America the Not-So-Great

Most Americans -- myself included -- think we live in the greatest country on earth.  After all, we have the biggest economy, the most powerful military, the most pervasive popular culture, and, of course, the American Dream.  We've got Wall Street and Silicon Valley, Walmart and Amazon, Hollywood and Nashville.  We have -- well, we used to have -- the biggest city, the tallest building, and the largest manufacturing output.  

But when it comes to some of the basics, we're not doing so well.

Take health care, for example.  If you listen to politicians, we have the best health care in the world.  And, indeed, if you have enough money (or really good insurance), happen to live in the right zip code, and manage to stumble upon the right doctors/hospitals, that's true.  You can get the best health care in the world here.  But fail any one of those qualifiers, maybe not.

Most of us know that, whatever else is true about it, we definitely have the most expensive health care system in the world -- by far.  Many of us have also started to realize that we're not getting very good value for that spending.  By most objective measures, our health outcomes are middle-of-the-pack, or worse.

Various other studies offer an embarrassment (literally) of findings, including:

• The University of Washington scored nations on a health-care quality index (HAQ), and found the U.S. rated at the bottom of the second decile, next to Estonia and Montengro.  
• The Lancet rated the U.S. only the 28th healthiest country.  
• Bloomberg rated the U.S. 50th out of 55 countries in their Health Care Efficiency Index.   
• The Commonwealth Fund ranked the U.S. health care system last of eleven industrialized nations.  
• Over 60 countries have better infant mortality rates than we do; we rank between Bosnia and Serbia.  
• The U.S. health care system ranked 15th among the 60 countries in the U.S. News & World Report's "Best Countries" survey.
• A Health Affairs study found we had one of the largest income-based health disparities in the world.  
• There are significant geographic and racial differences in health care within the U.S. as well.  

If our problems were only with health care, we'd have our hands full.  But that's not the only problem area.

We profess to place a great deal of importance on education, but the facts would suggest otherwise.  We may have most of the best universities, but even they are slipping in worldwide comparisons.  More telling are the results for primary and secondary education.

Earlier this year the Pew Research Center summarized some of the disturbing results.

• We're middle-of-the-pact for high school students on reading, science, and math results.
• We're at least in the top ten -- although not top 5 -- for math and science for 4th and 8th graders.
• Only 40% of our 4th graders, 33% of 8th graders, and 25% of 12th graders are at least proficient in math.  
• Only 29% of Americans rated our K-12 STEM (science, technology, education, and mathematics) education as above average in the world; only 16% of scientists agreed, while 46% rated it below average.

As with health care, we spend more than our peers to get these dismal results, although at least our educational spending is not quite as stratospheric in comparison.  Also like health care, its costs -- especially for higher education -- is rising more rapidly than income.

There is more than $1.2 trillion in student debt, which is only behind mortgages in consumer debt.  Defaults are hitting record levels.

As dismaying as these facts, there are still other important areas where the U.S. lags.

Infrastructure -- e.g., roads, bridges, dams, airports, schools -- recently got a D+ from the American Society of Civil Engineers (ASCE).  Of the 16 categories scored, only one (rail, surprisingly) got as high as a B and only two (ports and solid waste) got a C+.  The rest were D or D+.

Drinking water, for example, got a D.  That would come as no surprise to anyone living in Flint, but what happened there is only the tip of the iceberg, so to speak.  A new survey found that 87%  think that clean water is our most important natural resource, but two-thirds believe their local drinking water is at risk.  96% think we should be investing more.

Many people -- including President Trump -- have called our infrastructure "third world."   As harsh as that sounds, it's not far off.   The President has called for a $1 trillion infrastructure investment, but ASCE thinks we need more like $4.5 trillion by 2025.  Spending is only one of the problems;  Bloomberg's Noah Smith thinks we're "forgotten how to do infrastructure."  Projects that would take weeks or months elsewhere can take years or even decades here, and cost much more.

Then there is an area where one would think the U.S. would do particularly well: internet speeds.  We are home to internet giants like Google and Facebook, and we pride ourselves on our smartphone ownership (80%) and broadband penetration (73%).  But we still settle for poor performance.

We are just barely cracking the top 10 in average internet speeds; our average speed is only two-thirds of the leader (South Korea).  We're only 16th in peak average speed, with that speed being less than half of the leader (Singapore).

It's even worse on the mobile side, where we rank only 28th, our average speed only 41% of the leader (United Kingdom).

We should be doing better.

Our federal debt is closing in on $20 trillion, we have states teetering on bankruptcy, and most Americans live in "financially precarious circumstances."  Yet, as Mr. Smith asserted, "construction, like health care or asset management or education, is an area where Americans have simply ponied up more and more cash over the years while ignoring the fact that they were getting less and less for their money."  

We simply cannot afford to tolerate poor performance or wasteful spending.

These are disparate problems, and will take disparate solutions, but one thing is clear: this is not a time for "more-of-the-same."  We will have to innovate our way out of these messes.  The U.S. has always prided itself on innovation, but, here again, we're not even doing that very well, barely cracking the top ten most innovative countries.  We're lagging on investment in R&D and basic science.

If we truly love our country, we need to expect -- demand! -- more for it, and for us.