Wednesday, August 29, 2012






Exceptionalism Misunderstood



Alex Pareene, blogging in Salon, notes

There’s obviously a weird contradiction between the “new American Century” talk and the “face up to the fact that we can’t spend money on things like education and infrastructure and entitlements” message but that’s just how Hard Truth-Tellers roll.

There is also a contradiction, one common to Republicans nowadays, in simultaneously claiming "exceptionalism" for America while denying its actual existence.

In his keynote address, Chris Christie targeted "an enormous government that has overtaxed, overspent and over-borrowed a great people into second-class citizenship."  Clearly, the Governor, arguing "we stand up once again for American greatness," believes the U.S.A. is not now great, apparently  because we are suffering under the yoke of an oppressive, Democratic government with a president who lacks "leadership."

Predictably, the confused governor does not cite as "great" such things as increasing opportunities for women and minorities in higher education and the workforce; the large numbers of individuals skilled in science, technology, engineering, and mathematics graduating from American colleges; a transportation network accessible to most citizens; or even the nation's unparalleled military strength buoyed by the sacrifice of (mostly) young men and women throughout the nation.

Instead, Governor Christie claims "Mitt Romney will tell us the hard truths we need to hear to end the debacle of putting the world's greatest health care system in the hands of federal bureaucrats and putting those bureaucrats between an American citizen and her doctor." Obviously, the traditional service for fee, privately-based health care system places the insurance company between the citizen and his or her doctor.   Christie knows this, but exuding a crude gruffness has gained him an undeserved reputation for candor.

We now have information more current than the World Health Organization study in 2000 ranking the U.S.A. 37th in health care worldwide.   The Atlantic's Brian Fung explains

It's an uphill climb by any measure to argue that the United States has the world's best health-care system, bar none. If the claim were true, then under no circumstance should the United States find itself behind its peers. Under very few circumstances, at any rate, if we're being generous. And yet... Let's start by considering these two facts from the OECD: We spend at least -- at least -- 53 percent more on health care per capita than any other nation in the developed world. We also pay more than three times what the British or the French pay out of pocket per capita on health care -- that's the third-highest rate among all OECD nations.

You might think spending a lot leads to superior outcomes; that might be true in some instances, but certainly not in so many that we could claim first place overall. For instance, we've got the fourth worst rate for infant mortality in the OECD. The United States is third-to-last in terms of mortality for children under 20, and it's 12th from the bottom when it comes to child suicide. We have the second-highest teen birth rate in the OECD, we're eighth from last on overall life expectancy at birth, and we're tied with Slovenia for third-worst place in terms of doctor density -- a count of how many doctors are available per 1,000 citizens

In 2009, we were in fourth-to-last place in terms of health insurance coverage rates (Excel) -- ahead of Chile, Mexico, and Turkey, but behind the Slovak Republic, Estonia, and Poland. As a percentage of total health expenditures, we rank seventh when it comes to prioritizing preventive care; countries that spend more on preventive services include Canada, New Zealand, Slovenia, and Hungary. Our hospital admission rates for heart attack patients alone are astronomical; compared to other Western developed countries, Americans can expect to go back to the hospital after a myocardial infarction a whopping 68 percent more than their foreign-born peers.

Again, we're great in a lot of ways. America has some of the best doctors, the best technology, and an amazing repository of medical and scientific knowledge. But to have an intelligent conversation about the future of health care, we ought to be realistic about what the country has and hasn't accomplished.

Facts, however, don't matter, at least to a guy like Christie.  America, he implies, is great, but not now, a fundamental misunderstanding of the nature of American exceptionalism. President Obama, the 112th Congress, or the federal judiciary as currently composed may not be great.   But if the U.S.A. is exceptional- which it probably is, though in ways the GOP does not recognize- it was yesterday, is today, and will be tomorrow, irrespective of the occupant of the White House, the party controlling Congress, or judges currently sitting on the federal bench.   It's a tough concept for those Republicans, such as Paul Ryan, Ann Romney, and Chris Christie, who believe America is great, but only when their guys run it.




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