Deaths of Despair and the Future of Capitalism

This is a data book designed to be used as a foundation for policy ideas. It is painfully, scrupulously careful not to say anything that might suggest the authors have a partisan agenda. And therefore it doesn’t really have any ideas in it and it is SUPER boring. (The authors occasionally try to throw some wit and humor in; it falls quite flat, in my opinion.) To the extent the book has any “idea” in it (beyond presenting and explaining data findings), it would be that the brokenness of the U.S. healthcare system has much larger and wider deleterious effects on the U.S. economy as a whole than one might think.

It’s not a bad book. It’s just an extremely unfun one. Even Piketty’s book is way more fun than this one. Unless you are an academic or policymaker, I would recommend the following books instead for understanding the roots of U.S. poverty and deaths of despair, particularly for white America: Desmond’s Evicted (this is the best one!); Putnam’s Bowling Alone; Murray’s Coming Apart; Goldstein’s Janesville; Vance’s Hillbilly Elegy.

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.

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

In 2014, Anne Case and Angus Deaton, professors in Princetons 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 Bachelors 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, theyve 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 Trumps election. His voters sent him to Washington to vandalize a system that hasnt worked for them in up-close and personal ways.

Of course there were other causes: a sense of contemptuous treatment by elites (Hillary Clintons deplorables) and disrespect for their fundamentalist Protestant religion. Beware of disrespect for religion! Its 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. Whats 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. Its 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.

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.

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