Archive for November, 2006

Working Together

Tuesday, November 28th, 2006

Clueless in America

James Howard Kunstler

Last week, I had one of those clarifying moments when the enormity of the American fiasco stirred my livers and lights again. I was riding in a car at sundown between St. Cloud and Minneapolis on I-94 through a fifty-mile-plus corridor of bargain shopping infrastructure on each side of the highway. The largest automobile dealerships I have ever seen lay across the edge of the prairie like so many UFO landing strips, with eerie forests of sodium-vapor lamps shining down on the inventory. The brightly colored signs of the national chain fried food parlors vied for supremacy of the horizon with the big box logos. The opposite lane was a blinding river of light as the cars plied north from the Twin Cities to these distant suburbs in the pre-Thanksgiving rush hour.

All that tragic stuff deployed out on the prairie was but the visible part of the storm now being perfected for us. On the radio, Iraq was coming completely apart and with it the illusion of America being able to control a larger set of global events — with dire implications for all the glowing plastic crap along the interstates, and the real-live people behind the headlights in those rivers of cars.

The main fresh impression I had amidst all this is how over it is. The glowing smear of auto-oriented commerce along I-94 (visible from space, no doubt) had the look of being finished twenty minutes ago. Beyond the glowing logos lay the brand new residential subdivisions full of houses that now may never be sold, put up by a home-building industry in such awful trouble that it may soon cease to exist. If suburbia was the Great Work of the American ethos, then our work is done. We perfected it, we completed it, and, like a brand new car five minutes after delivery, it has already lost much of its value.

The chief failure in American politics lately has been the inability to appreciate the relationship between how we live here and how other people in other lands support us with their resources — oil from the Middle East, human labor and money saved from the fruits of human labor from the Far East. The oil obviously runs all the cars and the money from China and Japan supports our debt (and incidentally pays for building ever more big box stores and fried food emporia). The Middle East is now so close to exploding that we may not get so much oil from them in the years ahead. China and Japan have stepped back from buying American debt in the form of US Treasury certificates.

Even if there were no exogenous forces operating, the proverbial Man-From-Mars casual observer would have to conclude that America has built all the shopping venues it will ever need (and far beyond), and certainly more single-family housing subdivisions useful only in a happy motoring meta-system. But the exogenous events are out there and they are going to assert their power to make us uncomfortable and to alienate us from the very stuff that we have poured all of our wealth and spirit into.

The New York Times headlined yesterday that the US government might try to start negotiations with Iran and Syria over the fate of Iraq — an idea so preposterous that it might have been a wire-story from The Onion. Iran and Syria have no interest in the matter whatsoever except in the failure of America to control events, and the humiliation entailed by that failure, which is happening on its own. So the story is a clear signal of our desperation that we are even pretending to make overtures.

For the US military this is a tragedy of classical Greek dimensions, a playing out of implacable forces despite its heroism or even good intentions. But for the American public, back home, enjoying the bright lights of the WalMarts and the steaming heaps of baby back ribs, and the comfort of the ride home with the latte plugged into the cup holder and Jay-Z’s inspirational thoughts playing on the car stereo — it’s really the end of the road.

I’ve been saying for a long time that as our illusions dropped away, the US economy would fall on its face. I think the process is underway, especially with last week’s movement of the dollar against the Euro. All the elements are now set for a full-throttle depression in which currency loses value while credit dries up and incomes are lost. You get a fire-sale of assets that behaves like a deflation while the dollar itself inflates. The Federal reserve can’t possibly drop interest rates if foreigners will not buy our bonds.

Losing your house to the re-po man is a major illusion-breaker. The housing bubble has popped and entered a downward self-reinforcing feedback loop that will be understood as a death-spiral of valuation. Even if nominal house prices stayed close to where they are, dollar inflation would signify a real drop in value. The jobs associated with the bubble — everything from the legions of house-framers to the realtors to the creative mortgage hawkers to the Crate-and-Barrel furniture elves — will drop into a black hole. Mortgage obligations will not be met, credit card payments will stop, house refinancings will no longer be possible as equity dissolves, the WalMart associates will get their pink slips, the vacancy signs will go up in the strip malls, and a mighty sob will be heard above the prairie wind.

This is really a tight spot. Wider war in the Middle East is hardly out of the question, with Iran and a broad array of jihadistas emboldened by America’s flounderings in Iraq. A year from now, perhaps, or less, we will lose our access to a substantial portion of the imported oil that we run all our stuff on. The sodium vapor lamps will flicker out. The last taco will be served. The US public will have to start paying attention and making other arrangements. I believe what Garrison Keilor says about the people in Minnesota. Scratch below the surface, you’ll find a thoughtful, practical mentality. I believe that when they can’t do anymore of what they’re doing now, they’ll turn around and do something else.


Visit James Howard Kunstler’s website.

Working Together

Tuesday, November 21st, 2006

A long time reader recommends this essay by Mr. James Howard Kunstler.



Cities of the Future

James Howard Kunstler

Back in the early 20th Century, when the cheap oil fiesta was just getting underway, and some major new technological innovation made its debut every month – cars, radio, movies, airplanes – there was no practical limit to what men of vision could imagine about the future city, though often their imaginings were ridiculous.  The representative case is Le Corbusier (Charles-Edouard Jeanneret; 1887 – 1965), the leading architectural hoodoo-meister of Early High Modernism, whose 1925 Plan Voisin for Paris proposed to knock down the entire Marais district on the Right Bank and replace it with rows of identical towers set between freeways.

Luckily for Paris, the city officials laughed at him every time he came back with the scheme over the next forty years – and Corb was nothing if not a relentless self-promoter. Ironically and tragically, though, the Plan Voisin model was later adopted gleefully by post World War Two American planners, and resulted in such urban monstrosities as the infamous Cabrini Green housing projects of Chicago and scores of things like it around the country.

Other visions of that early period involved Tom Swiftian scenes of Everest-size skyscrapers with Zeppelin moorings on top, linked to zooming air trams, while various types of personal helicopters swooped between things.  Virtually all these schemes had one thing in common: the city of the future they depicted was vibrant. We know now, here in the USA anyway, that this was the one thing they got most wrong.  By 1970, many American cities were stone dead at their centers, especially the industrial giants of the Midwest. Ten years later, the American city of the future was the nightmare vision of Blade Runner, an acid rain-dripping ruin fit only for androids.

These days, a new generation of mojo architect savants such as Daniel Libeskind and Rem Koolhaas are retailing an urban futurism that is basically warmed-over Corbu with an expressionist horror movie spin, featuring torqued and tortured skyscrapers, made possible by computer-aided design, clad in Darth Vadar glass or other sheer surfaces, with grim public spaces exquisitely engineered to induce agoraphobia. There´s more than a tinge of sadism in all this, though Koolhaas is much more explicit in his many writings than the less-voluble Libeskind about consciously surrendering to a zeitgeist of cruel alienation.  But these are also very rarified exercises among a tiny group of mutually-referential fashionista narcissists, while the general public itself – at least the fraction that thinks about anything – only grudgingly goes along with it as a sort of drear obeisance to the religion of art.

An alternate awful urban vision of the future, advanced by public intellectuals such as author Mike Davis (The Ecology of Fear), is actually more about the city of the present: the third world mega-slum as embodied by such ghastly organisms as present-day Lagos, Lima, and Karachi. This is a vision of plain toxic hypertrophy with no particular artistic or architectural overlay to it. These cities have organized according to a simple logarithmic progression of horrible conditions – more people, more pollution, more poverty – nourished by cheap energy globalism, with the expectation that they will only continue along that path and get worse.

Yet another vision of the future is supplied by the New Urbanists, who have campaigned for a return to the body of principle and methodology drawn from successful historic practice rather than science fiction, politics, or metaphysics. That is, they rely on urban design that has proven to work well in the past and is worth emulating – by which I mean the relations of buildings to public space and with each other, not the deployment of sewer lines and other infrastructure.  The New Urbanists are marginalized because their reliance on tradition is considered sentimental and nostalgic.  Their work is viewed by the mandarins of architecture through the lens of Modernist ideology, which, going back a hundred years to Adolf Loos´s declaration that ornament is crime, has worked to decouple contemporary practice from what they regard as the filthy claptrap of history.  Of course, Modernism itself has self-evidently become historical in its own right, and the more this is true, paradoxically, the more its defenders insist that history does not matter.  Whatever else this represents in the form of intellectual imprudence, it at least promotes a discontinuity of human experience which cannot be healthy.

The New Urbanists are also disdained for their modesty of ambition.  They are not interested in the biggest this or that. Their plans are typically scaled to the quarter-mile walk and rarely include super-sized buildings. The cutting edge holds no attractions for them in and of itself.  They want to create neighborhoods and quarters, not intergalactic space ports.  They want the streets, squares, and building facades to provide decorum, legibility, and even beauty, while the latest crop of Modernists seek to confound our expectations about the urban environment as much as possible, in the service of generating anxiety rather than pleasure. The Modernists use the lame adjective edgy to describe their methods.  It is supposed to signify excitement, novelty, and especially innovation, but mostly they have managed to innovate only new ways to make people feel bad about where they are.

*

The future direction of urban experience depends a great deal on an understanding of history, and of recent history in particular, because the hyper development of the past two hundred years has followed the arc of increasing energy resources and, above all, we are now facing the world-wide depletion of energy resources.

As the industrial age gained traction in the early 19th century, so did the demographic trend of people increasingly moving from the farms and villages to the big cities.  Industrial production was centralized in the cities and recruited armies of workers insatiably.  Meanwhile, mechanized farming required fewer farmers to feed more people. The railroad, by its nature, favored centralization. By 1900, cities such as London and New York had evolved into mega-urbanisms of multiple millions of people.  Around the same time, electrification was generally complete and with it came skyscrapers serviced by elevators.  Over the next twenty years, oil moved ahead of coal as the primary fuel for transport and, especially in the US where oil was cheap and abundant, led to mass automobile ownership. That, in turn, sparked the decanting of households into massive new suburban hinterlands, and to the extreme separation of activities by zoning law there, which climaxed – with interruptions for depression and war – in the evolution of the late 20th century car-dependent metroplexes like Los Angeles, Houston, Phoenix, and Atlanta. That is where things stand now.

Now my own view is that we face severe energy problems in the decades ahead and they will not be ameliorated by any combination of alternative fuels or schemes for running them.  This permanent global energy crisis will have all kinds of consequences, most particularly on our cities.  These looming circumstances imply several major trends which contradict conventional expectations, especially of continued urban growth.

One certain impact will be the contraction of industrial activity per se and of the financial sector whose instruments and certificates represent the expectation of growth in accumulated wealth.  This alone will comprise a basic challenge to industrial capitalism – apart from the sociopolitical strife that such financial catastrophe is apt to generate.

I hasten to add it is a mistake to suppose that the US industrial economy has already been replaced by a so-called ìinformation” economy or a consumer economy.  In reality, manufacturing activities have been insidiously replaced over the past twenty years by a suburban-sprawl-building economy –  and the mass production of suburban houses, highways, strip malls and big box stores is just a different sort of manufacturing than making hair driers and TV sets. The sprawl industry also drove a reckless debt creation racket and multiple layers of traffic in mortgages and spinoffs of mortgages (such as the derivatives trade based on bundled, securitized debt) which represents, at bottom, hallucinated wealth that in turn has spread false liquidity through the equity markets and is certain to affect them badly sooner or later. All this is what we have been calling the ìhousing bubble” and it is now beginning to fly apart with deadly effect.

Much of the suburban real estate produced by this process is destined to lose its supposed value, both in practical and monetary terms as energy scarcities get traction.  So, on top of the sheer distortions and perversities of the glut in bad mortgage paper, America will be faced with the accelerating worthlessness of the collateral – the houses, Jiffy Lubes, and office parks – as gasoline prices go up, and long commutes become untenable, and jobs along with incomes are lost, and the cost of heating houses larger than 1500 square feet becomes an insuperable burden.

All this is to say that the suburban rings of our cities have poor prospects in the future.  They therefore represent a massive tragic misinvestment, perhaps the greatest misallocation of resources in the history of the world. It is hard to say how this stuff might be reused or retrofitted, if at all, but some of it, perhaps a lot, may end up as a combined salvage yard and sheer ruin.

Another major impact of the coming energy scarcity will be the end of industrial agriculture.  Without abundant and cheap oil and gas-based fertilizers, pesticides, herbicides, and fuels for running huge machines and irrigation systems, we will have to make other arrangements for feeding ourselves. Crop yields will go down – a big reason, by the way, to be skeptical of ethanol and bio-diesel alternative fuel schemes based on corn or soybean crops.  We will have to grow food closer to home, on a smaller scale, probably requiring more human and even animal labor, and agriculture is likely to come closer to the center of economic life than it has within memory – at the same time that mass production homebuilding, tourism based on mass aviation, easy motoring, and a host of other obsolete activities fade into history.

I think this will lead to an epochal demographic shift, a reversal of the 200-year-long trend of people moving from the farms and rural places to the big cities. Instead, I believe we will see is a substantial contraction of our cities at the same time that they densify at their cores and along their waterfronts.  A preview of this can be seen in Baltimore today.  The remaining viable fabric of the pre-automobile city is relatively tiny and concentrated in the old center around a complex harbor system.  With little need for industrial workers, vast neighborhoods of row housing built for them are either abandoned or inhabited now only by such economically distressed people that abandonment is inevitable.  The pattern of contraction may not be identical in all American cities.

In some it will be a lot worse. Phoenix, Tuscon, and Las Vegas will just dry up and blow away, since local agriculture will not be possible, and they will be afflicted with severe water problems on top of all the other problems growing out of energy scarcity and an extreme car-dependent development pattern.  Cities in the ìwet” sunbelt such as Houston, Orlando, and Atlanta, will probably still be there but revert to insignificance for the additional simple reason that a lack of cheap air conditioning will make them unbearable.

It is worth keeping in mind that cities generally are located on important geographical sites – harbors, rivers, railroad junctions – and some kind of urban settlement is likely to persist in many of these places, unless climate change drowns them.  In recent years, most waterfront property has been reassigned from industrial and commercial uses to condominium sites, and greenways. This will not continue.  If we are going to have any kind of commerce between one place and another, we will have to reactivate our waterfronts for shipping – and not necessarily of the automated steel container variety.  Like virtually everything else in the coming energy scarce world, maritime trade will have to be rescaled.  It may even have to rely on wind power again to some extent. These operations will require wharves, warehouses, cheap quarters for sailors and all the other furnishings typically required through history.

Those who are infatuated with skyscrapers are going to be disappointed.  I do not think we will be building many more of them further along in this century.  We will have trouble running the ones we have, since most of the glass towers built after 1965 have inoperable windows, and even the ones that have them would have to be retrofitted for coal furnaces, and a less than absolutely reliable electric power grid may make life in a twenty-fifth floor apartment impossible when the elevators go out. In short, I think we will discover that the skyscraper was purely a product of the cheap oil and gas age. Exciting as they may be, we might have to live without them.

The process I have described will probably be messy. Social turbulence should be expected. For instance, the urban underclass will be squeezed even harder than the suffering middle classes, and they already have a nascent warrior culture that could easily redirect its energies from hip hop entertainments to real guerilla warfare if the competition for resources became desperate. Economic distress in the US is also likely to only aggravate unfavorable conditions in Mexico, sending increased streams of impoverished migrants north. Meanwhile, the faltering US middle classes may be so inflamed by the loss of their entitlements to an easy motoring existence that they will vote for maniacs and venture into scapegoating. I certainly expect the American public and their leaders to mount a vigorous defense of suburbia, even if it proves to be a gigantic exercise in futility and a waste of precious resources.

We will be lucky if we can make the transition from our current circumstances to a future of re-sized, re-scaled cities and a reactivated productive rural landscape outside them, with a hierarchy of hamlets, villages, and towns in between, and some ability to conduct commerce and manufacturing.  This would, in effect, be a reversion to prior living arrangements, and to some extent it is a model proposed by the New Urbanists – or at least a template they would understand as fundamental.  Many things might stand in the way of this. The physical disaggregation of civic life in our small towns is now so extreme that nothing might avail to repair it, especially since we will have far less capital to work with. The suburbs running from Boston through New Jersey to Washington have paved over some of the best farmland in the nation´s most populous region and it may be centuries before it is restored to productivity, if ever.  Physical security may become so tenuous that people will sell their allegiance for protection, or take to living behind fortifications. In earlier periods of history when societies got into trouble – for instance, the plague years in Europe – rural places were beset by banditry and lawlessness, adding another layer of difficulty to food production on top of the loss of the peasant labor.

We don´t know how any of these things may actually play out. I have not even mentioned the potential for geopolitical mischief, which could skew the picture a lot more.

But the urban future isn´t what it was cracked up to be when we were riding high, surfing the big waves of cheap energy in the seemingly endless summer of oil.  It won´t be fun fun fun ‘til Daddy takes the T-bird away. It won´t be a Herbert Muschamp smorgasbord of delicious, rarified architectural irony.  The Koolhaas celebration of alienation will not seem worth partying for.  The metaphysics of Libeskind and Peter Eisenman will stand naked in the transparency of their phoniness. By and by, even the mega slums of the third world will contract as the surplus grain supplies of the formerly-developed nations are reduced to nothing and export ceases.

I often wonder what people will think decades from now if they are able to view those old Doris Day and Rock Hudson comedies of the mid 20th century.  Invariably these stories took place in a Manhattan of sparkly new glass towers, and streets full of cars with tail fins, and companies that ruled the world, and men and women who had come back from a World War full of confidence that there was no limit to what people with good intentions could do and nothing that they couldn´t handle.  We are their children and grandchildren and it is a different world now.


Visit James Howard Kunstler’s other website.

Working Together

Wednesday, November 15th, 2006

This open letter to President George W. Bush was originally published in May of 2004. It was overlooked like a lot of good ideas, but it seems even more intelligent today. From the SynEARTH Archives: I have been a reader of Joseph George Caldwell for a number of years. He is remarkably intelligent and his opinion always well reasoned and expressed. In this letter, he recommends a plan for Iraq that might solve a lot of problems.



Joseph George Caldwell, PhD


Lusaka, Zambia

8 May 2004 (expanded 11 May) 

President George W. Bush
The White House
Washington, DC

Dear President Bush:

I am writing to you to offer you a solution to the present quagmire in Iraq.

First, I will introduce myself.  I am Joseph George Caldwell.  I have spent much of my career working in military systems analysis.  At one time, I served as director of research and development at the US Army Electronic Proving Ground´s Electromagnetic Environmental Test Facility at Fort Huachuca, Arizona.  At the present time, I am working as a management consultant in Zambia.

I have conducted much research in the area of strategic planning and analysis, and maintain a popular Internet website on strategy, politics, and warfare.  I will be very brief in my comments to you today.  If you will read the article, It´s the Oil, Stupid!, you will see my proposed solution to the problem in Iraq.  If you adopt the solution proposed there, you will be able to resolve this problem quickly and honorably.  You will be able to dramatically reduce the troop levels in Iraq in a matter of weeks, and restore order, sovereignty and honor to the Iraqi peoples.  Moreover, in short order Iraq´s oil fields will be flowing once again, providing Iraq, America, and its allies with access to Iraq´s abundant energy resources.  In short order, you will win the war in Iraq and achieve honorable objectives for Iraq, America, and its allies.  The slaughter of American soldiers and civilians in Iraq will end.

My proposal is this: Divide (balkanize) the country into three parts – three countries: one for the Kurds (ìKurdistan”), one for the Sunnis (ìSunnistan”) and one for the Shiites / Shias (ìShiastan”).  Relocate people as required to create a homogeneous population within each country (as was done, e.g., in Cyprus and in India/Pakistan a several decades ago and in a number of countries in North and South America a few of hundred years ago).  In each country, place a powerful and respected family in charge.  Each family will be responsible for running its country in an orderly fashion.  Each family will be beholden to the US for its position.  The requirement for continued US support will be the development of its oil resources, and trade oil with the outside world.  If it does not comply with this requirement, it will be replaced.

As currently constituted, and under current circumstances, Iraq is not governable.  There is not, as is so often referred to in the press, an ìIraqi people.”  There are basically three Iraqi peoples – the Kurds, the Sunnis, and the Shias.  My proposal recognizes this fact.  A strong nation is comprised of a population that is highly homogeneous with respect to basic human attributes, such as language, religion, race, geography and culture.  Profound differences in ethnicity and religion are currently tearing Iraq apart.  As three separate nations, stability, order and peace will return.  I know that diversity is important to you, and trying to minimize diversity by forcing a single nation instead of three diverse ones is very much counter to the goal of promoting diversity.

I know that you have expressed a desire to install democracy in Iraq.  Unfortunately, Iraq is not ready for democracy.  Iraq´s religion, politics, and culture are hundreds of years behind the West.  Cultures cannot be changed very fast – recall the fate of Shah Reza Pahlavi of Iran, who tried to ìwesternize” that country too fast.  Democracy is not very important to current Iraqi peoples.  What is very important to them at the present time is self-determination.  And there are three major subpopulations, each of which wishes to be independent of the others.  It took the West a thousand years to evolve its current democratic institutions from those of the Middle Ages.  Expecting Iraq to move from its Middle-Age culture overnight is unrealistic.

The solution that I am proposing is not original with me.  It was proposed hundreds of years ago by Machiavelli – and thousands of years ago by Sun Tzu.  It is based on sound and tested principles of politics and warfare.  The current approach of trying to impose an alien culture (democracy) overnight in Iraq, and govern radically different and inimical populations by means of democracy, is doomed to failure.

With specific reference to the recent events concerning prisoner abuse in Iraq, I have this to say: Continue to support Mr. Rumsfeld.  He is very capable, and he serves you well.  The recent incidents have nothing to do with his tenure in office.  They stem from several decades of lack of discipline in our armed forces, and a lack of purpose and direction – and permissiveness – in contemporary American culture.  You may certainly hold the generals who testified yesterday along with Mr. Rumsfeld responsible, since they have spent their lifetimes and careers in the system that spawned the abuse.  But Mr. Rumsfeld is not in any way responsible for these recent events, and he can, with your continued support, continue to be very effective in helping to accomplish your goals.  There have been calls for Mr. Rumsfeld´s resignation.  If Mr. Rumsfeld should resign, then you should resign.  Mr. Rumsfeld should not resign.

Your instincts have served you very well in the turbulent times of the past several years since the attack of September 11, 2001.  Your leadership has been strong and well directed.  But recent events, if not addressed properly, threaten to undermine your position, and lose both the war in Iraq and your presidency.  Please take time to read and consider my proposal.

Sincerely,

Joseph George Caldwell

 


Visit Joseph George Caldwell’s website, Write Joseph George Caldwell

Working Together

Monday, November 6th, 2006

Reposted from YES! Magazine.


Has Canada Got the Cure?

Holly Dressel

Should the United States implement a more inclusive, publicly funded health care system? That’s a big debate throughout the country. But even as it rages, most Americans are unaware that the United States is the only country in the developed world that doesn’t already have a fundamentally public–that is, tax-supported–health care system.

YES! MagazineThat means that the United States has been the unwitting control subject in a 30-year, worldwide experiment comparing the merits of private versus public health care funding. For the people living in the United States, the results of this experiment with privately funded health care have been grim. The United States now has the most expensive health care system on earth and, despite remarkable technology, the general health of the U.S. population is lower than in most industrialized countries. Worse, Americans’ mortality rates–both general and infant–are shockingly high.

Different paths

Beginning in the 1930s, both the Americans and the Canadians tried to alleviate health care gaps by increasing use of employment-based insurance plans. Both countries encouraged nonprofit private insurance plans like Blue Cross, as well as for-profit insurance plans. The difference between the United States and Canada is that Americans are still doing this, ignoring decades of international statistics that show that this type of funding inevitably leads to poorer public health.

Meanwhile, according to author Terry Boychuk, the rest of the industrialized world, including many developing countries like Mexico, Korea, and India, viscerally understood that “private insurance would [never be able to] cover all necessary hospital procedures and services; and that even minimal protection [is] beyond the reach of the poor, the working poor, and those with the most serious health problems.” 1 Today, over half the family bankruptcies filed every year in the United States are directly related to medical expenses, and a recent study shows that 75 percent of those are filed by people with health insurance.2

The United States spends far more per capita on health care than any comparable country. In fact, the gap is so enormous that a recent University of California, San Francisco, study estimates that the United States would save over $161 billion every year in paperwork alone if it switched to a singlepayer system like Canada´s.3 These billions of dollars are not abstract amounts deducted from government budgets; they come directly out of the pockets of people who are sick.

The year 2000 marked the beginning of a crucial period, when international trade rules, economic theory, and political action had begun to fully reflect the belief in the superiority of private, as opposed to public, management, especially in the United States. By that year the U.S. health care system had undergone what has been called “the health management organization revolution.” U.S. government figures show that medical care costs have spiked since 2000, with total spending on prescriptions nearly doubling. 4

Cutting costs, cutting care

There are two criteria used to judge a country´s health care system: the overall success of creating and sustaining health in the population, and the ability to control costs while doing so. One recent study published in the Canadian Medical Association Journal compares mortality rates in private forprofit and nonprofit hospitals in the United States. Research on 38 million adult patients in 26,000 U.S. hospitals revealed that death rates in for-profit hospitals are signifi cantly higher than in nonprofit hospitals: for-profit patients have a 2 percent higher chance of dying in the hospital or within 30 days of discharge. The increased death rates were clearly linked to “the corners that for-profit hospitals must cut in order to achieve a profit margin for investors, as well as to pay high salaries for administrators.”5

ìTo ease cost pressures, administrators tend to hire less highly skilled personnel, including doctors, nurses, and pharmacistsÖ,” wrote P. J. Devereaux, a cardiologist at McMaster University and the lead researcher. ìThe U.S. statistics clearly show that when the need for profits drives hospital decisionmaking, more patients die.”

The value of care for all

Historically, one of the cruelest aspects of unequal income distribution is that poor people not only experience material want all their lives, they also suffer more illness and die younger. But in Canada there is no association between income inequality and mortality rates–none whatsoever.

In a massive study undertaken by Statistics Canada in the early 1990s, income and mortality census data were analyzed from all Canadian provinces and all U.S. states, as well as 53 Canadian and 282 American metropolitan areas.6 The study concluded that ìthe relationship between income inequality and mortality is not universal, but instead depends on social and political characteristics specific to place.” In other words, government health policies have an effect.

ìIncome inequality is strongly associated with mortality in the United States and in North America as a whole,” the study found, ìbut there is no relation within Canada at either the province or metropolitan area level — between income inequality and mortality.”

The same study revealed that among the poorest people in the United States, even a one percent increase inincome resulted in a mortality decline of nearly 22 out of 100,000.

What makes this study so interesting is that Canada used to have statistics that mirrored those in the United States. In 1970, U.S. and Canadian mortality rates calculated along income lines were virtually identical. But 1970 also marked the introduction of Medicare in Canada — universal, singlepayer coverage. The simple explanation for how Canadians have all become equally healthy, regardless of income, most likely lies in the fact that they have a publicly funded, single-payer health system and the control group, the United States, does not.

Infant mortality

Infant mortality rates, which refl ect the health of the mother and her access to prenatal and postnatal care, are considered one of the most reliable measures of the general health of a population. Today, U.S. government statistics rank Canada’s infant mortality rate of 4.7 per thousand 23rd out of 225 countries, in the company of the Netherlands, Luxembourg, Australia, and Denmark. The U.S. is 43rd–in the company of Croatia and Lithuania, below Taiwan and Cuba.

All the countries surrounding Canada or above it in the rankings have tax-supported health care systems. The countries surrounding the United States and below have mixed systems or are, in general, extremely poor in comparison to the United States and the other G8 industrial powerhouses.

There are no major industrialized countries near the United States in the rankings. The closest is Italy, at 5.83 infants dying per thousand, but it is still ranked five places higher.7

In the United States, infant mortality rates are 7.1 per 1,000, the highest in the industrialized world — much higher than some of the poorer states in India, for example, which have public health systems in place, at least for mothers and infants. Among the inner-city poor in the United States, more than 8 percent of mothers receive no prenatal care at all before giving birth.

Overall U.S. mortality

We would have expected to see steady decreases in deaths per thousand in the mid-twentieth century, because so many new drugs and procedures were becoming available. But neither the Canadian nor the American mortality rate declined much; in fact, Canada´s leveled off for an entire decade, throughout the 1960s. This was a period in which private care was increasing in Canadian hospitals, and the steady mortality rates reflect the fact that most people simply couldn’t afford the new therapies that were being offered. However, beginning in 1971, the same year that Canada’s Medicare was fully applied, official statistics show that death rates suddenly plummeted, maintaining a steep decline to their present rate.

In the United States, during the same period, overall mortality rates also dropped, reflecting medical advances. But they did not drop nearly so precipitously as those in Canada after 1971. But given that the United States is the richest country on earth, today’s overall mortality rates are shockingly high, at 8.4 per thousand, compared to Canada’s 6.5.

Rich and poor

It has become increasingly apparent, as data accumulate, that the overall improvement in health in a society with tax-supported health care translates to better health even for the rich, the group assumed to be the main beneficiaries of the American-style private system. If we look just at the 5.7 deaths per thousand among presumably richer, white babies in the United States, Canada still does better at 4.7, even though the Canadian figure includes all ethnic groups and all income levels. Perhaps a one-per-thousand difference doesn´t sound like much. But when measuring mortality, it´s huge. If the U.S. infant mortality rate were the same as Canada´s, almost 15,000 more babies would survive in the United States every year.

If we consider the statistics for the poor, which in the United States have been classified by race, we find that in 2001, infants born of black mothers were dying at a rate of 14.2 per thousand. That´s a Third World figure, comparable to Russia´s.8

But now that the United States has begun to do studies based on income levels instead of race, these “cultural” and genetic explanations are turning out to be baseless. Infant mortality is highest among the poor, regardless of race.

Vive la diffÈrence! Genetically, Canadians and Americans are quite similar. Our health habits, too, are very much alike — people in both countries eat too much and exercise too little. And, like the United States, there is plenty of inequality in Canada, too. In terms of health care, that inequality falls primarily on Canadians in isolated communities, particularly Native groups, who have poorer access to medical care and are exposed to greater environmental contamination. The only major difference between the two countries that could account for the remarkable disparity in their infant and adult mortality rates, as well as the amount they spend on health care, is how they manage their health care systems.

The facts are clear: Before 1971, when both countries had similar, largely privately funded health care systems, overall survival and mortality rates were almost identical. The divergence appeared with the introduction of the single-payer health system in Canada.

The solid statistics amassed since the 1970s point to only one conclusion: like it or not, believe it makes sense or not, publicly funded, universally available health care is simply the most powerful contributing factor to the overall health of the people who live in any country. And in the United States, we have got the bodies to prove it.


Holly Dressel was born south of Chicago and lives in Montreal, Quebec. She is a writer/researcher and the best-selling co-author, with David Suzuki, of Good News for a Change and other works.

This article was adapted from Holly Dressel´s book God Save the Queen–God Save Us All: An Examination of Canadian Hospital Care via the Life and Death of Montreal´s Queen Elizabeth Hospital, to be published in 2007 by McGill/Queen´s Press.



1Terry Boychuk. The Making and Meaning of Hospital Policy in the United States and Canada. University of Michigan Press, Ann Arbor: 1999.

2David U. Himmelstein, et al. Health Affairs, Jan.–June 2005, http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1

3Professor James Kahn, UCSF, quoted in Harper´s Magazine, ìHarper´s List,” Feb. 2006.

4National Health Expenditure Data, http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf.

5Devereaux, Dr. P.J., et al. ìA Systematic Review and Meta-Analysis of Studies Comparing Mortality between Private For-Profit and Private Not-For-Profit Hospitals,” Canadian Medical Association Journal, May, 2002.

6Nancy A. Ross et al. ìRelation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics,” Statistics Canada, reprinted in Health Geography, GEOG-303, ed. Nancy Ross, McGill University, 2005, pp. 109-117.

7CIA World Fact Book. http://www.cia.gov/cia/publications/factbook/rankorder/2091rank.html

8See, among many studies blaming race, Child Health USA 2003, Health Status – Infants; HRSA, with graphs such as ìBreastfeeding Rates by Race/Ethnicity, 2001”; ìVery Low Birth Weight Among Infants, by Race/Ethnicity 1985-2001”; http://www.mchb.hrsa.gov/chusa03.