"Don’t settle for happiness”
I HAVE OFTEN wished that Jefferson had not used that phrase, “the pursuit of happiness,” as the third right—although I understand in the first draft it was “life, liberty, and the pursuit of property.” Of course, I would have been one of those properties one had the right to pursue, so I suppose happiness is an ethical improvement over a life devoted to the acquisition of land, acquisition of resources, acquisition of slaves. Still, I would rather he had written life, liberty, and the pursuit of meaningfulness or integrity or truth.
I know that happiness has been the real, if covert, goal of your labors here. I know that it informs your choice of companions, the profession you will enter, but I urge you, please don’t settle for happiness. It’s not good enough. Of course, you deserve it. But if that is all you have in mind—happiness—I want to suggest to you that personal success devoid of meaningfulness, free of a steady commitment to social justice, that’s more than a barren life, it is a trivial one. It’s looking good instead of doing good.
"Be fully present”
IN WHATEVER YOU do, try to be present, fully present. As Satchel Paige put it, “Work like you don’t need the money. Love like you’ve never been hurt. Dance like nobody’s watching.” You gotta be all in. This means leaving your technology behind occasionally and listening to a friend without half of your brain preoccupied by its inner longing for the red light on the BlackBerry. I have gotten some glimpses of modern learning: In many college classes, laptops depict split screens—notes from a class, and then a range of parallel stimulants: NBA playoff statistics on ESPN.com, a flight home on Expedia, and a new flirtation on Facebook....I know how good you are at multitasking. You have developed the modern muscle set. I know of what I speak because I, too, am a culprit. You have never seen a U.S. government official and new mother so dexterous in her ability simultaneously to BlackBerry and breast-feed. But I promise you that over time this doesn’t cut it. Something or someone loses out. No more than a surgeon can operate while tweeting can you reach your potential with one ear in, one ear out. You actually have to reacquaint yourself with concentration. We all do. We should all become, as Henry James prescribed, a person “on whom nothing is lost.”
"Choose to stand up”
President Barack Obama
Miami Dade College
WE’VE GONE THROUGH periods of great economic turmoil, from an economy where most people worked on farms to one where most people worked in factories to now one fueled by information and technology. Through it all, we’ve persevered. We’ve adapted. We’ve prospered. Workers found their voice, and the right to organize for fair wages and safe working conditions. We carried forward.
When waves of Irish and Italian immigrants were derided as criminals and outcasts; when Catholics were discriminated against, or Jews had to succumb to quotas, or Muslims were blamed for society’s ills; when blacks were treated as second-class citizens and marriages like my own parents’ were illegal in much of the country—we didn’t stop. We didn’t accept inequality. We fought. We overcame. We carried the dream forward.
We have carried this dream forward through times when our politics seemed broken. This is not the first time where it looked like politicians were going crazy. In heated debates over our founding, some warned independence would doom America to “a scene of bloody discord and desolation for ages.” That was the warning about independence. One of our greatest presidents, Thomas Jefferson, was labeled an “infidel” and a “howling atheist” with “fangs.” Think about that. Even I haven’t gotten that one yet. Lincoln, FDR, they were both vilified in their own times as tyrants, power hungry, bent on destroying democracy. And of course, this state has seen its fair share of tightly contested elections.
And we’ve made it through those moments. None of it was easy. A lot of it was messy. Sometimes there was violence. Sometimes it took years, even decades, for us to find our way through. But here’s the thing. We made it through. We made it through because in each of those moments, we made a choice. Rather than turn inward and wall off America from the rest of the world, we’ve chosen to stand up forcefully for the ideals and the rights we believe are universal for all men and women.
“All medicine is local”
Stanford Medical School
HALF A CENTURY ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.
It should be no wonder that you have not mastered the understanding of them all. No one ever will. That’s why we as doctors and scientists have become ever more finely specialized. If I can’t handle 13,600 diagnoses, well, maybe there are fifty that I can handle—or just one that I might focus on in my research. The result, however, is that we find ourselves to be specialists, worried almost exclusively about our particular niche, and not the larger question of whether we as a group are making the whole system of care better for people. I think we were fooled by penicillin. When penicillin was discovered, in 1929, it suggested that treatment of disease could be simple—an injection that could miraculously cure a breathtaking range of infectious diseases. Maybe there’d be an injection for cancer and another one for heart disease. It made us believe that discovery was the only hard part. Execution would be easy. But this could not be further from the truth. Diagnosis and treatment of most conditions require complex steps and considerations, and often multiple people and technologies. The result is that more than forty per cent of patients with common conditions like coronary artery disease, stroke, or asthma receive incomplete or inappropriate care in our communities. And the country is also struggling mightily with the costs. By the end of the decade, at the present rate of cost growth, the price of a family insurance plan will rise to $27,000. Health care will go from ten per cent to seventeen per cent of labor costs for business, and workers’ wages will have to fall. State budgets will have to double to maintain current health programs.
And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it’s the economic bailout plan. But take both away and you’ve made almost no difference. Our deficit problem—far and away—is the soaring and seemingly unstoppable cost of health care.
We in medicine have watched all this mainly with bafflement, even indifference. This is just what good medicine is like, we’re tempted to say. But we’d be ignoring the evidence. For health care is not practiced the same way across the country. There is remarkable variability in the cost and quality of care. Two communities in the same state with the same levels of poverty and health can differ by more than fifty per cent in their Medicare costs. There is a bell curve for cost and quality, and it is frustrating—but also hopeful. For those getting the best results—the hospitals and doctors measured at the top of the curve for patient outcomes—are not the most expensive. They are sometimes among the least.
Like politics, all medicine is local. Medicine requires the successful function of systems—of people and of technologies. Among our most profound difficulties is making them work together.
"There will always be evil.”
University of Notre Dame
A RECURRING THEME in America for nearly a century has been a tendency to conclude after each war that the fundamental nature of man and the iron realities of nations have changed. That history in all of its unpredictable and tragic dimensions has come to a civilized end. That we will no longer have to confront foreign enemies with size, steel, and strength. Another tendency, repeated over the last century, has been for Americans repeatedly to avert their eyes in the belief that remote events elsewhere in the world need not engage this country—from the assassination of an Austrian archduke in unknown Bosnia–Herzegovina in 1914 to the rise of a group called the Taliban in Afghanistan and their alliance with an organization called al Qaida in the 1990s. The lessons of history tell us we must not diminish our ability or our determination to deal with the threats and challenges on the horizon, because ultimately they will need to be confronted.
If history and religion teach us anything, it is that there will always be evil in the world, people bent on aggression, oppression, satisfying their greed for wealth and power and territory, or determined to impose an ideology based on the subjugation of others and the denial of liberty to men and women. More perhaps than any other secretary of defense, I have been a strong advocate of soft power—of the critical importance of diplomacy and development as fundamental components of our foreign policy and national security. But make no mistake, the ultimate guarantee against the success of aggressors, dictators, and terrorists in the 21st century, as in the 20th, is hard power—the size, strength, and global reach of the United States military.
All selections are excerpts of longer speeches. Copyright ©2011 by The New York Times Co.
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