Archive for the ‘International Comparisons’ Category

American exceptionalism in medical care

July 22, 2019

Click to enlarge.

I’ve often run versions of this chart on my web log.  It shows that we Americans pay more for medical care than do people of other rich countries, and yet our health is worse, and many of our citizens lack good medical year.  Yet a lot of us are afraid to change.

As a writer for The Economist said:

Republican reluctance to embrace health care, despite the president’s best efforts, is understandable.

On the one hand, America’s health-care system is woefully dysfunctional: the country spends about twice as much on health care as other rich countries but has the highest infant-mortality rate and the lowest life expectancy.  Some 30m people, including 6m non-citizens, remain uninsured.

And yet, though costs remain a major concern—out-of-pocket spending on insurance continues to rise—Americans say they are generally satisfied with their own health care. Eight in ten rate the quality of their care as “good” or “excellent”.  Few are in favour of dramatic reform.

Source: Health spending and life expectancy – The Big Picture

I think many Americans are in the same situation I am.  I have medical insurance that I can afford, providing by a company that I don’t think is going to cheat me.  I don’t know what I’d do if I had to pay my medical bills out of pocket—partly because the insurance company can negotiate lower rates than I would have to pay as an individual.

So it is natural to fear any change, and to be skeptical of anybody who promises to take away what I’ve got and replace it with something else that supposedly is just as good.

So these fears lock me into a system in which I’m at the mercy for for-profit insurance companies whose profitability is based on maximizing what they take in as premiums and minimizing what they pay back as benefits.

In the best of cases, the insurer’s need for profit is added to the medical bill.

T.R. Reid, in The Healing of Americawritten 10 years ago, said one of the reasons why American pay more for medical care and get less than people of other rich countries is the for-profit insurance system.  At the time he wrote, only Switzerland had for-profit insurance companies.

The other reason is that the other countries negotiate drug prices on a national basis, which the U.S. government is forbidden by law to do, and that medical professionals in the U.S. get more than in other countries.  I don’t have any reason to think any of these things has changed in 10 years.

The justification for the high fees of American physicians is that they have to pay off their medical school debt.  Medical education in other advanced countries is free or affordable.  If Americans ever wanted to cap physicians’ fees, we should combine that with some kind of medical debt forgiveness.

Reid said that there are three alternatives to the U.S. system: (1) the Canadian Medicare model, in which health insurance is nationalized, (2) the British National Health model, in which medical care is nationalized and (3) the system in Germany and Japan, in which non-profit organizations, accountable to patients, provide health insurance.

I don’t think it is feasible to create a patient-run cooperative insurance system for scratch, and I don’t think we Americans have the administrative capability of duplicating Britain’s National Health, even if we wanted to.

So that leaves Medicare for All as the path forward.  And it’s not Medicare for All unless we get rid of private insurance and regulate drug prices.


Why a “Public Option” Isn’t Enough by Benjamin Studebaker and Nathan J. Robinson for Current Affairs. The two writers conflate Britain’s National Health with Medicare for All, which is based on the Canadian system, but otherwise an excellent article.

“Medicare for All” vs “Public Option”: the 2020 Field Is Split, Our Survey Shows by Abby Goodnough and Trip Gabriel for The New York Times.  Where the Democratic Presidential candidates stand.

A ranking of countries by civic honesty

June 28, 2019

Click to enlarge.

To gauge the honesty of people in different nations, social scientists turned in 17,003 “lost” wallets to people in charge in various public businesses and institutions in 355 cities in 40 countries around the globe, and recorded how many of the wallets were actually returned.

Click to enlarge

One surprising result was that there was a higher rate of return with wallets containing a small amount of  money ($13.46) than of empty wallets, except in Mexico and Peru.

In three countries, the United States, the United Kingdom and Poland, they also left wallets with a larger sum ($94.15),  There was an even higher rate of return for wallets with big money than just a little money.

This is contrary to what both experts and non-experts predicted.

Researchers thought that people made an extra effort when money was involved in order to avoid thinking of themselves as thieves.

Switzerland had the highest rate of return for empty wallets and Denmark for wallets with money in them.  European countries overall, including Russia, got high marks for honesty.

China had the lowest rate of return for empty wallets and Peru for wallets with money.  I am disappointed that the United States is so far down on the list.


Humans are surprisingly honest when it comes to returning lost wallets by Katherine J. Wu for PSB NOVA.

Civic honesty around the globe by Alain Cohn, Michel Andre Marechal, David Tannenbaum and Christian Lukas Zond for Science.


Global warming requires global action

March 28, 2019

Click to enlarge.  Source: The Conversation

We Americans have actually done quite a bit to cut back on greenhouse gas emission, as the chart above shows.

But while we and the other North Atlantic nations have been cutting back, China and other nations have been pumping out more.

The average Chinese doesn’t add all that much to global warming, compared to the average American.  But there are so many more Chinese than Americans that China as a nation does more heat up the world more than the USA does.

Click to enlarge. Source: The Conversation.

The problem is that, for now, the economic growth of China, India and the Global South in general requires more use of coal, oil and natural gas.  If I were Chinese or Indian, I would be unwilling to give up my hope of a better material standard of living while Americans and Europeans have so much more than I do and individually leave so larger a carbon footprint than I do.


The top 1 percent in Russia

October 6, 2017

I’ve posted many charts about the growing concentration of income and wealth in the United States in the hands of a tiny elite.   Here is a chart illustrating inequality in Russia.

You should take note about what this chart shows and doesn’t show.  The ruling elite in the old Soviet Union didn’t have large incomes, and they didn’t live like American millionaires and billionaires, but they did have special privileges, much like military officers compared to the rank and file or like American corporate executives with huge expense accounts.    They had special stories, special medical care, special schools for their children, etc.

Also, the chart indicates that relative equality isn’t everything.   I don’t think many Americans would have wanted to trade places with the average person in the old Soviet Union.


How strong is North Korea?

September 11, 2017

North Korea has the world’s fourth largest army.   It has nearly 1.2 million troops under arms, slightly less than the USA and behind India and China.

South Korea has about 655,000 active duty troops, more than Britain, France and Germany combined.  A war between North and South Korea would be catastrophic, even if the USA, China and Russia were not involved.

Click to enlarge

Some observers claim that South Korea is the stronger of the two, because, they say, North Korean troops are malnourished and South Korean troops are better trained and have better equipment.   I wouldn’t know.


How the U.S. lags peer nations in health care 2

June 11, 2017


I came across a 2015 study by The Commonwealth Fund that shows the Americans spend more on health care, use more medical technology and take more prescription drugs than citizens of most peer nations, but aren’t necessarily more healthy.

We’re not the worst in this respect, but we’re far from the best.

The charts above and below tell the story.   I doubt things have changed much since 2013.


Rich people’s countries, poor people’s countries

February 28, 2017

Double click to enlarge.

This map shows national output (GDP) per person in different nations.   The leaders seem to be financial centers (Luxembourg, Switzerland, Singapore) and oil and gas producers (Qatar, Brunei, United Arab Emirates and maybe Norway).

The USA is both a financial and energy-producing center, ranking eighth behind those seven nations, but way ahead of Russia and China.

While China’s overall economy is thought to be larger than the American economy, that doesn’t mean that the average Chinese person is rich.

Of course GDP per person is not the whole story, either.  How the average person does depends on how wealth is distributed.  What the GDP figure shows is how potentially well off the individual person is.


Which Government System is the Best for People’s Wealth? on howmuch.

Who are willing to fight for their countries?

February 24, 2017
The darker the red, the greater the willingness to die for one's country

The darker the red, the greater the willingness to fight.

Only 44 percent of adult Americans are willing to tell pollsters they’d fight for their country.

The percentage is even less for some U.S. allies, such as Canada (30%), France (29%), the United Kingdom (27%), Italy (30%), Germany (18%) and Japan (11%).

In contrast, 71 percent of Chinese and 59 percent of Russians say they’d fight for their countries.

This is the result of a public opinion poll of more than 1,000 people in each of 64 countries in late 2014 by WIN / Gallup International.   The complete results are below.

I’m not sure what to make of this.  I think it partly depends on people mean by “fight for country”.

I think almost all Americans would be willing to fight to defend our nation from an invader.  I think only a minority are willing to go to some foreign country to fight to increase U.S. geopolitical power.

The problem for us Americans is that someday U.S. power will begin to slip, and countries that now fear to go against the United States will become our enemies.

When that backlash comes, our nation will need the patriotism that our leaders now exploit and abuse.


Nations of immigrants and the future

May 17, 2016


Hat tip to Jim Rose.

I’ve always thought of the United States as a nation particularly welcoming to immigrants, but the chart shows many other nations have proportionately larger immigrant populations than the USA.

I’m less surprised at the high ranking of Australia, New Zealand and Canada as at nations such as Switzerland, Austria, Sweden and Ireland, which I’ve always thought of as ethnically and culturally homogeneous.

I’d be interested in the figures for Argentina, Brazil and other Latin American countries.

[Update 2016/5/19.  I came across an interesting interactive graphic, Origins and Destinations of the World’s Migrants, 1990-2015, from Pew Research Center that answers my question.  Also, I forgot about peoplemovin- A visualization of migrant flows, an interactive graphic to which I linked previously.]


What is killing middle-aged white men? Despair

November 4, 2015


We take it for granted that, in scientifically advanced countries, the death rate will decline.  But since 1999, there has been a dramatic increase in the death rate among non-Hispanic American white men aged 45 to 54, especially those without education beyond high school.

No such increase occurs among middle-aged white people in other countries or among other American ethnic groups.  Although the death rate for African-Americans is higher, it is not increasing, and, as the chart shows, the death rate for middle-aged Hispanic Americans (USH) is decreasing.

A Princeton University study indicates that the main reasons for the increased death rate are an increase in alcohol-related disease (liver disease), in drug overdoses (heroin and opioids) and in suicide—all diseases associated with depression and despair.

[Note added 11/13/2015: Some experts say the increase is primarily among middle-aged white women.]


Darwin’s theory and American exceptionalism

January 20, 2015

20150119_differnt_0Source: Calamities of Nature via Zero Hedge.

As this chart shows, we Americans are less likely to believe in Darwin’s theory of evolution than the people of any European nation.

Oddly, though, we are more likely to believe in social Darwinism (although we don’t call it that)—the idea the law of life is survival of the fittest, and society does not exist so that people can cooperate for mutually beneficial ends, but so that the population can be sorted into winners and losers.


China leads the world in executions

October 21, 2014


Source: The Independent

Last year China executed more people, by far, than the rest of the world combined.

Live long and prosper? A world map

October 14, 2014
Click to enlarge

Click to enlarge

How long you’re likely to live depends to a large extent on where you’re born.  Somebody born in Japan can expect nearly five more years of life than somebody born in the USA, and 32 more years of life than somebody born in the African nation of Chad.

Click on Global Life Expectancy for detailed maps and comparisons by region, courtesy of Global Post.  Notice that South Africa has the second lowest life expectancy on the African continent.  Is this because the benefits of South Africa’s advanced 20th century economy never trickled down from the whites to the black majority?  Or is it because South Africa’s post-apartheid leaders denied the reality of the AIDS epidemic?  Or something else?

The education of America’s rich and poor

October 11, 2014

 Robert Reich, who was Secretary of Labor in the Clinton administration, took note on his blog of the education gap between rich and poor.

  • The United States, among the 65 nations participating in the Program for International Student Achievement, has one of the largest gaps in achievement between children of the rich and children of the poor.  This wealth gap in educational achievement has been growing while the gap between white and black Americans has been shrinking.
  • The United States, among the 34 nations that belong to the Organization for Economic Cooperation and Development, has one of the largest gaps between spending on schools attended by children of the rich and schools attended by children of the poor.

He quoted Eduardo Porter, who wrote about unequal education in the New York Times.

“The debate about education reform is a lot about process,” said David Sciarra, executive director of the Education Law Center in Newark, an advocacy group for disadvantaged students. “To a large extent it is a huge distraction. We never get to the question of what resources we need to get the students to meet the standards.”

The United States is one of few advanced nations where schools serving better-off children usually have more educational resources than those serving poor students, according to research by the Organization for Economic Cooperation and Development.  Among the 34 O.E.C.D. nations, only in the United States, Israel and Turkey do disadvantaged schools have lower teacher/student ratios than in those serving more privileged students.

Andreas Schleicher, who runs the O.E.C.D.’s international educational assessments, put it to me this way: “The bottom line is that the vast majority of O.E.C.D. countries either invest equally into every student or disproportionately more into disadvantaged students. The U.S. is one of the few countries doing the opposite.”

The inequity of education finance in the United States is a feature of the system, not a bug, stemming from its great degree of decentralization and its reliance on local property taxes.



The young nations and the aging nations

October 7, 2014
world baby boom

Click to enlarge.


Click to enlarge.

I think the leveling off of population growth is a good thing.  There is a limit to how many people the earth can support.  I don’t claim to know what that limit is, but it will be passed at some point unless population growth is leveling off.

demographic transitionThe good news is that this is starting to happen.  The problem is that it is not happening in every nation at once.

Some nations have low birth rates and an aging population that is growing in relation to the working-age population.  Other nations have high birth rates and a young population who can’t all find jobs.

Should there be more immigration from the growing young nations to the static older nations?

What happens to the world balance of power when the population of some nations is static and the population of others grows?  If present trends continue, India will have a larger population than China.  Mexico could become a more populous nation than the USA.  What then?

Bertrand Russell years ago wrote that in order to achieve world peace, nations needed to limit their populations as well as limit their armies and armaments.  Is that possible?

Demographers say that a nation’s population growth starts to level off when women are emancipated enough to be able to decide whether or not to have children, and when a nation reaches a level of prosperity such that parents think their security in old age is better with a few well-educated and well-off children than with many poor children.

I hope this comes true for the whole world.  Expressing this hope is as close as I can come to answering the questions I asked.

What do you think?


Protests in perspective

October 6, 2014
Click to enlarge.

Click to enlarge.

Source: The Economist (via Naked Capitalism)

The difference between average and typical

July 23, 2014


Here is a case study in statistics—showing why what is statistically average is not necessarily typical.

If all the wealth in the United States were divided equally, every American household would have $301,000.  But only a minority of Americans have that much net worth.  The more meaningful measure is the median, the point that divides the wealthiest half of Americans from the poorest half.  That midpoint is $45,000, a much lower figure.

Some of the reasons middle class Americans have less than their counterparts in other advanced countries is that we have greater debt and less equity in our homes, and also have to pay more for higher education and medical care, which reduces the ability to save.

For details, click on Middle class Americans: Not so rich as we think by Tami Luhby for CNN Money.

American exceptionalism in health care

January 28, 2014

1. prices_intl_nyt

Jon Perr explained for Daily Kos why Obamacare does not fix the dysfunctional U.S. health insurance system.

On January 1, 2014, the Affordable Care Act went fully into effect.  But for all of the furious fighting over the law these past five years, Obamacare was always an evolutionary reform grafted onto the existing American health care system.  The Medicaid public insurance program has been extended to roughly four million lower income Americans so far.  About two million more people have purchased private insurance, many of them aided by subsidies from Uncle Sam.

And while many (though not all) of the worst abuses that let insurers pad their profits by denying or dropping care for the sick have been banned, the edifice of private insurance remains largely intact.

Far from a “government takeover of health care,” Obamacare preserves all of the hallmarks—private insurance companies, private hospitals, private doctors, and the patchwork of different systems for veterans, seniors, workers, and the poor—that define the American model of health care provision.

Click on Why the U.S. should treat health care like a utility, not a market to read Perr’s full article.  Hat tip for to Bill Elwell for the link, which is the source of the charts.


The USA is a low-tax country

October 3, 2013
Click to enlarge

Click to enlarge.  “This year” in the captions is 2011.

I don’t advocate taxes for the sake of raising taxes or reducing the incomes of rich people.  But I do think that taxes should be high enough to cover the normal cost of operating the government, and I don’t think Americans should rule out a modest tax increase as a contribution to balancing the budget.

These charts were created by the Center for American Progress two years ago, but the situation they depict hasn’t changed since then.

The tax reductions proposed by President George W. Bush had an expiration date.  That is unusual, and was done for a reason.  Some people in Congress worried about the impact of cutting taxes in the midst of war, and voted for the tax reduction as an experiment, so see how it worked out.

Well, we know the result of the experiment.  It was one of the two main reasons, along with the economic recession, that the government is so much in the red now.   Returning to Clinton-era taxes, eliminating unnecessary government programs and growing the economic are not mutually exclusive.  We should do all three.

Inequality and well-being: country comparisons

August 9, 2013

Click to enlarge

The United States is a leader, and not in a good way.

Source: New York Times.

Hat tip to The Big Picture.

Massachusetts schools: Why not be like the best?

July 9, 2013

If a factory manager was trying to improve performance, he might try to adopt the best practices of successful manufacturers.   He certainly would not adopt the practices of failing manufacturers.

But this is not what school reformers in the United States do.  They advocate unproven policies (teacher-bashing, union-busting, charter schools) that are typical of the worst systems rather than the best.

A blogger who uses the handle Mike the Mad Biologist pointed out that the Massachusetts school system is by far a leading system not just by United States standards, but by world standards.  So why not, he reasonably asked, simply copy the Massachusetts system.

Here is one of the charts he published on his web log.


Click on Instead of Racing to the Tops or No Children Left Behind, Why Not Just Clone What Massachusetts Has Done? for more of Mad Mike’s data and his full comment.

Click on TIMMS, Alabama and Massachusetts: States Matter for Mad Mike’s detailed report on the educational gap between Massachusetts and Alabama.

The Massachusetts-Alabama gap is not explained by differences in race or economic class.   The average test scores of white students in Alabama are roughly equal to scores of black students in Massachusetts.  No matter how you break things down, Massachusetts is ahead.

So if you really want to improve American schools, the first step would be to look at what Massachusetts, Minnesota and other high-performing states are doing and see if there is a lesson to be learned for states such as Alabama.

But just what is it that Massachusetts is doing right?  It isn’t what Bill Gates and Michelle Rhee recommend, but what is it?  Is it financial support?  Curriculum?  Let me know what you think.


American exceptionalism

July 4, 2013

A writer named Alan R. Sanderson pointed out recently that the United States is still No. 1, at least in some things.

As our nation adds another candle on its cake […], let’s take stock of where we stand in the world after a couple centuries of trying.  Yes, we are about the only country with pick-up trucks and a preference for ice in drinks; we have an immense prison population and large carbon dioxide emissions, and, for a developed economy we have a troubling amount of income inequality.  We are a portly people, though the rest of the world is—pun intended—gaining on us; and we spend (waste?) far more time on Facebook than citizens in any other country. […]

No-1-USA-patch-197x300We have the largest Gross Domestic Product (GDP) in the world, about triple our nearest rival—China (on an exchange-rate basis, though only 50 percent larger on a purchasing-power-parity standard).  On a per-capita measure there is even more distance between us and Beijing, though not in comparison with several Scandinavian countries.

We have the highest spending—as a percentage of GDP—on health care of any nation, though that may be understandable—we’re rich!  And while we are not #1 in life expectancy, once one adjusts for the heterogeneity of our population, income inequality, infant-mortality, obesity, a high murder rate and automobile fatalities, we look more respectable.

With just 4.5 percent of the earth’s population, the U.S. produces 20-25 percent of all output, has a per-capita income 4-5 times the world average, and holds a third of the world’s wealth. […]

In terms of industrial and manufacturing output, the United States, China, Japan and Germany are the top four world economies.  We lead everyone by a wide margin in the production and export of services.  Three of the four largest non-bank businesses (by market capitalization) in the world are U.S. firms, and they reflect our diversity: Exxon Mobil, Microsoft, and Walmart. By the same metric we have four of the largest ten banks in the world, and the largest stock market. […]

flag-fireworksChina, India and the United States have the largest agricultural outputs, though it is only one percent of our GDP and less than two percent of our labor force.  (We lead the world by far when it comes to the consumption of coffee and cocoa!)  China, Germany and the United States are the three largest when it comes to the dollar volume of international trade, though in spite of all the political rhetoric and grousing about goods made abroad, relative to GDP the U.S. has one of the smallest foreign-trade sectors among developed nations.  In dollar terms, we have the world’s largest trade deficit, though it is less than 4 percent of our GDP.  (For Goldfinger fans: we have by far the world’s largest gold reserves.)

When it comes to flying, no other nation is close to us in logging air miles, and two of the three largest airports in the world, measured by passengers served, are in the U.S.—Atlanta and O’Hare.  France, Indonesia and the United States are the three top tourist destinations, though in terms of visitors’ spending, the U.S. comes out on top.  The most popular museums? In the U.S., France, and U.K.

Most of the world’s top universities are in the United States and, not surprisingly, in physics, chemistry, medicine and economics, 41 percent of all Nobel prizes have been awarded to Americans or scholars working here, and we lead the world in R & D expenditures.

via Chicago Life.

I’m grateful for my good fortune in being the citizen of a rich and powerful nation, but my greater gratitude is for being an heir to the United States’ tradition of freedom and democracy.

When President Abraham Lincoln referred to the United States as the last, best hope of earth, the United States was not No. 1 in gross domestic product and did not have full spectrum military dominance.  What Lincoln could justly claim is that the United States was a country in which ordinary working people had a voice in their government, and could better their condition through their own efforts.

A high national GDP is good and strong military power is good, but what matters is what they contribute to the well-being and liberties of the citizens of the nation.

Click on Celebrate the 4th of July for Sanderson’s complete article.

Click on Rethinking American Exceptionalism for David R. Sirota’s thoughts in In These Times.

Click on American Exceptionalisms for Richard J. Gamble’s contrast in The American Conservative of the older American exceptionalism and the new.

I don’t see how Obamacare can work

July 3, 2013

I don’t see how the Affordable Care Act, aka Obamacare, can work.  It’s too complicated.  It provides too many openings to game and undermine the system.  It doesn’t get at the causes of out-of-control health insurance costs.

obamacare_screw_o_1There are good things in Obamacare—the provisions that you can’t be denied medical insurance for a pre-existing condition; that grown children continue to be covered by their parents’ policies until age 26; that insurance companies can’t set a lifetime limit for coverage.

But the employer mandate gives an incentive for companies to avoid health insurance costs by cutting workers or cutting hours so that they are exempt from the bill.  The individual mandate give the health insurance industry a captive market without any protection against overcharging or underinsuring.

The Republican right wing’s war opposes Obamacare for exactly the wrong reason.   They oppose Obamacare not because it can’t achieve it’s stated goal of providing adequate medical care for all Americans, but because they are opposed to that goal.

President Obama actually is helped by the kind of enemies he has.  It makes his medical insurance plan seem better than it is.   That’s one reason I was willing to give Obamacare the benefit of the doubt when it first was proposed.  I thought that anything so vehemently opposed by the likes of Sarah Palin and Rick Perry must have something good about it.


Pay vs. productivity growth around the world

June 6, 2013

Double click to enlarge.


Click to enlarge.

The gap between growth of workers’ productivity and workers’ wages exists in a number of countries, but the gap is much wider in the United States than in other advanced industrial countries.

I took the second chart from an on-line article by an analyst who thinks this is a good thing, not a bad thing.  This analyst thinks it means that U.S. manufacturing is becoming more competitive internationally.

The failure of wages to keep up with productivity could be a good thing if it meant that the profits of U.S. industry were being plowed back into modernizing factories and infrastructure, expanding industrial research and creating new industries.  Do you see any sign this is happening?  Or is this just income being redistributed upward?

Click on US Manufacturing Restores Competitive Vigor for the source of the second chart and an optimistic view by Joseph G. Carson on the AllianceBernstein Blog on Investing.

Click on Signs of Factory Revival Hard to Spot for a skeptical view in the Wall Street Journal.


Who works the hardest, Greeks or Germans?

June 5, 2013

A friend of mine was a little surprised when I told him that the average Greek puts in many more hours of work in a year than the average German, or the average American.  I promised him I would look up the figures.  Here they are.


Click to enlarge

Here is a comparison of countries that includes Greece.


Click to enlarge

A country’s economic success depends less on the hard work of its people than on the technology that makes their work productive.   Here are international comparisons of productivity.


Click to enlarge.

Click on the following two links for more interesting charts and even longer lists of countries.

BBC News – How hard do you work?

BBC News – Where are you on the global pay scale?

Be warned.  Every country measures these things in its own way, so these charts only give general indications, not exact comparisons.

In my next post, I’ll look at the relation between productivity and wages.