In their book, Deaths of Despair and the Future of Capitalism, Ann Case and Angus Deaton study the rising premature death rate from suicide, drug overdose and alcohol liver disease. Four findings:

1. The rate has steadily fallen over 30 years in comparable Western countries (U.K., France, Australia, Switzerland, Canada, Ireland, Italy). It’s also fallen for U.S. Hispanics. But not for U.S. non-Hispanic whites.
2. The rate is steady among Americans with at least a B.A.; it’s rising for those without.
3. The younger the cohort, the worse the rates.
4. Compared to other countries, the U.S. spends more on health care and has worse outcomes.

Case and Deaton on May 4 presented for an hour on Zoom through the Economic Policy Institute, a D.C. think tank. The following four charts are my screenshots from their talk.

Among their conclusions:

1. Employer-based health insurance is destroying our economy. Because it costs so much – about $21,000 a year for family coverage – employers will cover fewer and fewer workers over time. It only makes sense for them to offshore production.
2. The government must rethink anti-trust law in the face of hospital mergers, which have driven up the prices of health care. (I would add that the failure of the Justice Department to pursue antitrust might not matter, because the Supreme Court has been dismantling antitrust law for 30 years.)
3. The “health-care” industry has five lobbyists for every member of Congress, reflecting the absence of any effective campaign finance limits (thanks to congressional opposition and Supreme Court interpretation). The interests of labor have neither effective representation nor a sympathetic ear in Washington.

These interlocking political realities are having the greatest effect on the Americans described in the charts. They are dying prematurely, Case and Deaton write, from the loss of work, loss of community, loss of family cohesion. They are also, based on the authors’ study of the country analyzed by one thousand geographic areas, Trump’s base.

The Republican Party, which has held the presidency and/or effective control of Congress for 36 of the last 39 years, has worked to undermine the interests of that base while catering to a shrinking class of the wealthiest.

So, the next inquiry: Whose interests are behind these COVID-19 protests against shut-down orders intended to protect public health? As has been reported, the network of right-wing funders who created the tea party are doing the same once again. In both cases, and in the litigation initiated by GOP state attorneys general asking the Supreme Court to void Obamacare, one of the goals is to destroy government-financed health care.

As a practical matter, I cannot understand how it serves a reactionary elite to eliminate a fragile leg of support from millions of voters. I suppose it is reflexively fighting the same battle it has waged for a century.

On the eve of his reelection in 1936 (the second-largest contested reelection margin in history), Franklin Roosevelt addressed the choice facing voters. Starting with the election of 1920, through the 1929 crash and the three years of government inaction that followed, Roosevelt said:

For twelve years this nation was afflicted with hear-nothing, see-nothing, do-nothing government. The nation looked to government but the government looked away. Nine mocking years with the golden calf and three long years of the scourge. Nine crazy years at the ticker and three long years in the breadlines. Nine mad years of mirage and three long years of despair. Powerful influences strive today to restore that kind of government with its doctrine that that government is best which is most indifferent.

History does not repeat. But it rhymes.