Responding to the jingoism around the First Gulf War, Andrew Shapiro’s 1992 book, We’re Number One!: Where America Stands – and Falls – in the New World Order was a sober-minded reality check on how the US really measured up. Just last month, a worthy successor appeared, a short ebook, Decline of the USA, by Edward Fullbrook, comparing the US to the other 29 countries in the OECD (Organisation for Economic Co-operation and Development) in a series of tables, with only a brief dash of introductory text.
Fullbrook is the editor of the Real World Economic Review, the online journal of heterodox economics that emerged out of the empirically-driven “post-autistic economics” movement of the previous decade. The data presented here – challenging presumptions of superiority and leadership with stubborn facts – epitomises what the post-autistic movement was all about.
The book looks at eight indicators each in seven categories, ranking counties in order along with precise figures for how they score. It also divides them into first, second and third divisions (in sets of 10), which comes in handy for gauging overall performance. The seven categories are: health, family, education, income and leisure, freedom and democracy, public order and safety, and generosity. Indicators include things like life expectancy at birth, infant mortality rate, share of income received by richest 10 per cent, years of life lost in injury, etc. Those with some awareness of these sorts of measures will probably not be surprised to learn that the United States ranks next to last overall (go Mexico!), while those who get their information from FOX or other corporate media may be stunned to the point of disbelief.
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But there’s more to this than so-called “America bashing”. The indicators raise serious questions about what we value (even just attend to) and why, as well as presenting some interesting surprises. They also reveal who we Americans ought to be modelling our policies on if we really want our country to excel.
Health and wealth
Let’s start off by considering the health category, since healthcare is very much in the news in the US, and what’s happening with it now so richly illustrates the value of Fullbrook’s austere marshalling of stubborn facts. Republicans repeatedly claim that the US has the best healthcare system in the world. And if you’re a third-world dictator – the Shah of Iran, most famously – you would probably be inclined to agree. But for actual American citizens? Not so much. The indicators in this category, along with the United States’ ranking, are as follows: life expectancy at birth (24), healthy life expectancy at birth (24 [tied] out of 29), probability of not reaching the age of 60 (25), infant mortality rate (25), obesity (30), practicing physicians per capita (23), acute care hospital beds per capita (25 out of 29), psychiatric care beds per capita (25 out of 29).
There is no indicator for percentage of people with health care, perhaps because universal coverage is taken for granted in the rest of the developed world, which includes virtually all of the OECD members except Turkey and Mexico. On the combined index of health care indicators, the US comes in at 28, just ahead of … Turkey and Mexico.
Why does the US fare so poorly? It can’t be lack of resources, since the US is still the richest nation in the world, and spends far more per capita on health care than anyone else. Political will is another matter entirely, however, as illustrated by the latest fall-out from the Supreme Court’s healthcare decision: A number of Republican governors are rejecting expansions of Medicaid that would substantially reduce the number of people without healthcare – which, of course, could only help the US’ ranking in Fullbrook’s book. The federal government would pay for all the costs the first three years and at least 90 per cent of the costs in the long run.
Even paying 10 per cent, states could make money on the deal, because fewer people are uninsured, requiring more expensive ER treatment, more people get less expensive preventive treatment, etc. But if you hate the federal government as much as you hate poor people, it’s easy to spin this expansion as a bad thing. Texas Governor Rick Perry – who presides over the largest such state – shows us how. Talking Points Memo reported:
“One in four Texans are uninsured, the highest rate of any state. The Medicaid expansion would cover 49.4 per cent of uninsured Texans by 2019, according to the Kaiser Family Foundation. The programme is broadened to cover Americans within 133 per cent of the poverty line – currently the eligibility for a working Texan parent cuts off at 27 per cent. The federal government will cover the full cost of the first three years and pay 90 per cent thereafter.”
But Perry was defiantly proud of Texas. When pressed by a usually friendly Fox News reporter, who pointed to Texas’ last-place ranking on a multifaceted measure of state health care performance, Perry exhibited classic conservative behaviour, engaging in several ego defence mechanisms at once – most notably narcissistic ones. His over-all approach was a form of rationalisation (making excuses), he went into denial (calling the data “fake and false on its face”), he engaged in projection (saying that the federal government doesn’t like Texas) and fantasy (claims about how wonderful Texas health care is). Here’s a short snippet of what Perry said:
“We’ve got some of the finest health care in the world whether it’s MD Anderson or UT Southwest, some incredible health care facilities in the country. So the idea that this federal government which doesn’t like Texas to begin with to pick and choose and come up with some data and say somehow Texas has the worst health care system in the world is just fake and false on its face. The real issue here is about freedom.”
If you want to finish in last place, that’s the way you do it – indulging in unconscious defence mechanisms to make yourself feel better, rather than using conscious coping strategies that can help you actually do better. In the real world, the Agency for Healthcare Research and Quality exists to identify what works and what doesn’t – indispensable information if you want to things right. But in Perry’s hyper-defensive mind, it only exists to make Texas look bad. And Perry’s attitude typifies the US all too well, as you read through Fullbrook’s book. Clinging to a false sense of superiority is the absolute worst strategy for actually attaining superiority. And yet it seems to dominate American political discourse.
Exhibit A, in that regard: American conservatives just love to yammer on about the family, as if they invented it. But the US record on family issues is no better than its record on health care. The family indicators are as follows, along with the US rank: teenage pregnancy births per 1,000 women aged 15-19 (28 out of 28); paid maternity leave entitlement as a percentage of annual wage (29/29); public spending on family benefits in cash, services and tax measures (26/29); child poverty rate (25/26); family-time index (22/27); percentage of young people (0-14) living with both parents (21/23); percentage of young adolescents living with both parents (26/26); and divorce rate (30). All together, the US comes in dead last in the combined index of family indicators.
These low rankings are directly related to conservative practices and social policies. Divorce rates and teen pregnancy rates are both higher in “red states”, a result of patterns of family formation according to law professors Naomi Cahn and June Carbone in their book Red Families v. Blue Families: Legal Polarisation and the Creation of Culture. Even aside from culture, practices like “abstinence only” sex education and restrictive access to birth control both make for higher teen pregnancy rates. In the US, conservative politicians even opposed unpaid maternity leave – no wonder the US is the only advanced industrial nation with zero weeks of paid maternity leave – and very low rates of any public spending in the way of family support. In short, conservatives really are uniquely responsible for the United States’ poor showing in the family category – the exact opposite of what they tend to believe.
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When it comes to freedom and democracy, however, conservatives are not alone in mistakenly thinking that the US leads the world, when it’s actually dragging up the rear among the advanced industrial nations. The US does score in the mid-range on a couple of indicators, but fails abysmally on others: voter turnout for parliamentary elections (30); female parliamentarians (24); gender gap [economic, political, etc.] (13 -tied); corruption perceptions index (18); press freedom index (26/29); collective bargaining coverage (24/25); prisoners per capita (29/29); support for human rights [international agreements signed] (30). For the category as a whole, the US ranks 28th out of 30.
The story is not much different for three other categories: The US scores last in public order and safety (30th) and in generosity (24/24), and 27th out of 30 in income and leisure.
There is one category in which the US does dramatically better than any other – education. Although its Number 18 rating is still slightly below average, this is the only category in which it finishes more than a few slots from the bottom. Yet, this is the one category on which you will regularly hear the US get bashed by its own elite political class.
The reason for this isn’t hard to figure out: It’s the only category that conservatives routinely bash the United States for (much less tolerate America-bashing by others). It’s part of their war on everything public or governmental, and education-bashing also serves as a scapegoat for all the other failures that conservatives categorically deny. Neoliberals like Clinton and Obama have joined in with conservatives, seeking one more illusory “grand bargain” while dropping almost all talk about the United States’ real education problem – its spectacular levels of child poverty (25/26) and economic inequality (28/29).
For example, a 2010 international comparison found that US schools which had fewer than 10 per cent of their students receiving free or reduced lunches due to poverty had a reading score of 551 – second only to Shanghai, China. On the other hand, schools with 75 per cent or more in those programmes scored 446 – less than Greece, which scored 483 and received last place. Thus, education – the one area the US does relatively well in – is scapegoated to avoid debating the real underlying problems facing the US, where it ranks almost at the bottom. This is precisely the way conservatives want things, and yet the so-called “liberal media” and much of the national Democratic Party goes along with it as well.
As I argued in a recent column, even most conservative voters don’t want to cut welfare state spending. Yet the Republican Party keeps moving further and further to the right, and Democrats keep trying to compromise with them – getting further and further away from what the American people really want. One reason this pathological dynamic persists can be found in what I’ve just described – a perverse set of narratives embraced by bipartisan elites, which simply has no place for pesky old facts to get in the way.
In the meantime, Fullbrook’s book reminds us that there’s a rational order in the world – that countries can learn from one another’s experience in tackling social problems and challenges, and that by striving to match what already works elsewhere, they can make their own countries better. This is, after all, the Enlightenment faith on which the United States was founded. Real patriots fix problems, they don’t deny them.
Paul Rosenberg is the senior editor of Random Lengths News, a bi-weekly alternative community newspaper.