history, citing books by Jean Larteguy, T.E. Lawrence and others who detailed successful strategies of counter-insurgency, Petraeus realized that if the U.S. had employed those strategies in Vietnam they might well have achieved a different outcome.  

The basic premises of fighting insurgents is that the point of fighting them is to protect the ordinary citizens of that country.  By assisting those people with various aid and infrastructure and by separating them from the insurgents, the military can make allies of the locals.  In some cases insurgents also can be converted away from their cause and the act of nation building can occur.  Killing bad guys is not a way to win such wars.  It is more about winning the ‘hearts and minds’ of the local people.

The book lists many people, both military and academic, who shared Petraeus’ beliefs.  It is a bit frustrating that Kaplan lists so many names and gives more background than seems necessary about each character, their credentials, how they met each other and so on.  Yet this is not a novel where characters are developed.  Without developing these characters, the story becomes a monotonous, disconnected string of meetings and encounters spread over 40 years.

It is a painful struggle, with plenty of very bright, determined and talented people, many of whom were in high positions of authority.  Yet continually their cause of fighting wars appropriately is thwarted by the highest reaches of power within the Pentagon and White House.  There is very little information about those who resist change.  Most of the effort is by a small but growing number of players who see that you cannot do nation building with tanks and bombs, and that you must adjust your battle plans according to the nature of your enemy.

The good news is that after a 40-year struggle to achieve this change, Petraeus and others finally succeeded, under President Obama in 2012.  So presumably now the U.S. military will embrace a doctrine of applying appropriate actions based on goals and the nature of an enemy.  In other words, they will add to their toolbox and train soldiers to use either carrot or stick appropriately.  We’ll see.

Overall an interesting topic, though quite tedious at times.  I actually skipped the middle third of the book because I felt I was not learning from it and that the endless lists of people and encounters did not make a compelling story.  In the end though, after enough old-timers had retired and enough new players had risen to prominence, and after two more failures in Iraq and Afghanistan, the Pentagon finally agreed to acknowledge the new world and attempt to adapt.

The Cleanest Race

by B.R. Myers

published 2011

Rating: 4.3

B.R. Myers wrote this book in 2009 and has obviously spent a lot of time studying the culture and propaganda of DPRK.  Having traveled there myself in 2012, I found his book fascinating.  His observations explained many of the strange things I observed in DPRK, and I found his explanations completely plausible and consistent with my own experience.

Myers explains that DPRK is actually not a Confucian society as many scholars assume, and is not a Marxist society either.  It is nominally a personality cult, although the predominant belief that drives all of the internal propaganda is that the Korean people are a uniquely pure, virtuous and child-like race, unlike any others on the planet.  This aspect of Korean belief can be traced to their 35 years of Japanese occupation, in which they adopted these themes from their imperialist occupiers.  

Myers argues that to understand DPRK we must understand how they see themselves and how they see the outside world.  Many assume or believe that the leadership of DPRK does not believe in their own propaganda, but Myers explains that the evidence suggests that they do in fact believe it.  In a nutshell, they see themselves as pure and virtuous people who must continually struggle to keep the evil world at bay, and especially the depraved imperialist Americans.   Surprisingly, many in South Korea share some of the most basic tenets of these beliefs, though of course not the cult-like worship of Kim Il Sung.   South Koreans are overwhelmingly in favor of U.S. troops maintaining their presence (after this writing, South Korea has agreed that the U.S. will gradually reduce and eliminate its military presence on the peninsula).  It appears that all Koreans on the peninsula share a high degree of xenophobia, though the ROK (south) has greatly moderated this after 70 years of democratic rule and rising material wealth.  

I think I would not have found this book as interesting had I not traveled through North Korea recently.  Though well-written, the details of the propaganda would have appeared somewhat unbelievable.  But I was there, and can verify that I saw just about everything the writer references, and if fact had many of the same observations, though of course not his depth of knowledge.  

As DPRK becomes less air-tight regarding influences from South Korea, China and elsewhere, it will become increasingly challenging for the DPRK propaganda machine to maintain its storyline.  They have traditionally had two storylines:  one for internal use and another for the outside world.  That will become more problematic as tourism and ties to South Korea grow and better technologies find their way inside the regime.  After nearly 70 years of isolation and total power within their borders, the new ruler (Kim Jong Un) at 29 years old seems unprepared to deal with the eventuality of a more open society.

Myers concludes that western governments are wrong to assume that Pyongyang wants normalized relations.  In fact that is the one thing that would surely eliminate their etre’ de raison.  The logic for his conclusion goes like this:  Koreans are the purest, cleanest race, most virtuous race on the planet, childlike in their ways.  They have no interest in becoming an imperial power or of attacking anyone, other than perhaps the U.S. for pre-emptive reasons or retaliation for past crimes.  Given their pure and child-like nature, they need a strong parent-leader to protect their country and race from the evil world, and especially the depraved Americans.  

So as you can see, if Pyongyang were to normalize relations with the U.S., or to relinquish its nuclear arsenal or reduce its military threat, the leadership would cease to have a reason to exist.  Such a development would run counter to 70 years of relentless propaganda - three generations of unquestioning belief.  In fact Kim Jong Un has no choice but to continue being as belligerent as possible to both South Korea and the U.S.  It would not be entirely surprising if he actually attacked South Korea or even the U.S., other than the presumed fact that we expect his military would fall short of the task.  But the North Koreans have already shown a high aptitude to turn lemons into political lemonade.  As with the Korean war, despite the fact that Pyongyang was leveled and that they had no choice but to sign an armistice, they managed to claim victory, even today, as evidenced by the food aid the U.S. sent to DPRK in an attempt to make amends!

Here’s some text from page 150 of the book:

It is no coincidence that a poster illustrating that story’s (Korean War) central crime - the caption “100,000 times revenge on the Yankee vampires” - appeared in 1999, when North Korea was the Clinton administration’s main aid recipient in Asia.  Nor was it by accident that Jackals (DPRK novel) was simultaneously republished complete with racist caricatures, in three magazines in August 2003, just before and during the first round of the six-party talks.  Ever since Kim Jong Il proclaimed his military first government, effectively shaking off responsibility for the country’s economic ruin, declines in real-world tension between Pyongyang and Washington have seen an intensification of anti-Americanism, not a lessening of it.  Only one conclusion is possible:  The regime is worried that the masses might cease to perceive the US as an enemy, thus leaving it with no way to justify its rule - or even to justify the existence of the DPRK as a separate state.

Not sure I would have enjoyed this as much had I not toured DPRK.  Still, well-written and documented with cogent arguments throughout.  Hope he writes a second edition if and when conditions in DPRK change.

The Path Between the Seas

by David McCullough

published 1978

rating: 4.8

David McCullough uses his masterful story-telling skills to present the story of the dream, the struggle, the folly and failures and ultimately of the triumph of connecting the Atlantic and Pacific oceans through the jungles at Panama.  The story spans the forty year period from the beginning of the disastrous French effort to the completion of the successful American effort to build the canal.   He draws from diverse sources spanning centuries to portray the vast interests and obstacles facing virtually everyone whose lives were touched or consumed by the canal project.  Ultimately he succeeds in writing an entertaining page-turner for this non-fiction story where we already know the outcome.

The author mentions that as far back as Columbus, explorers and governments were intrigued with the prospect of a canal through the isthmus separating the Atlantic and Pacific.  Such a canal would save 8,000 miles for thousands of ships every year, greatly increasing world trade and reshaping the geopolitical map.  

But not until the charismatic Frenchman Ferdinand de Lesseps completed the Suez canal in 1869, did the world take notice and begin to seriously consider that such a massive feat of engineering might be at hand.  If they could do it at Suez, ‘why not Panama’ was the inevitable thinking of the day.   As perhaps the most key figure in the early part of the canal story, de Lesseps gets credit for Suez effort.  Though not a scientist, engineer, businessman or politician, de Lesseps used his charm, wit and unfailing belief in the power of modern science to conquer anything.  He alone convinced key Egyptian and French leaders that the canal was possible and he alone, at least in the minds of most ordinary citizens, is credited as the main force behind Suez.

McCullough pays tribute to this accomplishment with lively stories of Lesseps and Egyptian sultans riding horseback through the desert, arguing his case and gradually converting all who would listen into believers of the possible.  Upon the successful completion of Suez, Lesseps turns his attention to Panama as his next logical conquest.  

Here the author is thorough and patient in taking the reader through the same painful process that French and American investigators endured in surveying the isthmus, trying to find the best route for a canal.  Unlike Suez, which is a dry, low-lying desert, relatively free of disease, unpopulated and geographically close to Europe, the American isthmus is a remote mountainous jungle, replete with disease-carrying insects, venomous snakes, huge annual rainfall, impoverished and work-adverse peoples, and a wholly inhospitable environment for the likes of French or American builders.  

At the start of the California gold rush in 1849, thousands of fortune seekers chose to sail to Panama, cross that isthmus by mule then sail north to San Francisco.  This was often quicker and less dangerous than crossing the North American continent, despite the dangers of the jungle.  Seeing this huge volume of traffic across the isthmus, entrepreneurs secured land rights from Columbia to build a railroad traversing the 46 miles between the Atlantic and Pacific at Panama.   Completed in 1853, the railroad, owned by Americans, was a huge commercial success, even though traffic tapered off when the California gold fever subsided and especially when the transcontinental railroad opened in 1870.  

In France, greed and patriotism fueled the formation of the French canal company to undertake the grand project of a sea-level canal across Panama.  Despite vigorous protests from various engineers on this unwise approach, and despite hopelessly unreal budgets, inadequate surveys and insufficient preparations, money was raised and work was started by the French.  Trouble began immediately, untold thousands died of disease, and work progressed at a hopelessly slow pace.  After scandalous cover-ups, extensive graft and tragic deaths, the French company finally collapsed amid shame and extensive losses, primarily borne by average French citizens who, fooled by their own greed, accepted the rhetoric of their own leaders.

Despite the miserable failure of the French, they did display moments of brilliance and ingenuity in their work, which eventually gave the Americans a head-start some twenty years later.  Some American engineers on site in Panama would come to respect their French counterparts for the thousands of buildings, huge excavations and other accomplishments in infrastructure, especially considering the miserable conditions the French faced on the isthmus.

The American story, which began around 1900, when Roosevelt was still vice president, was initially a contentious debate as to where to locate the canal.  Some favored Nicaragua while others favored Panama.  We will probably never know all of the facts, but McCullough is careful to convey that the issue had many vested interests as well as technical opinions on both sides of the controversy.  Ultimately one of the central figures in this period was Philippe Bunau-Varilla, a French citizen who had worked on the French canal effort and who owned shares in the failed canal company.  He and his brother, plus an American attorney-lobbyist hired by the French (Cromwell) had huge personal stakes in seeing that the Americans would choose to build in Panama and that they would pay the failed French company for the idle equipment, empty buildings and work already completed.  

After several years of formal debate in congress and the senate, and after direct lobbying by Bunau-Varilla on dozens of key Americans, including Roosevelt himself, the decision was made to pay $40 million to the French company and to begin work in Panama.  This left the remaining issue of signing a treaty with Colombia, which leads directly into the next problem, and perhaps the most controversial action of Roosevelt’s career:  he is credited with the unlawful Panama revolution in which Columbia lost control of the isthmus.  

The telling of this episode suggests that the Americans really did very little to participate in the creation of the independent Panamanian state, other than to quietly and unofficially give the impression that they stood ready to lend military support to the very small number of Panamanian rebels in their efforts to gain independence from Columbia.  The fact that the Colombian military was easily bought off and that no shots were fired by either side makes this ‘revolution’ seem nearly comical.   The mere belief of U.S. military might held by the Colombian soldiers probably contributed to the ease with which they were encouraged to run without a fight.  There was misunderstanding, misrepresentation, greed and apathy on all sides.  There were no heroes and no casualties, yet in a matter of hours, Panama become an independent state and Columbia was out of the picture.  

The U.S. government quickly signed a very lopsided treaty with the newly formed Panamanian government, hugely favorable to the U.S..  Then the U.S. paid the French company $40 million for their assets on the isthmus.  Finally the Americans began the long campaign to build the canal where the French failed.  From the beginning, the Americans made many of the same mistakes that the French made, including the arrogant disregard of the threats of disease, despite the warnings and pleading of experts who had learned how to combat yellow fever and malaria.  As always, nothing is more damaging to a new truth than an old error.  This maxim was proved in spades by the thousands of needless deaths from mosquitos, as stubborn administrators ignored the evidence from recent successful efforts in eradicating those diseases in Havana.  The U.S. even put Dr. Gorgas in charge of health care in Panama.  He had virtually eliminated yellow fever a few years earlier in Cuba after painstakingly observation there.  He now pleaded with the canal administrators for funding and permission to employ the same techniques in Panama, yet was repeatedly ignored as thousands died needlessly.

Eventually, after wasting a year, a lot of money and many lives, the chief engineer at Panama, John Wallace, quit his job.  So for all of the talk of French inefficiency and failure, the Americans up to to this point had actually underperformed the French.  

Upon the resignation of Wallace, Roosevelt appointed John Stevens as chief engineer of the canal project and gave him wide authority to run the project as he saw fit.  A self-made, accomplished railroad engineer, Stevens attacked the Panama project head-on.  He insisted that all work stop until the facilities were cleaned up.  He gave Gorgas everything he requested and full authority to do whatever needed to eliminate mosquitoes,  unsanitary conditions and rats (there was a case of bubonic plague).  He cleaned up the cities and towns, fixed the railroads, repaired the equipment and took careful stock of the work to be done.

Stevens primarily saw the canal project as a railroad task in that the major challenge was not digging dirt, but rather of removing and disposing of the dirt once dug.  As an experienced railroad builder, he greatly improved the scope, size, capacity and efficiency of the railroad along the canal project before finally resuming work.  Also, unlike Wallace, Stevens was seen every day among to rank-and-file workers, asking questions, observing, staying familiar with every detail of the project and of the lives of the workers.  And finally, Stevens embraced the theories of Gorgas, and thus gave the doctor carte blanche to employ his techniques to rid the area of disease.  

Stevens and Roosevelt shared a mutual admiration and respect for each other.  After Roosevelt’s famous two-week tour of the canal project in 2007, the president paid high praise to Stevens in a public speech.  So it was particularly disturbing to the President when Stevens resigned shortly after the president’s Panama tour.  Though he gave no specific reason for his resignation, the best guess is that he was simply exhausted from the relentless detail and wholly absent leisure that a man of Steven’s age would inevitably begin to crave after a life of hard work.  Not a glory-seeker, Stevens simply wanted a break, to enjoy the fruits of his labors for whatever years he might have remaining.  

Wasting no time, Roosevelt and his war secretary Howard Taft decided to appoint George Washington Goethals as the new head of the canal project.  They also reorganized the administration of the project so that Goethals became the absolute czar, able to avoid red tape or budget concerns.  Goethals indeed had full authority and virtually unlimited funds to do whatever it took to complete the canal.  The other important departures from previous canal administrations were that Goethals would run the operation from Panama, and that Goethals was a colonel in the army corps of engineers.  So the canal project, to date the biggest engineering task ever attempted, would be run by the United States Army.  

Goethals was not a people person, though he was without question a talented engineer, and more importantly to Taft and Roosevelt, as a military man, he would be extremely unlikely to quit as his predecessors had.  As a military officer, he would do exactly as he was commanded - he would follow orders.  Goethal’s reception on the isthmus was cold and hostile, as most workers assumed they would be forced to work in military conditions, with uniforms and such.  Canal workers made an emotional, festive farewell to Stevens and all but ignored the arrival of Goethals.  

But their fears were badly misplaced.  Goethals, while not a ‘man of the people’ as Stevens had been, was fully aware of the task at hand and how best to accomplish it.  He began by announcing that neither he nor anyone working for this project would wear a uniform.  He readily fired anyone who caused trouble and quickly established both his absolute authority as well as his fairness and good judgement.  He would remain on the job until completed, and under Goethal’s administration, canal zone employees would come to enjoy what many would come to see as the best years of their lives.  Pay was ample, vacation and sick leave benefits were generous for the times, food and stores were well-stocked items and inexpensive and living arrangements, social life, the arts, and all forms of entertainment were widely enjoyed, all in the service of the larger-than-life project that would benefit humanity for centuries to come.  It was truly a workers’ paradise.  In fact, the anti-socialists of the day worried that when the canal project ended and all of those happy workers returned to U.S. soil, their experience would form a frightening socialist lobby.   However others noted that unlike a true socialist society, the canal project was a benevolent dictatorship.  Goethals was the undisputed leader with access to the bottomless pocket of Uncle Sam, so the socialist comparison had only limited viability.

Many of the tourists and journalists who had visited Panama during Goethal’s time remarked that to their surprise, the canal project, though impressive in its own right, was not what caught their attention.  Particularly for those who had viewed the canal project in the earlier, mosquito-infested days, the transformation of the jungle into a sparkling and efficient tropical work zone was nothing short of a miracle.  Fear of yellow fever and disgusting living conditions had been replaced with a genuine enthusiasm for working in idyllic living conditions on an exciting project of world importance.  Indeed, when the canal opened, Goethals was asked what was the most important factor in competing the work.  He answered that the fact of a motivated workforce was certainly the most critical element.

Toward the end of the story McCullough shifts into a more statistical and qualitative mode, covering the human, financial and engineering aspects of the canal without regard to timeline.  He provides statistics, body counts, amounts of excavation and measurements of every sort relating to the canal project.   He also provides a description of the great disparity between black and white workers on the project, both during the French era and the American era.  Here he supplies plenty of statistics where available and keeps his story in context with the politics and common beliefs regarding skin color during the canal years.  By far the majority of the workers were black men from the West Indies, who as uneducated, black and non-Americans were paid less and given much less in the way of housing, entertainment and other benefits, yet served a critical role in the construction of the canal.  Due to the nature of their work and their poor housing conditions, this population suffered a higher death rate from all causes during the entire project.  Still, they were provided free medical care, and McCullough includes one lengthy description written by one of those black patients.  

Despite the lack of spending restraints, the canal project was completed both in less than the allotted time and less than the allotted budget - a truly rare occurrence, particularly for such a large project.  And according to McCullough, at the time of his story some six decades after the canal opened, there was still no evidence or graft or corruption in the American effort, which clearly sets it apart from the French effort.  The canal mechanisms have worked flawlessly for a century.  

McCullough finally closes his story with a quote from John Stevens, who ran the canal project in 1906 - 1907, and like Lesseps before him, had great faith in human intellect and creativity.  Stevens, who died in 1943 at the age of 90, addressing young engineers, wrote  “ . . the great works are still to come.  I believe that we are but children picking up pebbles on the shore of the boundless ocean.”

 

The Healing of America

by T.R. Reid

Rating:  4.6

Highly recommended, though written 1 year before the adoption of ACA, which should address some of the problems of U.S. health care covered by this book.

The author sets out to explore the differences between health care in the United States and other developed countries.  The book was published in 2009 before the passage of ACA (Obamacare), so may have contributed to the case for that landmark legislation.  All references to U.S. health care are pre-Obamacare.

Reid debunks many American myths about medicine outside of the U.S. as he sets out to provide a balanced assessment of the strengths and weaknesses of each system.  His premise is that the U.S. does not necessarily need to change to one of these other systems, but that it can learn from each of them and modify its own health care to achieve some of the success that other countries seem to enjoy.

He cites extensive studies by the WHO (world health organization) and many American organizations that all seem to agree that the U.S. ranks dead last among developed nations in terms the the cost, quality and fairness health care.  In short, we do everything wrong, plus it costs more.

The most striking difference between health care in the U.S. versus other countries, is that the U.S. does not have a single system.  Veterans have one system, native American tribes have another system.  Everyone over 65 gets medicare.  Poor children under 16 get coverage, but poor people over 16 don’t.  Those with renal failure get full care paid for by the U.S. government.  Prisoners get free medical care.  Insurance companies all have different rules, and in fact the ‘death panels’ that fear-mongers warn about don’t actually exist in Europe, though one could argue that they do exist among American private insurance companies.  Within the insurance industry, when they pay a claim they record it as a ‘medical loss’, meaning that any payout for claims reduces their bottom line, which all corporations try to minimize.  He states that 700,000 Americans file bankruptcy each year due to medical bills.

As a foreign correspondent for the Washington Post, the author travels extensively and visits doctors in many countries to see how they will handle his injured shoulder.  He names each physician and paints a vivid picture of their daily practice, their income, their motivations, their complaints.  He also describes these systems from the perspective of patients, again detailing accessibility, affordability and quality of care in each country.  For any American who has dealt with the frustrations of medical care in the U.S., or attempted to traverse the bureaucratic maze that is our insurance industry, the stories of care in other countries appear as a patient’s utopia.  

France:

France is ranked as the best overall system in the world by the WHO study.   It is not the cheapest care as a measure of GDP, though it has very low out-of-pocket costs for patients, quality is considered excellent and French citizens are very proud of their system (although as with everything else, they complain about it incessantly).

France is one of several countries that use the Bismark system, named after the German leader Otto von Bismarck.  In the19th century Bismarck consolidated the Germanic principalities into a modern nation and instituted a national health care system.  He did this partly out of charitable kindness (what he called ‘applied Christianity’), though mostly to build solidarity in his new nation, and to boost the health of its citizens.  The plan became immediately popular and has remained in effect for 125 years, surviving world wars, Soviet occupation and countless political upheavals.  

In France, physician pay is mediocre, but they accept this and appreciate that they don’t need to practice defensive medicine or worry about lawsuits or billing.  Any French citizen can visit any hospital or doctor in the country.   Unlike the U.S., all prices are posted for all procedures.  

The author visits an orthopedist and sees that his consultation will cost $33.  He will submit that cost to the insurance company and be reimbursed about 70% of that, and won’t need to worry if his insurance will pay.  Everything is covered, so all procedures will be reimbursed.  In the U.S. that consultation would have cost at least 4 times as much, and the patient would often be uncertain as to whether the insurer would pay, plus the patient could only visit a doctor that is approved by the insurance company.  The patient in the U.S. would need to complete lots of paperwork, some of which would deal with liability, and the patient would need to answer the same medical history questions every time he visits a new doctor.   U.S. doctors don’t have access to the patient’s medical records.  On the bright side, in the U.S. the doctor’s office would be a bright, clean, spacious and nicely decorated facility.  In France, most offices and hospitals are dingy, spartan affairs.  

All French citizens have a health card with a microchip that contains all of their medical records.  They can visit any doctor in the country, give him their card and the doctor has instant on-screen access to the patient’s entire medical history.  France medical costs are about 11% of GDP (2005).

One further difference between France and the U.S., is that the French system covers a much wider range of treatments, including spa treatments, herbal remedies and acupuncture.  Croissants and jam are not covered.  Sacrebleu!

Britain

In Britain they have the Beveridge system, also called the NHS (national health system) in which all medical care is free for everyone.  There is no insurance and no co-pay, no bills whatsoever other than in the very small private sector.  The government decides what procedures and medicines it will pay for and how much it will pay.  Doctors and hospitals are private, though prices for every possible procedure are set by the government.  Further, the government does not cover all procedures nor all medicines - only the ones they consider necessary and cost-effective.

Since the health of each citizen will directly impact the nation’s fiscal health, their system is strongly biased toward preventive care and doctors are rewarded for having a large number of healthy patients.  They call this the ‘capitation system’ and there are specific payments made to doctors based on a complex set of criteria.   There is no incentive for their doctors to perform unnecessary procedures as in the U.S.  Their infrastructure is very old, though the quality of the care is described as excellent.  They historically had a problem with long wait times, though have greatly reduced that in the past decade.  One example of the power of NHS is that men are not given routine prostate exams as in the U.S.   The NHS has determined that this test is not cost-effective.  To pay for this system taxes are high in the U.K.  Sales tax is 17.5% and prices are generally very high for most things.  But the Brits love their health care system and no sane politician would try to dismantle or reduce it.

Canada

Canada uses the National Health Insurance model,  introduced in Canada by Tommy Douglas in 1944.   As a six year old boy in Scotland, Tommy fell, bumped his knee badly and was handicapped, potentially for life.  His family moved to Canada in 1910 and Tommy was randomly selected by a local surgeon who wanted to show off his new orthopedic surgical procedure.  Tommy was miraculously cured, though felt that the randomness of his luck was unfair to countless others who needed medical attention.  In 1944 Tommy became Premier of Saskatchewan and instituted a government funded single-payer system for all Saskatchewan residents.  The system was extremely popular and was later adopted by other provinces and eventually became a national system in 1961.  

In the NHI model, all citizens pay monthly premiums to their provincial insurance company.   Providers (physicians and hospitals) are private, though prices are strictly regulated by the government.  Citizens who can not afford the monthly premiums are covered by the government.  For most Canadians most of the time, other than monthly premiums there are no out-of-pocket costs.  The major problem in Canada is a shortage of doctors and seriously long wait times.  However no one in Canada, rich or poor ever dies of a curable disease, and no Canadian ever goes bankrupt from medical bills.

Taiwan, Korea and other countries have copied the Canadian model, and the U.S. medicare system for seniors also is modeled after Canada.  Even the name ‘medicare’ came from Tommy Douglas.   There is some flight to the U.S. among wealthy Canadians who don’t want to wait, though these numbers are small.  Costs are rapidly rising in Canada, though still far cheaper than the U.S.

Germany

Germany is of course under the Bismarck system, where all providers and insurers are private, though under strict price controls and required to include all citizens and even guest workers, whether legal or not.  The insurers are non-profits yet still are very competitive.  They are required to pay all legitimate claims, so they don’t waste any effort on trying to deny claims.  The package of benefits is generous, including doctors, dentists, opticians, physical therapists, prescriptions, nursing homes and even spa visits if recommended by a doctor.  

The premium that workers pay is a percentage of pay, very similar to U.S. social security, in which the employee and employer contribute the same amount to the fund.  Wealthy Germans can opt out of the system, which about 7% do.  There are private, for-profit insurers and hospitals to cater to this wealthy sector, although that practice is controversial.  

Like all other countries, costs are rising rapidly, so Germany instituted a co-pay policy in 2006 where patients must pay $13 per visit, up to a maximum of $13/quarter.  People of course were outraged, but by now have probably gotten used to the idea.

Government pays the tuition for medical school, and the cost of malpractice insurance is extremely low.  As costs rise, physician pay is getting squeezed, so many doctors earn extra income by performing cosmetic procedures that are not covered by the insurance system.  

Supply of hospitals and providers is ample, so wait times are very short, generally shorter than in the U.S.  Quality of care is considered excellent, among the top in the world.  Only downside seems to be cost, with German health care consuming 11% of GDP.  That’s higher than most of the world, with the exception of course of the U.S. (17%).

Germany recently adopted a digital health card similar to the one used in France, which saves on admin costs and improves efficiency.  Patients can use any of 200 private insurers and see any doctor in the country.  So compared to the U.S. they have more choice and better care at less cost, and without the fear of being dropped by their insurance or denied coverage for pre-existing condition.

Japan

Japan also uses the Bismarck system.  Hospitals, doctors and insurance is private, but prices and coverage rules are strictly regulated by the government.  All citizens have coverage, generally paid for by employee and employer, with the unemployed covered by the government.  Prices are extremely low, so Japan spends only 8% of GDP on health care. The group who suffers from this is doctors, who earn only moderate incomes (100K-150K) and hospitals that are underfunded and thus not investing in upgrades.

However the author describes Japanese doctors as the most competitive in the world, advertising their services and being very entrepreneurial in running their practices. Patients pay for service and are reimbursed usually 70% by their insurers (who cannot deny claims).  Costs are very low.  Since prices are so low, Japanese citizens go to their doctors on average 14 times/year.  This compares with an less than 5 times/year for Americans.  One result of the low fees is that major surgeries are less common in Japan, since doctors are less likely to recommend them.  So Japan has extremely low costs, high usage, total consumer choice and excellent health/life span stats.

Taiwan

In 1994 Taiwan searched for a health care system, consulted with an American health economist, and decided to study systems around the world and find what would work for Taiwan.  As a fiercely capitalist nation whose primary supporter (militarily) is the U.S. and since most Taiwanese greatly admire the U.S., their first thought was to adopt the U.S. model.  But they spoke with many Taiwanese doctors who practiced in the U.S. and were advised against this.  They were told that the U.S. system is really not a system at all - it’s a market, where some who cannot pay don’t get care and others go bankrupt paying for care.  

So Taiwan adopted the Canadian model, though insisted on a single, government-run insurer and private hospitals and doctors.  This gives them control of costs, with all payments going through the single insurer.   All citizens pay a premium through payroll deductions.  They also give every citizen an electronic card that contains their medical history and billing info.  Government controls prices for every procedure.  

Adoption of this plan in 1994 was a hot political issue.  Cleverly, the conservatives in power at the time decided to support nationalized care, thus taking some wind out of the sails of the liberals.  Sure enough, the plan was adopted and became very popular, helping conservatives to maintain political power.  Interestingly, the same year Taiwan adopted their national health plan, President Clinton was making the same attempt in the U.S.  That effort went down in flames under heavy lobbying from all of the vested interests.  

Taiwan health care is about 6% of GDP.

Switzerland

Was similar to the U.S. in that it was a for-profit system with very high costs and many citizens without access to care.  In 1996, despite vigorous lobbying by the medical industry, the Swiss adopted a variation of the Bismarck system (similar to France and Germany).  Insurance companies were forced to become non-profits and to offer coverage to everyone, and all citizens were required to purchase coverage, at least for a basic plan.  

The insurance companies cannot profit on basic plans, though they still compete by offering upgrades such as private rooms, cosmetic procedures and so on.  Despite their restrictions, the insurance industry in Switzerland is thriving, with 70 companies competing for business of 8 million citizens.  Cost are about 11% of GDP.

When the Swiss nation debated the health care issue in 1994, the central issue was one of fairness, of solidarity.  By contrast, when the issue was debated in the early years of the Clinton presidency, the issue was seen as economic.  Fairness was rarely part of the debate.

China

Only nation that seems to have regressed.  Under Mao China had national health care, sort of a poor-man’s version of the Beveridge model with universal access and rural clinics.  Under Mao, life expectancy increased dramatically and infant mortality dropped.  Then in the 80’s after Mao’s death, China scrapped that system for a totally private system.  So there are modern hospitals in big cities that cater to wealthy patients, but the vast poor population essentially has no medical care.  Out-of-pocket costs are very high at 60%.  And predictably, infant mortality rates have increased, life expectancy has remained stagnant while other countries have improved, and some infectious diseases are on the rise.

India

India, like most poor countries, has no health care system, and is thus described as an ‘out-of-pocket’ system.  This means that patients pay directly to any provider, which generally means that only the wealthy receive care.  70% of Indian’s population live in poor rural villages and most will never see a doctor in their life.  

Cuba

Similar to Beveridge model of national coverage, zero co-pay, though actually based on old Soviet system.  Stats are very good for life-span and very low infant mortality, cost is 6% of GDP, though infrastructure is crumbling.  Overall ranking on WHO list is 39, just two behind the U.S. ranking of 37.

Review:

Overall a very readable and interesting book, with plenty of anecdotes to illustrate his findings.  Well explained although the author has a clear bias toward universal coverage.  The statistics he presents regarding all measures of health and cost seem to overwhelmingly support his opinion.

One aspect of a market system that the author barely mentions is when doctors prescribe treatments that are not really necessary.  The profit motive surely creates lots of unnecessary procedures, at both great financial and health cost to patients.  He also makes scant mention of the downside of defensive medicine, preferring instead to focus on the macro measurements such as life-span, infant mortality and total cost as a percentage of GDP.

If I were assigned the task of supporting the U.S. system (before Obamacare) I would point to the benefits of a free-market economy with a minimal social safety net, to our relatively high employment rate and our status as a land of opportunity and innovation.  I would argue that consumer goods in the U.S. are far cheaper than most of the other countries mentioned, that taxes are lower and that opportunity is greater.  

And then I would apologize for making these arguments, book a flight to Berlin or Paris or Bangkok and schedule an appointment with a physician.