We already knew that the number of Americans who are on disability has skyrocketed over the past three decades. But the usual response has been that they’re gaming the system, claiming disabilities that “lend themselves to subjective manipulation” and being encouraged to do so by overly generous government payouts. Therefore, the conclusion is, “taxpayers are paying able-bodied Americans to drop out of the work force, increasing the burden on those who are still working.”
That was the existing common sense—the widely shared view that society had the responsibility (in the name of all “those who are still working”) to identify the truly disabled, weed out the others who are falsely claiming disability, and force them to get back to work.
Now we know, thanks to a recently published study by Anne Case and Angus Deaton, that something else has been going on: American workers are suffering from an “epidemic of pain, suicide, and drug overdoses.”
Specifically, Case and Deaton show that, after 1998, there was a marked increase in the morbidity and mortality of middle-aged white non-Hispanic men and women in the United States, especially for workers with less education.
The changes are dramatic. As we can see in the chart at the top of this post, even while mortality rates in other rich countries were declining (as were the rates for Hispanic and black Americans), U.S. white non-Hispanic mortality rose by half a percent per year. As they observed, “No other rich country saw a similar turnaround.” That turnaround in mortality was driven primarily by increasing death rates for those with a high-school degree or less. And, while their focus is on middle-age, they also make clear that all 5-year groups between 30 and 64 have also suffered increases in mortality.
According to Case and Deaton, the three causes of death that account for the mortality reversal among white non-Hispanics are not lung cancer (which is declining) or diabetes (which has remained relatively constant), but drug and alcohol poisoning, suicide, and chronic liver diseases and cirrhosis. All three increased year-on-year after 1998.
And it’s not just that white Americans are being killed by this epidemic; they’re also increasingly victims of poor health, both physical and mental, as well as of pain and alcohol consumption. What we’re talking about here is a dramatic increase in the walking wounded (who often find it difficult to even walk).
The question is, why? Why have the rates of mortality and morbidity for white non-Hispanic Americans risen so dramatically in the past 15 years?
Case and Deaton suggest the epidemic may have been caused by the increased availability of opioid prescriptions for pain (although it’s not at clear if the increase in opioid use or the increase in pain came first) as well as growing economic insecurity (which started even before the crash of 2007-08), which may in fact continue into the future, given the shift away from defined-benefit to defined-contribution pension plans, if U.S. workers “perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans.”
What they don’t mention is the role of jobs. The fact is, most Americans are forced to have the freedom to sell their ability to work to someone else—and they suffer both when they have a job and when they don’t. When they’re fortunate enough to have a job, they’re working in Walmart stores, Amazon warehouses, and fast-food restaurants and suffering the physical and mental pains and indignities imposed by their employers. And when they don’t have a job—when they’ve been discarded by their employers—they’re suffering from the jobs they once held and from the struggle to find another job. As a consequence of both having jobs and joblessness, an increasing number of middle-age Americans are dying, committing suicide, and are the victims of pain, poor health, and psychological distress. And, unless we do something about it, the middle-age Americans who do survive the current epidemic will carry their pain and ill health into old age.
And the corporate elite doesn’t want to take responsibility for having used up and pushed aside these Americans or, once they’re disabled, paying the taxes to support them. It has simply discarded them.
As for the political consequences, Paul Starr suggests we may be witnessing a “dire collapse of hope.”
The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. We are not talking merely about “status anxiety” due to rising immigrant populations and changing racial and gender relations. Nor are we talking only about stagnation in wages as if the problem were merely one of take-home pay. The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change. Much of that support is now going to Republican candidates, notably Donald Trump.
And, I would add, support to Kentucky’s new elected governor Matt Bevin and to Tea Party favorites in other states (such as Maine’s Paul LePage, Kansas’s Sam Brownback, and Wisconsin’s Scott Walker). They’ve all enacted—or promised to enact—a wide variety of radical measures, from Right to Work laws to restrictions on welfare and federally funded healthcare programs.
We now live in a society in which, on one hand, those at the top have simply disabled the white non-Hispanic working-class and left it to suffer “an epidemic of pain, suicide, and drug overdoses.” And, on the other hand, many of those same workers have responded, out of fear and hopelessness, by electing public officials who are making their plight even worse.