Map of life expectancy at birth from Global Education Project.

Friday, January 22, 2010

American Exceptionalism

Contrasting the U.S. with the U.K. Constance A. Nathanson writes in the new Lancet:

Reduction of health inequalities is certainly not a goal of federal policy in the USA, even in these days of health-care reform. We have an extraordinary record of government support for the documentation of health “disparities” (the currently preferred term), and although health disparities have become a highly fundable research topic, even this fairly anodyne research arena is largely divorced from serious policy making. In the absence of a universal system of medical care with the declared goal of mitigating inequalities, health disparities, inequalities, and inequities have by default become the province of public health, perhaps accounting for our plethora of public health institutions relative to other Western countries: in the USA public health departments play a major role as caregivers for the poor. Many Americans are perfectly content with a two-tiered system that renders not only health inequalities but also the costs of the system that perpetuates those inequalities largely invisible.

Actually the elimination of health disparities has been an official national goal since the Clinton Administration. Unfortunately, the target date was 2010 and, err, we didn't make it. Actually we didn't even make any real progress, although we did invest in data tracking systems and, as Nathanson says, it's been a fundable research topic. We certainly know more about it than we did before. By "we," however, I mean those of us who get the grants to study the issue and go to conferences where we talk to each other about it. And, of course, the 6 1/2 readers of this blog.

The fact is that justice is simply not a value that is important to Americans, at least not in comparison with most people the world over. This cultural fact translates into a social fact: we have more inequality than other wealthy countries, and we are getting more and more unequal. The Supreme Court's ruling yesterday that corporations have the rights of humans -- actually even more than the rights of humans -- to spend unlimited resources on influencing elections through paid advertising and whatever other means they desire (they can already buy cable news channels) will just accelerate the process. As U.S. society grows more and more predatory and the people continue to be bamboozled into voting against their own interests, it will be interesting to see where the limit may be to this process. One would suppose there must be one, but how will it end?

This has occurred in the past, of course, and has been interrupted by crises in which a segment of the capitalist class elected to save the system by reforming it. One such hero is on the dimes in your pocket. Will they be so wise next time?


kathy a. said...

i didn't read this one before commenting on the last.

we need for the actual science to be part of the discussion.

i personally need to shove myself out of my preferred role, and kick my congresscritters and everyone else i can find until they start doing their jobs.

and hell, i believe in the courts and that they provide a better way to resolve actual disputes than gunfire or suchlike, but we are so in need of a different lineup, up there. there are four i'd trade out in a heartbeat, but i'd settle for retiring any one of the bunch,.

roger said...

i do see a sliver of the capitalist class working to change the system. still, peasants with pitchforks seem more likely to rise up, so far.

it would seem a good sign, if a small one, that there is funding to look at the problem of health disparity.