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insist on imposing them in social sectors and basic services, where factors other than simple cost/benefit ratios presumably ought to count for something? The chief author of the report has an explanation. He is fond of likening the provision of healthcare and education to shopping for a sandwich. Choice and competition must be part of the process in order to ensure that the customer/patient/student gets the best possible deal. For example, if you go into McDonald’s, ask for a Big Mac without pickles, and the resentful, inefficient slowpoke cashier tells you that you’re getting pickles whether you like it or not, youas a free agentcan slog down the street to Burger King, where the service personnel are so motivated to make a sale that they behave in a more appealing, attractive, and effective manner.You get a picklefree hamburger, no problem, Burger King makes money, the cheerful sales associate gets promoted to franchise manager, McDonald’s goes out of business and the surly burger seller loses her job and goes back to the slums where she belongs. \(Because it is a sensitive multicultural institution, the World Bank modifies the WDR to include samosas, saltenas, and shoo-mais in its So, it’s the same with health care! Get it? “Clinical care is unlikely to be effective without client power but, because of the gulf in knowledge between the doctor and patient, is also a service that the client is least able to monitor. Nevertheless, strengthening the power of clients through demand-side subsidies and co-payments can go a long way towards improving these services for poor people.” It’s simple. If every transaction is based on the naked cash nexus, then poor people can hold the “provider” accountable. Give me a physical and hold the blood test. I’ll have a large valium and a shot of morphine, please.The same with education. Like, how much for a B plus? Also water services. “Separating the policymaker incentives to monitor the provider, can improve service outputs. Devolving responsibility to local governments and the private sector and increasing community participation in financing are elements in achieving this separation.” Well, actually this is a little different. There is only going to be one provider in this case, no matter what. But encouraging the provider to be efficient by firing as many people as possible and raising water rates will enable the provider to make a lot of money, which the provider will ultimately reinvest in the water system, improving outputs, and spreading wellness throughout the Third World. Unhappily, there are still a few kinks in this plan. The provider, being a shrewd capitalist instead of a charitable institution, notices that the profits he has accrued by allowing “increased community participation in financing” could be invested more rewardingly in some high-concept arbitrage arrangement between Euros and U.S. dollars than in the renovation of some decrepit water pipery in Tegucigalpa. Using his instantaneous international capital transfer informatics system and his crack accounting division in Hong Kong, he shifts the revenues from last month’s Tegucigalpa water bills into an account in the Caymans and plays the currency markets for a bit. The Honduran government can’t stop him because the IMF and the World Bank made it lift capital controls as a condition of granting the loans it needs to cover the gaps in the public revenue stream that resulted from the sale of the telephone system, also at the insistence of the World Bank. The whole problem, according to this year’s draft report, with getting services to work for poor people is that the workers now providing these services ignore and mistreat poor people. They don’t like poor people because are you ready for this? Poor people have no money. I am not kidding. They really don’t. So doctors, nurses, clerks, teachers, firemen, mailmen, etc. feel free to abuse them. Also, according to the WDR, to neglect them, run away from them, steal from them, and trick them. Unlike the World Bank, of course, which frequently invites poor people in for tea. Not really. The WDR argues that public workers must be held accountable to poor people in order to get them to do their jobs. The best way to accomplish this is to fire them from the cumbersome public institutions that now employ them, eliminate such miserable salaries as they now enjoy, and rehire some of them on tenuous, cheapskate, short-term contracts through large private companies or through small-scale, sandwich-shoppey operations that they put together themselves. As a result, these workers will be accountable to the poor because they too will be poor. And this is actually what is happening. It explains the dramatic increases in output per worker, the collapse in formal employment, and the appalling levels of poverty all at once. The most astonishing thing about the whole policy is that it is a more-or-less unmitigated disaster and has been for at least 15 years. Even economically, it’s starting to look like a dead loss for the Banks. The IDB has just lent $1.5 billion to the government of Argentina to provide monthly $50 stipends to keep what used to be the middle class from suddenly starving to death. The IMF made the country a loan in January to pay the interest on the government’s IMF loan. This is like charging your Master Card payments to your Master Card. It isn’t even a clever Ponzi scheme. If you or I tried this, we would be arrested for fraud. But not the World Bank.Why is that? Why does everybody but the Bank have to be efficient, competitive and accountable? What about this idea for an alternative WDR: Holding the Bank Accountable? It would be a relatively slim volume; unfortunately, we don’t have many illustrative anecdotes we can use. Gabriela Bocagrande writes about multilateral misfeasance for the Observer. 7/4103 THE TEXAS OBSERVER 19