Thursday, April 18, 2013

American Exceptionalism - A Myth Exposed


American political leaders and average Americans too take great pride in trumpeting the United States as the greatest country in the world.  We are the strongest, the richest; we have the best medical system; we have the best educational system; and the list goes on and on.

But are we the greatest country?  While it is incontrovertible that we are the strongest country in the world militarily, and that we are the richest country in the world in terms of the size of our economy, when it comes to the health and welfare of the American people we are far from the greatest, as the data below will show.  And I believe it is in the ability of all Americans to pursue the American promise of “equality” and “life, liberty, and the pursuit of happiness” that our greatness is best measured.

You might ask, “Why bother exposing this myth?”  Because we have many problems in this country which seem to be intractable, largely because people ... both most leaders and the average American ... refuse to acknowledge the facts, let alone view them as presenting a serious problem that must be addressed.  Most people are so caught up in how great we are and how good life in this country is that we have come to believe the illusion and cannot see the gritty reality which is quite different.  

Only when our leaders and the public are able to see and admit these significant problems that limit our greatness will the political will exist to do what is necessary to fix them.  And they can be fixed.  We have the riches and the knowledge to do all that needs to be done.

In the data below, the United States is compared with the rest of the developed world, and at times the entire world.  The areas I will examine ... health, education, income inequality, violence/security, social mobility, and equal opportunity ... are essential to the ability of our country to live up to the promises made in the Declaration of Independence and truly be the great nation we aspire to.

Health:  Despite having by far the most costly health system in the world, the United States consistently underperforms on most measures of performance.  Looking at quality of care, access to care, efficiency, equity, and living healthy lives, the US ranks last or next-to-last when compared with Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom.  Most troubling is the failure of the US in the area of health outcomes ... people leading healthy lives.

The summary table below says it all:

                   AUS CAN      GER     NETH        NZ    UK       US
Overall Ranking (2010)           3      6             4         1         5     2          7
Quality of Care               4     7            5         2         1      3           6
Access             6.5     5            3         1         4      2         6.5
Efficiency               2     6            5         3         4      1           7
Equity               4     5            3         1         6      2           7
Long, Healthy Lives               1     2            3         4         5      6           7
Health Exp/Capita (2007)   $3357   $3895   $3588  $3837   $2454  $2992  $7290

This data, which comes from a report by The Commonwealth Fund, is consistent with the findings of other reports and surveys.  For example, a recent report sponsored by the National Research Council and the Institute of Medicine compared the US with 17 other developed countries, and the US came in last.  The report shows a “strikingly consistent and pervasive” pattern of poorer health at all stages of life, from infancy to old age.  Further, the report shows that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. 

Education: The US fares somewhat better in education comparisons, in that it was not dead last.  This is the one area regarding which the media will occasionally ring the alarm bell that “we are falling behind.”  In data comparing the G-8 countries, American 15-years old come in 3rd in Reading, 6th in Math, and 5th in Science.  In looking at high school graduation rates, the US and Canada tie for the lowest rate, 76%.  The other 6 G-8 countries range from 85% (Italy) to 97% (Germany).   This is a huge failure of our system.

Income Inequality: In a report on income inequality in 17 developed countries based on various studies, the United States had the greatest income inequality.  The top 1% of income earners accounted for 17.4% of US income while at the other end, in the Netherlands, the top 1% accounted for only 5.4% of income.  In looking at World Bank figures for the entire world, with the exception of China and Hong Kong, only undeveloped or developing countries, mostly in Africa and Central and South America, had greater income inequality than the US.

And income inequality is been increasing steadily in the US over the past 50 years.  For example, in 1949, the top 1% accounted for 11% of income, similar to or less than many developed countries at that time.  But for 10 of the 17 countries, income inequality has actually decreased in the past 50 years while those that have increased have experienced a much lower percentage increase than the US.

In looking at total net worth, the top 1% in the US accounted for 34% of net worth, the top 10% accounted for 70%, while the bottom 80% accounted for only 15%.  According to a UN report on the distribution of household wealth worldwide, only 4 countries in the world had greater inequality in household wealth than the US!

Violence/Security: In 2003, there were 30,000 fire-arm related deaths in the US  (homicides and suicides).  According to an American Bar Association report, the rate of death from firearms in the US is eight times higher than in other industrialized countries.  According to the U.S. Centers for Disease Control,  the fire-arm related death rate among US children younger than 15 is nearly 12 times higher than among children in 25 other industrialized countries combined.  The US has the highest rate of youth homicides and suicides among the 26 wealthiest nations.  

In a UN report comparing the intentional homicide rate (i.e. excluding suicide) worldwide, the US at 4.8 per 100,000 people was the highest for a developed country.  The next highest was 2.2 for Finland.  Germany, Italy, and France were 0.8, 0.9, and 1.1 respectively.  The United Kingdom was 1.2.

It would seem that our vaunted right to purchase firearms of all sorts has helped to create a more violent, less secure environment for Americans, rather than a less violent, more secure one as argued by gun proponents.  Interestingly, in a recent article regarding the Texas District Attorney and his wife who were murdered in their home, it was reported that he had 60-72 guns of all types planted all over the house and that both he and his wife were expert at using them.  But apparently all those guns were to no avail.

Social Mobility:  America has always prided itself as being the land of opportunity.  Over the years, especially the late 1800s and early 1900s, tens of millions of immigrants came to the US because of the American dream.  And indeed, while data is not available, certainly anecdotal stories of the upward mobility of immigrants abound.  Surveys show that Americans still think of their country as being a meritocracy; that is, if you have what it takes and you are hardworking, you will succeed.

But the data from two recent studies show that the image is far from true.  Yes, there is still social mobility, but the US is hardly the leader in this area.  In a study by the PEW Economic Mobility Project of 10 developed countries, the US had a lower generational income mobility than that of the other countries.  That means that a child’s income (as an adult) was more a function of his father’s income.  Likewise, in a study that compared 6 developed countries regarding the likelihood of children remaining in the same income quintile as their their father, 42% of American children in the poorest quintile remained in that quintile, a rate of poverty persistence far greater than the 30% in the United Kingdom and the 25-28% range found in the Scandinavian countries.  Likewise in looking at the percentage who moved from the lowest quintile to the highest quintile, the US rate was 7.9%, while the rate in the other 5 countries was 11 - 14%.

Equal Opportunity:  The United States has fine laws guaranteeing equal opportunity, meaning freedom from discrimination.  But even if those laws worked perfectly and there was no more discrimination in this country, which of course is far from the case, there would still be a significant lack of equal opportunity because your parents’ income usually determines where you live and the quality of education that you receive, which in turn determines the range of your opportunity.  Given the high income inequality in the US, that means that true equal opportunity is really a phantom in our country.  

While this lack of equal opportunity is not just a function of unequal funding, legal and legislative efforts to alter this dynamic by changing the way in which schools are financed ... equally by the state rather than unequally by school districts ... have not gained traction anywhere because of the opposition of those who fare better under the current system.  While there is no comparative data on this specific issue with other countries, the data on social mobility reflect this reality.

In summary, the data show that the United States has the worst health system in the developed world, even if it is by far the most expensive.  It has a mediocre educational system compared with other developed countries.  It has the highest income inequality in the developed world and almost the highest wealth inequality in the entire world.  It has the highest rate by far of people dying from firearms in the developed world.  The social upward mobility of Americans from generation to generation is now significantly lower than that in other developed countries.  And equal opportunity is not available because lower income Americans receive an inferior education.

This data is cause for our political leaders and the public to stop and consider what has caused these problems to develop and what needs to be done to return America to the path of greatness.  It is not just a matter of throwing more money at a problem.  Each of these problems reflects structural defects in our system that must be corrected.  The American people are hurting.  Further, the combined impact of these problems will lead, if not addressed, to a steadily weaker America on the world stage.