OT: Deaths of Despair and the Future of Capitalism

“Deaths of Despair and the Future of Capitalism,” by Anne Case and Angus Deaton, Princeton Press, Princeton, 2020. This 312-page hard back examines the cause of declining life expectancy in the US using CDC death certificate info. The authors find the long tend in increases reversed in about 1998. They note significantly greater death trends in those without a college degree. The change is due to deaths by suicide, drug overdoses, or alcoholism especially cirrhosis of the liver. This is attributed to increased despair caused by the decline is good paying manufacturing jobs. The authors cite the American health care system as a major tragedy that costs too much and provides mediocre results. Extensive charts are used to show trends in the data.

Major gains in health were achieved by control of infectious diseases–especially pneumonia, TB, and gastrointestinal infections. Antibiotics and improved water treatment played a major role. By 2000, heart disease and cancer were the leading causes of death. People stopped smoking; better treatments for heart disease were developed. A chart shows the steady decline in death rates from 1900 to 1998 in American men and women aged 45 to 54.

A chart shows death rates bottomed and began to increase in 1998 in the US, but the downward trend continued in France, UK, and Sweden. Increases were largest in West Virginia, Kentucky, Arkansas and Mississippi–states with low education levels. Decreases continued in California, New York, New Jersey, and Illinois, states with high education levels. FDA approval of oxycontin from Purdue Pharmaceutical in 1996 was a major factor in increased drug deaths. Methamphetamine and cocaine contributed to increases in heath attacks and sudden cardiac deaths. Smoking, hypertension, and obesity were also factors. Drug addiction is a form of chemical slavery.

A chart shows that deaths in the non-Hispanic white population in Kentucky increased sharply in the less than BA group while the BA group was flat from 1998 to 2018. In 2017, 84% of Americans with BA degrees aged 25 to 64 were employed vs 68% with a high school diploma. Another study found in the 45 to 54 age group, 10% of those with a degree unemployed vs 25% of those with a high school diploma. Educated people marry later, are more likely to stay married, have children later, and are less likely to have children out of wedlock. Studies found those with degrees were happier and more satisfied with life. Employers are more likely to segregate by education. Low skill jobs are more likely to be outsourced. Republicans are increasingly the party of the less educated. Education has a significant impact on life expectancy.

A chart shows deaths from drugs, alcohol, and suicide in white non-Hispanics age 45-54. Deaths are lower in women by about half but increase in both groups with less than a BA, flat in those with a BA. Another chart shows death rates by birth year. The curves were flat for the less than BA group in those born 1935 to 45 but increased in each group to 1985.

Height is taken as an indicator of nutrition. In the US, men born in 1980 are 1.5 in. taller than those born a century earlier. Other rich countries including Germany, Norway, and Netherlands do even better.

Blacks have higher death rates than whites, but their data continue to improve longer. Another chart shows 1992 to 2017. Black death rates are lower than white death rates in both groups and are flat for those with a BA. White death rates without a degree increased steadily. Black death rates without a degree were flat and then increase sharply after about 2013. This increase is attributed to fentanyl. An earlier study found that inner city African American communities were negatively impacted when urban manufacturing left leaving blacks unemployed. Also educated blacks moved out of the urban black community. Lack of marriageable partners due to unemployment is a factor in children born out of wedlock.

Women are less likely to commit suicide than men. They use less effective methods–drugs vs guns. And they are less socially isolated than men. Social causes include pain, loneliness, depression, divorce, and unemployment. The “suicide belt” follows the Rocky Mountains from Arizona to Alaska. The highest suicide states are Montana, Alaska, Wyoming, New Mexico, Idaho, and Utah. The lowest suicide states are New York, New Jersey, Massachusetts, Maryland, California, and Connecticut. A chart shows suicide rates in those born in 1970 are higher in those with less than a BA.

The Progressive Movement of the early twentieth century gave us prohibition, woman’s suffrage, and direct election of senators as well as anti-trust laws, and the Pure Food and Drug Act.

As religion faltered, opioids became the opium of the masses. Purdue reformulated Oxycontin in 2011 to reduce abuse. Users found heroin a cheap substitute. Black tar heroin became available from Mexico at about the same time. Johnson & Johnson supplied most of the raw material for opioids in the US from a subsidiary, Tasmanian Alkaloids, which grew poppies in Tasmania. Lobbyists were able to block regulation of excessive prescriptions with the Ensuring Patient Access Act of 2016.

Poverty and inequality are often cited as the cause of despair. They contribute to health poverty, but do not explain despair. The timing is wrong.

Rent seeking, ie the manipulation of public policy for financial gain is a major cause of wage stagnation in working class America. The Corn Laws in UK kept grain prices high while people starved, an example of rent seeking.

A chapter examines the US health care industry. It absorbs 18% of GDP, four times defense expenditures, and three times spending on education. The expense reduces worker’s wages. A chart compares life expectancy vs health care expenditure per capita. UK, Australia, France, and Canada all have better life expectancy by about five years at less than ½ the per capita cost. Switzerland has the highest life expectancy at about 2/3 the cost. Studies show the US wastes about a quarter of its spending on health care. Pharmaceuticals are about three times more expensive in the US. An MRI costs $1100 in the US vs $300 in Britain. In Britain, the National Institute for Health and Care Excellence evaluates treatments and determines if they are cost effective. A chart shows that health care cost has increased steadily as a percentage of GDP. The industry spends heavily on lobbyists.

Traditionally displaced workers relocate to find a job. But the high cost of living in successful cities makes that difficult. Globalization has been cited as a cause, but France and Germany also import from China and have avoided death by despair. A stronger safety net is thought to be a key factor. An effort to enact national health insurance during the Truman administration after World War II failed.

In Washington, if you do not have a seat at the table, you are probably on the menu. America should follow other nations to provide universal health insurance and control health care costs. Universal basic income is recommended as part of the better safety net. The minimum wage should be raised in stages to $15/hr.

This is a thought provoking book with much data presented clearly in charts. It’s a bit hefty on data, but well explained. References. Index.