But our system is also remarkable for the magnitude of the costs, the incidence of those costs across the economy, the number of uninsured, and our poor performance on health outcomes even compared with less wealthy economies. To cite just one example, infant mortality rates in the United States are more than two times the level in Japan. In a world in which economic performance depends increasingly on flexibility and adaptability to change, we probably need to move to a system in which a change in employer or profession does not carry the substantial uncertainty it does today about how one will provide for one’s health and that of one’s family. This seems fundamental to the willingness of Americans to support the level of openness to trade and to change that is an essential part of our present and our future. A defining feature of the American economy has been our embrace of the market, and the recognition that market forces are, in general, the most effective way of allocating resources. But markets cannot solve all problems, and government policy plays an important role in how well markets function. The test of policy is not just in the incentives we create for competition and innovation, but also in the clarity and stability offered by the regulatory framework and in the quality of public goods that governments deliver.
This is a remarkably favorable picture; and yet there is growing concern about the long-term challenges for the U.S. economy and their implications for future prosperity. In parts of the business community, there is growing anxiety about a perceived shift in the locus of dynamism and growth away from the United States toward Asia and other parts of the world. Public opinion surveys report increased concern among Americans about economic security; about the prospects for future income growth and economic mobility; and about the implications of the long-term increase in income inequality. And there we can see growing concern among the general public and in the business community about the struggle to find a political consensus to support reforms to help us meet these challenges. The United States has long been one of the most open of the major economies. This basic policy choice, along with a range of other actions that have made our economy relatively flexible, has allowed us to be a substantial beneficiary of the rapid increase in global economic integration and in the growing economic success of the rest of the world. Globalization has brought challenges as well as benefits, however. The combined forces of technological change, immigration, and the rapid integration of China, India, and other economies into the world economy are altering the dynamics of competitive pressures on U.S. companies. The pace of change seems to be increasing, and more things we produce, and more of our services, are becoming tradable.