Deaths of Despair and the Future of Capitalism

“Deaths of despair” are by suicide, drug overdose, and alcoholic liver disease. Their increase in the US is explained by indignity and loss of pride, not globalization, inequality or automation. The US is doing something very wrong. But the problem is not capitalism.

So argue Anne Case and Angus Deaton. This well-researched, compassionate book aims for a more just society. The authors follow Amartya Sen, liberal political philosopher famous for “development as freedom.” According to Sen, identifying injustices, and removing them, makes a better world.

These “happy” authors care about those who are not. They ask what can be done.

The health system, rent seeking, and pharmaceutical industry are three big causes. The health system is a “cancer at the heart of the economy . . . that has widely metastasized, bringing down wages, destroying good jobs.” People’s well-being is subordinated to gain for the rich, including doctors.

Rent seeking, identified by Adam Smith as the tendency to increase one’s own wealth without producing wealth, is worst in the US among medium size businesses and professionals, including the American Medical Association. Physicians and their associations control access to medical schools, keeping the numbers of doctors down and salaries high.

The third cause is the pharmaceutical industry. Although Purdue, makers of OxyContin, may lose billions of dollars of past profit, aggressive marketing of opioids to doctors and patients is still in place.

These three phenomena have brought alienation and misery. The authors quote Emile Durkheim: Suicide is about meaninglessness. Life is not worth living.

Solutions are considered, such as wage subsidies, raising minimum wage, anti-trust legislation, universal basic incomes, and government regulation of pharmaceuticals. Since deaths of despair occur in those without a BA, education can be changed so the less educated are not disrespected.

Thus, capitalism can be “better monitored and regulated” and should not “be replaced by some fantastical socialist utopia in which the state takes over industry. Democracy can rise to the challenge.”

The conclusion jars. First, any philosophy student knows that in fair argument, one considers one’s opponents in the best light. Assuming one’s opponents stupid, without arguing for the claim, makes one’s job easy. It’s bad scholarship.

Socialism is a view about democracy. It may be wrong, but assuming this without argument is called “begging the question.” It's uninteresting, at best. But let’s assume socialism is “some fantastical utopia.”

There’s an urgent problem with the argumentative strategy, following Sen. The question is why people kill themselves in increasing numbers in the world’s richest and most free (according to Noam Chomsky) society. It matters.

In 1975, (in “The analytic and the synthetic”), US philosopher Hilary Putnam argued that before Einstein there existed empirical evidence against Newton; however, because Newton’s views were well-established, taken for granted, the evidence wasn’t interesting. Only after Einstein reconceptualized the universe, rethinking mass and energy, did empirical evidence against Newton become relevant.

It became plausible. We consider empirical evidence when the importance of such evidence is plausible given expectations possessed as a result of social and intellectual practises.  

This point is now well-known in philosophy.

Following Sen, these authors consider injustices given expectations of liberal capitalism. They don’t bother considering alternative expectations for a meaningful life. They exist. And they are not hard to find. They exist beyond the toxic bubble identified by the authors. But the authors take for granted the ideas of “democracy” and “meaningfulness” they’re comfortable with.

Maybe they’re correct, but since there are other views, responsible argument would consider them. Indeed, some scientists in the US, practicing medicine, also concerned with the colossal failure of the US medical system, have considered the failure of philosophical liberalism itself to explain deaths of despair. Its core ideas make care implausible. Then, medicine itself becomes implausible.

In Soul of Care, Dr. Arthur Kleinman, Harvard professor for four decades, identifies a contradiction between caregiving and “politically useful fictions” like the “self-made man” and “every man for himself.”  He sees them as “fundamentally wrong” and against medicine. He carves out an alternative vision. It involves reciprocity, which involves renunciation. You give stuff up and you gain, humanly.

Marx taught reciprocity, as did Lenin, the Buddha, and Christian philosophers Thomas Merton and Ivan Illich. Two points matter here: Reciprocity  explains capacities. Second, it explains access to truths.

But evidence for such claims, provided by Kleinman, won’t matter if there’s nothing such evidence explains, just like the evidence against Newton didn’t matter until Einstein’s vision. Even to look for such evidence, requires what Stephen Hawking calls a “leap of faith”: having courage to identify and believe what might be.

If any investigation deserves such a  leap, deaths of despair do.