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.