Voice

Keeping It Central

From health care to education, what the United States can learn from poorer countries.

Humility is a wonderful thing, because it lets you learn. It's also not one of the traditional traits of the United States. Every year, we tell other countries what they should do in terms of national security, economic policy, and even social norms. But what would happen if we tried learning from them?

We might have a much stronger nation. By some basic yardsticks of human development, the United States is not living up to its global reputation and economic might. To equip today's Americans for success tomorrow, here are some areas where the performance of poorer countries suggests we could improve.

Health. What do Chile, Costa Rica, and Cuba have in common? They're not just Latin American countries that start with C -- they're all countries with higher life expectancies than the United States. It's well known that the United States lags behind wealthy countries in Europe and East Asia in this area, but several countries with far less money to spend on health also outperform us. 

Even Sri Lanka, which spends about $100 per person annually on health care between the public and private sectors, managed 99 percent vaccination rates for diphtheria, tetanus, and pertussis (DTP), hepatitis B, bacillus, measles, and polio in 2012. The United States, which spends close to $9,000 on health care per capita, clocked rates of 95, 92, 90, 92, and 93 percent, respectively, which was mostly an improvement over 2011.

How is this possible? In Sri Lanka, the public health system is at once centralized and far-reaching. In the United States, access to health care depends on location, income, and myriad other factors.

The resulting infant mortality among American children, which was worse than in 11 former Soviet bloc countries, has not been the nation's only health problem. Reducing deaths of children under 5 to zero would still have left the United States with a life expectancy lower than Chile's and Costa Rica's.

No, at almost any age, Americans are less healthy.

Relative to poorer countries, we eat far more fatty food -- well, we eat far more, period. We also pay more for the same health care goods and services, in part because doctors have an incentive to prescribe the costliest ones and patients have little incentive not to accept them. We don't even allow the government to buy products in bulk for Medicare and Medicaid. Think any of that might matter?

Education. It's not news that the United States lags far behind many European and East Asian countries in reading, math, and science. It is news, however, that the list of those countries now includes Vietnam. Don't feel too bad -- the Vietnamese, with their strong educational tradition, outscored quite a few rich countries on the most recent tests through the Program for International Student Assessment (PISA). And the tests cater to students trained by rote memorization, which doesn't necessarily augur for future success as innovators and entrepreneurs.

But then again, Poland -- which has an educational system more similar to ours -- also finished high above the United States, spending about the same percentage of GDP on education, and thus far less per pupil. That said, spending per pupil varies widely across the United States. Adjusted for local prices, Vermont spends more than twice as much per public school student as California.

What can we learn from Poland? Sometimes it's the simple things, like a uniform curriculum that mandates 18 classes a week of math and science for all students in grades 10 through 12, a greater emphasis on preparation for college, and a national shift away from vocational education. Centralized curriculums can save money through economies of scale in teaching materials and training, too.

Child welfare. American kids are better off than kids in the poorest countries, but not necessarily better off than kids in all poor countries. The problems occur from the start. Babies are more likely to enter the world with low birth weight in the United States than in Rwanda. The gross rate of enrollment in early childhood education (pupils of all ages divided by the population of children of statutory school age) stood at just 73 percent in the United States in 2011, lower than in dozens of other countries. Ghana manages 114 percent enrollment, Thailand 110 percent, Mexico 99 percent, and Suriname 88 percent. (Because children outside statutory ages can enroll, the gross figure can rise above 100 percent.) And all the way through to early adulthood, youths may face a higher homicide rate in the United States than in many poorer countries, especially in Asia.

Part of the problem is undoubtedly cultural. But the devolution of responsibility for the protection of children to the states may also play a role. Roughly one-quarter or more of children live in poverty in Alabama, Arizona, Arkansas, Kentucky, Louisiana, Mississippi, New Mexico, South Carolina, Tennessee, Texas, and the District of Columbia. Poor states, states with major cities in decay, and states with especially tight budgets tend to have the highest homicide rates -- and almost all of the ones in the list above are among them.

There's a common theme here. When national priorities aren't actually taken care of at the national level, two things happen: First, some states lag behind others, and second, people in the leading states, where everything seems fine, don't particularly worry about the laggards. But when everyone is taken care of at the national level -- as in, say, Medicare -- this disjoint can't happen so easily. Standards are uniform and so, to a much greater degree than in state-managed systems like Medicaid, is funding. Most importantly, if the quality of service is lousy, even people in rich states will complain. Medicare is decent precisely because everyone gets it.

In many poorer countries, standards and funding for health, education, and child welfare are, like Medicare, the responsibility of the national government. Our system, by contrast, places much of the burden for these crucial contributors to well-being on the states. Some states just can't hack it, and so the data make our nation look like a developing economy. But as the people of many developing economies know, centralization of strategy, standards, and funding is one of the best ways to move forward.

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COLUMN

National Stupidity

In international politics, pride goeth before a fall.

What's the most powerful force in world affairs? There are plenty of candidates, but nationalism has to be a strong contender. The twin ideas that the human race is divided up into various "nations" (i.e., peoples with various shared traits who regard themselves as part of the same "imagined community"), and that these various nations are entitled to their own "state," have shaped the formation of the European system, inspired the anti-colonial revolutions that dismantled the British, French, Austro-Hungarian, Ottoman, and Soviet empires, and help explain why the number of states has risen steadily for decades and shows no signs of stopping.

That's not necessarily a bad thing, mind you. A powerful sense of national feeling has many virtues. It can help societies overcome collective action dilemmas, as contending groups within a country agree to make sacrifices for the common good and to tolerate other forms of difference (such as religion). By encouraging citizens to work hard for shared purposes, it can also help spur national ambition and economic growth. And as the world discovered following the French Revolution, nationalism is a potent source of military power: troops infused by a love of la patrie will fight harder than hired mercenaries or soldiers whose loyalties are divided.

But nationalism also has a dark side. National narratives invariably highlight a particular people's positive achievements and tend to downplay any episodes where they behaved badly. In short, all nations tell themselves a sugar-coated version of their own history. Or as the late political scientist Karl W. Deutsch mordantly observed, a nation is a "group of people united by a mistaken view about the past and a hatred of their neighbours." This feature tends to blind every nation to the views of others and makes it difficult for them to understand why the same event can been seen so differently, sometimes with good reason.

It's no surprise, for example, that what Americans label the "Iranian Hostage Crisis" is known to Iranians as the "Conquest of the American Spy Den" -- which tells you all you need to know about how the two countries view that particular episode. By whitewashing their own past, nations forget why others might have reasons to be suspicious of them, and this collective amnesia makes them more likely to see an adversary's present behavior in the worst possible light. Most Americans have long forgotten about our various predations in Latin America, for example, but Mexicans, Guatemalans, Nicaraguans, and others have not.

Nationalism can also make it harder to resolve existing conflicts, especially when competing national narratives create contending claims to the same territory. When this happens, both sides will regard their own claims as beyond dispute and see the other sides' claims as unwarranted aggression that has no legitimate basis, and must therefore be resisted. (See under: Israel-Palestine.) Moreover, such attitudes rob diplomats of the flexibility that is often needed to reach a compromise, because achieving anything less than complete victory will be seen as a betrayal of some sacred national value.

Finally, extreme nationalism also fuels overconfidence. National ideologies tend to portray the nation as both different from others and in some way superior; indeed, national pride depends on convincing citizens that it is better to be Turkish, French, Japanese, Thai, Irish, Egyptian, Russian, etc., than to be anything else. Americans are no strangers to this sort of thinking: just look at all the ink that's been spilled proclaiming American "exceptionalism." From there it is but a short step to the conclusion that others are in some sense inferior, and that they will be easy to defeat on the battlefield.

In short, despite nationalism's many virtues, it can also be a profound source of national stupidity. At worst, unchecked nationalism has a way of leading countries to do things that leave them worse off than they would otherwise be. In extreme cases -- such as Nazi Germany or Imperial Japan -- virulent hyper-nationalist beliefs helped pave the road to national disaster, along with the suffering and deaths of millions along the way.

Some have argued that globalization and the emergence of post-national structures such as the European Union mean that these dangers are a thing of the past. Or that now that 1 billion people are on Facebook, that tribalism is dead. Hardly. Just consider the following examples of national stupidity, exacerbated by unthinking nationalism.

From Sea to Chinese Sea

Chinese national pride is deeply felt, and the desire to rise above what they regard as two centuries of weakness and humiliation has been a powerful engine of progress over the past quarter-century. Nationalism also provides an important source of unity now that economic inequality is rising and Marxism-Leninism has been effectively discarded as China's official ruling ideology. It is therefore no surprise that the ruling Communist Party has gone to some lengths to foster a deeper sense of national identity.

But that same force is also leading China to engage in a number of foolish and self-defeating behaviors. In particular, its aggressive territorial claims in the South China Sea, its recent unilateral declaration of an offshore "air defense identification zone," and its hard-line stance in the Diaoyu/Senkaku Islands dispute have discredited Beijing's earlier assurances about a "peaceful rise" and alarmed many of its Asian neighbors. Whatever one may think of China's claims, this behavior is dumb, because it encourages China's neighbors to balance more vigorously and makes them eager for more U.S. protection. It would be smarter for Beijing to play the long game and refrain from such demands until China is much stronger than it is today. But given national feeling in China itself, it is not clear that China's leaders can maintain such a wise and patient approach.

Not-so-honest Abe

Ironically, Japan offers an even more vivid example of counterproductive contemporary nationalism. Tokyo has been equally uncompromising about its claims to the Diaoyu/Senkakus; even worse, Japan continues to quarrel with South Korea over the Liancourt Rocks, an even less important set of tiny islands. Some Japanese leaders -- including current Prime Minister Shinzo Abe -- have also said disturbing things about Japan's actions on the Korean Peninsula during World War II, including denying its use of Koreans as "comfort women" for Japanese troops. News flash for Tokyo: China is a rising power, and it is a lot bigger than you are. Japan is going to need as many friends in Asia as it can get if it wants to maximize its freedom of action against its larger Chinese neighbor. Obvious conclusion: pointless quarrels with South Korea are counterproductive -- even foolish -- and so are those visits to the Yasukuni Shrine that your politicians keep taking in order to appease right-wing nationalist sentiment.

Spoiled Milk and Honey

At its root, Zionism is the Jewish version of 19th-century European nationalism. By encouraging national unity, patriotic sacrifice, and the support from the Jewish diaspora, it has been an important source of many of Israel's past accomplishments.

Today, however, the evolution of Zionism -- in more extreme directions -- may be imperiling Israel's long-term future. Instead of merely seeking a secure homeland, the Israeli state is increasingly fixated on establishing a "Greater Israel" in perpetuity, while confining its Palestinian subjects to a few isolated enclaves under strict Israeli control. Not surprisingly, these policies are accompanied by increasingly racist attitudes toward Arabs both inside and outside the state itself, as Max Blumenthal has recently documented. These trends explain why Israel faces growing international criticism and may even be losing support and sympathy in the United States, including among American Jewry. As with other states, the downside of Jewish nationalism is encouraging policies that are not in the country's long-term interest.

A City on a Mountain

American nationalism differs in certain ways from many other countries: it is a "civic" nationalism that rests primarily on shared political principles and liberal cultural values, rather than on ethnicity or ancestry. This feature has made it easier for the United States to incorporate successive waves of immigration (albeit not without certain tensions), a phenomenon that was critical to its rise to great power status.

Yet over time, and especially since the United States became a great power, American nationalism has also incorporated a dangerously inflated view of its own "exceptional" qualities. In particular, Americans (and especially foreign policy elites), often believe it is America's right and responsibility to exercise "world leadership," not simply because the United States is a very powerful country, but because it has the best form of government, the most virtuous citizens, and is always acting for the greater good -- even when it is blowing things up in some distant land or toppling some supposedly unfriendly government.

The negative consequences of this strand of American nationalism should be apparent by now. Because they believe the United States always acts for good, American leaders routinely underestimate the degree to which U.S. power worries other countries and leads them to try to take various steps to rein in Washington. Because they are convinced the American system of government is the best one ever devised, they overestimate their ability to export that system to other countries. Because the United States is a uniquely successful multicultural experiment, they do not recognize that local identities and sectarian differences are much harder to overcome in other places. And because they think Americans are smarter, more unified, more heroic, and just plain better than others, they have trouble imagining that a bunch of Vietnamese, Iraqis, or Afghans could possibly defeat us -- even when we're fighting on their home turf and in conditions where they are highly motivated and can almost certainly outlast us.

My point here is not to rail against nationalism per se, which isn't going to disappear anytime soon. It is rather to warn against the unthinking, uncritical, "my-country-right-or-wrong" version of nationalism that sometimes infects an entire society. When that happens, legitimate pride in one's own national group can easily morph into something darker, cruder, and far more dangerous. And when it does, it tends to make a country do stupid things. In international politics, as in the lives of individuals, (national) pride goeth before a fall.

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