In all the public discourse surrounding Tiger Woods and his alleged infidelities, one of the primary topics of interest has been the millions of dollars he may have paid to silence his mistress(es) and mollify his wife. While there has been a lot of speculation about who got how much, I haven’t seen anyone question the idea of linking money and monogamy.

The same linkage underlies another contemporary phenomenon: the “bad boy clause” in some pre-nuptial agreements, in which one spouse (oddly, it’s usually just one, not both) agrees to pay a financial penalty for cheating on the other. It’s hard to say how common this is, but such contracts are apparently enforceable and have been upheld in court.

The money-monogamy link raises a number of questions in my mind, including:

• What are these payments supposed to mean to the wronged spouse?
  Say Tiger Woods has really paid millions to his wife as a result of cheating on her—is his wife supposed to understand that money as a conciliatory gift, like an XXL version of a bouquet of flowers with an “I’m sorry” note attached? Or is she supposed to receive it as a form of compensation, like the victim of medical malpractice who gets a big settlement in return for the loss of her health?

  
  Economic sociologists will recognize here the outlines of Viviana Zelizer’s (1996) taxonomy of exchange types and the kinds of social relationships they imply (“Payments and Social Ties”).
  
  Either way—gift or compensation—there is acknowledgement that a wrong has been done, which is probably valuable in its own right. What I’m asking, however, is the question implied by the Zelizer article: what kind of payment is this, and what kind of relationship does it imply between the spouses? Typically, gifts are associated with private life and emotional intimacy, whereas compensation forms of exchange more often occur in the public sphere. Gifts are (at least nominally) personal and emotion-laden, whereas compensation is impersonal, with legal-bureaucratic associations.

  The distinction would seem to matter for the future of the relationship: a gift would imply that there was still intimacy and a personal bond left to repair, and perhaps a hoped-for future together; in contrast, framing the payment as compensation has a kind of “cashing out” finality to it, shifting the relationship onto ground usually occupied by adversaries who have no intention of remaining connected to one another.

  In more concrete terms, if you’re the spouse receiving the kind of multi-million-dollar payment that Elin Nordegren Woods is supposedly getting from her supposedly cheating husband, what does that exchange mean to you in terms of the relationship, and your own self-image?

  It’s easy to be glib about this, and focus on her ability to “take the money and run.” But that ignores the emotions involved: if Elin loves her husband, the money may seem both totally inadequate as compensation for a broken heart and broken dreams, and inappropriately impersonal as a gift; if she doesn’t love him, she may still feel angry at the public humiliation she has experienced as a result of his behavior, and feel that neither gift nor compensation can fix the damage to her dignity.

  In other words, one can imagine situations in which the offer of money by a cheater to his wronged spouse could actually come across as adding insult to injury—as a cheap substitute for real understanding of the impact of infidelity, as if the wronged spouse is a kind of coin-operated machine, whose sense of betrayal can be assuaged with the application of sufficient funds to the wound.

• Do financial penalties deter infidelity?
  From the perspective of the spouse who has been or might be unfaithful, does paying out a large sum of money alter his or her future behavior? If Tiger Woods has in fact paid millions to control the damage of having extra-marital affairs, should we expect the experience to make him think twice about cheating on his wife going forward? Or does someone who signs off on a “bad boy clause” in a pre-nuptial agreement really run through a mental calculus weighing the costs and benefits of having an affair?
  
  Causal linkages of this sort are implicit in the money-monogamy link, but I’m skeptical. I don’t think people are that rational, especially when it comes to governing their appetites for sex, power, admiration, or whatever extra-marital affairs may signify for them.

  
  Social scientific research established decades ago that humans are boundedly rational. And philosophers reached that conclusion even earlier: 18^th century Scottish thinker David Hume—a rough contemporary of Adam Smith, and like Smith, an economist as well as a moral theorist—famously argued that emotions drive our decision-making. Rationality, he claimed, enters into

  

  the decision process at the end, in the form of rationalizations applied to obscure the true nature of our choices. In Hume’s own formulation,”Reason is and ought only to be the slave of the passions.”

  Social psychology provides another reason for skepticism about the money-monogamy link, emphasizing the power of context over character in shaping human behavior. One consequence of this is the fundamental attribution error. As I’ve written elsewhere, the lesson I take from this literature and from my own research is that rationality is not so much a property of individuals as of situations.

  Schemes involving payment for infidelity represent one attempt to change the context of extra-marital affairs—to introduce a negative consequence. But there have long been other negative consequences of cheating which many have found all too easy to ignore, such as causing pain to one’s spouse and other family members, loss of reputation or social status, and even loss of one’s job (cf. former New York Governor Eliot Spitzer). If none of that has been sufficient to deter infidelity, why would a financial payout achieve better results?

To answer these questions, we’d really need to hear from people who have faced this situation in real life: both the cheaters and the spouses they betrayed. Unfortunately, we rarely—if ever—hear about the money-monogamy link except in the context of gossip magazines, where any commentary given by the parties involved is bound to be primarily about impression management. They’re certainly not the place to look for reflection and insight.

What’s really strange to me, however, is that in the absence of any evidence that say, “bad boy clauses” actually deter infidelity, people still use them. And that may be the most compelling evidence for interpreting them as purely punitive devices.

But that just raises another set of questions, like: why would you want to marry on those terms? When one spouse seems so likely to cheat that it’s necessary to have a “bad boy clause” in the pre-nup, and the other spouse spells out how s/he plans to exact retribution for any infidelity, I have to wonder why the couple are bothering to marry in the first place. The whole arrangement just has “train wreck” written all over it.

And why stop at infidelity when you could enumerate all the other deal-breakers in the relationship, like snoring and hogging the remote? Turns out people actually do this! For a bracing example of taking ideas to their logical extremes, check out this list of “14 Popular Provisions in Pre-Nuptial Agreements” from the Irish Times:

1. Who will do the housework, what type of housework, and how many times a week.


2. How many times a year is suitable to go on vacation, and where.

3. No contact with people from previous relationships.

4. No cheating, especially with people from previous relationships. Sometimes known as the ‘bad boy’ clause. Taking a second spouse is also sometimes forbidden . . . in Islamic pre-nuptial agreements.

5. No snoring.

6. No leaving the toilet seat up.

7. How many times a week it is acceptable to expect sex.

8. The division of seasonal tickets to sports games and the theatre.

9. How many times a year is suitable to visit the in-laws, and for how long.

10. A declaration of who owns the remote control.

11. A limitation of how much can be spent on a shopping spree, and how often said sprees should take place.

12. A declaration of the monthly plastic surgery budget.

13. Who takes out the rubbish.

14. No weight gain beyond an agreed point.

Each one of these provisions could be the basis for a short story—probably something really bleak and despair-inducing, à la Raymond Carver or John Cheever. And remember, these are just the “popular” ones: imagine what might constitute an uncommon stipulation in a pre-nup. The horror…the horror.

For about six weeks, from the beginning of June to the middle of July, I didn’t write a word for Economic Sociology, interrupting my steady two-posts-a-month rate.  I wasn’t on vacation, but instead spending a lot of time with German doctors, trying to figure out why I suddenly couldn’t walk, sleep or eat without pain. I was sick, unable to walk a single step without holding onto something for support, and just miserable 24/7. It would have been a drag in any context, but trying to get help in a foreign language, in a country that is not exactly warmly disposed toward foreigners, made the whole situation very difficult.

One of the best parts of the experience, however, was a very small thing that made seeking medical help a lot less stressful: the segregation of the business part of a medical practice (the part that does billing and takes in payments) from the care-giving part. That means when you go to a doctor’s office, everyone from the office staff to the physician’s assistants to the doctors are focused on the same things that you are as a patient: dealing with what ails you. That’s what people in the business school world call “alignment of interests,” and it works very well in terms of minimizing the roadblocks between people in need of care and those who can provide it.

This separation of business from care in medicine also has a surprisingly comforting aspect emotionally, particularly if you’re used to a system in which the business part of medicine is inextricable from the care part. Though they are intertwined, they don’t work very well together. I think this is because, as Viviana Zelizer pointed out years ago in her article “Payments and Social Ties” (1996), the notions of “care” and “payment” are essentially antagonistic.

Probably every American has a story about the ways that the business part of a medical practice obstructed his or her ability to get care. I once knew a woman who, despite being well-insured, was harassed in her hospital bed by a billing department employee demanding to know how she–still groggy and in pain from an operation to save her life–was going to pay for her treatment; the hospital employee strongly implied that the woman would be “evicted” from her bed if she couldn’t prove that her bills would be paid. That apparently seemed like reasonable behavior to the hospital employee, “just doing her job” by looking out for the hospital’s business interests; the ethics of badgering an ill and vulnerable woman just out of surgery–in other words, the ethic of care–didn’t enter into the discussion.

For a few more–documented!–stories of this type, and an articulate, compelling discussion, check out “Health Care and Profits Don’t Mix” by Elizabeth Mika. (And try not to get mauled by a bear.)

These anecdotes do not argue against compensation for doctors–or any other caregivers, professional or otherwise. Rather, the point is that the motivations and incentives in relationships mediated by payment are often at odds with the motivations and incentives that we think are supposed to govern relationships defined by the term “care giving.” This is one reason many people have such a strong negative emotional response to the idea of paying stay-at-home spouses for their housework: the spouses are supposed to keep house, and possibly rear children, out of love and caring, not a desire to get paid; plus, there’s the fear that if stay-at-home spouses were paid, their emotional attachments to family members would deteriorate, replaced by a more impersonal employer-employee dynamic.

Back to Germany: Doctors certainly get paid for their services here, and seem to make a nice living. But when you walk into the reception area of their practices, you don’t see any apparatus for handling money: no credit card runners, no cash registers, nothing. All that is outsourced to firms located outside the doctors’ offices, often in different cities. Those outsource firms send a bill to your insurance firm, or–if you’re like me and have to pay every penny out of pocket–to you, the patient. Surprisingly, this doesn’t create the kind of snarled bureaucratic nightmare I would have expected: when I had questions about a bill from one of those outsource firms, I took the bill and the questions directly to my doctor, who called in his office assistant, and together they got on the phone with the billing firm and straightened things out for me on the spot.

This means that when you visit a doctor in Germany, the whole event is aligned around care from start to finish. That doesn’t make medicine a charitable undertaking, as some of the straw-man arguments in the US health care debate might lead you to think. Doctors here show no signs of having a forced choice between “doing well” and “doing good;” that distinction was also long held inviolate in the world of investing, and while the evidence has been around for over 15 years showing it to be a crock, it’s one of those snippets of economic ideology that seems impervious to reality.

Nor do patients face “rationing” of services in this system–apparently, the kinds of “socialized medicine” horror stories that Americans hear so often when we start talking about health care reform are drawn primarily from models like the NHS in Britian. Based on accounts from NHS patients, doctors and British politicians, that horror seems well-founded.

But not all “socialized medicine” is created equal, as it turns out. This came as a big surprise to me, child of the Reagan 80s, when I spent a year of high school in France and realized that a) it was being governed by the socialist party, and had been for some time, and b) people there had a much higher quality of life than most people I knew back in my suburban Chicago milieu. And nobody, ever, complained about the quality or availability of health care. So it wasn’t surprising to learn recently that independent studies by the United Nations and academic institutions (outside of France) ranked the French health care system the best in the world:

So this year [2008], two researchers at the London School of Hygiene and Tropical Medicine measured something called the “amenable mortality.” Basically, it’s a measure of deaths that could have been prevented with good health care. The researchers looked at health care in 19 industrialized nations. Again, France came in first. The United States was last.

Germany only made it to 12th on that list, but still–in nearly three years here, I have never heard a peep against the health care system, and certainly nothing remotely like the tragic litany of needless suffering (emotional and physical) and death that we hear in connection with the US system.

The French and German health care systems have another thing in common: they involve money (indeed, they are quite costly), but people living under both systems seem perfectly content to pay for the care they get, whether they do so out of pocket (like me) or through income taxes and health insurance premiums (like the majority). A big reason for that is quality: generally, people are willing to pay when they perceive they are getting value for their money. At the same time, in both systems as I’ve experienced them, the actual business of payment is kept physically separate from the provision of care.

I’m arguing that this segregation of business and care in medical services is not incidental to the subjective experience of quality and value on the part of the patient. Not having to deal with the “show me the money” issues up front, when you come to a doctor’s office or an ER in pain, makes a huge positive difference from a patient’s perspective. I hope that more Americans will get to test my claims for themselves, on home soil, rather than having to come to Europe to experience the enormous difference that such a simple change can make.