the U.S. was comparable to other developed nations in health care costs and outcomes in the 70’s. But where other countries have gained, America has fallen behind.

A damning new book from Nobel winning economists paints a grim picture of how flaws in the American health care system have contributed to a legacy of death and economic hardship among a large number of Americans.

Deaths of Despair and the Future of Capitalism” looks a trio of problems that have hit Americans hard—especially white, working-class citizens. Opioid abuse, alcoholism, and suicide have combined to actually reduce life expectancy rates of this demographic—at a time when other groups are seeing life expectancy rates continue to increase. Over the past two decades, the researchers said, there has been a 25 percent drop in life expectancy for white Americans without a university degree.

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