Angus Deaton on How Neoliberal Ideology Produced Abject US Falling Life Expectancy for Less Educated

Reader Anthony L recommended an article in the Boston Review, based on a series of speeches Angus Deaton, which extends his landmark work on deaths of despair which earned him and his co-author Anne Case a Nobel Prize.1

The latest sighting is grim. As before, Deaton ties the US record of falling life expectancy among the less educated, which is a serious outlier by advanced economy standard, to the opioid epidemic. But his data updates show US outcomes to be getting even worse over time despite efforts to curb the pill-pushing practices of opioid makers, exemplified by Purdue Pharma.

Deaton also attributes the success of Purdue Pharma and its fellow travelers in ending curbs on what amounts to prescribing heroin to the widespread uptake of Chicago School of Economic ideology, which strongly favors de-regulation. Mr. Market is supposed to take care of bad actors. Yet even though Alan Greenspan, a strong-form libertarian, confessed that the 2007-2008 financial crisis showed his ideology was flawed,2 it still retains many adherents because libertarianism is good for business, bugger the costs for broader society. Deaton attributes the popularity of this bogus belief to a deliberate misreading of his fellow Scottish economist Adam Smith.3

I strongly urge you to read the Deaton article in full.

Recall that the Case-Deaton work, first published in 2015, found that all-cause mortality had increased among middle-aged non-Hispanic whites. Note that the chart below is not stratified by educational attainment. These deaths by suicide, opioid and drug overdose, which later work found were concentrated among those with at most a high school education, were substantial enough to lead to a reported increase in all-cause mortality for the entire non-Hispanic white cohort for that age group:

Case and Deaton have been refining their findings as the passage of time adds new data. The update per the Boston Review is grim. The death rate in the US among those in their mid-40s to mid-50s with only a high school education (note this now is for all races) has become so high that it has led to a fall in life expectancy among all adults with a high school education or less (Deaton also notes that only Scotland among advanced economies is following this trajectory), and that is what is driving the decline in US life expectancy overall. Note the declines started before Covid. From the Boston Review:

This chart show the difference in the US between the more and less educated:

Deaton elaborates (emphasis his):

Figure 2 shows life expectancy at twenty-five and, for the United States, divides the data into those with and without a four-year college degree. In Scotland, we do not (yet) have the data to make the split. The remarkable thing here is that, in the United States, those without a B.A. have experienced falling (adult) life expectancy since 2010, while those with the degree have continued to see improvements. Adult mortality rates are going in opposite directions for the more and less educated. The gap, which was about 2.5 years in 1992, doubled to 5 years in 2019 and reached 7 years in 2021.

One has to wonder if Obamacare played a secondary role. It became law in 2010 and its main provisions had phased in by the start of 2014. One benefit to the poor was Medicaid expansion, but many states refused to take that up. The complexity of the scheme would also work against the less educated. Even with Federal subsidies, most policies have high deductibles that render them high-cost catastrophic coverage.

Deaton describes how Purdue Pharma won FDA approval for OxyContin in 1995. A key point:

Traditionally, doctors in the United States did not prescribe opiates, even for terminally ill cancer patients—unlike in Britain—but they were persuaded by relentless marketing campaigns and a good deal of misdirection that OxyContin was safe for chronic pain.

He neglects to include that Perdure Pharma reformulated OxyContin from an 8 hour dose to a 24 hour dose that did not last 24 hours. This was a deliberate scheme to create addicts. When the pain resumed before the 24 hours were up, doctors were told to increase the dose, even though Purdue Pharma knew that would not change outcomes.

Deaton points out that Purdue Pharma reformulated OxyContin in 2010 to reduce its potential for abuse, but by then, the horse had left the barn:

By 2012 enough opioid prescriptions were being written for every American adult to have a month’s supply. In time, physicians began to realize what they had done and cut back on prescriptions. Or at least most did; a few turned themselves into drug dealers and operated pill mills, selling pills for money or, in some cases, for sex. Many of those doctors are now in jail….

In 2010 Purdue reformulated Oxycontin to make it harder to abuse, and around the same time the docs pulled back, but by then a large population of people had become addicted to the drugs, and when prescribers denied them pills, black market suppliers flooded the illicit market with cheap heroin and fentanyl, which is more than thirty times stronger than heroin. Sometimes dealers even met disappointed patients outside pain clinics.

Deaton stresses that Smith has been misrepresented and quotes one American economist quipping that Smith had been imprisoned by the Chicago School. He turns to his economic argument. I have excised a lot in the interest of both space and not over-hoisting:

Smith’s notion of the “invisible hand,” the idea that self-interest and competition will often work to the general good, is what economists today call the first welfare theorem. Exactly what this general good is and exactly how it gets promoted have been central topics in economics ever since….

I want to discuss two issues. First, there is the question of whose good we are talking about. The butcher, at least qua butcher, cares not at all about social justice; to her, money is money, and it doesn’t matter whose it is. The good that markets promote is the goodness of efficiency—the elimination of waste, in the sense that it is impossible to make anyone better off without hurting at least one other person. Certainly that is a good thing, but it is not the same thing as the goodness of justice…

A second condition is good information: that people know about the meat, beer, and bread that they are buying, and that they understand what will happen when they consume it…..Patients must rely on physicians to tell them what they need in a way that is not true of the butcher, who does not expect to be obeyed when she tells you that, just to be sure you have enough, you should take home the carcass hanging in her shop….This is (at least one of the) reason(s) why almost all wealthy countries do not rely on pure laissez-faire to provide health care.

So why is America different? And what does America’s failure to heed Arrow have to do with the Sacklers, or with deaths of despair, or with OxyContin and the pain and despair that it exploited and created? There are many reasons why America’s health care system is not like the Canadian or European systems, including, perhaps most importantly, the legacy of racial injustice. But today I want to focus on economics.

Neither America nor American economics was always committed to laissez-faire….

Chicago economics is important. Many of us were brought up on a naïve economics in which market failures could be fixed by government action; indeed, that was one of government’s main functions. Chicago economists correctly argued that governments could fail, too…Free markets, on the other hand, would produce both freedom and equality. These ideas were often grounded more in hope than in reality, and history abounds with examples of the opposite…

Chicago analysis serves as an important corrective to the naïve view that the business of government is to correct market failures. But it all went too far, and morphed into a belief that government was entirely incapable of helping its citizens…

If the government could do nothing for African Americans, then it certainly could do nothing to improve the delivery of health care….

There is no area of the economy that has been more seriously damaged by libertarian beliefs than health care.

I hope you will read this important article and circulate it widely.

1 I believe most readers recognize that the economics “Nobel” is a Swedish central bank counterfeit, and I do not highlight that because it also takes too many words to make the point.

2 From the New York Times on the relevant section of Greenspan’s Congressional testimony in October 2008:

Mr. Greenspan admitted…“Those of us who have looked to the self-interest of lending institutions to protect shareholders’ equity, myself included, are in a state of shocked disbelief,” he told the House Committee on Oversight and Government Reform….

“You had the authority to prevent irresponsible lending practices that led to the subprime mortgage crisis. You were advised to do so by many others,” said Representative Henry Waxamn of California, chairman of the committee. “Do you feel that your ideology pushed you to make decisions that you wish you had not made?”

Mr.Greenspan conceded: “Yes, I’ve found a flaw. I don’t know how significant or permanent it is. But I’ve been very distressed by that fact.”

3 Deaton is far from alone in pointing out the way Smith’s beliefs have been misrepresented and misused. For instance, we made that point in what amounts to the thesis statement of ECONNED:

In 1776, Adam Smith published The Wealth of Nations. In it, he argued that the uncoordinated actions of large numbers of individuals, each acting out of self-interest, sometimes produced, as if by “an invisible hand,” results that were beneficial to broader society. Smith also pointed out that self-interested actions frequently led to injustice or even ruin. He fiercely criticized both how employers
colluded with each other to keep wages low, as well as the “savage injustice” that European mercantilist interests had “commit[ted] with impunity” in colonies in Asia and the Americas.

Smith’s ideas were cherry-picked and turned into a simplistic ideology that now dominates university economics departments. This theory proclaims that the “invisible hand” ensures that economic self-interest will always lead to the best outcomes imaginable. It follows that any restrictions on the profit-seeking activities of individuals and corporations interfere with this invisible hand, and therefore are “inefficient” and nonsensical.

According to this line of thinking, individuals have perfect knowledge both of what they want and of everything happening in the world at large, and so they pass their lives making intelligent decisions. Prices may change in ways that appear random, but this randomness follows predictable, unchanging rules and is never violently chaotic. It is therefore possible for corporations to use clever techniques and systems to reduce or even eliminate the risks associated with their business. The result is a stable, productive economy that represents the apex of civilization.

This heartwarming picture airbrushes out nearly all of the real business world. Yet uncritical allegiance to these precepts over the last thirty years has produced a world in which corporations, especially in finance, are far less restricted in their pursuit of profit. We show in this book how this lawless environment has led the financial services industry to pursue its own unenlightened self interest. The industry has become systematically predatory. Employees of industry firms have not confined their predation to outsiders; their efforts to loot their own firms nearly destroyed the industry and the entire global economy.

Similarly destructive behavior by other players, often viewed through a distorted lens that saw all unconstrained commercial behavior as virtuous, added more fuel to the conflagration.

Some economists have opposed this prevailing ideology; indeed, comparatively new lines of inquiry focus explicitly on how economic actors can fool themselves or others into making poor, even destructive, choices.

But when the economics profession has used the megaphone of its authority to dominate discussions with policymakers and the public, it has spoken with one voice, and the message has been the one described here. We therefore confine our criticism to these particularly influential ideas.

Theories that fly in the face of reality often need to excise inconvenient phenomena, and mainstream economics is no exception. Idealizing the rational aspects of business decisions means refusing to notice behavior that is predatory, destructive, criminal, or simply stupid. Believing that risk is manageable through mechanical systems has required not just unrealistic assumptions but also willful blindness to clear signs of danger.

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  1. Henry Moon Pie

    Excellent essay, Yves. The policy choices around pharmaceuticals parallel those made around Overshoot and Covid. Profit is the goal driving every system in the U. S.

    It’s so depressing, I think I need to get my mind off of it by visiting some wonderful new art museum. (scroll down)

    1. Kurtismayfield

      Hey at least it’s free admission!

      The fact that Deaton and the overall drop in life expectancy gets little press speaks volumess about the PMC’s attitudes towards the poor. In their minds they deserve it because they didn’t “work” hard enough to get into Harvard. (I put work in quotations considering the studies of admissions to the University that have been published lately). Every time I see the results of what the top desire I keep hearing the Frank Herbert quote “Scratch a liberal you find a closet aristocrat..”

    2. Offtrail

      It’s a bit jarring, in the context of this thread, that one of the museums profiled in this link is the Arthur M. Sackler Museum.

      1. Henry Moon Pie

        And Harvard doesn’t spare the praise:

        With the generosity of Dr. Arthur M. Sackler [scroll to “Philanthropy Backlash], a leading psychiatrist, entrepreneur, art collector, and philanthropist, the Harvard Art Museums founded a museum dedicated to works from Asia, the Middle East, and the Mediterranean.

        Most of the museums to which the “leading psychiatrist” gave money, like the Tate and the NY Met, took the Sackler name off or gave the art back. Maybe Harvard has crappy lawyers. Ironic.

        At least Harvard gave back a little of Epstein’s money:

        A university review launched in September found that most of Epstein’s donations occurred before his 2006 arrest, including a $6.5 million gift in 2003 to help create the university’s program in evolutionary dynamics. Harvard President Larry Bacow said the university will donate about $200,000 in unspent gifts from Epstein to organizations that work with victims of human trafficking and sexual assault.

        Even with all that, I think that if there are historians 50 years from now, they will judge Harvard’s relationship with Gates to have done the most harm.

  2. DJG, Reality Czar

    Excellent essay, and the underlying essay/speech by Angus Deaton is thought-provoking. His explanation of Arrow’s thinking that health care cannot be governed by the market because of the enormous disparities in information is worth remembering.

    Deaton mentions this without following up: “The reversal of mortality decline in the United States has many proximate causes; one of the most important has been the slowing—and for the less-educated an actual reversal—of the previously long-established decline in mortality from heart disease.” Heart disease is up.

    With regard to Yves Smith’s discussion above of Obamacare as a factor–I’d agree. I was a free-lance when Obamacare rolled out, as were several close friends. We all lost our insurance, and the plans offered as substitutes were much worse. Remember those “Bronze” plans? Pure crap–with enormous deductibles.

    1. JohnnyGL

      I’ve know someone who ran into the buzzsaw of various tiers and buckets under obamacare recently. He’s been seeing a number of specialists for back pain caused by a chronic spine injury. But, he made the mistake of getting a better job and making a bit more money and took a tax hit and had to get a new health care plan from the exchanges. It’s been months before he could get a primary care doctor and get seen and back on a progam to fix his back pain.

      Months of hassle and additional pain and suffering…and to what end?!?!?

      1. Pat

        It saved his old insurance plan and his new one money.
        And making sure that insurance companies get as many customers as possible while having to provide little or no actual health care, including the supposed required services, is one of the healthcare goals of our elected officials.

        (Along with commercial real estate woes, I truly believe that one of the driving forces pushing Congress to end even cursory Covid care was Insurance companies didn’t want their customers getting used to no questions asked when getting healthcare.)

    2. digi_owl

      The information issue is ever present these days as the range and complexity of products have ballooned massively.

      Never mind that increasingly one find that even product reviews can’t be trusted, as more and more rely on the product being donated to them for review in the first place.

      It is virtually impossible to be an informed “consumer” these days.

  3. eg

    America’s profligacy with respect to the health and well being of its general populace is astonishing, even in purely amoral “human resource” wastage terms.

    I eagerly await the orthodox neoclassical paper explaining how America’s falling life expectancy is actually beneficial because reasons … /sarc

    1. JonnyJames

      (Twisted humor warning), Yes! it is good for the oligarchy: they can get rid of the “surplus or excess” population, extract any wealth they have left, create more ill debt peons and bankruptcy etc. More interest charges and fees, more health extortion. This will also count as GDP increases. So it is beneficial…

      In addition, with the increased deaths, a new Soylent Green market can be established. SG will provide organic fertilizer, food, and even Green Energy. Let’s look at the bright side: falling average life expectancy will create ground-floor investment opportunities for the SG market. At the same time we can save the planet with SG! And at the same time, we can make a killing! It’s a win-win!

    2. digi_owl

      The illustration of the modern US capitalist is that of a vampire who has a cellar filled with humans that gets tapped for blood like they were casks of wine. Only it is not blood but debt generated money that is being drained. And once they are drained dry, the husk is discarded to the curb like any other refuse.

  4. john

    Great essay. Also note that a study by University of Texas physicians pointed out a strong correlation between a high level of opiod prescriptions in a county and the likelihood of people in that county to vote for Trump; the same level of correlation was not shown for other necessary prescriptions like insulin. The data was derived from Medicare data; i.e. voters has some form of government subsidized health care. States’ refusal to expand Medaid were political decisions, as federal funds could be used to off-set. (See Commonwealth Fund report). Looking at states’ rationale for not expanding, you find “dying of whitemess” language, which voters bought,

    Other studies on the impact of Covid have linked high death rates to lower education levels. i.e. high-school or less. IMO however, it’s about a lack of critical thinking skills and community organization efforts. In cases where churches, libraries, neighborhood associations engaged, people learned about AHA and signed up or learned about how to protect themselves and families duing the pandemic. This kind of involvement seems to be lacking in low-income non-hispanic white communities.

    Regarding Adam Smith, misrepresented is a mild way of putting it. His writings are objects of “suspicious attention,” (McGoey,The Unknowers.) Since no one reads his 6 volumes, you can (mis) quote Smith out of his historical and economic context to justify any market place shinanigans.

    wrote–what 6 vol

  5. Rob Urie

    Very good piece.

    The problem that I have with the ‘deaths of despair’ explanation is that it still serves the ‘personal responsibility’ view of drug addiction.

    During the Vietnam war I made friends with the older kids who were returning from the war addicted to heroin.

    From reports, heroin was everywhere in Vietnam and was distributed through quasi-official channels.

    I was therefore expecting massive opioid addiction after the US wars in Afghanistan and Iraq were launched.

    This go ’round, the opioids were channeled to returning veterans through legal channels.

    While I have no way to scale this to the problem, opium production in Afghanistan surged after the US invaded (in late 2002?).

    The link below has a graph illustrating this surge in opium production following the US invasion of Afghanistan (numbered page 4).

    Otherwise, education is an indicator of class. Not perfect, but approximate enough.

    The rich live fifteen years longer than the poor in the US.

    This isn’t to conflate level with rate of change, but class appears to be the central determinant of propensity for ‘excess’ death.

    1. Pat

      We purposely included the groups behind opium production as part of our consortium invading Afghanistan. Between that and our protecting oil fields above all else in Iraq our actual goals were very clear regardless of what we claimed.

    2. Cristobal

      I understand that in this last year opium production has declined sharply in Afganistan in response to the Taliban´s efforts to eradicate it in their country. Sorry I don,t havve the link at hand. The synthetics will see a boom.

    3. flora

      “despair” is another word for “demoralization”. goodness knows the US political neoliberal system of destroying good local jobs to find cheaper workers in another country, losing a good job and all that goes with it – health insurance, retirement benefits, a steady paycheck – and not being able to find another is demoralizing. How many divorces, foreclosures, medical debt bankruptcies, giving up on a better future, and addictions/overdoes have resulted?

    4. digi_owl

      Likely because morphine (opium) was (and seem to still be) the issued painkiller for combat medics. A young conscript got shot? Slam a syringe of morphine in him and get to halting the bleeding. If the first dose runs out before reaching the field hospital, have another courtesy of the medivac crew and so on.

  6. ISL

    Interestingly, in the linked article there is a deceleration in the trend of life-expectancy improvements for European countries as the EU has promoted neoliberal policies in the interest of economic efficiency (or wealth accumulation by the 0.0001%). Could be interesting to model.

  7. Michael Hudson

    Well, it’s certainly nice to see the charts of the SYMPTOM of dysfunction.
    But as I think I’ve mentioned before, I met Deaton in Berlin when his book was being Published by Klett Cotta German along with may Killing the Host (Der Sector) and David Graeber’s debt book. Mr. Deaton refused to appear with us on the press conference later, because he said he “wouldn’t sit on the same platform with people who didn’t believe in capitalism.” I.e., David G. and me. He was so terrified that there might be a “new thought” that I guess he would have taken OxyC himself if he had to respond to our discussion of debt.
    His own presentation of his book was so right-wing and tunnel-visioned that David and my publisher turned to me and said something to the effect of, “Don’t even bother responding to this crap.” Nothing about economic failure, but a celebration of free enterprise referring to the movie the Great Escape, where innovators were escaping from government control — just the opposite of what his face-saving article here writes.
    The question is, WHY are these Oxycontin deaths spreading? What is going wrong with THE SYSTEM?

    1. spud

      thank you mr. Hudson. its like the environmental frauds that wail on about climate change, yet won’t acknowledge what steve keen has said about free trade and climate change. or the fraudulent humanitarians that say free trade is good for the worlds poor, even as people of color are raped and looted by the free traders, their hands cover their eyes, ears and mouths as i point out what is going on in africa, and why.

    2. aleph_0

      Thanks for the anecdote. It helps paint a more complete picture of why their criticism always seems to stop short.

      1. digi_owl

        Yeah, Deaton’s declaration that Chicago school thinking was basically correct but for a few exceptions irked me enough that i gave up on the article.

    3. dirke

      Dr. Hudson to answer your question. The problems were solved in the Netherlands 60 years ago in dealing with heroin addiction. A study was done on the addicts. It showed that the cycle of addiction was around 10 years and the addict was either off the drug or died in that time period. A heroin addict can hold a job live a somewhat normal life provide they get their fix. So a program was set up to provide a daily dose (a prescription at no cost), monitoring of heath and a program to help the addict off the drug (if they wanted it). So what were the results? A major reduction in street heroin related problems: eliminated crime related to heroin addiction, a massive reduction in new cases of heroin addiction, a major reduction in medical cases involving dirty needles and pretty much ended heroin deaths by overdose and dirty heroin. So the same program could be instituted here for drug addiction in general. The spreading Oxycontin deaths are do the impurities of black market drug. the first step is to make Oxycontin a generic drug so it can be produced in quantity. A second step would to outlaw drug manufactures paying kickbacks to physicians for each prescription the write.
      There are more steps if you are interested. I doubt any this will ever succeed.

      1. Revenant

        Controlled prescription of heroin was also known as the British approach. It only changed in the 1970’s with the US war on drugs and stupid UN resolutions and treaty commitments. I think William Burroughs writes about this.

        We then moved to methadone prescription, which is an imperfect substitute hedonically and pharmacologically and is dispensed in demeaning circumstances by pharmacies to queues of addicts forced to down their snot coloured liquid on the spot. There is a thriving secondary trade in “spit method” otherwise. :-(

        As to high functionimg heroin addicts, Mrs Thatcher’s GP Clive Froggatt was unmasked as a heroin addict! :-)

        1. CanCyn

          Ontario also uses the humiliating ‘stand in line, take your dose in front of the pharmacist’ methadone practice. Like so many things under capitalism, if the solution affects profits negatively, it is unlikely to be viewed as possible.

    4. Dropout

      I’m glad you brought up the ideological/class bias of the author(s). I wrote a review of their book this year ( ) with the same focus: that the people they show as those dying are the former industrial proletariat, and that they (the authors) do not, or cannot recognize this, detracting greatly from the value of the analysis. Charles Dickens, in “A Tale of Two Cities”, referred to industrial capitalism as “that machine which turns young people old”; modern society could similarly, if less poetically, be called the machine which produces alienated, hopeless drug addicts. My review is also biased, however, because, as I bring up, I have lost many close friends to the “Deaths of Despair” epidemic. I hope that the perspective I offer is a worthwhile addition to the understanding of this phenomena, especially to those who study it in an academic manner without being effected by it.

    5. begob

      Next time you meet Deaton, you might recommend to him an antidote to the Great Escape – Breaking Bad. Jesse, an addict caught up in the supply-side of the drug war, is the only character who realizes that money is driving them all mad. He literally throws away his dollars, then gets enslaved, but in a violent showdown breaks free with a laugh of madness. As the credits roll, the audience stands with hand over heart and sings The Star-Spangled Banner.

  8. LAS

    Too much of the US healthcare (medical) system is diverted into profitable treatments rather than best treatments, and the negotiation between big entities (hospital, pharma, insurance cos. and gov regulators), which is done at the expense of high quality dialogue between doctors and patients. Women’s reproductive healthcare is just one example of how everyone else wants to influence a woman’s treatment and a woman’s care in lieu of her own choice. Because it’s a political hot potato, it’s visible to us. But in every other facet of healthcare the same thing is going on, including what dialysis patients get and don’t get (though it would make their treatment safer). Who can give blood and who can’t. You have to scratch the surface presentation to find the true influential designers and the way health risks and care are rationalized. The only solution I see are willful rejection of consumerism and the adoption of stronger civil advocacy. And I don’t see it on the horizon. We make do with patient advocates and family members helping navigate the system (if one is lucky enough to have them). Class sometimes has perverse effects; affluent persons can endanger their optimal health with too much healthcare eagerly performed for profit. One must be careful in generalizing on class when it comes to healthcare. It varies from state to state.
    I love Case and Deaton for following up on a very serious matter for the country.

  9. spud

    “However, the removal of protectionist and retaliatory measures can cause great harm if the measures are removed too quickly: “Humanity may in this case require that the freedom of trade should be restored only by slow gradations, and with a good deal of reserve and circumspection. Were those high duties and prohibitions taken away all at once, cheaper foreign goods of the same kind might be poured so fast into the home market, as to deprive all at once many thousands of our people of their ordinary employment and means of subsistence. The disorder which this would occasion might no doubt be very considerable.””

    and that is why i believe the new deal would have never worked as good as it did, without smoot-hawley.

    germany, italy and the U.K. would have flooded america with under priced goods, sucking away almost all of the benefits of increased money flows that were going downwards.

    we see this today. no matter how much money flows downwards, it almost all goes offshore stimulating foreign producer countries.

    cash for clunkers i am sure the germans, japanese, south koreans and chinese loved it.

  10. 10leggedshaodow

    This is my take on what has gone wrong, from someone living down here on the bottom.
    There is no hope of a better life even suggested by conditions on the ground. The min. wage is stuck at 7.25, wages are stagnating, and even college graduate with mountains of debt with no guarantee of even getting a job in their chosen field. Upward mobility is basically dead unless you have rich parents. The rent is too high, food too and people are forced to run on this treadmill to survive. Drugs make that easier, not to mention all those people with chronic pain got cut off and turned to heroin. To me this is a prime example of Just Die! and it is working perfectly. The physical addiction is also terrible, and control drugs like suboxone are even worse to get off of. An example of a self licking ice cream cone.
    The PMC would rather blame the individuals then the system, because they have done so well in this system and believe in it wholeheartedly.

  11. aleph_0

    Good stuff.

    When we start looking at the opiate crisis, I do think the Tarence Ray article, United in Rage makes a nice complement to talking about the Sakler family.

    1. Lambert Strether

      > The Tarence Ray article, United in Rag

      Tarance Ray of the Trillbillies podcast is very, very good. I really resent the Ukraine War for destroying my podcast time.

      1. aleph_0

        I’ve really enjoyed my time listening to Tarence and Tom. They did for the NGO sector what Chapo did for the media; they showed how inept, corrupt, and ridiculous the vast majority of them are while being deeply funny. They also manage to show the impact on small communities in touching way. I would probably still wear a “Leftists for Erosion Control” shirt or hat had they made one.

  12. David in Friday Harbor

    Yves, your new surroundings seem to be doing you a world of good. Terrific piece!

    However, as loathsome as the Sacklers and their scheming promotion of Oxycontin were and are, the current plunge in life expectancy is down to fentanyl — a madly powerful narcotic compounded in Mexico from Chinese-manufactured precursors and delivered by the semi-load via the slimly-regulated ports of entry at San Ysidro, Nogales, and El Paso. Many if not most of those currently dying from fentanyl didn’t enter their medicated bliss via Oxy, which has been significantly dialed-back while the dead continue to pile-up. Deaton says why:

    We see this labor market disaster as one of the most powerful of the forces amplifying deaths of despair among working class Americans—certainly not the only one, but one of the most important.

    Lose your capacity or ability to pay your rent, lose your housing, and start sleeping on the ground in your late 40’s or early 50’s. You will learn about unbearable pain and do anything to numb it. Crushing deplorable working people and their unions has been the mission of the American elite political duopoly for the past 40 years. They have succeeded. Fentanyl is the coup de grace.

    Rule 1: Because Markets! Rule 2: Go Die!

  13. rob

    I agree with the post and the comments. I wonder if there is any reason( profitable to someone), to actually look at this anecdata of WHO is dying young? From the trenches at the street level; I would have to guess when they say the “working” class…. they mean laborers, of every kind.
    Physically demanding jobs, where your body is your “tool”….wear people out. by the time the young and strong turn 40 or 50…. they aren’t so much any more. Now we are nursing injuries and constraints, to do the jobs we have always done. And with no end in sight, because unless we are integrating family or apprentices to help us get the jobs done…. we are going to have to work… until we can’t anymore. That world is crushing, and unless an individual is able to take some “off-ramp”… that is the road you’re on.
    I know a lot of working class people , using pharmaceuticals to get by…. even if they work, and you don’t get addicted… what is happening to your kidneys,livers,insides??
    Couple that with the ACA mess which was one of the most overtly fascist acts of the US, since the 1947 national security act. The coupling of your ID, Tax info, employee/earnings record, with heath care information… reconciled for idiocy every year…. all for useless products(plans with high deductibles and co-insurance; so that if anything happens people can’t afford to use it), but still have to pay…. lest you be out of the system…. for whatever good that may be…. or maybe you just decide to GO on without any insurance…. which again brings us back to the same place.
    This is akin to a suicide pact.
    And the Damn “man”…. even makes euthanasia illegal…. just to make life even more treacherous.

    Yeah, It is, “go die”

    1. Neutrino

      Econ students, from undergrad on up, should do field work to see the results of those policies that they study. Connect the dots, see the flatlines, get out of the carrel and away from the screen. See that Homo Economicus is flesh and blood, not a graph or dot plot.

      Some parents used to have their pre-driving children sit in an ER for an evening to observe the real, human costs of driving. Econ and other students can expand that to the costs of being human. Take time to visit what was once called Skid Row and is now visible all over.

      Empathy isn’t dead, just camouflaged in modern, distracted societies.

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