I am a fundamental optimist. As a professor, I regularly remind students of the incredible progress that has been made since World War II. Life expectancy has increased from around 65 to over 80 in most rich countries. This progress is also widespread. The 2013 Human Development Report tells us that from 2000 to 2012 every country in the world improved on the Human Development Index, a measure that includes income, life expectancy and education.
It seems amazing that there were improvements in every country, but increasing living standards are the norm. The countries that we see backsliding are those wracked by conflict or crisis such as Syria or Venezuela. Everywhere else, incomes and educational attainment steadily increase while mortality rates decline. Even Greece saw declining mortality rates throughout the last decade. That’s the power of continued innovation and economic growth. It also brings into sharp relief the extraordinary exception to the trend: increasing mortality in the United States. In recent years the death rate has increased substantially for whites without a bachelor’s degree, driven largely by what economists Anne Case and Angus Deaton have dubbed “deaths of despair” -- those from drug overdose, suicide or alcoholism.
Case and Deaton recently summarized their research and the numbers are stark. From 1992-2017, drug, alcohol and suicide mortality rates among whites without a bachelor’s degree more than doubled in almost every age group. Their explanations start with the opioid crisis, but they conclude that this recent crisis is more symptom than cause. People are driven to despair by financial strain, lack of good jobs, rising inequality and a decrease in participation their communities.
Why? Case and Deaton begin with jobs, acknowledging that outsourcing has depleted manufacturing jobs. In Europe, the economic impact of outsourcing was cushioned by stronger welfare states; there is no corresponding mortality increase in European countries. By contrast, U.S. political and corporate leaders worked in tandem to weaken labor. Our policies exacerbated the negative impacts of globalization on workers.
More of the blame, however, falls on the U.S. healthcare system. Case and Deaton describe how this system flooded the market with opioids. The U.S. system provides financial well-being to doctors, pharmaceutical companies, medical device manufacturers, insurance companies and hospitals but performs horribly in aggregate health outcomes. Healthcare spending per person in the United States exceeds $8,000 (in 2010 dollars); most European countries spend around $4,000 per person. Yet life expectancy in the U.S. is two to five years lower. Deaths of despair led to decreasing overall life expectancy in the United States from 2014-2018, while it continued to increase elsewhere. Our system is so inefficient that Case and Deaton conclude that “life expectancy is falling in the U.S. not in spite of what we spend on health care but because of it.”
There is not a happy ending to Case and Deaton’s analysis. They point out the obvious: we need to reform health care and labor needs a stronger voice. How to do either is tricky, and Case and Deaton are loath to wade too far into politics. But addressing the political question is necessary, because politics are the root of the problem.
The data are clear. The decline in living standards among working class whites is due to the deterioration of unions, increasing corporate power, outsourcing, opioids, guns (access to guns increases suicides), healthcare costs and rising inequality. All of these trends are the result of political choices, and one political party has consistently pushed policies that have exacerbated every trend. What is surprising is that the demographic most harmed – whites without college degrees – supports this same political party by a wide margin.
In modern times political parties usually provide some material benefits for their supporters. The steady progress we’ve seen since World War II is strong evidence. In every other rich country, the political system has maintained gradual progress. This progress, in turn, reinforces its legitimacy. There is an implicit social contract. Leaders so corrupt they harm core supporters are voted out. The Republican Party is the clear exception; it has managed to produce greater death and despair among its core supporters without losing their votes.
A basic premise of representative democracy is that voters will select politicians who improve voters’ well-being. But what if a significant block of voters cares more about feelings of moral superiority, dramatic name calling and raucous rallies than their material well-being? The United States has gone down a path of selecting leaders that are more entertaining but less competent, to the point that it is actually killing us.
The global trends of continued progress over the past 70 years are so strong that they only are reversed by political failings: choosing leaders so unaccountable and incompetent that they make things worse for their constituents. The good news for the United States is that we have multiple means to hold our politicians responsible. In this year of political drama, we would do well to consider one basic question: What are our leaders doing to actually make our lives better?
Alan Green is associate professor of economics and chair of the economics department at Stetson University.