The slope is steeper now than it was for my grandfathers’ generation. Men of that age remembered the Great Depression and fought in the Second World War. To cheer up my kids during coronavirus isolation, one of their grandmothers sent a card about what her father had done in the Pacific campaign. Those were tougher times than these, was the message, and true enough. But the four decades after the war were an era of upward social mobility. The last four decades have been tough. The number of manufacturing jobs peaked in 1979. Factory jobs are not only rarer today, but also less likely to come with benefits and union cards. “Right to work” propaganda teaches Americans that we should go it alone, without unions, which leads to worse jobs, fewer friendships, more racism, poorer health care, and more anger.
Small farming is becoming untenable as a way of life. Farmers, the men who seemed invulnerable to me as a kid, now kill themselves in higher numbers than people in just about any other line of work. The federal suicide hotline for farmers has been eliminated. This is part of a broader demolition of the ramparts of the American dream. The welfare state, meant to complement the solitude of ambition with the solidarity of support, has been taken apart.
On farms and in factories, physical toughness had measurable payouts. Suffering was part of productivity. Facing things down could be the right thing to do. Until the 1980s, American fathers who worked hard could expect better life chances for their children. That is no longer true. When the economy changed and the welfare state weakened, when pain lost its purpose and suffering its efficacy, men were understandably confused. Americans perform less physical labor now and report more physical pain. Sadly, pain has become part of the economy, and of our political system. It used to be that American politicians competed with visions of a brighter future. Now a good deal of our politics is the solicitation and manipulation of pain.
Commercial medicine is part of the problem. The “pill mills” that emerged in the 1990s revealed the logical extreme of a medical system that offered a naked choice between suffering and pharmaceuticals. Pill mills are doctors’ offices where physicians do nothing but prescribe opioids, usually in exchange for cash. The first one was seventy miles from my grandparents’ farms, in Portsmouth, Ohio, which was a thriving manufacturing town when I was young. One year, the eighty thousand people of Scioto County, of which Portsmouth is the county seat, were prescribed ten million doses of opioids. Suffering was no longer productive for those who suffered, but it had become profitable for those who did not.
Opioids are a problem for women and men of all ages and backgrounds. White women in the South are living shorter lives, in part for this reason. The life expectancy of middle-aged white males has stagnated. Their American dream of solitary self-sacrifice has failed, and without the solidarity once offered by unions and the welfare state, they have been left alone with their resentment. If all we have is lonely rage, we fail, become addicted, listen to the wrong people, harm those we care about, and die. Opioids take over the mental space we need to contemplate, to think about children, spouses, friends, or anyone else.
The double desperation of pain and addiction affects our politics. People who lived in places wracked by opioids voted for Donald Trump. The one piece of information that best predicts whether Mr. Trump won or lost a county in November 2016 was the degree of opioid abuse. In Scioto County, ground zero of the opioid epidemic, Mr. Trump took a third more votes in 2016 than Mitt Romney had in 2012. It was a surprise when Donald Trump won Pennsylvania. He got the majority of votes in several Pennsylvania counties that Barack Obama had won four years before. Every single one of those counties was in public health crisis as a result of opioid abuse. This also held for the counties in Ohio that Barack Obama had won and Mr. Trump took four years later: all but one of them was in opioid crisis. Votes of desperation, like deaths of desperation, are understandable. Yet those who remain behind suffer. Desperate voters close off care to themselves, their families, and everyone else by voting for politicians who traffic in pain.
Solitude is salutary, up to a point. We are not free if we do not know how to be ourselves, by ourselves. Yet too much solitude makes freedom impossible, first for the lonely, and then for everyone else. A solitary rage is part of freedom, but only part. If we have no help from others, our rage no longer protects us but endangers everyone. Once pride becomes resentment, we forget that we need help and claim that only others do. A fury that lashes out blindly is no mark of liberty, but an opportunity for politicians who provide targets for the anger. The downward spiral from pain to desperation and from pride to resentment is something that politicians like Mr. Trump understand and accelerate. They want people staggered by suffering, and so they oppose health care. Pain is their politics; their propaganda is a death trap.
Such politicians tell white people that they are too proud and upstanding to need insurance and public health, which, they say, would only be exploited by others less deserving (blacks, immigrants, Muslims). Flattery lubricates the downward slide to death: white Americans are told to face pain as solitary individuals, and that they betray themselves and their country if they admit that they need support. Only dark-skinned whiners, goes the story, ask for help. Of course, the elected representatives who say such things have their own health care provided by the government, and are denying something to their constituents that they know works for them. But hypocrisy is the least of their sins. Flattering while denying care adds sadism to manslaughter.
Everyone is drawn into a politics of pain that leads to mass death. Opposing health care because you suspect it helps the undeserving is like pushing someone else off a cliff and then jumping yourself, thinking that your fall will be cushioned by the corpse of the person you murdered. It is like playing a round of Russian roulette in which you load one bullet in the cylinder of your revolver and two in the other fellow’s. But how about not jumping off cliffs; how about not playing Russian roulette? How about we live and let live, and all live longer and better?
Between the choice to live in pain and the choice to take pills, there should be a world of alternatives: health care that we can find, or that can find us. This would mean easier access to doctors, but also to other, simpler means of health. A great deal of physical pain, for example, is best treated with physical therapy and physical exercise. These options require human contact, and do not generate the quick profits of pharmaceuticals and surgical implants. If we are concerned about American health, and American freedom, then everyone should be insured, and everyone’s insurance should cover what helps to relieve pain. We need a system of solidarity that no individual can create but from which every individual would gain.
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It is easy to fall into mental habits that make the status quo seem acceptable. It is tempting to find meaning in suffering and death. In this way well-meaning Americans provide rationalizations for those in power who hurt and kill. When someone dies we can tell ourselves that it had to be so, that it happened for a reason, that it was God’s will. These beliefs prevent us from challenging a system of commercial medicine that treats us as sources of profit rather than as children of God. My suffering only has meaning if I learn from it, and my death would have been senseless. I am unconvinced that God wants my fellow Americans to suffer and die so that commercial medicine can make a few people rich.