The American working class is in trouble just as are the working classes struggle elsewhere. This has always been so even before Friedrich Engels’ seminal book On the Condition of the Working Class in England (1844) exposed the misery of the Industrial Revolution. One-hundred and seventy-one years later, the most recent assessment of conditions for the proletariat in the USA has been outlined by Anne Case and Angus Deaton (a Nobel Prize winner). Both Princeton economists, Case and Deaton wrote an earlier study on the “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century” printed in the prestigious Proceedings of the National Academy of Sciences.
Their latest book, Deaths of Despair, deals with what they perceive as three leading causes of high worker mortality rates: suicide, drug overdose, and alcoholic liver disease. These three causes are particularly prevalent among workers without a university degree and those with only a high-school diploma. In contemporary America, Trump’s America, the four-year college degree seems a small way of escape from death by despair. In 2018, there were 171 million Americans aged between 25 and 64. Of these, 62% were categorised as white and non-Hispanic. Among them, a further 62% did not have a college degree. Thus, roughly speaking, 38% of the American working class are classified as white and “poorly educated.”
These are the very people President Donald J. Trump loves so much because they are easy prey for his white populism and his favourite television news channel Fox’s propaganda. Capitalism and death by despair jointly hit the Trump base very hard, and now in 2020 it has made them vulnerable to the Corvid-19 pandemic.
Let us look at the statistics Case and Deaton provide. After correction for inflation, the median wage of American men has been stagnant for half a century; for white men without a four-year degree, median earnings lost 13% of their purchasing power between 1979 and 2017. Meanwhile, among America’s 350 largest firms, the average CEO earning in 2018 was $17.2 million ($47,000 a day!), 278 times the average worker’s wages. Even Marx and Engels would be astounded by the disparity.
Decades of declining wages, however, have been just one of the forces working against less-educated working men and women. Another to be factored in is the economic and political power that has shifted from small groups of workers to giant globalized corporations and the deliberate weakening of trade unions. Since the days of Ronald Reagan, civil society has eroded drastically: hardly anyone joins the Boy or Girl Scouts these days, neighbourhood groups have almost all disappeared, and friendly sports teams have been overly-organized and commercialized. Individualized employment contracts and the myth that all unions are corrupt and gangster-dominated have left workers increasingly vulnerable to the lowering of wages and the worsening of employment conditions. For reasons such as these, the working class has found itself exposed to a kind of reverse Robin Hood economy where capitalism takes from the poor and gives to the rich, and where democracy proclaims that everyone has the right to sleep rough under a bridge. This is ideologically camouflaged as trickle down economics and rationalized away by the hallucination that as the floods pour in all the boats will float to the top. In reality, a massive vacuuming up of wealth has taken place. In this process, much of this Adam Smith’s absurd and oppressive monopolies play a vital role as the conglomerates and their managerial elites become richer and richer and even super-richer while ordinary labouring people sink into the morass of poverty and die early.
Let us repeat: The worsening conditions of the American working class can be seen in the fact of a decline in life expectancy. It fell between 2013 and 2014, between 2014 and 2015, and again between 2016 and 2017. Never before has American life expectancy fallen for three years in a row since data started to be collected more than a hundred years ago. Unsurprisingly, the largest increases in premature deaths occurred in West Virginia, Kentucky, Arkansas, and Mississippi, states that voted heavily for Donald J. Trump in 2016.
These are also the mortality rates of despair in which death by suicide, drugs, and alcohol continues to rise. Overall, for whites between the ages of 45 and 54, deaths of despair tripled from 1990 to 2017. Case and Deaton argue that education and its lack is clearly one of the keys to understanding who is dying and why. In 2018, 158,000 Americans died from what can be called deaths of despair that is the equivalent of three full 737 MAXs falling out of the sky every day, with no survivors. Even one 737 MAX crashing down would make international news. But the slow and painful extinguishing of three times that number of working peoples’ lives every day goes unrecognised. It is unrecognised for a reason: it would make capitalism looks like what it is – a deadly game with the odds stacked against the uneducated, the poor and the non-white.
Another way of looking at these numbers is to compare it with the roughly 40,000 traffic deaths and the roughly 20,000 homicides annually in America. The prime killer among workers, however, is suicide. Around the world, suicide rates have been falling since 2000 with one exception. The USA is the global leader in these statistics. Meanwhile, the six highest suicide states in America are Montana, Alaska, Wyoming, New Mexico, Idaho, and Utah. With the exception of New Mexico, Donald Trump carried all these states in the 2016 election. Overall, suicide is becoming steadily more common among white males who do not have a bachelor’s degree.
Alcoholism tells a similar story. To Gallup’s question, has drinking ever been a cause of trouble in your family, 15% answered “yes” in 1948, 12% in the 1970s but a staggering 33% agreed in 2018, the highest ever recorded. Lastly, there is the abuse of illicit drugs and in particular opium. This narcotic has a curious history. Opium was planted for the British East India Company in India and then sold to Chinese people by the British in the 19th century. When China objected, Britain sent gunboats to enforce “free trade,” while imposing punishing tariffs on China. It was bit as if the Mexican government were asking the USA to compensate Mexican drug cartels for a shipment seized by the DEA and, then, upon non-payment, Mexico invades Texas to make America pay. Trump’s call for Mexico to fund his absurd wall has a long history.
Harvested in the Australian picturesque island of Tasmania, known as the Opium Island, the drug in the refined form of heroin makes its way into a FDA approved (1995) drug called OxyContin (also known as hillbilly heroin). Opioids like these relieve pain but also make people physically dependent, facing withdrawal symptoms such as delusional parasitosis or formication, according to Case and Deaton. The current opioid epidemic is underscored by the fact that more than a third of all US adults, 98 million people, were prescribed opioids in 2015.
Among these despairing victims of capitalist greed, two-thirds have no more than a high school education. Selling heroin to the uneducated is good business. Corporations rake in handsome profits. The Sackler family’s Prude Pharma sold somewhere between $30bn and $50bn worth of OxyContin. What does $50bn look like? $50,000,000,000. The average US house price in 2020 was $320,000. Big Pharma corporations like this (just marginally inside the law as it stands) could easily buy 156,000 houses. Not surprisingly, this is also the reason why business school professors have invented ideologies like business ethics and corporate social responsibility. The self-deluding ideology of capitalism exists to make sure that much of this appears ethical and legitimate, never mind the fact that 90% of those who die on a drug overdose have no four-year degree to help them convince themselves it is all for their own good. It is manual labour that is killed. The meaningless of life where you don’t have a chance to better yourself.
Much of this began at a time when the American military was busy bombing the opium supply in Helmand province in Afghanistan. At the same time, moreover, the giant pharmaceutical corporation of Johnson & Johnson was legally growing the raw material for the nation’s opioid supply in the aforementioned island of Tasmania. And we are meant to believe that the right hand does not know what the left is doing.
In any case, the opioid epidemic would not have happened without the carelessness – and profiteering – of some doctors; without a deliberately structured but very flawed approval process at the FDA; and without the pursuit of profits by the industry at whatever human cost. This is not new. Why this is done has been explained in Karl Marx’s mid-nineteenth-century classic Das Kapital: With adequate profit, capital is very bold and enterprising:
- 10% will ensure its employment anywhere;
- 20% certain will produce eagerness;
- 50% positive audacity;
- 100% will make it ready to trample on all human laws;
- 300% and there is not a crime at which it will scruple, nor a risk it will not run, even to the chance of its owner being hanged.
If turbulence and strife will bring a profit, capitalism will freely encourage both. Smuggling dangerous goods and the slave-trade have amply proved all that is here stated, which is why they are still with us today.
This list of duplicitous methods employed by the super-moneyed-classes applies to capitalism whether it is slavery, Ford Pinto, asbestos, big tobacco killing millions smokers (passive as well as active) in the 20th century, Big Pharma or any other profitable enterprise. If the price is right, phrama salespeople can bribe doctors to prescribe fentanyl to patients who do not need it. However, the opioid epidemic did not happen in countries other than in the good old USA both because they had not systematically destroyed their working class and because elsewhere in Europe and other advanced nations pharmaceutical companies are better controlled and governments are less easily influenced by corporations seeking profits, write Case and Deaton.
Meanwhile the aforementioned Sackler family are seen as philanthropists. In any case, philanthropy is yet another propaganda illusion that makes corporations and corporate capitalism look good. Like charity, though usually without the sympathy, the multi-billionaires would rather give out money by random acts of whim and caprice (and tax dodges), than ensure a democratic and egalitarian social welfare system that ensures poverty, ignorance and disease are eradicated and not seen as faults of improvident and lazy individuals.
As the case of big tobacco has shown, Big Pharma simply follows what is outlined in the Master Tobacco Settlement of 1998. Corporate profits and such settlements are paid for by the predominantly poorer and less educated Americans who smoke and use the products of Big Pharma—anything to relieve the intolerable pain of a useless life
As in the opioid epidemic, the poor pay the price for the brazen subordination of human needs to corporate profit. This affects different people differently. Money, as so often, makes a difference as individuals with larger incomes live longer. The fact that the working class has been left behind economically remains important. It defines who dies and who lives. Since the 1970s, the richer got richer at the expense of the rest of America. In short, since 1970, growth has predominately gone to those who were better off, leaving everyone else to decline unprotected by government regulations or trade unions. To those who have, it shall be given: in this case, “it” is money, lots and lots of it.
Traditionally, trade unions had linked wage increases to gains in productivity. Today, capital has severed this link. From 1979 to 2018, for example, productivity grew by 70% but hourly wages grew only by 12%. In other words, the gains in productivity and profits that it generates no longer go to those making these profits possible.
Worse, there is an almost continuous decrease in wages from one birth cohort to the next for the less educated at the bottom. Even ghastlier is the fact that median wages for men in the US have been flat for the last fifty years. For white men without a bachelor degree, the average growth in median wages from 1979 to 2017 was minus 0.2% a year.
Meanwhile good jobs for less educated men are disappearing fast. To justify all this and to divert attention away from mass poverty, the corporate media is at hand to blame the poor, stir up resentment against immigrants, and make the underemployed and the unemployed feel it is their own fault. It is just as the philosopher Bertrand Russell once noted, among the strongest advocates that the poor should work more are the idle rich, who have never done anything useful to earn a living. Increasingly, there is not only a world of the bourgeoisie and the working class, there is also a world of the more educated and a world of the less educated. One of the systems that works more against the less educated than against the better educated is the health care system.
The US healthcare system absorbs 18% of GDP or $11,000 per person which is three times what the US spends on education. For that American workers get one of the worst heath systems in the OECD’s club of rich countries largely because stratospheric profits go to “absurd and oppressive corporate monopolies” (Adam Smith). “To them that have, it shall be given.”
Funnily, the US has lower life expectancy than many other countries but vastly higher expenditure per person on health. One reason for that is the staggering profits that go to the monopolies of Big Pharma. On that point, the former editor of Harvard Business Review once made the following stunning revelation,
Business executives are society’s leading champions of free markets and competition, words that, for them, evoke a worldview and value system that rewards good ideas and hard work, and that fosters innovation and meritocracy.
Truth be told, the competition every manager longs for is a lot closer to Microsoft’s end of the spectrum than it is to the dairy farmers. All the talk about the virtues of competition notwithstanding, the aim of business strategy is to move an enterprise away from perfect competition and in the direction of monopoly. Private hospitals, corporatized medical professionals and greedy insurance companies add to the misery of those who do not have the money to keep well.
In a capitalist system, private insurance companies, luxurious doctor’s offices, and competitive hospitals spend huge sums on administration, negotiating rates, and trying to limit expenses for insurers. They no longer see patients as patients but as customers at best and as a cost factor to be reduced at worst. In the entire profits system, corporations and corporate hospitals play a key role. They are nothing short of local monopolies charging up to 12% more simply because they can. Trump and his supporters convince those who miss out that any interference by the state to control the health system is communism. The very idea that a citizen has a right to health care from cradle to grave is anathema, though it is normal practice in almost every civilized nation on earth.
When someone is unconscious, for example, there can be no bargaining over hospitals rates and no competition to restrain prices. In such conditions, you either pay what you are asked—or you are tossed out, literally. The poor can be shuttled from hospital to hospital until they reach either the lowest of charity clinics or are sent home to die alone. Millions of low-income American families are one serious illness or injury away from bankruptcy, life-long debt and homelessness. And this is where corporate profits come in. Unsurprisingly, there are hospital CEOs making $4.5 million (2014). Worse, in 2017 hospitals spent $450 million on advertising in the USA, as they were five-star hotels – not improving patient care.
To assure that politics does not interfere with the American way of life, corporate lobbying in health has grown dramatically in the last forty years. In 2018, health care corporations employed around 3,000 lobbyists, which is more than five for each member of Congress. In 2018, there were 11,654 “registered” (!) lobbyists in Washington, DC. Corporate lobbying also gave $1.3bn of campaign money. Overall, corporate lobbying was spending $567 million in 2018. This is more than ten times as much as the “total” of organized labour. It is, as the old saying goes, “We have the best politicians money can buy!”
In Western Europe, as in the USA, for every dollar spent by labour unions and public-interest groups on lobbying, large corporations and their lobbyists spend $34. With a 34:1 ratio, it is not surprising that EU and US laws favour big corporations over honest working people. In return for their lobbying, private companies and conglomerates receive low or no corporate tax bills, have easy access to tax havens and benefit from rafts of pro-business regulation (euphemistically labelled deregulation). This disadvantages workers and their families systematically. For their meagre $1 for lobbying, worker advocates get their clients low wages, high job insecurity, mass unemployment, horrific working conditions, the rise of precariat (a fancy word meaning “people whose employment and income are insecure, especially when considered as a class”), wage stagnation, and gig jobs (another technical term meaning “a job that lasts a certain period of time, often the life of a project or as long as the company has that specific need”. In brief, what the workers gain for all their efforts is a sense of powerlessness, despair and mental illness.
The entire system reminds one of the Sicilian shopkeeper who, when asked to pay protection to the Mafia, threatened to call the police and was told in no uncertain terms that the extorter “is” the police. The US government is complicit in extortion by the health care industry. In sharp contrast to that, Case and Deaton explain, the government is not so complicit when minimum wages are concerned. Largely, government follows the neoliberal ideology. It makes politicians believe that a government-imposed minimum wage that is higher than the going wage will cause employers to lay off workers, and workers know all too well this is what will happen. This is what virtually all neoliberal economics textbooks sanctimoniously teach. As a consequence of the neoliberal hegemony, the federal minimum wage in America has not increased since 2009 – a whopping eleven years!
By contrast, Britain under Tony Blair in 1999 changed from no minimum wage to a relatively high minimum wage. According to most neoliberal economist textbooks, unemployment should have followed. Did it? Dozens of studies since then have failed to find any significant effect on employment levels in the UK. Did the economic textbooks get re-written? Well, frankly, no. Never let the lack of factual evidence get in the way of a good ideology. Despite the neoliberal ideology, minimum wage legislation remains imperative when even large corporations like Google, for example, have more temps and contractors than it has employees, as happened in 2019. This persistence of ideology over fact defines life at the lower end.
Meanwhile, back in the USA, at the upper end of politics, corporate lobbying, healthcare lobbyists from Big Pharma, hospitals, insurers, and, of course, doctors themselves, spent more than half a billion dollars on keeping things as they always were. This lobbying delivers real results for the health industry. It is money well spent for those who have money. If you cannot afford to lobby on a big scale, you are not represented. Worse is to come. The often-used but very correct Washington dictum simply says: “If you do not have a seat at the table, you are on the menu.”
In other words, those who want to make money out of human suffering know how to use the machinery of democracy, how to manipulate the system, and how to sit on the table serving up a menu of ordinary people and their money. It has already allowed Big Pharma two decades of profiting on prescriptions of opioids. This has done nothing to decrease (reports of) pain. Yet in the last few years the USA has experienced drug overdoses as the single largest category of deaths of despair.
So, as a different kind of theorist once said, “what is to be done?” – it actually is the title of an 1863 Russian novel by Nikolai Chernyshevsky. The title was later used by a certain revolutionary leader by the name of Lenin. What is needed to alleviate the suffering of those at the bottom of the American working class, those without a bachelor’s degree? Case and Deaton suggest the universal basic income (UBI), as well as a system of wage subsidies. The authors conclude by saying, capitalism needs to be better monitored and regulated, not to be replaced by some fantastical socialist utopia in which the state takes over ownership and management of industry. According to these two academics, democracy can rise to the challenge…
To us, though, their optimistic conclusion raises two issues. The first relates to Rosa Luxemburg who once said, “There can be no socialism without democracy and no democracy without socialism.” In other words, to bring her adage up-to-date, as long as democracy is based on capitalism and corporate lobbyists have a free hand, deaths of despair will continue. Contrary to Case and Deaton’s naïve view, democracy cannot rise to the challenge because, as the authors themselves say, the political system is asphyxiated by excess lobbying.
The second little tiny quibble we have is with Case and Deaton’s failure to imagine any other kind of world than a capitalist world. This lapse reminds us of the American literary critic Fredric Jameson who said, “It has become easier to imagine the end of the world than the end of capitalism”.
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