- 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
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