Unhealthy America
The Moment of truth for health care is at hand, and the distortion that perhaps gets the most traction is this:
We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world? As Senator Richard Shelby of Alabama puts it, President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.”
That self-aggrandizing delusion may be the single greatest myth in the health care debate. In fact, America’s health care system is worse than Slov—er, oops, more on that later.
The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures. We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.
Canadians live longer than Americans do after kidney transplants and after dialysis, and that may be typical of cross-border differences. One review examined 10 studies of how the American and Canadian systems dealt with various medical issues. The United States did better in two, Canada did better in five and in three they were similar or it was difficult to determine.
Yet another study, cited in a recent report by the Robert Wood Johnson Foundation and the Urban Institute, looked at how well 19 developed countries succeeded in avoiding “preventable deaths,” such as those where a disease could be cured or forestalled. What Senator Shelby called “the best health care system” ranked in last place.
The figures are even worse for members of minority groups. An African-American in New Orleans has a shorter life expectancy than the average person in Vietnam or Honduras.
I regularly receive heartbreaking e-mails from readers simultaneously combating the predations of disease and insurers. One correspondent, Linda, told me how she had been diagnosed earlier this year with abdominal and bladder cancer — leading to battles with her insurance company.
“I will never forget standing outside the chemo treatment room knowing that the medication needed to save my life was only a few feet away, but that because I had private insurance it wasn’t available to me,” Linda wrote. “I read a comment from someone saying that they didn’t want a faceless government bureaucrat deciding if they would or would not get treatment. Well, a faceless bureaucrat from my private insurance made the decision that I wouldn’t get treatment and that I wasn’t worth saving.”
It’s true that Americans have shorter waits to see medical specialists than in most countries, although waits in Germany are shorter than in the United States. But citizens of other countries get longer hospital stays and more medication than Americans do because our insurance companies evict people from hospitals as soon as they can stagger out of bed.
For example, in the United States, 90 percent of hernia surgery is performed on an outpatient basis. In Britain, only 40 percent is, according to a report by the McKinsey Global Institute.
Likewise, Americans take 10 percent fewer drugs than citizens in other countries — but pay 118 percent more per pill that they do take, McKinsey said.
Opponents of reform assert that the wretched statistics in the United States are simply a consequence of unhealthy lifestyles and a diverse population with pockets of poverty. It’s true that America suffers more from obesity than other countries. But McKinsey found that over all, the disease burden in Europe is higher than in the United States, probably because Americans smoke less and because the American population is younger.
Moreover, there is one American health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.
That brings me to an apology.
In several columns, I’ve noted indignantly that we have worse health statistics than Slovenia. For example, I noted that an American child is twice as likely to die in its first year as a Slovenian child. The tone — worse than Slovenia! — gravely offended Slovenians. They resent having their fine universal health coverage compared with the notoriously dysfunctional American system.
As far as I can tell, every Slovenian has written to me. Twice. So, to all you Slovenians, I apologize profusely for the invidious comparison of our health systems. Yet I still don’t see anything wrong with us Americans aspiring for health care every bit as good as yours.
DID Republicans win so many of the elections on Tuesday because of their conservative base or because they went beyond it? The answer to both questions is yes.
In some places in 2009 it was enough to not be a Democrat, just as it was sufficient for Barack Obama to be an alternative to President George W. Bush in 2008. In Greensboro, N.C., an unknown 70-year-old conservative who has never held elective office beat the incumbent mayor, the first such defeat there since 1973. Message to Republicans: When only 20 percent of Americans self-identify as Republicans, it is not our brand voters are buying. It’s the other guy’s brand they are rejecting.
Republicans won, fundamentally, because President Obama and the Democratic leadership in Washington have rebranded themselves as the party of economic irresponsibility. In New Jersey, where the Republican, Chris Christie, won the governorship, 57 percent of voters said the economy and taxes were the top issues. In Virginia 60 percent said the same — and Bob McDonnell, the Republican governor-elect, won economic voters by 15 percentage points. As my friend James Carville might now say, “It’s the economy, again, stupid.”
While the conservative base was energized yesterday — conservative turnout was up 7 percent in Virginia and 5 percent in New Jersey from 2008 — something else took Republican candidates across the finish line: They remembered that their principles were good for more than saying no. Republicans won’t find a more conservative candidate than Bob McDonnell if they draw lots from National Review’s subscription list. He didn’t abandon or “moderate” his principles to win the middle. Instead, he complemented them with an optimistic, populist vision of economic success.
Mr. McDonnell offered suburban voters, working women and independents a better way to increase jobs and expand the economy, from the bottom up. It was a stark contrast to what Americans are seeing in Washington, where elitist Democratic politicians, in bed with the Wall Street establishment, are taking Americans’ tax dollars away to invest in arrogant, top-down public-sector schemes. This helped Mr. McDonnell forge a powerful coalition involving not just independents but also young voters; he won the under-30 vote by 10 percent. Thanks for the opportunity, President Obama. On Tuesday, Nov. 4, in Virginia a New Republican Party was born. See you in 2010.
Start with the predictive value of the Virginia and New Jersey victories: there is none. Sometimes the party that wins both those governorships gains seats in the next Congressional election; sometimes that party loses seats. Far more consequential is the historical pattern that the new president’s party tends to lose seats in the first midterm election. Once that is taken into account, as the political scientist Alan Abramowitz of Emory University has shown, victories in Virginia and New Jersey gubernatorial races tell you nothing about who will gain seats in 2010 or how large that gain will be.
But perhaps voters were repudiating the president and his policies? In New Jersey, this analysis makes no sense. While an approval rating isn’t the same thing as the percentage of votes received, both figures are good measures of a politician’s overall standing. So it’s significant that Mr. Obama’s approval rating among 2009 voters (57 percent) was identical to the percent of the vote he received there in 2008. In Virginia, while the president’s 2009 approval rating was 5 points less than his 2008 voting result, the 2009 electorate was also far more conservative than last year’s. Besides being far older and whiter than in 2008, the voters in Virginia on Tuesday said they had supported John McCain last November by 8 points, meaning they were not favorably inclined toward President Obama to begin with. In fact, given that only 43 percent of these voters said they supported Mr. Obama last November, his 48 percent approval rating among them does not indicate a shift away from him but rather toward him.
If any repudiation is going on, perhaps it is of the conservative wing of the Republican Party. Democrats captured New York’s 23rd Congressional District for the first time since 1872, as Bill Owens defeated Doug Hoffman, the hard-line conservative who forced a moderate Republican out of the race. Mr. Hoffman’s narrow defeat is now likely to embolden conservatives — who far outnumber moderates in the party — to challenge Republican incumbents they find ideologically impure.
That will be a problem for those in the party seeking to emulate the electoral strategies of Bob McDonnell in Virginia and Chris Christie in New Jersey. Those men sought to cover up the conservatism of their views in many areas. That was relatively easy to do in governors’ races in an off-year election. It will be harder for candidates to do in national elections in 2010 and especially 2012.
So the good news for Republicans is that they now have two more governorships. The bad news is that they’re still Republicans — with all the baggage that entails.
Tuesday’s vote — particularly the election of Republican governors in New Jersey and Virginia — has produced heated predictions about the revived power of Republican social conservatism and the declining fortunes of Barack Obama and his 2008 coalition.
If there were broad messages in the grab bag of contests, they were for both parties: Voters remain fearful about the economy. Independent voters are a force to be reckoned with. And everyone wants results.
In New York City, Mayor Michael Bloomberg narrowly won a third term. It is impossible to link that to President Obama — who nominally endorsed the Democrat, William Thompson Jr., but left little doubt that his affection lay with the mayor. Mr. Bloomberg won on competence. Voters who said they cared most about experience and knowledge of the city’s problems voted heavily for him.
The closeness of the race contained another message for Mr. Bloomberg: Tone down the arrogance. Voters who said they most valued a leader who understood them went overwhelmingly for Mr. Thompson. If the mayor wants to create a legacy of leadership to match his legacy of competence, he needs to be less imperious and listen more closely to his constituents.
Competence was also the issue in New Jersey. Gov. Jon Corzine, a Democrat, failed to deliver on the promise of his financial expertise and could not get even party loyalists to vote for him in sufficient numbers. Independents who were still more fed up with Mr. Corzine voted for the Republican, Christopher Christie, who won with just under 49 percent of the vote.
That election was not about Mr. Obama, although he is probably regretting the three visits he made there. It certainly was not a referendum on Republican orthodoxy, since Mr. Christie did not run as a social conservative. And while Mr. Christie did run a traditional anti-tax campaign, most voters polled on the eve of the election said they did not know much about his views.
In Virginia, Republican Robert McDonnell also avoided trademark social conservative issues like abortion and same-sex marriage. His two main pledges were to create jobs and fix the public transportation system. He handily beat R. Creigh Deeds, even in the state’s more Democratic and liberal precincts.
One race, a special election for the House of Representatives in upstate New York, did turn on an ideological divide — but it was within the Republican Party. The party’s leadership drove its candidate, Assemblywoman Dede Scozzafava, out of the race because she crossed the line on issues like abortion. The anointed conservative, Douglas Hoffman, then lost to the Democrat, Bill Owens.
So what does this all mean for next year’s election? Above all, it means that voters want their leaders to focus on sound policy making, not party orthodoxy. And the No. 1 issue in every poll is the economy.
That means that Mr. Obama and Democrats in Congress should not draw the wrong conclusion and get timid about vital tasks like health care reform or more stimulus spending to ensure that any recovery also creates more jobs. At some point, they are going to have to bite the bullet and raise taxes to pay for all of this.
Mr. Christie and Mr. McDonnell, who promised to do more for their citizens, will also have to deliver. And we suspect that they are going to find it very hard do that and cut taxes. The voters are not in a forgiving mood.
As a former beat cop, Ron Huberman, the new chief of public schools in Chicago, learned long ago that violence among young urban people could not be solved simply by hauling ever larger numbers of children off to jail.
With the prompting and support of his boss, Mayor Richard M. Daley, Mr. Huberman is trying a new approach to the violence that has killed and maimed hundreds of young people and turned Chicago’s poorest neighborhoods into precincts of terror and despair.
The ambitious plan will offer mentoring, counseling and jobs to high-risk students. To determine who they are, Mr. Huberman analyzed the cases of more than 500 young people who were killed or wounded in gun violence over the last two years. The analysis suggests that nearly 10,000 of the city’s 113,000 high school students are at risk of becoming victims of gun violence and need help.
Their lives follow a clear pattern. They are absent from school more than 40 percent of the time, on average. They have fallen behind and are more likely to be enrolled in special education. And they generally attend 38 of the city’s nearly 140 public high schools.
None of the shooting incidents studied occurred inside the schools, and most happened well after school hours. But the chaotic schools attended by high-risk students tend to differ from better-run schools in measurable ways. They have fewer counselors and social workers. They have higher rates of suspension and expulsion. They more often involve the police in minor skirmishes, like shoving matches, that then go unresolved.
Mr. Huberman wants to remake the high-risk schools by beefing up the social work and counseling staff, by better training security guards and overhauling a disciplinary process that seems designed to throw out as many children as possible as quickly as possible. Most crucial, he hopes to improve involvement by guardians and parents.
Chicago has a significant gang turf problem. To deal with that, the city plans to do a better job of creating safe-passage lanes so that students will be able to come and go from school without being harmed. At-risk students will be offered paying jobs and paired with local advocates who will engage the young person’s family and be available around the clock. The point is to provide these young people with the constructive adult relationship that so many of them seem to lack.
The plan, which will be started with federal stimulus money, will cost $60 million for the first two years. But it will more than pay for itself if it reduces the number of shootings and deaths and puts more young people on the road to productive lives instead of the road to prison. It deserves full and enthusiastic support from the city, community groups and from the business community, which could play an essential role by providing the young participants with jobs.
The swine flu vaccine has encountered a remarkably mixed reception. Some people are railing against their doctors about the vaccine’s scarcity while others are waiting hours in line for their shots. But a surprisingly large number of people — even some health care workers — are holding back because they fear the vaccine or don’t view the virus as all that great a threat.
Our advice is that the most vulnerable people — the young and pregnant women — and those in critical jobs, like health workers, should take the vaccine.
From all available evidence, it seems just as safe as the flu vaccines that tens of millions of Americans routinely take every year. It has been produced by the same manufacturers using the same techniques they always use. It has not been “rushed” into production (the fearmongers’ term). The only “rushing” involved loading the vaccine into vials while simultaneously finishing clinical trials to determine the correct dosage.
The trials have shown that the vaccine is extremely well matched against the current swine flu strains. The trials have also detected no safety problems so far. Almost 14,000 adults, children and pregnant women have received the vaccine without serious adverse effects. Pain and swelling at the injection site were the most common complaints.
Of course, safety problems could always emerge as tens of millions of people get vaccinated. Federal health officials have wisely initiated an expanded system of monitoring to detect any serious adverse effects among recipients and quickly determine whether they are caused by the vaccine.
So far, the swine flu virus looks no more virulent than a normal seasonal flu. That is bad enough. It has killed roughly 4,000 Americans and sent roughly 40,000 to the hospital. The virus is active in 48 states, and even if it begins to taper off soon, another wave might hit us early next year. Those most at risk would be wise to get vaccinated when they can find a supply.
The rising sun over the Koolau Mountains cast a glow upon the ballistic missiles planted on the lawn of a submarine museum at the edge of Pearl Harbor, throwing long shadows across the water. They pointed at the bone-white memorial to the U.S.S. Arizona and, just beyond it, at the still-floating battleship Missouri, about to leave her pier.
It’s not every year that you get to see a World War II battleship on the move. Particularly in the heart of Pearl Harbor, along what used to be Battleship Row, ground zero for the carnage of Dec. 7, 1941. The sight drew me and about 50 other people to the water’s edge just after dawn on Oct. 14.
The Missouri, mothballed for years, was towed to Hawaii from Washington in 1998 to be a bookend to the U.S.S. Arizona Memorial, symbols of Japan’s surprise attack and abject defeat. The Arizona was blown up and lies at the harbor bottom, a tomb for her crew. The Missouri sailed triumphant into Tokyo Bay in 1945; surrender papers were signed on her deck.
Rusting and leaky, the Missouri was being towed to dry dock for three months of repairs. As per the aphorism, turning her took a little while. Shortly after 7 a.m., she came into full broadside view, then swung around. From head-on, 16-inch guns bristling, she looked like every fat-bellied battle wagon in every newsreel you ever saw. In the foreground, she was dwarfed by the aircraft carrier Ronald Reagan.
The Pearl Harbor shipyard resurrected the Pacific fleet in the months after Dec. 7 and is doing the same for the Missouri. But whatever conflicts lie ahead for the Pacific Command, the Missouri will not be involved. Among other repairs, a local paper reported, she is getting a new tent on her fantail, “for parties and other revenue-generating events.”
It would never be good to get misty-eyed about World War II, whose horrors will cast shadows to eternity. But it is possible to appreciate and even honor its relics, like the sea-changed Arizona, and makeshift monuments, like Mighty Mo. Once it was the deadliest instrument of all-out war, now it is tamed and a gathering place for tourists, sailors and schoolchildren.
Her main duty now is to preserve the great moment that took place on her deck, so different from today, when a global war with a beginning and a middle finally came to an end.
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