Every once in a while we should step back from our country’s everyday problems and look at the bigger picture. In my last post I pointed out that, while there has been enormous human material progress around the world in the last two hundred years, some prominent thinkers say that the U.S. is now mired in complacency and is at great risk of deteriorating.
In particular, Charles Murray has well described how U.S. society has separated into a new Upper Class (20% of all Americans) and a new Lower Class (30% of all Americans) with totally distinct characteristics and interests. He presents two possible scenarios:
A Hollow Elite, characterized by:
- The collapse of a sturdy moral code. It has lost self-confidence in the rightness of its own customs and values (marriage, industriousness and civic engagement) and preaches only non-judgmentalism instead.
- Unseemliness. CEOs make increasingly enormous salaries and receive incredibly huge separation bonuses. Also, hundreds of billions of dollars in government funds are up for grabs as contracts or tax expenditures.
- Drifting towards the European model of more welfare paid for with higher taxes because paying taxes is a cheap price for a quiet conscience.
A Civic Great Awakening, characterized by:
- Watching the European model implode. As publicly financed benefits grow, so do the populations who think they need them, and the fewer people there are in the private sector to pay for them. There is no way out of the self-destructive dynamics of the welfare state and America is watching this happen first in Europe.
- The increasing obviousness of an Alternative. Mr. Murray proposes that our current welfare state be replaced by a guaranteed annual income of $10,000 (in 2002 dollars) for all, phased out at incomes above $25,000. The idea is that such a proposal will become increasingly desirable as our welfare state becomes increasingly unaffordable.
- The resilience of American ideals. Mr. Murray believes that a civic Great Awakening will take place among the new upper class. He believes that American exceptionalism has a historical basis and that the qualities of industriousness, neighborliness and self-confidence will reassert themselves and put the ‘American Project’ back on track.
Conclusion. Regardless of the specific details of what he foresees, Charles Murray is an optimist and so am I.
It Does Not Add Up 
Alexis de Tocqueville, a citizen of France, toured our nation for nine months beginning in 1831. He published two books in French, 1885 and 1890, to describe the socio-political character of our young nation at the request of the French government. In sum, it was a generally positive assessment. Our nation’s governmental institutions, at all levels, and their community level adaptability characterized this assessment.
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Many will recall that originally in 1790, only land owners could vote. As voters, they voted based on their self-interests that fortunately were guided by their judgement for the Common Good at the National, State and Community levels of government. And, it was generally clear to everyone how their self-interests were defined. Eventually, all citizens became voters and their sense of each candidate’s true self-interests are now shaded by all sorts of influences that are not totally knowable. Over-all, the Federal government’s failure to manage our annual Federal deficits, our nation’s unfunded liabilities (Medicare risk funds) and our nation’s failure to offer high-quality healthcare to each citizen are together indicating a potentially disastrous future for our nation.
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As two measures, I remind Jack’s followers of the following: maternal mortality ratio and the cost of our nation’s healthcare as a portion of our national economy. The maternal mortality ratio is the number of deaths related to a pregnancy per 100,000 births per year for a defined population (as in State or Nation). For a variety of poorly validated reasons, there have been no State by State data for the United States since a data set for 2001-2006 was published. But as a basis for long term trends, the World Health Organization (WHO) in combination with the United Nations and the International Monetary Fund has periodically published an over-all evaluation of maternal mortality world-wide for nearly 20 years. The last report was titled “Trends in MATERNAL MORTALITY: 1990 to 2015.” And, coincidentally, Wikipedia updated its “Developed Country” post on April 14,2017. It now uses the United Nation’s definition for a nation’s ‘very high’ Human Development Index (MDI) to rank the top 51 nation’s of the world for 2015. We rank 10th best MDI among the 51 nation’s (tied with Canada).
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Using the two data sets to rank order the 51 best nations of the world and their maternal mortality ratio (MMR) during 2015, the following observations are clear. The USA is the ONLY nation that has had a MMR that has WORSENED over the last “25” years, at 0.6% worsening a year. And, we would need to reduce it by 70% to rank among the best ten nations (Iceland, Finland, Poland, Sweden, Austria, Italy, Czech Republic, Greece, Kuwait and Norway). The USA MMR ranked 42nd worst among the 51 nations. Theoretically, this would have represented @400 excess maternal deaths in 2015. There were nearly 4 million live births in 2013.
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Using data from the Altarum Institute, the cost of our nation’s healthcare has presented 18.3%, 18.4% and 18.3% of our national economy, respectively, for the first three months of 2017. The Organisation for Economic Co-operation and Development (OECD) periodically reports data about the financial status of its 30 member nations. This has included the Nation by Nation portion of their economy attributed to healthcare. These nations all spend 13.1% or less of their national economy on healthcare, except by the United States (as noted above). The difference between 13.1% and 18.3% for our economy in March was $988 Billion. Most importantly, nearly 40% of the healthcare expense in the USA was paid in cash from the Federal treasury. Our nation’s deficit for last 4+ years has been averaging $500 Billion. SO, the excess COST of our nation’s healthcare represents “80%” of our nation’s annual Federal deficit. Unfortunately, there is absolutely no reason to believe that ANYTHING within our nation’s current healthcare strategy will fix this.
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One possible view of this deep-seated conundrum and its resolution can be found at http://www.nationalhealthusa.net/home/rationale/
It’s clear that healthcare spending in the U.S. is a huge drain on our national resources and a primary reason why we have such large annual deficits in federal spending.
I have some connections in progress and have begun writing a thirteen-part set of essays to foster a community “conversation” about improved HEALTH, without the direct involvement of the healthcare industry. With a head start by this fall from within the general community, I will begin contacts within the hospital groupings to foster their willingness to generate monitoring data. Can’t really achieve much without data!
Paul
Jack,
Charles Murray is complicated thinker. When he wrote his book on educational development among blacks and whites, “The Bell Curve” he was too narrow in his research and alienated many social scientists. He certainly did me. He and his co-author (?Robert?) Ornstein saw biological inferiorities that had no substantive way of confirmation, rather than the many contrasting and conflicting political, social, economic and psychological histories of the two peoples. What I have always understood about him was his religious leanings, which I took no issue. Yes, I like his general social values. Now if the Republicans and Democrats have any possibility of ‘coming together’ it just might happen through Murray’s more recent writings.
Yet, in my mind he is kind of a lightweight when it comes to the inherent base of being human. Thinking the upper classes are going to generate a new civic responsibility seems simply too remote for me right now, or at least if not before the next presidential election if not a greater distance. People like Attorney General Sessions are too plentiful in positions of power right now on the domestic front.
Still, it is pleasant to read your optimism.
Doug
I understand that Charles Murray’s Bell Curve work is highly controversial. But his more recent Coming Apart work is very solid. It’s based on socio-economics and not race. He lays out the current problems in American society very clearly and in great detail.
The continued success of the ‘American Project’ depends upon figuring out how to boost the prospects of the new “Lower Class.” More later!
I’m pleased to hear about your forthcoming suggestions for how to foster a community conversation on improving healthcare.