[piano instrumental] [television jingle] [static] America is the greatest country on Earth! The strongest, the richest, the most powerful country on Earth. As an American, I'm sure you've heard that roughly 135 times a year.

235 if you go to public school; 335 if you go to a Christian academy. We're told that Americans have the best lives of any people in the world. That we have low taxes, small government, and the highest living standards on Earth. And, most inaccurately, that we're the freest.

Well, it is partly true; America is the richest country, not just in the world, but in the history of the world. It's really hard to comprehend just how rich we are. We have 18 million people who are millionaires.

American households own about 100 trillion dollars in wealth, an almost unthinkable amount of money. Okay, so America is the richest country ever, but there's a curious paradox: most Americans actually have a much worse standard of living than people who live in poorer countries like

Germany, or Finland, or Britain. But how can that be? That shouldn't make any sense. Well, here's the shitty deal: Americans get significantly worse services because our tax dollars don't fund them. So, of course, our services are worse

and thus, we enjoy less happy lives than people who live in the aforementioned countries. Not that difficult a concept to conceive, really.  "You get what you pay for!" said the cartoon dog to the other cartoon dog. And while you might think the reason American

The claim that tax dollars don't fund as many services because we pay lower taxes than other countries is false! When you add federal, state, local, and sales taxes, and include other costs and services not covered by our taxes

but covered by other countries' taxes—like our uniquely high health insurance premiums—you'll find that Americans actually pay MORE of their wages in taxes than most of the developed world. For example, in Canada, for a married worker with two kids, all the previously mentioned costs combined,

from taxes to health insurance premiums, make up only 11% of the average wage; in the UK, it's just about 26%. Meanwhile, once you add the cost of our exorbitant health insurance premiums, you're spending a whopping 43% of your paycheck

That's more than France, Finland, Sweden, and Norway. In reality, Americans keep much less of their income than people in other countries. In other countries, the government takes more in taxes but then gives that money back to citizens in the form of healthcare,

or job support, or a general safety net for all vulnerable citizens. So what do Americans get for the money we pay? Well, we get crumbling infrastructure, shameful homelessness, and millions of hungry, neglected children.

BUT we also get some of the worst services in the developed world.  Take our healthcare: American healthcare is simultaneously the most expensive, the least efficient, and the least effective healthcare system in the developed world.  The devil's trifecta!

And in exchange for this extremely expensive, inefficient healthcare system, what do we get? Well, we get some of the worst health outcomes in the developed world. We have fewer hospital beds per capita than people in Turkey or Brunei. Americans have a lower life expectancy than

people in Lebanon or Cuba. And in the Mississippi Delta and much of Appalachia, life expectancy is lower than in Bangladesh. In fact, in 2017, the United Nations sent a commissioner to West Virginia to document what he saw, and he described

"third-world conditions of absolute poverty." We even have a higher infant mortality rate than people in Russia and Serbia. In every single metric, America does worse across the board. So why is healthcare so expensive? Because it's so complicated.

You have to look for in-network physicians, schedule an appointment for established care, beg for coverage from your insurance company that couldn't care less about you—and that's if you're lucky enough to have good insurance! Compare that to Britain and all of those other

evil, socialist-like countries where it's simple: public hospitals provide free treatment to people who need it. That's it. I'll repeat that: Public hospitals provide free treatment to people who need it. And here's the best part:

Even though Britain offers healthcare for free, their system is actually a lot cheaper to run than ours. Per capita healthcare spending in the U.S. is almost three times what it is in Britain, and almost five times what Canadians spend.

In fact, Americans spend the most per person of any country in the world on health care. "But the free market is more efficient," you screech. But in America, private systems often aren't efficient at all; private drug companies have an incentive to

charge whatever they can get away with for pharmaceuticals. In Canada, a carton of insulin costs about 20 bucks. In the U.S., it costs 300 bucks. And with private insurance companies footing the bill, hospitals have an incentive to get as much money

out of patients as possible, too. In 2015, the average cost of an MRI scan in the U.S. was $1119. But it was only $215 in Australia. Spain? About $181. And our health care system is so inefficient

that we spend over a third of our costs on administration. The United States spends significantly more on administration than it spends on preventative or long-term health care. That's just not smart. "Okay, we get it. We all know that American health care

is so much more expensive," you say. "But that's the cost of having the freest freedom in God's favorite country!" Well... guess what? Medical procedures that are totally free in Britain, like giving birth, cost tens of thousands of dollars in the United States.

I mean, you want to talk about the cost of freedom? Sadly, because of these high costs, Americans often avoid going to the doctor—something almost half the population say they do. With shoddy or nonexistent health insurance, Americans will wait until their conditions force them into

the emergency room, where treatment is far more expensive. Again, not a smart system. Quite often, they end up putting off medical visits and dying. Susan Finley, a 53-year-old Walmart employee in Colorado, got pneumonia and took one day off of work

beyond what Walmart's policy allows. So, of course, Walmart went to Walmart, which they did, by firing her. Without her job, she lost her nominal health care coverage, struggled to find new work, and after avoiding a visit to the doctor for

flu-like symptoms, she was found dead in her apartment. When Americans do manage to get treated, they frequently can't afford it. Simple, life-saving treatments can cost tens or hundreds of thousands of dollars, and if they don't have really good insurance,

they're forced to take on medical debt. Tens of millions of Americans owe medical debt, often into the tens of thousands of dollars. Meanwhile, in a country like Britain or Norway, medical debt is almost unheard of. But hey, that's why GoFundMe is such a critical

component of American health care. One in three GoFundMe campaigns is now for medical bills. I'll repeat that: one in three GoFundMe campaigns is now for medical bills. America is such a strong, powerful, rich, and great country

that its citizens have to beg strangers on the internet for money so they can get life-saving treatments that are free in the rest of the developed world. But hey, that's just health care. Americans get terrible deals wherever you look. Let's take work, for example.

Americans work longer hours than people in any other rich country in the world, and that's not because they enjoy sleep deprivation and not seeing their families for days at a time. It's because they don't want to starve, freeze, or die.

See, America has the least generous job support programs, the least generous family benefits, and the least generous unemployment benefits of any wealthy country. It's one of the only countries on Earth that doesn't guarantee paid time off for vacations. It doesn't even provide paid time off for parents

who just had a child. And it's not coincidental that we're also one of the most hostile countries to workers' rights. America has one of the lowest unionization rates in the entire world. Maybe this deprivation, our refusal to give people

the means to lead a good, dignified life, commensurate with how rich our country is, can explain a bit of what we've seen in the United States over the last few decades. Fraying communities, rising rates of depression and suicide,

huge numbers of deaths from drug overdoses. These so-called "deaths of despair"—suicide, drug overdoses, alcoholic liver disease—are one big reason why American life expectancy has actually started to decline over the last few years.

And with such poor conditions, it's not a surprise that poverty is so rampant in the United States. America devotes a smaller percentage of spending on social welfare than any other industrialized economy because, say it with me, 'socialism is evil.'

It's evil! Go to Denmark and try telling those happy, healthy families enjoying their paid vacation that their system of government is evil. Guess what? I guarantee they'll know you're an American. But I digress; America also has the highest rate of child poverty

of any developed country, and the highest percentage of workers earning significantly less than the national median income. THAT seems pretty evil to me. Especially since such a tiny fraction take as much of your money from themselves and their families as you will let them.

All the while, both parties smile and shake hands. Across every single metric, no people accept a worse deal than Americans today: high taxes, high costs of living, for next to nothing in return from the government. The most expensive health care system

for the worst health outcomes. More money taken from workers, for the highest rate of child poverty. We are the richest country in the history of the world, but we have fewer miles of high-speed rail than Uzbekistan. We are the greatest country in the world,

yet we have the most people in prison of any country and the highest incarceration rate as well. And a higher rate of police killings than in Angola and Sudan. America is bad at everything because, instead of choosing to make life better for people,

through a public health care system, or more generous child care policies, or better public transit, or programs that allow people to spend more time with their families, American law is designed and crafted to protect a class of parasitical middleman industries.

Instead of using a proportionally tiny piece of the massive amount of wealth in this country to make people's lives healthier and happier, most of our elected leaders are, and have been for generations, engaged in a massive project of looting.

Gently and lovingly guiding as much money as possible from working people into the pockets of the well-connected and the ultra-rich. Think about that as we start hearing about the inevitable rise in homelessness, poverty, starvation, and sickness that will occur during

these coming months and years in the greatest, strongest, richest, most powerful country on the face of the Earth. I'm David Cross, for the Gravel Institute. [Techno music plays]

David Cross: Why America Sucks at Everything

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