Unhealthy, Unwealthy, Unwise

When I was doing research for a former book–my first sabbatical project, back in 2007– I came across data confirming the relationship between individual and social health.  It turns out that countries with strong social safety nets have substantially fewer social ills–not simply less crime, but also less divorce, fewer unwed teenager mothers, etc.

I thought about that research when I read a fascinating article shared by a reader of this blog.The article from Harpers Magazine was written by the son of a doctor who’d practiced for most of his career in Great Britain’s National Health Service–the NHS–and it compared his observations of that system to the reality he encountered after moving to the United States.

When I moved to New York, many things seemed strange. Among them were the crutches I saw discarded on the street, leaning against the hunter-green fences of construction sites or on the steps of the public library where I had an office. It felt like finding evidence of miracles: the lame had risen up and walked. Later I learned that people were often expected to buy such items, rather than being given or lent them by a health provider. Once finished with them, they naturally enough threw them out. I connected this in my mind to the chronically ill people I saw living on the street, many with mobility issues—people who seemed to need care and weren’t getting it, like the woman nodding out on the corner in a wheelchair, or the man wearing nothing but a hospital gown, looking as if he’d been discharged from a psych ward straight into Tompkins Square Park.

As a freelancer, I bought my own insurance—my second-largest expense after rent. Despite spending hundreds of dollars a month, I still had to hand over something called a copay to be seen by a doctor. When I expressed shock at this fact, my American friends laughed bitterly. Step by step, I was initiated into this strange new health culture, so different from the one I was used to. Why did I need permission from the insurance company if my doctor thought a treatment was necessary? This was a medical decision, wasn’t it? In that first year, I went to see a physiotherapist and realized that he was shamelessly upselling me, trying to persuade me to embark on a complicated and expensive course of treatment that I didn’t need. Oddly, this disturbed me most of all. I was used to a system where there was no incentive to do such a thing, and it felt like a breach of trust. Deep inside, I was still the doctor’s kid, conditioned to see medical professionals as benevolent authorities.

I began to hear horror stories: the uninsured woman who slipped in a gym changing room, knocking herself unconscious, then woke up and tried her best to stop the ambulance from coming, as she couldn’t afford the cost; the young musician who’d tried to set his own broken arm using instructions from the internet. Everything seemed absurdly marked up ($1,830 for a pair of orthotic insoles?), and hovering over us all was the threat of medical bankruptcy. It was mind-bending to think that I was one serious illness away from losing my life savings. I contributed to GoFundMe campaigns and began to experience something new, a low-level background anxiety.

That reference to “low-level anxiety” triggered my recollection of that long-ago research, because it found that individuals’ feelings of personal safety have a marked and important effect on the health of the overall society. People who feel secure in their persons and prospects are less suspicious, more neighborly, and less likely to engage in risky or anti-social behaviors.

Recent unwarranted shootings–the elderly man who shot a teenager who rang his doorbell, the homeowner who responded with a hail of bullets to an unknown car in his driveway–point to the negative aspects of a society in which “low level anxieties” are widespread.

The Harpers article traces the history of America’s health care failure–how we got here. The paragraph that best explains just where “here” is, is the following:

The U.S. health care sector is massive. In 2020, it amounted to 19.7 percent of GDP. In the previous (pre-pandemic) year, that number was 17.6 percent. The United States spends more on health care than any other developed country, and not by a small amount: $12,318 per capita in 2021. In the rest of the developed world the average is under $6,000. What do we get for all this money? Lower life expectancy and higher infant mortality than almost all other developed nations. Despite the huge deployment of resources, the system is, by almost every metric, a dismal failure.

It isn’t just a failure that harms individuals. We Americans pay extra for the social dysfunction.


The Social Safety Net and the Ideologues

I know I tend to harp on the difference between thoughtful policymaking and ideology. Good policymaking depends significantly upon expertise and research, learning from experience (otherwise known as trial and error) and careful empirical observation; ideology dismisses poor results and unfortunate side-effects as irrelevancies or attributes them to insufficiently thorough implementation.

Congressional Republicans, led by Paul Ryan, and with the likely concurrence of the Senate GOP and Mitch McConnell, are determined to make drastic changes to American social policy. To the extent they are not prompted by corruption (that is, acting on behalf of and at the behest of their donor base), their desired changes to Social Security, Medicare and Obamacare are entirely ideological. They don’t want to improve these programs; they want to dismantle them.

It has long been an article of Rightwing faith that welfare programs—indeed, social insurance of any sort—creates unhealthy dependency. (Somehow, that belief does not extend to corporate welfare. But that is a post for another time.)

The evidence, not unsurprisingly, suggests otherwise.

There is substantial research suggesting that countries with more robust social safety networks experience fewer socially undesirable behaviors: less crime, less divorce, less child abuse…the list goes on. Rates of murder, robbery, burglary, rape, and other serious crimes are generally much higher in the U.S. than in industrialized nations offering universal health care and other social supports. Homicide rates in the U.S. have consistently ranged between three and twenty times those of other industrialized countries.

It is particularly notable that Canada’s murder rate is far below that of the U.S. (running around a fourth of our levels). For homicides committed by youth, the U.S. rate has been as much as ten times the Canadian levels. Yet Canadians watch American television, log onto American websites, read American publications, share our culture. There is also widespread gun ownership in Canada.

What most differentiates us is the fact that Canadians have guaranteed health care and less social insecurity.

The U.S. is more economically stratified than any other advanced country. Its levels of income inequality and relative poverty are triple those of other wealthy nations. Scholars tell us that developed countries having relatively low levels of income inequality have low crime rates; in countries where one segment of the population has great wealth while another segment is in extreme poverty, crime rates are high.

As a 2015 article in The Week noted, the differences in approach to social welfare are ideologically based.

Conservatives often want to tie safety net programs to having a job, so that people aren’t tempted by handouts to hold off working. There are work requirements for food stamps. More heavy requirements were added to traditional welfare in the late 1990s. And now Republicans are suggesting requirements for Medicaid as well. This makes little sense. The much more generous European systems have higher labor force participation, and the U.S. economy has done progressively worse over the last three decades at actually creating enough jobs for everyone to have.

Add it all up, and it’s not surprising that most other advanced Western countries have much lower poverty rates than America.

Recent research has tied declining rates of marriage to poverty, and has confirmed that “failing schools” are typically those trying to educate children from impoverished homes—that growing up in poverty creates identifiable physical and emotional impediments to learning.

There is an overwhelming amount of evidence that a strong social safety net reduces crime and other social dysfunctions that cost Americans significant tax dollars—and that the availability of such social supports does not discourage workforce participation.

Evidence, however, is no match for rigid ideology. Americans should expect a full-court effort to gut Social Security and Medicare by zealots impervious to evidence.


Religion and Hostility

Nothing causes Americans to clutch their pearls and get their panties in a twist like arguments about religion. Let Starbucks omit snowflakes from their seasonal cups, and the fundamentalists are up in arms–they just know that those plain red cups are an attack on Jesus!

Is a failure to specifically endorse a religion (a la the offense of plain red cups and “Happy Holidays”) really equivalent to an attack? (And not so incidentally, don’t you people screaming about these assaults have lives to live and other things to do?)

Americans don’t agree on the definition of religion, let alone what constitutes an insult. What is the difference between a religion and a cult? Between religion and ideology? Are some religious beliefs better for society than others, and if so, which ones and why? We may not be able to answer these questions, but most of us seem firmly convinced that whatever it is, religion is good for us.

Maybe it’s more complicated than that.

As Phil Zuckerman recently wrote in the LA Times,

In the aftermath of the shooting at Umpqua Community College, for example, Fox host Bill O’Reilly cited weakening religion as the culprit. “As the world becomes more secular,” he declared, “civilized restraints to bad behavior drop.” Former Arkansas Gov. Mike Huckabee offered similar sentiments after the 2012 school shooting in Newtown, Conn., blaming such wanton violence on the fact that “we have systematically removed God from our schools.”

The theory is simple: If people become less religious, then society will decay. Crime will skyrocket, violence will rise, and once-civilized life will degenerate into immorality and depravity. It’s an old, widespread notion. And it’s demonstrably false.

If it were true that when belief in God weakens, societal well-being diminishes, then we should see abundant evidence for this. But we don’t. In fact, we find just the opposite: Those societies today that are the most religious — where faith in God is strong and religious participation is high — tend to have the highest violent crime rates, while those societies in which faith and church attendance are the weakest — the most secular societies — tend to have the lowest.

Zukerman notes–quite properly–that correlation is not the same thing as causation. But the correlations are certainly striking:

According to the latest study from the Pew Research Center, the 10 states that report the highest levels of belief in God are Louisiana, Arkansas, Alabama, Mississippi, Georgia, South Carolina, North Carolina, Kentucky, Tennessee and Oklahoma (tied with Utah). The 10 states with the lowest levels of belief in God are Maine, Vermont, Connecticut, Rhode Island, New Hampshire, Massachusetts, New York, Alaska, Oregon and California. And as is the case in the rest of the world, when it comes to nearly all standard measures of societal health, including homicide rates, the least theistic states generally fare much better than the most theistic. Consider child-abuse fatality rates: Highly religious Mississippi’s is twice that of highly secular New Hampshire’s, and highly religious Kentucky’s is four times higher than highly secular Oregon’s.

Given self-proclaimed “Christians” proclivity to wax hysterical over the loss of snowflakes on a Starbucks cup,  I think we might infer some measure of causation…