5

Why Don’t We Fix It?

Imagine yourself sitting up in the sky, busily building a SimCity, designing its buildings, institutions, and norms. But there is a catch: as soon as you are done, you will be born into this community randomly, not knowing what advantages or disadvantages that you will have. No idea of social standing, intelligence, sex, race . . . If we took John Rawls’s classic, A Theory of Justice, seriously we would not allow the things we see daily on the streets of San Francisco, New York, Vancouver, Mexico City, and so many other great cities. We know it is wrong to walk past a shoeless person in the snow, a hungry person outside a supermarket, someone who is in pain and clearly needs help. Yet almost all of us do. Every day.

Why are there so many instances where our behavior, and treatment of others, becomes far more ethical across time, and so many other instances in which we still treat those around us in ways we would never want to be treated?

A combative economist, William Baumol, provides some clues . . .

Baumol’s Cost Disease

William Baumol was a cool guy. Growing up in a poor area of the Bronx, he went from the rough-and-tumble streets to CUNY, and then dared apply to the haughty London School of Economics, where no one had heard of CUNY.

LSE rejected Baumol from the PhD program, and barely admitted him for a master’s. But when he showed up, he surprised the nattering LSE nabobs just a touch:

Lionel Robbins ran a seminar in which animated discussion was the name of the game. Well, there was no place like the City College for dirty debating as a blood sport. I mean, we were trained as no other group could have been trained. The Oxford Debating Society was composed of amateurs and children by our standards. So just by instinct, whenever I disagreed with something I would wait for the appropriate moment and come in charging with my sword drawn, and they’d never seen anything like this. So quite unjustifiably, given what I knew at the time, within two weeks, I believe it was, I was switched from a Master’s to a Ph.D., and three weeks later I was a member of the faculty.1

Baumol ended up a Princeton professor, wandering through the manicured campus, thinking about the original gig economy: musicians and artists. He focused on an interesting, if obvious, observation: while much of the economy was on the track to faster, better, cheaper . . . It took the same amount of time for four musicians to play a piece in 1965 as it did in 1865. But it costs a whole lot more to pay musicians in 1965, because, as other areas of the economy got more productive, overall salaries were, on average, higher. Regardless of whether productivity in any given sector increased or not, people expected higher pay.

Turns out there are many areas of the economy where there is little productivity gain across time and costs continue to rise; this observation is now known as Baumol’s cost disease.

2014 was a tipping point for orchestras:

for every dollar of income, $0.43 came from donations

and $0.40 from ticket sales.

Lockouts, strikes, and pay cuts flourished.

The Louisville, Honolulu, and Philadelphia orchestras filed for bankruptcy.2

Were it only musicians and actors affected, the problem would be somewhat addressable. But wide swaths of our economies are victims of Baumol’s cost disease . . . And a whole lot of ongoing ethical wrongdoing can be found in the sectors plagued by the Baumol effect . . .

It is far easier to be generous, and alter what many know is wrong, if one has the economic margin to address the injustice. Where there is increasing wealth and decreasing costs, one might see rapid ethical shifts. Not so where costs relentlessly increase and problems mount.

Where “faster, better, cheaper” rules, one is far likelier to see radical ethical shifts.

But where productivity is falling, we may continue to tolerate unethical behaviors for a long time.

Salaries and productivity going through the roof? Expect rapid change in ethical mores. But wherever you see costs growing much faster than inflation in other sectors, you might find egregious abuses of individuals and groups: “Medical care, education, public safety and social work suffer from the fact that they are so labor intensive. It’s hard, if not impossible, for them to be produced more efficiently.”3 So we continue to tolerate really unjust behaviors as long as changing a system on a large scale would be prohibitively costly.

Look at the following graph through the lens of a Rawls’s “just society.” Things that are nice to have, like toys and TVs, got a lot cheaper over the last two decades. But the things essential to thrive in a knowledge economy raced ahead of poor and middle-class incomes.4 College is three times as expensive. Education in general almost 1.5 times. If you need medical care or child care, good luck.

To have a chance to rise into the upper-middle class, or to get rich, you likely have to be able to get a good education, stay healthy, take care of your kids. Yet these are precisely the sectors most prone to Baumol’s cost disease—on top of which, one gets tremendous market distortions . . . Compare what is going on in health care with your last car purchase. While the price of new cars has remained relatively steady, in real dollars, their features have drastically improved. The older your car the greater the chances you will die in a crash.5 Now tell me about your last hospital visits . . . Do you feel far safer because you are spending more on health care every year? Do you feel more comfortable, better cared for, when you go to a hospital today than you did a decade or two ago? How about college tuition and the price of textbooks? Getting more bang for the buck?

“Nonprofit” and predatory for-profit entities drive US health care. It is not a system that is getting faster, better, cheaper. “Free markets” do not work in big chunks of health care. There is no “price elasticity,” no reduction in demand or need, when one is talking about a kid in anaphylactic shock or in dire need of insulin. So just why was it ethical for Mylan to buy out a competitor that sold two EpiPens for $94 and up the price, for virtually the same product, to $700+? Why is it OK for the list price of insulin to triple between 2002 and 2013?6 Increasing insulin prices and access seriously hurts some of the poorest and most vulnerable: “Between 2006 and 2013, average out-of-pocket costs per insulin user among Medicare Part D enrollees increased by 10% per year for all insulin types.” Hmmmm . . . wonder if this has anything to do with there being a whopping three insulin providers who control a $27 billion market (Eli Lilly, Novo Nordisk, and Sanofi)?7 There is a lot of finger pointing as to who is to blame, and who gets more money. But the bottom line, for those having type 1 diabetes, is that their average spending per year, per person, exceeded $5,700.8 So in 2019 caravans began crossing the border to Canada to buy insulin for one-tenth of the US price.

Just slightly ironic, given that one of the discoverers of insulin sold his patent to the University of Toronto for $1 because he recognized how many lives he could save.9

Same pattern holds for hospitals. When seriously sick, you have little choice but to go to the hospital. As long as there is little price elasticity, and, as long as someone else pays, there is little accountability for excess spending and excessive billing. (At one point, Dallas-Fort Worth had more medical helicopters than all of Canada and Australia.)10 So hospital CEOs can perform miserable jobs and still get paid disproportionate salaries; during 2018, thirteen CEOs earned between $5 and $21 million. And 62 health care and pharma CEOs took home over $1.1 billion in pay.11

It is unconscionable, and unethical, to take that which people most need, when they most need it, and drive access at a higher cost. But in sectors plagued by Baumol’s cost disease, that is precisely what we allow and tolerate. As long as technology does not allow us to provide more for less, we accept what will someday be judged as terribly unethical.

So Sorry You Are Sick—Now You Owe Me . . .

The primary, and fundamental, function of any modern government is to provide safety and prosperity to its citizens. In developed economies, there are far fewer armed robberies. But within the U.S. there are an ever greater number of stick-‘em-ups, just not on the streets; a series of cartoons depict pharmacists, doctors and executives holding a vial of medicine while saying “your money or your life”?

When you talk about DC lobbyists’ “swamp ethics,” US healthcare is exhibit A. In almost every civilized society, not being able to pay does not equal a death sentence. In the United States, sometimes it does. If you live in the bottom fifth of the economic ladder, you are three times as likely to die in middle age as the top 20 percent.12 These already stark numbers are getting worse year by year. If your income was in the top 50 percent in 1970, you might have expected to live 1.2 years longer than the rest. By 2000 the gap was 5.8 years. Now “men in the top 1 percent of the income distribution can now expect to live fifteen years longer than those in the bottom 1 percent.”13

Among all developed countries, this “pay to live” paradigm is a particular ethical outlier. Let’s examine this policy in terms of two contrasting systems. Imagine an education system where no kindergarten is free. Same with grammar school, college, graduate school, post-graduate, and vocational training . . . In fact no education is free, or guaranteed. Until you hit the magic age of 65. At 65 everything changes. You can take any course you want, almost no matter what the cost or outcome. That, with some nuance, is how much of the US medical system operates.

Contrast that with Britain, exhibit B, where the criteria is very different. Everyone is somewhat covered, but only for treatments that make sense under DALY, an acronym for Disability Life Years. Measure each medical proceedure by how many years of good health you get per intervention. In a pay-for-outcomes system, governments prioritize and pay for procedures that have a substantial impact on lifetime health, even though these may generate minor profits for pharmaceuticals and hospitals. Cheap childhood treatments, like vaccines and antibiotics, often prevent or cure lifetimes of suffering, so they get the highest DALY priority.

In contrast, the US’s pay-for-procedure system incents a lot of marginal, if not outright useless or harmful interventions, especially at the end of life. This leads to perverse ethical outcomes. Try a thought experiment: You are CEO of a giant pharma company, Zed. And there are three teams of brilliant scientists waiting in your boardroom to pitch you on where you should invest over the next year . . . Team A comes in and tells you they have developed a fantastic vaccine that prevents a horrendous disease. One cheap dose and you don’t have to treat again for decades. A huge savings and return on investment for the patient and society. Not so for Zed.

Team B comes in and tells you that we are about to enter a horrendous period of antibiotic resistance. But fortunately they have found an efficient and cheap new series of antibiotics. Patients who take this miracle drug for a week are, usually, completely cured. All for a few thousand dollars.

Team C comes in and explains they have developed a terribly expensive, last ditch, protocol to treat cancer in patients nearing the end of their lives. At best it will help on 10 percent of its users live a few months longer. Treatments cost more than a million dollars. Most recipients will rapidly deplete their life savings.

In a DALY system, it is a no-brainer. The government reimburses A, B, and likely not C. Per dollar spent, you would much rather cure a children, allowing them to lead a productive life, than marginally treat very sick people who have already led full lives. But which is the rational choice for our hypothetical Zed Pharma CEO, who needs to show quarter-to-quarter growth and bigger margins to Wall Street? Well then . . . If a person needs a last-ditch, hyper-expensive treatment, by all means spend hundreds of thousands of public and private dollars!

Cheaper treatments, the ones that save the most lives, are not the priority.

Are you shocked that very few companies develop new antibiotics or vaccines?

Were this a US policy alone, OK—then maybe it’s just the US’s ethical pile-up, while the rest of the world goes on acting better. But here is the problem. The United States is such a systemically dominant regulatory and financial market that pharmaceutical research, and many treatment protocols, are driven globally by the United States. Almost all pharma development targets, other than specific conditions subsidized by organizations like the Gates Foundation, the Global Vaccine Alliance, and the WHO, do not follow a DALY development logic but a maximize-profitable-new-products-for-the-US-markets logic.

This kills a LOT of people.

Pharma gets a lot of justifiable grief, but there are other health care sectors operating on ethical thin ice. US hospitals are the single biggest component of health care costs. And, as in pharma, a pay-per-procedure system generates perverse incentives. There is an enormous incentive to test and treat even when the outcome of some protocols and treatments is worse than the disease. Older patients become ATMs and provide most of a hospital system’s income; many of these patients are subsidized through Medicaid and Medicare. Meanwhile, younger patients either pay a lot, use emergency rooms, or die. There is little spent on prevention and little spent to help the young. One can measure the consequences through Years of Life Lost (YLL); for every person who dies before they reach age 70, add one YLL. (For example, if a person dies at 45, add 25 YLLs). In 2017, the US YLL was 12,282 versus 7,764 for other countries.14

And the US DALY measure is 31 percent worse than comparable countries.

Alongside worse outcomes, U.S. costs continue to escalate, especially for patients covered by private employers. So employers, in turn, are crunching their employees.

In 2006, just 11.4 percent of private-sector workers had high deductibles.

In 2016, that number was up to 46.5 percent.15

So 60 percent of those with chronic conditions and high deductibles postponed care.16

Is the idea to kick folks when they are most down? Just how does it seem right to pay for some mothers’ regular births but charge them for still-births?17 Why should cancer treatments lead to frequent bankruptcies in the United States but not in most developed countries? Sixty-six percent of US bankruptcies are related to medical issues. That takes half a million people out of the middle class. EVERY YEAR.18 Other developed countries do not allow this behavior. They do not tie treatment and survival to having the right employer. Ninety percent of Germans never see a medical bill. In France coverage gets better the sicker you are; acne is not completely covered but being hit by a car is.

In other OECD countries, average hospital stays cost $10,530 and last 7.8 days.

In the United States? $21,063 for 6.1 days.19

Again . . . IT IS NOT GETTING BETTER. Hospitals continue to merge in the name of “greater efficiencies.” And still administrative costs soar as do executive salaries. In places where there remain only one or two major players, price changes were on average 44 percent higher for common procedures.20

Average CEO salaries at “nonprofit” hospitals went up 93 percent in a decade (to $3.1 million).

The cost of nonclinical workers increased 30 percent.

Meanwhile nurses’ salaries went up 3 percent.21

Besides the terrible cost to individuals, a health care system as inefficient and unjust as that of the United States may, eventually, destroy a nation’s competitiveness. No health care system is perfect, far from it. If one is a Brit, there are constant complaints and long waits. But the United States spends more per patient, with worse results, than almost any other OECD country. In 2018 the United States spent $10,586 per person on health care. The United Kingdom spent $4,070. Yet British men and women, on average, live years longer than Americans. The impact of maintaining such an inefficient system is hard to overstate. By focusing on sick care instead of health care, we may end up breaking the US economy. In 1970 the United States spent 6.2 percent of its GDP on healthcare. By 2018 it was 17.9 percent.22

So now, back to ethics . . . Have really I told you anything about health care that you did not know? You may not have known every statistic or trend, but before reading this chapter you already had a pretty good sense that what we are doing is unjust and inefficient. And the folks working their butts off in hospitals and doctors’ offices also have a pretty good idea that this system is FUBAR.

We are tolerating, and paying for, a system that is seriously unethical. But in places plagued with an epidemic of Baumol’s cost disease, where things are not getting faster, better, cheaper, where there is not a growing economic margin to be generous, it is easier to ignore and tolerate behaviors that are fundamentally wrong. So we continue to harm people, to let them die. Other countries have shown us that there are alternatives, better ways to do things at a lower cost. But when close to one-fifth of the US economy and jobs depend on such an inefficient system, one is, again reminded of Upton Sinclair’s maxim: “It is difficult to get a man to understand something, when his salary depends upon his not understanding it.”23

It will not be this way forever. Something has to give. And when things are eventually different, future generations will justifiably ask: how did we dare to have treated our sickest, most vulnerable, this way? Why did we think what we were doing was OK?

Education

Just as occurred with musicians, and health care, the cost per hour of a public school education just keeps going up. Average scores do not. A classic case of Baumol’s cost disease.

Inflation adjusted spending per public school student went up 117 percent over thirty years. Meanwhile . . .

The average math score in 1982 was 298, which rose by 8 points over next 30 years.

Average reading score? Fell by 2 points.24

At the university level, the problem is far worse. Here is what it looks like in current dollars:25

Universities are getting more donations than ever. In 2017 US colleges and universities raised $44 billion. Bequests in the hundreds of millions are becoming almost normal. Yet there are perpetual calls for saving, cutbacks, capital campaigns; as occurred with orchestras, education suffers a severe outbreak of Baumol’s Disease. But unlike orchestras, where patrons can choose other entertainment or not pay if too expensive, the cost of not having a higher degree is pretty extreme. Median weekly earnings by education:26

PhD	$1,743
Professional	$1,836
Master’s	$1,401
BA	$1,173
Some college	$774
High school	$712
No high school diploma	$520

It is not just a matter of wages; it is hard to sustain democracy and science without an educated populace. Education enables power, access, and control. That is why, during slavery, there were explicit provisions to prevent the education of the colored population; in Virginia, in 1848, “If a white person assemble with negroes for the purpose of instructing them to read and write, or if he associate with them in unlawful assembly, he shall be confined to jail not exceeding six months.”27 This is not an extinct concept; one of the first things today’s wannabe tyrants do is shut down the universities, jail the educated, control school curriculums, and re-educate the masses.

In a knowledge economy, there is little price elasticity: college is a minimum. However, if college is ever more expensive and less productive year after year, tuitions rise and rise and . . . STUDENT DEBT GOES THROUGH THE ROOF. The average class of 2016 student owes $37,172 in student loans. Forty-four million US students owe over $1.6 trillion. The greatest percentage of debt is held by 30- to 39-year-olds. That means these sandwich generations cope with school debt, children, and sick parents all at once. Their debt load is now $461 billion, a 30 percent increase in the past five years.28 This is creating enormous pressure on the college-educated, driving many out of the middle class. (Increasing costs are not, primarily, driven by paying faculty. As ever more schools turn to cheaper teaching by poorly paid adjuncts, university bureaucracies blossom, as do football “investments.”)

Faced with overwhelming debt burdens, more and more are choosing not to go to college. And most of those going now understand that they cannot afford to major in writing, music, theater, or social service. Some of the most creative, quirky, and talented are lost.

In 2011, 16.6 million enrolled in colleges. In 2017? 14.6 million.29

To make matters worse, you cannot get rid of this debt. This, this is crazy! You can apply for ten credit cards, max them out on designer clothes and night clubs and declare bankruptcy. But you cannot do this with most student debt. Creditors pursue you, everywhere. Courts do not shield you. And despite the debts being lower risk, and harder to get rid of, many predatory lenders still charge you higher interest rates. The poorest, who often end up in the clutches of for-profit colleges are most at risk. This is just EVIL; this is just WRONG; dare I say it . . . this is just UNETHICAL.

Cutting back on education, overcharging for education, is a sure way to condemn a population to future poverty. We all see it, we all know it, and yet, the system persists decade after decade. We accept it and, often, participate in it. And someday we will be judged for it . . .

Mass Incarceration

Taking someone’s freedom is a BFD. One would hope that before THE STATE chooses to do that to someone, it would consider all other alternatives and really focus on rehabilitation rather than cruel punishment. Not all countries do. The three worst offenders, housing half of all prisoners on Earth? China, Russia, and the United States.

Are folks living in the United States just that much nastier, crueler, more evil than people anywhere else? If not . . . why does a country that represents 4.4 percent of global population house 22 percent of the global prison population? Why confine your citizens six to nine times more often than Canada and Western Europe?30

What is particularly vexing is that crime in the United States is down to about half of what it was in 1991.31 Yet more and more people are getting jailed, even though the marginal benefit of each additional prisoner, in terms of further crime reduction, is close to zero, and in some cases negative.32 Sentences go longer and longer, even though each additional year increases the tendency toward recidivism by 4 to 7 percent. At these levels of incarceration, especially when half of prisoners are nonviolent offenders, the overall effect may be “criminogenic.”33 There is negligible focus on rehab, on “you paid your debt to society, now go forward and be productive.” Punishment and ostracism are institutionalized and often perpetual. Folks come out with few job prospects, have little societal standing, and often cannot vote. Average salaries decrease by 10–40 percent versus the non-jailed. Advancement is severely limited, leaving few options besides minimum wage or more crime.

With the introduction of “three strikes, you’re out,” “truth in sentencing,” “10–20-life,” and other similar laws, much judicial discretion was removed. Life-without-parole sentences quadrupled since 1984.34 People began going to prison for life for minor, nonviolent crimes. In the United States, there are over TEN MILLION jail admissions per year; the prison population is larger than the population of fifteen different US states.35 That means half of US adults have had a family member incarcerated.36

If jailing ever more ineffective, costly, and destructive, why do we continue to do it? Well, I know this might shock you, because it would be truly unethical . . . but could it be, in some places, that so many are jailed because so many are making money? Louisiana has the highest incarceration rate on the planet: five times higher than Iran and thirteen times that of China. Many local parish jails house lifers. Why would local sheriffs do this? Because they get $25 per prisoner per day from the state. And if the neighboring, for-profit, prisons grow, they too provide a bounty for the sheriffs.37 Everyone has fingers in the till. Some phone companies charge prisoners $25 for a fifteen-minute phone call. According to one study, by the time one adds up what the prison system costs governments, prisoners, and their families the number is a staggering $182 billion per year.38

The degree of cynicism is breathtaking. We know alcohol is more harmful than pot. We have known this for decades.39 Despite state after state decriminalizing or legalizing pot, in 2017, about 600,000 people were arrested for marijuana possession.40 Yet when John Boehner was Speaker of the House, he was “unalterably opposed” to any drug legalization. He consistently earned an F rating from the National Organization for the Reform of Marijuana Laws. So people just kept getting arrested; Michael Thompson is serving forty years in a state where marijuana is now legal.41 Meanwhile Boehner retired and had a “slight change” of heart; he joined the board of Acreage Holdings, a marijuana company, and could now make $20 million. So now he says, “I don’t know that there’s any harm that’s been done” by any delay in legalizing marijuana.42 Not all agreed. After Boehner’s “evolution” got reported, one New York Times reader, commenting using the name “learning hydroponics,” begged to differ just a touch: “Rage blinds me. I cannot read this article. I can see only the title, the photo, and the number, $20 million. I think of my cousin, sent to prison, killed there. I think of others, imprisoned, beaten, raped, marked for life as felons, drug addicts. I think of beating I took when police believed I might possibly be in possession of marijuana. I think of police with pistols aimed at me because I reached into my jacket pocket for my identification.”43

And, for good measure, ever mindful of American’s health, Boehner also joined the board of a tobacco company.

And then there is the small matter of incarceration as a form of quasi-slavery . . . During the Middle Ages debtors were locked up until their families paid. Throughout the Spanish Americas, haciendas kept workers, who in theory were not slave labor, indentured to the patron through debts incurred at the company store, Tiendas de Raya. “Civilized” European governments maintained a broad network of debtor prisons where people worked under bondage to pay off their debts. In theory these practices went away in the mid-nineteenth century.

Germans came up with the perfect word for these types of practices: Pressionshaft.

Greece jailed people for debts to banks through 2018.

United Arab Emirates still does.

The US indentured servitude market thrives today. How can this quasi-slavery possibly be legal? Well the 13th Amendment abolished slavery and involuntary servitude “except as punishment for crime.” And, wouldn’t you know it, Southern states took full advantage; “between 1880 and 1904, Alabama’s profits from leasing state convicts made up 10 percent of the state’s budget.”44 My, how entrepreneurial of them . . . Never mind that during the nineteenth century the leased prisoner death rate exceeded that of Soviet gulags.

A quasi-slave trade thrives today for profit, prisons “rent” out labor, to “state-owned industries” for an average of $0.33 per hour. Or, if prisoner is “highly skilled” he or she can make $1.41. Wages have actually dropped when compared to 2001 and many get docked for “court-assessed fines, court costs, victim witness assessments” and a host of other surcharges.45 (In Colorado it takes a woman two weeks of work to buy one box of tampons.)

While private companies may profit from ever-increasing incarceration, taxpayers do not. In California it costs an average of $284,700 to keep a child locked up. (Unless you are in Santa Clara County where it costs a mere $531,400.)46 As violence continues to drop the budgetary impact of this vast private profits-public pays system will eventually be recognized as unsustainable and indefensible.

Meanwhile “authorities” continue to act in an unethical manner. And we, the general public, . . . well, we have other fish to fry. So we let something completely FUBAR and unethical continue. We do so at our peril, thinking “if I do nothing wrong” . . . But a profit-driven incarceration system seriously undermines property rights. Police departments, the feds, and private interests directly prosper from taking what you own. They can do so in three ways: if you commit and are convicted of a crime (criminal asset forfeiture); if you have unpaid debts (administrative asset forfeiture); and then there is the innocuous sounding, and way overused, civil asset forfeiture . . . The latter dates back to the English Navigation Act of 1660, which allowed any non-English ship that docked in England or the colonies to be seized, including all cargo and property on board, with no need for a criminal trial. These types of broad powers were modernized and codified by the Comprehensive Drug Abuse and Prevention and Control Act of 1970, which allows police to seize all drugs and any property used in their production or transportation. The owner is not the one accused of aiding and abetting the crime. It is the property that is charged. So you don’t have to convict the property owner. Law enforcement simply has to believe there is probable cause linked to illegal activity, and it gets to keep the loot.

To add further perverse incentives, the 1984 Comprehensive Crime Control Act allowed the profits of these seizures to fund local and federal law enforcement. This created just a mild incentive to take your property; by 1995 the Government Accountability Office was warning that law enforcement agencies “were becoming overzealous in their use of asset forfeiture laws or too dependent on the funds derived from such seizures.”47 Deaf ears. A 2001 study showed 60 percent of counties and municipalities considered forfeiture a key part of their budget.48 It has only gotten worse since then.49 Artist Cameron Rowland displayed the extreme cruelty of these laws by exhibiting some of the objects seized from the poor:50

Tanaka hedge trimmer: $87.09

Stihl gas backpack blower: $ 206

One stroller: $1

Eight used bikes: $ 104

P.S. Newsflash: In February 2019 the US Supreme Court voted 9–0 to restrict excess forfeiture. A heinous practice may be, partially, on its way out. But so many police departments love monetizing other people’s property that this may take a long time.

Everything’s Disposable . . .

Once upon a time, in eco-conscious Vancouver, the owner of the East West Market was frustrated by customers who forever failed to bring reusable bags; week after week they demanded disposable plastics. Mr. David Lee Kwen thought to himself: Hmmmm, plastic bags are a big problem; every little bit helps. How might I incent my customers to change their behavior? No one but Mr. Kwen knows just how many late night, perhaps alcohol-fueled, brainstorming sessions transpired, but the results were spectacular. Startled neighbors suddenly saw their peers walking around with bags that said: “The Colon Care Co-Op,” “Dr. Toe’s Wart Ointment Wholesale,” and “Into the Weird Adult Video Emporium.” But the best-laid plans . . . Instead of being embarrassed, customers began collecting the bags. Demand increased, so the resourceful Mr. Kwen decided to continue to provide the bags, but only in canvas.

Plastics used to be the future . . . (Remember the second-most iconic line in the movie The Graduate?) A few decades later, disposable plastics are a perfect metaphor for the unethical. We know it is wasteful to use things once and throw them away, especially when what you trash will last a few centuries. Yet disposable plastics are sooo cheap, sooo easy, that time and again we reach for that water bottle in the gas station, accept the plastic disposable bag, use plastic cutlery and straws. Coca-Cola alone produces over 110 billion single-use plastic bottles.51

We clearly know what we are doing is wrong.

We have known this for a long, long time.

We still do it.

Cheap, easy, convenient, often trumps ethical.

Walk around wherever you are with a small pad of paper and one of those disposable hotel pens. Spend ten minutes checking off every item you see made of plastic, with a second check mark if it is single-use. Soon you will realize why, over the course of 65 years, we have gone from almost no plastic to 400 million metric tons per year.52 Plastic is so cheap to produce, so easy to throw “away.” We are all so soothed by the green recycle bins that we conveniently forget that even though plastics last longer than most other consumer materials, in the United States only 9 percent of plastics are recycled (2015), versus 67 percent of paper, 61 percent of yard trimmings, 34 percent of metals, and 26 percent of glass.53

Much of the un-recycled plastic ends up in the oceans. In 2003 Captain Charles Moore crossed from Hawaii to California, but instead of taking the normal windy route, he went through an area light on breezes, which is usually bypassed. What he discovered was hair-raising, a patch of plastic the size of Texas that no one knew existed: “As I gazed from the deck at the surface of what ought to have been a pristine ocean, I was confronted, as far as the eye could see, with the sight of plastic. . . . It seemed unbelievable, but I never found a clear spot. In the week it took to cross the subtropical high, no matter what time of day I looked, plastic debris was floating everywhere: bottles, bottle caps, wrappers, fragments.” Should you want to clean it up . . . It would take 67 ships, working a full year, to clean up less than 1 percent of the Great Pacific Garbage Patch.54

When I was lucky enough to sail around the world on a science expedition, one of the most disconcerting things I saw is that there is no spot left untouched on earth or sea. We went to some really, really remote spots. Islands with no villages at all. Every single place was jammed with human remnants. The worst offenders by far? Plastics. Seventy percent of the non-biodegradable junk that flows into the oceans are single-use plastics: cutlery, bags, polystyrene containers, cotton swabs . . .55 We all knew. We did nothing. So now microplastics are found everywhere on Earth, from giant Pacific gyres the size of countries, to Antarctica, to floating in the air above the Pyrenees. Around the world ocean racers find them at Point Nemo, the most remote ocean spot on the planet. Bathyscaphe operators find them in the Mariana Trench, the deepest part of the seas.

Only in 2018–2019 did most countries to really begin to act. Evidence of the scale of our lack of plastic ethics became so absolutely overwhelming that, despite not having many faster, better, cheaper alternatives, we finally began doing something. In 2019 the EU Parliament passed a law, by 560 votes to 35, banning single-use plastics. Canada will ban single-use by 2021. Those countries most overwhelmed by mounds of garbage resort to the most extreme measures. Using a plastic bag in Kenya could lead to a four-year prison sentence or a $38,000 fine. That eliminated the 100 million flimsy bags used each year in their supermarkets. A further 127 countries have followed suit, albeit with more modest fines. Even terrorist Al-Qaeda banned plastic shopping bags as a serious threat to the well-being of humans and animals.56

Our health may be at risk. Plastics are inside us; a study by the Medical University of Vienna and the Environment Agency Austria “looked at stool samples from eight individuals in eight different countries: Finland, Italy, Japan, the Netherlands, Poland, Russia, the U.K. and Austria. Every stool sample tested positive for up to nine different plastic types, with an average of 20 particles of plastic per 10 grams of stool.”57 When you eat something wrapped in plastic, or drink out of a plastic water bottle, you are ingesting microparticles. Even those “green” fleece jackets so popular amongst the eco-friendly shed microfibers with every wash.

As Chelsea Rochman, at the University of Toronto, puts it: “We’ve mismanaged our waste, and it’s come back to haunt us at our dinner table. What the effect is on your body is uncertain. But, if you are a mouse, there are signs it is not good: they alter your intestinal barrier, change the gut microbiota, and alter your metabolism. If you are a fish, it is even worse, the stuff accumulates and begins to destroy your liver.”58 But other than that . . .

We will, eventually, find green plastics and other cheaper materials that break down after use. When we do, we will spend quite a bit of time cursing our ignorant ancestors who covered the planet in a gunk that will haunt the Earth and oceans for centuries if not millennia.