Deaths of Despair and the Future of Capitalism, Anne Case and Angus Deaton

Author:Kenneth Rogoff
Position:Thomas D. Cabot Professor of Public Policy and professor of economics at Harvard University.
Anne Case and Angus Deaton
Deaths of Despair and the
Future of Capitalism
Princeton University Press,
Princeton, NJ, 2020, 312 pp., $27.97
The real villain in the book is
the US health care system.
Ailing and Unequal
THIS BOOK BUILDS ON Case a nd Deaton’s extraor-
dinarily inuentia l research on the mortal ity
resulting from the tra gic opioid epidemic in the
United States, including suicides and a lcoholic liver
disease. e book is ex traordinarily well w ritten,
sweeping yet succinct.
ere is a brilliant tension that run s throughout
the book between the boldfac e portion of the title,
“Deaths of Despair” (a phrase Ca se and Deaton
made famous), and the sweeping subtext of “and
the Future of Capitalism.” To understand it fully,
one has to appreciate that Case and De aton’s
studies have become a Rorschach te st for jour-
nalists, opinion writers, and even many social
scientists for what they believe a ils America today.
Inequality, urbanization, globalization, the edu-
cation divide, and the overpriced yet i nadequate US
health system have all been singularly bla med for
the shocking rise in de ath rates, particularly a mong
middle-aged white men and disproport ionately in
poorer rural communitie s that have been left behind.
e authors express sympathy for progressive
perspectives on modern society a nd what might be
done to improve it, but are cautious in pinning the
blame. Looking at cross -state evidence, they show
“poverty is not the source of the surge of deaths
of despair.” While West Virginia and Kentucky
are poor and have high overdose rates, Mis sissippi
and Arkans as are also poor but do not have nearly
as severe a problem. On the other hand, there
are relatively rich states such a s New Hampshire
and Utah that have been severely i mpacted. New
York City and San Francisco are ground zero for
inequality, but have had less of an opioid problem.
Another popular culprit the authors ta ke up is
the global nancia l crisis. e timing would seem
to make sense. Countries suc h as Greece had vastly
deeper and longer recessions than t he United States,
however, and even during that country’s darkest
hours, life expecta ncy continued to climb. e
same was true in Spa in and most of the rest of
Europe. Despite these reservat ions about standard
progressive explanations of ”deat hs of despair,”
Case and Deaton accept t hat in rural communities
a loss of jobs and empowerment may have helped
fuel the crisis.
e real villa in in the book is the US health
care system. e authors ar gue that hospitals,
insurance compan ies, pharmaceutical companies,
doctors, and device makers are all wildly over-
paid by international standa rds, often because
of the curious US tolerance for monopoly in
recent decades. Case a nd Deaton oer an array
of sensible solutions to foster lower prices and
inclusion. Interestingly, however, they have no
patience for those who see “Medicare for all” as
a panacea. ey empha size that many countries
have successful m ixes of public and private care,
that there is no one size ts all, and t hat transition
eects need to be considered.
Simply put, this is a terric book. I suspec t
it will be on many people’s top 10 book lists of
2020. Although written before COVI D-19, the
book’s critique of the US approach to health care
and inequality is rema rkably prescient. In many
ways, the opioid crisis Case and Deaton analyze
is a microcosm of the angu ish the world is experi-
encing today, and we would be remiss not to pay
attention to their insights.
KENNETH ROGOFF, Thomas D. Cabot Professor of Public
Policy and professor of economics at Harvard University

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