Tuesday, March 23, 2021


There are some serious problems in the US. In no way is this better demonstrated than by this chart showing life expectancies of all the rich countries:

The US has diverged dramatically from its peers. Why this is not some national emergency that both political parties at all levels are highly focused on solving is a mystery to me. In Tightrope: Americans Reaching for Hope, the authors go into the causes and effects and some possible solutions to America's problems.

The book changed my mind on a number of issues, and as I'm a stubborn fool that earns it an A+ from me. For example, I put a lot of emphasis on personal responsibility: it's up to each individual to improve their lot. But this book has made it clear to me that institutional failures are causing fewer people to be able to succeed. When America's outcomes are so much worse than those of the rest of the developed world, people who would have been successful (i.e. those who would have escaped poverty in another country, but not in the US) are being let down. The ramifications are of course felt by everyone in the form of crime, violence, cost of rehabilitation, lost potential etc., not just those who fail.

The book is a fantastic mix of narrative and statistics. It doesn't let you get bored by firehosing a bunch of stats at you, but it provides a ton of info accompanied by the stories of the people who bring the stats to life. It digs deep into a number of topics and offers solutions to improve America's outcomes. There were a number of WTF moments I had while reading the book. I wanted to list a few here:

- The poor are made even more poor by government actions. For example, if you get behind on child support, they can take away your driver's license. How is someone supposed to work if they can't drive? When they're caught driving, they're thrown in jail. In this way, some states have suspended *almost 10%* of their adult populations' driver's licenses!

- Poor Americans have a life expectancy similar to that of Mongolia, a homicide rate higher than Rwanda, and an incarceration rate that is the *highest in the entire world*

- A woman is twice as likely to die in pregnancy/childbirth in America as in Britain. One of the most dangerous places in the advanced world to become pregnant is the American South

- The number of Americans in jail has increased *sevenfold* from 1970, and is *6 times* that of Canada (per capita)

- The UN official in charge of extreme poverty warned that the US now has the lowest rate of social mobility in the rich world.

- One in seven American children don't finish highschool on time (including 1/4 of black students)!

- The US was a leader in female labour force participation; now it's 20th out of the 22 richest countries

- 1/4 of those who manage to graduate from highschool can't pass the military's qualifying exam

- American children die at 55% higher rates than children in other advanced countries

- A baby born in zip code 19106 (an affluent part of Philadelphia) has a life expectancy *20 years longer* than a baby born *four* miles away in zip code 19132.

Another way the book changed my mind is with respect to charitable donations. I've generally leaned towards donating to poor countries, thinking everyone around here has been born lucky and has had a chance to make something of their lives. I don't believe that anymore. Some children are even born addicted to drugs. There are plenty who need help right here through no fault of their own.

Before this book, I also did not properly understand the role of the US military. I've always seen it as this big, bloated organization that has probably pushed America into many destructive wars. But I did not properly appreciate its positive effects on young men who lack positive role models and other opportunities. It gives young people a job, structure, discipline, experience and education to fill the voids of parents, schools and communities that are not up to the task.

I'm not that familiar with the real world depicted by the authors. That's partly because I've avoided it, knowing it's not a good path for me. But it's also partly because I grew up in a family that offered me other options. Too few kids have these other options. We need to do better!

There is hope. The authors offer a number of solutions. The good news is, many of these solutions are not highly risky; we know this because other countries are already doing them, and are outperforming the US. So why not copy best practices? A number of these also generate substantial returns on investment. Convert a user from a criminal who goes in and out of prison to a tax payer, and the return on investment for society is astronomical.


juan said...

Saj, you say this book changed your mind about charities, because you now see many people in America also need help. But do you agree that one's charitable donations should go not only to where there's a need, but to where the donations will do the most good?
If so, it seems difficult to do better than donating to the most efficient charities working in the third world.
For example, GiveWell estimates you'd save a kid's life by donating $5K to one of its top two recommended charities, which fight Malaria in Africa. The same amount might help a poor U.S. kid do better in school for a semester: https://www.givewell.org/giving101/Your-dollar-goes-further-overseas

Saj Karsan said...

Hi Juan,

You're absolutely right that donations to efficient charities in the third world will do a lot of good. But because earnings are so high here, turning people from lives of drugs/crime into productive members of society could also have a large impact. With those gains, someone here could then save multiple overseas lives, for example.

I'm not saying your point is not valid, just that the whole thing is complicated.

juan said...

Fair point, Saj.

I think GiveWell and similar outfits try to include in their calculations some of the indirect and longer term effects of giving to particular charities. I believe the Gates Foundation does that too, and has concluded that, if you assume every life has equal value, giving abroad is more cost effective, and so tries to get governments, including that of the U.S., to increase their foreign aid budget. Although does spend money in the U.S. too (about 10% of its 2017 budget, if a chart I googled is correct), which probably means they think there are some cost effective opportunities there.

Of course, it's impossible to quantify every possible ramification of one's giving (e.g., what if helping the American kid do better in school does lead to his making more money and donating some overseas, but it also prevents or delays America's reckoning with its institutional failures and its adopting the best practices "Tightrope" recommends?).

Besides the difficulty of calculating returns far in the future, another reason to favor shorter term impact is that world is getting better all the time, and so the efficacy of charity is likely to decline. Some years from now, malaria will no longer be around, and $5K might not be enough to save a life.

Anonymous said...

US is the only country in the world where people eat themselves to death. Don't be fooled into this rich vs poor narrative. Everyone in the US is rich. Life expectancy in the US is not a health issue. It is a cultural issue.