Yet progress on this front—and so many others essential to public health—has stalled. The United States once led the world in life expectancy and height. Americans now die younger and are significantly shorter than citizens in most of western and northern Europe. Despite historic progress, lead poisoning remains a scourge. As science continues to evolve, researchers have increasingly concluded that the 10 micrograms per deciliter threshold is too high and that, in fact, levels half that can cause very serious damage. Many cities continue to have elevated levels of lead in their water—in some, considerably higher levels than those in Flint. Evidence suggests that expenditures on lead abatement would provide benefits far in excess of costs: a dollar spent reducing the hazards of lead paint has been estimated to save at least $17 and perhaps much more in the long-run. Yet federal money for such efforts is drying up in the relentless downward push on domestic discretionary spending.
It is tempting to search for a single villain in the Flint crisis: the austerity measures of state Republicans and especially Governor Rick Snyder, the weakness of local protections, the missteps of the EPA. But the reality is that these threats to public health and social well-being are at work across the United States, and they have much deeper roots. Figuring out where responsiveness broke down, punishing those responsible, and fixing systems of accountability are all imperative. But that won’t solve the deeper problem—America’s retreat from an effective mixed economy.
Begin with the plummeting investment in the physical underpinnings of communities, the roads, bridges, water systems, and other public goods that make the places where people live and work safe, livable, and productive. American infrastructure once used to be the envy of the world and a major source of Americans’ improved living standards. But in an era of government-bashing, it has been allowed to crumble, risking health, safety, and economic success. A similar process has played out with federal investment in R&D, so vital to technological progress as well as economic growth, as well as in the kinds of basic health research that promoted lead-abatement, reductions in tobacco use, new drugs and treatments, and other measures that have made lives longer and healthier.
Meanwhile, federal health and safety rules have eroded. Regulations are ever more outdated, the agencies that enforce them ever more under-manned and cross-pressured by the blandishments of corporate lobbies, with their enticing revolving door. In retrospect, the dying gasp of America’s long, successful tradition of bipartisan problem-solving was the 1990 update of the Clean Air Act—legislation that has, since its inception in the 1970s, added an estimated one to two years to American life expectancy. Yet rather then recognizing these extraordinary achievements of a mixed economy, our conversations typically celebrate markets and denigrate government. Today, conservative politicians relentlessly attack government as a parasitical threat to liberty, while many on the left deride it as corrupt or fail to make a positive case for it at all.