Why It Makes Sense for an M.D. to Lead the World Bank

I lived with a surgeon for 25 years. From the decisions Ginny made, I learned that doctors are better than economists at balancing the costs and benefits of delay.

Economists teach that time is money, but we never specify the exchange rate. If delay costs $x per day per person, the total cost scales with the number of people. In my lifetime, the most important lesson economists have learned is that in countries of all sizes–small ones like Singapore, medium-sized ones like South Korea, large ones like China and India–better policy can lift people out of poverty more quickly than we dared hope. Because a billion people still live in extreme poverty, each day of delay in taking full advantage of this lesson imposes a cost that is staggering.

The mantra that emerged at Intel was “disagree, then commit.” Economists disagree elegantly but endlessly because we use uncertainty as an excuse not to commit. Doctors learn to commit because they meet the people they serve and see firsthand how costly delay can be. The longer a seizure lasts, the harder it is to stop. There are several drugs that can help bring one to an end. When a patient is seizing, delay is so costly that doctors tend to administer a default without taking the time to collect all the information they would need to decide which would be best.

Ginny’s surgical practice involved clinical decisions about cancer. She also did research on cancer therapy, which led to a job at a pharmaceutical company. I observed several iterations of a scenario that, in the first instance, went like this:

Management: Ginny, could you look at our project on the pharmacological manipulation of circadian rhythm as a possible treatment for jet lag? We have been working on this for years and have invested millions. The team reports that one more study would confirm whether it works. We know this is outside of your realm of expertise, but could you tell us what you think?

Ginny, reporting back: Shut the project down. Don’t worry about what to say. The team understands.

Management: Oh no! Did you ask Communications about the right way to deliver bad news?

Ginny: If by “right” you mean without upsetting anyone, there is no right way. Bad news is upsetting.

The team has been focused on the science, which is exciting. But the potential revenue is smaller than they realized. A treatment for jet lag sounds great to us, but we are not representative of the population. Each year, relatively few people travel across many time zones.

I told the team as soon as this became clear, even though I knew they would hate giving up without learning whether the treatment works. It’s like the time I learned that a single mother’s tumor had metastasized and would soon kill her. I spoke to her right away and explained the new information as clearly as I could, without hiding behind the type of euphemism that Communications would suggest. She had important decisions to make.

She raged against the gods; against doctors too. Then we talked about whether it would be better for her children if she died at home or in a hospice.


When I heard in 2012 that the final choice for the president of the World Bank was between an outsider M.D. and two insider economists, I sided with the economists. What I did not see then, but do see now, is that the Bank had the same problem as the pharmaceutical company that Ginny joined. An early success generated lots of revenue. For years, it followed a strategy of “letting 100 flowers bloom” by spending more on research when new projects surfaced. Before Ginny arrived, it had reached the limit on research spending but had not yet developed the capacity to shut down projects that turned out to have only modest prospects. Because she had experience with clinical medicine and could look with fresh eyes, Ginny was better than the insiders at acting without delay, pulling the plug on even good projects, and freeing up resources for new ones with the potential to be great.

I now see that back in 2012, the Obama Administration made an inspired choice when it nominated the outsider M.D., Jim Yong Kim, to be the president of the Bank. This summer, I decided to join the Bank because I saw the cuts and restructuring of Jim’s first term and expected that he would be asked to stay on and complete the transformation of the Bank into the type of impatient organization that forces decisions, refuses to settle for modest success, and shuts things down without concern for the feelings of insiders. This will give it the chance to keep starting projects that are as unreasonably ambitious as the ones that turned out so well in Singapore, South Korea, China, and India. Some of the new ones, perhaps many, will disappoint and will in turn be stopped. As long as everyone commits to “failing fast,” and no one treats a shut-down as shameful or an insult to honor, failures cost little. What matters are the dramatic successes. It takes only a few to make a world of difference.

An impatient Bank will produce some bruised feelings for the people the Bank employs. These are of little consequence compared to the benefits that it can generate for the people the Bank serves.

Delay is costly. Impatience is a virtue.

Everybody wants progress; nobody wants change

Alain Bertaud once told me, ruefully, that he was part of a failed effort at the World Bank to end the implicit subsidy for car trips created by the Bank’s offer of free employee parking. This proposal generated complaints, but that does not mean that it was a bad idea. If Steve Jobs had followed a strategy of avoiding all complaints, my MacBook Pro would still have an optical disk drive. Examples like these suggest a general lesson about cooperation in large groups:

Everyone wants progress.
Nobody wants change.

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Abstraction vs. Radical Specificity

Someone asked “What if Germany ran Detroit?” This kind of what-if-pigs-could-fly question mixes abstraction and specificity in a way that I do not find helpful. What works for me is iterating back and forth between two extremes — abstraction and radical specificity — and avoiding the middle.

At one extreme, I ask abstract questions such as “Could there be gains from trade in government services like the gains from trade in private services?” Then I consider specific questions such as “Could the new authority that was formed to fix the street lights in Detroit sell its services to other cities?”

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Professionalism and the Academic Division of Labor

In my work, I have tried to avoid revealing anything about my personal political beliefs and even worked to obfuscate as necessary. When my father was visible in national politics as a Democrat, it was helpful to have a letterhead appointment at the Hoover Institution.

Although I stay away from the battles of national politics, in my role as an advocate for science as the greatest human institution, I am now drawn into the battles of academic politics. I seem to be the designated nag when Nobel Prize winners disappoint.

Ed Prescott has a new NBER paper (with a co-author I do not know) on monetary policy with negative nominal interest rates. Other economists have written on this topic. None of the work I know in this area is mentioned in Ed’s paper.

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Conditional Optimism about Progress and Climate

Last Friday at the NBER Summer Institute, Martin Stuermer presented a thought provoking paper (written jointly with Gregor Schwerhoff.) It takes an important and puzzling fact seriously, then uses some credible theory to work out the implications of the fact. In the discussion afterwards, a challenge to the paper’s apparent optimism yielded an insight that might have practical implications for ongoing policy debates. It was a wonderful illustration of how science works.

The practical insight is that there are two very different types of optimism. Complacent optimism is the feeling of a child waiting for presents. Conditional optimism is the feeling of a child who is thinking about building a treehouse. “If I get some wood and nails and persuade some other kids to help do the work, we can end up with something really cool.”

What the theory of endogenous technological progress supports is conditional optimism, not complacent optimism. Instead of suggesting that we can relax because policy choices don’t matter, it suggests to the contrary that policy choices are even more important than traditional theory suggests.

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My New Position as Chief Economist at the World Bank

I’m pleased to report that President Jim Yong Kim has asked me to join the World Bank as Chief Economist and I have agreed to accept his offer. This may surprise you. It surprises me.

I have often said to myself that the intersection of the set of jobs in Washington DC that I would find intellectually exciting and the set of jobs that I would accept is empty. Intellectual excitement depends on the chance to learn. The decisions people make when they work in Washington tend to have real consequences, so it is risky to be learning on the job there.

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Economic Growth

Compounding

In an update on an old story, an investment banker asks the client to pay by placing one penny on the first square of a chessboard, two pennies on the second square, four on the third, doubling the number on each square that follows. If the banker had asked for this on only the white squares, the initial penny would double thirty-one times to $21,474,836 on the last square. Using both the black and the white squares, the sum on the last square is $92,233,720,368,547,758.

People are reasonably good at estimating how things add up, but for compounding, which involved repeated multiplication, we fail to appreciate how quickly things grow. As a result, we often lose sight of how important even small changes in the average rate of growth can be. For an investment banker, the choice between a payment that doubles with every square on the chessboard and one that doubles with every other square is more important than any other part of the contract. Who cares whether the payment is in pennies, pounds, or pesos? For a nation, the choices that determine whether income doubles in one generation or two dwarf all other economic policy concerns.
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Martha Derthick and Policymaking for Social Security

derthickMartha Derthick died recently at the age of 81. I never met her, but I became intimately acquainted with her book Policymaking for Social Security. I stumbled when I was collecting raw material for a paper I wanted to write to illustrate the importance of what political scientists call “expressive” voting. The book turned out to be a gold mine. It has more page markers than any other book I own. (See the photo below.)

When the Social Security program was introduced in the 1930s, it covered only a portion of the labor force. In some recent posts (see e.g. here), Paul Krugman cites this fact to illustrate the harsh realities that policymakers face when they innovate.

The evidence in Derthick’s account drives this point home with the power of a pile driver. Policymaking is like battlefield medicine. The leaders who succeed sustain a clear-eyed commitment to triage.

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Site Refresh

It has taken much longer than I anticipated, but I’m finally ready to go live with a new version of my blog. It should be easier to read and explore, particularly on smaller devices. Getting something that works on screens of different size forces tradeoffs. If you are having trouble getting around on a small screen, try the Mobile option from the menu on the top.

I’ve tested this version on my Mac (with Chrome, Safari, and Firefox) plus a recent Android phone, an aging iPad, and an ancient iPhone. It is built on top of basic functionality offered by WordPress that has been tested more widely. But with software, you know something will go wrong. If you see anything amiss, let me know by email: blog AT paulromer.net.