Floors, Ceilings, and Health

On the car radio today I was listening to an American doctor giving a lecture someplace. I couldn’t stay to hear the whole thing, but what I did hear was interesting, though now I sure wish I’d found out who he is.

He was trying to explain the poor health of the American population, comparing it to other countries (especially rich ones) and to its own relative ranking in earlier periods. He said that the US is now the unhealthiest of all the affluent industrialized countries. (Maybe he gave morbidity figures and life expectancy numbers earlier in the show but if so, I missed them. But I’ve seen data before and know that his generalizations are correct.)

His explanation was inequality. Not only is inequality highest in any the US, compared to other affluent countries, but there is much greater inequality in the US than a generation or two ago — and the healthiness of the population has declined accordingly. He says that Canadians are healthier and even that Cubans are as healthy as Americans, despite their relative poverty. The degree of inequality is far less in Cuba, and whatever money the government can scrape together is spent on health care and free education.

The healthiest society on earth is Japan, he says, but they were not so healthy at the end of World War II. It was General Douglas MacArthur who made them healthy, he said, by capping the income that anyone could receive. That’s one way of creating greater equality in society, of course, and probably this doctor is right in his basic argument: that income equality is a great determinant of health in the society. However, I was a bit surprised at the method that he described MacArthur as employing: to put a ceiling on the income of the highly-paid businessmen. That’s not the approach I’d use. Personally, I favor floors instead of ceilings.

In fact, I think it’s not the best approach to make equality a goal in itself. There have been lots of societies that made equality the main objective and even achieved it, but with unfortunate results. Socialist countries, for example, narrowed the gap between the richest quintile of the population and the poorest — but the results were not satisfactory. Whenever a culture endorses an ethic of invidious comparison, in which one pursues one’s own well-being by trying to keep up with the Joneses, the outcome is often that people lose any sense of their own true needs and give themselves over to envy or vainglorious pride.

When MacArthur capped the income levels of the rich in Japan, he assumed that their wealth would go instead to the poorest segments of the population — and it probably did, with good effects on their health. Indeed, I have no reason to suppose that the Japanese are particularly oriented toward comparative status rankings. However, I do know that the socialist countries experienced deleterious effects, overall, by the overemphasis on equality. Often it was considered better to keep everyone equally poor rather than let anyone become more prosperous.

The doctor on the car radio mentioned the changing ratio over time and among countries between the income of the top executives and the average worker. The US has definitely become more unequal over time and in comparison to other societies. And the effects are harmful, by and large. Equality makes populations healthier – including even the rich within each society. So my goal, too, is to make societal distribution fairer.

However, I wouldn’t go about it the way MacArthur did. Instead of lowering the ceiling to limit the income of the rich, I’d raise the floor, to make sure that the poor all receive a decent basic minimum standard of living.

And actually, that is politically more palatable anyhow. A few years ago Ed Broadbent, the great Canadian social democrat who led the New Democratic Party for many years, argued in a book that it will always be a hard sell for politicians to equalize the standard of living in society by taxing the rich and distributing the money directly to the poor. Instead, he suggests that it is much more acceptable to the rich to offer services to the entire population equally, which would benefit the affluent as well as the poor. Improve the access to health care, education, parks, day care for infants, good transportation systems, and the like. The poor will benefit proportionately more from these cheap amenities than the rich, but the changes will not rankle so much. To promote that approach, however, requires us to change the rhetoric and even the standards by which judgments of well-being are made. Instead of demanding equality, we expect that everyone in the society be afforded a decent minimum, simply because that is the civilized thing to do. If human needs are met all around, I don’t care how rich the wealthiest people become. Make your pile, if that’s what you enjoy doing. But let us all care for the most disadvantaged, whether we like them or not, and whether we even consider them deserving.