Deaths of Despair and the Future of Capitalism

by Anne Case

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.

At its worst, this power has allowed some pharmaceutical companies, protected by government licensing, to make billions of dollars from sales of addictive opioids that were falsely peddled as safe, profiting by destroying lives.

redistributes income upward to hospitals, physicians, device makers, and pharmaceutical companies while delivering among the worst health outcomes of any rich country.

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. It is, in a sense, the opposite of freemarket capitalism, and it is opposed by the Left, because of its distributional consequences, and the Right, because it undermines freedom and a truly free market.

There was some slowdown in progress during the 1930s and the Great Depression, but progress was also slow in the booming 1920s; there is no obvious relationship between mortality rates and the state of the economy.

Deaths of despair among white men and women aged forty-five to fifty-four rose from thirty per one hundred thousand in 1990 to ninety-two per one hundred thousand in 2017.

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

Even with white death rates rising, the difference in levels between white and black mortality remains stark: black mortality rates in 2017 were only slightly lower than those experienced by whites forty years earlier.

Midlife Americans are not getting sicker just because they are getting fatter.

The opioid epidemic did not happen in other countries both because they had not destroyed their working class and because their pharmaceutical companies are better controlled and their governments are less easily influenced by corporations seeking profits.

Inequality and death are joint consequences of the forces that are destroying the white working class.

There is simply no increase over time in poverty that can explain the surging epidemic.

In summary, unemployment is not always good at identifying the places where social and economic structures have been destroyed.

Before 1970, there was growth and no increase in inequality. Afterward, there was lower growth and growing inequality.

As economic growth declined, working-class people were left further and further behind by an economy that increasingly reserved its rewards for those with higher education.

Not only are the college-educated rewarded with higher earnings, but those who do not heed the incentive are punished with lower earnings. The winners get the prizes, and the losers get worse than nothing.

Yet recall the large increases in pain and the deterioration in physical and mental health that we documented in chapters 6 and 7; much of the increase in disability can be attributed to the higher prevalence of ill health, rather than to people gaming the system.12