Deaths of Despair and the Future of Capitalism

April 20, 2020
Husband and wife economists Case and Deaton (The Great Escape) analyze the factors contributing to rising death rates among white, working-class Americans in this grim yet galvanizing account. Attributing much of the overall increase to suicides, drug overdoses, and alcoholic liver disease, Case and Deaton show that 158,000 people succumbed to such “deaths of despair” in 2017 (“the equivalent of three full 737s falling out of the sky every day, with no survivors”). They also note that the mortality rate among white men aged 45–54 without a bachelor’s degree has increased 25% since the early 1990s, while decreasing 40% for those with a college diploma. Looking behind the numbers, Case and Deaton examine how solid, blue-collar jobs that could support a stable family life have been replaced by low-paying service industry jobs, contributing to wage stagnation; the role of the pharmaceutical industry in the opioid epidemic; and deficiencies in American health care (“a disgrace”). In a brisk final chapter, they outline possible reforms, including universal health care, wage subsidies, the loosening of patent protections to buoy business innovation and competition, and German-style apprenticeship programs as a college alternative. Complementing their candid prose with enlightening charts and graphs, Case and Deaton make the scale and immediacy of the problem crystal clear. This is an essential portrait of America in crisis.