(I’m traveling for a few days, plus I’m thinking that I won’t be producing the newsletter much on weekends, hence the few day gap here).
Aaron Carroll, the physician and excellent health/medical writer for the New York Times, wrote a column yesterday about the perils for many workers of calling in sick in the United States. It’s likely that among those still working, almost everybody reading this has health insurance through their employer and also has paid vacation and paid sick leave. But that is not true for many Americans. And as Carroll points out, while the pandemic has highlighted how critical it is for people to be able to stay home from work when they are sick, earlier work flexibility is ending in many American workplaces.
The United States is an outlier among its wealthy peers when it comes to guaranteeing paid sick leave. Indeed, we are the only wealthy country that doesn’t guarantee any paid days off.
And that’s a familiar refrain. On a range of measures of social policy and well-being, the United States fares worst or among the worst compared to its peers in the Organization for Economic Cooperation and Development (OECD), a group of 38 countries that tracks a variety of social, economic and health indicators. Among those countries, no one spends more money per capita on health care than the United States. But in important respects, few have worse outcomes. Among the OECD countries, the United States ranks about 30th in life expectancy, at just over 77 years. The OECD countries that do worse are all manifestly less well off overall, including Mexico and Colombia. Among our European peers, we live four years or more less on average. And of course, we are the only wealthy country without an essentially universally guaranteed system of health insurance for all citizens.
As the Times reported last year, while the right to access to abortions is expanding elsewhere globally, including much of Latin America, where there has been strong resistance historically to legal abortion, the United States is among only two OECD countries (Poland is the other) that is rolling back access (and, of course, that’s about to get worse). Despite the spike in crime the past two years, the United States has experienced a dramatic reduction in its homicide rate since the 1990s. Nevertheless, among OECD countries, only Colombia’s and Mexico’s are higher.
We are, famously, an outlier on access to guns (which contributes importantly to our very high death rates, including by suicide). And we have more road fatalities per capita than any other country. And, for another post, we fare particularly poorly across on many indicators of poverty, inequality and wealth concentration. We also have among the highest incarceration rates in the world, if not the highest.
Why am I complaining about all this? Partly it’s because I’m up at 5am, so what’s a guy to do? But it’s also because of a persistent and nagging feeling that, in America in 2022, so much energy is being expended screaming about everything except what matters most - the well-being of ordinary people. That’s not new, really. It just *seems* like it’s worse than ever. A lot of my liberal friends are very exercised these days by things like “cancel culture,” for example. I have somewhat complicated feelings about the interrelated phenomena that have been flattened into that (largely unhelpful) phrase. But that, alongside critical race theory, inflation (a real problem, but potentially - hopefully - a short-term one), and other cultural maelstroms have drowned out almost any focused attention on the fact that a wealthy country with astonishing resources - natural, human, etc - at its disposal, serves so many people so poorly. Oh, and I did I mention that the planet is on fire and our political system is uniquely ill-equipped to deal with that?
Our most immediate and pressing problem is the Republican Party, which Norman Ornstein and Thomas Mann once aptly described as an “insurgent outlier - ideologically extreme; scornful of compromise; unmoved by conventional understanding of facts, evidence and science; and dismissive of the legitimacy of its political opposition.” (and that was in 2012!), which is why I’ll spend a lot of my energy on it. But it’s not our only one, needless to say. Those other ones will also merit attention in future posts.
The miserly, punitive and violent realities of our society, which still shocks many in short bursts of horror and outrage, as after last week’s massacre in Uvalde, unfolds in every day life in far less dramatic, but no less insidious ways. It’s worth trying to remember that and orient our energy accordingly.
And with that, I guess I should try to go back to sleep for a little while.