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From economist Anne Case and Nobel Prize winner Angus Deaton, a groundbreaking account of how the flaws in capitalism are fatal for America's working class Life expectancy in the United States has recently fallen for three years in a row--a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, d From economist Anne Case and Nobel Prize winner Angus Deaton, a groundbreaking account of how the flaws in capitalism are fatal for America's working class Life expectancy in the United States has recently fallen for three years in a row--a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, drug overdose, and alcoholism have risen dramatically, and now claim hundreds of thousands of American lives each year--and they're still rising. Anne Case and Angus Deaton, known for first sounding the alarm about deaths of despair, explain the overwhelming surge in these deaths and shed light on the social and economic forces that are making life harder for the working class. They demonstrate why, for those who used to prosper in America, capitalism is no longer delivering. Deaths of Despair and the Future of Capitalism paints a troubling portrait of the American dream in decline. For the white working class, today's America has become a land of broken families and few prospects. As the college educated become healthier and wealthier, adults without a degree are literally dying from pain and despair. In this critically important book, Case and Deaton tie the crisis to the weakening position of labor, the growing power of corporations, and, above all, to a rapacious health-care sector that redistributes working-class wages into the pockets of the wealthy. Capitalism, which over two centuries lifted countless people out of poverty, is now destroying the lives of blue-collar America. This book charts a way forward, providing solutions that can rein in capitalism's excesses and make it work for everyone.


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From economist Anne Case and Nobel Prize winner Angus Deaton, a groundbreaking account of how the flaws in capitalism are fatal for America's working class Life expectancy in the United States has recently fallen for three years in a row--a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, d From economist Anne Case and Nobel Prize winner Angus Deaton, a groundbreaking account of how the flaws in capitalism are fatal for America's working class Life expectancy in the United States has recently fallen for three years in a row--a reversal not seen since 1918 or in any other wealthy nation in modern times. In the past two decades, deaths of despair from suicide, drug overdose, and alcoholism have risen dramatically, and now claim hundreds of thousands of American lives each year--and they're still rising. Anne Case and Angus Deaton, known for first sounding the alarm about deaths of despair, explain the overwhelming surge in these deaths and shed light on the social and economic forces that are making life harder for the working class. They demonstrate why, for those who used to prosper in America, capitalism is no longer delivering. Deaths of Despair and the Future of Capitalism paints a troubling portrait of the American dream in decline. For the white working class, today's America has become a land of broken families and few prospects. As the college educated become healthier and wealthier, adults without a degree are literally dying from pain and despair. In this critically important book, Case and Deaton tie the crisis to the weakening position of labor, the growing power of corporations, and, above all, to a rapacious health-care sector that redistributes working-class wages into the pockets of the wealthy. Capitalism, which over two centuries lifted countless people out of poverty, is now destroying the lives of blue-collar America. This book charts a way forward, providing solutions that can rein in capitalism's excesses and make it work for everyone.

30 review for Deaths of Despair and the Future of Capitalism

  1. 5 out of 5

    Michael Perkins

    "When it comes to people whose lives aren’t going well, American culture is a harsh judge: if you can’t find enough work, if your wages are too low, if you can’t be counted on to support a family, if you don’t have a promising future, then there must be something wrong with you. When people discover that they can numb negative feelings with alcohol or drugs, only to find that addiction has made them even more powerless, it seems to confirm that they are to blame. We Americans are reluctant to ac "When it comes to people whose lives aren’t going well, American culture is a harsh judge: if you can’t find enough work, if your wages are too low, if you can’t be counted on to support a family, if you don’t have a promising future, then there must be something wrong with you. When people discover that they can numb negative feelings with alcohol or drugs, only to find that addiction has made them even more powerless, it seems to confirm that they are to blame. We Americans are reluctant to acknowledge that our economy serves the educated classes and penalizes the rest." Great review from a doctor-writer, Atul Gawande, at The New Yorker explaining the meat of the book. https://www.newyorker.com/magazine/20... ============== The labor participation rate is the more accurate measure of how bad unemployment is.... https://www.bls.gov/charts/employment... =================== "Poor whites were co-opted by the rich, who told them that they might not have much, but at least they were white. As Martin Luther King Jr. summarized, “The southern aristocracy took the world and gave the poor white man Jim Crow,” so that when he had no money for food, “he ate Jim Crow, a psychological bird that told him that no matter how bad off he was, at least he was a white man, better than a black man.” This division goes back to the Colonial Era.... http://www.historyisaweapon.com/defco... ============= Update: https://www.theguardian.com/us-news/2... Does a Gun Make Your Home Safer? Nope. Quite the opposite. https://www.safewise.com/resources/gu...

  2. 5 out of 5

    Peter Tillman

    Whether or not you read this book, you should read Dr. Atul Gawande's long, detailed review: https://www.newyorker.com/magazine/20... Excerpts: "Between 1999 and 2017, more than six hundred thousand extra deaths — deaths in excess of the demographically predicted number — occurred just among people [in the USA] aged forty-five to fifty-four. . . White men without a college degree account for most of these excess deaths. "Among the men, median wages have not only flattened; they have declined since 19 Whether or not you read this book, you should read Dr. Atul Gawande's long, detailed review: https://www.newyorker.com/magazine/20... Excerpts: "Between 1999 and 2017, more than six hundred thousand extra deaths — deaths in excess of the demographically predicted number — occurred just among people [in the USA] aged forty-five to fifty-four. . . White men without a college degree account for most of these excess deaths. "Among the men, median wages have not only flattened; they have declined since 1979. The work that the less educated can find isn’t as stable: hours are more uncertain, and job duration is shorter. Employment is more likely to take the form of gig work, temporary contracting, or day labor, and is less likely to come with benefits like health insurance." Case & Deaton argue that "the United States has provided unusually casual access to means of death. The availability of opioids has indeed played a role, and the same goes for firearms (involved in more than half of suicides); we all but load the weapons of self-destruction for people in misery. The U.S. has also embraced automation and globalization with greater alacrity and fewer restrictions than other countries have." And they argue that "our complicated and costly health-care system" is another major factor. Whether or not you agree with the authors (and/or Gawande) about the best way to solve this, it is a major, ongoing problem. "The blighted prospects of the less educated are a public-health crisis, and, as the number of victims mounts, it will be harder to ignore."

  3. 4 out of 5

    Russell

    It is difficult, at least for me, to think about these issues. I felt, and feel, powerless against the forces of inequality and despair, as I am sure most do. But, averting our eyes isn't doing us any good either. This book has armed me with more information and more arguments and ideas for policy solutions, and for that I am thankful to it's authors for taking this subject on.

  4. 5 out of 5

    Bevan

    This is a very poignant and disturbing examination of the effects of late-stage Western capitalism, although the authors probably wouldn’t call it that, on the less-educated white population in the U.S. Time and again, those with less than any college education are disadvantaged; this can lead to grim life chances, and the deaths of despair of the title. Two factors figure prominently in this book: the opioid crisis and our terrible healthcare system. The last chapter is, to my mind, a bit of a This is a very poignant and disturbing examination of the effects of late-stage Western capitalism, although the authors probably wouldn’t call it that, on the less-educated white population in the U.S. Time and again, those with less than any college education are disadvantaged; this can lead to grim life chances, and the deaths of despair of the title. Two factors figure prominently in this book: the opioid crisis and our terrible healthcare system. The last chapter is, to my mind, a bit of a disappointment. After delineating all that is wrong with our system, one might think that a call to the barricades would be appropriate, but that isn’t the case here. The authors propose to attempt to fix the injustices one at a time, which might be good. And, of course, they could not have anticipated our present crisis. Everything that is discussed is now multiplied by ten. So, what now? I wonder if the authors will need to augment the arguments in this book due to our current circumstances; not only the crisis of the coronavirus, but the discussions around the issue of racial equality.

  5. 5 out of 5

    Jonathan Mckay

    30th book of 2020: American Carnage. In deaths of despair, the authors discuss the rising trend of three types of fatalities: drugs, alcohol, and suicide. In most of the first part of the book, the authors break apart the trend, but all you really need to know is the graph above. Since 2000, deaths in this category have nearly tripled across the country, and the trend does not show signs of slowing down. This book shows that to some groups of people, Trumps vision of American carnage is real. "W 30th book of 2020: American Carnage. In deaths of despair, the authors discuss the rising trend of three types of fatalities: drugs, alcohol, and suicide. In most of the first part of the book, the authors break apart the trend, but all you really need to know is the graph above. Since 2000, deaths in this category have nearly tripled across the country, and the trend does not show signs of slowing down. This book shows that to some groups of people, Trumps vision of American carnage is real. "When it comes to people whose lives aren’t going well, American culture is a harsh judge: if you can’t find enough work, if your wages are too low, if you can’t be counted on to support a family, if you don’t have a promising future, then there must be something wrong with you. When people discover that they can numb negative feelings with alcohol or drugs, only to find that addiction has made them even more powerless, it seems to confirm that they are to blame. We Americans are reluctant to acknowledge that our economy serves the educated classes and penalizes the rest." What the book criticizes is not American capitalism itself, but some of the perverse incentives and systems of upward redistribution (sheriff on nottingham redistribution) that help the affluent at the cost of those in need of the most help. The causes listed are not new, though I was surprised at the relative weight the author gives them: 1. America's healthcare system. (20% tax on GDP, costs have gone up, disproportionately hurt the poor) 2. International wage competition and automation. (the usual boogeyman for this sort of book, not as much the focus as I expected) 3. Increasing oligopilies, less competition, and more economic surplus going to corporations. (Authors make a good argument for increasing the minimum wage here) While the data and proposed causes are not novel, the authors package them in a way that I found convincing.

  6. 5 out of 5

    Kent Winward

    The main conclusion of this intriguing look at the United States loss of life expectancy and wage stagnation is the US is messed up, particularly on healthcare. We spend more and get worse outcome on our medical system than anywhere else in the world. As an employer, I know that after payroll, my biggest cost isn't rent, supplies, technology, or anything else, it is health insurance. The current protests for Black Lives Matter and the Covid-19 outbreak show several of the fundamental flaws in th The main conclusion of this intriguing look at the United States loss of life expectancy and wage stagnation is the US is messed up, particularly on healthcare. We spend more and get worse outcome on our medical system than anywhere else in the world. As an employer, I know that after payroll, my biggest cost isn't rent, supplies, technology, or anything else, it is health insurance. The current protests for Black Lives Matter and the Covid-19 outbreak show several of the fundamental flaws in the current system. Medical care cannot be relegated to a market system and work effectively, but it is important to note that the US system is not a free market, but a highly regulated market that has effectively removed all cost control and bargaining power for the people. The book left me wanting more analysis looking at the problems in healthcare other than a cursory look at the opiate crisis.

  7. 5 out of 5

    Matt Schiavenza

    President Trump's shocking victory in 2016 launched an endless series of articles examining the demographic that pushed him over the edge: the white working class. Why did these men and women, who had supported Democrats as recently as four years before, pulled the lever for a New York reality TV star? Why did Trump's anger and dark vision of the country resonate so much with them? To an urban sophisticate, it all seemed so baffling: After the Great Recession, the country really did seem to be d President Trump's shocking victory in 2016 launched an endless series of articles examining the demographic that pushed him over the edge: the white working class. Why did these men and women, who had supported Democrats as recently as four years before, pulled the lever for a New York reality TV star? Why did Trump's anger and dark vision of the country resonate so much with them? To an urban sophisticate, it all seemed so baffling: After the Great Recession, the country really did seem to be doing better. But was it? Earlier, during the last years of the Obama presidency, the U.S. passed a grim milestone: life expectancy began to fall. If there was ever a statistic that advertised things not going well, it's this one. Yet the news didn't click for the Americans for whom the notion of perpetual progress had become an article of faith. Deaths of Despair is an attempt to get to the bottom of this phenomenon. Angus Deaton and Anne Case, a husband-and-wife duo from Princeton, find that the white population in America is now split between those with a college degree and those without. Forty years ago, it was still possible for Americans to graduate from high school and find steady employment in the manufacturing sector. Now, these jobs no longer exist. Many of the factories that formed the heart of communities across America left for China, or Mexico, or somewhere else. And many of those factories that remained replaced their workers with robots. Americans with college degrees found gainful employment in the country's still-thriving service sector. But the poorly-educated were left behind. And as the jobs fled, families began to fall apart. Young men and women desperately sought an escape in the form of opiates, pushed by unscrupulous companies like Purdue Pharma. And so when a presidential candidate came along and told them that their problems could be blamed on immigrants, or our black president, or the hated cultural elite in the coastal cities — none of which were, of course, true — these people were ready to listen. If this story sounds familiar, it's because the same thing happened decades earlier to inner-city black Americans. Lured to cities during the first half of the 20th century, black Americans found themselves bereft of employment when manufacturing shifted to distant suburbs. Broken families and drugs, in the form of crack cocaine, became a massive social problem. And because of racism, commentators mused that there must be something intrinsic to African Americans that they simply couldn't figure it out. The phenomenon afflicting America's left behind people is not unique to the United States. But the problem is exacerbated by our broken social welfare system. Even those Americans who manage to prosper are afflicted by an affordability crisis: housing in major cities is prohibitively expensive, and a single hospital visit will all but wipe out the uninsured. The infusion of money into politics has fueled corruption on a gargantuan scale, and those responsible for immiserating the poor almost never face any consequences. Case and Deaton do not write like academics. This is a compliment. Deaths of Despair is a bracing read, succinct and insightful, and free from jargon. Anyone who tells me, in good faith, that they don't understand why anyone would vote for Trump would be well-served by reading it. Anyone who just wants to understand America should do the same. In the book's last chapter, Case and Deaton offer some policy proposals that would ameliorate this crisis. They may not be as radical as some would like — they pour cold water on Andrew Yang's universal basic income scheme, for example — but they would represent a clean break from the cronyism seen in Trump's White House. Will they happen? Even the most optimistic liberal knows that the answer is probably no — at least not yet. But we can at least be sure that if Trump wins again, this time we'll have a better sense of why.

  8. 4 out of 5

    Keith Swenson

    People in America are dying at an alarming and increasing rate at a time when technology and the economy would predict the opposite. What is more surprising is that they seem to be killing themselves. The trend is not spread across all sectors of the population, but instead most pronounced in one sector: white men without a college degree. Anne Case and Angus Deaton spend the first three parts of this masterpiece laying out the background and the data that supports their thesis. For the past cent People in America are dying at an alarming and increasing rate at a time when technology and the economy would predict the opposite. What is more surprising is that they seem to be killing themselves. The trend is not spread across all sectors of the population, but instead most pronounced in one sector: white men without a college degree. Anne Case and Angus Deaton spend the first three parts of this masterpiece laying out the background and the data that supports their thesis. For the past century or so death rates in any particular age group have been falling as people live longer. For 100 years, progress in technology, medicine, transportation, product automation, electronics, information technology, and just plain better science has progressively improved lifespans, and decreased death rates in all age groups. They focus on the 45 to 54 year olds because early middle age is a turning point in life, past the childbearing years, but still in the normally working productive years not quite yet prone to specific diseases of old age. Across many countries, across races, across incomes the data show decreasing death rates for 100 years. In 2000 there is a change. The death rates for certain kinds of death -- suicide, drug overdose, and alcoholism -- start rising to be today many times what it was in 2000 or any any year earlier. American life expectancy actually DECREASED for three years in a row, something that has never happened before since America started recording lifespan. Why? Why do other similarly advanced nations NOT show this trend for increasing deaths? These kinds of deaths -- suicide, drug overdose, and alcoholism -- are called deaths of despair because they might all be a kind of suicide. When a person overdoses on drugs it is never quite certain whether it was a suicide or not, and kinds of drugs killing them -- mostly opiates -- are often associate with people trying to escape their own situation. Alcoholism is also used to escape the world. While some of these deaths are pure accidents, most of the people dying this way are in one way or another GIVING UP on life. These deaths are correlated to level of education and to race. White men without a college degree show the most pronounced trend. White women without education as well increased, but women kill themselves at a fraction of the rate the men do. Hispanic men and women do not show this increase, nor do those of asian descent. Blacks do not show the trend either, at least not until 2013, and then to a smaller extent. White men & women with a college degree seem to escape the problem. The book is filled with enough charts and graphs to delight the most nascent budding economist in any reader. It is truly astonishing that having a college degree makes such a pronounced difference in death rates. "economists seek to explain why people choose to commit suicide, while sociologists explain why they have no such choice." The big question is: why is this happening? There is more pain in general today. More drinking, and certainly more opium. Arthur Sackler (drug magnate) and his brothers (exclusive promoters of OxyContin) were compared to the key players in the Opium War between China and England: huge piles of money were made in both cases, people were knighted and celebrated officially in both cases, and there was a huge toll on life of civilians in both cases. "As religion faltered, opioids became the opium of the masses." "Doctors may not even know that their patients have died from drugs that they have prescribed." The opioid crisis looms as a huge ugly problem, but why does it hit this particular economic sector? The authors carefully eliminate poverty itself as a cause, because there are plenty of poor people who don't show rising deaths of these types, particularly poor hispanic. The great recession came and went, yet the death rates of white non-eduducated men show no particular rise in those years. Rising inequality is a big problem, but that alone does not explain the problem. Part 4 of the book delves into causes and solutions: The leading cause is the American healthcare system itself. The second cause is that "corporations have accumulated market power that is increasingly used against both workers and consumers." "The cost of healthcare is like a tribute that Americans have to pay to a foreign power" "The US healthcare system absorbs 18% of GDP . . . about four times what the country spends on defense, and about three times what is spends on education" "American healthcare is the most expensive in the world, and yet American health is among the worst among rich countries." You have heard of "Robin Hood" style redistribution of money? The authors introduce a new term: "Sheriff of Nottingham style redistribution of money." Stealing from the poor and giving to the rich. Hospitals are consolidating and eliminating competition giving them a monopoly over a given area. "Surprise bills" support the predatory behavior of hospitals and emergency response. "This sort of predation is a prime example of a system that transfers money upward." "health insurance is less about protecting your health than about protecting your wallet against the healthcare system" Aggregate state spending on healthcare grew from 20% in 2008 to 30% in 2018, while spending on education fell from 22% in 2008 to 29.6% in 2018. Healthcare proponents like to think that healthcare is a free market, but that is far from the truth. Drug companies are given monopolies and absolutely no price controls. The healthcare lobby is the largest lobby in Washington, with more than 5 lobbyist for every member of congress. The supply of doctors is controlled and greatly limited by the AMA. "The industry that is supposed to improve our health is undermining it, and Congress . . . is supporting the shakedown." Other rich countries do not have this problem because the most disadvantages are still protected by a safety net. The insufficiency of this in America has been hardest felt by those without a college degree now being squeezed by robotic automation and global trade. Corporate greed has been left to run amok with ample collusion by the government. Hiring practices for gig-style work has eaten away at worker protections that citizens used to count on. What to do? The culmination comes (naturally) in the final chapter -- and excellent read well supported by all the hard date preceding it in the book. There are no easy solutions. It will take a combination of: * Opioids are like gasoline showered on a smoldering despair. Opioid addiction treatment would prevent a lot of deaths, but the underlying problem is that the pharma industry is free ranging, government supported system for exploiting American citizens and needs to be reigned in. * Americans should follow other rich countries in providing universal insurance and controlling healthcare costs. This would free up literally trillions of dollars that could be spent on other necessary improvements in the country. * A comprehensive reform of US corporations including employee representation on boards would be good but challenging to do. Outsourcing firms should not exist simply to cut wages or benefits. Non-compete clauses should be outlawed everywhere. * They are not in favor of universal basic income in the current situation, but believe there are changes that could prevent the worst of the laws that ravage the poor and make work difficult. * Action should be taken to reduce monopsony -- market power on labor markets -- which allows employers to pay less than a competitive wage. * A national minimum wage of $15 is long overdue. Lobbyists spread fear that raising the lowest wages will reduce employment or hurt companies, however there is sufficient well researched evidence that this is baseless fear mongering. * Patent protection should be reduced. "Much of patent protection is unnecessary and against the public interest" * College education needs to be more open to all people. There are creative answers, but what is clear is that less-skilled workers are no longer in demand. * "We must somehow stop of reverse the decline of wages for the less educated Americans." "The fundamental problem is UNFAIRNESS, that the great wealth at the top is seen as ill-gotten in a system that gives no change to many. We argue that limiting rent-seeking and reducing plunder will rein in the rich and reduce the unfair top incomes without high taxes on income or wealth that is widely seen as fairly earned." The geographical map of where people are dying from deaths of despair happens to match closely the geographical areas for Trump voters. This is evidence of a deep pain that those of us educated people may not see or hear of. As we close in on the 2020 presidential election, it is important to remember that Trump did not bring these problems. They existed long before, and will survive after he is replaced. The real job is correcting these systemic problems and we must not falter. "Democracy in America is not working well, but it is far from dead."

  9. 5 out of 5

    Ben Schneider

    The book gives a full and harrowing account of the social and physical destruction of the white working class (those without college education). One of the most compelling arguments ties the enormous and wasteful cost of US healthcare to the elimination or outsourcing of low wage jobs and pay reduction for unskilled workers with jobs. Companies only hire additional workers if they produce more than their cost of employment. As costs of health insurance rise, companies either reduce the wage shar The book gives a full and harrowing account of the social and physical destruction of the white working class (those without college education). One of the most compelling arguments ties the enormous and wasteful cost of US healthcare to the elimination or outsourcing of low wage jobs and pay reduction for unskilled workers with jobs. Companies only hire additional workers if they produce more than their cost of employment. As costs of health insurance rise, companies either reduce the wage share of worker cost or eliminate the job.

  10. 5 out of 5

    Marcel Santos

    Impressive (and sometimes unbelievable) extensive research done by the authors in this book, who found in 2019 that life expectancy at birth in the USA had been falling for the previous 3 consecutive years. The cohort responsible for such a fall in the still biggest economy in the World is working age non-Hispanic white Americans without a four-year degree, especially men. The causes for early deaths: suicides, alcohol and drugs. The authors identify, as a result of an extensive empirical work, Impressive (and sometimes unbelievable) extensive research done by the authors in this book, who found in 2019 that life expectancy at birth in the USA had been falling for the previous 3 consecutive years. The cohort responsible for such a fall in the still biggest economy in the World is working age non-Hispanic white Americans without a four-year degree, especially men. The causes for early deaths: suicides, alcohol and drugs. The authors identify, as a result of an extensive empirical work, a true epidemic of opioid abuse, something that differentiates the United States from other rich countries, which have not been experiencing the same problem. The book investigates and denounces the various possible causes, from the rapid transformation of forms of work, which have been making low-grade workers increasingly obsolete, to the reduction in importance of unions, to the competition with China, but especially to the role of the pharmaceutical industry in the US, with intense rent seeking activity. They see the growth of lobbying and poor enforcement of antitrust law in this sector as central problems, in addition to the inefficiency of the health system vis-à-vis its immense costs. The book also goes through the economic problems underlying the "deaths of despair", such as: growing inequality and separation in cities and communities between rich and poor. It is also interesting to note that the social problem that hit the black American community 50 years ago — yet in that case with crack cocaine — now affects non-Hispanic whites without a four-year degree with the use of painkillers. Another factor also for reflection and further research especially in the field of Psychology: the greatest impact of the phenomenon on men, which leads to questioning not only cultural issues but also constitutive aspects of man while dependent on his work (see studies on big 5 personality traits, Jordan Peterson, etc.). The authors propose solutions, broadly analyzing aspects of regulation and institutional design, more active enforcement of competition laws and greater regulation of the lobbying. With positions like these, it is easy to incorrectly classify the authors (one of them Nobel Prize laureate in Economics) as leftists; however, they are very careful to say that the capitalist system is the best existing system, although the American health sector suffers from major structural issues and bad incentives, therefore, should not be left under a free market regime. Another point for reflection: if the crisis seems to be going up in the social hierarchy, what will be the next social group in the queue to suffer from similar problems? Historian Yuval Noah Harari points out that advances in automation and artificial intelligence, unlike what happened in the past, are now as fast as ever, which will make a gigantic contingent of people at working age and with some education totally obsolete. If the epidemic of deaths is largely instrumentalized by the use of opioids, it is worth asking whether in the future with a greater strangulation of the labor market, valuing only the highly qualified, the next epidemic of medicines will be with the so-called “brain enhancers”. Their abusive use has also been identified among students and executives under pressure to increase their intellectual performances.

  11. 4 out of 5

    Elizabeth

    As heard on The Indicator from Planet Money (Healthcare And Economic Despair): https://www.npr.org/2020/03/12/815128... As heard on The Indicator from Planet Money (Healthcare And Economic Despair): https://www.npr.org/2020/03/12/815128...

  12. 5 out of 5

    Bob Harris

    An in-depth look at data generated by a variety of sources to trace the rise in what the authors call 'deaths of despair': death from suicide, drug overdoses (accidental or otherwise) and alcoholism. These data, briefly brake down between those with a bachelors degree or higher and those who don't. The latter category be overly represented among those in the south-east and mid-west who generally vote Republican. This is a depressing report and should be required reading for every member of congr An in-depth look at data generated by a variety of sources to trace the rise in what the authors call 'deaths of despair': death from suicide, drug overdoses (accidental or otherwise) and alcoholism. These data, briefly brake down between those with a bachelors degree or higher and those who don't. The latter category be overly represented among those in the south-east and mid-west who generally vote Republican. This is a depressing report and should be required reading for every member of congress and state legislatures, since the authors provide policy suggestions for alleviating the suffering of millions of Americcans.

  13. 5 out of 5

    Kirsti

    I thought this book would be too intellectual for me, but I was able to keep up and understand things. This book is actually a little repetitive. That's not the worst thing in an audiobook! The authors state up front that they designed the audiobook to be understandable without having to refer to the charts, graphs, and other visual information in the print book. I wish more audiobooks would do this. The main focus of the book is that deaths of despair, which include those from suicide, drug addi I thought this book would be too intellectual for me, but I was able to keep up and understand things. This book is actually a little repetitive. That's not the worst thing in an audiobook! The authors state up front that they designed the audiobook to be understandable without having to refer to the charts, graphs, and other visual information in the print book. I wish more audiobooks would do this. The main focus of the book is that deaths of despair, which include those from suicide, drug addiction, and alcohol addiction, are on the rise. Average lifespan in the United States was actually declining slightly in the years before COVID-19—a decline that other rich countries did not see. These deaths happen at a much higher rate among Americans who do not have a bachelor's degree. The main message of the book is that in general, Americans who lack a four-year degree are really getting shafted. The decreasing power of unions and increasing number of lobbyists means that politicians who are supposed to represent all the people are mostly focusing on the rich and the middle class. To me, the biggest surprise was that the authors do not favor a universal basic income. They believe that older people and people with disabilities would be worse off under a UBI. Also, even though they are both college professors, they point out that free four-year college educations would be very expensive and would mostly benefit people who are already doing better than average. The comparisons between the United States and other rich countries were very helpful. It's good to know how other countries do things, so we know that it's not impossible to improve the U.S. economy and make government more responsive to all the people.

  14. 4 out of 5

    Yong Kwon

    Case/Deaton provide indisputable evidence of a crisis underway in American society - white men without college degrees are killing themselves at an alarming rate. However, the book falls short on answering why this is happening. They lay out several potential reasons, including the general decline in income. But they also refute economic causes by pointing to the absence of the same trend (so far) among African Americans who face much worse life conditions. Refreshingly, they take a stronger soci Case/Deaton provide indisputable evidence of a crisis underway in American society - white men without college degrees are killing themselves at an alarming rate. However, the book falls short on answering why this is happening. They lay out several potential reasons, including the general decline in income. But they also refute economic causes by pointing to the absence of the same trend (so far) among African Americans who face much worse life conditions. Refreshingly, they take a stronger sociological perspective, looking at the trajectory of a cohort's life outcomes (i.e. getting better v. worse) as a stronger predictor of whether that cohort is likely to fall prey to opioids. But this hypothesis is not tested among other cohorts or in other time periods, leaving the readers to mull on a complex issue without a satisfactory answer. While race plays a prominent role, one also wonders whether the gross yoke of capitalism that Case/Deaton lays out in the book has not actually made the oppression of the unskilled working class colorblind. Black men may not be committing suicide but they still suffer higher mortality rates - and the "deaths of despair" among white workers are bringing the two cohorts' mortality rates on a convergent path. The second part of the book is a sturm und drang critique of the system that has created the misery the authors spend so long describing. For liberal readers, many of the statements will echo their beliefs about the need for stronger regulations, etc. However, the prescriptions are not rigorously defended. Moreover, they make strange arguments such as one that claims corporations' monopolistic aspirations are not as bad as a monopsony. Statements like that make me question whether the authors have really taken into account the profile of the modern economy where Amazon is both a monopsony because it is a monopoly. The book is worthwhile. But if you are short on time, their research paper may be more suitable and more efficient vehicle for consuming their key points.

  15. 5 out of 5

    Patrick

    Ehh. First half was 5 stars, second half was 1. They do a good job highlighting how bleak the US is at this point, and how things went wrong. But the recommendations and conclusion section? Really just bows out and doesn’t offer substantial challenge to rent seeking and capitalism. For spending so long excoriating the woes of inequality, the “let’s hope things can be more fair in the future” attitude of the ending rang especially empty. I saw another GR review say this could have been a long edi Ehh. First half was 5 stars, second half was 1. They do a good job highlighting how bleak the US is at this point, and how things went wrong. But the recommendations and conclusion section? Really just bows out and doesn’t offer substantial challenge to rent seeking and capitalism. For spending so long excoriating the woes of inequality, the “let’s hope things can be more fair in the future” attitude of the ending rang especially empty. I saw another GR review say this could have been a long editorial, and I probably agree. But it is an important thing that the authors really took to task the idea of prosperous capitalism and goodness in this country, and offered plenty of evidence as to the current state of things. And I did enjoy reading it, after all. So three stars, but really only useful insofar as it offers context.

  16. 4 out of 5

    Sarah

    Case and Deaton's earlier New York Times article introducing Deaths of Despair pointed my interest in this direction in 2015/2016 and influenced my first master's thesis. Now their research is more fully explained in book length, and I would recommend this title to anyone looking to understand just one major piece of the confusing puzzle we find ourselves in. As it happens, the point of my thesis in broad strokes was more concisely and better described by Dave Chappelle in one part of his most r Case and Deaton's earlier New York Times article introducing Deaths of Despair pointed my interest in this direction in 2015/2016 and influenced my first master's thesis. Now their research is more fully explained in book length, and I would recommend this title to anyone looking to understand just one major piece of the confusing puzzle we find ourselves in. As it happens, the point of my thesis in broad strokes was more concisely and better described by Dave Chappelle in one part of his most recent post-2020 election SNL monologue. Best quote from the book came to me on the morning of our most recent election. In discussion of the OxyContin/Sackler family garbage fire they write: "Like an eighteenth-century wig, the perfume disguises, but does not eliminate, the stench of moral decay." (p.120)

  17. 4 out of 5

    Luis

    Superb treatise on the consequences of American capitalism By focusing on explaining what is driving the increase of the deaths of despair (suicides, drug overdoses, alcohol linked hepatic failure) among white non college educated Americans, the authors are able to provide a stark portrait of the workings of American capitalism. In particular, it exhibits how the mixture of external and technological shocks, with policy failures in high impact areas such as pharmaceuticals, and a faulty instituti Superb treatise on the consequences of American capitalism By focusing on explaining what is driving the increase of the deaths of despair (suicides, drug overdoses, alcohol linked hepatic failure) among white non college educated Americans, the authors are able to provide a stark portrait of the workings of American capitalism. In particular, it exhibits how the mixture of external and technological shocks, with policy failures in high impact areas such as pharmaceuticals, and a faulty institutional design in healthcare, has led to a societal collapse among the white non college educated population . By doing that, it also provides a necessary input for any analysis of the current political landscape in the US.

  18. 4 out of 5

    Angie Boyter

    The book is a real treasure house of interesting data, and the authors have a credible theory that I believe they overdo. I skipped or scanned much of the last 2/3 and so will not rate it formally.

  19. 5 out of 5

    Emily Duchon

    Somewhere between a 3 and 4 for me. Very interesting, well documented, a bit repetitive for my tastes.

  20. 4 out of 5

    Marks54

    This is a book by a husband-wife team of distinguished economists at Princeton, one of whom was a recent Nobel prize winner. The purpose of the book is to explore, explain, and expand upon one empirical pattern that the authors had identified in an earlier 2015 paper. What pattern? That since 2000, there has been a significant decline in life expectancy among working class white Americans between the ages of 45 and 54 who lack a college degree. The cause for this decline has been a clear increas This is a book by a husband-wife team of distinguished economists at Princeton, one of whom was a recent Nobel prize winner. The purpose of the book is to explore, explain, and expand upon one empirical pattern that the authors had identified in an earlier 2015 paper. What pattern? That since 2000, there has been a significant decline in life expectancy among working class white Americans between the ages of 45 and 54 who lack a college degree. The cause for this decline has been a clear increase in this group of what the authors call “deaths of despair” due to suicide, drug overdose, and kidney related diseases. This pattern is not a continuation of past tendencies. It is not shared by whites of the same age but with a college degree or higher education. It is not shared by others in different ethnic groups of similar ages. It is not present in other industrialized countries. Isn’t this like what happened to African American communities in the 1980s and 1990s? Yes, in some ways although not in others. Case and Deaton link their analysis to work by Willian Julius Wilson on the hollowing out of black communities (The Truly Disadvantaged). However, they are focusing on a more recent development, one which is not occurring in African American communities. Think about this effect. Life expectancy does not decline in the US, long one of the richest countries in the world. One has to go back to 1918-1919 and the Spanish Flu to see the last example (not counting wars, of course). This is not a result that occurs in Western developed economies. It is a very unusual statistical “fact” that they set out to explain and not a pleasant one to consider. Many will no doubt claim that this cannot be correct, that there must be a data problem, that something has been left out, or that in some other way, this is an artifact rather than a finding with a basis in any social reality. Rest assured - the authors have all or most of the data and know how to use the data. The book clearly examines all sorts of data and analysis related issues. Given the people who reviewed the book (see the acknowledgements), if there were these sorts of problems, the authors would have been informed if they did not catch them on their own. This appears to be a real result. Some might complain about the lack of experimental results to nail down the analysis, but those sorts of more macro issues do not follow laboratory schedules and to expect that they would comes across as phony at best. There is considerable craft that goes into a good economic study. But if it is solely an economics study, the result tends to seem overly complex, abstract, and a bit dry. Since the world is complicated, a good study will not just do the economics well but will also link to other aspects of the world that help explain what is going on. Case and Deaton tell a complex story. Issues of suicide, addictions, and self-destructive behavior have tended to resist efforts at rational explanation. Case and Deaton recognize this and link with both health care and management-labor dynamics, in addition to the more expected explanatory lines of automation, globalization, outsourcing, and the “knowledge economy”. The explanatory story is one that ties together many of the conventional explanations into a general account of how the way of life of the American working class has changed since 1970. It is well worth reading. The authors conclude with policy recommendations that are general and that reflect the complexity of changing social policy in the highly contextualized US situation. Besides, the policy discussion is heads and tails above current discussions by policy makers and I am fine with that. This is not just an “academic” discussion for me. When you encounter suicides among the people you grew up with or when you see firsthand how alcoholism and drug abuse can destroy families, your attention gets focused sharply on the broader costs of “deaths of despair” - and you appreciate those with the skills and courage to write about them. This is an extraordinary book. As a coda, I can only wonder how the consequences of the current plague (COVID-19) is going to affect the dynamics chronicled in this book, but I suspect that they will. ***I just saw that Case and Deaton have an opinion piece in the NYT Sunday Review (4/19) on health care reform that raises many of the points they raise in their book.

  21. 5 out of 5

    Martyn Smith

    This sociological study held particular interest for me because of the suicide some years back of my closest friend in high school and early adulthood. I know alcohol was involved, and financial pressures. In his darkly short inaugural address Donald Trump used the phrase “American carnage.” I couldn’t then understand how that word could describe the outlook of the white Americans who voted for him. This book takes a more temperate tone, but the authors still speak in terms of “wreckage” and an This sociological study held particular interest for me because of the suicide some years back of my closest friend in high school and early adulthood. I know alcohol was involved, and financial pressures. In his darkly short inaugural address Donald Trump used the phrase “American carnage.” I couldn’t then understand how that word could describe the outlook of the white Americans who voted for him. This book takes a more temperate tone, but the authors still speak in terms of “wreckage” and an “unfolding loss of a way of life.” Those suffering this loss most acutely are middle-aged whites without a bachelor’s degree. This book is both timely and untimely. It goes some way to explaining the angry and nihilistic block of voters that put Trump in the White House. This is by no means a political book, but of course the connections come through, such as when the authors note “The fraction of people in an area who voted for Donald Trump in 2016 is also strongly correlated with the fraction in pain.” I put down this book, with its graphs and maps of a kind of red state pain belt, and felt like it had given me a valuable window for understanding the present. Yet it’s an untimely book since its focus is on the white working class, a significant percentage of whom feel that whites are more likely to be treated unfairly than blacks. It’s a group brimming with resentment (which only makes me more proud of how my friend kicked against hatred of others until the end of his life). The authors devote a chapter to explain why concentrating on this group makes sense. This group has seen life expectancy drop and has suffered the most from “deaths of despair” (a phrase that bundles together suicide, drug-overdose, alcohol related deaths). The book is not just a description of the problem, but an investigation into the root cause of this epidemic. The economic numbers are part of the story. Wages have remained flat for the working class for many years. The authors give particularly close attention to health care costs, which redistribute wealth from the working class to the wealthy. The authors liken health care costs to a “tribute that Americans have to pay to a foreign power”—meaning it’s money from which most Americans see no benefit, either in the private or public spheres. Economic loss doesn’t fully explain despair, and this is where the book particularly captured my interest as a professor of religious studies. Loss of community is another major contributor. The role of families, workplace groups, and religious organizations has declined steadily for this group of middle-aged whites without a college education. Deaths of despair should be understood as related to this loss of meaningful community, and here the authors look back to Émile Durkheim’s work on suicide. This loss of community also makes sense of the message I hear over and over at Evangelical churches, offering purpose and connection and the breaking of chains. Evangelicals have their own reckoning on the way for their actions, but they are on the front line of ministering to those who the authors of this book describe, without irony, as the “left behind.”

  22. 5 out of 5

    AndPeggy

    A good examination of the increase in deaths of despair (suicide, drug overdose, alcohol-related deaths), primarily among white middle-aged people and especially those without a college degree. It examines the role of the healthcare system, the reduction of union power and increase in corporate power and monopolies, and the advancement of corporate interests through lobbying. The authors are pro-capitalism, while allowing that competition is not a favorable solution to all services, and advocate A good examination of the increase in deaths of despair (suicide, drug overdose, alcohol-related deaths), primarily among white middle-aged people and especially those without a college degree. It examines the role of the healthcare system, the reduction of union power and increase in corporate power and monopolies, and the advancement of corporate interests through lobbying. The authors are pro-capitalism, while allowing that competition is not a favorable solution to all services, and advocate for reforms to capitalism and the elimination of cronyism. The book is divided into four parts with three examining numbers that go into deaths of despair and reflect the quality of life, and the fourth part is dedicated to causes and recommended solutions such as anti-trust, healthcare reform, wage policy reform, solutions such as making Facebook and Google pay everytime they use information from users, increasing minimum wage or using wage subsidies.

  23. 4 out of 5

    Kyle Chapman

    "The Sheriff of Nottingham has taken up residence in Washington, DC, and the good cops have left town. Robin Hood is nowhere to be seen." The importance of Deaths of Despair lies in its ability to successfully lay out the major issues of American democracy and capitalism today. Anne Case and Angus Deaton strive to understand why thousands of Americans are dying of "despair" (suicide, drugs, and alcohol), and why these high numbers of deaths have been steadily increasingly over the decades. In 201 "The Sheriff of Nottingham has taken up residence in Washington, DC, and the good cops have left town. Robin Hood is nowhere to be seen." The importance of Deaths of Despair lies in its ability to successfully lay out the major issues of American democracy and capitalism today. Anne Case and Angus Deaton strive to understand why thousands of Americans are dying of "despair" (suicide, drugs, and alcohol), and why these high numbers of deaths have been steadily increasingly over the decades. In 2017 alone, 158,000 Americans died from suicide, drug overdose, and alcoholic liver disease. When compared to other rich countries, the US ranks first, with second not even being close. Its obvious that something is going awfully wrong in America. Why are so many people, most of whom are middle-aged, dying? And whatever these reasons may be, is there anything that can be done to fix it? These are the questions the authors explore and answer. Without giving away too many spoilers, Case and Deaton realize that the majority of those currently suffering and dying are less-educated working-class whites (people who do not have a bachelor's degree). Due to the fact that the white working-class has been hit the hardest, the book tends to solely focus on the white working-class. It's made clear from the start that what's happening is not a racial issue, but a class issue. Blacks have long faced discrimination in all aspects of public life in America, and because of this, the black working-class has tended to face more poverty and hardships than whites. In the past couple decades however the lives of many blacks have improved, as they face less discrimination and are open to more opportunities. Despite these improvements, many blacks in America still face tremendous hardships. But while the lives of blacks have been slowly increasing, the lives of the white working-class have been rapidly deteriorating (financially and socially). The reasons behind this are numerous and complex, but the authors try to simplify it by pointing to a couple key factors: the healthcare system, the opioid epidemic, and rent-seeking (transfer of power from labor to capital). Upon reading this book I realized just how corrupt and broken the current American system is. The lowering of wages, destruction of unions, increase in temp firms, lobbying, insanely overpriced healthcare, lack of an effective safety net - its no wonder why the lives of the American working-class are being destroyed. People are not only seeing a lowering of income, their seeing their dignity and pride being taken away as well. What good is a healthcare system that charges $1,100 for an MRI, or $40,000 for a hip replacement surgery? Due to their stress, more Americans are experiencing pain (physical and/or mental) and are thus turning to drugs, many of which are prescribed by their doctors. Large pharmaceutical companies see an opportunity and overcharge their product and pressure doctors to over-prescribe their patients with certain drugs (an example is OxyContin, which is essentially legalized heroin). As a result of all this, many are finding it too hard to live and are turning to addiction to cope, or in the worst case scenario, end it all through suicide. Its a sad story, but one that needs to be told and heard because it is happening NOW. Case and Deaton end on a somewhat optimistic note by suggesting ways the US can overcome the crisis (healthcare reform, stronger antitrust enforcement, etc.), and by looking in the past and seeking inspiration from how the country faced and conquered similar issues (the Progressive Era's war on monopolies and inequalities).

  24. 5 out of 5

    Miguel

    Whenever one encounters examination on income inequality it is hard to escape references to the research from Deaton and Case and this work neatly encapsulates their main body of study into poverty and welfare. Even though Deaton was awarded the Nobel in Economics, there are no equations to be found within and this reads much more like a sociological study than one based in economics although of course it is inevitably firmly rooted in both fields. The book shows the major finding of declining l Whenever one encounters examination on income inequality it is hard to escape references to the research from Deaton and Case and this work neatly encapsulates their main body of study into poverty and welfare. Even though Deaton was awarded the Nobel in Economics, there are no equations to be found within and this reads much more like a sociological study than one based in economics although of course it is inevitably firmly rooted in both fields. The book shows the major finding of declining longevity among the poor in the US (almost unheard of to date in the industrialized world) and their work looks into the reasons behind this anomalous fall. As stated it’s been cited so often that the information doesn’t necessarily feel new, but this book certainly does a stellar job in corralling all of the findings and presenting it in a very straightforward fashion. It’s one of those books that you wish that a large percentage of the electorate in the US would read for some light bulbs to go up atop many heads, yet unfortunately it will likely remain a little read university press publication. The only quibble is with the recommendations. It does seem like the very modest proposals put forward at the end would likely have an effect on turning the tide back on the trend of these deaths of despair. They also have a very convincing case against implementing a UBI – one of the best summations of its shortcomings. However, it does feel that in spite of expertly detailing all of the shortcomings of the US system that the authors can’t quite seem to offer a more meaty set solutions to address the underlying issues. Nevertheless the contents more than make up for some of the lackluster market oriented solutions they propose.

  25. 5 out of 5

    Sam McCarthy

    Good book on the decline of the white working class. The argument that working class whites are now suffering the deindustrialization that devastated inner city Black communities is novel and compelling. Nevertheless, I was a bit frustrated by the constant insistence that higher taxation is not NECESSARILY needed to curb income inequality. Ultimately, ideologically, the authors seem to fall on the Warren end of the Democratic spectrum—endorsers of expanding healthcare, raising minimum wage, trus Good book on the decline of the white working class. The argument that working class whites are now suffering the deindustrialization that devastated inner city Black communities is novel and compelling. Nevertheless, I was a bit frustrated by the constant insistence that higher taxation is not NECESSARILY needed to curb income inequality. Ultimately, ideologically, the authors seem to fall on the Warren end of the Democratic spectrum—endorsers of expanding healthcare, raising minimum wage, trustbusting, etc., without questioning the underlying legitimacy of capitalism, as a Bernie/DSA type would.

  26. 4 out of 5

    Steve Nolan

    This is maybe the most "Elizabeth Warren 2020" book I've ever read. Which is like, mostly good! But just doesn't get all the way there in figuring it out.

  27. 5 out of 5

    Stephen Hiemstra

    Even before the corona virus pandemic, life has been difficult for many Americans. For those without a college degree, real incomes have been flat or declining since around 1980. In recent years, we have seen multiple years of declining life expectancy and record levels of suicide, drug overdoses, and opioid deaths. Adding insult to injury, mainstream politicians of both parties have mostly ignored these problems. When I heard about Anne Case and Angus Deaton’s book, Deaths of Despair and the Fu Even before the corona virus pandemic, life has been difficult for many Americans. For those without a college degree, real incomes have been flat or declining since around 1980. In recent years, we have seen multiple years of declining life expectancy and record levels of suicide, drug overdoses, and opioid deaths. Adding insult to injury, mainstream politicians of both parties have mostly ignored these problems. When I heard about Anne Case and Angus Deaton’s book, Deaths of Despair and the Future of Capitalism, I immediately ordered a copy. Introduction When it is reported that life expectancy has been declining in the United States in recent years, the implication is that death (or mortality) rates are rising. Case and Deaton write: “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…deaths of despair…The book is about these deaths and about the people who are dying.” (2) These deaths of despair are preventable, not happening in other industrialized countries, and primarily among middle-aged white, non-Hispanic men (4)—the ones commonly described in popular culture as those benefitting from “white” privilege, which has vaporized in this generation (5). Case Deaton observe: “The widening gap between those with and without a bachelor’s degree is not only in death, but also in quality of life; those without a degree are seeing increases in their levels of pain, ill heath, and serious mental distress, and declines in their ability to work and to socialize. The gap is also widening in earnings, in family stability, and in community. A four-year degree has become the key marker of social status.” (3) In part one of this review, I will offer an overview and focus on changes affecting individuals. In part two I will discuss the economic environment that brought about these outcomes. Background and Organization Anne Case and Angus Deaton are economists emeriti of the faculty of Princeton University. Deaton won the Nobel Prize for economics in 2015. Deaths of Despair and the Future of Capitalism is written in sixteen chapters divided into four papers: PART I. PAST AS PROLOGUE The Calm before the Storm Things Come Apart Deaths of Despair PART II. THE ANATOMY OF THE BATTLEFIELD The Lives and Deaths of the More (or Less) Educated Black and White Deaths The Health of the Living The Misery and Mystery of Pain Suicide, Drugs, and Alcohol Opioids PART III. WHAT”S THE ECONOMY GOT TO DO WITH IT? False Trails: Poverty, Income, and the Great Recession Growing Apart at Work Widening Gaps at Home PART IV. WHY IS CAPITALISM FAILING SO MANY? How American Healthcare is Undermining Lives Capitalism, Immigrants, Robots, and China Firms, Consumers, and Workers What to Do? (vii) These chapters are preceded by a preface and introduction, and followed by Acknowledgments, Notes, and an index. Dimming Prospects A key motivator for writing about deaths of despair starts with a stark economic reality: “After correction for inflation, the median wages of American men have been stagnant for half a century; for white men without a four- degree, median earnings lost 13 percent of their purchasing power between between 1979 and 2017…. Since the end of the Great Recession, between January 2010 and January 2019 nearly sixteen million new jobs were created, but fewer than three million were for those without a four-year degree. Only fifty-five thousand were for those with only a high school degree.” (7) The easy summary of this problem is to observe that less educated white American men are substantially less able to participate in the American dream of having a good paying job, a family, a house, medical and pension benefits. Here we are talking about 38 percent of the working-age population (4).  Case and Deaton observe: “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.” (4) Less money, less connection, less religion, less life-expectancy. Without a job, white men are simply shamed as losers. This shame and guilt is currently being turned inward, but the authors note that this is likely soon to turn outward into violence (14). The current political climate suggests that this later outcome is not far off. Assessment Anne Case and Deaton’s Deaths of Despair and the Future of Capitalism provides a detailed look into the disturbing problem of declining life expectancy in America. While in the past poor economic performance has usually been attributed to the entry of poorly educated immigrants, racism, or a multicycle of poverty, the authors point to growing class distinctions correlated with college graduation, an oligopolistic corporate structure, and changing trends in the workforce. Deaths of despair uniquely affect non-Hispanic, white American men. Blue-collar European men face the same economic reality, but have a healthcare plan and have a longer life-expectancy. This book is well written and documented. It should be required reading for those studying economics and cultural trends, especially presidential candidates. This is part 1 of my review. The second part will appear on T2Pneuma.net on October 13, 2020.

  28. 4 out of 5

    Carolyn

    Suicide, drug overdose, and alcoholism -- these are the types of death caused by despair. These causes of death have increased in recent years such that there has been an actual decrease in life expectancy in the United States. The authors cite disturbing changes in capitalism as a reason for the despair. I was surprised at the seeming protective effect of a four-year college degree.

  29. 5 out of 5

    James

    This book is a good summary of the shocking Case-Deaton findings about the epidemic of deaths by drug overdoses, drinking, and suicide among the white working class in the U.S. since the mid-1990s. They also make a convincing case that the U.S. health system is both unfair and insanely overpriced. Their closing discussion about what to do about the problem is less compelling.

  30. 5 out of 5

    Kathleen Hulser

    A wonderful book that marshalls evidence to discuss why mortality is rising in a small swathe of America -- mainly less educated middle-aged white men. Anne Case and Angus Deaton, a sociologist and an economist pay attention to data, so they were puzzled by an anomaly in statistics. In western industrialized countries, mortality has been falling, sometimes a lot, sometimes a bit but no country has a trend for rising mortality. Except the US, since the 1990s, when rising job losses and inequality A wonderful book that marshalls evidence to discuss why mortality is rising in a small swathe of America -- mainly less educated middle-aged white men. Anne Case and Angus Deaton, a sociologist and an economist pay attention to data, so they were puzzled by an anomaly in statistics. In western industrialized countries, mortality has been falling, sometimes a lot, sometimes a bit but no country has a trend for rising mortality. Except the US, since the 1990s, when rising job losses and inequality, especially for the less educated seem to be wreaking visible damage. Their investigation of this statistical blip plunges them into issues that are the heart of unequal and unjust America, a place where people have decided not to use the US's incredible, world-historical wealth to do much of anything to improve people's lives. It is not inequality alone which is causing what they term the "epidemic" of deaths of despair; it is both the fact of declining living standards and the glaring abuse of power that is keeping wages down and sending wealth to the one percent that create a context for loss of hope. In order to find out what causes the rise in what they call "deaths of despair" they focus on where and how the high rates of suicide, drug overdoses and alcoholism are killing people. Places where jobs have been lost on a large scale (and seemingly forever) and opportunity is low seem to be the key hot spots for rising mortality. So West Virginia and Kentucky, places with low rates of college degrees and high rates of unemployment contribute more than their share to the 158,000 deaths a year that Case and Deaton classify as possibly preventable. "Declines in income work alongside negative social and political factors," they write. But inequality is an important part of this: poverty undermines social relationships as well as making life incredibly difficult. The writers emphasize that this trend relates to not just income, but the loss of meaning that "good jobs" once had. "Jobs are not just the source of money; they are the basis for the rituals, customs and routines of working-class life," and can mean devastating loss of dignity, pride and self-respect which are at least as corrosive as lack of wages are. The core problem is the blatant and visible unfairness of today's system, which contrasts with what people knew in living memory when some benefits of a growing economy could be reaped by those at the low end of the social scale, as in the expansive 1950s. Case and Deaton call the American healthcare system a calamity. They see it as a social failure with wide ripple effects: the astronomical extortion level costs ("delivering the worst health outcomes of any rich country) actually suck money out of the economy that could easily go to education, social services, infrastructure and many other needs. The wastage of national income is a societal scandal, not just a disaster for those who have little or no access to healthcare. Poor, deficient or absent health care contributes to the crisis they are describing -- substance abuse is often entangled with ill health, and mental health issues afflict large portion of prison populations. The authors believes that the situation could be remedied and offer practical policy proposals on education, antitrust actions, tax and benefits policies, corporate governance and healthcare. Elizabeth Warren must be familiar with these prescriptions. But it remains to be seen if and how America will wake up and take the bold steps needed to "reform capitalism" before democracy collapses here under the weight of these systemic failures.

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