United States of America

AmeriKKKa Anowara:kowa
Flag
Capital	Washington, DC
Largest city	New York City
Official languages	English
Dominant mode of production	Capitalism
Government	Fascism
• President	Joe Biden
• Speaker of the House	Nancy Pelosi
• President of the Senate	Kamala Harris
History
• Declaration of Independence	1776 July 4th
Area
• Total	9,833,520 km²
Population
• 2020 estimate	331,449,281
Currency	United States dollar

The United States of America (USA), commonly known as the United States (U.S. or US), is a fascist country situated primarily in North America. It consists of 50 states, a federal district, five major unincorporated territories, and 326 Indian reservations. With about 332 million inhabitants, it is the third most populous country in the world. It is also the fourth largest country in the world by land mass. With only 4% of the world's population, it consumes 25% of the energy produced on the planet, and despite its immense national wealth more than a third of its population is not assured of medical care.

A modern empire, the United States sit at the center of a cabal of imperialist western regimes. Beginning as a settler-colony of European maritime empires, it became an independent nation in 1776. It has achieved remarkable economic, scientific and military development through the process of imperialism, where it uses military power to ensure access for its private industries to exploit the nations of the world. Many, although not all, of its methods of exploitation employed outwardly are also employed inwardly towards its own population.

History

Native American Genocide

With the advent of the war of 1776 against the British empire and afterwards, the fledgling United States expanded westward with President Thomas Jefferson (the third in a long line of Presidents) referring to the nation as an "empire of liberty." As Nancy Isenberg elucidates in her book White Trash: The 400-Year Untold History of Class in America: "The Louisiana Territory, as he envisioned it, would encourage agriculture and forestall the growth of manufacturing and urban poverty—that was his formula for liberty. It was not Franklin’s “happy mediocrity” (a compression of classes across an endless stretch of unsettled land), but a nation of farmers large and small. This difference is not nominal: Franklin and Paine used Pennsylvania as their model, while Jefferson saw America’s future—and the contours of its class system—through the prism of Virginia."

Around 1800, as the lands further to the west were opened up to the fledgling United States, the young state saw the land as a way to appease its population and strengthen its power in the world. As Nancy Isenberg further explains: "By 1800, one-fifth of the American population had resettled on its 'frontier,' the territory between the Appalachian Mountains and the Mississippi. Effective regulation of this mass migration was well beyond the limited powers of the federal government. Even so, officials understood that the country’s future depended on controlling this vast territory. Financial matters were involved too. Government sale of these lands was needed to reduce the nation’s war debts. Besides, the lands were hardly empty, and the potential for violent conflicts with Native Americans was ever present, as white migrants settled on lands they did not own. National greatness depended as much as anything upon the class of settlers that was advancing into the new territories. Would the West be a dumping ground for a refuse population? Or would the United States profit from its natural bounty and grow as a continental empire more equitably? There was much uncertainty."

Polynesian Genocide

By the end of the 19th century, the United States would find itself as a predominant imperialist power in the world, invading countries such as the Philippines in a brutal war for control. In J. Sakai's book Settlers, it's recounted that: "U.S. Brig. Gen. James Bell, upon returning to the U.S. in 1901, said that his men had killed one out of every six Filipinos on the main island of Luzon (that would be some one million deaths just there). It is certain that at least 200,000 Filipinos died in the genocidal conquest. In Samar province, where the patriotic resistance to the U.S. invaders was extremely persistent, U.S. Gen. Jacob Smith ordered his troops to shoot every Filipino man, woman or child they could find 'over ten' (years of age)."

The United States would expand beyond its continental borders with the colonialist acquisition of lands such as Hawaii, the Philippines, Guam, etc. With the attack on several of these territories by the Japanese empire, most notably at Pearl Harbor, President Roosevelt would downplay the colonialist additions to the American empire, such as the Philippines, and give more emphasis to the U.S. territory of Hawaii (which was not yet a state during this time). From Daniel Immerwahr's How To Hide An Empire: A History of the Greater United States:

"Why did Roosevelt demote the Philippines? We don't know, but it's not hard to guess. Roosevelt was trying to tell a clear story: Japan had attacked the United States. But he faced a problem. Were Japan's targets considered 'the United States'? Legally, yes, they were indisputably U.S. territory. But would the public see them that way? What if Roosevelt's audience didn't care that Japan had attacked the Philippines or Guam? Polls taken slightly before the attack show that few in the continental United States supported a military defense of those remote territories. Consider how similar events played out more recently. On August 7, 1998, al-Qaeda launched simultaneous attacks on U.S. embassies in Nairobi, Kenya, and Dar es Salaam, Tanzania. Hundreds died (mostly Africans), and thousands were wounded. But though those embassies were outposts of the United States, there was little public sense that the country itself had been harmed. It would take another set of simultaneous attacks three years later, on New York City and Washington, D.C., to provoke an all-out war."

While an embassy is different from a territory, as the book concedes, a similar logic was at play. And as Immerwahr says, Hawaii had more Americans and was closer to statehood. However, as Immerwahr explains, even Roosevelt felt the need to say that the "American island of Oahu" was attacked and that "very many American lives" had been lost. As Immerwahr says in explaining the nationalism implicit in Roosevelt's speech after Japan's attack on Pearl Harbor: "An American island, where American lives were lost - that was the point he was trying to make. If the Philippines was being rounded down to foreign, Hawai'i was being rounded up to 'American.'"

21st century

End of American empire

Internal crises

The US is embroiled in crisis as its middle class (the petit bourgeoisie) is increasingly impoverished. This is due to the capitalist class deciding to offshore well-paying industrial jobs to lower-income countries, as well expansionary monetary policy which enriches the bourgeoisie through asset price inflation, and deepens the crisis among the poor by weakening their purchasing power.

As a result of this ongoing crisis of capitalism, populist movements have risen to challenge the rule of "the elites." Occupy Wall Street was a popular movement against the financial elites in 2011. During the 2016 presidential election, the corporate-owned media attacked both the left-wing populist Bernie Sanders, as well as the right-wing populist Donald Trump. The Democratic Party's strategy to "elevate Trump" to make the Republican ticket look unsavory ended up backfiring and resulting in Trump's victory.

Socialist and communist groups in the US have grown massively during this time, but the rise of the far-right has also risen accordingly, given that both tend to arise during crises of capitalism.

External losses

The American empire has been on the decline since the 21st century and possibly earlier. This is a slow process that will take years to complete however. One major factor of this decline is the United States' incapacity to respond to the People's Republic of China's Belt and Road Initiative, as more countries are moving towards the PRC and away from the USA for trade and loans.

If a superpower is measured through objective metrics such as scientific output (number of research papers per year), exports & other trade metrics, GDP, then these metrics show the US is on the decline and has been for several years. In subjective metrics, a superpower's hegemony is measured in its soft power (putting compradors in power abroad to ensure collaboration), its cultural exports (media, entertainment, software), and generally its respect in the world. In these trends too we see the USA declining. They have been unable for some time to ensure compradors in other countries, and are becoming less respected in the eyes of the international community (see list below). The United States' cultural export is still high, but even at home people are increasingly moving away from domestic entertainment, though it remains to be seen if this will be a lasting trend.

Other losses that the American empire has had to endure in the 21st century include, in chronological order:

• The September 11, 2001 terrorist attacks, which completely blindsided intelligence and security agencies, showed a very big weakness in the imperial apparatus: it was not as invincible as it thought.
• A smear campaign originated in the US media in january 2019 when Venezuelan president Nicolás Maduro was reelected. US News organisations started reporting about a supposed humanitarian crisis in the country, owing to Maduro's allegedly "disastrous" policies. Two weeks later, president of the Assembly Juan Guaido proclaimed himself president of Venezuela as he contested Maduro's results -- under the guise that he was not allowed to run for office a third time as per the constitution. Juan Guaido, who enjoyed very little support at home and was a nobody, was nonetheless instantly recognized as the legitimate president of Venezuela by the United States and other countries and organisations (Canada, European Union...). An attempted color revolution then was planned in Venezuela, but went nowhere. Guaido was then slowly phased out of the public eye in the international community, though he continues to make noise in Venezuela. Maduro remains the president of Venezuela.
• In late 2019, Bolivian president Evo Morales was reelected at his position. The election results were immediately contested by the Organisation of American States, a US-led organisation for the purpose of securing imperialism on the American continent. While these allegations proved to be false, Morales went in exile for over six months while Jeanine Añez, a far-right comprador politician, was placed as an interim. After delaying new elections twice, Añez finally relented and took a huge blow when Luis Arce, from the same party as Morales was elected. Añez is now in prison awaiting trial on various charges including terrorism, sedition, and leading a coup against the government.
• In January 2020, the United States ordered the assassination of Iranian general Qasem Soleimani while on visit in Baghdad, Iraq. Later that month, Iran retaliated by launching an attack on a US military base in Iraq on a scale never seen before. The US however did not retaliate against this attack in any way.
• In August 2021, the United States, after 20 years of occupation in Afghanistan to prevent the Taliban from controlling the state, did exactly the opposite and let the Taliban seize the Afghan state.

It is important to compare this list to earlier imperialist ventures of the United States who, for example, considered South America their "backyard" for most of the 20th century and successfully pulled of coups and regime changes unimpeded in the region. While the Empire also took losses in the 20th century (the invasion of Vietnam, the Bay of Pigs invasion...), it must only contextualised by looking at the general trends and how these losses are rapidly adding up.

Government

U.S. flag restyled to illustrate the plutocratic and corporatist nature of the political system

The US political system is a de-facto plutocracy; a government entirely controlled by the wealthy.

Dominated by two right-wing political parties, the Democratic Party which is center-right and is controlled by the monopolistic managerial bourgeoisie who seeks to maintain the stability of the imperialist system by being less reactionary on inconsequential social issues, while the Republican Party is further right on social issues and tends to pander to the petit bourgeoisie in their effort to deepen the exploitation of labor.

The election system further solidifies this duopoly with its "First Past the Post" system, resulting in citizens having to choose "the lesser of two evils." The two political parties stir up public debate around their small disagreements to create a facade of democracy, but bipartisan agreement reigns on questions of foreign policy (imperialism, war, attacking socialist countries) as well as domestic policies such as prioritizing funding for police repression over social programs such as free housing, higher education, healthcare, etc.

Given the presence of campaign donations and lobbying (legalized corruption), the billionaires who buy off politicians to serve their will are sometimes referred to as the "Donor class".

In his autobiographical account of taking on monopolistic corporations as president, President Theodor Roosevelt recounted:

…we had come to the stage where for our people what was needed was a real democracy; and of all forms of tyranny the least attractive and the most vulgar is the tyranny of mere wealth, the tyranny of a plutocracy.

Despite various anti-monopoly countermeasures (anti-trust legislation, etc.) the underlying system of capitalism and the desire to accumulate more surplus value and increase profitability continues to result in monopolistic formations within the US economy. These monopolies are more powerful than the public state apparatus, and by most approximations can be considered the same object. According to fascist dictator Mussolini, the merging of corporate power and state power is the definition of fascism.

Foreign Policy

The United States has long seen itself as a very special nation, playing a uniquely noble role on the world stage. While other nations are said to be guided by vulgar self-interest, the United States is supposedly different; the primary goal of American foreign policy is, according to the State Department’s website, to “promote and demonstrate democratic values and advance a free, peaceful, and prosperous world.” But how well does the United States live up to those so-called “democratic values”? Does it in fact promote the cause of a “free, peaceful, and prosperous world”? Let’s look at the facts.

Foreign Aid and Human Rights

To begin with, the US has a horrific foreign aid record. It seems that American aid is quite a good predictor of human rights abuses, and that this trend goes back decades; according to a 1981 study in the journal Comparative Politics, US aid is “clearly distributed disproportionately to countries with repressive governments… this distribution represented a pattern and not merely one or a few isolated cases.” Indeed, it is quite easy to find examples of the United States supporting vicious repressive regimes (such as Pinochet's Chile, the Shah of Iran, and the military junta of El Salvador).

Similarly, a 1984 study in the Journal of Peace Research looked at human rights and US aid under Nixon, Ford, and Carter. The authors found that “under Presidents Nixon and Ford foreign assistance was directly related to levels of human rights violations, i.e. more aid flowed to regimes with higher levels of violation, while under President Carter no clear statistical pattern emerged.” They therefore conclude that “the Carter administration did not implement a policy of human rights which actually guided the disposition of military and economic assistance.” In other words, the US attitude towards human rights seems to vary from outright hostility (under more conservative administrations) to mere indifference (under more liberal ones).

More recent studies have painted a similarly bleak picture. A 2008 book by Rhonda Callaway and Elizabeth Matthews found that “both United States economic and military aid have detrimental effects on security rights of the citizens in recipient states.” They note that these results “provide support for those critical of the US foreign assistance program.” The most recent research has continued to back up these conclusions. A 2016 study in the Quarterly Journal of Political Science sampled 150 countries from 1972 to 2008, finding that “US aid harms political rights, fosters other forms of state repression (measured along multiple dimensions), and strengthens authoritarian governance. [...] These findings counter the publicly stated objectives of the US government to foster political liberalization abroad via bilateral economic assistance.”

All-in-all, it seems that aid from the United States has a deleterious impact on the human rights situation in recipient nations. It provides military and economic aid to repressive regimes, arming and propping up some of the most vicious dictators on the planet, all in service of its own interests.

The War on Terror

Lest we think that the harm of US foreign policy stops at providing aid to dictators, the United States has also carried out a great deal of violence all on its own. To demonstrate the enormous death toll of US military intervention and invasion, let's take a look at the post-9/11 "War on Terror," including the invasions of Iraq and Afghanistan (among others).

According to a 2019 report from Brown University's Costs of War project, "between 770,000 and 801,000 people have died" in what the report refers to as "America's post-9/11 wars." This tally does not include so-called "indirect deaths," such as those resulting from displacement and the destruction of crucial infrastructure (e.g. water and sanitation systems). In a 2019 article for the Hill, David Vine (Professor of Anthropology at American University) writes that "total deaths during the post-2001 U.S. wars in Afghanistan, Iraq, Syria, Pakistan and Yemen [are] likely to reach 3.1 million or more — around 200 times the number of U.S. dead." Others have come to similar conclusions. According to a 2018 report from the Intercept:

In addition to those killed by direct acts [of] violence, the number of indirect deaths — those resulting from disease, displacement, and the loss of critical infrastructure — is believed to be several times higher, running into the millions.

These death tolls are backed up by earlier research. A 2009 article from the MIT Center for International Studies, which looked only at Iraq, found that "we have, at present, between 800,000 and 1.3 million 'excess deaths' in this war as we approach its six-year anniversary." Keep in mind that this is only one of the invaded countries, and that this article was authored in 2009 (more than a decade ago). The current death tolls, when factoring in all nations (as well as the decade of subsequent warfare), are likely many times higher.

The United States government has engaged in a concerted effort to hide the civilian cost of its Middle Eastern wars. According to a 2017 report from the New York Times, the actual rate of civilian causalities inflicted by coalition forces in the Middle East is "more than 31 times that acknowledged by the coalition. It is at such a distance from official claims that, in terms of civilian deaths, this may be the least transparent war in recent American history."

In point of fact, US forces often kill more people than the terrorists they are supposedly there to fight; a 2019 article in the New York Times reports that "more civilians are being killed by Afghan government and American forces than by the Taliban and other insurgents, according to a [United Nations] report on Wednesday." This is not even mentioning the US drone program, which was detailed in a 2013 report from the Intercept. To make matters worse, civilian casualties from US wars have been increasing dramatically since Donald Trump took office, according to a 2018 article from the Washington Post.

While it must be noted that the United States did not personally kill all of the millions of people mentioned above, it still bears a heavy burden for these deaths, having initiated the invasions, and started the entire conflict. In the same way that we hold Hitler responsible for the deaths of WWII (since he was the one who started it), so too should we hold the United States responsible for the deaths listed above. For more information on the civilian cost of US intervention, I recommend The Deaths of Others: The Fate of Civilians in America's Wars, a study authored by John Tirman, director of the MIT Center for International Studies.

Coups and Regime Change

The United States has a long history of overthrowing governments it doesn't like, typically then replacing them with brutal dictatorships. There are many, many examples of this, ranging from Jacobo Arbenz in Guatemala, to Mohammad Mosaddegh in Iran (a coup for which the CIA actually admitted responsibility in 2013).

Chile

In 1973 the United States helped to overthrow the elected socialist government of Salvador Allende in Chile, replacing it with the right-wing dictatorship of Augusto Pinochet. Peter Kornbluh, the director of the National Security Archive's Chile Documentation Project, said the following of Chile:

“To see on a piece of paper, for example, the president of the United States ordering the C.I.A. to preemptively overthrow a democratically elected president in Chile is stunning,” Mr. Kornbluh said. “The importance of having these documents in the museum is for the new generations of Chileans to actually see them.”

As if this were not enough, in a 2014 interview with the Atlantic, Jack Devine (a former CIA agent who was in Chile at the time of the coup) confirmed that the Nixon administration was directly instructing the CIA to support the coup. According to declassified documents, Nixon had previously ordered Henry Kissinger to "make the economy scream," in an effort to rally support for the right-wing forces. The United States also attempted to prevent Allende from being inaugurated after his election, and provided support for state-terrorist campaigns after the coup. Now that the US role has been established, let's look at what Pinochet did once in power.

To begin with, Pinochet killed, tortured, and "disappeared" tens of thousands of people. According to a 2011 article from the BBC, the "total of recognized victims" numbers over 40,000, including more than 3,000 who were killed or forcibly disappeared. The rest were kidnapped, tortured, exiled, or some combination of the above. Pinochet was one of the most vicious dictators in the history of Latin America, and the United States played a direct role in propping up his regime.

In addition, Pinochet introduced hard-line neoliberal reforms, which did immense damage to Chile's economy. A good study on this was published in 1990 in the journal Critical Sociology. The authors note that growth rates under Pinochet were remarkably unimpressive:

The Pinochet model produced growth rates well below the Chilean average established over the 1950-72 period. The average yearly GDP rate of growth in the latter period was 3.9 percent, while the Pinochet regime averaged 1.4 percent over the 1974-83 period... overall growth throughout the 1980s has been far from miraculous: GDP per capita grew at a 1.2 percent average rate between 1980 and 1989, below the 1.7 percent average yearly rate for 1950-72.

In addition, the authors charge Pinochet with "creating a great deal of poverty," noting that unemployment "rose dramatically after the coup," while real wages fell. At the same time, social expenditures were reduced, and "infectious diseases readily associated with poverty, overcrowding poor hygiene, and inadequate sanitation underwent explosive growth." This assessment is echoed by a study in the International Development Planning Review, which found that "the radical neoliberal policies and structural adjustment of the 1970s and 1980s during the Pinochet regime had severe negative effects on the poor and middle class." The poverty rate itself increased dramatically; according to a report from the North American Congress on Latin America:

The number of poor Chileans doubled during the Pinochet regime. By 1989, 44% of Chileans lived in poverty.

In addition, it seems that Pinochet's privatizations also helped to create enormous corruption. According to a study in the Journal of Economic History, "firms were sold underpriced to politically connected buyers." This had predictable consequences:

These newly private firms benefited financially from the Pinochet regime. Once democracy arrived, they formed connections with the new government, financed political campaigns, and were more likely to appear in the Panama Papers. These findings reveal how dictatorships can influence young democracies using privatization reforms.

Sources

• U.S. Department of State | About Page
• Comparative Politics | U. S. Foreign Policy and Human Rights Violations in Latin America: A Comparative Analysis of Foreign Aid Distributions
• Journal of Peace Research | Human Rights and U.S. Foreign Assistance from Nixon to Carter
• Routledge | Strategic US Foreign Assistance: The Battle Between Human Rights and National Security
• Quarterly Journal of Political Science | Does Foreign Aid Harm Political Rights? Evidence from U.S. Aid
• Brown University | The Cost of the Global War on Terror: $6.4 Trillion and 801,000 Lives
• The Intercept | It's Time for America to Reckon With the Staggering Death Toll of the Post-9/11 Wars
• MIT Center for International Studies | Bush's War Dead: One Million
• The New York Times | The Uncounted
• The Washington Post | Middle East Civilian Deaths Have Soared Under Trump. And the Media Mostly Shrug.
• MIT Center for International Studies | The Deaths of Others: The Fate of Civilians in America's Wars
• CNN | In Declassified Document, CIA Acknowledges Role in '53 Iran Coup
• The Atlantic | The Other 9/11: A CIA Agent Remembers Chile's Coup
• National Security Archive | Chile and the United States: Declassified Documents Relating to the Military Coup, September 11, 1973
• The New Statesman | How Thatcher Gave Pol Pot a Hand

Domestic Policy

Poverty

According to a study from the Brookings Institute:

53 million Americans between the ages of 18 to 64—accounting for 44% of all workers—qualify as “low-wage.” Their median hourly wages are $10.22, and median annual earnings are about $18,000.

Almost half of the American workforce is officially "low-wage," and that's only if we use an extremely low standard (below minimum wage, in some states). This is especially horrifying when we remember how many deaths can be directly linked to poverty and deprivation in the United States. According to a study from Columbia University:

Overall, 4.5% of U.S. deaths were found to be attributable to poverty... the number of deaths the researchers calculated as attributable to low education (245,000) is comparable to the number caused by heart attacks (192,898), which was the leading cause of U.S. deaths in 2000. The number of deaths attributable to racial segregation (176,000) is comparable to the number from cerebrovascular disease (167,661), the third leading cause of death in 2000, and the number attributable to low social support (162,000) compares to deaths from lung cancer (155,521).

The United States also ranks at the very bottom of the developed world in terms of preventable deaths. According to an article in Reuters:

If the U.S. health care system performed as well as those of [comparable nations], there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.

Hundreds of thousands of people are dying every year because of poverty, deprivation, and lack of access to social services. Capitalism is a fundamentally broken system, which must be abolished.

Healthcare

The American healthcare system is among the most dysfunctional institutions imaginable, with the highest costs in the world, and some of the worst outcomes of any advanced country. That being said, there are still those who deny the necessity of completely overhauling the system, and as such, it is useful to take some time and go over the essential facts of the matter. As always, all sources will be listed at the end.

Health Outcomes

The USA ranks near the bottom of the developed world in most essential health outcomes. A 2020 paper from the American College of Physicians (published in the Annals of Internal Medicine) reports that "despite higher spending, the United States generally has less favorable outcomes than other countries." Let's take infant mortality, for example. According to a 2016 study from the American Economic Association:

The United States has higher infant mortality than peer countries... The US disadvantage persists after adjusting for potential differential reporting of births near the threshold of viability.

The ACP paper confirms that America's poor infant mortality ranking persists "even after adjustment for reporting differences." According to the AEA, this subpar performance "is driven by poor birth outcomes among lower socioeconomic status individuals." As if this wasn't bad enough, maternal mortality is also shockingly high in the USA. According to an article from NPR (reporting on data from the CDC):

More American women are dying of pregnancy-related complications than any other developed country. Only in the U.S. has the rate of women who die been rising.

To make matters worse, there is evidence that the official statistics actually leave out a great number of deaths, meaning that the actual rate is probably much higher. According to an article from ProPublica, "the new rate, while capturing just how poorly the U.S. ranks among other countries, is actually a significant underestimate of the problem." This only makes the issue even more horrifying. In addition, healthcare-amenable mortality is generally higher in the United States than in peer countries. According to the American College of Physicians:

The United States has a higher mortality rate for medical conditions for which there are recognized health care interventions than Germany, the Netherlands, Japan, France, and Australia.

A 2017 study in the Lancet looked at global amendable mortality, finding that the United States ranked 35th in the world in overall performance. In a press release following the publication of the paper, Dr. Christopher Murray (the study's lead author) said the following:

What we have found about health care access and quality is disturbing. Having a strong economy does not guarantee good health care. Having great medical technology doesn’t either. We know this because people are not getting the care that should be expected for diseases with established treatment. [...] America’s ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country. Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short.

While many people acclaim the US health system for its advanced technology, it is clear that this does no good if people cannot actually access the care they need. All-in-all, it clear that outcomes in the American healthcare system are extremely subpar, especially when one takes into account the ludicrously high cost. On that note, let's discuss cost and expenditures.

Cost and Expenditures

The United States spends more per-capita on healthcare than any other country on Earth. According to the aforementioned study from the American College of Physicians:

The United States spends far more per capita on health care than other wealthy countries, and spending is increasing at an unsustainable rate. [...] The pricing of health care goods and services is substantially higher in the United States than in other developed nations. A 2003 analysis of OECD data showed that health care utilization in the United States did not exceed that of other countries, and price was the key driver of spending differences.

Much of this excessive cost is due to the enormous inefficiency and bureaucracy of the American system. There is a massive amount of administrative spending in the US, which is due primarily to the fragmented multi-payer nature of the healthcare system. According to the ACP:

In large part owing to its pluralistic financing system, the United States spends more on administration of health care than peer countries. One study estimated that in 2012, the United States spent $471 billion on billing and insurance-related costs—$375 billion (80%) more than in a “simplified financing system,” such as Canada's single-payer model. Another study concluded that administrative costs were 31% of total U.S. health care expenditures, nearly double those of Canada.

These findings are validated by a study in the Journal of the American Medical Association, which said the following:

The fragmented financing system is one of the principal explanations for the high cost of medical care in the United States. A careful consolidation of financing into some form of single-payer system is probably the only feasible solution.

Another study from the same journal says the following:

The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.

According to a 2020 study in the Lancet (conducted at Yale Medical School), a single-payer system would save an enormous amount of money and (more importantly) lives:

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). [...] Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1.73 million life-years every year compared with the status quo.

Claims that a single-payer system would be unaffordable are entirely baseless, and contradicted by the overwhelming mass of evidence. A 2020 meta-analysis in PLOS Medicine found "a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US." As they put it:

There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents. To achieve net savings, single-payer plans rely on simplified billing and negotiated drug price reductions, as well as global budgets to control spending growth over time. Replacing private insurers with a public system is expected to achieve lower net healthcare costs.

Access to Care and Lack of Insurance

To make matters worse, a large chunk of the American population is uninsured, and many are forced to go without the care that they need. According to the ACP:

The United States is the only wealthy industrialized nation without universal health coverage, a crucial component to ensuring quality health care for all without financial burden that causes delay or avoidance of necessary medical care... nearly 30 million remain uninsured, millions more are underinsured, and the number of uninsured persons is expected to grow.

The high rate of uninsured people is extremely troubling, especially seeing as a lack of insurance is associated with increased risk of mortality. A 2009 study in the American Journal of Public Health said the following on the matter:

Uninsurance is associated with mortality. [...] Lack of health insurance is associated with as many as 44 789 deaths per year in the United States, more than those caused by kidney disease.

A 2017 study in the Annals of Internal Medicine validated these findings, saying:

The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

The high costs of US medical care cause a great deal of financial strain for patients. According to a 2019 study in the Journal of General Internal Medicine (carried out by the American Cancer Society), "medical financial hardship is common among adults in the USA, with nearly 140 million adults reporting hardship in the past year. Among those aged 18–64 years, more than half report problems with medical bills or medical debt; stress or worry; or forgoing or delaying health care due to cost." A 2019 Gallup poll found that 25% of Americans say that they or a family member have put off treatment for a "serious illness" in the past year because of cost, with a further 8% saying they or a family member has put off treatment for a "less serious illness" in the past year.

Overall, there is strong evidence that the United States' lack of universal healthcare causes tens of thousands of deaths every year, and financial ruin for many more.

Sources

• Annals of Internal Medicine | Envisioning a Better U.S. Health Care System for All
• American Economic Association | Why is Infant Mortality Higher in the United States Than in Europe?
• Physicians for a National Health Program | America's Ranking on Amenable Mortality is an Embarrassment
• Journal of the American Medical Association | Is Single Payer the Answer for the US Health Care System?
• American Journal of Public Health | Health Insurance and Mortality in US Adults
• Journal of General Internal Medicine | Prevalence and Correlates of Medical Financial Hardship in the USA

References

Bibliography

Print Sources

• Isenberg, Nancy (2016). White Trash: The 400-Year Untold History of Class in America. Viking. ISBN 9780670785971.
• Sakai, J. (2014). Settlers: The Mythology of the White Proletariat from Mayflower to Modern. Kersplebedeb and PM Press. ISBN 9781629630373.
• Immerwahr, Daniel (2019). How To Hide An Empire: A History of the Greater United States. Farrar, Straus and Giroux. ISBN 9780374172145.