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According to Sen, if we identify injustices, and remove them, we get a better world.
The health system, rent seeking, and the pharmaceutical industry are three big causes identified in Deaths of Despair.
The US health system is a “disgrace”, delivering the worst life expectancy of any rich country. It is a “cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs, and making it harder and harder for states and federal governments to afford what their constituents need.” The well-being of ordinary people is subordinated to the private gain of the already well-off, including doctors and health administrators.
Rent seeking (e.g. lobbying and protection rackets) is the second big cause. It is not just Google, AT&T and Boeing who are to blame. According to Case and Seaton, rent seeking is most lethal in the US among medium size businesses and professionals protected from competition by political interference. This includes physicians and their associations, for example, the American Medical Association, who control access to medical schools, keeping the numbers of doctors down and salaries high.
Rent-seeking is basic to capitalism, identified by Adam Smith as the tendency to increase one’s own wealth without producing new wealth. In the US, corporate CEOs are not the guiltiest but rather, for example, car dealers, realtors, optometrists and the US Chamber of Congress. Small and medium sized businesses, through their associations, spread over the country in every congressional district, lobby for exemption from regulations and special tax breaks. Lawyers show them how to avoid jail.
The third big cause is a pharmaceutical industry which “has been responsible for an epidemic of addiction and death that earned it billions of dollars”. Although Purdue, makers of OxyContin, may lose billions of dollars of past profit, aggressive marketing to doctors and patients is still in place. The behaviour of pharmaceutical companies is like “showering gasoline on smouldering despair”.
Drug overdoses are the largest category of deaths of despair in the US. However, eliminating the drug epidemic would not eliminate the root causes of despair.
Solutions are considered: wage subsidies, raising minimum wage, anti-trust legislation, universal basic incomes, and government interference in the pharmaceutical industry. Since deaths of despair occur most among those without a BA, the educational system might be changed so those without a BA are not so disrespected.
The beast should be tamed not slain. In nineteenth century UK, at the beginning of the century, capitalism failed many. By the end, without war or pandemic, it had changed. The example justifies “limited optimism”. Capitalism can be “better monitored and regulated, not to be replaced by some fantastical socialist utopia in which the state takes over industry. Democracy can rise to the challenge.”