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© 1986-2004

The Three Americas

How the Middle-class Helps the Top 10% Ignore the Poor

By MATT WELCH, July 3, 2000

LOS ANGELES -- The World Health Organization last month ranked the health care systems of 191 countries, measuring the average number of healthy years a citizen lives, response time, "fairness" of coverage among different income groups, spending per person, efficiency, and overall "attainment."

Not surprisingly, the United States ranked first in spending, a woeful 37th in efficiency (behind Morocco), and a grim 54th in fairness.

What was actually surprising -- or more accurately, enlightening -- was the WHO's neat way of describing the stark differences among the "Three Americas." Our top 10% is absolutely the healthiest batch of people in the world, bar none. The great middle 80% enjoys "mediocre" care, and the lowest 10% "have health conditions as bad as in sub-Saharan Africa."

If you're looking for some useful shorthand to describe the American condition in the year 2000, the Three Americas formula is not a bad place to start. We are the richest, most powerful, most dynamic and most violent country in the world by far, with the most advanced technologies, best higher-education system, best movies (it's true, admit it) and best rock & roll. The people in charge of this excellence are the highest paid humans on earth -- the average American CEO makes a salary that would make all but the top few European executives blush with pure shame.

And yet, beyond being able to buy the fruits of all these labors for comparatively cheap, life in the middle 80% is frequently mediocre. Even the best public K-12 schools usually stink, HMOs charge too much and jerk you around, employers too often do not provide health insurance, you're lucky to have three weeks vacation a year, and you are openly encouraged to have crass and consumerist tastes.

And at the bottom, horror. I heartily recommend everybody to get hold of the July 3 New Yorker, and read Peter J. Boyer's "Two Mothers" story, a profile on the women who raised six-year-old killer and the five-year-old he shot near Flint, Michigan this February. It is a straight-ahead, thorough and unemotional description of a life few of us should ever have to fathom. Almost all of the men beat their girlfriends and deny fathering their children, the women aspire to have babies from the earliest possible age, unemployment and drugs flourish, and hope is next to dead. How in hell are people living like this in the 21st century?

I don't know, but the way our public affairs is organized this lowest 10% (or 30%, or more) is officially ignored by politicians and journalists alike, except in emergencies. Bill Bradley tried briefly to suggest that a government ought to do something about helping out the 44 million uninsured, and New Democrat Al Gore savaged him as "irresponsible," destroyed him at the polls, and shifted the debate to the richest segment of society with a health-care problem -- seniors who want better drug coverage.

Journalists, even the idealistic ones, are continuously tempted with fat money to write for and about technology companies, rather than raise hell about how government policy, from the White House to the local courthouse, affects citizens. We belong to the upper bit of that middle 80%, and many of our views (especially about globalization and business) mirror that of the top 10.

We'll find out in the next year or so whether our nine-year boom will end with a "soft landing" or a crash. Either way, more bottom-dwellers will find it harder to get a job, just as their state assistance runs out. Meanwhile, crime is already rising in several cities (sharply in L.A.), and a bubble generation of young people -- the demographic that always commits the most crimes -- is just now coming of carjacking age. It is time for the First Two Americas to take heed.

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