The main idea of this book is to recognize serous problems of American society that expressed by decrease in life expectancy of one part of population – low educated white men due to increase in suicide, drug overdose, and alcoholism among this population. It is also to analyze reasons for these “Deaths of Despair” and recommend measures, mainly in form of government intervention to handle this problem.
Introduction: Death in the Afternoon
Authors start introduction by describing their thoughts upon discovery that suicide rates of white middle age males is rapidly growing. Then they added to these other categories: deaths from drugs and alcohol combining all into one category – deaths of despair. They linked it to failure to pass tests of meritocracy, which they associate with education that divide prosperous and poor parts of population. Authors then compare white and black uneducated people and somehow conclude that blacks have it harder, but whites suffer more because of loss of white privilege. Finally, they link it to stagnant wages and loss of jobs, specifying that:” Jobs are not just the source of money; they are the basis for the rituals, customs, and routines of working-class life. Destroy work and, in the end, working-class life cannot survive. It is the loss of meaning, of dignity, of pride, and of self-respect that comes with the loss of marriage and of community that brings on despair, not just or even primarily the loss of money.”
Authors also discuss causes: globalization, increase of corporate power versus unions, and even healthcare. Finely, they express concern that all these combined with loss of believe in Democracy that perceived to be captured and corrupted by elite could lead to serious push back and they see signs if it in election of Trump.
Part l. Past as Prologue
1. The Calm before the Storm
In this chapter authors look at statistical history of mortality in USA and the great progress that occurred until last decade. They discuss mortality causes that moved away from contagious diseases to illnesses of old age and self-inflicting damage such as drugs and alcohol. They present a graphic support for these ideas:
At the end of the chapter, they describe the range of the problem they are trying to understand in such way:” There are two stories, often seen as competing, though they need not be. One, the “external” or circumstantial account, emphasizes what happened to people, the opportunities that they had, the kind of education, occupation, or social environment that was available to them. The alternative, “internal” account emphasizes what people did to themselves, not their opportunities but their choices among those opportunities, or their own preferences. It is a debate between worsening opportunities, on the one hand, and worsening preferences, or declining values or even virtues, on the other.”
3. Deaths of Despair
Here authors discuss the specific causes of deaths of despair and present a few anecdotes describing how it happens and how sometimes it is difficult to differentiate suicide form unintentional drug overdose.
Part ll. The Anatomy of the Battlefield
4. The Lives and Deaths of the More (and Less) Educated
Here authors move to compare circumstances of different parts of population that are inflicted by deaths of despair to very different degrees. First of all, they discuss difference in education and how it impacts human life in environment of “meritocracy”:
They describe an interesting dynamic in Black community when success of civil rights movement opened gates for talented and hard-working individuals and the first thing that they did was to run away from Black community, “denuding” it from their talents and role models. Authors link it to earlier epidemic of use of crack cocaine in inner city and corresponding mortality. They also critic Murray thesis that in both cases welfare states suppressed industriousness and morality of people leading to all these negative consequences.
6. The Health of the Living
Here authors move from deaths of despair to general and mental health conditions of population and link it to education:
8. Suicide, Drugs, and Alcohol; 9. Opioids
These two chapters overview final causes of increase in mortality, also demonstrating that this is quite recent phenomenon inflicting uneducated population:
Authors also provide an interesting breakdown of costs:” American physicians pay more for malpractice insurance, although the total cost of around 2.4 percent of total healthcare expenditures is small compared with the expenditures on hospitals (33 percent), physicians (20 percent), and prescription drugs (10 percent). Compared with those in other rich countries, American hospitals and doctors make more intensive use of “high margin, high volume” procedures, such as imaging, joint replacements, coronary artery bypass graft surgery, angioplasty, and cesarean deliveries.” Authors discuss some typical tricks such as use by companies and charitable foundations to pay inflated prices of their medical products.
14. Capitalism, Immigrants, Robots, and China; 15. Firms, Consumers, and Workers
These chapters are about other features of contemporary American capitalism that devalue American labor, eventually causing deprivations and deaths of despair.
16. What to Do?
These chapter is about authors’ prescription for what to do:
Opioids – create new government agency
Healthcare – Increase government expenditures and create Cost Control Board
Corporate governance – more power to unions with representation on company board
Tax and benefits policy – UBI, but not now, rather sometime in the future.
Antitrust – limit mergers and force payment for monetizable information provided to companies.
Wage Policies – raise minimum wage and provide subsidies for jobs.
Rent-Seeking – limit use of patents and curtail protection of small business. Per authors the main cause of inequality are not CEOs, but rather owners of “small” businesses with 20M in sales and 100 employees. Also impose restrictions on lobbying.
Education – modify the systemin in such way as to remove sharp cut off at bachelor degree, maybe via expansion of apprentice system.
The final advice – to learn more from Europe.
At the end authors profess their optimism and believes that Democracy in America and Capitalism could do much better job that they do now and remove causes of death of Despair.
MY TAKE ON IT:
It is the great collection of statistical data demonstrating beyond reasonable doubt that white men with low levels of education are under serious stress due to their redundancy for contemporary production process that causes loss of meaning of life and escapism to drugs, alcohol, or even suicide. I am fully in agreement with authors’ presentation of the problem, but in complete disagreement with their analysis of reasons and suggested solution for the problem. The reasons that authors present: Healthcare high cost and low quality, Immigration, Robots, China, and loss of labor power to oppose management – all of this in my opinion result of massive and constantly increasing intervention of government into areas of economy and overall lives of regular people. There is tendency to refer to government as some kind of superior being either good or bad, but I completely reject this approach because government is nothing more then hierarchically organized group of individuals in possession of coercive power that allow them make decisions and enforce implementation of these decisions without any responsibility whatsoever. Any area in which these individuals interfere: Healthcare, Education, Financial markets demonstrate dramatic deterioration in their functionality and similarly dramatic increase in costs. Consequently, authors’ suggestions to increase power of these individuals and their interference in all areas of life is bound to be ineffective. In my opinion, for example, Healthcare could be improved not by implementation of National system as had been done in many socialist and semi-socialist countries, but rather expulsion of government interference in health insurance and delivery of services, obviously with exception of prosecution of criminal deception and misrepresentation of information.