The War on Normal People: The Truth about America’s Disappearing Jobs and Why Universal Basic Income Is Our Future

by Andrew Yang

  The best approach is what they do at the Cleveland Clinic—doctors simply get paid flat salaries. When doctors aren’t worried about billing, they can focus on patients. Dr. Delos Cosgrove, the CEO of the Cleveland Clinic, said, “I think you have to recognize that people do what you pay them to do. If you pay doctors to do more of something, then that’s what they’ll do. If you put the emphasis on looking after patients, they’ll do that.” The Cleveland Clinic is consistently ranked among the top hospitals in the country. And physician turnover is only 3.5 percent per year, much lower than normal.

  The Cleveland Clinic has achieved financial success in part by universalizing a sense of cost control. They put price tags on things so everyone knows how much it costs to, say, open up a new set of sutures. They don’t allow redundant tests. They include doctors in purchasing decisions. Everyone is interested in the company’s financial sustainability because they feel a sense of ownership and mission. Plus, if the hospital does well, you’re more likely to get a raise.

  What’s required is an honest conversation in which we say to people who are interested in becoming doctors, “If you become a doctor, you’ll be respected, admired, and heal people each day. You will live a comfortable life. But medicine will not be a path to riches. On the bright side, we’re not going to burn you out by forcing you to see a million patients a day and fill out paperwork all the time. We’re going to supplement you with an army of empathetic people equipped with AI who will handle most routine cases. We’ll only call you when the case genuinely requires distinct human judgment or empathy. We want you to become the best and most human version of yourself, not Dr. Speed Demon who can bang out a nine-minute appointment. Let’s leave that to Watson.”

  I’m sure that many doctors would enjoy this shift in role and embrace becoming better, more empathetic clinicians. Changing their incentives would change everything.

  A shift in incentives would also allow doctors to treat patients holistically. The Southcentral Foundation, a health care provider for Alaska Natives, treats health problems and behavioral problems as related issues. When you get a health checkup, you also get a psychological appointment. It turns out that problems like obesity and depression are linked, and the local citizens’ top concerns—child sexual abuse, child neglect, domestic violence, and addictions—all involve psychology and behavior as much as medicine and drugs. Integration of physical and psychological services at Southcentral lowered hospital admissions and visits to the emergency room by more than a third between 2000 and 2015, and 97 percent of patients said they were satisfied with the care. Integrating medical and behavioral health care could save tens of billions of dollars each year from the nation’s health care costs. Southcentral CEO Katherine Gottlieb, an Alaska Native, received a MacArthur “genius” grant for her work.

  In time, freedom from being paid a fee for service would give physicians and organizations the opportunity to solve problems in new ways. At first, the goal would be to measure patient outcomes and decrease readmissions and errors. Eventually, one can imagine hospitals being measured against statistics on the health of the surrounding population. Primary care specialists could distribute biometric devices, monitor a patient’s interactions with other doctors, and encourage preventative measures. AI coaches could be employed to remind people to stick to their treatment or regimen, or to assist with psychological disorders. Patients could volunteer to share their health data to usher in revolutionary new approaches. The goal would be to make each hospital a hub of health and vitality that solves or reduces problems beyond its walls. Technology that streamlines costs and improves patient care would become a clinician’s best friend.

  We have so many brilliant doctors—they should be innovators, detectives, guides, and sources of comfort, not glorified assembly line workers. And freeing health care from being locked to a job would be a massive boon to economic growth and dynamism.

  Some of the winners in the current system would make less money in the new world even as patient care improves. The message should be, “Thank you for taking care of us. Now, the country needs you to adapt and evolve. You possibly knew that this time would come sooner or later—we hope you’ll be even more excited to help people get well now that you have the time to really focus on it.”

  TWENTY-TWO

  BUILDING PEOPLE

  EDUCATION IN THE AGE OF AUTOMATION

  Reimagining college in the age of automation begs the fundamental question—what are people sent to college to learn? Originally, the idea of an education was to develop a sense of morality. As Mary Woolley, the president of Mount Holyoke, stated in 1901, “Character is the main object of education.” The Harvard psychologist and philosopher William James wrote around the same time that character and moral significance are built through adopting a self-imposed, heroic ideal that is pursued through courage, endurance, integrity, and struggle. It’s the development of these ideals that was once the purpose of a university education.

  Of course, for many decades now, the point of college has been to set people up for jobs. But what happens when the jobs disappear? Similar to health care, the automation wave should lead us to invest more people in education and human capital development. It should also drive us to dramatically increase our emphasis on technical and vocational training and apprenticeships at the high school level to take advantage of the jobs that will continue to exist. The difficulty is that schools will need to reinvest and adapt even as the monetary returns on education diminish and jobs become harder to come by.

  Some believe that we can inexpensively educate large numbers of people using the latest technology. A couple years ago I spoke at an awards dinner with Sal Khan, the founder of the Khan Academy. If you don’t know Khan Academy, you should—they make education videos that are used by millions around the world on everything from basic arithmetic to great literature to quantum physics. Sal was a hedge fund analyst turned explainer of all things. Bill Gates’s kids used to watch the videos to supplement their schooling, leading Bill to become one of the many million-dollar donors to Khan Academy. Their mission is to educate the world.

  Sal gave an inspiring talk that night. The high point went something like this: “Back in the Middle Ages, if you asked the literate monks and scholars how many of the farmers and peasants walking around would be capable of learning to read, they’d scoff and say, ‘Read? Most of these peasants could never learn to do something like that.’ They might guess that 2 to 3 percent of the peasants would be capable of becoming literate. Today we know that the real number is closer to 99 percent. Virtually everyone is capable of learning to read. But if I ask you today how many people are smart enough to study quantum physics, you might say only 2 or 3 percent. This is as shortsighted as the monks were in the Middle Ages. We are just scratching the surface of how smart people can become if we give them the proper tools to learn. In the years ahead, we will find that people are capable of much more than we can imagine.”

  Sal’s speech received a rousing ovation. It was an exhilarating vision. Technology and universally accessible, low-cost education materials would accelerate a new age of smarter human beings. Presumably, these new smarter human beings would innovate and create new jobs and businesses.

  As we walked away, I found myself asking, “Is he right?”

  At least here in the United States, it’s very hard to say that he is. The Internet became widely available and adopted in 2002. A majority of American households have had broadband Internet at home for more than 10 years now, and 85 percent today have either a broadband home connection or a smartphone. We have years of information about how unlimited access to materials like Khan Academy has influenced learners around the country. Unfortunately, SAT scores have declined significantly in the last 10 years. High school graduation rates have edged upward. College readiness is generally down. We don’t seem to be getting any more enlightened despite ubiquitous online lessons.

  It’s impossible not to love Khan Academy. I fully intend
to strap my kids in as soon as they’re ready for it, and I fantasize about coming home and having them say things like, “I learned thermodynamics today!” But if one gives a 12-year-old access to high-speed Internet, they are infinitely more likely to chat with their friends, play video games, or watch the latest Honest Trailers video than delve into a deep, thought-provoking discussion of War and Peace. Among the biggest gainers from Khan Academy are people abroad and learners like Bill Gates’s kids, who already had some things going for them.

  The clearest impact of technology on teen development to date has been starkly negative. According to psychologist Jean Twenge’s 2017 book, iGen, smartphone use has caused a spike in depression and anxiety among people born from 1995 on, and a diminution in sociability and independence. An excerpt of her book in The Atlantic was aptly titled, “Have Smartphones Destroyed a Generation?” They are not using their smartphones to learn calculus, but they are trying to keep their Snapstreaks going.

  In 2011, everyone began taking about massive open online courses (MOOCs), and many believed they were going to revolutionize education. In 2013, Udacity rolled out the core coursework of Stanford and MIT in topics like artificial intelligence. Tens of thousands of students around the world enrolled. Pundits and experts predicted the disruption of college as an institution. Instead, these MOOCs kind of flopped. Only about 4 percent of students completed the average course, with many quitting after only one or two sessions. In one case, an online math course was found to be less effective than a remedial college class in person and scaled back. Though these online courses continue to improve, college applications remain higher than ever.

  PEOPLE (STILL) LEARN FROM OTHER PEOPLE

  Too often people mistake content for education and vice versa. We act as if we can take a textbook or lesson online and make it interactive, and then that will educate someone. But no one would consider putting a child in an empty classroom with a textbook “education.” We would call that reading or maybe punishment. Max Ventilla, the founder and CEO of AltSchool, has said that “the worst use of software in [education] is in replacement of humans… that’s craziness… It’s about the relationship that kids have with their peers, with adults. That’s what creates the motivation that creates the learning.” AltSchool is a company founded in 2014 to personalize education for all children across the country. AltSchool has raised over $175 million from Mark Zuckerberg, Emerson Collective, and others. It has opened six schools that collectively serve hundreds of elementary school students in San Francisco and New York. It employs more than 50 engineers who are developing tools each day that teachers request. The school uses video cameras to monitor tiny student interactions for playback.

  “We believe that the vast majority of the learning should happen non-digitally,” Max explains. He is the former head of personalization at Google and parent to three young children, and he wants to build schools that prepare children for the future. “In any AltSchool classroom, most of what a kid is doing is not on a screen, but for every kid, we have a digital representation of the important things that relate to that child’s learning, not just their academic learning but also their non-academic learning. [They learn] that their character skills matter, that their grit, their perseverance, that their experience with being successful after failing a bunch of times is as much a part of the education as… learning history facts and knowing how to multiply two numbers.”

  AltSchool represents a sophisticated blend of using software to do the things that technology is excellent at—recording and synthesizing large amounts of data over a growing number of people and making recommendations—while retaining the essence of how people learn: from other people. I had dinner with Max and his wife, Jenny, in San Francisco last year. I could see how AltSchool raised $175 million; Max is an exceptional guy and completely sincere in his mission of furthering how our children learn. He’s in it for the long term. It probably helps that his mother and sister are teachers.

  Perhaps the best thing about AltSchool is that it focuses on character skills. In an age with less and less employment, the abilities to self-manage and socialize will become the new keys to success in life. We should recognize that the majority of high school students will not go to college, and that their ability to function should be independent of further education. Grit, persistence, adaptability, financial literacy, interview skills, human relationships, conversation, communication, managing technology, navigating conflicts, preparing healthy food, physical fitness, resilience, self-regulation, time management, basic psychology and mental health practices, arts, and music—all of these would help students and also make school seem much more relevant. Our fixation on college readiness leads our high school curricula toward purely academic subjects and away from life skills. The purpose of education should be to enable a citizen to live a good, positive, socially productive life independent of work.

  EDUCATION STARTS AT HOME

  One enormous favor we could do for teachers would be to try to keep parents together. Children raised in two-parent households have better outcomes by most dimensions. Technology could potentially help here—one can imagine an AI life coach with the voice of Morgan Freeman trying to help people manage their differences. The government should provide or subsidize marriage counseling to essentially anyone who wants it. If you have kids and you want to stay together, we should help you do it. Even successful married couples shudder if you bring up the early years when their children were first born. Any marriage or relationship that remains whole is a win for the next generation.

  We should also make sure that parents have ample time to spend time with their children. Our lack of family leave for new parents is barbaric, antifamily, sexist, regressive, economically irrational, and just plain stupid. Studies have shown that robust family leave policies improve children’s health and heighten women’s employment rates because they don’t feel they need to leave work entirely in order to be successful. The United States is one of only four out of 196 countries in the world—and the only industrialized country—that does not have federally mandated time off from work for new mothers. The other three are Lesotho, Swaziland, and Papua New Guinea—not exactly a list of world beaters. We’re in the bottom 2 percent of recognizing that new parents might need to spend time with their new baby—it’s the most obvious example of our prioritizing capital in a misguided way over humanity. In contrast, Denmark gives parents 52 weeks of paid leave they can split between them, with a minimum of 18 weeks of full pay for the mother.

  If current trends continue, there are going to be many more single moms in the years ahead; there are already 11.4 million single mothers raising 17.2 million children in the United States, 40 percent of whom live in poverty. Single mothers make up more than 82 percent of single parents, and 40 percent of them work in low-wage jobs, one of the highest proportions in the world. Ideally we would create communal living arrangements specifically for single moms to be able to pool resources, cooking time, and babysitting, and to be able to put their kids down without worry. The trend of cohousing is increasingly popular among millennials, and there are already 150 cohousing communities in the United States. Communal living arrangements have been shown to increase social cohesion, which is very helpful for children, parents, and older people alike.

  We also should start school earlier. The benefits to children, particularly those most in need, are massive and clear. There is a movement toward pre-kindergarten offerings in New York, San Antonio, and other cities. The United Kingdom now offers universal pre-kindergarten options for all three-and four-year-olds, and China and India are undergoing massive expansions.

  When children get to school, there are a few things that have been shown to be helpful and effective. Unfortunately, additions like laptops and software have thus far been shown to be largely unhelpful in making poor schools better. Technology is additive to existing environments; in a strong school with good teachers, it’s helpful. In a low-performing school, it doesn’t really
solve anything. We know what works—better teachers, better cultures, teamwork, and individualized attention. We’re just not very good at delivering these things. We fall in love with scale and solutions that promise more for less.

  I ran an education company, Manhattan Prep, that started as a solo tutoring shop and eventually grew to serve tens of thousands of students per year. We used current technology, but we became the industry leader primarily by finding the best teachers, compensating them more, and then empowering them to teach their classes how they saw fit. People teach other people. If you want to teach thousands of students well, you teach one student well. Then you do it thousands of times.

  COLLEGE ISN’T ALWAYS THE ANSWER

  Starting at the grade school level, we overemphasize college readiness and stigmatize vocational training. Only 6 percent of American high school students were enrolled in a vocational course of study in 2013, compared to 42 percent in the United Kingdom, 59 percent in Germany, and 67 percent in the Netherlands. Many available categories of employment will fall into nonroutine middle-skill jobs of welding, glass installation, electricians, machinists, maintenance, line repair, technicians, and the like even as the economy changes. A Georgetown center estimated that there are 30 million good-paying jobs that don’t require a college degree, many of which need some specialized training. A few summers ago my office’s air conditioning system broke and we had to pay a couple thousand to get it repaired as fast as possible. There are going to be old air conditioning systems in the United States for decades to come.

  College is being dramatically overprescribed and oversold as the answer to all of our job-related economic problems. The most recent graduation rate for first-time, full-time undergraduate students who began seeking a bachelor’s degree was 59 percent after six years. That is, only 59 percent of students who started college in 2009 had completed a bachelor’s degree by 2015, and this level has been more or less consistent the past number of years. For those who attended private, selective colleges, this number will seem jarringly low; the same number at selective schools is 88 percent. Among schools with open admissions policies the rate is only 32 percent, and among for-profit universities the six-year graduation rate is 23 percent. Similarly, the graduation rate from two-year associate’s degree programs within three years is only 29.1 percent. College, more than high school, is America’s true dropout factory.