Is the US a failed state? Healthcare points to yes.

For the first time in US history, life expectancy is decreasing instead of increasing. The trend started in 2020 during COVID and has continued to plummet. Data also shows that people of color experienced more of a drop in their life expectancy. The pandemic laid bare many of America’s failings. It exposed the pipes in the walls of our swank, affluent home—rotten, rusted, leaking, uninhabitable.

I wonder if it’s too far gone to be fixed. My hope is that no, it’s not. Yet, when you look at the data without your heart in it, it shows how close we are to the edge of a failed state, in all respects, not just healthcare. But especially healthcare.

We see protests in France, streets lit aflame, the stench of trash littering the opulent Parisian sidewalks, café goers sipping frothy cappuccinos next to a blazing fire.

A classic bourgeoise proletariat slug-out.

Detachment. Dissociation. Apathy. But also, fighting, striving, voicing, demanding. The signs of a nation with at least a pulse.

“Don’t do to me what you did to America,” Sufjan Stevens’ repeats in his song “America” from his 2020 album The Ascension. Don’t do to me what you did to America. It keeps ringing in my mind. It’s the personal desperation of what our once promising capitalist structure, perhaps always a guise, of greed and exploitation did to us, turned us into.

The most vocal we’ve seen our populace is the recent Tennessee gun control protests after the mass shooting at a school in Nashville, killing six. Mostly young Americans filled their state House holding signs of “End Gun Violence,” and “Protect students, not guns.” Footage showed chanting and anger, a lot of anger—where a few days later two of the state representatives were then expelled for participating in it. For the first time, guns are the leading cause of death in children in the US.

We are dying by guns or by deteriorating health. Not quite the signs of a healthy nation.

Other developed, wealthy nations, like France, are not seeing their populace lose years of their lives—after a pandemic dip, it went back to increasing. The country that spends the most on healthcare and its citizens carry the most debt, has not experienced the same bounce back.

It’s got me thinking, is America a failed state when it comes to healthcare?

How long it will take America to become like France? There are differences, sure. Americans seem to accept the status quo of corporate and capitalist gouging of our lives in ways the French do not. The French know how to utilize the act of protest like no other country. Their latest demonstrations have turned into Bastille Day optics, all spawned from the government’s new law to raise the retirement age from 62 to 64.

I would argue that America is not a failed state, but it is rapidly approaching that precipice. However, when it comes to American health and healthcare, the US has become a failed state.

The definition of a failed state is specific. It deals with ability to govern affectively and legitimately. A failed state is a state of near-anarchy, where “political power,” “law enforcement” and “civil society” has broken down. As dysfunctional and gridlocked our legislative branch is, there is still a legitimate body to govern and it is able to implement and pass laws. As unjust as our justice and police system is when it comes to black and brown people versus white and wealthy, it still functions, albeit tilted and violently. As our civil society has fractured, separating into two camps, and we scurry to our echo chambers far away from each other, we are still one nation… for now.

Americans have accepted that our state of healthcare is just how it is. The structures, both government and corporate, are too massive to take on. Even as 2020 Democratic primary candidates like far-left Bernie Sanders and Elizabeth Warren called for Universal Healthcare, while a center-left candidate like Pete Buttigieg called for a public option, the structures held. The structures doubled down.

In infant mortality, the death of a baby in the first year of life, and what some health policy experts use as an indicator of a populace’s health, the US does not have a shining review.

“The U.S. and comparable countries have seen a decrease in infant mortality rates in recent years,” an analysis from the Peterson-KFF Healthcare tracker reporter, “but the U.S. has been slower to improve its consistently higher average rate of infant deaths, and significant disparities exist within the U.S.”

The deeper south you go, the higher the infant death rate becomes. Mississippi and Arkansas are the highest. The surrounding states like Alabama and Louisiana come in second. These states also invest the least in healthcare, education and social safety nets. As they are “red” and conservative-leaning and, as conservative political ideology dictates, government funding is sparse.

All of this while reproductive rights are slashed, forced births are taking place, doctors are being criminalized for performing abortions, and we’ve reached a renewed war on a woman’s right to choose.

And then we have the virus. COVID-19 was the third leading cause of death in the US in 2022. Yet, “normal life” has resumed, masking mandates are ending and President Biden is disbanding his COVID Task Force in a month, allowing the public health emergency status to end with it.

Yet, tens of millions of Americans are dealing with Long Covid . I recently reported for CNN Business that Americans who have become disabled from COVID, are unable to work and unable to access tax-payer funded disability aid through the Social Security Administration. For Long Covid, there is no FDA approved treatment. It is affecting our labor force. Recent data from the Brookings Institute estimates 4 million are out of work due to it. Yet, crickets from our government and healthcare officials on how they plan to address the crisis.

The most I’ve gotten recently as a COVID long-hauler myself, was at an ER visit. The very patient, attentive doctor reassured me “Long Covid is real and it’s debilitating.” No treatment offered, just palliative care to “keep me comfortable.” And yet, I was happy about his validation—the bar is so low from the gaslighting and the denial of this illness that starting from a point of the opposition, confirming I wasn’t crazy and that yes, indeed I have a real illness was the best he could give. I thought, thank you, thank you, thank you and then, no shit, so what are we gonna do about it.

And what will I get for this confirmation of my illness? A $2000 hospital bill.

Americans are drowning in medical debt. They were before COVID, they are even more now. And there is no government plan—thus far—to cancel it.

According to 2020 KFF data, despite 90 percent of Americans having health insurance (mostly tied to their employment), 23 million owe “significant medical debt,” with 3 million owing more than $10,000. Another disturbing finding? The majority cannot afford their family’s deductible—often $6000 before coverage goes into effect.

“Households do not have enough money available to cover the cost of a typical deductible in a private health plan,” KFF stated. “For example, about a third (32%) of single-person households with private insurance in 2019 could not pay a $2,000 bill, and half (51%) could not pay a $6,000 bill.”

Another way America reaches failed state status when it comes to healthcare? In addition to Americans living shorter lives, we spend double on healthcare per capita compared to peer countries.

Out of pocket spending, meaning spending often for the uninsured, has increased 10.4% from 2020 to 2021. This means Americans spent a staggering $433 billion from their own pocket on healthcare.

And yet.

Are we any healthier for it? No, not even by a longshot.

All of this spending, if you’re able to. If you can’t afford to go into debt to take care of your health? If you or your family’s basic needs like housing, which continues to rise 5.5 percent in 2023, or food, which has increased due to inflation by 10.2%, comes before healthcare, you do not have access to it in America. Wages? Those have not increased since 2009. A paltry $7.25 an hour.

So Americans are forced to choose: go without care and stay sick, or spend, spend, spend.

A country where the wealthy stay housed, fed and healthy, and the poor ruin their credit trying to stay housed fed and healthy. Or they are simply locked out, staying away from the expense of healthcare altogether. They become and stay sick, eventually unemployable, an then die.

This is the bleakness that failed states like Somalia and Syria carry. America, for all its pageantry is not a functioning state. When it comes to health, it is a failed state.