To US eyes, putting up with low cancer survival rates is the real madness
We live in a small world. There are two degrees of separation between you and someone who attended the concert in Las Vegas last Sunday at which Stephen Paddock killed 58 people. That is because you are reading my column and my son’s nanny was there with a group of her friends. (Luckily, she left before the shooting began, and none of her friends was hit. Spattered with the blood of others, but physically unscathed.)
One of many pathologies of a small world is groupthink. I arrived in London shortly after the Las Vegas massacre. I encountered unanimity, right across the political spectrum. Americans are crazy, I was repeatedly told. How can you live in a country where such things are possible?
Now it is true that Americans have a gun problem, but it is not quite the problem most Britons imagine. As The Times pointed out last week, more Americans have died from guns in their own country since 1968 than have perished in combat in all the nation’s wars (including the Civil War). On average between 2011 and 2014, guns were linked to 34,000 deaths a year in the United States.
But such figures are deceptive. More than half those 34,000 deaths were the results of suicide, not homicide. All last week the media published exaggerated statistics on mass shootings (“477 days. 521 mass shootings”— The New York Times). Defining a mass shooting as a single attack in a public place in which four or more victims were indiscriminately killed, I count 91 mass shootings across the country since 1982, in which 760 people have died.
That is still an unacceptable death toll, to be sure. Also troubling is the trend in the direction of more frequent massacres and larger death tolls. Yet we need to be clear about the nature of the problem. It is not, as many Britons seem to imagine, that America is full of gun-toting trigger-happy maniacs.
The country is No 1 in the world for firearms per capita, with 88.8 guns per 100 people. But three-quarters of Americans don’t own a gun. Just 3% own half the guns. Paddock possessed 42 firearms, 23 of which he took to Las Vegas. He was one of a very small proportion of the American population that takes advantage of flaws in US law to amass large numbers of guns.
This state of affairs is not what the authors of the second amendment had in mind when it was adopted in 1791. Read it for yourself: “A well regulated Militia being necessary to the security of a free State, the right of the people to keep and bear Arms shall not be infringed.” In United States v Miller (1939), the Supreme Court ruled that the second amendment did not protect weapons that did not have a “reasonable relationship to the preservation or efficiency of a well regulated militia”. That is plainly the correct reading of the text.
Yet in District of Columbia v Heller (2008) the Supreme Court held that the amendment protects an individual right to possess and carry firearms. This was surely wrong. The second amendment was intended only to ensure an adequately armed citizen militia for reasons of national defence. It was not designed so that an individual citizen could accumulate a vast private arsenal. No doubt most of the people who accumulate assault rifles are like stamp collectors: they just like to look at them. But if just one gun collector a year goes on a killing spree, the law is an ass.
The practical case for tighter gun controls is also clear. First, there is a precedent for a federal ban on assault weapons: the 1994 law that was allowed to expire in 2004 and could have been revived in 2012 after the Sandy Hook primary school massacre. In many states there are no mandatory background checks for gun sales because of a loophole that exempts sales at gun fairs. Another indefensible loophole is that machineguns — automatic weapons — made before 1986 can legally be owned. Close to 200,000 of those are believed to be in circulation.
Will anything change in the wake of the Vegas massacre? At most, bump stocks, which effectively convert semi-automatic weapons into automatic ones, will be banned. Otherwise I expect little to change. Gun control has for years been a partisan issue, favoured by Democrats, opposed by Republicans. Not only do the latter control the White House and Congress, they also hold 34 governorships. The Democrats have undivided control of only six states, all of which already have restrictive gun laws.
Does this mean Americans are nuts? Let’s keep this in perspective. Of the 2,596,993 total deaths in the US in 2013, 1.3% were related to firearms. For some reason the people who say, “You are more likely to be killed in a road accident than by a terrorist,” never say: “You are more likely to be killed in a road accident than by a firearm.” In the US both statements are true.
Yes, we in Britain are far less likely to die from gunshot wounds than our American cousins. Generally speaking, according to World Health Organisation statistics for 2015, the American rate of mortality from interpersonal violence is four times higher than the British. Americans are also between two and three times more likely to die from drug abuse, poisoning or intentional injury. The American way of death is violent. This is another way of saying that the US is more like Latin America than western Europe. But you knew that from the movies, didn’t you?
In any case, we Britons have our own idiosyncrasies when it comes to death. In 2015 we were five times more likely than Americans to die of the lung cancer mesothelioma, nearly three times as likely to die of oesophageal cancer, twice as likely to die of stomach cancer and nearly twice as likely to die of prostate and bladder cancer.
These figures are in line with a variety of studies showing Britain is not the best place in the developed world to be diagnosed with cancer. Between 2000 and 2007, for example, the adult five-year survival rates for patients diagnosed with nine types of cancer were lower in the UK than the European average. Meanwhile, according to a 2012 study, cancer patients in the US “lived longer than in the EU, and these survival gains were not due to more aggressive screening of US patients”, but to the higher expenditure that characterises the American system. Yet the NHS is an institution so beloved by British voters that woe betide the politician who does not pledge to preserve it.
True, a growing number of Americans are persuaded by “single-payer” enthusiasts such as the Vermont socialist Bernie Sanders. In the late 1990s only 40% of Americans favoured a single-payer, government-run system like the NHS; today the figure has risen to 53%. But most Republican voters don’t want to know.
Maybe, as Hillary Clinton said, Republicans really are just a basket of deplorables who are nuts to prefer the National Rifle Association to the National Health Service. However, when I tell conservative Americans how British friends have been treated after a cancer diagnosis — one who had a breast tumour was told to take her usual summer holiday as there was a queue for treatment — here’s what they say: Brits are crazy. How can you live in a country where such things are possible?
We do indeed live in a small world. And yet we all — Americans and Britons alike — still struggle to see ourselves as others see us.
Niall Ferguson’s The Square and the Tower: Networks, Hierarchies and the Struggle for Global Power is published by Allen Lane