Deaths of Despair and the Future of Capitalism

The author points out the chasm that has developed between the educated haves and the less educated have- nots. He gives data and logical arguments to support his theses convincingly. To e tend his thesis to explain the attachment of the poor and less educated to the MAGA movement is a short step.

By focusing on explaining what is driving the increase of the deaths of despair (suicides, drug overdoses, alcohol linked hepatic failure) among white non college educated Americans, the authors are able to provide a stark portrait of the workings of American capitalism. In particular, it exhibits how the mixture of external and technological shocks, with policy failures in high impact areas such as pharmaceuticals, and a faulty institutional design in healthcare, has led to a societal collapse among the white non college educated population . By doing that, it also provides a necessary input for any analysis of the current political landscape in the US.

This book, along with “The Hardhat Riots” help explain what is happening in America today. I would go a step farther to blame the MAGA movement and the Capitol riot on this underlying sense of loss that the uneducated formerly middle class segment of our society has experienced. This book goes on to proffer some solutions.

In 2014, Anne Case and Angus Deaton, professors in Princeton’s economics department, discovered that white male American deaths from suicide were rising sharply. A deeper dive into the statistics revealed that deaths of all white males were rising for the first time since the flu epidemic of 1919. Middle-aged white men reported more pain as well. The publication of these results in 2015 was, in retrospect, the first hint that someone like Trump could be elected President. In Deaths of Despair, the authors report that the three main cause of white male deaths are suicide, alcoholic liver disease, and drug overdoses. Furthermore, deaths rose principally among white men without a Bachelor’s degree. The BA degree acted, speaking statistically, like an inoculation. Many of the drug deaths followed from repeated overdoses, as if these were suicide attempts. This white male demographic group matches the profile of the Trump voter. They are likely to be less educated and more likely to live in a rural area. There are reasons for the demoralization of this population. Foremost, they’ve suffered from decades of real wage stagnation. The authors report that “white men without a four-year college degree lost 13 percent of their purchasing power between 1979 and 2018. Over the same period, national income per head grew by 85 percent.” Men without jobs and men with poorly paying jobs make poor marriage partners. Economic research suggests this is why their marriage rates declined, denying them the benefits of companionship. Many middle-aged white men do not know their own children, while the majority of less-educated white women have children outside of marriage. As family ties weakened, church-going declined, removing a source of comfort. Trade unions have declined as well. We have instead a stunning rise of alcoholism and narcotics addiction. Deaths from narcotics overdose now run at 70,000 per year. This resembles the experience of less-educated African-American males several decades ago. Mortality rates among Afro-American men have always been higher than those for whites. The gap, however, has been narrowing for many years. The combination of stagnant real wages and poor health help explain the rage that led to Trump’s election. His voters sent him to Washington to vandalize a system that hasn’t worked for them in up-close and personal ways. Of course there were other causes: a sense of contemptuous treatment by elites (Hillary Clinton’s “deplorables”) and disrespect for their fundamentalist Protestant religion. Beware of disrespect for religion! It’s easy to dismiss the Trump voters as racists and extremists, though many were Obama voters. Of course some are openly racist and Trump appeals directly to anti-Mexican and anti-Chinese sentiment. But I am writing to deny that race was the primary issue in the 2016 election. Case and Deaton devote half the book to a discussion of the economic sources of wage stagnation. These are statistically well established features of our economy and less interesting than their account of the public health facts. Globalization and technological change are probably the main causes of wage stagnation for the less-educated. What’s special about the US is that high doctor, hospital, and especially pharmaceutical costs have cut the purchasing power of our population. Moreover, greater concentration of industry has increased oligopoly power and raised prices, further cutting household purchasing power. The problem is most evident in the pharmaceutical and internet platform industry (Facebook, Amazon, Microsoft, or example). The information in this book cries out for compassion for the Trump voters –from Democrats and Liberals. The division in America does not flow entirely from extremism on the right. It’s visible in dismissal of the Trump voters as racists and, broadly, bad people. Time to recognize the other side as full human being who face real problems.

Anne Case and Angus Deaton claim that the American medical industry is at the heart of the deaths of despair in America, using copious amounts of data to support their argument. First, let’s define deaths of despair: suicides, overdoses, and alcohol-related diseases. Some might blame globalization and the gutting of American industry for causing this despair, but European countries are facing the same globalization and aren't experiencing record numbers of suicides, overdoses, and alcohol-related deaths. Additionally, there is a stark contrast between the death rates of those with a bachelor’s degree and those without; men without a bachelor’s degree are significantly more likely to die from deaths of despair. The authors argue that the medical industry is responsible for these deaths due to rent-seeking behavior that funnels money from the working class to the medical industry, thereby eliminating good jobs that once supported the American middle class.

This is a good book, but I bought the ebook version and "Anne Case" who read this book outloud for the audible version doesn't sound like a human being to me. I'm glad robot americans are getting credited for their work reading ebooks, but it's not a very nice listening experience.

I recommend this read. Although it focuses near exclusively on white non-Hispanics between the ages of 45-54 in the USA (well, since I fit into this category, it's germane to me), these two professors (Case & Deaton) make repeatedly cogent and substantive arguments about the correlation between "deaths of despair," (deaths from alcohol, opioids, & suicide) with those who have a bachelor's degree or higher versus those who do not. It's striking. A number of variables are controlled for. Moreover, the discussion of how the country was stratified economically, around the year 1970 is logically and factually laid out quite well. Moreover, the reference list provide a great resource for other reads that I'm already ordering on eBay on the cheap

Overall, I recommend this book as it tries to explain the plight of white, working class Americans. Having lost so many things, including the privilege of race, it's easy to see why the white working class would vote for Trump. The first part of the book can be a bit dry, but uses loads of data to power its hypotheses. The second part of the book falls short, as it blames only one culprit for a poor outcome. True, the American healthcare system perversely generates inequality instead of provides universal care. However, I would have liked to see more discussion about education. Is it possible that our inefficient educational system also perpetuates generational inequality and transfers wealth from lower income students to rich university bureaucrats who contribute little of actual value? More discussion needed. I imagine multiple entrenched interests bleed money from the working class, reinforcing health and life outcome disparities that amplify through generations. While one book cannot possibly call out all those "Sheriffs of Nottingham," it should at least offer one chapter of discussion.

Good book, really insightful

Still reading it, but it is extremely interesting and well put together, combining different parts of society and economy and their effects. The findings are from a thorough research on the yearly deaths and the reasons, which amonst others, the lack of education plays an important role.

Es un libro muy interesante, recomiendo ampliamente su lectura.

This is definitely a book that everyone should read. It is very well-written, not technical, and passionate about a dreadful subject.

spedizione etc: tutto ok