How Do You Think?

It is often argued that the United States is exceptional with regard to its capabilities and responsibilities.  With respect to its military prowess, and defense budget, it is certainly exceptional.  I am curious however.  To what extent is the US exceptional in other important ways?  Is the US the envy of the world with regard to its educational system and its healthcare?  How safe are Americans?  Further, does America prove exceptional with regard to issues such as equality, democracy, and opportunity?  I for one, am all for being exceptional.  Shouldn’t we strive for superiority in all these areas?  Is not a person’s character judged based on variables other than one’s physical strength?  Are not issues such as kindness, fairness, and morality given important consideration when we evaluate each other?  I suggest that nations too should be judged on these issues.  We as a people certainly judge other nations based on these attributes.

So, how does the US compare to other wealthy and developed nations on these important issues?  Let us take a closer look.  By far, the best accessible and concise analysis of this question is contained in The Measure of a Nation by Howard Steven Friedman.  Dr. Friedman is a prominent statistician and health economist at the United Nations and he teaches at Columbia University.  Measure of a Nation was named by Jared Diamond (author of Pulitzer Prize winning Guns Germs and Steel) as the best book of 2012 in an interview published in the New York Times.  I have to agree with Diamond’s opinion.  Friedman’s book is a data driven assessment of 14 nations, each meeting specific criteria for population (at least 10 million) and wealth (mean GDP at least $20,000).   Friedman methodically and carefully analyzes data from each nation and creates a relative ranking system whereby each nation is evaluated on diverse issues such as Health, Safety, Education, Democracy, and Equality.  The comparison countries include: UK, Canada, Germany, Spain, Portugal, France, Belgium, Italy, Greece, Netherlands, Australia, Korea, and Japan.

Friedman’s book constitutes an ambitious undertaking and he is careful to be clear about the pitfalls associated with the measures and analyses used.  In the end however, as a skilled statistician and economist, he was able to pull together a clear and concise  comparative ranking system that factually answers the question – “Is America Exceptional?”

He are the rankings:

Data is from The Measure of a Nation, by Howard Steven Friedman

I don’t know about you, but I was appalled by these findings.   The US comes up with a last place ranking on a majority of very important quality of life variables with regard to health, safety, democracy, and equality.  It gets worse when you look at all the comparisons drawn in Friedman’s book.  I included only those measures that could easily be put in a table without the need for deeper explanation.   And with regard to education, we are in the middle and bottom third of the rankings, except when it comes to years of education and percent of the population getting secondary education.   Our literacy rankings are unacceptable.

Neither Friedman or I are driven to bash the United States.  Instead, he and I both are motivated by a desire for exceptionalism across all these measures.  Friedman makes recommendations about how we as a people, and a nation, could improve on all these important variables.   The subtitle of his book is How to Regain America’s Competitive Edge And Boost Our Global Standing.  The problem is one of over-confidence and unquestioning nationalism.  To boldly contend that America is exceptional in every way is both unsubstantiated and untrue.  How I wish it was otherwise.

It is time to step back, look deeply at these issues, accept the reality that we can do better, and then devote our efforts to making it so.  We are arguably the richest and most powerful nation in the world with a vast capability for excellence.  It comes down to priorities and hubris.  If “we the people” demand excellence in these areas, and stand-up and make our voices heard, politicians will have to respond.  If however, we bombastically proclaim “We’re #1” regardless of what the evidence suggests, we will continue to languish.   Should not the measure of a nation, with such capabilities,  be the best?

Spread the word, get and read Friedman’s book.  Let’s start changing the dialogue in this country away from the current divisive and unproductive rancor, and begin focusing on what really matters.  It starts with knowledge and it ends with a healthier, safer, smarter, and more fulfilled populace whose politicians truly represent them and actually address important issues.

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For other discussions and data points on US rankings relative to other nations see:

We’re # 37! USA! USA! USA! A look at the US Healthcare System

A 2010 US Department of Education report releasing the 2009 Program for International Student Assessment (PISA) scores indicated that 15-year-old students from the US scored in the average range in reading and science, but below average in math.

Happiness as Measured By GDP: Really?

There is no doubt that violent crime in the US is a major problem.  Murder is certainly not a uniquely American act, but as in other things, we Americans excel at it.  The U.S. murder rate is nearly three times the rate that it is in Canada and more than four times the rate that it is in the United Kingdom.

The year 2011 proved to be a challenging year.  A number of serious health issues in close family members took center stage.  The frequency of my posts declined in part due to these important distractions but other factors also played a major role.  Although I published fewer articles, the number of visits to my blog increased substantially.

Over the course of the year, I had 18,305 hits at my website by 15,167 unique visitors, accounting for over 25,000 page views.  I had visitors from every state in the Union and visits from people from 140 nations around the world.  Visitors from the United States accounted for the vast majority of those hits, but the UK, Canada, and Australia also brought in a large contingent of visitors.

One article in particular far outpaced all other posts.  My post on Brain Waves and Other Brain Measures accounted for as many visits as the next three most popular posts combined.  Of my posts published in 2011, only four made it to this year’s top ten list.  The other six were published in 2010.  Of those six from 2010, four were also on the top ten list last year.

Great interest persisted in my post entitled Nonmoral Nature: It is what it is.  This review of Stephen Jay Gould’s most famous article sustained a number two ranking for a second straight year.  I had also reviewed in 2010 a very popular New York Time’s article by Steven Pinker entitled The Moral Instinct.  This article moved up a notch this year, ultimately ranking number three.  My critical article on the Implicit Associations Test ranked number four this year, versus a number six ranking last year.  And my Hedgehog versus the Fox mindset piece ranked number ten this year, compared to a number seven ranking last year.

So here is the Top Ten list for 2011.

1. Brainwaves and Other Brain Measures (2011)
2. Non Moral Nature: It is what it is (2010)
3. Moral Instinct  (2010)
4. IAT: Questions of Reliability and Validity  (2010)
5. Where Does Prejudice Come From?  (2011)
6. Cognitive Conservatism, Moral Relativism, Bias, and Human Flourishing  (2011)
7. What Plato, Descartes, and Kant Got Wrong: Reason Does Not Rule.  (2010)
8. Intuitive Thought  (2010)
9. Effects of Low SES on Brain Development  (2011)
10. Are you a Hedgehog or a Fox?  (2010)

It’s interesting to me that this list includes the very foundational issues that have driven me in my quest.  And each was posted with great personal satisfaction.   This encompassing cross section of my work is, in fact, a good starting point for those who are new to my blog.  There are several popular 2011 posts that ranked outside the top ten but ranked highly relative to other posts published in 2011.  These other posts include:

• Tribal Moral Community
• Schadenfreude
• Narrative Fallacy
• What not to say to someone with cancer: And what helps
• Parenting Style May Matter for Infants & the Economically Deprived
• Narrative Fallacy: A “Sign” of Cognitive Maturation

One article I published late in 2011 has attracted significant attention.   I believe that it is perhaps one of the most important posts I’ve written.  As I was writing this retrospective, Conspicuous Consumption and the Peacock’s Tail was far outpacing all other posts.

The most emotional and personally relevant articles pertained to significant problems in healthcare in the United States and my wife’s battle with breast cancer.  These articles include: (a) What not to say to someone with cancer: And what helps; (b) Up and Ever Onward: My Wife’s Battle With Cancer; (c) Cancer, Aging, & Healthcare: America, We Have a Problem; (d) We’re Number 37! USA USA USA!; and (e) Tears of Strength in Cancer’s Wake.  The latter pertains to perhaps the proudest parental moment of my life.

Another very important issue that I wrote a fair amount about includes the pernicious affect of poverty on child development.  Clicking here takes you to a page that lists all of the articles on this topic.  Knowing the information in this series should motivate us, as a society, to truly evaluate our current political and economic policies.

One of my favorite articles tackled my long standing curiosity about the geology of the place I live.  The article itself did not get a lot of attention, but I sure loved writing it.

This two-year journey, thus far has resulted in perhaps unparalleled personal and intellectual growth.  It has changed the way I look at life, the world around me, and my fellow human beings.   It is my sincerest hope that those who have seen fit to read some of my material have experienced shifts of perception or at least a modicum of enlightenment.

The bottom line:

The human brain, no matter how remarkable, is flawed in two fundamental ways.  First, the proclivities toward patternicity (pareidolia), hyperactive agency detection, and superstition, although once adaptive mechanisms, now lead to many errors of thought.  Since the age of enlightenment, when human kind developed the scientific method, we have exponentially expanded our knowledge base regarding the workings of the world and the universe.  These leaps of knowledge have rendered those error prone proclivities unessential for survival.  Regardless, they have remained a dominant cognitive force.  Although our intuition and rapid cognitions have sustained us, and in some ways still do, the subsequent everyday illusions impede us in important ways.

Secondly, we are prone to a multitude of cognitive biases that diminish and narrow our capacity to truly understand the world. Time after time I have written of the dangers of ideology with regard to its capacity to blindfold its disciples.  Often those blindfolds are absolutely essential to sustain the ideology.  And this is dangerous when truths and facts are denied or innocents are subjugated or brutalized.  As I discussed in Spinoza’s Conjecture:

“We all look at the world through our personal lenses of experience.  Our experiences shape our understanding of the world, and ultimately our understanding of [it], then filters what we take in.  The end result is that we may reject or ignore new and important information simply because it does not conform to our previously held beliefs.

Because of these innate tendencies, we must make additional effort in order to discover the truth.

I have little tolerance for unabashed patriotism. When you look closely at the facts with regard to important quality of life indicators, the good ole US of A falls short in many areas.  Life, liberty, and pursuit of happiness and unalienable rights seem to apply more to corporate entities than they do to we the people. And freedom now has more to do with economic opportunity in other countries than it does with civil liberties for our own citizens.  Don’t get me wrong, I am happy to be an American.  Thanks to my brave and industrious parents and their forefathers, I have had a steady launching pad and subsequently have done moderately well for myself.  However, I am very fortunate not to have been born Gay, a minority, or poor.  To paraphrase an old Seinfeld episode “Not that there is anything wrong with being any of these,” but the reality is that these folks suffer at disproportionate levels in this country.  And I suggest that this is a direct result of social and economic policies.

Somehow, patriotism has become the exclusive domain of those on the Right who through Conservative policy support deregulation, free markets, hawkish military doctrines, government downsizing and subsequent cuts in social services and regulatory agencies.  Even the Democrats have shifted to the right and this has been particularly true since the Clinton Administration. These policies certainly bolster corporate interests and the financial portfolios of the very wealthy.  But those gains have come at the expense of the vast majority of Americans.  The income divergence between wealthy Americans and the rest of us is no secret.  Charts and graphs, easily accessible, have uniformly detailed the relative economic flat line that most of us have endured for decades while those in the top 1% show skyrocketing and seemingly geometric growth rates.  Meanwhile, policies that may level the playing field for most Americans, have somehow been castigated as “Socialist” and “Anti-American.”  This latter thinking is wrong on so many different levels.

Regardless of the real world consequences, nearly half of Americans latch onto and support the Conservative – pro-business policies that are clearly at odds with their well being.  One important way this plays out is in healthcare.  When it comes to life expectancy, the USA ranks number 37 in the world.  That’s right 37!  There are 36 nations that, as a people, take better care of each other than we do.

In a recent study published in Population Health Metrics on life expectancy in the United States, data regarding life expectancies in every county from 2000 to 2007 shows how U.S. mortality compares with that from other wealthy nations.  The results indicate that life expectancy in the United States has not kept pace with other nations.  In fact, the data suggests that life expectancy has fallen in many counties, particularly in Appalachia and the deep south.   Women in such settings have fared far worse than men.

Here are some of the highlights from the study.  The highest life expectancy for women in 2007 turned out to be in Collier County near Naples, Florida – where women lived on average for 86 years.  In contrast for women from Holmes County, Mississippi the average age at time of death was 73.5 years.  That is nearly a 13 year discrepancy.  Further it was indicated in the report that:

In 2007, life expectancy at birth for American men and women was 75.6 and 80.8 years, ranking 37th and 37th, respectively, in the world. Across US counties, life expectancy at birth ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women (Figure 1a). Geographically, the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard. In addition to these broad geographic patterns, there are more isolated counties with low life expectancies in a number of western counties with large Native American populations. Clusters of counties with high life expectancies for males and females are seen in Colorado, Minnesota, Utah, California, Washington, and Florida.

What accounts for this gap and the lower relative ranking among our fellow longer living earthlings from other nation states?   On June 16th, 2011, Melissa Block from NPR – Talk of the Nation discussed the results of this study with Dr. Ali Mokdad, a global health professor at the Institute for Health Metrics and Evaluation at the University of Washington.   Dr. Mokdad noted that: “there are four factors – three are equally affecting men and women in this country.”   He then indicated that the three equal opportunity factors included:  (1) socioeconomic status;  (2) access to healthcare/health insurance or no insurance; and (3) quality of medical care.  In other words, if you’re poor, you don’t have medical insurance, and you live in remote areas with poor medical facilities, with less proficient professionals, you are more likely to die early.  On the other side of the coin, it is true that we have the best quality medical care in the world, BUT, many Americans do not have access to this Tier 1 level of care.  It’s only true for certain pockets of the population who are relatively affluent and living near major medical institutions.

The fourth factor, preventable risk factors (e.g., smoking, obesity, poor diet, lack of physical activity), affects both genders but women and particularly poor women disproportionately.  The study points out that in more than 300 counties in the United States, life expectancy declined over 20 years for women.

It is time to wake up America!  These statistics are appalling and embarrassing.  Look at the the real world human costs of economic policies that create and sustain such divergence.  The most recent recession, clearly the result of financial deregulation and unfettered free market greed, has had catastrophic global consequences that have reshaped the landscape.  Budgetary discussions center around deep government cuts to education and social services – further compromising the very people who have been hurt the worst.  Elimination of continued tax breaks to the richest Americans is absolutely off the table.  And now the Conservative agenda is to abolish “Obama Care?”  Look at the evidence people – its all around you.  Before you buy into an ideology – look at the real world consequences – look at the evidence, and ask yourself how you and your loved-ones are affected.  It scares me that such callus disregard for our fellow citizens is the new chic.

I find myself in an unfortunate spot.   Both my mother and father are suffering from seemingly intractable health problems and my wife was just diagnosed with breast cancer.  My parents, each suffering for years with chronic pain have been victimized by aimless care in an over burdened, understaffed, and misguided healthcare system.   The maladies of a healthcare system driven by economists has left us with a patient care system that is often just mediocre and sometimes atrocious.  More evidence for this has played out in the sequence of events that has left cancer undiagnosed and unabated inside my wife’s breast for six months after she first detected a lump.

What I have personally witnessed over the last year has left me appalled.  There is not enough time, space, or reader interest, I suppose, to take you through these respective journeys.  And my anecdotes, as deeply meaningful as they are to me, tell only a minute fraction of a complicated story.   Multiple factors have coalesced to degrade healthcare, and these forces have been primarily dictated by the motive for profit, austerity, or the quest for financial viability.  These interests have seemingly superseded the drive for quality care.

When I had my own private practice (as a Licensed Psychologist) the reimbursement schedules set up by insurance companies provided financial incentives for care provision that were incompatible with my training and my personal and ethical care standards.  Viability as a service provider demanded either compliance or unsustainable practices.  In large part due to these realities I chose a different career path.  This is all too common.  Two of the best medical doctors I’ve known have left the field because of similar issues.  When you can’t do what’s right and you feel like you have to thin your care to stay in business, the whole patient care scenario becomes compromised.

Medical care for run of the mill ailments seems adequate (if you are fortunate enough to have health insurance); however, when issues are complex or they involve multiple body systems, the quality of care seems to break down.  My father, for instance has many health issues.  His care, when any of these issues becomes acute, pits one specialist against another and thus one body system against another.   Just recently his acute pulmonary difficulties landed him in the ER and there, the care, as prescribed by an ER Doc, resulted in an adverse reaction necessitating yet another ER visit that resulted in a worsening response necessitating admission to the hospital.

His care has been so fragmented and communication so compromised that he experienced in this circumstance, a doctor induced overdose.  Looking back over the last several months, he has experienced intolerable amounts of pain and suffering – the likes of which no one should have to experience.

While in the Hospital after his initial diagnosis of pneumonia, he fell and injured his back causing significant and persistent pain that was initially misdiagnosed as pleurisy.  Months of pain and misdiagnoses left lingering unresolved pain. My mother likewise has an idiopathic issue that results in protracted and unimaginable pain.  The poor women has experienced dumbfounded docs and care that resulted in multiple re-admissions and ultimately no resolution of the issue.   We have traveled to distant cities to see experts with hopes that we can get her issue under control.  An appointment just this week left even the Doctors at Cleveland Clinic shrugging their shoulders in ignorance.  Idiopathic pain unresolvable by the best.  This isn’t anyone’s particular fault, but it leaves my mother wondering when the next episode will incapacitate her with pain. That is no way to live. She now needs experts in pain management.

My parents are strong, independent, self-reliant, humble and unassuming people who do not have a bone of entitlement in their make-up.  They have worked hard throughout their lives as solid contributors to society.  They are careful and cautious people trying to do what is right.  What they have gone through in their golden years is tragic.  And some of it, certainly not all of it, lies at the feet of modern health care.

Now, we have cancer care on the immediate horizon. I cannot and will not tolerate the mediocrity that pervades the healthcare system in pursuit of my wife’s recovery.  We will advocate for the best possible care available, and will not accept less than best practices should our insurance company attempt to compromise my wife’s care to save a buck.  This will not be easy and perhaps not cheap, but life and time are precious.  Far more precious than the material possessions that surround us.  I keep saying that if Lance Armstrong can survive the extensive cancer he had and go on to win a record number Tours de France, than we can beat this.  The only question is – will we get Tier 1 level of care?

Clearly there are three tiers of healthcare in the United States.  There is the reactive or non-existent care received by the poor and those at the lower end of the SES spectrum who cannot afford insurance.  Then there is the care for those of us with health insurance – adequate for run of the mill ailments – but stressed by complexity.  Then there is Tier 1 care for those with no financial restraints.  Money talks and it can buy you the best care in the world.

We do not have limitless resources or the fame and backing that Lance had, but but we do have resolve, determination, and the best breast cancer surgeon in Western New York.  I laid it out on the table when we met with her doctor:

“Only the best for my wife! I don’t want an insurance bureaucrat making medical decisions for us.  I’ll sell my house if I need to – Tier 1 Care – nothing less!”

And so the journey begins. We have a lot to learn and a formidable opponent. Cancer can be tough too.