of marketing more highly than a skilled caregiver. As in any other economic sector, the race for profits translates into pressure to reduce costs, and the easiest way to do it here is to cut back on services to unprofitable patients, that is, those who are more sick than rich.
This is exactly what insurance companies are doing under the banner of âcompetitivenessâ: denying coverage to those who need it most. In many cases, there is not even any greater efficiency to show for the greater inequity. âAmong providers, competition has led to a stunning round of spending on facilities and equipment in an attempt to lure patients from other providersâand never mind if the new facilities are [unnecessary].â 19 The result: hospital costs are actually
higher
in areas where there is more competition for patients. 20
There are few pockets of the U.S. economy in which competition between firms is introduced for the first time. When people talk about increasing the competition in a given sector, they often mean abandoning government regulation in order to more nearly approximate a laissez-faire or âpureâ market. Recent developments of this kind, such as in the airline industry, serve only to increase oneâs skepticism about the value of competition. 21
But the data with which I am more familiar concern the effects of competition within a given workplace. Add to the research cited in chapter 3 a bushel of new studies that Dean Tjosvold of Simon Fraser University in British Columbia conducted at utility companies, manufacturing plants, engineering firms, and many other kinds of organizations. Over and over again, Tjosvold has found that âcooperation makes a work force motivated,â whereas âserious competition undermines coordination.â 22 (Interestingly, one study from Georgia State University discovered that competition reduces the quality of oneâs performance, even if one happens to be a rhesus monkey!) 23
Meanwhile, the management guru celebrated from Detroit to Tokyo, W. Edwards Deming, has declared that the practice of having employees compete against each other is
Â
unfair [and] destructive. We cannot afford this nonsense any longer. . . . [We need to] work together on common problems [, but] annual rating of performance, incentive pay, [or] bonuses cannot live with teamwork. . . . What takes the joy out of learning . . . [or out of] anything? Trying to be number one. 24
Â
What
does
lead to excellence, then? This depends on what field and task we are talking about, but generally we find that people do terrific work when (1) they are inspired, challenged, and excited by what they are doing, and (2) they receive social support and are able to exchange ideas and collaborate effectively with others. * The data show that competition makes both less likely.
The dissolution of the Soviet Union has led a lot of Americans to construct the following syllogism: since (a) our economic system is based on competition, (b) their system collapsed, and (c) we were rivals, this must mean that (d) competition works. It would take considerably more space than I have been allotted here to offer a serious challenge to this rather dubious bit of deduction. Suffice it to say that the very adversarial nature of the relationship between the two countriesâcompetition writ large, in other wordsâhas had a great deal to do with trouble experienced on both sides of the old iron curtain. Of course, many factors played a part in sinking communism, but if we are looking for a simple explanation, we would do well to focus not on the absence of competition but on the absence of the Soviet citizenâs commitment to his or her work, chiefly due to the lack of personal autonomy and genuine democracy in that country. Then we might consider that the very same factors are present in this country. 25 â
Another unsettling event, although it is already fading from
Susan Klaus
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Katherine Losse
Unknown
Bruce Feiler
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Murray Bail