Cause of death: late-stage capitalism

According to the National Center for Health Statistics, in 2015 average life expectancy in the United States dropped, from 78.9 years to 78.8 years, the first time that’s happened since 1993. We know that the drop in 1993 had a few particular causes (AIDS and high homicide and accidental death rates, for example), and while last year’s dip seems to involve smaller increases in death rates due to a much larger array of causes, there is one thing that sticks out: opioid abuse. More people in 2015 died of heroin overdoses than were killed in gun homicides, which has never happened before.

Our worsening national opioid problem is one of those things I have been increasingly aware of but not all that knowledgeable about. But New York Magazine’s Jesse Singal has what strikes me as a pretty sensible theory as to the roots of the problem:

Whatever’s going on, a lot of it has to do with opioid abuse — the government believes that those who illicitly take prescription opioids are far more likely than other people to try injecting heroin — and the opioid crisis has hit whites harder than blacks, partly for the depressing reason that doctors appear to be less likely to recognize and treat pain in black patients. These new stats reflect the massive amounts of despair strongly hinted at by Case and Deaton’s work — after all, two of the areas that saw mortality increases between 2014 and 2015 were suicide and “unintentional injuries,” a category that includes overdoses.

So when those two findings are combined, it’s hard to deny that something truly dire has ensnared a large chunk of the country. In a country as big, complicated, and diverse as the United States, that “something” is actually a great many things, but I would argue they can be broadly summed up by one idea: what I call the “one-bad-break test.”

The one-bad-break test states simply that you can tell a lot about a society by what happens when its economically vulnerable members encounter a majorly bad break. That bad break can be anything — an injury, the sudden need to take in and care for an ailing relative, an unexpected layoff — and the effects of a single bad break vary tremendously depending on who you are, where you live, and what resources you have access to. (Rich people hit bad breaks too, of course, but they generally have far more capacity to handle them than everyone else, so I’m restricting this discussion to those who lack those resources.)

In societies that function well, there are various safety nets in place to prevent a bad break from leading to a tailspin for particularly vulnerable victims. Compared to many other rich nations, the U.S. is not such a society — all too often, when vulnerable Americans encounter a bad break, there’s nothing underneath them to stop their slide. Instead, devastation follows, sometimes in the form of bankruptcy and addiction and death.

America’s opioid addiction, then, is a symptom of America’s far deeper addiction. We’re truly addicted to a radical right-wing societal model that fetishizes tax cuts for billionaires, obscene levels of defense spending, and phony deficit austerity that’s nothing but an excuse for slashing every government program that might have the slightest positive impact on the lives of people for whom “one bad break” is a constant fear. And if we’re to take Republicans at their word and assume they will spend the next 2-4 years privatizing Medicare, block-granting Medicaid, repealing without replacing Obamacare (which is a very shitty market-based system but for many critically at-risk people is still better than the “free market” health care system we had previously), and tossing every other safety net program into the government version of a garbage disposal, then the problem is only going to get worse. We’ll be stuck waiting for the economic growth that all of those tax cuts are supposed to, but never actually do, provide, while wages continue to flat-line and the gap between the rich and the rest of us keeps getting bigger and bigger. It’s Paul Ryan’s Better WayTM, and it’s literally killing us.

What made Singal’s piece resonate with me was that he cited the example of 1990s Russia, where things were so bad that life expectancy didn’t just go down, the population shrank. And alcohol abuse (which, by the way, is also increasing here alongside opioid abuse) was a major cause for the decline. Russia in the immediate post-Soviet period is perhaps the classic example of “Shock Doctrine” capitalism–the economy was suddenly and radically transformed from state-controlled to “free market,” a handful of oligarchs sucked up most of the gains, and the rest of the Russian people were left, literally, to drink themselves to death because there was little reason not to do that. Forget failing Singal’s “one-bad-break test”; living in Russia in the 1990s, after the Chicago Boys got done with the place, was your one bad break.

We’ve been implementing the same program here–austerity, privatization, tax cuts, entitlement “reform”–for the past 35 years plus, but it’s taken longer for the effects to really kick in because we never underwent the kind of national collapse that you need to do what we did to Russia. Luckily, they’re here now in full force, and except for the kleoptocrats at the very top of our society, we’re all feeling the effects.

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