By Anne Case & Angus Deaton
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.
Sonalde Desai on Population and Development Review wrote:
This book builds on Case and Deaton’s extraordinarily influential research on the mortality resulting from the tragic opioid epidemic in the United States, including suicides and alcoholic liver disease. The book is extraordinarily well written, sweeping yet succinct. [...] The real villain in the book is the US health care system. The authors argue that hospitals, insurance companies, pharmaceutical companies, doctors, and device makers are all wildly overpaid by international standards, often because of the curious US tolerance for monopoly in recent decades. Case and Deaton offer an array of sensible solutions to foster lower prices and inclusion. Interestingly, however, they have no patience for those who see “Medicare for all” as a panacea. They emphasize that many countries have successful mixes of public and private care, that there is no one size fits all, and that transition effects need to be considered. [...] Simply put, this is a terrific book."
Arlie Russell Hochschild on The New York Times wrote:
"In 2017, 158,000 Americans died from deaths of despair. All three kinds of death—suicide, drugs, alcohol—involve actions of those who die. Following Emile Durkheim's seminal work Suicide, Case and Deaton argue that, to understand these self-inflicted deaths, we must look beyond the individual to the society. An economy that has left behind middle-aged whites and led to alienation from work, family, and society created a situation in which life has little meaning. Individuals seek oblivion either immediately, via suicide, or on the installment plan, via substance abuse. The most interesting part of the book emerges in the final section where Case and Deaton provide an analysis of the processes that brought about this perfect storm. Their analysis of the trends that brought the nonuniversity-educated white population to this impasse rests on two pillars. First, they argue that it is not the secular trends in the economy that have left less-educated individuals behind, but rather deliberate choices made by the society. Second, they suggest that economic decline, coupled with social and historical processes that robbed the less-educated white population of their historical advantages have created a pain that can only be annihilated by suicide or numbed through addiction."
Carlos Lodoza on Washington Post wrote:
"Though repetitive, the prose in Deaths of Despair is clear, the style is discursive and the spirit reflects the boundless curiosity that led the two economists to sociology — where they found in the French sociologist Emile Durkheim the key to suicide: loss of community. [...] One issue this book does not raise is how, at a time of great partisan divide, readers will receive its message. Those on the conservative side might question the idea of deaths of despair since they tend to see addiction and suicide as moral flaws. They might also resist the authors’ steady focus on social class and search instead for more all-encompassing measures of well-being, like G.D.P., which obscure the growing class divide. As for the authors’ call to counter capitalism’s unrestrained impulse to distribute up, the conservative might counter, “Not to worry, benefits will trickle down.” Readers on the liberal left, on the other hand, are likely to applaud the authors’ many highly thoughtful proposals to counter growing inequality. But while liberals tend to root for the underdog, white males have not been first in line for their sympathy. So one possible source of resistance to this book’s message for them might arise from something else: splitting. This is the tendency to hold apart two apparently incompatible images or ideas, without seeing how the two connect.
Susan Babbitt on New York Journal of Books wrote:
"Many memoirs, histories and investigations have been written on America’s white working class in recent years, probably too many, but fewer purely economic studies. Case and Deaton are world-renowned practitioners of the dismal science (Case is a top expert on the links between economic and health status, while Deaton snagged a Nobel in 2015 for his work on household poverty and welfare), and their lens on the subject makes for stark reading. They estimate the magnitude of the deaths of despair in the United States by comparing the improving trend lines of recent decades — i.e., if mortality rates had continued falling as before — with what actually came to pass. [...] Case and Deaton are largely dismissive of arguments that stress the supposed individual or cultural failings of the white working class, and they focus instead on systemic shortcomings that lead to deaths of despair. [...] Case and Deaton focus on the white working class because it is undergoing a particularly harrowing shift, not because they believe this demographic matters more than others (they don’t) or because it is worse off in absolute terms than others (it isn’t). Black mortality rates remain persistently higher than white ones, the authors point out, even considering the increased deaths of despair among white Americans. But black mortality rates are falling faster than white rates — and the deaths of despair among white citizens are the difference. [...] The authors often write in the dispassionate tone of their profession, but they break free of such detachment when pointing to the underlying culprit behind all these trends: the corruption of the American economic system [...] Case and Deaton condemn America’s health-care system and health industry more than any other sector [...] For all their criticisms, Case and Deaton have come to write of capitalism’s future, not just its failure. “We believe that capitalism is an immensely powerful force for progress and for good, but it needs to serve people and not have people serve it,” they write. Unfortunately, their policy proposals — such as universal health insurance, reforms in corporate governance and the use of non-opioid alternative treatments for chronic pain — are not terribly detailed, nor do they appear to match the scale of the problems the authors outline."
Stephanie Mencimer on Washington Monthly wrote:
"These 'happy' authors care about those who are not. They ask what can be done. The health system, rent seeking, and pharmaceutical industry are three big causes. [...] Solutions are considered, such as wage subsidies, raising minimum wage, anti-trust legislation, universal basic incomes, and government regulation of pharmaceuticals. [...] Thus, capitalism can be “better monitored and regulated” and should not “be replaced by some fantastical socialist utopia in which the state takes over industry. Democracy can rise to the challenge.” The conclusion jars. [...] these authors consider injustices given expectations of liberal capitalism. They don’t bother considering alternative expectations for a meaningful life. They exist. And they are not hard to find. They exist beyond the toxic bubble identified by the authors. But the authors take for granted the ideas of “democracy” and “meaningfulness” they’re comfortable with."
Rahul Gupta on Democracy; A Journal of Ideas wrote:
"Deaths of Despair is an academic book, laden with charts and facts and figures, and the authors devote a significant amount of ink to shooting down things they think are not causing the crisis—problems like obesity, for instance. But after dismissing a variety of possible causes for increasing mortality rates, they essentially come to the same conclusion Carlson did: that rapacious capitalism and predatory corporations, protected by politicians indebted to them, have destroyed the white working class. American capitalism, they write, is uniquely toxic and often looks “more like a racket for redistributing upward than an engine of general prosperity.” They believe that the way capitalism has run amok in the U.S., without much regulation or a safety net for those caught up in its creative destruction, is literally killing people. [...] One key policy question that the authors don’t address is whether or not the Affordable Care Act has impacted mortality rates, which seems like a glaring oversight for a book like this. [...] While Deaths of Despair does an admirable job of describing the scope of this epidemic and some of its causes, apparently not even a Nobel Prize–winning economist can figure out what to do about it. Case and Deaton throw up one or the other idea kicking around in politics in recent years—a universal basic income or higher marginal tax rates on the rich—only to dismiss the proposed solutions as ineffective, too expensive, or politically unpalatable."
David R. Henderson on Regulation (Cato Institute) wrote:
"Deaths of Despair magnificently attempts to tease out facts from fiction with data and charts in a subtle but remarkably coherent manner, deciphering why we are experiencing some of the highest levels of inequality and poverty among the richest nations on earth. [...] Case and Deaton offer very pragmatic and politically balanced commonsense solutions not only to replace the carpet but the entire living room. They lay out policy and actions that would stop rent-seeking, control lobbying, and create pro-market measures designed to cease the misuse of market power. The approach is one of balanced incrementalism; to identify and act upon, with broad agreement, selected injustices that are most likely to have an impact. [...] This book is a must-read for anyone attempting to objectively understand our collective American pain as well as those gaining from it."
"Fortunately, their argument is much more nuanced than the bookjacket. But it is also, at times, contradictory. Their discussion of the health care system is particularly interesting both for its insights and for its confusions. In their last chapter, “What to Do?”the authors suggest various policies but, compared to the empirical rigor with which they established the facts about deaths by despair, their proposals are not well worked out. One particularly badly crafted policy is their proposal on the minimum wage. [...] In short, they are best at what they know best: death rates by age, race, and education. They are right to criticize some of the facile claims of causation made by others. They also, fortunately, do not blame capitalism as much as the book jacket suggests. Unfortunately, the policy proposals they focus on most either do not address the problem they want to solve or would actually make the problem worse."
Discussion with Case & Deaton about the book
- "United States of Despair" - article by Case and Deaton at Project Syndicate, 15 June 2020
- "Deaths of despair" - interview with Deaton in the Boston Review, 15 May 2020
- "'Deaths of despair': The deadly epidemic that predated coronavirus" - interview with Case and Deaton at VOX, 15 April 2020
- "Deaths of despair strike women too" - blog by Case at the website of Princeton University Press, 1 March 2020
- "Economist Anne Case on America’s ‘deaths of despair’ — and how to tackle them" - interview wit Case in the Financial Times, 28 February 2020
Official website of the book with more relevant links
Table of Contents of Deaths of Despair
Part I - Past as Prologue
- The Calm before the Storm
- Things Come Apart
- Deaths of Despair
Part II - The Anatomy of the Battle Field
- The Lives and Deaths of the More (and Less) Educated
- Black and White Deaths
- The Health of the Living
- The Mystery and Misery of Pain
- Suicide, Drugs and Alcohol
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?
About Anne Case and Agnus Deaton
Anne Case is the Alexander Stewart 1886 Professor of Economics and Public Affairs, Emeritus at Princeton University, where she is the Director of the Research Program in Development Studies. Dr. Case has written extensively on health over the life course. She has been awarded the Kenneth J. Arrow Prize in Health Economics from the International Health Economics Association, for her work on the links between economic status and health status in childhood, and the Cozzarelli Prize from the Proceedings of the National Academy of Sciences for her research on midlife morbidity and mortality.
Angus Deaton is a Senior Scholar and the Dwight D. Eisenhower Professor of Economics and International Affairs Emeritus at the Woodrow Wilson School of Public and International Affairs and the Economics Department at Princeton University. He was the recipient of the 2015 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel.