Deaths of Despair and the Future of Capitalism

by Anne Case

Along the way, we had discovered that suicide rates among middle-aged white Americans were rising rapidly.

Health among the elderly was improving while health among the middle-aged was worsening.

Deaths from alcoholic liver disease were rising rapidly too, so that the fastest-rising death rates were from three causes: suicides, drug overdoses, and alcoholic liver disease.

These kinds of deaths are all self-inflicted,

The increase in deaths of despair was almost all among those without a bachelor’s degree.

Those with a four-year degree are mostly exempt; it is those without the degree who are at risk.

For Americans without a bachelor’s degree, marriage rates are in decline, though cohabitation and the fraction

Our story of deaths of despair; of pain; of addiction, alcoholism, and suicide; of worse jobs with lower wages; of declining marriage; and of declining religion is mostly a story of non-Hispanic white Americans without a four-year degree.

The historian Carol Anderson states that to someone who has “always been privileged, equality begins to look like oppression.”

White non-Hispanics are 62 percent of the working-age population,

A majority of less educated white mothers have currently had at least one child outside marriage.

Whites without a college degree are not the poorest group in the US; they are much less likely to be poor than African Americans. Instead,

Globalization and technological change are often held up as the main villains because they have reduced the value of uneducated labor, replacing it with cheaper, foreign labor or cheaper machines. Yet other rich countries, in Europe and elsewhere, face globalization and technological change but have not seen long-term stagnation of wages, nor an epidemic of deaths of despair.

There is something going on in America that is different, and that is particularly toxic for the working class. Much of this book is concerned with trying to find out just what that something might be.

We believe that the healthcare system is a uniquely American calamity that is und...

We shall also argue that in America, more than elsewhere, market and political power have moved aw...

The rising economic and political power of corporations, and the declining economic and political power of workers, allows corporations to gain at the expense of ordinary people, consumers, and particularly workers.

More generally, the American healthcare system is a leading example of an institution that, under political protection, redistributes income upward to hospitals, physicians, device makers, and pharmaceutical companies while

A subsidiary of Johnson & Johnson grew the poppies in Tasmania that were the raw material for almost all the opioids produced in the US.

The US spends huge sums of money for some of the worst health outcomes in the Western world. We will argue that the industry is a cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs, and making it harder and harder for state and federal governments to afford what their constituents need.

Political protection is being used for personal enrichment, by stealing from the poor on behalf of the rich, a process known to economists and political scientists as rent-seeking.

We do not think that taxation is the solution to rent-seeking; the right way to stop thieves is to stop them stealing, not to raise their taxes.

We need to correct the process, not try to fix the outcomes.

The election of Donald Trump is understandable in the circumstances, but it is a gesture of frustration and rage that will make things worse, not better.

Some causes of death, such as Alzheimer’s or late-life cancers, were uncommon simply because people rarely reached the ages where they matter.

The root cause of an epidemic of typhus in 1848, as the great pathologist Rudolf Virchow saw it, was poverty and lack of political representation.

Figure 2.1

all states with education levels lower than the national average.

suicides and alcohol together kill more whites than do drugs.

Death continues its journey. Having moved from the bowels of children into the lungs and arteries of the elderly, it is now backtracking into the minds, livers, and veins of the middle-aged.

For whites between the ages of forty-five and fifty-four, deaths of despair tripled from 1990 to 2017.