Exploring Trade Union Identities: Union Identity Niche Identity and the Problem of Organizing the Unorganized, by Bob Smale. Bristol University Press, Bristol, UK, 2020, 186 pp., ISBN (print) 978‐5292‐0407‐0, £45, hardback
| Published date | 01 September 2020 |
| DOI | http://doi.org/10.1111/bjir.12542 |
| Date | 01 September 2020 |
| Author | Yang Song |
British Journal of Industrial Relations doi: 10.1111/bjir.12558
58:3 September 2020 0007–1080 pp. 743–758
BOOK REVIEWS
Deaths of Despair and the Future of Capitalism, by Anne Case and Angus Deaton.
Princeton University Press, US, 2020, 312pp.,ISBN: 9780691190785, Price 27.95,
h/b
Princeton economists Anne Case and Angus Deaton (Nobel Prize 2015) warn that
deteriorating lives among the US working class generate ever more deaths of despair.
These deaths from suicide, drug overdose and alcoholic liver disease threaten the
success of the country. The fastest-growing causes of death, they are concentrated
among whites without universitydegrees. The death rate from these causes tripled since
the 1990s for those without degrees and didn’t change for those with degrees. This
growth caused overall US life expectancy, already lowamong industrial democracies,
to decline for the rst time in generations.Increasing deaths of despair and declining
life expectancy are uniquely American, a sad exceptionalism.
The deaths happen in the second half of a fty-year decline in earnings for less-
educated Americans. Each cohort of entering workers without degrees experienced a
decrease in real wages compared to those that came before. This fuels the growing
education premium. Yet, inequality is, to the authors, an effect. Inequality and
deaths of despair jointly result from the politics, power and social change destroying
America’s working class. The consequences are profound. Those without university
degrees report being less happy, less healthy and in more daily pain. Marriage as an
institution is failing. Labor forceattachment is increasingly weak. Social organizations
vanish, organized religion fades as political and social capital falls. These citizens
increasingly “bowl alone.”Large corporations from which they once gained belonging
now contract out to rms providing no health insurance.
The authors review other false explanations beside inequality. The timing is wrong
for the great recession to be a root cause. They see no general moral failing of the
less educated as declining wages combined with declining participation indicates a
reduction in labourdemand not in labour supply.While automation and trade certainly
inuence America’s less educated, the authors view these as generating growth and
increasing wealth. More importantly, both inuence other developed democracies that
have avoided deaths of despair. They recognize a less complete US social safety net
failed to cushion the blow but do not see insufcient redistribution as the central
problem.
The central problem is unfairness. The authors give top billing for two villains: the
American health care system and a government-run “protection racket”on its behalf.
American health care is exorbitantly expensive, woefully inefcient and delivers poor
public health compared with other industrial democracies. It vacuums up almost one
dollar in ve and per capita expenditures y off the international chart. If the US
© 2020 John Wiley& Sons Ltd.
744 British Journal of Industrial Relations
adopted a system typical of other industrial democracies, its average health would
likely improve but, more profoundly, it would save over $10,000 per year per worker.
The high cost of employer-provided insurance generates labour market segregation.
Rising health costs “turn good jobs into worse job and eliminate jobs altogether
(p.206).” Pharmaceutical companies unleashed the opioids used in deaths of despair
and now offer drugs to end the addiction. The prices of both far exceed those charged
elsewhere. Millions have no health insurance and medical bills lead the causes of
personal bankruptcy. The authors viewAmerican health care, safely protected by the
government, as “the Sherriff of Nottingham” transferring untold wealth from the
many poor to the few rich.
The government’s role is fundamental. The FDA is legally prohibited from
considering societal costs of addiction and secondary illegal markets so approved
the opioids. The virtual prohibition on doctors immigrating and explicit limits
on medical school seats provide physicians economic rents and give the US the
fewest doctors per capita and among the shortest ofce visits. Medicare’s explicit
legal prohibition on considering costs allows expensive interventions with little
benet to prosper in the US even as they are inconceivable elsewhere. Eliminating
the Ofce of Technology Assessment removed the primary source of even basic
information on costs and effectiveness. Medicare is legally required to cover any
drug approved by the FDA regardless of its cost effectiveness. Medicare remains
legislatively prohibited from negotiating the price of drugs. Antitrust statutes are
ignored as mergers and patent pools protect rms from meaningful competition.
The purchase of generic producers by name brand producers happens in hopes of
encouraging innovationeven as pharmaceutical companies spend more on advertising
than on research and development.The authors’ description of legislation and inaction
protecting pharmaceutical and health care rms is a dark catalog of government
malfeasance.
Yet,government merely reacts to incentives. The authors show that the health care
industry funds political campaigns and spends more money lobbying than any other
industry. They provide six lobbyists for every congress member and most come from
congress or congressional staffs. Not surprisingly the working class routinely claims
that government ignores its interests. More surprisingly, the academic literature shows
this is reality. The authors conclude that Congress consistently votes the interests
of wealthier people and corporations over the interests of others. They summarize:
the industry that should improve the health of the less educated undermines it while
lowering their standard of living. The government that should represent their interests
“supports the shakedown.”
Careful presentation of evidence and argument represent this book’s strength.
Identifying deaths of despair and their cause is laudable and a call to action. The last
chapter identifying that action seems weaker tea. The healthcaresystem must change.
They authors call for universal coverage and active cost control saying the latteris of
greater benet to the working class. More active enforcementof antitrust lawsis vital,
especially to restrain mergers. Tax and wage policy should encourage employment
of labour instead of capital. The counterproductive emphasis on preparing everyone
for college reinforces educational segregation in the labour market. Many should
be prepared for something other than college. Crucially, the authors recommend
brighter sunshine to make rent seeking less successful. Voters deserve accurate,routine
information on who is lobbying whom for what. Perhaps limits on lobbying might
result. The gross unfairness and the deaths of despair come not from capitalism
© 2020 John Wiley& Sons Ltd.
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