Between 2015 and 2017, life expectancy in the United States declined for the first time in modern history. This coincided with an accelerating upward trend of deaths caused by pharmaceutical drug overdose and alcohol abuse. In their book Deaths of Despair and the Future of Capitalism, Ann Case and Angus Deaton, in conversation with Alberto Magnani, explain that the phenomenon is especially stark among the less educated, who have been more affected by job losses, wage cuts and the dissolution of local communities associated with globalisation and increased automation.

These threats are often blamed on capitalism; for Case and Deaton, the root cause is a model of capitalism which has over-protected certain parts of the economy. “The essence of capitalism is competition and innovation,” said Deaton, “but in the US we see a failure of competition.” Anti-monopolistic laws are not sufficiently enforced; the result is enormous social inequality.

The healthcare system perpetuates this inequality. One in five US dollars goes into the healthcare system, where drugs, devices and hospital stays cost more than any other country in the world. Among the highest paid 1%, doctors are the largest group. Moreover, this increased spending does not translate into results. US life expectancy is closer levels in Eastern Europe rather than Western Europe. “These dollars are not available for the government to spend on education, police and other services.”

Is there a risk of this model being exported to Europe? The European healthcare system is cheaper, because it is financed by tax revenues. There is a better safety net, financed by VAT. “The right would argue that increased taxes cut jobs, but there is very little evidence that this is true,” said Deaton. “Europe also has a great sense of community,” added Case. “That will protect European countries.”

The economists are optimistic about the Biden administration’s policies aimed at correcting these issues. “We need to harness the power of capitalism to work for the majority instead of against.” It remains to be seen whether the forces of inequality will be able to stop them passing.