A new study published in JAMA compares the health of middle-aged Americans and Brits and shows that, even though we shell out more than twice as much per capita for medical care, Americans are far less healthy.

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Does this help make the case for universal health care? Yes, but if that's all we get out of it (and that's a lot), I think we'll be missing possibly the most important conclusion to be drawn.

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In the Associated Press version of the story, an expert is quoted as saying that if you look at all the quantifiable health factors that separate Brits and Americans, none of them either alone or together are likely to account for the differences in outcomes. The one factor that might, however, is harder to measure: stress.

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If that's the case, it would mesh nicely with other studies that show Americans, who used to be among the tallest people in the developed world, are now the shortest. There was a good piece on this in The New Yorker a few months back. Contrary to what you'd think, genetics have little to do with height across large populations. The key factors are nutrition and stress at the three key growth periods early in life.

Thus, Dutchmen are now the tallest people in the world, with an average male height of 6-foot-1, followed closely by Scandinavians at a fraction over 6 feet and Germans at a bit under 6 feet. American men average 5-foot-9 1/2, where we've been stuck for more than a century. American women average out at 5-foot-4. Of course, what we lack in stature we make up in girth, but that's another matter.

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Stress, some might argue, is part of the essence of the American experience. I guess I can see that, but I can't agree that it's somehow desirable or unalterable. In any event, there ought to be some point or some positive outcome to justify the burden of the added stress. If the pre-eminent result is that we're less healthy, less productive and more inclined to invade the odd nation on flimsy pretexts, it's hardly reason to wave the flag.

Let me commence this blog with a simple idea. There has been an extended discussion on TPMCafe of the "common good," with many writers embracing this as an appeal that the Democrats should somehow return to after decades in the wilderness of multicultural and identity politics. I'll go along with this in a general way, but it seems to me that we'll encounter quite a substantial stumbling block very quickly on that path.

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One of the salient features of Democratic politics, at least since John Kennedy, has been the idea that if you ask people to make sacrifices, they'll respond, often enthusiastically. Contained in the notion of sacrifice is the kernel of the common good. In fact, if you appeal to the common good without asking for sacrifice, it sounds phony or cheap.

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Since Kennedy, however, liberals have had a rather more selective notion of this, too often asking sacrifice of some but not others. Some examples:

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1) Busing. South Boston is emblematic here, as someone very near and dear to me with close experience of the situation has noted. When the judge ordered that white children be bused, they weren't the kids from good schools in upper-class neighborhoods. They were from Southie.

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2) Affirmative action. The students who clear the academic bar but are not admitted to elite schools because of affirmative action are seldom rich or well-connected. Most often they're students from middle-class or working-class families.

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3) Illegal immigration. If we grant that this has been an overall benefit to our economy, we still have to acknowledge that many Americans at the lower end of the economic scale have been hurt because government has deliberately refused to enforce the law. Thus we see wages in certain industries that used to pay middle-class wages of $20 an hour or more in the 1970s (equivalent to $30 or more now) falling to $8 or $9 an hour, with no benefits. This is like a taking in eminent domain, but with no compensation.

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4) The "volunteer" military. Keep in mind here that young people who enter the military are sworn to defend their country. But then, most often, if they see any action, it's in some faraway land that has little or, more likely, nothing to do with our security. Think Panama, Grenada, Somalia and Kosovo as well as Vietnam and Iraq. A lot of these interventions would never have happened if kids like the Bush twins and Chelsea Clinton had to serve their time in uniform.

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Common to all this is the deep notion among the elites that they have ideals, perfectly sound and unassailable ideals, for which OTHER people must make sacrifices. Americans, I believe, have long since caught on to this.

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I saw Joe Klein on C-SPAN this weekend, and he addressed a related point. I can't remember just how he phrased it, but the essence of it was that Republican candidates have very simple instructions for their campaign consultants: How do I get my message out. Democrats, on the other hand, have to ask their campaign people: How do I get my message out but finesse it in such a way that I don't turn everyone off.

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This sounds odd when you consider that voters are with the Dems on issue after issue, but it makes more sense in light of the fact even though the Republicans are polling very low, the Democrats are, too. They don't benefit from the rock-bottom esteem for Bush and the GOP.

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And this goes to what Klein (I think) and I are talking about--the absence of a core belief or narrative. I'm just trying to go a step beyond that and say that the core narrative (the common good) is there, it's just inaccessible to Dems. And that's because there's a big, damned barrier in the way, built brick by brick from the items enumerated above. Dems have too often asked just certain Americans to make sacrifices--usually Americans least well-provisioned in life to give up anything.

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With the exception of busing, Dems are not about to give up any part of this agenda.