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.

The book was written by Anne Case, a professor of economics at Princeton, and Angus Deaton, also a Princeton professor, who won the 2015 Nobel Prize for economics. In their book, the two conclude that the American health care system is an important factor in a phenomenon that kills 158,000 Americans every year. The researchers' famous illustration of the impact of "deaths of despair" is to ask people to imagine three 737s' worth of passengers falling out of the sky in the U.S.–every day.

What's wrong with America?

The book does not shy away from identifying the problem as unique to this country. "There is something going on in America that is different, and that is particularly toxic for the working class," the book said.

In speaking about their research, Case and Deaton say difficulties with obtaining a college education and good-paying jobs are part of the problem. "It's not inequality in general that is causing rising death rates (among working-class white Americans), but the way the economy works today, which is unfair to many. It's holding down real wages in the U.S., especially for those less educated and who do not have bachelor's degrees," Case said in a 2019 presentation.

In the book, the authors talk about three upward trends in the U.S. in recent years: rates of liver disease, drug overdoses, and suicides. In this country, suicide rates for whites are higher than in Western Europe and approaching the rates of former Soviet Union states.

"This is happening to both men and women … and it's happening everywhere — rural and urban areas. And underneath the body counts, we find a sea of pain and poor mental health among people," Case said.

A brutal assessment of health care as income redistribution

The book's exploration of how our health care system has fallen short is unflinchingly critical. The authors note that health care in the U.S. is far more expensive than in other wealthy nations—with notably worse outcomes as well as relatively high rates of uninsurance and underinsurance.

It wasn't always this way—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.

Part of the reason for this, the book said, is that we pay our physicians roughly twice as much as other countries do, and our administrative costs are much higher. "The industry is not very good at promoting health, but it excels at promoting wealth among health care providers," the researchers wrote in an article for Time. "The industry also delivers vast sums to the owners and executives of pharmaceutical companies, to medical-device manufacturers, to insurers and to large, ever-more-monopolistic hospitals."

The book accuses the American health care industry of establishing a "Sheriff of Nottingham redistribution" system, which squeezes money out of working-class Americans and enriches already-wealthy corporations. As health care costs have risen, average Americans have been stuck with larger and larger shares of the cost, increasing their economic insecurity and stress.

"The American health care system is a leading example of an institution that, under political protection, redistributes income upwards to hospitals, physicians, device-makers, and pharmaceutical companies while delivering among the worst health outcomes of any rich country," the book said.

Not just free markets to blame

To some, these statements might be seen as a standard anti-capitalism critique. But in an interview with the Guardian, Deaton responds with language familiar to anyone following U.S. politics. "It's not a free market at all. It's a swamp," he said, referring to the regulatory and tax policies that are the foundation of the U.S' health care sector. "It's a giant swamp that's killing people in large numbers and making a lot of providers very rich."

At a time where this country has never depended more on its health care system, a re-examination of that system's foundations may be difficult to process. But "Deaths of Despair" makes a case that such a re-assessment may be necessary for America to regain both its physical and economic health.

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New book links U.S. health care system to increasing rates of suicide, drinking, drug abuse

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