The United States is not No. 1 in several measures
Businesses admit shortcomings; why is it hard for government?
Other countries offer lessons in health care, education, even business
Current political polarization doesn't help, observers say; we need some pragmatism
Editor’s Note: This is the second in a series exploring the concept of American exceptionalism. On Sunday, we examined its powerful effect on the country’s development and politics.
In the opening scene of the new Aaron Sorkin show, “The Newsroom,” a news anchor goes on a tirade when asked why “America is the greatest country in the world.”
“It’s not the greatest country in the world,” he fumes. “We’re seventh in literacy, 27th in math, 22nd in science, 49th in life expectancy, 178th in infant mortality, third in median household income, No. 4 in labor force, and No. 4 in exports. … So when you ask what makes us the greatest country in the world, I don’t know what the f*** you’re talking about.”
It’s another slab of “Network”-esque bravado from Sorkin – the creator of “The West Wing” – but the point is well taken, even if his statistics could be a bit off. By a number of objective measures, America is not No. 1.
Good luck in saying that aloud, however. Forget Social Security. The third rail of American politics is acknowledging we may not be the greatest country in the world.
“If you can think of a politician who can say consistently ‘We’re not No. 1; we’re not No. 1,’ then I’d be very surprised,” says Melvyn Levitsky, a retired U.S. Foreign Service officer and former ambassador to Brazil.
It’s not like acknowledging flaws is the same as acknowledging failure. The business sector seldom rests on its laurels. Successful companies assume there’s room for improvement, and they’ll put themselves through ISO 9000, Six Sigma, benchmarking, best practices and any number of other assessment programs to get there. (Some sectors of government – which is often unfavorably compared to business by critics – do that, too, but it doesn’t grab anyone’s attention unless its Vice President Al Gore illustrating his ‘90s “Reinventing Government” initiative by smashing an ashtray on the David Letterman show.)
If businesses don’t evolve, they end up like Atari, Pan Am and Woolworth’s, onetime industry leaders that crashed against the rocks of strategy, innovation and competition. So the successful ones aren’t shy about borrowing good ideas from others.
Then why is it so hard for the United States to admit its shortcomings and do the same?
Craig Wheeland, a political scientist at Villanova, believes it has something to do with America’s innate wariness of government.
“We have a peculiar set of approaches to how government should act in our economy and in our society,” he says. “That creates a barrier to looking at best practices and borrowing ideas. The business world doesn’t think like that. They look at ideas that seem to solve problems and test them out, and if they don’t work, they change. They’re more pragmatic.”
Former Massachusetts governor and Democratic presidential candidate Michael Dukakis is blunter. He describes the problem in one word: Hubris.
“Some interest in what’s happening elsewhere and how other people are doing this would benefit us enormously,” he says. “I think a little less hubris and a little more focus … would do us a lot of good.”
But Gerry Keim, a management professor at Arizona State University, isn’t quite so harsh.
“We’re not exceptional in all categories, [but] we’re clearly exceptional in some categories, and I think we should be proud of that,” he says, mentioning America’s entrepreneurial spirit as an example.
However, he adds, “There are other areas [in which] one could learn a lot from other countries.”
In that vein, here are a few lessons the U.S. may draw from leaders in the rest of the world.
Health care: What the doctor ordered
It took almost two years, hundreds if not thousands of meetings and reams of pages to produce the Patient Protection and Affordable Care Act, popularly known as Obamacare. After all that, almost nobody was happy with it; it was criticized as going too far, not going far enough, too complex and too much. The Supreme Court upheld the law on Thursday, but it still faces headwinds from critics and a skeptical public.
Nevertheless, virtually everybody agrees that the United States has a health care problem. Almost 50 million Americans are without insurance, creating a burden on hospital emergency rooms and forcing people who need services into deep debt. Too few take advantage of primary care.
And it’s costing a fortune: In 2011, the United States spent 18% of its gross domestic product on health, much more than its allies.
Contrast those figures with Japan. The Asian country of 125 million spent just 8.5% of its GDP on healthcare in 2009, among the best figures in the developed world. Yet, despite lower costs, it’s No. 3 on the list of life expectancies (behind tiny Monaco and Macau) and 220th (out of 221) in infant mortality, according to the CIA Factbook. The United States ranks 50th in life expectancy and 173rd in infant mortality.
What’s so special about Japan?
Sabine Fruhstuck, a professor of modern Japan at the University of California-Santa Barbara, attributes some of the system’s success to Japanese ideals.
“The social contract is very different,” she says. “There’s an expectation and a commitment by the state to the welfare of the people.”
In the United States, she observes, there’s an emphasis on personal choice; in Japan, there’s a more sympathetic relationship between the individual and the state.
Like the U.S. system, the Japanese arrangement is a combination of public and private. Insurance is mandatory, and citizens who can’t afford the premiums are assisted by the government. The majority of hospitals are private, as are medical practices. Patients can pick their doctors and hospitals. Patients are not shy about using the system; a 2009 Washington Post article reported that Japanese citizens visit a doctor 14 times a year.
Nor are doctors shy about seeing patients, since they receive a payment for each visit. That’s one of the system’s flaws, says political science professor T.J. Pempel, a former director of UC-Berkeley’s Institute for Asian Studies.
“Doctors have every incentive to move people through quickly,” he says. “So you can get the feeling you’re part of an assembly line.”
The Japanese system doesn’t pay for childbirth, nor does it cover cosmetic surgery. The system also has suffered from issues with Japan’s aging population. The elderly consume more medical care than the young, and Japan’s society hasn’t added enough young workers to support retirees. Like other industrialized countries, it’s struggling to keep costs under control.
However, the government is particularly committed to care throughout life, whether it’s prenatal care or employee health, Pempel says. Pregnant women are given a wealth of information; many corporations, because they have a stake in the system, have clinics on site.
“There’s a lot of [primary care], and it’s covered. There’s strong encouragement to go into a clinic at the first sign of problems,” he says.
Indeed, the U.S. individualist tradition in health care generally runs counter to the rest of the industrialized world. Free-marketers like to point to the Swiss system, in which individuals buy their own insurance. But it, too, has a mandate. Many countries have cost controls in place, some more extreme than others. And the culture of the citizenry – whether it’s regarding diet, abortion, gun control, child and elder care traditions or personal responsibility – can’t help but play a role.
In the case of health care, Fruhstuck says, there’s something to be said for group accountability.
“In Japan, there’s attention to harmony, and the sense that everybody is responsible for everybody,” she says. “The way you are has an impact on everybody around you, so you think about your behavior.”
Education: Teach to the best
Today, Finland is regularly ranked as having one of the best-performing education systems in the world. The country’s literacy rate is tops, its math proficiency second, according to the Organisation for Economic Co-operation and Development, an international trade group. Students from elementary through high school are among the world’s best in test scores.
A generation ago, that wasn’t the case. In the 1970s, Finland’s schools were among the worst in the developed world.
The problem was attacked on all sides, says Pasi Sahlberg, a former official in Finland’s education ministry.
The country invested heavily in teacher education, requiring master’s degree-based, five-year qualifications instead of three-year bachelor’s degrees. Child poverty was addressed with meals, health care, dental care and counseling – all free of charge for children. Finally, the system pursued what Sahlberg calls “intelligent accountability” that combines standardized testing with teacher assessment and school self-inspection – with an emphasis on the teachers, not the tests.
Where did they get their ideas? Actually, they got a lot of them from the United States.
“Within your 15,000 districts and 100,000 schools you have probably all the educational innovation that anybody needs to build good schools or well-performing districts,” he says. “The Finnish education system owes a lot to these American ideas.”
And yet Americans are forever lamenting the state of their schools. As Diane Ravitch, education historian and former assistant secretary of education to President George H.W. Bush, points out, we’ve been fretting about the American system and looking enviously over our shoulders for decades, whether it’s to Germany, England, the former Soviet Union, Japan or China.
“We have this narrative that we’re failing, failing, failing. The rest of the world would like to be like us, and we’re saying, ‘What’s wrong with us? We’re so terrible.’ It must be some kind of American inferiority complex,” she says.
Yes, of course there are schools with problems. Some districts have been damaged by cheating scandals, others suffer from poor facilities. The battle to improve test scores, led by federal programs such as No Child Left Behind and Race to the Top, has provoked criticism (including Ravitch’s). Some officials want to give more money to charter schools at the expense of the public system or offer “school choice” through vouchers.
Finland, which is small, homogenous and has less income inequality between rich and poor, managed to completely remake its structure. Is that possible in the polyglot, poverty-pocked United States?
It’s already happening. West Virginia has instituted some of Finland’s ideas – some of which, of course, originated in the United States. Sahlberg believes they can work throughout the country, but they have to start with respect and training for the teacher.
“I think there is far too much loose rhetoric criticizing public school systems and blaming teachers in the U.S. that has no ground,” he says. Finland has such respect for teachers that the job is now seen as being “on par with other academic positions, such as lawyers and doctors,” he says. But it’s because the country invested in the profession and continues to do so.
Ravitch adds that society has to join in. “There’s a youth culture that’s very disobedient, and the laws are such that it’s very hard to maintain any kind of standard of discipline, and everybody blames the teachers,” she says. “But it’s kind of a vicious circle, because you have a lot of parents who are not particularly responsible either. The most common complaint at schools is if there’s a parent night, there are many schools where nobody shows up.”
Business: Making the sale
Perhaps surprisingly for a country that prides itself on its ability to do business, the United States does not lead the world in several indices of commerce. The International Finance Corporation and the World Bank ranked 183 countries in 11 areas; the United States didn’t finish first in any of them, ending up fourth behind Singapore, Hong Kong and New Zealand in ease of doing business, 20th in trade across borders, and a dismal 72nd in paying taxes.
New Zealand, in fact, ranks highly in several areas. It’s No. 1 in the world for starting a business, protecting investors and incorruptibility. The World Bank list placed it No. 3 overall. On last year’s Forbes list of best countries for business, it was No. 2, behind Canada. The United States was 10th.
Richard Laverty with the New Zealand Trade and Enterprise office attributes the country’s status to its aggressiveness in addressing business needs, though not at the expense of what makes the country special.
“We’re a small country. We need all the help we can get,” he says. But, he adds more seriously, New Zealand has a “regulatory regime that’s simple and transparent and applies across the country.”
There’s some need for investment. The country’s economy is highly reliant on natural resources and not exactly an entrepreneurial center, especially compared to another small country like Israel, which is known for its trailblazing high-tech and pharmaceutical industries.
In recent years, New Zealand has become a filmmaking hotbed and has a growing high-tech sector, thanks to one of its leading citizens, “Lord of the Rings” director Peter Jackson. Director James Cameron bought a place there and plans to get going on “Avatar’s” sequels; investor Peter Thiel, a big supporter of entrepreneurship, established a venture capital fund.
If New Zealand’s small scale makes it challenging for the United States to emulate – the country has more sheep than humans and, says Laverty, operates by “two degrees of separation” instead of six – there’s another country that may be more comparable, despite stark differences: Germany.
Not only has it been the world’s leading exporter for several years in the past decade, it does so with a heavily unionized, relatively expensive labor force that gets six weeks of vacation a year and works a slightly shorter week than U.S. workers.
The Germans succeed by investing in their people from an early age, says Arizona State’s Gerry Keim. A student from a German business school will likely speak three languages and have spent two semesters at two different partner schools outside of Germany.
“When they graduate, they’ll be your competitor,” he tells his students. “In terms of doing business globally, who do you think will have the advantage?”
His students, many of whom have never traveled outside the United States, are shocked, he says.
“They’ve never heard anyone raise these questions before,” he says.
Germany can compete, despite its more generous benefits, because it has leaders who are knowledgeable about global markets. “They go to these other places and they’re sponges,” he says.
Americans, on the other hand, focus on what’s different about other countries and why they’re not more like the United States, Keim says. That provincial attitude frustrates him to no end.
“When you live in a country where if you can speak a foreign language it costs you points in an election poll, I wonder about the whole idea of American exceptionalism,” he says.
The individual and the community
Can these success stories work for the United States? Other countries are more homogenous and have traditions of top-down government and higher taxes. The American Experiment arose out of something messier.
Throughout its history, the United States has balanced uneasily between honoring the group and venerating the individual. Thanks to the ongoing economic crisis, the issue has once again come to the fore. Why should we fund mass transit, some people ask, when 95% of American households own a car? Why should we invest in public schools when 1 out of every 10 students goes to a private institution?
Back and forth the debate goes.
If we wanted to follow the path of other countries, it wouldn’t just take effort and money. It might take something even harder to put a price on, a soul-searching sense of what America is, which is at the very heart of the debate over “American exceptionalism.”
Given the country’s polarization, it’s not an issue that will be settled easily, says Villanova’s Wheeland.
“I see ideology as a driving force in national politics now,” he says. “It seems the way to mobilize your core constituency in order to get them out in primaries and ultimately turn out in a general election. In American politics now, you have legislative institutions that are really drawn or created in a way to filter out people of more pragmatic, more centrist, more moderate, more problem-solving approaches, and you get the most ideologically oriented people elected today.”
However, he observes, America is still creative, still willing to take risks. Levitsky, the former ambassador, notes that the reach of American culture is unparalleled.
Dukakis says “we have a degree of freedom other countries envy.” They’re strengths that foreign observers – even if their countries are ahead of the United States in one area or another – still look at with respect.
“One of the things Kiwis really admire is Americans’ entrepreneurial attitude,” says New Zealand’s Laverty. “I think that there’s a greater appetite for risk and a greater acceptance of failure in the U.S. There’s a cultural, go-at-it, you-can-do-it nature that we admire.”
Wheeland agrees – but hopes we’re able to do more.
“Our political culture is one that almost celebrates the individual’s ability to start over, and we take great pride in that,” he says. “I think we just lose sight sometimes of the common good – what helps us all as a community do better.”