Review

Deaths of Despair and the Future of Capitalism, written by Princeton University Economics Professors Anne Case and Angus Deaton, was both a New York Times and Wall Street Journal bestseller for very good reasons. Through statistical research, the couple (Case and Deaton are married) found an anomalous drop in American life expectancy, which had otherwise been climbing for nearly a century. Through an exhaustive study of death certificates, they found that the change was specifically in the life spans of midlife white Americans, men and women without Bachelors degrees. The cause was an epidemic of alcoholism, drug abuse and suicide, and often more than one of these factors. Collectively, they called them "deaths of despair" a term which has been used over and over during the coronavirus epidemic when these deaths have risen sharply. Ironically, the book, which cites the 1918 flu epidemic as the last time death rates climbed and often refers to the "pandemic" of deaths of despair, was published in March 2020, the week of the original U.S. coronavirus shutdown. In his review of the book, Harvard Professor Kenneth Rogoff summarized the root causes as "Inequality, urbanization, globalization, the education divide, and the overpriced yet inadequate U.S. health system." Particularly the health system. The most compelling chapter, to me, was entitled "How American Healthcare is Undermining Lives." The U.S. health care system absorbs 18 percent of the American gross domestic product, four times what is spent on defense and four times what is spent on education. "American healthcare is the most expensive in the world, and yet American health is the worst among rich countries" per Case and Deaton, leaving too many people uninsured and suffering. Too much of the U.S. health insurance is provided by employers. Because the CEO's insurance costs are the same as the cleaning staff's, the lower paid, less educated workers are a disproportionate burden. This leads companies to raise co-pays, pare jobs, and resort to outsourcing. The chapter also describes the power of the medical associations, hospitals, medical device makers, and insurance and pharmaceutical companies' lobbyists (five for every member of Congress) to influence legislation. I, personally, wish that chapter could be made into a more popularly accessible book along the lines of Matthew Desmond's Evicted, with case studies describing the devastation of families, legislative histories, and stories like the EpiPen cost hike. However, even now, when the book is mainly statistics and charts, it is clearly written, very readable, and important. Healthcare is just one issue which Case and Deaton explore and document. There are many more disturbing factors which contribute to "The Future of Capitalism" part of the title.

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