Even before the formidable and destabilizing march of coronavirus throughout our nation and world, a significant segment of the American citizenry had not been doing very well. For some time, white, middle-aged, poor, working-class adults have been afflicted by a raging epidemic of premature death. “In 2017, 158,000 Americans died from what we call deaths of despair … That is the equivalence of three 737 MAXs falling out of the sky every day, with no survivors.” This tragic reality has been investigated in depth by two Princeton professors of economics—authors and married couple Angus Deaton and Anne Case. In 2015 Deaton was awarded a Nobel Prize for his work in the area of consumption, poverty and welfare.
Disturbing trends this duo have assiduously analyzed are detailed in their most urgent book. They expound upon the inordinate rise in drug addiction, alcoholism and suicide manifesting within the ranks of low-income white citizens. This demographic is characterized by minimal academic achievement and bleak job prospects. The same grim calculations do not seem to apply to other parts of America’s poor and working class. While they may experience similar economic straits, Black and Hispanic people do not show up markedly in the lethal statistics populated almost exclusively by distressed whites.
Case and Deaton also note that this alarming phenomenon is absent elsewhere in just about every other wealthy democratic dominion where income disparities and class inequities exist. One exception is found in the United Kingdom, in Scotland.
There is a serious persistence of deep poverty in the social topography of America, and the challenges of working-class life here are more onerous than in most other wealthy countries. Historically, a supportive social infrastructure has been in place throughout much of the developed world. In various configurations, humane programs provide reliable safety nets to their impoverished and working-class citizens. No comparable comprehensive system has ever existed in the United States.
So, what’s happening? The economists proffer pointed explanations to provide clarity and encourage practical ways to address this calamity. They are not engaged in a condemnation of capitalism. Quite the contrary: They argue it is a productive system that has generated wealth and innovation and afforded an enhancement of living conditions for multitudes in many parts of the world.
This evokes the comment Winston Churchill uttered in the House of Commons in 1947 regarding democratic governance: “Indeed it has been said that democracy is the worst form of government except for all those other forms that have been tried from time to time.” Case and Deaton are not oblivious to the glaring flaws that abound in the system. Within the current capitalistic arrangement, the authors decry that throngs of poor and working-class individuals are ill-served and locked out from the fruits of material prosperity. Readily admitted, the present structure is profoundly unfair.
The writers offer a symbol of unbridled, cutthroat capitalism: Robin Hood’s archrival, the Sheriff of Nottingham. The villainous sheriff personifies the ruthlessly rigged capitalist dynamic. Long has this venal machine been distributing wealth upward to the opulent American echelons. Simultaneously accompanying this outrage is the evacuation of long-standing corporate operations and businesses from many localities. This abandonment is compounded by a changing work environment permeated by automation and novel technologies.
The dignity of work is a critical factor in this study. A vast number of solid jobs endeavored over the lifetime of working people — employment that offered decent wages, security and consistency for workers without college degrees — are increasingly a thing of the past. Union membership has shrunk drastically. Too many of today’s available jobs are low-paying and/or part-time affairs with no benefits. The so-called gig economy is often the only option for those seeking a job. A growing portion of working age individuals — mostly men, the so-called discouraged workers — have stopped looking entirely and are no longer accounted for in labor statistics. Pride once felt by multitudes in their places of work and the adequate remunerations they earned have been stripped from millions of lives. The fearsome disruption of coronavirus is predicted to make this situation even more egregious .
Desperation is pervasive among citizens whose sense of connection to community and traditional institutions has been eroded. It is a result of “a long-term and slowly unfolding loss of a way of life for the white, less educated, working class.” This has gone hand-in-hand with mounting alcohol and drug abuse, and the ultimate expression of alienation and disconsolation: suicide.
Case and Deaton excoriate American health care. It was the “absurd and oppressive” system itself that cynically opened the floodgates to dangerous prescription drugs that went unchecked long after the dire consequences of such narcotics were known. A carnival of greed and chaos allowed slime-ball profiteers to rake in vertiginous sums as they fostered a growing population of addicts. One particularly egregious example: “In one two-year period, nine million pills were shipped to a pharmacy in Kermit, West Virginia, population 406.” This is only one aspect of dysfunctional elements in for-profit medicine. In 2019, the Global Health Security Index reported that of 195 countries surveyed, the adequacy of U.S. health care — “the most expensive in the world” — was tied with Gambia in 175th place.
“Free-market competition does not and cannot deliver socially acceptable healthcare.” This is a resounding imperative and thorough reforms are long overdue. While they do not advocate for one approach, the economists argue against a full-blown governmental intervention. Genuine democracy can guide other versatile and creative solutions. None of this is going to be easy in our divided country. A recent article in The Nation salutes the trenchant analysis performed by the authors, but critiques their recommendations as too diffident, as “half-measures” when a far deeper and extensive transformation is a necessity.
Writing in The New York Times in April, as coronavirus was surging, the authors state: “Yet we cannot go on as we have been. America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic.”
An alarming piece by journalist William Wan appeared this month in The Washington Post warning of a looming mental health crisis related to psychological stress precipitated by coronavirus. The same afflictions detailed by Case and Deaton are arising anew. Our perennially incoherent and underfunded mental health system will not likely be capable of sufficiently meeting this burgeoning challenge.
Read more in the June 3-9, 2020 issue.