The Roots Of American Misery

project-syndicate |  In refreshing contrast, Anne Case and Angus Deaton, wife-and-husband economists at Princeton, offer a careful, deep, and troubling look at the America that lies beyond the Ivy League. In a study organized around the grim recent decline of life expectancy among white males and the equally grim rise of deaths from suicide, alcohol, and opioids, they demonstrate a broad range of knowledge, analytical nuance, and open-mindedness. They do not start with some certainty that will be hammered home, nor do they try to explain everything with a single trademark concept, as Putnam does with individualism and Sandel with meritocracy. Rather, their book is an exploration of historical patterns guided by a meticulous effort to reconcile statistical facts with plausible explanations.

A great merit of Case and Deaton’s approach is their blunt assault on named villains, starting with the producers and peddlers of opioids. “In the opioid epidemic,” they write:

“… the agents were not viruses or bacteria but rather the pharmaceutical companies that manufactured the drugs and aggressively pushed their sales; the members of Congress who prevented the [Drug Enforcement Administration] from prosecuting mindful overprescription; the DEA, which acceded to lobbyists’ requests not to close the legal loophole that was allowing importation of raw material from poppy farms in Tasmania that had been planted to feed the epidemic; the [Food and Drug Administration], which approved the drugs …; the medical professionals who carelessly overprescribed them; and the drug dealers from Mexico and China who took over when the medical profession began to pull back.”They also single out Republican US Senator Marsha Blackburn of Tennessee, former Republican Senator Orrin Hatch of Utah, and the now-notorious Sackler family (two of whom were knighted by Queen Elizabeth in 1995), the owners of Purdue Pharma, the manufacturer of OxyContin.

Case and Deaton christen the problem of declining white male life expectancy “deaths of despair,” a term that captures the social psychology behind the lethal abuse of booze, pills, needles, and guns. Skeptical of simple economic explanations, they examine and then rule out any direct relationship between deaths of despair and poverty, income losses from the post-2008 Great Recession, or even unemployment. This absence of economic determination is understandable once one realizes that mere income losses are, to a considerable extent, cushioned by unemployment insurance and Social Security, contrary to the Cambridge consensus.

But if not income losses, poverty, or inequality, then what? Case and Deaton describe “a long-term and slowly unfolding loss of a way of life for the white, less-educated, working class.” While unemployment rates rise and fall, and poverty can cause real pain, the decline of community that follows the loss of a major employer – reflected in small-business closures, decaying schools, and declining local services – cuts deep. Case and Deaton argue that the insecurity, precarity, and despair accompanying life in such communities are much harder to deal with than mere loss of personal income.Case and Deaton do also stress the gap between those with and without a college education. It’s a divide that runs deep, but how should it be interpreted? It is tempting to reify the diploma, to read the divide as evidence that if more people went to college, they would ipso facto lead happier, more fulfilling lives. But the US already puts more people through college than most countries, and yet, so far as we know, deaths of despair are decidedly more prevalent in America than in, say, Europe or Asia.

A more convincing analysis would lead back to those inconvenient economists: Marx, Keynes, and Galbraith père; to the early writings of Bowles and Gintis; and to Harvard’s own great mid-twentieth-century reactionary, Joseph Schumpeter – to whom Case and Deaton do pay fair homage. The lesson is that society only has a certain number of open doors to what Thorstein Veblen famously called the “leisure class”: the professions, the academy, competitive finance. College opens those doors, but does not widen the doorways. And when the industrial classes have been decimated by technology and trade, it is inevitable that millions who were once supported by industry will fall down, not climb up – irrespective of how much schooling or retraining they obtain.The services jobs that have fueled US economic growth for the past 40 years – until the pandemic began to destroy them – are numerous. But generally, they are neither well-paid nor otherwise rewarding. Often, they are what the late David Graeber memorably called “bullshit jobs.” While not typically backbreaking, they are often demanding in a repetitive, tedious, chronic-pain-inducing way. Expanding college completion without creating better jobs would merely increase the number of frustrated aspirants to the leisure class. That could be a formula for more despair, not less.