Tuesday, November 3, 2015

The Culling of the American Herd (Update)

The only thing more surprising than a new study showing that middle-aged white people are dying in a virtual epidemic of suicide and substance abuse is that the experts are so shocked by this news. After all, the USA is the richest, most technologically advanced, most exceptional country in the history of history. Aren't minimum wage earners taking advantage of the Obamacare shopping network and champing at the bit to fork over $5,000 in deductibles every year before predatory insurance kicks in to treat their ingrown toenail? What gives?

The discovery by a pair of Princeton economists of the awful truth that tens of thousands of people in their forties and fifties are dying prematurely and unnecessarily was made purely by accident. Co-author Anne Case, herself suffering from a painful and inoperable back condition, was curious about the possible relationships among happiness, pain and suicide rankings in the various states. She and her husband, recent Nobel economics prize-winner Angus Deaton, were stunned to learn that the death rate for whites 45 to 54 years old with no more than a high school education increased by 134 deaths per 100,000 people from 1999 to 2014. The causes of these deaths are not diabetes, heart disease or hypertension: they are suicide, and the liver-damaging, life-shortening effects of alcohol, and accidental overdose from heroin and prescription opioids. 

They write:
 This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population.


The New York Times:
 The analysis by Dr. Deaton and Dr. Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans, Dr. Deaton and Dr. Case found.
 (snip)
“Wow,” said Samuel Preston, a professor of sociology at the University of Pennsylvania and an expert on mortality trends and the health of populations, who was not involved in the research. “This is a vivid indication that something is awry in these American households.”
Dr. Deaton had but one parallel. “Only H.I.V./AIDS in contemporary times has done anything like this,” he said.
Wow? More like duh. Another economist, from Harvard, is quoted as sniffing that he'd always just assumed that these drug deaths were just "blips on the radar," and  that "everyone's" health is improving, just as the "economy" is supposedly improving. Actually, the new study shows that by "everyone," the experts mean those of a higher educational and socioeconomic status, who can afford to see a doctor because they have actual jobs paying a living wage. The premature death effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent, while they actually fell for those with a college education. 

It's the class war, stupid. It's the wealth inequality, geniuses. It's the corporate media propaganda telling us that new Speaker of the House Paul Ryan is a "moderate" who will join with Democrats to soberly, responsibly and wonkishly cut what remains of the social safety net out from under millions of struggling, suffering Americans. It's Social Darwinism newly illustrated on a spreadsheet. It's the continued, deliberate culling of the American herd.



This silent epidemic of sadism within the political class has been going on for decades now. That the new findings of premature death are about white people probably accounts for much of the elite shock, since the death rates among blacks and Latinos are still higher than those of even the poorest whites. They simply have reached something of a plateau of pain, while whites are rapidly playing catch-up in their trek to the misery mountaintop.

It's telling that the Deaton-Case study didn't delve into the correlation between the higher death rates of poor whites with residence in states opting out of Medicaid expansion under the Affordable Care Act. Liberal pundits are very fond of blaming higher mortality and morbidity among whites in red states on Republican governors and legislatures refusing to join in the expansion, even though it is initially being paid for by federal funds.

Therefore, a Harvard study last year showing that as many as 17,000 people will needlessly die every year in states opting out of Medicaid expansion was met by a group shrug by liberal experts, who pointed to GOP nihilism rather than the despair and hardship of the individuals affected by the lousy economy as the cause. If only more people could access the rare doctor willing to accept those paltry Medicaid fees, the conventional wisdom went, people would be alive and well and happy.

The new study turns that supposition right on its head. Poor people are dying way too young in all 50 states, Medicaid or no Medicaid, Obamacare or no Obamacare. While official Census Bureau figures show that one in six people exists below the official poverty threshold, the reality is much worse when you consider that more than half of us don't have enough savings to cover a $1,000 medical co-pay or a $500 car repair. 

And we are all supposed to be surprised that a person would rather self-medicate with cheap heroin or a six-pack than log on to the Healthcare.gov website and be faced with rate hikes as high as 40 percent a year. Pay up, or else the IRS will charge you a penalty. Your pain is their gain.

It is obvious is that more and more people have been forced to treat their pain with opioids and booze because they can't afford a surgeon or a dentist. The authors of the study are still unsure what came first: the pain, or the substance abuse.  And they do not purport to find a link between the death rate and the financial crisis.

But an earlier study on the increasing fatal use of painkillers by white women squarely blames the plutocracy-spawned financial meltdown for premature deaths of poor and working class females:
Increases in midlife mortality are paralleled by increases in self-reported midlife morbidity….The increase in reports of poor health among those in midlife was matched by increased reports of pain. Rows 4–7 of Table 2 present the fraction reporting neck pain, facial pain, chronic joint pain, and sciatica. One in three white non-Hispanics aged 45–54 reported chronic joint pain in the 2011–2013 period; one in five reported neck pain; and one in seven reported sciatica. Reports of all four types of pain increased significantly between 1997−1999 and 2011−2013….
The epidemic of pain which the opioids were designed to treat is real enough, although the data here cannot establish whether the increase in opioid use or the increase in pain came first. Both
increased rapidly after the mid-1990s. Pain prevalence might have been even higher without the drugs, although long-term opioid use may exacerbate pain for some (26), and consensus on the effectiveness and risks of long-term opioid use has been hampered by lack of research evidence (27). Pain is also a risk factor for suicide (28). Increased alcohol abuse and suicides are likely symptoms of the same underlying epidemic (18, 19, 29), and have increased alongside it, both temporally and spatially.

Although the epidemic of pain, suicide, and drug overdoses preceded the financial crisis, ties to economic insecurity are possible. After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents. Growth in real median earnings has been slow for this group, especially those with only a high school education. However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience (lanekenworthy.net/shared-prosperity and ref. 30). The United States has moved primarily to defined-contribution pension plans with associated stock market risk, whereas, in Europe, defined-benefit pensions are still the norm. Future financial insecurity may weigh more heavily on US workers, if they perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans (31).
Between 2007 and 2013, median wealth dropped a shocking 40 percent, leaving the poorest half with negative wealth (because of debt), and about 100 plutocratic families owning as much wealth as the bottom 60 percent of Americans combined.  The wealth gap is now the highest ever recorded.



And the experts still have the chutzpah to call themselves "startled" that half a million desperate white people (a probably too-low figure, in my opinion) are killing themselves at rates comparable to those during the collapse of the Soviet Union in the 90s. Methinks they had better rethink their definitions of the American Empire, and American Exceptionalism.


We'd also be wise to define Chronic Despair as a public health emergency. The pathology of the plutocrats is trickling down like a ton of Ebola and killing people right in their tracks.

19 comments:

Pearl said...

Add in the use of food to self medicate involving obesity, anorexia and bulimia, which shorten or end lives, the huge ingestion of over the counter pain and other medications to deal with depression, anxiety, ad infinitum.
The pulse of the nation indicates a very sick country.
Many of these figures mentioned in your article, Karen, may possibly be found in very poor countries but in the richest country in the world are truly shocking.

Meanwhile what passes for health coverage is costing more and more. I also think that statistics for less poor white people may indicate high levels of anxiety - just the fear that guns puts into people, women face in domestic violence, insecurity in jobs, ad infinitum. Reading the news gives me a stomach and headache and the progressive news proving our worst fears are real, doesn't help. To say nothing of the effects on children generally who are made aware via TV, texting gadgets and family conversations of the chaos in their world.

I doubt Hillary represents someone who can alleviate some of these problems. After all her daughter and granddaughter are kept safe in a ten million dollar condo which is her reality. Interestingly a recent article indicates that young millennium women are not turned on by her as she seems to represent the older generations politically and personally and they feel a woman will definitely fill the office of the presidency in the foreseeable future so why push it now. Bernie's vision seems to attract them more. Interesting.
Thank you for a sobering report, Karen.

Jay–Ottawa said...

The last to know about the everyday realities are the most educated; the first to know are the least educated.

The most educated count with precision and are sometimes moved to a 'Wow!" The least educated groan with the data of experience they carry every day.

The most educated in face of all their findings, still can't figure it out. The least educated aren't around anymore to study the graph lines they ride right off the charts.

With apologies to Sonia Faruqi for recasting one of her lines: "Certain forms [of scientific certitude] are dependent on drinking a drug of ignorance."

Pearl said...




From Today's NYTimes:

Small Towns Face Rising Suicide Rates

By LAURA BEIL

People living in rural areas kill themselves far more often than those in urban settings. One reason: poor access to mental health care.

43 Comments

Ken Wallace said...

All of my conservative friends would explain this trend as more deterioration of lower class attitudes and family values. Tightening the screws would give them more motivation to lift themselves out of poverty and despair. I suspect we'll be hearing this very thing from Paul Ryan as he takes the reins in the House.

Bernie is the only candidate that give a rat's ass about these people, and even he has a Herculean task ahead to reshape private sector job creation. This will require massive reform of our tax and trade policies to cut off the corporate gravy train of globalization. But this is a whole other topic.

Cynic Pearl said...

Jay: regarding 'the most educated in face of all their findings, still can't figure it out'. I think they do but don't like the answers which will force them to face change which can be dangerous and threaten their lifestyle.

Meredith NYC said...


Thanks, Karen for this great sum up on ongoing tragedy. Stuff is hitting the fan.
This was also a Times article a few days ago:

In Heroin Crisis, White Families Seek Gentler War on Drugs
By KATHARINE Q. SEELYE
837 Comments
.... ‘And the growing army of families of those lost to heroin — many of them in the suburbs and small towns — are now using their influence, anger and grief to cushion the country’s approach to drugs, from altering the language around addiction to prodding government to treat it not as a crime, but as a disease.’

So seems whites are using influence now to be treated as sick not criminals? Now so much mass incarceration isn’t such a great idea?

Also Karen, I appreciated your comment to Krugman’s last column ...you said re Gop:
‘These people are not conservatives. They are radical counter-revolutionists who use the language of a mass movement to undo all the social programs of the New Deal and Great Society.’

That point has to be promoted. Let’s stop the Orwellian distortion of terms.

The irony is that our ‘liberals’ are the true conservatives---they want to restore and protect America’s democratic traditions of equality and upward mobility. It was govt action that allowed that to flourish.

Our ‘liberals’ are the ones who want to conserve prudent, responsible, govt regulations that protected the US from crashes for over 60 years. It’s the gop ‘conservatives’ who are reckless, lawless, and subversive, extracting and hoarding our resources.

Bernie Sanders in that sense is a true conservative---aiming to
restore the more fair policies that were once quite centrist, even accepted by the species ‘moderate Repubs’ in prehistoric times. Fair tax rates, low cost public education, health care before soaring costs put it out of reach of most, union bargaining, and, for sure, sensible regulations on business that enabled the middle class to be secure.

No great mystery how all that worked. It’s all in our history—but now seemingly blacked out of the history, Soviet style.

These Princeton economists cited here should team up with the other Princeton researcher Martin Gilens who compiled stats showing that most of our laws are passed to benefit the elites, ignoring the wishes and welfare of the majority. The connection is obvious.

Patricia said...

Karen, thank you for this. I am a 57 year old widow. I work part time, since I can't find full time work. I can't afford, "Obamacare" I have not been to a doctor for over five years. Btw, I have a college education and teaching credentials, I graduated at the top of my class, Deans List. I was a married to a Nursing Home Administrator, he died at the age of 39, in a car accident. I was left with raising my 2 children and a very small stipend from life insurance that was inadequate, to say the least,it didn't even add up to 2 years of his income. I could not afford to stay in our home and of course, had to sell in the worst real estate market, I was not underwater, I did not use my home as an ATM machine. Whatever my home was worth, was worthless. I was obliged to move on. Like you Karen, I live in New Jersey, with the highest taxes in the country. Now I live in what would be called a ghetto, I don't qualify for food stamps, since I make too much money, my part time job keeps me at 30 hours a week. I don't want charity, I just want to pay my bills but healthcare is out of the question..So where does a widowed woman go, who tries to make her way? I am invisible, that is purposeful, I know it, I have had to sell my paid off car since I can't afford car insurance. I walk everywhere which keeps me healthy. However, there is no way I ever thought with a college education and a middle class life, I previously had I would have ever thought I would end up in poverty, with not a thought of healthcare and walking to a part time job everyday. Guess what? I have no debt, so I am one of the "lucky ones." Where are you supposed to go when you have done everything you possibly could to survive? I'll leave you with that. I feel like I am living in a Bronte novel, or maybe in a Dickens novel, off to the poorhouse with me.

Meredith NYC said...

On msnbc chris hayes right now , he's mentioning the articles on the crisis in suicides, drugs and illness in an interview one on one with Bernie Sanders. Repeated later. Chris says many of these whites are working class gop voters. Sanders thinks the Dems can reach them.
Their jobs have been sent to China, their retirement is very insecure, their kids can't afford college, and health problems are overwhelming.

How many generations will it take to break this voting block who have voted against their own interests?

Jay–Ottawa said...

If you're not an unemployed, middle-aged white guy, it's a sweet life. Don't worry, be happy. Never mind your diminishing buying power year after year on a fixed income with no respectable COLA. The decay probably won't reach your doorstep. With luck you'll die before you go broke.

Sociologists and economists like Case and Deaton spend a good deal of their time measuring happiness, or the lack thereof. How much do the subjects of investigation smile, frown? Which boxes do they check on contentment surveys? Why on earth are they suicidal? Lots of numbers to crunch on the department's supercomputer. Then, voila!, X degrees of happiness or unhappiness.

Are there simpler, more direct ways of knowing? How about looking over the fence to see with your own eyes how your neighbor is doing. Or read the testimonies of the Patricias of our land. Or have you always driven through the urban landscape with your eyes closed? Proximity and your own eyes, which you might suppose would be great aids to frontline observation, don't seem to count for much in the ivory tower. Princeton is only 38 miles away from Camden––or it's 51 miles away. Depends on whether you're a crow or a car. Either way, the two places are pretty close, don't you think? But short mileage doesn't help our academic sleuths to have a clue about despair or contentment in those two places.

On the other hand, the similarity or apartness of these two communities when measured in dollars (Aha! moment) proves to be much more informative. Bring on the economists, warm up the computer.

The Census Bureau's 2006-2010 American Community Survey showed that (in 2010 inflation-adjusted dollars) median household income for Princeton was $107,071; and the median household income of Camden was $26,705. Let that sink in. OK, textbooks closed and without peeking at the heavy-duty research, guess which community is likely to have a higher score on the misery scale.

Every scale worth its salt needs a beginning and an end that are in sharp contrast. You know: where do you peg yourself on a scale of one to ten, if one is death wish territory and 10 is ignorant bliss? We should welcome severe social contrasts to ascertain clearly just how lucky we are, are aren't, as Americans. That's right, disparity is good, at least for those seeking truth. Swedes and Danes, for example, avoid marked social contrasts; that's why they're so dull. Life in America is exciting because of the contrasts. As that perspicacious American John Steinbeck once remarked, "For how can one know color in perpetual green, and what good is warmth without cold to give it sweetness?"

Karen Garcia said...

I'm glad Chris Hayes brought up the study, and so was Bernie Sanders. (thanks for the heads up on the segment, Meredith!) I am shocked, shocked that other politicians aren't touching this epidemic of despair with a ten foot pole. It must be because it does not follow the established narrative in an election year(s) -- neither establishment party can blame the other for this crisis. Social Darwinism is a truly bipartisan effort.

Like Patricia, I was a widowed mom with two young children. My big problem back in the 90s was not work, but child care, the costs of which pretty much cancelled out the paycheck. I eventually had to sell my house to pay off medical debts and sky-high property taxes. Nobody is immune from plutocratic predation, except for the plutocratic predators at the very tippy top.

We need a counter-elite revolution. Of course, despair is the big enemy, when it's not working too many hours and having too little leisure time!

Pearl said...



Today's NYTimes

Stressed, Tired, Rushed: A Portrait of the Modern Family http://nyti.ms/1PmhNeT via @UpshotNYT

Tommybones said...

So what happens yesterday with the elections? The Washington Post declares "The Daily 202: From coast to coast, conservatives score huge victories in off-year elections."

Suicide by vote.

Meredith NYC said...

Chris Hayes also had Krugman on the other night--seems PK's now going on relatively liberal media? Guess it was ok after Hillary was interviewed by Rachel Maddow. But I didn't think he sounded very persuasive or forceful. Usual easy stuff on the rw Gop crazies.

Meredith NYC said...

Karen.....re pain killer addiction..check this out when have time. I just caught part of PBS Nightly Business Report... “The pain killer: A drug company putting profits above patients.” re addicting drugs pushed by doctors, paid off by drug companies. Repeated later tonight, and part 2 is tomorrow. Shocking. Transcript at NBR.com.

Investigations have gone on for years. Says....“The US opiate drug problem isn’t limited to illegal narcotics. The sale of dangerously addictive painkillers willfully prescribed by our physicians has quadrupled in the past decade, and one company in particular is pushing pain to the legal edge of aggressive medical marketing.

Per attorney generals’ reports, specialty pharmaceutical company Insys Therapeutics — with the help of several physicians across the country now under investigation — is putting profits before patients as it makes millions off your pain.”

.....sales staff were under immense pressure, including threats of termination, to get doctors to write more prescriptions and higher doses of Subsys for everything from neck pain to migraines.”

A nurse practitioner pleaded guilty to accepting about $83,000 in return for prescribing highly addictive drug, Subsys.

“It’s not uncommon for pharma to pay physicians speaking fees, but if you’re suspicious about your own doctor or are curious about level of fees paid, you can give your doctor a financial checkup on the Centers for Medicare & Medicaid Services Open Payments website.”

Also......Pearl, good Times Upshot column and comments.... thanks.

Meredith NYC said...


Karen.....re pain killer addiction..check this out when have time. PBS Nightly Business Report... “The pain killer: A drug company putting profits above patients.” re addicting drugs pushed by doctors, paid off by drug companies. 3 part series Transcript at NBR.com.

Investigations have gone on for years. Says....“The US opiate drug problem isn’t limited to illegal narcotics. The sale of dangerously addictive painkillers willfully prescribed by our physicians has quadrupled in the past decade, and one company in particular is pushing pain to the legal edge of aggressive medical marketing.

Per attorney generals’ reports, specialty pharmaceutical company Insys Therapeutics — with the help of several physicians across the country now under investigation — is putting profits before patients as it makes millions off your pain.”

.....sales staff were under immense pressure, including threats of termination, to get doctors to write more prescriptions and higher doses of Subsys for everything from neck pain to migraines.”

A nurse practitioner pleaded guilty to accepting about $83,000 in return for prescribing highly addictive drug, Subsys.

“It’s not uncommon for pharma to pay physicians speaking fees, but if you’re suspicious about your own doctor or are curious about level of fees paid, you can give your doctor a financial checkup on the Centers for Medicare & Medicaid Services Open Payments website.”

Also...Pearl, good Times Upshot column and comments.... thanks.

Valerie said...

Patricia,
I have often thought that we are moving back in the direction of a Dickens novel. I have friends in their forties and fifties who were laid off during the Recession and who have never found meaningful work again. They also must subsist on part time work. Aging is even more frightening when a person must worry about not having access to health care in addition to concerns about ongoing employment. We have all been sold such a bill of goods - "go to college, be a good student, work hard, stay away from unnecessary credit card debt and you will be financially stable in your middle age." I know so many people who have followed the rules and are struggling and worried.

Most of us don't mind downsizing and living simply. What we don't want is insecurity. I can only hope that ordinary people pull their heads out of their phones and mindless television and rise up. We can only fight those in power and those pulling the strings of power if we unite and remind them that we matter.

I see these movies

Valerie said...

And I agree with you, Karen, despair is the enemy. So many people who used to fight are so beaten down and demoralized by their situation, they can't bring themselves to fight back. The plutocrats are counting on it which is why they think they can control the narrative.

Cathy Talbott said...

Well written and I live what you write of here. My town is 10,500 mostly white precariously existing working class. All the ills you list are all around me.

I read and write for a paper that attempts to educate these precarious workers as to the root of their problems. I would be pleased if you could link to the paper. www.peoplestribune.org

Thank-you for your very passionate and timely piece.

Cathy Talbott
Dying Small Town, U.S.A.

Karen Garcia said...

@Cathy Talbott,

Thanks for alerting us to your newspaper. I have gladly added it to my Blogroll.
Keep up your great work!