Symptoms of U.S. Decline

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September 1, 2012 · Posted in Commentary 

Leslie Evans

In his State of the Union address this year President Obama declared, ”Anyone who tells you that America is in decline, or that our influence has waned, doesn’t know what they’re talking about.”

 

Mitt Romney says the same thing, excepting a few admissions of slippage he feels he can blame on Obama, harping on America’s “exceptionalism” and the supposedly pending new “American Century,” the last one, proclaimed by Time magazine’s founder Henry Luce in 1941, having run a bit shorter than planned.

 

The counter argument was voiced by Jeff Daniels as the fictional news anchor in HBO’s new series The Newsroom, in a clip widely circulated on YouTube. Asked why America is the greatest country in the world he responds, “It’s not the greatest country in the world. We lead the world in only three categories: number of incarcerated citizens per capita, number of adults who believe angels are real, and defense spending, where we spend more than the next twenty-six countries combined, twenty-five of whom are allies.”

In graduate school twenty-five years ago we learned that people in different occupations will turn conversation to define status to their benefit. Stock brokers tell how much money they make, artists about galleries where their work is displayed. The discussion of whether the United States is doing well or badly runs the same way. Conservative historian Victor Davis Hanson in an April 26, 2012, post to National Review Online assures us that “Never in the last 70 years has the U.S. military been so lethal.” He defines the symptoms of apparent decline quite narrowly: the large federal deficit, high oil prices, and self-pitying claims of poverty (“The underclass suffers more from obesity than malnutrition”) from people who by world (or at least third world?) standards have adequate housing and medical care. The deficit can be cured by “a new tax code, simple reforms to entitlements, and reasonable trimming of bloated public salaries and pensions,” while oil prices can be lowered by drilling off both coasts and in Alaska.

 

We could quibble about how deep the cuts would have to be to eliminate the deficit, given Republican calls for more big tax cuts for the rich, or whether all the oil in and around the United States could free the country from its current 8 million barrels a day import habit or change the international price, or whether the problems of the American under class can be reduced to bad eating habits. I would start somewhere else entirely, as Hanson, like the hypothetical stock broker we heard of in graduate school, wants to define decline solely by issues for which his party has neat talking points.

 

To suggest the broader terms of the problem here is Time magazine editor Fareed Zakaria:

 

“The U.S. remains the world’s largest economy, and we have the largest military by far, the most dynamic technology companies and a highly entrepreneurial climate. But these are snapshots of where we are right now. The decisions that created today’s growth – decisions about education, infrastructure and the like – were made decades ago. What we see today is an American economy that has boomed because of policies and developments of the 1950s and ’60s: the interstate-highway system, massive funding for science and technology, a public-education system that was the envy of the world and generous immigration policies. Look at some underlying measures today, and you will wonder about the future.

 

“The following rankings come from various lists, but they all tell the same story. According to the Organisation for Economic Co-operation and Development (OECD), our 15-year-olds rank 17th in the world in science and 25th in math. We rank 12th among developed countries in college graduation (down from No. 1 for decades). We come in 79th in elementary-school enrollment. Our infrastructure is ranked 23rd in the world, well behind that of every other major advanced economy. American health numbers are stunning for a rich country: based on studies by the OECD and the World Health Organization, we’re 27th in life expectancy, 18th in diabetes and first in obesity. Only a few decades ago, the U.S. stood tall in such rankings. No more. There are some areas in which we are still clearly No. 1, but they’re not ones we usually brag about. We have the most guns. We have the most crime among rich countries. And, of course, we have by far the largest amount of debt in the world.”[1]

 

These suggestions of a downhill slide have various causes. In some cases other countries are making investments in education, health, and infrastructure that the United States has cut back on. The promotion of extreme inequality in the United States compared to other advanced countries has had an impact on a wide range of measures of productivity and well being of the lower quintiles of the population. Offshoring much of American industry has driven down domestic wages, which in turn affects the sales of businesses, including the ones saving on wages by doing the offshoring. The severe distrust in government by both left and right that set in at the end of the sixties spills over into attitudes toward public education, religious on the part of the Right, which tries to defund “anti-Christian” public education and remove its children to parochial schools or home study. Some negatives result from the financialization of the American economy in the 1990s, the long debt bubble, followed by the economic collapse of 2007. The Republican strategy of gridlocking and discrediting the federal government has for some years stalled government attention to a range of at least partial potential fixes. And still other negative statistics result from the growing global scarcity of cheap oil and many metallic ores that have driven prices relentlessly upward since around 2000, affecting most countries.

 

Let’s look at some of the parameters.

Education

 

On the bright side, the United States still ranks number one internationally in the quality of its universities. When it comes to graduation rates, however, the U.S. shows dramatic slippage. According to a November 2011 report by the Council of Graduate Schools:

 

“In 2009, the United States ranked third among OECD countries in the percentage of 55-64 year-olds who had attained tertiary [college] education. In the U.S., 41% of individuals in this age group had attained tertiary education in 2009, trailing only behind the Russian Federation (44%) and Israel (45%), and considerably higher than the OECD average of 22%. Among 25-34 year-olds, however, the United States ranked 16th in the percentage who had attained tertiary education, indicating that educational attainment is increasing faster in other OECD countries than in the United States. In the U.S., 41% of 25-34 year-olds had attained tertiary education in 2009, higher than the 37% OECD average, but considerably lower than top-ranked South Korea (63%). Canada (56%), Japan (56%), and the Russian Federation (55%) also had educational attainment rates for 25-34 year-olds that were considerably higher than the rate in the U.S.”[2]

 

The other countries with substantially higher percentage of college graduates among 25-34 year olds were Ireland, Norway, New Zealand, Luxembourg, United Kingdom, Australia, Denmark, France, Israel, Belgium, and Sweden.

 

 

When we turn to K-12 the picture is even worse. The OECD international test scores for fifteen-year-olds for 2009[3], where the U.S. came in 27th in math and 22nd in science, showed the U.S. below even the OECD average in both subjects, out-performed not only by Western Europe and Japan but by most of Eastern Europe and a formerly third world country like South Korea. A few samples: In math, South Korea scored 547, the Czech Republic 510, Poland 495, the U.S. 474. In science: Finland 563, South Korea 522, the Czech Republic 513, Hungary 504, the U.S. 489.

 

A March 2012 Council on Foreign Relations report on “US Education Reform and National Security”[4] prepared by Joel I. Klein, former head of New York City public schools, and Condoleezza Rice, former U.S. secretary of state, warned, “Educational failure puts the United States’ future economic prosperity, global position, and physical safety at risk.” The report noted that “More than 25 percent of students fail to graduate from high school in four years; for African-American and Hispanic students, this number is approaching 40 percent.” And “only 22 percent of U.S. high school students met ‘college ready’ standards in all of their core subjects; these figures are even lower for African-American and Hispanic students.”[5]

 

The Global Innovation Index, an annual international study by the INSEAD Graduate Business School and the World Intellectual Property Organization, in its 2012 rankings placed the United States 31st out of 125 countries in education overall and 46th for its low per capita expenditure compared to GDP. On pupil-to-teacher ratio in secondary education, at 13.8:1, the U.S. ranked 61st. In higher education, the U.S. ranked second in enrollment, but 74th in students graduating with science and engineering degrees.[6]

 

Then we have Fareed Zakaria again:

 

“In 2008, the U.S. high school graduation rate was lower than the rates of the United Kingdom, Switzerland, Norway, South Korea, Japan, Italy, Ireland, Germany, Finland and Denmark. That same year, the U.S. was the only developed nation where a higher percent of 55- to 64-year-olds than 25- to 34-year-olds had graduated from high school.”[7]

 

Not surprisingly the slackening of educational standards and participation is reflected in a shocking level of ignorance by our country’s adult population. The Christian Science Monitor reports: “Only one-third of Americans can name all three branches of government; another third cannot name any. The United States ranks 120th out of 169 democracies in voter turnout.”[8]

 

A 2008 survey by the Intercollegiate Studies Institute found that among elected officials, “43% do not know the Electoral College is a constitutionally mandated assembly that elects the president. One in five thinks it ‘trains those aspiring for higher office’ or ‘was established to supervise the first televised presidential debates.’”[9]

 

A Marist Institute for Public Opinion poll of American adults found that 26 percent did not know that the United States won its independence from Great Britain. Six percent named a different country, including France, China, Japan, Mexico and Spain. Twenty percent said they weren’t sure.[10]

 

Another survey, by the American Revolution Center, devoted to the study of the American Revolution, found that more than a third of American adults “did not know the century in which the American Revolution took place, and half of respondents believed that either the Civil War, the Emancipation Proclamation or the War of 1812 occurred before the American Revolution.”[11]

 

These kinds of gaps are discouraging enough, but when we come to science things quickly get worse. Jeff Daniels quips that one of the three measures in which America leads the world is the number of people who believe that angels are real. That is not a joke. An Associated Press-GfK poll at the end of last year found that 77 percent of American adults believe angels are real, a number that rises to 95 percent among Evangelical Christians.[12]

 

There is an inverse connection between this religion-based world view and knowledge of science, and, like the social and economic effects of the dominance of Islam in Muslim countries, it does not bode well for a nation in a highly technological and competitive world.

 

A Gallup poll in June 2012 found that when asked to choose whether humans are the product of evolution from lower animals, the product of such evolution guided by God, or if God created humans as they now exist within the last 10,000 years, 46 percent of Americans chose the 10,000-year version, a world view held by most peasants in the Middle Ages.[13] If the Earth is less than 10,000 years old, virtually everything known by biology, paleontology, geology, astronomy, and physics is impossible. Is it any wonder then that the United States is 74th among nations in the percentage of science and engineering degrees?

 

While I am not particularly fond of scriptural religions I would add here that both mainstream liberal Protestantism and most of the Catholic Church would choose evolution guided by God, a viewpoint that carefully avoids a clash with the known facts of science.

 

 

A national survey commissioned by the California Academy of Sciences and conducted by Harris Interactive in 2009 found that 47% of American adults did not know how long it takes the Earth to go around the sun, and 41% believed that humans lived at the same time as the dinosaurs.[14]

 

Our national ignorance of science, exacerbated by religion and right-wing politicians, has huge consequences in preparing for our future. A 2010 Yale University study found that “more than two-thirds of those surveyed believe that reducing toxic waste or banning aerosol spray cans will curb climate change. And 43 percent believe that ‘if we stopped punching holes in the ozone layer with rockets, it would reduce global warming.’” Just 1 in 10 of those surveyed said they were “very well informed’ about climate change and 45 percent said they were not very worried or not at all worried about it.[15]

 

In contrast, an August 2012 survey in Canada found that only 2 percent of Canadians deny climate change and only 9 percent deny human actions as a major cause.[16]

 

Finally on this point, UCLA scientist Jared Diamond, in an August 1, 2012, response to Mitt Romney’s misunderstandings of Diamond’s book Guns, Germs, and Steel, disputed Romney’s one-dimensional pronouncements that culture determines national success:

 

“We Americans fail to provide superior education and economic incentives to much of our population. India, China and other countries that have not been world leaders are investing heavily in education, technology and infrastructure. They’re offering economic opportunities to more and more of their citizens. That’s part of the reason jobs are moving overseas. Our geography won’t keep us rich and powerful if we can’t get a good education, can’t afford health care and can’t count on our hard work’s being rewarded by good jobs and rising incomes. Mitt Romney may become our next president. Will he continue to espouse one-factor explanations for multicausal problems, and fail to understand history and the modern world? If so, he will preside over a declining nation squandering its advantages of location and history.”[17]

 

Infrastructure

 

The United States was once a world leader in its highway system, network of bridges, advanced telecommunications. This is not true today.

 

According to a University of Virginia study, “America’s infrastructure is in grave disrepair. Analysts have determined that one-third of the nation’s roads are in poor or mediocre condition, and the Federal Highway Administration recently estimated that one out of every four bridges is either structurally deficient or functionally obsolete. Every infrastructure sector, from rail, air and seaways, to water supply, sewage and irrigation, to energy pipelines and the electric grid, are in need of significant capital.”[18]

 

This decline can’t be explained as typical of the developed world. World Economic Forum rankings for 2011 place the United States 23rd out of 139 countries on measures of transportation, telephony, and energy, tied with Spain, noticeably behind the major European countries, but also Singapore, the United Arab Emirates, South Korea, and Portugal, and even a bit below Barbados and Taiwan.[19]

 

The Urban Land Institute in a May 2011 report said that the United States has underfunded infrastructure over the last 30 years, while international competitors China, India, and Brazil have been heavily investing in theirs. The American Society of Civil Engineers has estimated that the U.S. would need to spend some $2 trillion just to repair deteriorating infrastructure networks and maintain roads, bridges, water lines, sewage treatment plants, dams and other infrastructure.[20]

 

Former Pennsylvania Governor Ed Rendell recounts that when he came into office in 2003 his state had 5,600 structurally deficient or obsolete bridges. He tripled his capital budget, from $200 million to $700 million a year, plus a special appropriation of $200 million for each of the next four years. By 2008 the number of deficient bridges had gone from 5,600 to 6,000.[21]

 

American waterways, on which a vast amount of material is transported, are in even worse shape. As an example, the main lock on the Ohio River near Warsaw, Ky, broke in July 2011. This jumped the delay for ship and barge traffic from 40 minutes to 20 hours. The lock is supposed to reopen in August 2012, more than a year later. Fourteen major locks are rated to fail between now and 2020, at a repair cost of billions. Freight bottlenecks from faulty locks, too-narrow-highways, and other congestion are costing a minimum of $200 billion a year, with the conservative U.S. Chamber of Commerce putting the estimate at $1 trillion.[22]

 

The same article gives as another example an 83-year-old lock on the Ohio River near Olmsted, Ill.:

 

“Congress set aside $775 million to replace it and another nearby lock in 1988. The project began in 1993 and was scheduled to be finished by 2009 but still isn’t complete [in May 2012], in part because of engineering modifications intended to save $60 million. Now, the cost has ballooned to $3.1 billion, and the new lock won’t be ready until 2020 or later.”

 

The president-elect of the American Society of Civil Engineers in June 2012 confirmed that the organization will probably repeat their near- failing “D” grade in its next report on U.S. infrastructure projects such as roads, railways and airports due in 2013 A group of municipal bond experts were polled on this and shared this opinion.[23]

 

Another aspect of infrastructure is communications. On cell phones, the U.S. ranks third in the world with 327 million, topped only by China with a billion and India with 934 million. The U.S. has slightly more phones out there than it has people, at 103.9% of population. That would seem to be enough, but perhaps this includes old units that no longer work. In any case many countries have far more cell phones per capita. America is 34th, after such unexpected rivals as Indonesia, Malaysia, Ukraine, and Guatemala. Brazil has phones for 132% of its population, and the United Arab Emirates for 197 percent.[24]

 

A quarter of the world’s 584 million Internet addresses in 2011 were in the United States. At the same time, neither the private companies that control access to the net nor the federal government have kept up with world standards in Internet speed. The United States ranks 14th, with an average connection speed of 5.6 megabits per second, compared to South Korea at 14.4, Hong Kong at 9.2, and Japan at 8.1. Other countries ahead of the U.S. here include Romania, Czech Republic, Latvia, and Ireland.[25]

 

Our space program saw a high profile advance with the Curiosity rover’s landing on Mars August 6. Less well known is the drastic decline of the U.S. orbital satellite system, which began in the mid-1990s. The satellites are used to track storms, contain oil spills, monitor flooding, forecast weather, measure the strength of hurricanes, manage fisheries, and check security in shipping lanes. A new study from the National Academies of Science says that the U.S. has lost all of its wind sensors and no longer has any sensors capable of measuring ocean currents. The Christian Science Monitor summarizes: “the number of in-orbit and planned NASA and NOAA [National Oceanic and Atmospheric Administration] Earth observing missions will decline from 23 in 2012 to only six in 2020. And the number of Earth observing instruments mounted on such satellites will fall from about 110 in 2011 to fewer than 30 in 2020.”[26]

 

While the American space program is being sharply cut back, the Monitor reports that “China, India, Russia, South Korea, Japan, European nations, and several other countries are aggressively developing oceanographic satellite sensors. . . . The American science community is often told by NASA managers to go look elsewhere for information and to use the foreign sensors if they can get the data.”

 

The problem is compounded by the Republican Party’s bizarre decision to oppose federal efforts to repair our infrastructure, apparently out of an animus toward Barack Obama that outweighs their concern for the country. As US News reports:

 

“Many Republican lawmakers have in the past decried spending on infrastructure. When President Obama introduced the idea of a national infrastructure bank in September 2010, Representative Eric Cantor called it ‘yet another government stimulus effort’ and House Speaker John Boehner called it ‘more of the same failed “stimulus” spending.’”[27]

 

Poverty and Homelessness

 

The United States among advanced countries has pretty much the highest poverty rate, the greatest percentage of children in poverty, and the most homeless. According to the Economic Policy Institute, based on the Census Bureau’s Current Population Survey, “Poverty rates in the United States increased over the 2000s, a trend exacerbated by the Great Recession and its aftermath. By 2010, just over 46 million people fell below the U.S. Census Bureau’s official poverty line.” Looking at OECD data, the U.S. has a higher poverty rate than any OECD country, at 17.3%, compared to 6.1% for Denmark, or the strongest European countries, France at 7.2%, Germany, 8.9%, and the United Kingdom at 11.0%.[28]

 

Thinking of Victor Davis Hanson’s snide dismissal of American poverty as unreal compared, I suppose, to sub-Saharan Africa, we should note that 17.3% of Americans is 52.7 million people, while the U.S. Census Bureau draws the poverty line these millions fall at or below at an annual income of $11,702 for a single person under 65 and $22,811 for a family of four.[29] In Los Angeles it is rare to find a one bedroom apartment for less than $1,000 a month. The median price is $1,117.[30]

 

The graph below shows that the U.S. ranked 26th among developed countries in child poverty in 2009, with 23.1% of its children living in poverty, compared to 5.3% for Finland. Germany was at 8.5%, France, 8.8%, and the UK at 12.1%.[31]

 

 

The United Nations Children’s Fund (UNICEF), ranking nations by children’s well being in 20 rich countries for 2007, based on six criteria, placed the U.S. at number 19, with the UK last. The criteria were material well-being, health and safety, educational well-being, family and peer relationships, behaviors and risks, and subjective well-being. With the lower the score the better, the U.S. scored 18.0, while the Netherlands was 4.2 and Sweden 5.0. Germany was at 11.2 and France at 13.0. In this comparison the UK trailed at 18.2.[32]

 

Homelessness in the United States and generally in Europe is defined most narrowly as people living on the streets or in temporary emergency shelters. There are three different statistics to define this problem. The most common is “point in time,” how many are, on the average, homeless on a given day. Then there is the number for how many are homeless for some part of a given year, a much larger number. And finally, there is the number for the chronic homeless, those without regular shelter for more than a year.

 

The most recent national survey of homelessness in the United States, “The State of Homelessness in America 2012″ by the National Alliance to End Homelessness and the Homeless Research Institute, put the point-in-time daily average for 2011 at 636,017.[33] 37% of that number are in homeless families. The chronically homeless numbered 107,148. The number of homeless veterans in 2011 was 67,495.[34] All these numbers showed a slight reduction from 2009, the worst  year of the recession. The declines were aided by a federal assistance program that provided aid to a million people. And while homelessness was reduced in 26 states, it increased between 2009 and 2011 in 24 states.[35] There were huge increases in the northern “Red” states: Montana, Wyoming, Idaho, North Dakota, and Utah.

 

Only the point-in-time statistics are comprehensive, but a standard extrapolation of how many people are homeless for part of each year is approximately 4 times the point-in-time number, or about 2.5 million for the United States.

 

The report adds:

 

“A majority of homeless people counted were in emergency shelters or transitional housing programs, but nearly 4 in 10 were unsheltered, living on the streets, or in cars, abandoned buildings, or other places not intended for human habitation. The unsheltered population increased by 2 percent from 239,759 in 2009 to 243,701 in 2011.[36]

 

How does America’s homeless problem compare with other rich countries? Statistics on this are not widely available, so I will limit the comparison to Germany, France, and the UK.

 

All four countries have somewhat comparable numbers of homeless people: Germany, with a population of 81.8 million has 272,000 homeless; France at 65.4 million has 133,364, and the United Kingdom with 62.3 million has 86,781. As a percentage of total population, homeless on a given day, in the U.S. and France are .002%, Germany .003, and the UK .001.[37]

 

If the gross numbers are similar, there the comparison ends. The British report cited above adds:

 

“England is highly unusual in providing, for some homeless groups, a legally-enforceable right to ‘suitable’ temporary accommodation which lasts, in most cases, until ‘settled’ housing becomes available. However, legislation has recently been passed by the French Parliament (March 2007) which attempts to establish a legally-enforceable right to housing for those who have experienced ‘an abnormally long delay’ in being allocated social housing.”[38]

 

In the United States, 38% of its homeless population, 243,701 on an average night in 2011, live on the streets.[39] In Germany it is only18,000, 6% of the total. The rest are in temporary housing. In France, out of its 133,244, 74,000 are in hostels, 39,000 are in temporary accommodations, and the remaining 19,854 combine both those who are “roofless” and those in emergency shelters. In the UK, out of a total of 86,781 counted as homeless, 70,730 were in temporary housing on an average night in 2008, 6,286 were in hostels, 8,852 in overnight emergency shelters, and only 813 people known to be still out on the streets.

 

If we look at the measure of how each country has treated its homeless and how it has tried to reduce the problem, the United States is the most cold hearted and with the most severe problem.

 

Health

 

The United States in unique among advanced countries in not providing health care for all of its citizens. It consumes the highest proportion of GDP for health expenses of any country in the world, 15.2% in 2005, with the least to show for it. In comparison, France spends 11.2%, Germany 10.7%, Sweden, 9.2%, and the United Kingdom 8.2%.[40]  The Kaiser Family Foundation estimated that for 2010, 16% of the U.S. population, or 56.8 million people, had no health insurance.[41] The Commonwealth Fund, a health-promotion foundation created in 1918 by a Standard Oil heiress, in an April 2012 survey found that during 2011 an even more shocking 26 percent of Americans between 19 and 64 had no health insurance during all or part of the year, the increase due mainly to people losing their jobs.[42]

 

 

The World Health Organization in 2000 conducted an in-depth survey of health care in 191 countries. In its ranked list the United States came in 37th, behind such countries as Colombia, Saudi Arabia, Morocco, and Costa Rica. Standings for the major advanced countries showed   France as number 1,  Japan 10, United Kingdom 18, and Germany 25.

 

The U.S. on one hand has the most technically advanced health facilities and technology in the world. But it fails dismally to make this available to large segments of its people. There are significant consequences for America’s very large omitted population and poor delivery system. The U.S. has the highest incidence of diabetes of any advanced country, 10.3% of the whole population. Germany stands at 8.9%, France at 6.7, and the United Kingdom at the remarkably low 3.6%.[43]

 

According to the CIA’s World Fact Book, the U.S. in 2012 ranks 50th among the world’s countries in life expectancy, at 78.49 years, behind such similar economies as Japan, 83.91 years, Canada 81.48, France 81.46, Germany 80.19, and the United Kingdom 80.17.[44]

 

Infant mortality tells a similar story. The CIA’s World Fact Book for 2012 ranks the U.S. worse than 48 other countries in infant deaths. The U.S. rate is 5.8 deaths per 1000 live births (down from 6.6 a few years earlier). The European Union rate is 4.49, but some countries are significantly better: Germany 3.51, France 3.37, Sweden 2.74, and Japan 2.21.[45]

 

Yet another measure is the number of deaths that could have been prevented by better health care. The numbers come from a major data study by the Commonwealth Foundation in 2008 and are for 2002-2003, limited to deaths before age 74. The U.S. ranked dead last out of 14 countries studied, with 110 unnecessary deaths in every 100,000 citizens for that year, compared to only 65 for France.[46] The U.S. number adds up to 335,500 Americans who die each year because of inadequate health care. In ten years the government’s savings on health care, so dear to Republican hearts, causes the unnecessary deaths of 3.35 million of our people. This compares to total U.S. military deaths in Iraq and Afghanistan up through the beginning of 2012 of 7,959.[47]

 

The study table compares preventable deaths in 1997-1998 to the 2002-2003 period. The authors make the following comment on the numbers from the United States:

 

“The decline in amenable mortality in all countries averaged 16 percent over this period. The United States was an outlier, with a decline of only 4 percent. If the United States could reduce amenable mortality to the average rate achieved in the three top-performing countries, there would have been 101,000 fewer deaths per year by the end of the study period.”

 

The authors also write, “[I]t is difficult to disregard the observation that the slow decline in U.S. amenable mortality has coincided with an increase in the uninsured population.”

 

Further they quote Commonwealth Fund Senior Vice President Cathy Schoen:

 

“It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance. By focusing on deaths amenable to health care, [researchers] Nolte and McKee strip out factors such as population and lifestyle differences that are often cited in response to international comparisons showing the U.S. lagging in health outcomes. The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals, and efforts to improve health systems make a difference.”

 

It’s also worth looking at the graph below, from The Lancet, on the numbers and causes of violent deaths of young people, aged 10 to 24, where the United States also leads the advanced countries of the world.

 

 

Before leaving this topic we should mention obesity in the United States. An August 1, 2012, article in the Philadelphia Inquirer states:

 

“Obesity is a uniquely urgent crisis in the United States. Americans are the fattest people in the world. The prevalence of obesity is significantly greater in America than in all the world’s other wealthy nations. Americans are about twice as likely as Western Europeans or Canadians to be obese, three to four times more likely than Scandinavians, and 10 times more likely than the Japanese, who enjoy the world’s greatest longevity.”[48]

 

This problem is quantified in a 2010 report by the International Association for the Study of Obesity. It is not quite true that Americans are the fattest people in the world. In a table ranked by female obesity the U.S. comes in at number 18, behind such places as Samoa, Egypt, Saudi Arabia, and Albania. 35.5% of American females and 32.2% of males are obese. The first European country to make the list is Scotland, number 32, with 26.5% of its women and 24.9% of its men too fat. By the time we get to Germany it is 21.1 and 20.5, France at 17.6 and 16.1, or Japan at 3.4 and 2.3. It is, after all, a cliche about declining empires that their people cease to be warriors and become fat and decadent.

 

The Republican argument on healthcare, as on the whole of the social safety net, is that there is no way to pay for it and that the proof is the lingering economic crisis in Europe, whose form of capitalism is based on a strong welfare state. A good example is this summation by Republican columnist David Brooks:

 

“[M]any Republicans have now come to the conclusion that the welfare-state model is in its death throes. Yuval Levin expressed the sentiment perfectly in a definitive essay for The Weekly Standard called ‘Our Age of Anxiety’: ‘We have a sense that the economic order we knew in the second half of the 20th century may not be coming back at all – that we have entered a new era for which we have not been well prepared. … We are, rather, on the cusp of the fiscal and institutional collapse of our welfare state, which threatens not only the future of government finances but also the future of American capitalism.’ To Republican eyes, the first phase of that collapse is playing out right now in Greece, Spain and Italy – cosseted economies, unmanageable debt, rising unemployment, falling living standards.”

 

If there is any truth to this idea, what should be debated is the Republican solution, of funneling vast amounts of money to the rich while abandoning the middle class and the poor. Still, we are not yet where the Republican punditocracy claim. U.S. social spending as a percentage of GDP is running at 16.2% a year. Greece, Europe’s basket case, is at 21.3%. Spain, in slightly better shape, spends more, at 21.6%, and Italy, better yet, spends still more at 24.9%. But the strongest and most stable of European countries spend even more than these countries on their social safety net: Sweden, 27.3%, Germany, 25.2%, France, 28.4%. The UK falls between the U.S. and the stressed European economies, at 20.5%.[49]

 

Unhappily, on health as on so much else the Republican Party, while proclaiming out of one side of its mouth that we are still number 1, essentially admits the decline by insistently claiming that nothing can be done about it and funding for any government effort to try should be slashed.

 

Ed Kilgore writing in the online June 10, 2012, Washington Monthly, looks at the partisan issues in this election year debate over health care:

 

“By now we should all understand that if you put together GOP plans to repeal the Affordable Care Act and also ‘block-grant’ Medicaid, tens of millions of Americans would quickly lose access to affordable health care. . . . There is a natural partisan-political and ideological affinity for today’s Republicans to pursue this old folks versus poor folks strategy, of course. With the two parties increasingly polarized by age and race/ethnicity, GOPers have every political reason to place the vitiation of Medicare (and for that matter, Social Security) on the back burner, and treat health care for non-seniors as ‘welfare,’ designed for those improvident and/or darker people, to be devolved to the tender mercies and inflexible budgets of state governments.”[50]

 

Opportunity, Inequality, Incarcerations

 

For two hundred years the great merit and attraction of America was its chance for individual advancement, endlessly contrasted to the deadening class barriers of old Europe. The era of the Robber Barons in the nineteenth century displayed uncontrolled power of the ultra rich, at the same time most of the great capitalists were examples of the promise the country offered. Standard Oil founder John D. Rockefeller’s father was a travelling salesman, steel magnate Andrew Carnegie worked in a bobbin factory. Banking lord J. P. Morgan was an unusual exception, his father a wealthy banker before him. There are a few recent examples to keep hopes alive, such as Steve Jobs and Bill Gates. But the class lines have hardened in the United States while easing in Europe. As Nobel laureate in economics Joseph Stiglitz writes,

 

“There is less equality of opportunity in the United States today than there is in Europe – or, indeed, in any advanced industrial country for which there are data. . . . America has the highest level of inequality of any of the advanced countries – and its gap with the rest has been widening. In the ‘recovery’ of 2009-2010, the top 1 percent of US income earners captured 93 percent of the income growth. Other inequality indicators – like wealth, health, and life expectancy – are as bad or even worse. The clear trend is one of concentration of income and wealth at the top, the hollowing out of the middle, and increasing poverty at the bottom.”[51]

 

Stiglitz dates the freeze in upward mobility to around 1980, from the first Reagan administration. It has been marked by the dominance of rent-seeking companies such as Bain Capital at the expense of companies that actually manufacture something, the off-shoring of jobs, and the radical reduction in tax rates for the superrich. He continues:

 

“Many at the bottom, or even in the middle, are not living up to their potential, because the rich, needing few public services and worried that a strong government might redistribute income, use their political influence to cut taxes and curtail government spending. This leads to underinvestment in infrastructure, education, and technology, impeding the engines of growth.”

 

A 2006 study found: “Both the United States and Great Britain have significantly less economic mobility than Canada, Finland, Sweden, Norway, and possibly Germany; and the United States may be a less economically mobile society than Great Britain.”[52]

 

Distinguished investigative journalists Donald L. Barlett and James B. Steele in their recent book, The Betrayal of the American Dream, offer some figures:

 

“From 2002 to 2007, the income gains of the top one percent rose 62 percent, compared to just 4 percent for the bottom 90 percent of households. . . . Among the richest of the rich – individuals and families with incomes in the top one-tenth of one percent – the gains were even more astronomical: their income rose 94 percent, or $3.5 million a household.”[53]

 

Barlett and Steele point squarely to the capture of Congress by special interests of the wealthy as the cause of rapidly advancing inequality and stagnation of the American economy:

 

“Over the last four decades, the elite have systematically rewritten the rules to take care of themselves at everyone else’s expense. As postwar U.S. history shows, it doesn’t have to be this way. For decades after World War II, personal income in the United States grew at roughly the same rate for the rich and everyone else, all except for the poorest Americans. During this period, the gap between the rich and the middle class remained about the same.

 

“The rich would have you believe that high taxes are a damper on the economy, but the postwar economic boom was marked by the highest personal income tax rates on the wealthy in peacetime U.S. history. At one point in the early 1950s, the top rate was 92 percent. . . .the wealthy paid a much higher percentage in taxes than they have paid for many years since. The federal government collected that tax money and routinely reinvested it in the American people. Veterans were able to go to college, families bought homes for the first time and government invested in infrastructure projects such as the interstate highway system.”[54]

 

Joseph Stiglitz in another article explains why our country’s gross inequality is not only unfair, but is a principal cause of the miserable economy:

 

“Those at the top spend a smaller fraction of their income than do those in the bottom and middle – who have to spend everything today just to get by. Redistribution from the bottom to the top of the kind that has been going on in the United States lowers total demand. And the weakness in the U.S. economy arises out of deficient aggregate demand.”[55]

 

Barlett and Steele show that the top 10% of American households have an average income of $930,000 while the bottom 90% average $36,000.[56] With such huge numbers of people circling the drain toward the poverty level it shouldn’t be surprising that another study has found that 46 percent of Americans die with less than $10,000 in assets. “Many of these households also have no housing wealth and rely almost entirely on Social Security benefits for support.” One consequence is that those in this income bracket have no resources for more than the most minimal health expenditures, and have health quality rated at half that of people whose income is even as much as $30,000 and who have assets of $25,000 to $50,000.[57]

 

Economic inequality particularly affects women. On the measure of gender equality, as on so many others, the United States ranks far below the more prosperous and egalitarian north European countries – and many from other parts of the world that should surprise people. A 2008 study of 130 countries by the World Economic Forum ranked nations on women’s wage levels compared to men, female participation in the labor force, and the percentage of female legislators, officials, and technical specialists. The U.S. came in at 27. The first three places were taken by Norway, Finland, and Sweden. But other countries that treat women more equally than the United States included the Philippines, Sri Lanka, Lesotho, Mozambique, and Cuba.[58]

 

Even on our much vaunted freedom of the press the U.S. is a distance away from the best world examples. A 2008 ranking by Freedom House put the United States in the 9th category from the top. Rankings from 0 to 30 were rated free, 31 to 60 partly free, and 61 to 100 unfree. The best scores went to Finland and Iceland at 9. The U.S. was rated 17.[59]

 

While the United States does not lead the pack in positive measures it does better in some of the negative ones affecting the life chances of those at the bottom of the economic heap. According to the United Nations Development Program, with a prison population of 2,186,230 in 2007 the U.S. led the world. It was tops also in the number incarcerated per 100,000 of population, at 738, followed by Russia at 611. Cuba, a Marxist police state, came 5th, at 487, Iran, a Muslim theocracy, at 214. By the time we reach a major European country it is Spain, with incarcerations running 145 per 100,000. Germany is at 95 and France at 85; India jails only 30.[60]

 

And should you dodge prison and pauperization there remains the risk of simply being murdered. Among developed countries for 2000 to 2004 you would have been the safest in Greece, however bad its economy. There, fewer than one person per 100,000 (.8) faced intentional homicide. In Germany it was 1, France 1.6, the UK 2.1, but in the United States 5.6. On this measure, however, the rates are much higher in most of Latin America, Argentina at 9.5 and Mexico at 13. Russia was the worst for an advanced country, at 19.9.

 

Conclusion

 

The far left has always described the United States as a plutocracy. It in fact became that over the last thirty years. Much of this is a consequence of policy. Manufacturing accounted for 30% of American jobs in 1950. In 2011it was only 9%.[61] Good-paying factory jobs were replaced by minimum wage service jobs, much of this in sectors that relied on discretionary spending and wilted during recessions. The static or falling income of the majority shrank demand, so while companies saved on wages by moving to China, India, or Malaysia, their customers at home had less to spend. As college tuitions escalated fewer people went or graduated, reducing the quality of the country’s human capital. The economy became dominated by financial speculators who created no value except numbers in computer spreadsheets. The country’s politics, through the ever more right wing Republican Establishment, has mirrored the values of the old white South, which believes deeply in the morality of an aristocracy ruling over a pauperized peon class. It was a decision of the new plutocracy to defund the training of human capital at home, to encourage governmental and private debt, to allow China to become the nation’s chief creditor.

 

Democrats have not been angels in all this. To blunt the Republican attacks they have sidled from classic welfare-state-defending liberals to centrists. And for the most part they have been unwilling to confront or try to do much about the mounting ecological threats. In their defense, in countries with large numbers of religious dogmatists democracy produces less than happy results. The overthrow of semi-secular tyrants in the Middle East more often than not opens the door to Islamic fanatics with a genuine mass base.

 

In the United States the militant Evangelical Christian Right with its vision of a pre-scientific theocracy commands a sizable portion of the electorate and has proven capable of setting serious limits to reform through electoral or congressional channels. That this movement, heavily composed of older racist whites, sees the poor as its enemy and our common government as an un-Christian evil, says a great deal about how far this movement has strayed from anything you might find in the New Testament outside of the bloodthirsty Book of Revelations, the favorite text of the supposed Bible literalists.

 

There are factors beyond policy and its woes that are shaping our dilemma. The rise of China, India, Brazil, and Russia have all promoted variants of strong-state capitalism, which is proving more able to compete in today’s world than the ultra-market American variety (which hypocritically includes almost limitless corporate welfare for companies that have providentially bought ties to American politicians).

 

Another element is the deepening environmental crisis, composed of overpopulation, resource depletion, and the early effects of global warming. As demand for finite materials such as oil, iron ore, phosphorus, rare earth metals, potable water, and arable land come up against physical limits, prices have been escalating and scarcities looming, contributing strongly to repeated deeper and deeper world recessions and threatening governments in the less prosperous parts of the third world, especially in the Middle East.

 

Oil, essential to transportation and agriculture, has escalated in price from $18.64 a barrel in 1997[62] to $97 in August 2012, with much of the country importing European oil at a current cost of $115 a barrel. Ravenous demands for many forms of metals are running ahead of world production as larger and easily mined deposits are tapped out. Prices consequently have been skyrocketing, placing heavy stresses on world economies. Here are some examples from the U.S. Geological Service of prices in 1997 compared to 2011[63]:

 

Iron and steel scrap: $124 a ton in 1997, in 2011, $500.

Tin: $2.65/lb in 1997, in 2011, $12.60/lb

Tungsten: $66/metric ton in 1997, in 2011, $250

Copper: $108/lb in 1997, in 2011 $405

 

Rampant inflation of such raw materials, matched to the depressed American economy, is producing symptoms more typical of the worst of the third world. The Los Angeles Times reports, “Burglars around California have torn up train tracks, carted off bleachers, nabbed park statues and helped themselves to copper wiring serving neighborhoods, hospitals and airports.”[64] They even stole a 200 pound brass bell from a Catholic church. Cities are taking down and hiding their historical brass plaques Six people have been electrocuted in the last two years stealing copper wire from street lights. The wiring from the Modesto Airport runway lights has been stolen twice. 10,000 street lights in Sacramento, the state capital, a quarter of the city’s total, went dark when thieves ripped out the wiring. The other side of this Banana republic picture is that cutbacks of inspectors have been so severe that there are only two detectives in the whole of Los Angeles County to try to monitor the scores of legal and illegal metal recycling yards where the stuff is sold.

 

The Republican Party, while it publicly denies virtually every specific of this growing crisis, founds it whole current economic policy on their reality, promoting a vision of the future that all too much resembles the last days of Rome, when, in face of social collapse, the Senators retreated to their rural villas and abandoned the public sphere, ruling as despots over vassals who had once been citizens.

 

I believe the ecological crisis is real and will only get worse. Thus far the North European welfare states have met it far better than the United States. On every measure of prosperity, well being, and fairness they come in at the top of the lists while America has fallen to the bottom. If we are going to see hard times ahead caused by objective forces such as global warming and price wars over scarce natural resources we should want to face this with a government we can trust to act in the interests of all of us, not only in the interests of an ever-richer and more arrogant minority.

 

Notes

[1] Time magazine, March 3, 2011.

[2] http://www.cgsnet.org/ckfinder/userfiles/files/comm_2011_11.pdf

[3] http://www.geographic.org/country_ranks/educational_score_performance_
country_ranks_2009_oecd.html

[4] http://www.cfr.org/united-states/us-education-reform-national-security/p27618

[5] http://www.cfr.org/united-states/us-education-reform-national-security/p27618

[6] http://www.globalinnovationindex.org/gii/main/fullreport/index.html

[7] Fareed Zakaria, CNNWorld, November 3rd, 2011.

[8] Christian Science Monitor, July 16, 2012

[9] Reported by USA Today, Nov 21, 2008.

[10] Washington Post, July 3, 2010.

[11] The Atlantic Wire, June 3, 2010.

[12] CBS News online, December 23, 2011.

[13] MinnPost 6-01-2012 http://www.minnpost.com/eric-black-ink/2012/06/almost-half-us-dont-believe-evolution.

[14] Science Daily, March 13, 2009.

[15] New York Times, October 1, 2010.

[16] CBC News, Calgary, Aug 15, 2012.

[17] New York Times, Aug 1, 2012.

[18] University of Virginia, Miller Center, http://millercenter.org/public/debates/infrastructure, accessed Aug 17, 2012.

[19] http://www.photius.com/rankings/infrastructure_quality_country_rankings_2011.html

[20] Knowledge Center, The Council of State Governments, May 23, 2011

[21] New York Times, Feb 15, 2010.

[22] USA Today, May 20, 2012.

[23] Bloomberg, June 13, 2012.

[24] http://en.wikipedia.org/wiki/List_of_countries_by_number_of_mobile_phones_in_use.

[25] TechSpot July 26, 2011.

[26] Christian Science Monitor, June 8, 2012.

[27] US News, Aug 22, 2011.

[28] http://www.epi.org/publication/ib339-us-poverty-higher-safety-net-weaker/

[29] http://www.census.gov/hhes/www/poverty/data/threshld/index.html

[30] http://www.numbeo.com/cost-of-living/city_result.jsp?country=United+States&city=Los+Angeles%2C+CA

[31] Adamson, Peter. 2012. “Measuring Child Poverty: New League Tables of Child Poverty in the World’s Rich Countries,” UNICEF Innocenti Research Centre Report Card 10. http://www.unicef.org.uk/Documents/Publications/RC10-measuring-child-poverty.pdf

[32] UNICEF Innocenti Research Centre http://www.photius.com/rankings/child_well_being_in_rich_countries_2007.html

[33] http://www.endhomelessness.org/content/article/detail/4361/, p. 5 of the PDF.

[34] Ibid. p. 9.

[35] Ibid., p. 16.

[36] Ibid., p. 6.

[37] http://www.communities.gov.uk/archived/publications/housing/internationalhomelessnessreview.

[38] An International Review of Homelessness and Social Housing Policy p. 17.

[39] http://www.endhomelessness.org/content/article/detail/4361/, p. 21 of the PDF.

[40] http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html

[41] http://facts.kff.org/chart.aspx?ch=477.

[42] http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Apr/Gaps-in-Health-Insurance.aspx

[43] Figures for 2010, from UNICEF, http://www.allcountries.org/ranks/diabetes_prevalence_country_ranks.html.html

[44] https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

[45] https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

[46] “Measuring The Health Of Nations: Updating An Earlier Analysis”, Ellen Nolte and C. Martin McKee, Health Affairs, 27, no. 1 (2008): 58-71 The ranking table was produced by Photius Coutsoukis, based on research supported by The Commonwealth Fund and published in the January/February 2008 issue of Health Affairs, Bethesda, MD, USA. http://www.allcountries.org/ranks/preventable_deaths_country_ranks_1997-1998_2002-2003_2008.html

[47] http://icasualties.org/

[48] http://articles.philly.com/2012-08-01/news/32982010_1_eric-finkelstein-obesity-premature-death

[49] http://www.oecd-ilibrary.org/social-issues-migration-health/government-social-spending_20743904-table1.

[50] http://www.washingtonmonthly.com/political-animal-a/2012_06/health_care_race_to_the_bottom037852.php

[51] http://www.slate.com/articles/business/project_syndicate/2012/06/the_american_dream_
is_dying_here_s_how_we_can_fix_it_.html

[52] Emily Beller and Michael Hout, “Intergenerational Social Mobility: The United States in Comparative Perspective,”

The Future of Children journal, Princeton-Brookings, Vol 16, No. 2, Fall 2006

[53] Betrayal of the American Dream, p. 18.

[54] Ibid., p. 17.

[55] http://www.washingtonpost.com/opinions/how-policy-has-contributed-to-the-great-economic-divide/2012/06/22/gJQAXTX2vV_story.html

[56] The Betrayal of the American Dream, p. 11.

[57] Wonkblog, Washington Post, August 3,2012.

[58] http://www.allcountries.org/ranks/gender_gap_gender_equality_country_rankings_2008.html

[59] http://www.photius.com/rankings/freedom_of_the_press_2008.html

[60] http://www.allcountries.org/ranks/prison_incarceration_rates_of_countries_2007.html

[61] The Betrayal of the American Dream, p. 268.

[62] http://inflationdata.com/inflation/Inflation_Rate/Historical_Oil_Prices_Table.asp

[63] http://minerals.usgs.gov/minerals/pubs/commodity/

[64] Los Angeles Times, Aug 22, 2012.

 

 

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