It’s now less than a year until Inauguration Day 2021. If you want the exact number of days, hours, minutes or even seconds until Wednesday January 20, 2021, click here. I have a bad habit of relating experiences in life to athletic challenges. Early on, I imagined a relationship between the Trump presidency and running a mile on a track. Over the years I spent a lot of time running laps on quarter mile tracks. I was not a track star, but for some reason I like running around in circles. In training for a marathon, I have run twenty miles on a quarter mile track. That would be eighty laps. More frequently, I would run a mile “for time” as part of a workout or a longer run.
What is interesting about running four laps on a track is that even though each lap is an identical 440 yards, the laps are not the same. You are fresh for the first lap, but a little cautious because you don’t want to “run out of gas” before you finish. The second lap usually goes relatively well although you are constantly reminding yourself that there is still over a half a mile to go, so, “stay within yourself.” The third lap was always the hardest. By the third lap, I was usually tired because I was unable to restrain myself on the first two laps and “went out too fast.” On the third lap there is still a long way to go, and by that time my legs were usually beginning to feel heavy. Then came the fourth lap. By the fourth lap you are near exhaustion and fear defeat. You know that the finish is just 440 yards away. You tell yourself that you have done 440 yards thousands of times. Despite exhaustion, and legs that feel like lead, you say to yourself that finishing is a piece of cake. There is no need to hold back. The finish line is just around two bends in the track, if you can push through the pain.
These days I feel like we are starting that fourth lap when we must push through the pain. As the Trump presidency began, I tried to pace myself so that I might survive for four years. There were a lot of people who “went out too fast.” Do you remember back in January 2017 the hundreds of thousands of women who made their way to the Mall in Washington, and to the centers of other cities, wearing their pink hats? This year, when there is proof that much of what they feared, like a shift to a more conservative Supreme Court that would threaten a woman’s control over her own reproductive health, has happened, there were significantly fewer, albeit still passionate, protesters.
During three years of Trump we have lost ground despite valiant resistance on many fronts. Trump has created tax breaks for the rich and corporations. More than a million fewer people have access to healthcare this year than had it last year. Many of us have growing concerns about global warming. Trump and his administration, with the help of Mitch McConnell and others in Congress, and now through a host of newly appointed conservative judges, continue their attacks on programs of social services, on undocumented immigrants, and on those seeking refuge here from harm in their own countries. It seems unreal that after three disastrous laps, and despite the fact that the president is facing his Senate trial after impeachment by a Democratic controlled House, every person I know who disagrees with him is terrified that our country may be facing another four years of Trump abuse. I hear people say that if it ends now, the country can recover and survive with its democracy, reputation, and place in the world intact, but another four years would irreparably damage us. They fear that further misdirected efforts to “Make America Great Again” might leave America in shambles. If the next president is not Donald Trump, there will be a lot of clean up to do. There will be many new, and many neglected problems to solve.
As we enter the fourth lap, I am sure that we could have an instant debate if we turned the clock back to Inauguration Day 2017 and tried to list the problems that faced us then. The debate would intensify if we proposed a discussion on the progress that we have made on those issues over the past three years. Said another way, “What were the issues in 2017? What’s better? Where have we made progress? Where have we lost ground? What have we learned.”
On the list of subjects that we could choose to debate, we might put gun violence and our epidemic of diseases of despair near the top of the list of ones where we have made no progress, or have lost ground. Last night my wife and I listened on a channel we rarely watch, FX, to interviews of Democratic candidates for president with the New York Times editorial board. Those interviews were the basis of the paper’s endorsement of Amy Klobuchar and Elizabeth Warren for the Democratic nomination for president. In those interviews the only candidate that I heard mention the “diseases of despair” was Bernie Sanders. He described the diseases of despair as the manifestation of the need for the changes and programs for which he is such a passionate advocate that might reduce our growing economic inequality. I wish others would take Bernie’s position. We need more candidates to propose solutions that might unravel many of the complexities of the inequality that complicate the discussion of all of our issues and their potential solutions.
One of my favorite columnists at the New York Times is Nicholas Kristof. He has effectively characterized gun violence as a public health issue. Now he has published two columns on our diseases of despair. As I described in a recent post, our falling life expectancy has been connected by Angus Deaton and Anne Case to diseases of despair. It feels to me that if we must embrace the urgency of finding a “cure” for this new epidemic of despair that is the manifestation of many of our root cause problems. Said differently, we may find that the search for victory over the epidemic of diseases of despair may go a long way toward solving other problems. The only other subject that comes close to offering such a “unity of solution” is the Green New Deal approach to the issues of global warming.
Last week Kristoff and his wife Sheryl WuDunn, also a well known journalist, published an interesting new book, Tightrope: Americans Reaching for Hope [Watch this 3 minute video to get a sense of what the book is about.] which was reviewed in the LA Times a few days ago by William Nottingham. I have not read the book yet, but Kristoff introduced much of the same material as the subject of his January 9 column “Who Killed the Knapp Family? Across America, working-class people — including many of our friends — are dying of despair. And we’re still blaming the wrong people.” If you have an hour to spare, there is an audio discussion of Tightrope that is available from The New York Times.
In his column Kristof begins where Nottingham reports the book begins, in Yamhill, Oregon, which is Kristof’s hometown. Kristof is writing about himself in the third person and the other children who rode to school with him each day on school bus number 6. The book and the column describe the same horrible fact. As Kristof writes in the article:
Chaos reigned daily on the No. 6 school bus, with working-class boys and girls flirting and gossiping and dreaming, brimming with mischief, bravado and optimism. Nick [Kristof] rode it every day in the 1970s with neighbors here in rural Oregon, neighbors like Farlan, Zealan, Rogena, Nathan and Keylan Knapp.
They were bright, rambunctious, upwardly mobile youngsters whose father had a good job installing pipes. The Knapps were thrilled to have just bought their own home, and everyone oohed and aahed when Farlan received a Ford Mustang for his 16th birthday.
Yet today about one-quarter of the children on that No. 6 bus are dead, mostly from drugs, suicide, alcohol or reckless accidents. Of the five Knapp kids who had once been so cheery, Farlan died of liver failure from drink and drugs, Zealan burned to death in a house fire while passed out drunk, Rogena died from hepatitis linked to drug use and Nathan blew himself up cooking meth. Keylan survived partly because he spent 13 years in a state penitentiary.
Apparently when I read the book I will discover many similar stories from across the country. Nottingham writes:
Along with a series of personal stories, Kristof and WuDunn provide a whirl of statistics suggesting that cycles of poverty, drug abuse, unemployment and — in the case of children — parental deprivation resulting from shattered families have left not quite half of our nation adrift and seemingly destined to stay that way.
You have seen the statistics before, but here are some important facts that Nottingham adds to his review:
- 70,000 Americans die annually from drug use, another 88,000 from alcohol abuse and 47,000 from suicide. More die from these three causes every two weeks than died in 18 years of war in Afghanistan and Iraq, they report.
- One in seven Americans lives below the poverty line; suicide rates are at a 30-year high; opioids and other drugs kill more each month than guns and car crashes; every seven minutes someone dies from an overdose; one child in eight lives with a drug-abusing parent.
In his column Kristof gives us pictures of the kids who were on the bus, as well as some pictures that allow you to see the wreckage of their adult lives. The prose that he adds points a finger, but not at them. He sees them as victims and not as the primary agents in their own demise.
The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies. The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them, but under him the number of children without health insurance has risen by more than 400,000.
Many of my friends say that Trump will be tough to beat. They say that as they think about the stock market and their 401 K retirement plans, things are looking good for them, but not for everyone in their “neighborhood.” There was a time in America when a high school dropout had a shot at getting a good paying job and giving his family a better chance. Kristof writes:
The stock market is near record highs, but working-class Americans (often defined as those without college degrees) continue to struggle. If you’re only a high school graduate, or worse, a dropout, work no longer pays. If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25…“I’m a capitalist, and even I think capitalism is broken,” says Ray Dalio, the founder of Bridgewater, the world’s largest hedge fund.
Kristof is not blaming the origin of the problem on the current administration. Perhaps, he is blaming the lack of energy looking for a solution on this administration, or for current policies that have made the problems worse. He seems to suggest that we have arrived at an outcome that is attributable to long established attitudes and poor policy choices for which both parties have some responsibility:
It would be easy but too simplistic to blame just automation and lost jobs: The problems are also rooted in disastrous policy choices over 50 years. The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did. As other countries embraced universal health care, we did not; several counties in the United States have life expectancies shorter than those in Cambodia or Bangladesh.
One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness. A low-end worker may not have a high school diploma and is often barely literate or numerate while also struggling with a dependency; more than seven million Americans also have suspended driver’s licenses for failing to pay child support or court-related debt, meaning that they may not reliably show up at work.
When we think about the Triple Aim we are often thinking about the care of individuals and the cost of care. It is easy to forget the “third aim,” healthier communities. There is no doubt in my mind that the “third aim” may be the hardest aim. Achieving the “third aim” will require a new direction in public policy. The picture in today’s header is from a trailer park near me. I know from my work with some of our local charitable efforts that there are adults and children who have been touched by the diseases of despair who live in this trailer park where there may be fifty or more families. Affordable housing is a huge problem in my part of New Hampshire. Inadequate housing, minimum wage jobs, and inadequate transportation are huge factors that impact the social determinants of health where I live.
It should not surprise you that Kristof’s column elicited some push back from more conservative readers. Whether he originally planned a second column or not, he did respond to the push back in his column last Saturday, January 18. The piece was entitled “Are My Friends’ Deaths Their Fault or Ours?: We need to move from pointing fingers to offering helping hands.” Yes, there were people who used Horatio Alger thinking to say that if things go off the rails, there is no one to blame but yourself. My state’s motto, “Live Free or Die” has frequently been misunderstood to be a celebration of libertarian ideals and a vote for low taxes that suggests that we owe nothing to one another. Kristof suggests that a misguided emphasis on self reliance is just that sort of thinking that has created the epidemic of diseases of despair. In the follow up column he writes:
Plenty of readers responded with compassion. But there was a prickly scorn from some that deserves a response because it reflects an ideology that underlies so many failed policies. It arises from the myth that we live in a land of limitless opportunity and that those who struggle have simply made “bad choices” and failed to muster “personal responsibility.” Dr. Ben Carson, who grew up poor and black in Detroit and is now the nation’s housing secretary, has described poverty as “more of a choice than anything else.”
This “personal responsibility” narrative animated some reader critics of the Knapps. “This article describes ruined, pitiful people,” one reader commented. “The main problem they have is weakness of character.”
I will not recount our tawdry history of talking about “welfare queens” and our misdirected war on drugs, but if you have the time, I would recommend that you read both his January 9 and January 18 columns. I have decided to get my local bookstore, Morgan Hill Bookstore, to order a copy of the new book for me. You can be sure that I will let you know more after I have read the book. I hope that whomever is inaugurated on January 20, 2021 will be focused on the diseases of despair as a very high priority.
