Friday, April 24, 2015

American Progress? 
We are falling behind

In my last blog I asked why there was no mention in the 20 or more presidential campaigns now underway of the results of the “Social Progress Imperative.” This public interest research program sets out to measure the accomplishments of different countries not by the amount of money they earn annually (GDP) but by outcomes, by what these countries accomplish on different dimensions. A summary of the scorecard for the US in 2015 is dismal: in health and wellness we rank 68th of all countries in the world. In personal safety we rank 30th, with respect to access to basic knowledge –which refers to primary and secondary education-- our rank is 45th (although we do much better in higher education), in ecosystem sustainability our rank is 74th. These are our scores in spite of spending more money, for instance, on health care than all other countries.
If we were third, or even fifth I would not give it a second thought, but 68th in health and wellness--that is really troubling. In 68 countries, most of them a lot smaller and not as rich as we are, citizens get better health and wellness care. That does not seem acceptable.
What will we have to do if we are to improve our health and wellness services, our primary and secondary education, our security and our treatment of our environment? Obviously the answer to that question will be complicated and in different categories different remedies will be needed. The problems of health care are different from those in trying to educate our children, and both of those need different remedies than our environmental heedlessness.
But there are also common themes in those different dimensions of our failures. Consider the issue of health care. Many countries have a publicly owned and run system of health insurance for all citizens. Our system is cobbled together with many different private health insurers. Our laws forbid the government expressly to bargain with pharmaceutical countries for lower prices. Dealing with many private insurers and suppliers makes our system excessively complicated and more prone to failures. The more complex a system the more likely that some patients will not receive the care they need.
In addition our health care system is designed to yield profits--large profits in some cases--for private companies. It should not surprise anyone that we spend more money with less impressive results because what we pay for is not merely an essential service but also healthy profits for private investors.
It is tempting, at this point, to complain about the greed of business men in the different branches of the health care industry. In the last few years this has become a very common reaction. But that would be unfair and dishonest because large numbers of ordinary Americans are convinced that services performed by privately owned, for-profit institutions will be cheaper and more effective than similar services offered by a government bureaucracy. Distrust of government has a long history in the US. As a consequence there is widespread support for farming out what should be government services to private enterprises. Ordinary citizens often only have themselves to blame for their unthinking support of privatization of public services.
The failures on the different international scales of social process are an eloquent demonstration of the foolishness of this mania for privatization. There may be services which would be better performed by private companies. Health care does not seem to be one of them. The many experiments in privately owned, for-profit education are largely failures and often fraudulent, taking money from veterans and people with limited resources without providing training that is at all useful. Different experiments that apply free market mechanisms to reduce global warming have, so far, not shown themselves to be effective. There exists a great deal of evidence to suggest that in many cases privatization does not have good results.
There are, of course, counterexamples. The failure of a number of regional VA hospitals--a government organized, run and financed health care system-- to provide timely care to veterans is a real scandal. But even there a private solutions was tried. Two private physicians networks have been hired to provide medical care to veterans living at a distance from the nearest VA. So far this solution through calling in the assistance of private for-profit business has proven to be a failure.
But Americans, rich and poor, are so distrustful of government that they do not see the facts in front of their own eyes. We will not improve our standings on the social progress scales until we end this blind devotion to privatization of public services.