1. Health care pricing.
Prices charged for health care goods and services in the U.S. are frequently excessive, show wild variations between prices charged for the same things without good reasons to the point of being arbitrary and random, and are not transparent.
The U.S. also spends excessive amounts of money on claim processing paperwork, advertising for prescription drugs (that consumers can't even purchase without physician prescriptions), and compensation for executives and shareholders in "for profit" health care companies.
2. Health care access.
Even with Obamacare, too many people don't have access to health care that they can afford. Access to mental health care is particularly poor. As a result, health care outcomes in the U.S. are poor despite the fact that the U.S. spends a huge amount of money on it.
3. Public health.
No country in the world has done a poorer job of dealing with the COVID-19 pandemic.
4. Elections.
We have a uniquely unequal and unfair electoral college system and misallocation of power in the U.S. Senate. Most of our elections are run via an obsolete single member district plurality vote system that as a practical matter imposes a two party system. Our political parties are anemic. Our voter turnout is very nearly the lowest in the world relative to the voting age population. We do more to unjustly limit the franchise than most developed countries. Our mechanisms for conducting elections widely very in quality with those that are well done (like Colorado) making up a small percentage of the total.
5. Gun ownership.
The U.S. has very high rates of civilian gun ownership that lead to high rates of homicide, other violent crimes, suicide and accidental deaths with firearms. The U.S. murder rate isn't the highest in the world, but it is far higher than most of our developed world peers.
6. Criminal justice.
The U.S. has police that routinely use force excessively, and violates citizens rights, compared to our developed world peers. Systems for keeping law enforcement accountable, through their employers, through the criminal justice system, and through civil litigation are very weak.
There is a high level of racial basis in how the criminal justice system is operated. Our rates of wrongful convictions are high compared to other countries in the developed world. Meanwhile, it fails to hold to account law breaking law enforcement and other white collar or middle to upper class white criminals for serious crimes.
It makes excessive use of both pre-trial and post-conviction incarceration, with sentences far in excess of what is reasonable for an offense in many instances. Jails and prisons are poorly managed making them hotbeds of abuse and turns inmates into more hard core and radicalized criminals.
7. Post-secondary education and training.
While the quality of the education received in American colleges and universities is generally among the best in the world, many academically qualified young people don't attend college or don't complete it due to a perceived inability to afford it.
We also suffer from credential inflation, with many careers requiring unnecessarily high levels of formal education, relative to the requirements of the position. Alternatives to a college and university education, like apprenticeships and trade schools are not well developed.
8. Foreign language instruction.
Foreign language instruction in the U.S. is done very poorly. It starts when students are too old. It has no significant immersion component. Foreign language teachers are often only marginally fluent themselves. The way the U.S. conducts foreign language instruction, we'd be better off not doing it at all for the most part, because the significant efforts devoted to it do not pay off very often at all.
9. Government contracting.
Few countries do as poor of job of managing large government contracts as the United States, where these projects are routinely far behind schedule, far over budget, and deficient in quality.
10. Addressing poverty.
The U.S. does a poor job of providing an economic safety net. This results in excessive levels of homelessness and individual suffering that could be avoided in a society as affluent as ours.
11. Immigration.
There isn't by any means a clear consensus in the U.S. or among developed nations concerning what an immigration policy should look like. But, it isn't hard to say that the U.S. approach is not one to be copied.
The U.S. has many undocumented immigrants who can't obtain legal status, leading to abuses by employers and others that undermine the integrity of regulations of labor, housing and other matters. Fear of immigration enforcement also leads to lack of cooperation in reporting suspected terrorists.
Hundreds of thousands of undocumented immigrants (who are part of the DACA program) have lived almost their entire lives in the U.S., are fluent in American English (and not infrequently in no other language), had no choice in their status, have graduated from high school, have committed no crimes, and are culturally American with strong ties to the U.S.
The U.S. treatment of asylum applicants, particularly children and families, is an international disgrace, and often deeply out of compliance even with U.S. laws.
It is hard to businesses to hire highly qualified high tech industry employees from abroad due to visa quotas, in a manner that significantly impairs the U.S. economy.
There are entire industries or sub-industries, such as agricultural workers, unskilled construction labor, landscaping, and cleaning services, where undocumented immigrants predominate, because legal immigration routes for these workers are largely unavailable, and because U.S. workers are not willing to do the work on the terms and at the rates offered by U.S. employers.
Immigration courts make a mockery of due process with wildly varied outcomes from judge to judge and court to court, and with children forced to represent themselves in court without assistance, for instance. Immigration courts are profoundly backlogged, and are unduly influenced by executive branch interference (they are not part of the judicial branch).
There is such a wide consensus that the immigration system is broken in some communities and subcultures in the U.S. that it is considered anti-social and unjust to invoke it.
The process for obtaining permanent resident visas results in sometimes long delays for uniting close family members and workers who would help our economy if allowed to enter the U.S., particularly from countries such as Mexico and the Philippines.
Immigration enforcement at the border tends to be abusive, arbitrary, and overly militarized.
12. Taxation.
The U.S. system of taxation undertaxes unearned income and corporate income, tends to be regressive, has mediocre levels of compliance especially among the self-employed and affluent, and routinely fails to collect enough revenue to avoid massive budget deficits. In part as a consequence of federalism, it is also cumbersome to administer.
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