Deaths of Despair and the Future of Capitalism

325 Pages·2020·8.293 MB·English

by  Anne Case, Angus Deaton

deaths of despair and the
future of capitalism

Deaths of Despair and the
Future of Capitalism
anne case
angus deaton
prince ton university press
princet on & oxford
Copyright © 2020 by Prince ton University Press
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Epigraph on page 83 from “In a Time” from Just Give Me a Cool Drink of Water ‘Fore I
Diiie: Poems by Maya Angelou. Copyright © 1971 by Maya Angelou. Used by permission
of Little, Brown Book Group Limited and Random House, an imprint and division of
Penguin Random House LLC. All rights reserved.
Library of Congress Cataloging-in-Publication Data
Names: Case, Anne, 1958– author. | Deaton, Angus, author.
Title: Deaths of despair and the future of capitalism / Anne Case, Angus Deaton.
Description: Princeton : Princeton University Press, [2020] | Includes bibliographical
references and index.
Identifiers: LCCN 2019040360 (print) | LCCN 2019040361 (ebook) |
ISBN 9780691190785 (hardback ; alk. paper) | ISBN 9780691199955 (ebook)
Subjects: MESH: Suicide—economics | Socioeconomic Factors | Drug Overdose—
economics | Capitalism | Educational Status | Politics | United States
Classification: LCC HV6548.U6 (print) | LCC HV6548.U6 (ebook) |
NLM HV 6548.U6 | DDC 362.28—dc23
LC record available at https://lccn.loc.gov/2019040360
LC ebook record available at https://lccn.loc.gov/2019040361
British Library Cataloging- in- Publication Data is available
Editorial: Joe Jackson, Jacqueline Delaney
Production Editorial: Terri O’Prey
Jacket/Cover Design: Karl Spurzem
Production: Erin Suydam
Publicity: James Schneider, Caroline Priday
This book has been composed in Arno Pro
Printed on acid- free paper. ∞
Printed in the United States of Amer i ca
10 9 8 7 6 5 4 3 2 1
For Julian, Celestine, Lark, Andrew, Ryan,
James, John, Marie, and Will
May they enjoy a world with more fairness and less despair.

contents
Preface ix
Introduction: Death in the After noon 1
part i. past as prologue 17
1 The Calm before the Storm 19
2 Things Come Apart 28
3 Deaths of Despair 37
part ii. the anatomy of the battlefield 47
4 The Lives and Deaths of the More (and Less) Educated 49
5 Black and White Deaths 62
6 The Health of the Living 71
7 The Misery and Mystery of Pain 83
8 Suicide, Drugs, and Alcohol 94
9 Opioids 109
part iii. what’s the economy got
to do with it? 131
10 False Trails: Poverty, Income, and the Great Recession 133
11 Growing Apart at Work 148
12 Widening Gaps at Home 167
part iv. why is capitalism failing so many? 185
13 How American Healthcare Is Undermining Lives 191
14 Capitalism, Immigrants, Robots, and China 212
15 Firms, Consumers, and Workers 226
16 What to Do? 245
Acknowl edgments 263
Notes 265
Index 293
vii

preface
In The Great Escape, published in 2013, one of us told a positive story
about human progress over the last two hundred and fifty years. The
story there was one of previously unimaginable material progress, a de-
cline in poverty and deprivation, and extensions in the length of human
life. The generation and application of useful knowledge made this
progress possible. A star of the show was capitalism, which freed mil-
lions from dire poverty, supported by the positive forces of globaliza-
tion. Democracy spread around the planet, allowing more and more
people to participate in shaping their communities and societies.
This book is much less upbeat. It documents despair and death, it
critiques aspects of capitalism, and it questions how globalization and
technical change are working in America today. Yet we remain optimis-
tic. We believe in capitalism, and we continue to believe that globaliza-
tion and technical change can be managed to the general benefit. Capi-
talism does not have to work as it does in America today. It does not
need to be abolished, but it should be redirected to work in the public
interest. Free market competition can do many things, but there are also
many areas where it cannot work well, including in the provision of
healthcare, the exorbitant cost of which is doing immense harm to the
health and wellbeing of America. If governments are unwilling to
exercise compulsion over health insurance and to take the power to
control costs—as other rich countries have done—tragedies are inevi-
table. Deaths of despair have much to do with the failure—the unique
failure— of America to learn this lesson.
There have been previous periods when capitalism failed most peo-
ple, as the Industrial Revolution got under way at the beginning of the
nineteenth century, and again after the Great Depression. But the beast
ix