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July 21, 2008

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In Flight of the Creative Class, I argued that America was no longer a single country, but  two or more divided along the lines of social and economic class. Now, alongside Bill Bishop's, The Big Sort, comes a new American Human Development Index, modeled on the landmark UN report.  The Independent summarizes some of its key findings.

The United States of America is becoming less united by the day. A 30-year gap now exists in the average life expectancy between Mississippi, in the Deep South, and Connecticut, in prosperous New England. Huge disparities have also opened up in income, health and education depending on where people live in the US, according to a report published yesterday.

The American Human Development Index has applied to the US an aid agency approach to measuring well-being – more familiar to observers of the Third World – with shocking results. The US finds itself ranked 42nd in global life expectancy and 34th in survival of infants to age. Suicide and murder are among the top 15 causes of death and although the US is home to just 5 per cent of the global population it accounts for 24 per cent of the world's prisoners.

Despite an almost cult-like devotion to the belief that unfettered free enterprise is the best way to lift Americans out of poverty, the report points to a rigged system that does little to lessen inequalities.

"The report shows that although America is one of the richest nations in the world, it is woefully behind when it comes to providing opportunity and choices to all Americans to build a better life," the authors said.

Some of its more shocking findings reveal that, in parts of Texas, the percentage of adults who pass through high school has not improved since the 1970s.

Asian-American males have the best quality of life and black Americans the lowest, with a staggering 50-year life expectancy gap between the two groups.

Despite the fact that the US spends roughly $5.2bn (£2.6bn) every day on health care, more per capita than any other nation in the world, Americans live shorter lives than citizens of every western European and Nordic country, bar Denmark..

Using official government statistics, the study points out that because American schools are funded primarily from local property taxes, rich districts get the best state education. The US has no federally mandated sick pay, paternity leave or annual paid vacation.

"Some Americans are living anywhere from 30 to 50 years behind others when it comes to issues we all care about: health, education and standard of living," said Sarah Burd-Sharps co-author of the report.

Although the US is one of the most powerful and rich nations in the world, the study concludes it is "woefully behind when it comes to providing opportunity and choices to all Americans to build a better life".


The report is here, some key factoids, and a series of maps.


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What does Connecticut have in common with Western Europe? Lots of rich white people. Hmmm. I'm sure the government can forcibly change everyone so that they live their lives like the Danes. Now if we could only get rid of that unfettered free market ...

Except that places like Switzerland and the Nordic countries have very competitive free-market economies, they just happen to also have large welfare states. This "market economies make people poor" meme that constantly resurfaces on this blog needs to go. You can argue about the proper size of the welfare state without pretending that "the market" causes poverty.

hayden fisher

The "inequalities" could also be argued to be increasing because it's become so much easier to become a millionaire in the US. And it truly has. It's become a lot easier to start a new business. And I would bet that we have a lot fewer outhouses in backwards America than we did 30 years ago.

The sad reality is that Europe seems to be moving more towards a market-based economy while some in the US want to take us backwards. Corporate taxing rates have been slashed considerably in many European countries for example. We taught them what to do, why people here don't get it is beyond comprehension.

Two quick points on the health care statistics: (1) murder and suicide need to be sorted-out of the statistics to get a true read; and (2) the government spends a lot of money on illegal immigrants and the truly poor, our system is very generous already, we don't need to socialize it and kill the golden goose.


In the USA, the market distorts healthcare delivery, so of course Americans do not live as long as those with government provided or guaranteed medical care. The market causes very unequal access to good quality education, particularly in the primary and secondary years. So quality of life is lower.

When US society is compared with that of Canada, for example, it is evident that Canada has a much , much smaller underclass, a more widespead middle class, and is a society where everyone gets healthcare - no families going bankrupt because of medical bills. Devotion to the idea of the free market has prevented the USA from developing a system that incorporates some socialistic elements where needed, such as in healthcare, most obviously.


The statistics aren't the most troubling thing. To me, it's far more worrying that there's limited awareness of findings like this. It seems to have gotten less coverage in US press than abroad; you picked it up from a UK paper. And back in the US, the debate seems to be all about whether the study is accurate and fair.

One thing that I think makes the data harder to grasp is the inability to compare the overall state-by-state HD index to other countries in the world. There are probably good statistical reasons to do that, but I do wonder if the data would be more meaningful that way. For example, it looks like the best state life expectancy (Hawaii) is equal to that in Hong Kong, which is ranked 6th in the world, while Mississipi is roughly on par with Macedonia, 88th in the world.

I can understand a vigorous left-vs-right debate once people start talkng about solutions, but it seems like there are some core findings that should cut across political lines. Shouldn't all Americans should be outraged by the billions of private and public money apparently wasted on inefficient health care? (This study shows overall spending is twice as much per capita as Australia, with worse results. That's too wide a gap to blame on illegal immigrants.) Isn't a "land of opportunity" at risk when so many statistics suggest that opportunity is far from equal? Or have US politics become so polarized that it isn't even possible to agree on the problems anymore?

hayden fisher

Good final comment Matt, they're definitely too polarized to be divided into Red and Blue like a tastes great/less filling Miller Lite commercial of the 80's.

More governmental involvement is welcome on the macro-economic level, finally Hamiltonian federalism has arrived!! And certainly government has a leading role to play in the areas of health care and education so long as it does not step over the line and begin to deliver health care. The inner city Catholic schools in this country do a MUCH better job educating troubled youths than do their public counter-parts with significantly less funds. So as much as the liberals would like to blame the wealthy and try to tax our way out this mess, it's not going to work. All of the dollars get lost in the DC black hole and administrative red-tape cycle. Government should provide the funds and set some benchmarks and guidelines and then get out of the way. Much like the Fed now regulates the markets. The actual educating and patient-treating should be conducted from the bottom-up subject to guidelines, or in the case of medicine, standards of care articulated from the top or via industry professional associations. It's complicated, but generally, that's how these two arenas should be framed.


Hayden, maybe it's not so complicated. You've come closer to describing the Canadian healthcare system than you (or some Canadians) might realize.

Canadian family doctors and specialists aren't civil servants and local clinics aren't government agencies -- routine health care is delivered by the private sector, including for-profit companies. But it's a "single-payer" system where, with minor exceptions, the government is the only insurer. Like a US private insurance company, the government has its specified rates and rules, just like private insurance companies in the US, but coverage is based on residency, not employment.

As for taxes, the dirty little secret is that it isn't much of a tax burden at all. Specific numbers from this report: in the US, health care spending per capita is $2887 public + $3514 private. In Canada (US$ at purchasing power parity), it's $2307 public + $1018 private. So there's actually _less_ tax-based healthcare spending in Canada, even as a percentage of GDP, and even though it's paying for near-universal coverage.

I mention all this because it's too easy to dismiss other countries' systems as "socialized", but if you look at the details you'll find more pragmatism than ideology. (To be fair, I don't think you'd like the Canada Health Act's restrictions on private insurance, but there are other countries that have mixed public/private insurance systems.)

Oh, and your comment made me wonder if the "DC black hole and administrative red-tape cycle" inflates the cost of public programs more than government administration in other countries. It may well be; the interesting question is why.



At least for education, you seem to be arguing for less governmental involvement, not more. What you described is basically a voucher system that would allow parents to choose to send their children to government schools or private schools using money from the government.

This would likely do more to help education in America than any other reform. However, people need to realize that there are genetic and cultural mores that will prevent a fairly large percentage of the population from "achieving high enough" with regards to education. Many people seem to forget that some people are plain dumb, and that others could care less about education. Throwing money at school districts is unlikely to help these folks.

hayden fisher

Matt and GU, great comments! Governmental participation in both education and health care is welcome so long as the government supplants insurance companies generally as the ultimate driver of health-care delivery and services. Profit margins are important but they should be derived by the doctors and practices that deliver the best health care at the most competitive price or some combination thereof. The patients should be choosing, not their employers, and certainly not insurance companies motivated solely by profits far and away from the physician-patient interactions. Patients, as customers, should be able to choose for themselves, forcing true competition amongst providers. The voucher education system would drive the same paradigm. Students/parents would choose schools and certainly companies would begin to specialize in providing education in diverse environments. For some, the focus would involve serous mental and emotional health counseling and the provision of care typically provided by parents. Others would focus on core fundamentals and still others on cultivating specific talents and gifts. In inner cities, public boarding schools should probably be considered for at risk children. Bottom line, we need innovative and creative solutions and to avoid knee-jerk dogmatic reactions to the same. If everyone could put aside their political agendas and strive towards a new model, things could be a lot better and costs could be reduced as well. Instead, we get useless rhetorical and customary responses like more laptops for the kids. What good does that do if the child's parent hijacks the the laptop at home to watch porn for example; of if the child receives minimal training about how to use the laptop. Putting computers in classrooms, by itself, does nothing except when implemented in the context of a specific plan.

In any event, complicated issues but the answers could be much more simple if we eliminated dogma and looked for creative common-sense solutions.

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