How to Really Make America Great Again

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Don the Con wheedled his way into the presidency with his brand of sloganeering and snake oil, sticking his opponents with his snide names and claiming he would “make America great again.” His administration appointments in the past several weeks provide a clue to what exactly that means: more trickle down, less regulation, and a heapin’ helpin’ of radical right. He has awakened the beast and now he has to feed it. Of course, he’s already backing off some of his signature bluster he used to rouse the rabble—maybe not a wall but a nice fence. Maybe he wouldn’t throw Hillary into jail.

But if he sincerely (and I use the term loosely) wanted to make America great again, statistics provide a wealth of information on how the United States has slipped relative to the rest of the developed world. What follows is just a portion of the categories we’ve fallen behind in, followed by extensive excerpts on some of these failings from the recent book American Amnesia: How the War on Government Led Us to Forget What Made America Prosper, by Jacob S. Hacker and Paul Pierson. As a New York Times book review remarked on the book’s thesis:

The country has been brainwashed by a powerful alliance of forces hostile to government: big business, especially Wall Street, spending unparalleled lobbying dollars to advance its narrow self-interest; a new wealthy elite propagating wrongheaded Ayn Randian notions that free markets are always good and government always bad; and a Republican Party using a strategy of attacking and weakening government as a way to win more power for itself.

In 2013, the Huffington Post (http://www.huffingtonpost.com/eric-zuesse/how-the-us-performs-in-re_b_3080446.html) published the following figures of our ranking in the world on these various categories:

“Child Well-Being in Rich Countries” ranks 29 developed countries, according to the well-being of their children, on numerous factors.

The U.S. ranks #26 overall for “Child Well-Being.” This overall rank includes: #26 for “Material Well-Being”; #28 for “Child Poverty Rates”; #25 for “Health and Safety”; #26 for “Infant Mortality Rates”; #26 for “Low Birthweight”; #22 for “Immunization Rates”; #27 for “Educational Well-Being”; #27 for “Preschool Enrollment Rates”; #25 for “Participation in Further Education”; #16 for “Educational Achievement by Age 15”; #29 for “Overweight”; #2 for “Exercise”; #29 for teen-pregnancy rates; #1 for “Alcohol” (U.S. receives the top rank for absence of drunkenness); #4 for “Smoking” (again, absence); #11 for “Fighting”; #12 for “Being Bullied”; #23 for “Housing”; #27 for “Homicide”; #3 for (lack of) “Air Pollution”; #23 for children’s self-reported “Life Satisfaction”; and #28 for “Relationships with Parents and Peers.”

A much broader ranking-system, from the World Economic Forum, is “The Global Competitiveness Report 2012-2013,” which ranks 144 countries, on a wide range of factors related to global economic competitiveness.

These include the following:

  • #34 on “Life Expectancy”
  • #41 on “Infant Mortality” (unlike the “Infant Mortality” rankings from UNICEF, this ranking is among 144 countries—thus some underdeveloped countries actually have higher life-expectancy than does the U.S.)
  • #38 on “Quality of Primary Education”
  • #58 on “Primary Education Enrollment Rate”
  • #28 on “Quality of the Educational System”
  • #47 on “Quality of Math and Science Education”
  • #12 on “PCT [Patent Cooperation Treaty] Patent Applications [per-capita]”
  • #14 on “Firm-Level Technology Absorption” (which is an indicator of business-acceptance of inventions), we are #14.

Trust is likewise only moderately high in the U.S.:

  • #10 on “Willingness to Delegate Authority”
  • #42 on “Cooperation in Labor-Employer Relations”
  • #18 in “Degree of Customer Orientation”

Corruption seems to be a rather pervasive problem in the U.S.:

  • #34 on “Diversion of Public Funds [due to corruption]”
  • #42 on “Irregular Payments and Bribes” (which is perhaps an even better measure of lack of corruption)
  • #54 on “Public Trust in Politicians”
  • #38 on “Judicial Independence”
  • #59 on “Favoritism in Decisions of Government Officials” (otherwise known as governmental “cronyism”)
  • #87 on “Organized Crime”
  • #29 on “Ethical Behavior of Firms”
  • #30 on “Reliability of Police Services”
  • #56 on “Transparency of Governmental Policymaking”
  • #37 on “Efficiency of Legal Framework in Challenging Regulations”
  • #35 on “Efficiency of Legal Framework in Settling Disputes”

Investors evidently find somewhat shaky ground in the U.S.

  • #33 on “Protection of Minority Shareholders’ Interests”
  • #23 on “Efficacy of Corporate Boards”
  • #19 on “Reliance on Professional Management”
  • #37 on “Strength of Auditing and Reporting Standards”
  • #80 on “Soundness of Banks”
  • #39 on “Regulation of Securities Exchanges”

* * * *

In American Amnesia, a well-annotated book for someone interested in their research, Hacker and Pierson write that the evidence of our drift downwards towards the Third World is evident in many ways:

Americans are no longer the tallest people in the world. Not even close: Once three inches taller than residents of the Old World, on average, Americans are now about three inches shorter. The average Dutch height for men is six foot one, and for women, five foot eight—versus five foot nine for American men and five foot five for American women. . . .

Because height is a powerful indicator of social and individual health, America’s relative decline should ring alarms. Our young are coming up short, relative not just to gains in stature of the past but also to gains in stature in other rich nations. . . .

So it is more than a little disconcerting that health is also where the United States does most poorly compared with other rich nations. In 2013, the prestigious National Academy of Sciences released a mammoth report with a self-explanatory title: U.S. Health in International Perspective: Shorter Lives, Poorer Health. “The United States is among the wealthiest nations in the world,” the report began, “but it is far from the healthiest. . . . Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries.”

On virtually all measures, according to the report, the United States is losing ground rapidly to other rich nations. At midcentury, Americans were generally healthier than citizens of other rich nations, and as late as 1980, they were still not far from the middle of the pack. Since then, however other rich countries have seen rapid health gains. The United States has not.

Take life expectancy at birth—the easiest statistic to track, since death records are generally reliable and consistent across nations. The National Academies study looked at seventeen rich nations. Among these, the United States ranked seventeenth for men in 2011 (life expectancy: 76.3 years, a full 4.2 years shorter than the top-ranking nation). It ranked an equally dismal seventeenth for women (81.1 years, 4.8 years shorter than the top-ranking nation. . . .

The relative decline has been particularly steep for an unlikely group: middle-aged white adults. In a groundbreaking 2015 study, the Princeton University economists Anne Case and Angus Deaton (the latter the recipient of the Nobel Prize in Economics that same year) dug into the mortality statistics to examine how and why the American experience departed so starkly from the international norm. Their startling result: Whites ages forty-five to fifty-four were dying at higher rates in 2013 than they had been in 1999, even as every other rich country had seen dramatic drops in mortality in this age group. . . . The only other example of such a shocking loss of life in recent decades is the AIDS epidemic.

The authors noted that this is particularly true among those citizens who might have been Trump’s biggest supporters:

The trend was most devastating for whites with a high school diploma or less. In 2013 there were 736 deaths per 100,000 people within this group, up from 601 per 100,000 in 1999. (By comparison, the death rate for people in this age group in Canada fell from around 300 per 100,000 in 1999 to just under 249 per 100,000 in 2011.) But those who had gone to college but not received a degree saw no distinguishable improvement in death rates either—even as, again, such rates plummeted abroad. Only among whites with a college degree did death rates fall substantially over this period. In 2013, white adults in the forty-five- to fifty-four-year-old age group with no more than a high school diploma were more than four times as likely to die as those with a college degree.

To be clear, many measures of health are improving in the United States. But they are improving much more slowly than in other countries. One grim statistic commonly used by demographers is the chance that a fifteen-year-old will die before age fifty. For American women, it’s 4 percent: four in a hundred women die between fifteen and fifty. The average for other rich nations is around 2 percent, and, on average, death rates in these nations fell below 4 percent almost forty years ago. We are more than a generation behind.

A similar story can be told about infant mortality, or deaths of children before their first birthday. In 1960 infant mortality in the United States was lower than in the majority of other rich nations. In recent decades, however, America has seen limited improvement, while death rates for infants have continued to plummet abroad. In 2011 the average rate of infant death in other rich nations was 1 child for every 300 or so births. In the United States, it was roughly twice that—1 child for every 164 births. That year, the only countries in the Organization for Economic Cooperation and Development (OECD) with higher rates of infant mortality were Chile, Mexico, and Turkey.

This unimpressive performance is particularly striking because the United States spends so much more on health care than other rich nations do—roughly twice as much per person. Of course, medical care is not the only or even the most important determinant of health. But the United States does poorly even where health care matters most. For almost every cause—from injuries to diseases—death rates are the highest or nearly the highest in the United States. And we have the highest rate of what health experts call “amenable mortality”: deaths that could have been prevented with the provision of timely and effective care. Despite high spending, we are falling behind other rich nations in reducing such preventable deaths. We don’t see our relative decline because we are getting better at preventing death. But we’re getting better far too slowly for a rich nation.

This problem in our healthcare system—a lack of universal insurance, the stranglehold Big Pharm has on pricing, and so forth—is well documented elsewhere, but the authors don’t stop there. They touch next on education, where we once led the pack:

As the Harvard economists Lawrence Katz and Claudia Goldin show in their revelatory The Race Between Education and Technology, we bolted decades ahead of other Western nations in the spread of elementary and then high schools during the twentieth century, and we were the world leader in college education in the immediate decades after World War II. No more. The United States is now a mediocre performer in international education rankings. . . . The United States now ranks twentieth out of twenty-seven OECD nations in the share of young people expected to finish high school.

A measure of that, of course, is attributable to the school-to-prison pipeline, duly noted:

Another reason is that young adults behind bars disappear from the statistics. In most rich nations, this distinction makes little difference because incarceration is so rare. In the United States—which incarcerates roughly ten times as high a share of the population (eight in a thousand versus fewer than one in a thousand in most other advanced industrial democracies)—it makes a real difference, especially for demographic groups with the highest rates of incarceration. Indeed, the high school dropout rate for young black men is more than 40 percent higher when we include in our count the incarcerated, wiping out all the apparent gains in their high school completion since the late 1980s. Here again, conventional indicators present an overly sunny picture of our relative performance.

The big story, however, is our relative decline in higher education. The United States has many of the finest institutions of higher education in the world. The problem is that the share of young people getting a degree is rising much more slowly in the United States than in other OECD nations. One reason is the erosion of public support through federal grants and state universities, leaving students and their families much more reliant on loans. Once without peer, the United States has fallen to nineteenth in college completion in the OECD, and the gap in completion between higher-income and lower-income students has widened. Older Americans are the most educated in the world. Younger Americans, not even close.

Much of the discrepancy can be laid on the inequality of educational opportunity. The push now—among people like Trump’s choice of Betsy DeVos to lead the Education Department—is for public funding of charter schools, in the form of vouchers. These schools have shown to be no better (and often worse) than their public counterparts. They not only siphon funds from public education; the money is also used to pay CEO salaries and the like. And as some reports have noted, the net effect in some states is that the schools are now more segregated than they were in the Fifties.

And if the United States as a whole is in the breakdown lane, some Americans are barely getting on the road. At least as striking as our poor performance among the young is how unequal educational opportunities in the United States are. Decades after de jure integration of schools and the famous 1966 Coleman Report on the subpar schooling of the poor, we remain a nation with gaps in educational quality, funding, and outcomes that are far greater than the norm for developed democracies. These gaps not only thwart the upward progress of tens of millions of Americans but hold back our economy overall.

Since the 1960s, the divide in test scores between children from high-income families and those from low-income families has grown by more than a third; it is now twice as large as the gap between blacks and whites. Yet the United States is one of the few nations that finances schools primarily through local property taxes, which magnifies unequal opportunity. As one OECD researcher puts it, “The vast majority of OECD countries either invest equally in every student or disproportionately more in disadvantaged students. The US is one of the few countries doing the opposite.”

Inequality of opportunity begins early, and it costs everyone. Good pre-K education, for example, more than pays off in higher growth and tax receipts and lower public costs, from social assistance to incarceration. Yet the United States ranks twenty-fifth in the OECD in the share of three-year-olds in early childhood education, and even lower, twenty-eighth, when it comes to four-year-olds.

And, of course, the big one: income. Here, the trends of trickle-down economics are most apparent:

Historically, economists have considered national income per capita the best single measure of the standard of living of middle-class citizens. For much of the twentieth century, it was. Since the early 1970s, however, the link has broken. The American economy is more and more productive, and national income has continued to grow smartly (if more slowly than before). But these gains have not translated into substantially higher wages for most Americans. The typical hourly earnings of American workers—adjusting for inflation and including the escalating cost of medical benefits—rose only 10 percent between 1973 and 2011. That works out to an annual raise of 0.27 percent.

But American families have grown significantly richer, right? Yes and no. Between the early 1970s and the late 1990s, the typical household’s income increased from around $49,000 to almost $57,000 (after adjusting for inflation). Yet the wage stagnation of the 2000s and the financial crisis that closed out the decade wiped out all of the gains created by the strong economy of the 1990s, leaving typical households about where typical households were in 1989. . . .

Just as important, the overriding reason the typical family earns a little more today is not more pay per hour but more paychecks per household, as women have moved into the paid workforce. This change isn’t because the United States has led the world in female employment. (In 2010 America was seventeenth in the OECD in the share of women in paid employment, down from sixth in 1990. It’s because US workers, both male and female, work many more hours than workers in other countries do—and the gap is growing. . . .

Where did all the growth go? The answer, it turns out, is simple: It went to the top, especially the very top. When it comes to inequality, the United States once looked relatively similar to other rich countries. Today it’s the most unequal rich nation in the world by a large margin. However else that matters, the increasing concentration of income at the top drives a wedge between overall economic growth and the income gains of most households. When a rising tide lifts all boats, economic growth is a better measure of ordinary Americans’ living standards than when a rising tide lifts only yachts.

You can see the disparity even more clearly when you look at wealth: housing, stocks, bonds, and all the other assets that people hold to weather economic shocks and build their future. Americans’ average net wealth is an impressive $301,000, the fourth highest in the world, behind only Switzerland, Australia, and Norway. Median net wealth—the amount held by someone exactly in the middle of the distribution—is another story. The typical American adult has just $45,000, which places the United States nineteenth in the world, behind every rich country but Israel (including such “economic heavyweights” as Spain and Taiwan). The obvious reason for the difference is that wealth is so unequal across American households. The richest 1 percent own more than a third of the nation’s wealth; the top 10 percent, more than three-quarters. No other rich country comes close to this level of concentration at the top.

Beginning with the Reagan years and its huge tax cuts for the upper crust, wealth disparity has skyrocketed. And the vaunted notion of the Horatio Alger success story—going from rags to riches—has been laid bare.

Today, however, the frontier is gone, and so is America’s mobility advantage. Indeed, the United States now has close to the lowest level of upward mobility in the advanced industrial world: lower than in Tocqueville’s France, lower than in Sombart’s Germany, and lower—much lower—than in our northern neighbor, Canada. Roughly two in three Americans born in the bottom fifth of incomes either stay there (42 percent) or rise just into the next fifth (23 percent). An American boy whose dad is in the bottom fifth has only a 30 percent chance of climbing into the top half. A Canadian boy has a 38 percent chance. This 8-point difference might seem small, but it’s not. With 138 million American men, 8 percentage points represent 2 million boys escaping the bottom fifth into the top half.

Again it’s the youngest of the young who are most disadvantaged. The United Nations Children’s Fund (UNICEF) has compiled a composite index of the “material well-being” of children in developed countries, which takes into account various measures of childhood poverty and material deprivation (lack of access to regular meals, for example). In the most recent report, the United States ranked twenty-sixth out of twenty-nine developed nations. First in the standings was the Netherlands, where soon-to-be-giants are born. UNICEF has produced its index since the early 2000s. The United States was one of only five nations that were ‘below average at that time yet failed to improve kids’ material well-being in the following decade. The other four were Greece, Hungary, Italy, and Spain.

The government role in research and development of new science and technology, once a hallmark of American exceptionalism, has shrunk to the extent that it could, as the zealots suggest, be drowned in a bathtub:

Though government promotion and funding of science has a long history, it expanded dramatically during World War II and continued afterward with the National Science Foundation (NSF), National Institutes of Health (NIH), and other public agencies that supported training in science and engineering and financed research in the private sector and academia. In the quarter century after World War II; the United States didn’t just lead the world in R&D funding. It owned the field. Well into the 1960s, the federal government spent more than the combined total of all R&D spending by governments and businesses outside the United States. The fruits of these investments ranged from radar and GPS, to advanced medical technology, to robotics and the computer systems that figure in nearly every modern technology. Far from crowding out private R&D, moreover, these public investments spurred additional private innovation. The computer pioneers who developed better and smaller systems not only relied on publicly fostered breakthroughs in technology; they also would have found little market for their most-profitable products if not for the internet, GPS, and other government-sponsored platforms for the digital revolution.

That was then. Over the last half century, R&D spending by the federal government has plummeted as a share of the economy, falling from a peak of nearly 2 percent of GDP in the mid-1960s to around 0.7 percent in the late 1990s, before rebounding slightly in recent years. Between 1987 and 2008, federal expenditures were essentially flat once inflation is taken into account (rising 0.3 percent a year). The United States now ranks ninth in the world in government R&D expenditures as a share of the economy. The majority of this spending, however, is for defense-related projects, which have fewer positive spillovers than nondefense R&D does. Take out defense, and the United States ranks thirty-ninth in government R&D spending as a share of the economy. . . .

We are not talking just about dollars and cents. We are talking about lives. Consider one chilling example: drug-resistant infections. As America’s breakthroughs in antibiotics recede into the past, bacteria are evolving to defeat current antibiotics. For more and more infections, we are plunging back into the pre-antibiotic era. In the United States alone, two million people are sickened and tens of thousands die each year from drug-resistant infections—mostly because private companies see little incentive to invest in the necessary research, and the federal government has failed to step in. . . .

And health research has fared better than most areas. Public investment of all sorts and by all tiers of government has reached the lowest level since demobilization after the Second World War. Until the 1970s, gross investment by the public sector—R&D plus investment in physical capital—averaged around 7 percent of GDP. It fell below 6 percent in the 1970s and 1980s, and below 4 percent in the 1990s and 2000s. It is now at 3.6 percent and falling. The biggest crunch is in infrastructure: roads, bridges, water supplies, communications networks, public buildings, and the like. These are among the most productive investments governments make, with average rates of return that are probably several times higher than those of typical private investments. And American infrastructure was once the envy of the world: The interstate highway system started under President Eisenhower—a Republican—eventually stretched over forty-two thousand miles, at a cost (in present dollars) of $493 billion. But the investment paid off, accounting for almost a third of the increase in the nation’s economic productivity in the late 1950s and around a quarter in the 1960s.

American infrastructure is no longer the envy of the world. The World Economic Forum, the Davos-based center of business-oriented thinking, ranks the United States fifteenth in the quality of railway structures, sixteenth in the quality of roads, and ninth in transportation infrastructure. The American Society of Civil Engineers estimates that the United States would have to spend $3.6 trillion more than currently budgeted just to bring our infrastructure up to acceptable levels by 2020. China and India are spending almost 10 percent of GDP on infrastructure; Europe, around 5 percent. Even Mexico spends just over 3 percent. The United States has not broken 3 percent once since the mid-1970s.

And this doesn’t begin to address the problems of pollution so blithely ignored by the powers that be as well as the ecological risks—i.e., global warming—facing the nation.

[T]he United States, once the unquestioned leader in addressing pollution and other ecological risks, lags behind the rich world on most measures of environmental performance. It emits more carbon dioxide per person than any affluent country besides tiny Luxembourg—roughly twice as much as Germany and Japan, and more than threetimes as much as France and Sweden. The widely respected Yale Environmental Performance Index, which assesses air and water pollution and other key environmental outcomes as well as measures relevant to climate change, ranked the United States thirty-third in the world in 2014—two spots down from its similarly uninspiring ranking of thirty-first a decade earlier.

We have seen how far we have to go in tackling the dangerous warming of our planet—a challenge that cannot be addressed without the leadership of the world’s sole superpower and second-largest carbon emitter. But consider a very different emerging challenge where lack of an effective response is literally weighing down America’s future.

A larger share of Americans are obese than in any other rich country. Defined as having a body mass index of 30 or higher (roughly two hundred-plus pounds for a five-foot-eight person), obesity now afflicts more than one in three adults and one in six children, compared with around one in seven people or fewer in most European countries. Individual medical costs associated with obesity are on par with those of smoking. In the aggregate, obesity accounts for a tenth of health spending in the United States, generating $270 billion in total economic cost due to medical bills, mortality, and disability. When additional consequences of obesity are factored in—lower earnings, lost work time, reduced productivity—the costs are even more staggering.

The basic causes are no mystery: Americans have become more sedentary, and they consume more calories than they once did. Even small differences in activity and diet can add up: One soda a day—a twelve-ounce can, not the megacups that are served at fast-food restaurants (KFC’s “Mega Jug” is sixty-four ounces)—adds up to 55,000 additional calories and fifteen extra pounds a year. And once again, adding up all these individual changes across the population leads to enormous effects (no pun intended), such as $270 billion in higher health spending a year. It’s often said that obesity is a personal problem. But people’s basic biological desire for fat and sugar hasn’t changed in the last few decades; their environment has. And American food policy—including federal subsidies for sugar and high-fructose corn syrup—has played a major role in shaping that environment.

Want a vivid image of how American bodies have changed? The average American woman now weighs around 165 pounds. According to the US Centers for Disease Control and Prevention (CDC), that’s essentially what the average American man weighed in 1960. (Today’s average man is around 195 pounds.) Americans were once the tallest people in the advanced industrial world. We are now not just among the shortest but also far and away the heaviest. Where once we towered over others when standing, now we only do so when everyone is lying down.

So you want to make America great again, Mr. President-elect? These are just some of the ways we’ve been found lacking, and it’s not because we don’t give free rein to the banksters or Wall Street CEOs, or a bigger share of the pie to those one-percenters. And the cure isn’t cutting regulations for our long-suffering corporate overlords or letting them park even more money offshore. The facts are there for all to see, though in your fact-free administration this may be a problem.

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