No Schillver Bullet
Who's Afraid of A Billion-Dollar Gift?
Hello new readers! I'm so glad to have you. FYI I'm treating this Substack lightly for the time being as I navigate the swirling storm of book promo, returning to teaching, and some newly intensive caregiving demands in my personal life.
On a recent podcast appearance (the terrific Fandom Made Me) I admitted that my pop culture journalism may well be what people remember me for most widely, and I’ve made my peace with that. To this day, anytime a new American Girl Dolls meme account pops up, or there’s major Beyonce news (which is to say, all Beyonce news), I get a flood of texts and it makes me smile. It tells me that I’ve written something that made people more aware, more curious, more engaged in something. They want me to know that they now see what I see. I think this is also what the kids call “having a strong brand.”
But the core brand, on the heels of my new book (and, like, a decade of research) is philanthropy, and thinking critically about what makes gifts “good” or “bad” — and so when Ruth Gottesman made a $1 billion gift to Albert Einstein College of Medicine, my phone got lit UP.
Just to cover the basics: Dr. Ruth Gottesman, chair of the Albert Einstein College of Medicine board of trustees, where she also had a distinguished career as a professor of pediatrics and researcher of learning disabilities and literacy programs, has committed $1 billion to the medical school as an endowment that covers all tuition costs for students going forward.
This is where my fictional game show, “Is It Good, Actually” would come in handy. So say it with me now:
I’m gonna tell you right now, you ever see another one of these polls from me, pick Both. Both is the C in this system.
What’s the balance? This one is mostly Good, Actually.
Three things I love about this gift:
It reflects a deep connection and relationship with a community. Einstein is the school where Dr. Gottesman has had her own career. She is the chair of its board. She has first-hand of the problem her gift is designed to address: the cost of medical school, the pressure it exerts on med school grads to choose higher paying specialties, the huge gaps in health care access that that creates for places like, well, the Bronx, and low-income and BIPOC communities everywhere. She knows the ecosystem, she knows the institution, she knows the people involved. It honors her own biography, but it does so in a responsive and embedded way.
Dr. Gottesman insisted the school keep the name Einstein, rather than renaming the school, which many donors who have given far less (a mere $200 million, say), have required. Her reasoning: “we already have the name.” It doesn’t get better brand-wise than Einstein. Accomplished as she is (and there are other initiatives that bear her and her late husband’s name), she will never be as universally revered as Einstein. As Avery Fisher said when asked to name the New York Philharmonic Hall, “who’s Major Deegan?” — meaning, just because your name is on something doesnt mean you achieve meaningful immortality. (In his case that was especially prescient: his heirs sold the naming rights to David Geffen in 2014). But it’s also a recognition of what’s important. The science. The ideas. The educational mission. It’s refreshing to see someone say their ego just might not be the most important thing - especially if, see above, you’re actually trying to solve a problem, not just burnish your image for posterity.
Gottesman’s gift poked the bear — namely, the efficiency bros who come out as if on cue to say, ah, but this endowment to fund medical school tuition isn’t MAXIMALLY effective! Doctors are going to earn high incomes, do they really need the help? Really, she should have bought 10 billion antimalaria nets.
Well well well, if it isn’t my book’s thesis in action. In this backlash we get to ask the question yet again: does philanthropy have to abide by a utilitarian standard? Can biography, community, local knowledge, personal values, or other factors play any role in people’s philanthropic decisions?
Some of the critique is the usual smug nihilism of dunking, of saying something the rubes think is good is bad, actually. Some of it comes from the narrow and rigid definition of good that you find in Effective Altruism — the absolutist perspective that giving has to save and extend lives in a direct, immediate and measurable way.
Never mind that ensuring more doctors can choose their career paths without the pressure of debt is likely to redirect them to lower-paying health care jobs in much-needed fields like primary care and in so doing…SAVE LIVES.
To these critics, this strategy is too indirect, doesn’t immediately prove itself correct, and most importantly, doesn’t SCALE the same way the models on the spreadsheets claim is possible, with just the right silver bullet.
What looks to these critics like a bug, I see as a strong feature: philanthropy should reflect relationships and biography and deep connection to specific communities and their needs. There can be careful strategy, sophisticated theories of change at work — and ideally they are also grounded in human experience and mutual trust.
Ok, so what’s bad?
Fine, fine. Here are the cynical points:
The Gottesmans’ money comes from Berkshire Hathaway investments (i.e. investing early with Warren Buffett). If our starting point is opposition to billionaire wealth, then yeah, maybe this isn’t for you.
As a couple, the Gottesmans made big donations for decades, but we have to admit that from a PR standpoint, hits different to have a widow, whose career is in the more humanitarian-adjacent field of medical research, be the face of billionaire giving. It’s a much more sympathetic image, one that softens the ire people might rightly feel towards ANY billionaire.
Of course higher education should be more heavily publicly subsidized. Of course we should not need billionaire largesse to address debt, one school at a time.
Of course health care should not be a private insurance cash grab and doctors should have career options besides “providing primary care while living on the knife edge of health care conglomerate acquisition and unmanageable insurance and regulatory incentives that make private practices unsustainable” or “make seven figures as a dermatologist.”
Spot on. Sending many, many hugs.