Stephanie Mencimer, Washington Monthly, April/May/June 2020

Deaths of Despair and the Future of Capitalism, by Anne Case and Angus Deaton, Princeton University Press, 312 pp.

In early January last year, the Fox News host Tucker Carlson took to the airwaves with a 15-minute rant about the way that American capitalism was crushing families and decimating white working-class communities. He blamed small government conservatives and liberal elites alike for ignoring the economic cause of the collapse of the working class. Conservatives, he complained, blame the problem solely on the breakdown of the traditional family. “Like the libertarians they claim to oppose, many social conservatives also consider markets sacrosanct,” Carlson said. “The idea that families are being crushed by market forces seems never to occur to them. They refuse to consider it.”

His indictment of American capitalism went viral and set off a familiar, if heated, debate, mostly on the right, where conservatives weren’t used to hearing such an assault on free market economics from one of their own. Yet Carlson’s assessment was rooted in solid academic research. In fact, his monologue could have served as the prologue for Deaths of Despair, a new book written by the married Princeton economics duo Anne Case and Nobel Prize winner Angus Deaton. They’re the academics who first shocked the country in 2015 with a new study finding that the mortality rates of white people, particularly those without college degrees, had spiked, after nearly a century of sustained decline.

{snip} Five years later, with Deaths of Despair, they’ve returned with a book-length investigation of the trends they first identified in 2015. Their updated data points are stark: Deaths from suicide, drug overdoses, and alcohol-related disease among middle-aged white men and women skyrocketed from 30 per 100,000 in 1990 to 92 per 100,000 in 2017. The spike in these deaths is almost exclusively confined to white Americans, both men and women, without a college degree. Mortality rates among college-educated Americans have continued to fall. Mortality rates for white-working class people in other wealthy countries are similarly in decline.

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Deaths of Despair is an academic book, laden with charts and facts and figures, and the authors devote a significant amount of ink to shooting down things they think are not causing the crisis—problems like obesity, for instance. But after dismissing a variety of possible causes for increasing mortality rates, they essentially come to the same conclusion Carlson did: that rapacious capitalism and predatory corporations, protected by politicians indebted to them, have destroyed the white working class. {snip}

Deaths of Despair features a battery of distressing statistics about the state of the white working class. For white men without a college degree, the average growth in median wages between 1979 and 2017 was a negative number (−0.2 percent a year), even as median hourly earnings for all white workers grew by 11 percent in the same period. This wage deflation has had well-documented cultural ripple effects, depressing marriage rates as men’s appeal as partners fell along with their earnings. Without a stable family life, these men are more isolated, with fewer of the sorts of social buffers that might inoculate them against suicide or drug abuse. As a result, the rates for both have gone up.

{snip} Women have always had lower rates of suicide, alcoholic liver disease, and drug overdoses, whether or not they have a four-year degree. But that has changed since the late 1990s. Working-class women without college degrees are dying from despair in about equal numbers as men. Case and Deaton don’t tease this out, but recent data suggests that white middle-aged women are now drinking themselves to death at a shocking rate. Between 1999 and 2015, alcohol-related deaths in this group soared by 130 percent.

But Case and Deaton argue that the deaths are far more than a product of stagnant wages or economic distress. If that were the case, African Americans would surely be leading the uptick, but they aren’t. White working-class people are much less likely to be poor than black Americans are, and while African Americans still have higher overall mortality rates, those rates have been falling for the past 20 years even as they’ve risen for white people without college degrees.

Instead, Case and Deaton point to something much broader at work in these numbers: the collapse of communities and the end of a way of life. Black communities experienced the ravages of deindustrialization decades before white communities did, along with an increase in mortality. {snip}

That means that, just as 1980s Detroit or Baltimore was a ripe environment for the crack epidemic, white working-class areas of Kentucky or Ohio were uniquely primed for the opioid epidemic. Of the drug overdose deaths since the introduction of OxyContin, 90 percent have been among those without college degrees. {snip}

But Case and Deaton also offer a harsh indictment of the pharmaceutical industry, which made obscene profits from getting vulnerable people hooked on deadly drugs. {snip}

Out-of-control health care costs have helped turn good jobs into bad ones as companies outsource work to shift the cost of care elsewhere, keep wages down to compensate for rising health care costs, or eliminate many jobs entirely. {snip}

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{snip} Starting with the 1994 Republican revolution in Congress, both the federal government and many GOP-dominated states have made it much harder for people suffering a job loss or other calamity to access everything from Medicaid to food stamps, a trend that has likely exacerbated the current misery of white working-class people today. {snip}

The lack of a safety net is one reason why Case and Deaton suggest that the working class in the U.S. is suffering in a way that those in other wealthy countries are not, even though the same forces of globalization and inequality are buffeting their citizens as well. {snip}

While Deaths of Despair does an admirable job of describing the scope of this epidemic and some of its causes, apparently not even a Nobel Prize–winning economist can figure out what to do about it. {snip}

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In a rare moment of optimism, the authors argue that these political problems are solvable. “Democracy can rise to the challenge,” they write. “Democracy in America is not working well, but it is far from dead and it can work again if people push hard enough, just as it was made to work better in the Progressive Era a century ago and in the New Deal of the 1930s.”

But there’s not much evidence that the ship of American democracy can be turned in time to save working-class people, in large part because they themselves don’t think it’s possible. In 2016, the enterprising Washington Post reporter Jeff Guo discovered that in counties where white people were dying the fastest, Trump performed best in the GOP primary. Since assuming office, President Trump and the GOP-controlled Senate have single-mindedly pursued policies that will harm white working-class voters, through cuts in social welfare programs like food stamps and Medicaid and by allowing huge corporate mergers. Yet these same sick and dying white working-class voters want nothing to do with the Democratic Party, whose platform at least offers some meaningful assistance.

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{snip} Even Tucker Carlson sees that the problem goes far beyond Trump. In his viral monologue last year, he said, “At some point, Donald Trump will be gone. The rest of us will be gone, too. The country will remain. What kind of country will it be then? How do we want our grandchildren to live? These are the only questions that matter.”