Forum Post: America in denial: We're number 29 (of 30)

By Paul Rosenburg

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.

US healthcare law leaves millions without coverage 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.

http://www.aljazeera.com/indepth/opinion/2012/07/2012717104035237926.html