I recently read an article in The Atlantic that makes an argument that I have made many times in recent years - America needs to learn from others in order to "make America Great Again". Americans need to travel more, and not in group tours or cruises if they can afford to travel independently (generally independent travel is significantly less expensive than tours, at least the "high" end tours).. They might as well go to an Imax for travel movies- except that the Imax theaters don't have as good of food as even most street carts do in other countries.
When Americans travel abroad, they are often surprised at how well other countries do the things we used to think America does best. In fact, one reason so many American businesses still lead the world is because they benchmark the competition and emulate best practices. But suggest to an American politician that we should try to learn from other countries, and he will look at you like you are from Mars. It is somehow unpatriotic even to raise such comparisons.
Imagine if a politician were to say, "France has a better health care system than we do." I can almost guarantee that politician would suffer electoral defeat -- even though the statement, in most objective respects, is true. The U.S. is, for too many, the only country that matters; experiences anywhere else are irrelevant. Remember, we have many members of Congress who boast they have no passport....
...many of our political leaders, rather than asking what we can learn from the countries that have surpassed us in various ways, choose instead to win applause with unqualified boasts of our inherent greatness. They imply that the answers to our problems are to be found not just by closing our borders to immigrants but to foreign ideas as well....
The countries that are making great strides follow quite a different path. Some of them are autocracies. Their leaders want to know which countries do the best job teaching elementary education or high school science, and how; which countries best prepare their people for tomorrow's jobs, and how; which countries best protect consumers while maintaining business vitality, and how; which countries best reduce their dependence on fossil fuels, and how. They benchmark against the leaders--just like the strongest American businesses do.
The article was written in 2012, and contains data that few Americans are aware of. We have slipped even farther behind since then.
As you know from my comments here, we have traveled extensively over a period of 50 years. Most of our travel as a married couple and family has been in Europe (also the Caribbean, Japan, and Australia), but that is enough to be able to compare quality of life in many different countries.
Lots of trips, lots of time for casual conversations, lots of time to observe how people live in those countries. We became real friends with some people, and stayed in their homes. We talked about many things (believe me, they are truly horrified by the American healthcare system - and they are absolutely right to be horrified!). These trips always led me to do more research when I got home. I studied the healthcare and educational systems of the world's other rich countries in some depth, and realized that Americans are even worse off compared to the citizens of the other industrial nations than I had been able to observe when traveling.
Biden is now proposing some family friendly and early childhood education support measures. It seems that he may be trying not to draw too much attention to the fact that these proposals may be inspired by practices that are a given in European and other advanced countries, perhaps because the GOP will start screaming "socialism", even though these countries are all capitalist countries.
Perhaps the younger generations will be able to help America become a better country to live in - because they travel in far greater numbers than do/did their parents and grandparents. They travel and they make friends, and they talk, and they observe. Then they come home, and may reflect on the differences in how others do things and how we do them. And many come to realize that America no longer leads the world in overall quality of life, in education, in healthcare, in work/life balance, in family friendliness.
Hi Anne, Katherine N. here. I am typing on my phone because I am visiting family where there is no internet connection, so I don't know if my name will show up.
ReplyDeleteI think travel will gradually return as more people get vaccinated. I agree that for the most part it is a good thing, especially if it leads people to get out of their bubble. Covid has brought home some of the weaknesses in our healthcare system. Unfortunately every country's healthcare systems have shown the weaknesses and cracks during the pandemic. Especially countries like Brazil which formerly had a fairly good system, but which is run by a dictator wannabee who seems to be doing his best to run things into the ground.
Agree that young people are going to see things differently than their patents' generations.
Katherine, enjoy your visit with your family. I know it's been hard on you to stay away.
DeleteI'm not referring to Covid when I discuss the difference in the healthcare systems. I'm referring to the fact that these other countries have universal access - nobody falls through the cracks because they can't afford health insurance - and affordability for all medical care - having a baby, getting stitches, being treated for a stroke. Big and little.
The healthcare spending in the US/person is between 8 and 2 times higher than every other OECD country in the world - and our outcomes are worse. Millions of Americans fall through the cracks, and don't seek healthcare when they should because they don't have coverage. They are the working poor. Their employers don't subsidize their health insurance. They aren't poor enough for Medicaid, and it's too costly to buy their own policies or pay out of pocket. So they have diabetes but don't know it until there is a crisis. Or they have diabetes and can't afford the insulin, so don't take all the doses they should and get sicker. Some Americans drive to Canada to buy insulin.
I did a deep dive into European and Asian healthcare in 2005, after my husband had a stroke while we were in France. What an eyeopener that was. Excellent care - and a small price for us relative to the US. When we came home, the bill for 2 days in the US hospital where they did a test (that they botched and then had to fix in a 3 hour operation) came to more than $85,000. Of course the insurance company didn't have to pay that much, but if we had been uninsured, they would have come after us for that amount. One reasons so many Americans declare bankruptcy is because they can't pay the ER and hospitalization bills. The insurance company paid about $40K. We would have had to pay the $85k if we had been uninsured instead of the deductible and copays. His total bill for a full week in French hospitals - that included 3 separate, long ambulance rides between hospitals (up to an hour one way) for tests and then changing hospitals to get him to one with a more extensive neurology dept), multiple high-tech tests (CAT, MRI, ECG, etc) came to about $6000. It was that "high" because he isn't a French citizen and obviously not covered under their health plan. A friend needed stitches in her finger while in France - she paid $35 total. In the US, stitches in the ER will be $500 or more. I needed stitches last fall - three trips to the local walk-in clinic for stitches, check for infection, and removal of stitches added up to about $800.
The US system is the only one among these countries that is based on a profit-making model. Obviously that means the people running the system are trying to maximize profit - they charge high prices to people who have few choices, and they cut costs to the bone, often in the form of personnel. Even low pay personnel, such as janitorial services. Just like making widgets - the bottom line is what counts in the US healthcare system.
Just saw a headline in the WaPo - the GOP is having fits about Biden's proposals, just as I knew they would.
I haven’t been anywhere except for Canada, however Betty went to London in 2005 on the way to visiting her Welsh ancestral home.
ReplyDeleteIn London her mother developed a pulmonary embolism. An emergency squad treated her. These are staffed by an RN or physicians assistant. They did all the diagnosis right there on the spot, ruling out a heart attack or stroke, and began administration of a medication to treat the condition.
When admitted to the nearby hospital she went quickly through the ER to a treatment ward. It was actually a very crowded ward. However from the beginning the people in charge made clear that they gave preferential treatment to Americans. They actually found her an alcove with a window.
There was very sparse staffing of the ward, and many of the patients were ambulatory, and there was much encouragement of self-care.
She was there for about four days. Betty was so pleased with her treatment that she left for Wales before her mother was discharged (another family member stayed with her).
The hospital equivalent of a social worker found a nearby flat, and provided a wheelchair. Her mother came back daily for blood checks by bus; all buses are wheel chair accessible.
Betty did have to give her credit card and she was charged. She does not remember how much but it was in the low single digit thousands. Thirty days afterwards Betty received a letter from the Queen with a refund check, apologizing for the billing and indicating that she had been treated as a guest of the Queen.
Betty is a descendant of Welsh royalty, the Morgan’s but not the rich branch like JP Morgan. She visited the family castle (which now is public) and found a portrait just like her of one of her ancestors.
I asked Betty if the treatment staff knew about this, and of course she told them the purpose of the trip. They called her mother the little princess and everyone gave her a lot of attention. So if you need health care in England I would not recommend depending upon your American citizenship for special treatment unless you are also a descendant of nobility.
I've only visited Germany, Italy and England with a day in Paris. I can speak some German and was able to have conversations. Of course, English speakers are everywhere. I was disabused of American exceptionalism and arrogance a long time ago. It makes travel more enjoyable when you like and respect the people you're visiting. I think that the people in the lands visited respond positively to that. It is pleasurable to find how we are the same and different. Perhaps some day I should stretch my boundaries and visit an Asian country. Right now, it seems China is being groomed as our next threat. This might make it more necessary to visit it. The language barrier is a problem but English speakers are everywhere.
ReplyDeleteMy friend M went to Japan on a business trip a couple years past. On the weekend, she avoided the packaged tour available and hopped a bus alone to the Mt. Fuji area without a word of Japanese. She had a good experience with the Japanese but I believe they are adept at surface politeness. I've heard that things get more honest if you get them drunk. The only bad aftereffect for M came from overexhuberant consumption of sushi. She was in abdominal distress for a month or more. I told her that we invented ways to make and control fire for a reason. I have no problem with the creatures I consume being not only dead, but sincerely dead.
Stanley, We have traveled many places, including countries where few people spoke English (at least when we were there - now it seems it's the universal language), and it didn't matter if there were no English speakers. We always took phrasebooks with us, and practiced a few short, polite greetings. We went to Japan many years ago, when few Japanese could speak English. We had been booked into a couple of day bus tours by my husband's Navy officer brother who was living there at the time, and absolutely hated them. We left one of the tours after two stops, and did everything else on our own. Including trips to off-the-beaten path places that required a combination of bus and trains. It worked out wonderfully and we never again took a tour anywhere we've traveled. People find a way to communicate, but we found people are always more open to helping hapless tourists if we knew at least a few polite phrases. It's definitely not an obstacle to enjoying travel in foreign countries. The one thing that can cause smiles to turn to icy stares is letting it be known that WE DON"T DO IT THIS WAY IN THE US. Remind yourself that "when in Rome,....".
ReplyDeleteRe: the intent of this post was really to discuss the main issue of America refusing to learn from other countries when they do things better - education, transportation, roads, support for families and family life, etc.. One of the many things they do better is healthcare - spend less, get more. I'm glad Jack's friends had a good experience with the NHS in England. It actually has the worst reputation of all the countries of western Europe. But, my son lived there for two years and he thought it was much better than the US.
A couple of examples of European healthcare (each country has a different system) are given in the YouTube video below and the article by the woman whose father died of cancer. The couple in Portugal have a YouTube series about moving overseas, and provide a ton of real information on what they have paid for rent, food, medical, transportation etc in several different countries. They finally settled down, choosing Portugal as their permanent home, have bought a house and are raising their two daughters there.
https://www.youtube.com/watch?v=QGUHpva3Gbk
If you were living with stage 4 cancer, where would you rather be treated? France or the US?
https://pnhp.org/news/the-french-way-of-cancer-treatment/
Anne, nothing surprised me about the account of French health care. A couple years ago, I watched Michael Moore's movie "Sicko". It was more broad brush and the article was much more detailed but in synch with what I saw in the movie. US health care IS being transformed but not necessarily in the way it should. The rapid and mass conversion of health care here to the corporate model, making even doctors into employees, has me concerned. These days, I mostly go to urgent care or, with a couple days delay, a nurse practitioner or physician's assistant. It must be comforting to live in a country where everyone can get health care. It has to considerably reduce the general anxiety. I can't help but think of Jean. I worry about how she is doing. I would much rather this country be a place where the need for health care isn't a catastrophic health burden. And, if my tax burden were higher, so be it.
ReplyDeleteHi Anne - I saw your note that you were requesting my thoughts on this. Much of what Gerson writes, I suppose I agree with: other countries do have better outcomes in a variety of areas.
ReplyDeleteRegarding healthcare, which has been the topic discussed in the comments here: my impression and understanding is that we in the US have great inequality in access and outcomes, and this inequality accounts for that fact that, on average, our outcomes aren't that impressive.
My decidedly amateur view is that we have four different healthcare systems here in the US. One is Medicare for seniors, which is relatively decent care, is relatively universal, and is relatively inexpensive. But you have to be 65+ to access it.
The second is employer-subsidized healthcare. I believe its outcomes are relatively good (although perplexingly, more expensive than what other countries spend), and many American have access to it, but many others do not. FWIW, this is what my own family always has utilized, and what my parents utilized when I was a kid. On the whole, we're a healthy family, so my anecdotal impression is that it works okay, at least for families like ours. One aspect of employer-subsidized health insurance which deserves more notice is that employers have a financial incentive to disqualify employees from the benefit, and over the last few decades, employers have become more expert at disqualifying employees (cf the "gig economy"). Of course, nowadays there is an Obamacare safety net, so whether this is as bad as it would have been pre-Obamacare, I am not certain.
The third is Medicaid, which is for the have-not-est of the have-nots. The folks who patronize our parish's Outreach ministry, especially those who are homeless, are entitled to Medicaid. Medicaid eligibility was greatly expanded by Obamacare - in fact, it's probably not much of an exaggeration to describe Obamacare most fundamentally as a Medicaid eligibility expansion act, as that has impacted more people's lives than the online exchanges. My take regarding Medicaid is that it's substandard health care. I wouldn't recommend it to anyone who has other options. Perhaps this creates a moral imperative to improve Medicaid. But from the conservative point of view, it also is a great cautionary tale: if the proposed model of universal, single-payer health care amounts to Medicaid For All, then expect great resistance to it from the American public, at least that portion of the public which has other, better options today. Medicaid makes me skeptical that American government is the cure for what ails American health care.
The fourth is everyone who doesn't qualify for the other three I described. The promise of Obamacare was that these were the people Obamacare was supposed to help. My understanding is that millions still fall through the cracks. Undoubtedly, part of this has to do with the stupidity and immorality of conservative politicians who don't think health care is a human right and don't care about people without it. But part of it also is because of the limitations of Obamacare itself, which was designed, built and passed by liberals, utilizing a political process guaranteed to leads to years or even decades of political warfare. The story with Obamacare for the last 12 or so years has been: we managed to pass it once, but we can't revise it meaningfully because it wasn't built on a bipartisan consensus. Again, this should serve as a cautionary tale for the Biden Administration, which I see as rehashing the same mistake in its trillion-dollar-plus proposals for pandemic relief, infrastructure, et al.
With the countries which have successful health care plans, my impression is that they are more like Medicare than Medicaid.
DeleteAs regards bipartisan consensus, is such a thing even possible any more? I don't say it's the right way to do it, but I understand why the administration plows ahead without it, because otherwise nothing would ever get done.
Some of the other things Gerson touches on, from education to guns to upward mobility to the quality of rail travel, are interesting. I would say: it's not that Americans are unaware that these are broken; it's that Americans either aren't sure what to do about them, or lack the will to do what needs to be done about them.
ReplyDeleteWhen it comes to public education, we know how to fix what is broken, but we lack the will to do so. Public education works quite well in well-off communities, even those with unionized teachers - but, on the whole, we have less acceptable outcomes in less-well-off communities. We know what works but we are unwilling and/or unable to do what needs to be done.
When it comes to the prevalence of guns, we neither know what to do about the problem, nor are willing to do what is possible. What prevents us from far-reaching changes is the Constitution. In my view, no still-current provision of the Constitution today is more amenable to further amendment than the 2nd Amendment. But I see little or no willingness to amend the 2nd Amendment. It's puzzling, because Americans have amended the Constitution many times throughout our history, so should know very well it can be done, and should know how to do it. Every time there is a mass shooting, liberals express anger and frustration that such things happen. Nothing can be done unless the Constitution is amended; but where is the movement to amend? Every new mass shooting should provide a bellows full of oxygen to an Amend-the-Second-Amendment movement.