By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She now spends most of her time in Asia and is currently researching a book about textile artisans. She also writes regularly about legal, political economy, and regulatory topics for various consulting clients and publications, as well as scribbles occasional travel pieces for The National.
Anne Case and Angus Deaton published a new paper last week, Mortality and morbidity in the 21st century,a follow-up to their groundbreaking 2015 paper on the mortality and morbidity consequences of the increasing immiseration of the American white working class.
Naked Capitalism has covered this issue extensively (see here, here, here, here, and here.) As Lambert noted in last Thursday’s Water Cooler, we’ll undoubtedly have much more to say on this topic in future days. Readers have already chimed in extensively with their thoughts on the latest paper in the comment threads and I encourage them to do so for this post as well.
Despair and US Politics
In their work, Case and Deaton document the stunning decline in health and rise in mortality, among white, working class Americans with low levels of education in this century. These changes are unprecedented in recent times in advanced industrial countries (although they were previously seen following the collapse of the Soviet Union). My aim in this post this post is not to discuss their work in great detail. What I do want to consider are connections between the problems that Case and Deaton document and the current state of US politics– as well as some possible Trump administration responses.
First off, let me start with Case and Deaton’s summary of what caused these morbidity and mortality patterns:
We propose a preliminary but plausible story in which cumulative disadvantage over life, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this implies that there are no policy levers to be pulled; preventing the over-prescription of opioids is an obvious target that would clearly be helpful.
What created those “progressively worsening labor market opportunities” that exacerbated this “cumulative disadvantage over life”? Well, I have an answer for that. How about those neoliberal policies that immiserated the working class and were enacted over the decades since I cast my first presidential vote in 1980? These include anti-union policies, trade liberalization, “starve the beast” budget policies, deregulation, the rightward lurch of the courts, and policies that promoted elite impunity not only for misdemeanors, but for outright crimes (and have encouraged those who can to misdirect or outright steal whatever isn’t tied down). (I am aware that some of these trends predate 1980– e.g. airline deregulation and I do want to mention in passing Jonathan Cobb and Richard Sennett’s excellent Hidden Injuries of Class— which I last read in graduate school– which suggest the indignities that the working class has suffered are not new.)
Reversing these policies– as regular readers are well aware– is a far from trivial project. And although vitally necessary, even if we lived in a world in which we could simply all clap our hands and instantaneously eliminate the scourge of neoliberalism, that action would, unfortunately, fail in itself to reverse the morbidity and mortality patterns Case and Deaton document.
Policy Failures Will Not Damage Trump’s Popularity With His Base
Unfortunately, however, the world in which we live in does not operate according to J.M. Barrie’s rules, and, thus, Tinkerbell must die. As the last several days have demonstrated, the Trump administration has a lot to learn about getting Congress to enact its announced policy goals– e.g., eliminating Obamacare (although I am of course aware that this health care system is an abomination, and despite that, allow for the possibility that the Trump administration may not, indeed, have wanted to kill it at this time).
Yet so far, the chaos surrounding Trump has yet to damage him with his base, as recent news coverage demonstrates (e.g., Angry over U.S. healthcare fail, Trump voters spare him blame and Donald Trump voters: We like the president’s lies).
Now, why is that? While Hillary Clinton’s infamously dismissed the views of a big chunk of the electorate as “deplorables”– a soundbite I’m sure she wishes she could take back– Trump is in tune with what plays to his base. So, what does this imply for the future– (especially with respect to health care deficiencies suggested by the most recent Case-Deaton paper)?
Donald Trump: Hedgehog or Fox?
For the answer, dear readers, allow me to revert again to graduate school. The starting point for what I wish to discuss is Isaiah Berlin’s famous essay, The Hedgehog and the Fox, which begins with an aphorism from the ancient Greek poet Archilochus: “The fox knows many things, but the hedgehog knows one big thing.”
Now, Donald Trump is famously shy on details– and thus is not by any stretch of the imagination, a fox. But he does know one big thing: he understands, that the white working class has been screwed. Though they undoubtedly wouldn’t put it in such vulgar terms, in their work, Case and Deaton spell out the recent mortality and morbidity consequences of this insight.
Allow me to speculate wildly, since given what came down last week, health care is on my mind. Suppose someone convinces Trump that one big thing that could alleviate the suffering of the working class– white and otherwise– would be for the US to adopt a better health care system such as single payer. I believe a hedgehog such as Trump could make this leap– if he grasped that the costs of the status quo fall disproportionately on his base and that these individuals would benefit from such a policy change (as incidentally would many others).
What follows? Is Trump merely a cynical opportunist who has successfully ridden the waves of (white) working class discontent to get where he is? Or is there more there there and is he capable of assembling a skulk of effective foxes who can push a single payer agenda– or indeed– any plausible health care alternative?
Without mentioning hedgehogs or foxes, however, Maureen Dowd on Sunday spelled out some obvious flaws with my thought experiment. Addressing last week’s health care failure, she said:
You mused that a good role model would be Ronald Reagan. As you saw it, Reagan was a big, good-looking guy with a famous pompadour; he had also been a Democrat and an entertainer. But Reagan had one key quality that you don’t have: He knew what he didn’t know.
You both resembled Macy’s Thanksgiving Day balloons, floating above the nitty-gritty and focusing on a few big thoughts. But President Reagan was confident enough to accept that he needed experts below, deftly maneuvering the strings.
You’re just careering around on your own, crashing into buildings and losing altitude, growling at the cameras and spewing nasty conspiracy theories, instead of offering a sunny smile, bipartisanship, optimism and professionalism.
I’m not sure that I agree with all MoDo says here. In particular, I think that getting sucked down the standard DC bipartisan rabbit hole is probably a dead-end for Trump, given the circumstances (crazypants Republicans, ineffectual and unimaginative Democrats). And further, I think Trump’s base not only regards itself as far worse off than its counterparts in the Reagan era would have done– and is indeed correct in doing so, at least as far as their health is concerned, as the latest Case-Deaton study suggests. So I’m not sure Trump’s outright contempt for Washington does not indeed play better to his base than did Reagan’s bromides.
But the bottom line is that the pain is real, and his base won’t be satisfied with rhetoric forever (nor, for that matter, will anyone else). So Trump needs to find a cunning little skulk of foxes, and soon, to press some effective policies, if he hopes to achieve anything other than broadcasting inane twitter blasts, and spouting press conference bluster. Will he do so? I’m not sure he’s capable of such vulpine behavior. If he’s indeed not, he’ll undoubtedly be yet the latest in the ongoing series of ineffectual Presidents who have failed to slow– let alone arrest, the slow steady decline of working class America.