Anne Case and Angus Deaton
102 «¬® ̄°±² ³««³°® ́
and Care Excellence (²°Å ̄), which assesses the costs and bene¥ts o
treatments and has the power to prevent the adoption o treatments
whose bene¥ts fail to exceed their costs. With an agency o this kind
regulating the U.S. pharmaceutical industry, the scourge o opioids
would never have been unleashed on the country.
More broadly, unregulated markets for health care are not socially
bene¥cial. The United States should follow other rich countries in pro-
viding universal health insurance and in controlling health-care costs
through an agency such as ²°Å ̄; the former is important, and the latter
even more so. The United States currently has the worst o both worlds,
where government interference, instead o controlling costs, creates op-
portunities for rent seeking, which inates costs and widens inequalities.
The roots o the crisis o deaths o despair lie in the loss o good
jobs for less educated Americans, in part due to globalization, out-
sourcing, and automation, and in part due to the cost o health care.
The loss o jobs devastates many communities and destroys ways o
life. There is a strong case for public policy that raises wages and
builds a more comprehensive social safety net.
Capitalism needs to serve people and not have people serve it. As
an economic system, it is an immensely powerful force for progress
and for good. The United States doesn’t need some fantastic socialist
utopia in which the state takes over industry; instead, what is required
is better monitoring and regulation o the private sector, including the
reining in o the health-care system. Other rich countries have a range
o dierent ways o handling health care; any one o those would be
an improvement over the current system in the United States.
The epidemic o deaths o despair in the United States neither was
nor is inevitable, but other rich countries are not guaranteed to have
immunity from this American disease. For now, the United States is
something o an anomaly among wealthy nations, a status it owes to
speci¥c policies and circumstances. But other countries may ¥nd
themselves following in American footsteps. I wage stagnation per-
sists in Western countries and i the use o illegal drugs grows, the
social dysfunctions o the United States could well spread in a more
concerted way. Working classes elsewhere are also grappling with the
consequences o globalization, outsourcing, and automation. The dy-
namic that has helped fuel the U.S. crisis o deaths o despair—o
elites prospering while less educated workers get left behind—may
produce similar devastating results in other wealthy countries.∂