Map of life expectancy at birth from Global Education Project.

Monday, September 19, 2005


Immanuel Wallerstein views the decline of the United States:

The entire world has been following with stupefaction the incredible performance of the U.S. federal government's response to the physical and human disaster of the hurricane Katrina. All the television networks of the U.S. and of many other countries plus all the major newspapers have been following the story in detail. The general reaction has been to ask how could the government of the richest and most powerful country in the world have reacted to this disaster as poorly as, or even much less well than, governments of poor Third World countries? The simple answer is a combination of incompetence and decline. And the results of this disaster will be a further diminution of respect for the president within the United States and a deepened skepticism in other countries about the United States' capacity to put action behind vacuous rhetoric.

But if the U.S. is really starting to resemble a so-called Third World country, perhaps this is not such a startling development as it seems to many people.

Let's begin with this: The average industrialized country spends $2,139/year per person on health care. The U.S. spends $5,267 – almost 2 ½ times as much. The country that spends the most after the U.S. is Switzerland, at $3,336/person.

All of the other wealthy countries (and some of the not-so-wealthy ones) insure 100% of their citizens. We don’t. We have, right now, about 45 million people without health care insurance. And in spite of throwing all that money at the problem, as the ruling party likes to say when the money in question isn't going into their own friends' pockets, we are closer to a Third World than a First World country when it comes to our health status.

The World Health Organization ranks countries in terms of various indicators including:

life expectancy -- the U.S. is 24th:
level of health (based on a complex index) -- U.S. is 72d:
and overall health system performance -- U.S. is 37th.

We have a First World sector, the one you see on television sitcoms and commercials, and read about in the Style Section of the newspaper, the one that people who live in it think is definitive of the United States. Then we have the Third World sector, where those folks live who Barbara Bush was so pleased to see enjoying a luxurious vacation in the Astrodome. Average them out, and you get the kinds of numbers you see above.

Of course the Bush administration is doing everything in its power to widen this divide, but it's nothing new. In fact it's deeply embedded in our national character, so much so that there are basic ideas which are taken for granted in most of the world that are marginalized in our political discourse. Anon, I will discuss the question of liberalism vs. libertarianism vs. conservatism. I think that will help to clarify the challenges we face.

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