Inequality is Weakening Social Security. Here’s How We Fix That.
When Congress set the cap on Social Security contributions in 1983, they didn’t anticipate forty years of rising inequality. And it’s cost us — a lot.
The United States has been competing in the modern Olympic Games since they began in 1896 — and doing well. We win the most gold medals in the summer games, and we usually stand second in winter contests.
The Olympic Games offer important measures of status for competing countries. They rally citizens to support their athletes to excel, beat previous world records, and make their countrymen and women proud.
Becoming an Olympic sport requires an international sanctioning body. What would it take to have a new event, paralleling the sports Olympics, that ranks countries according to their accomplishments in producing healthy citizens?
The World Health Organization would be an appropriate sanctioning body. Given today’s collection of annual births and deaths, a whole range of comparisons could be developed: the longest-lived overall, longevity for subgroups, death rates in young children, deaths to women from pregnancy-related causes.
Let’s call these the Mortality Games, or the Health Olympics.
How would the U.S. do in such events? In a word, badly. We would be eliminated in the early heats, unable to even qualify for the final day’s competition in any contest.
In life expectancy, we stand 35th in the world. Another 44 nations have lower child death rates, and for deaths of women in childbirth we stand 46th. For adult mortality, in 62 other nations a 15-year-old girl has a smaller chance of dying by age 60 than in the United States. Even Sri Lanka beats us in that event — a humiliating result. For boys, 52 nations do better.
If we had Iceland’s child death rates, something we could surely achieve, 49 fewer children would die every day in this country. We get justifiably upset with the recent tragic mass shootings in the United States. But those deaths amount to less than one day’s typical child mortality here. This high ongoing mortality is happening in the richest, most powerful country in world history, a nation that spends close to half of all health care outlays worldwide.
Scores for most Olympic sports events have seen progress over the decades, with shorter times and better outcomes. Mortality globally is also generally improving over time, but in the maternal mortality Olympics eight nations have seen worsening scores in the last 15 years. The United States ranks among these nations, along with Afghanistan, Guinea-Bissau, and South Sudan, a tragic and humbling reality.
If we rewind some 65 years, we find a different story. In the mid 20th century, the United States would have won the gold for low maternal death rates. We would have had cause then to be proud of our performance in the other health events as well. In 1952 we would have won the most medals and could have proclaimed our nation one of the healthiest places on the planet.
Since then, our health outcomes have improved somewhat. But they’ve improved considerably faster in other countries, so we have fallen behind in the world health rankings.
In only one event would we win the gold medal today without question — the amount of money spent on health care, over 17 percent of our huge economy. No one can touch us there.
How should we interpret our performance in the Mortality Games? The U.S. Institute of Medicine issued a document in 2013 entitled U.S. Health in International Perspective: Shorter Lives Poorer Health. This groundbreaking report pointed out that we were dead first among rich nations and highlighted that we had to look beyond our medical care system for the reason.
The two factors this report tagged as likely causes of our poor comparative health performance: our wicked levels of economic inequality and our lack of attention to early life.
Inequality, studies show, kills, with estimates of inequality’s death toll in the United States ranging into the hundreds of thousands. Our increasing inequality should take at least part of blame for our dismal showing in the Health Olympics.
We also need to recognize that health begins at the beginnings of life and growth. Early life, the first 1,000 days after conception, is when chronic diseases such as hypertension, cardiovascular disease, and diabetes are programmed. Roughly half of our health as adults is determined during that period.
Careful attention and care to infants in those first months of life has dramatic effects on their future health. Mothers in particular need to be with those infants for as much time as possible during their early months. Yet we are one of only two countries worldwide that do not have a federally mandated paid parental leave policy.
How should we train for the Health Olympics in future generations? It took us over 60 years to go from being one of the world’s healthiest nations to today’s dismal showing. We have no quick fix. No trainer or regimen can get us to gold-medal status in 2020, but we can begin to get back in shape.
Our gross levels of current inequality are not inevitable. Reasonable and fair economic policies can change them.
Because good health starts early in life, we as a nation must also establish greater support to parents for raising healthy children. That will take time and money. We could start raising that money by making small changes in the taxation of the wealth of the top 1 percent.
In a generation or two, we could become proud medalists again.
Let the games begin. Go Team USA!
Mary Anne Mercer is a public health practitioner specializing in the delivery of maternal and child health services in developing countries. The co-editor of the 2004 book Sickness and Wealth: The Corporate Assault on Global Health, Dr. Mercer is currently a senior lecturer in global health at the University of Washington. Stephen Bezruchka has been involved in international health issues since the 1970s when he set up the Dhorpatan Health Project in Nepal. Also a senior lecturer in global health at the University of Washington, Dr. Bezruchka coordinates the Population Health Forum.