Mirah’s Reflection: What Would Make the USA the Greatest Nation?

Mirah Riben, author and activist
12 min readFeb 27, 2021

In the opening minutes of the 2012 HBO series “The Newsroom,” Jeff Daniels plays a moderate republican who is anchor and managing editor of “News Night.” On a panel, he is asked “What makes America the Greatest Country in the World.” He starts with a politically correct response about freedom, and then, to th e shock of the audience, he says: “It’s not.” It is not, he says, the greatest country in the world and he gives some reasons.

Was this fictional news anchor correct? Are his claims and statistics still true today? How does the US compare? The United States of America is the world’s most dominant economic and military power. But is it the greatest?

Here are some areas we could look at for improvement if we are truly to be the greatest nation.


Let’s look at the first thing mentioned in the fictional news show as a “given” in terms of what would make America the greatest nation: Freedom.

The Human Freedom Index, which spotlights 162 countries, measures personal freedom — which includes freedom of movement, speech, assembly and religion — alongside economic freedom, the ability of individuals to make their own economic decisions without government or crony interference. New Zealand tops this year’s freedom index followed by Switzerland, Hong Kong, Denmark and Australia. The five least-free countries are (in descending order) Iran, Yemen, Venezuela, Sudan and Syria. Rankings for other significant countries include Canada (6th), Germany (9th), the United Kingdom and the United States (tied for 17th).

According to US News and World Report metrics, in partnership with the BAV Group and The Wharton School of the University of Pennsylvania, Switzerland again topped a list ranking the best countries in the world. The United States, ranked eighth last year, moved up to the №7 spot in 2020.

And some rank the U.S. second worst. A 2020 research study by the travel site Asher & Lyric revealed that the US has been named the second-worst wealthy nation to raise a family. Out of more than 35 countries, America was ranked 34 in comparison with the world’s biggest economies, scoring three F grades for safety, cost of living, and work-life balance. In terms of health, America received a D- and a C+ for happiness and education. Overall, it was given an F grade for raising a family, with only Mexico ranking worse.


U.S. student debt has increased by more than 100% over the past 10 years. In 2020 the year the United States surpassed owing a total of more than $1.7 trillion in student debt. 69% of the class of 2019 took out student loans, and graduated with an average debt of $29,900. Additionally, 14% of their parents took out an average of $37,200 in federal parent PLUS loans.

While American students are saddled with a lifetime of debt to obtain a higher education, the following countries offer free college education to residents.


Unlike most other developed countries, the United States does not have a universal healthcare program. Health insurance for Americans is provided through a combination of private health insurance, obtained through employment or purchased, and public health coverage, Medicaid for those who quality by age (Medicare) or financial need (Medicare). Those whose coverage is through employment risk loss of health insurance when they lose or change jobs.

The Commonwealth Fund is a private foundation founded in 1918 “to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color.” It’s 2020 survey found that 43.4 percent of U.S. adults ages 19 to 64 were inadequately insured, unchanged from 2018. More than two of five working-age adults are inadequately insured creating problems paying medical bills and lingering financial problems including damage to their credit ratings and depleted savings.

In an effort to avoid such financial medical bills many Americans do not get the health care they and their families need. Compared to people in other countries, Americans with below-average incomes were less likely to visit a doctor if they were sick, get a recommended test, treatment, or follow-up, fill out a prescription, or see a dentist.

America has some high cost technologies, such as MRIs, and performs specialized procedures such as hip replacements, more often than our peers and outperforms its peers in terms of preventive measures, having one of the highest rates of breast cancer screening among women ages 50 to 69 and the second-highest rate (after the U.K.) of flu vaccinations among people age 65 and older.

However, as a nation, we spend more on health care as a share of the economy — nearly twice as much as the average OECD country — yet has the lowest life expectancy and highest suicide rates among the 11 nations.

Despite this high spending, the U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average. And, the U.S. infant mortality rate (5.8 deaths under one year of age per 1,000 live births) is 71 percent higher than the comparable country average (3.4 deaths) and the highest maternal mortality rate among developed countries.


U.S. prices for the world’s 20 top-selling medicines are, on average, three times higher than in Britain, according to an analysis carried out for Reuters.

“Researchers from Britain’s University of Liverpool also found U.S. prices were consistently higher than in other European markets. Elsewhere, U.S. prices were six times higher than in Brazil and 16 times higher than the average in the lowest-price country, which was usually India.

“The United States, which leaves pricing to market competition, has higher drug prices than other countries where governments directly or indirectly control medicine costs.

“That makes it by far the most profitable market for pharmaceutical companies, leading to complaints that Americans are effectively subsidizing health systems elsewhere.”

Consumer drug advertising is uncommon globally. The United States and New Zealand are the only two countries in the world where direct-to-consumer (DTC) advertising of prescription drugs is legal. In 2015 the American Medical Association called for a ban on advertising prescription drugs and medical devices directly to consumers, saying the ads drive patients to demand expensive treatments over less costly ones that are also effective. In 2018, the pharmaceutical industry spent 3.79 billion U.S. dollars on advertising on national TV in the United States. Humira, Xeljanz and Eliquis were the top three most advertised drugs on U.S. TV in 2019 based on ad spend. Just considering television, 187 commercials for about 70 prescription medications have collectively aired almost half a million times since the start of 2018.

In 2018, the average insulin prices in the US were $98.70, compared to $6.94 in Australia, $12.00 in Canada, and $7.52 in the UK. October 12, 2020 — Insulin prices are more than eight times higher in the US than in 32 comparable, high-income nations combined, according to a RAND Corporation study.

And let us not forget the pricing scandal in regard to EpiPen, the life-saving treatment for anaphylactic allergy reactions, prescribed to some 3.6 million Americans annually. In 2009, the wholesale price (the price which pharmacies paid) was $103.50 for a two-pack of autoinjectors made by Mylan. By July 2013 the price was up to $264.50, and it rose a further 75 percent to $461 by May of 2015. By May of 2016, the price rose again up to $608.61. Over a seven year period, the price of EpiPen had risen about 500% in total. Because of lack of government control, the list price of a two-pack of EpiPen is about $69 in the UK, about $100 in France, and about $200 in Germany. These prices are dramatically lower than the $609 list price of EpiPen in the US. Mylan finalized a $465-million settlement with the U.S. Justice Department to resolve claims it overcharged Medicare.


The US has a significantly different stance when it comes to employment benefits such as sick leave and parental leave, compared to that of many other countries. The Center for Economic and Policy Research (CEPR) finds that the United States is the only 1 of 22 rich countries that fails to guarantee workers some form of paid sick leave in the report, Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries.

We are at the bottom of the pyramid.

The report finds that the United States is:

  • The only country that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment
  • 1 of only 3 countries that does not provide paid sick days for a worker missing 5 days of work due to the flu

Companies that are subject to the Family and Medical Leave Act (FMLA) must provide unpaid leave. This Act also dictates that relevant employees are entitled to parental leave. Only certain employees and employers are covered by this act.

There are no US federal law requirements pertaining to paid sick leave,


Most countries recognize surrogacy as exploitive of women, in particular women in financial hardship, and also as baby-selling or human trafficking. It is, thus almost universally illegal.

The US is one of only nine countries that legalizes surrogate pre-birth contracts. It was the first country in the world to recognize parentage created by payment and contract. Since 1985, the United States has become the preferred surrogacy destination for international parents such as British citizens Elton John and David Furnish as well as others from Australia, Canada, Spain, and Germany.


As of February 2021, 196 countries are party to the United Nations Convention of the Rights of the Child, the most rapidly and widely ratified human rights treaty in history, including every member of the UN, except the United States. The U.S. signed it but has not ratified or become party to it. We are now the only nation not to.


WHO found 10 countries have nearly half the global population of people with a substance use disorder. Of the ten, the US has the highest rate:

  • United States: 5.89%
  • Greenland: 5.63%
  • Mongolia: 5.24%
  • United Kingdom: 5.22%
  • New Zealand: 4.91%
  • Kazakhstan: 4.66%
  • Poland: 4.51%
  • Russia: 4.44%
  • Brazil: 4.33%
  • Denmark: 4.26%

Misuse of prescription pain killers was the second most prevalent form of illicit drug use in the U.S. The CDC has described opioid misuse in the United States as an “epidemic.” Of drug-related deaths in the U.S. in 2018, nearly 70% involved the use of opioids.

Drug overdose deaths in the United States have more than tripled over the past 20 years, resulting in American overdose deaths becoming almost four times higher than in 17 other wealthy nations in 2017 with more than 70,000 Americans dying from drug overdoses, according to the National Safety Council. More Americans are likely to die from an opioid overdose than a car crash.


As of June 2020, the United States had the highest number of incarcerated individuals worldwide, with more than 2.12 million people in prison. The U.S. was followed by China, Brazil, the Russian Federation, and India. Roughly 2.12 million people were incarcerated in the United States in 2020. China’s estimated prison population totaled to 1.71 million people that year.

Comparing prison populations per 100,000 inhabitants, as of June 2020 per Statista Research Department,the United States had the highest prisoner rate, with 655 prisoners per 100,000 of the national population. El Salvador, Turkmenistan, Thailand, and Palau rounded out the top five countries with the highest rate of incarceration.

Countries with the largest number of prisoners per 100,000 of the national population, as of June 2020:

The United States has the world’s largest private, for-profit, prison population. Of the 1.5 million people in state and federal prisons in 2016, 8.5 percent, or 128,063, were incarcerated in private prisons. Another 26,249 people -73 percent of all people in immigration detention- were confined in privately-run facilities on a daily basis during fiscal year 2017.

From 2000 to 2016 the number of people housed in private prisons increased five times faster than the total prison population. Over a similar timeframe, the proportion of people detained in private immigration facilities increased by 442 percent.

Racial disparities in policing and arrests per Prison Policy Initiative


The United States of America is the best/easiest place in the world to own guns. Period.

It’s estimated that American own 393 million firearms, and that 35% — 42% of the households in the country have at least one gun. The U.S. has the highest estimated number of guns per capita, at 120.5 guns for every 100 people. This means there are more guns than there are people.

The U.S. the only place you can get a gun at places like Walmart. Only 13 states require a background check. Guns can be advertised online and they cost as little as $100, making it the cheapest place to buy guns in the world. AR-15s can cost less than an Iphone. Iowa’s legislative bodies has passed a bill to allow children to handle handguns.

America has the 28th-highest rate of deaths from gun violence in the world. The rate of firearm deaths per 100,000 people is 4.43 deaths per 100,000 people in 2017 — far greater than what is seen in other wealthy countries. Compared to 22 other high-income nations, the U.S. gun-related homicide rate is 25 times higher.


US homicide rates were 7.0 times higher than in other high-income countries, driven by a gun homicide rate that was 25.2 times higher. For 15- to 24-year-olds, the gun homicide rate in the United States was 49.0 times higher. Firearm-related suicide rates were 8.0 times higher in the United States, but the overall suicide rates were average. Unintentional firearm deaths were 6.2 times higher in the United States. The overall firearm death rate in the United States from all causes was 10.0 times higher. Ninety percent of women, 91% of children aged 0 to 14 years, 92% of youth aged 15 to 24 years, and 82% of all people killed by firearms were from the United States.

See: America’s gun problem, explained

The countries with the highest murder rates per 100,000 people are El Salvador (82.84), Honduras (56.52), and Venezuela(56.33). The United States ranks fourth with (49.26 per 100k people), 2021.

Another title held by the USA is that of not only raising an estimated 2,000 serial killers, but according to recent research at Radford University, there are more serial killers here than anywhere else in the world.


The United States lead the globe in military spending in 2019. China ranked second in spending, as it has done since 2008. With military disbursals totaling 732 billion US dollars, the US spent about 38 percent of the total global military spending that year, 1.92 trillion US dollars. In 2019, United States military expenditure amounted to 3.4 percent of US gross domestic product (GDP), placing the U.S. lower in national military expenditure as a percentage of GDP to Russia, which spent 3.9 percent of its GDP, and Saudi Arabia, which spent 8.0 percent of its GDP.

The 15 countries with the highest military spending worldwide in 2019

For more on our military budges, such as comparison shares of GDP, see OurWorldinData.


These well-documented statistics raise many questions. Does our military spending keep us safer than nations swho spend a lot less? Does gun ownership keep us safer from being a victim of homicide, suicide or accidental shooting?

Should healthcare be a right or a privilege? Should more control be put on capitalism in regard to healthcare and prescription drugs?

Are we the greatest country in the world? Clearly not. And clearly there are many other isues such as racism.

But the real questions is: Can we be better in the areas described herein?

We can and we must.