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“We’re Number 61!”
Civilizations die from suicide, not by murder.
—ARNOLD TOYNBEE, British historian
We Americans are a patriotic tribe, and we tend to wax lyrical about our land of plenty and opportunity. “We have never been a nation of haves and have-nots,” Senator Marco Rubio once declared. “We are a nation of haves and soon-to-haves, of people who have made it and people who will make it.” We proudly assert, “We’re number 1!” and in terms of overall economic and military strength, we are. But in other respects our self-confidence is delusional.
Here’s the blunt, harsh truth.
America ranks number 40 in child mortality, according to the Social Progress Index, which is based on research by three Nobel Prize–winning economists and covers 146 countries for which there is reliable data. We rank number 32 in internet access, number 39 in access to clean drinking water, number 50 in personal safety and number 61 in high-school enrollment. Somehow, “We’re number 61!” doesn’t seem so proud a boast. Overall, the Social Progress Index ranks the United States number 25 in well-being of citizens, behind all the other members of the G7 as well as significantly poorer countries like Portugal and Slovenia, and America is one of just a handful of countries that have fallen backward. “Despite spending more on healthcare than any other country in the world, the US has health outcomes comparable to Ecuador, while the US school system is producing results on par with Uzbekistan,” the 2018 Social Progress Index concluded.
“Our country is failing on many of the things we hold most dear,” noted Michael E. Porter, the Harvard Business School professor and expert on international competitiveness who designed the Social Progress Index. “And it’s getting worse.” Democrats blame President Trump, while Republicans blame President Obama, but the country has regressed under Democrats and Republicans alike. Professor Porter warns that “the fracturing of our society is grounded not in the weaknesses of a particular leader but in the inability of our institutions to deliver meaningful social progress for the average citizen.”
What “the fracturing of our society” means in human terms is a dysfunction that statistics simply can’t fully convey. It’s a breakdown that rips apart families and tears the social fabric. Churches, social clubs and other civic organizations are not providing the social cohesion or assistance they once did. The government is unwilling to step in to fill the breach, so many children suffer needlessly and the dysfunction is transmitted to the next generation.
Molly is what we’ll call a friend of ours who lives along the Number 6 bus route. She dropped out in the eighth grade and gave birth to a daughter when she was just fifteen. At the time, Molly didn’t tell anyone who the father was, so she was assumed to be “loose” and “careless.” Many years later, she acknowledged that her daughter, whom we’ll call Laurie, was the result of a rape by her father. One of the first people she revealed her secret to was her mom.
“Your dad raped me, too, and that’s how you got here,” her mom replied. All this would be an enormous psychological burden for any family. Laurie, who grew up knowing that she was born of an incestuous rape, was homeschooled through grade school and then attended ninth grade for a few months before finding herself in over her head and dropping out. As an adult, Laurie is smart, plays the piano and is an excellent golfer, but she has five small children fathered by four dads. We were close friends with the paternal grandfather of two of the little girls, so we asked Molly about them.
Molly lives here with her son, along the Number 6 school bus route near Yamhill. (photo by Lynsey Addario)
“There are just too many kids for one person,” Molly told us worriedly. Laurie’s eldest boy was expelled twice from kindergarten, once for being disruptive and once for stealing the teacher’s iPad. This upset Laurie, who now is homeschooling the five kids, even though she herself had only a few months of formal education. Laurie didn’t want to talk to us about these issues, but Eric Pleger, a mutual friend of ours, sees the children periodically, so we asked him about the two toddler girls. He shook his head. “Sounds terrible to say this about two little girls,” he said glumly, “but they’re headed for the joint.”
Some of the stories we tell here are unsettling. We share them because Americans must appreciate new realities, and the grimness may be mitigated by the suggestions we offer both for smarter policies and for individual philanthropy. It is heartbreaking to try to chronicle the suffering of a place you love, and we found it particularly painful to watch the dysfunction in old friends replicated in their children and their children’s children. Yet that is the story of much of working-class America. Yes, economic growth entails change, and “creative destruction” is as necessary as it is inevitable. But creative destruction need not mean the demolition of families for generations.
For starters, America doesn’t adequately invest in children, whose potential so often goes unfulfilled. One reflection of the state of the American dream: 76 percent of the white working class expects their children’s lives to be worse than their own. The World Bank Human Capital Project estimates that American children reach only 76 percent of their potential because of inequality and shortcomings in our health and education systems. That gives the United States a ranking of 24 out of 157 countries, in line with its score on the Social Progress Index. Many other countries, even much poorer ones, do better.
Math scores on standardized tests are a good predictor of future incomes, and one worrying omen is that the United States ranks below average in the industrialized world in math scores for fifteen-year-olds on the PISA test. Almost one-third of American fifteen-year-olds perform below the baseline that is believed necessary to thrive in the modern world. Indeed, the only area where the American students really excel is overconfidence, PISA found: they are more likely than pupils in other countries to believe that they have mastered topics, even as they do worse.
Undereducated children grow into troubled adults who die at higher rates partly because of despair and anxiety. Many fear the future, or doubt they will find meaning and purpose in today’s society and economy. Suicide rates are at their highest level since World War II, and opioids and other drugs now kill more Americans each month than guns or car crashes. Every seven minutes, another American dies of a drug overdose, and one American child in eight is living with a parent with a substance use disorder. Dr. Daniel Ciccarone, professor of family and community medicine at the University of California, San Francisco, notes that drug abuse at the scale we see it is a symptom of a deeper malaise. “If we don’t address the root suffering of Americans, even if you took every opioid pill away, that suffering will manifest into another social and public health problem,” he told us. “If we want to end, truly end the opioid crisis, we need to understand the basic causes of suffering and pain in America.”
These deaths from drugs, alcohol and suicide have been called “deaths of despair” by the Princeton University economists Anne Case and Angus Deaton, and that pretty much captures the mortality on the Number 6 bus. The despair arises in part from frustrations about loss of status, loss of good jobs, loss of hope for one’s kids. Inequality is currently believed to be greater than it was in the Gilded Age of the nineteenth century, and just three Americans—Jeff Bezos, Bill Gates and Warren Buffett—now possess as much wealth as the entire bottom half of the population. Senator Mark Warner, a moderate Democrat from Virginia who before entering politics was a successful telecommunications investor and executive, put it to us bluntly: “I don’t believe modern American capitalism is working.” Ray Dalio, the billionaire founder of Bridgewater, the world’s largest hedge fund, agrees, saying: “I’m a capitalist, and even I think capitalism is broken.” Dalio added: “The problem is that capitalists typically don’t know how to divide the pie well and socialists typically don’t know how to grow it well.”
That skeptical view of capitalism is shared by young Americans in particular. As recently as 2010, more than two-thirds of Americans aged eighteen to twenty-nine had positive views of capitalism; today, according to Gallup, Americans in that age group have more positive views of socialism (51 percent) than of capitalism (45 percent). The problems are most stark in America, but they are also evident in Britain and to a lesser extent in some other developed countries; Martin Wolf of the Financial Times argues that we are undergoing a “crisis of democratic capitalism.”
The first lesson of our journey and theme of this book is that to a degree unnoticed in more privileged parts of America, working-class communities have collapsed into a miasma of unemployment, broken families, drugs, obesity and early death. America created the first truly middle-class society in the world, but now a large share of Americans feel themselves at risk of tumbling out of that security and comfort. There’s a brittleness to life for about 150 million Americans, with a constant risk that sickness, layoffs or a car accident will cause everything to collapse. One in seven Americans lives below the poverty line, a substantially higher rate than in Canada or other OECD countries, and scholars estimate that half of all Americans will at some point slip below the line. A recent Federal Reserve survey found that almost 40 percent don’t readily have the cash to cover a $400 emergency expense such as a broken car or a roof leak. They can’t even think of retirement. When all else fails, they sell blood plasma, up to twice a week, for $30 or $40 each time.
The second theme of this book is that suffering in working-class America was not inevitable but rather reflects decades of social-policy mistakes and often gratuitous cruelty: the war on drugs that led to mass incarceration, indifference to the loss of blue-collar jobs, insufficient health-care coverage, embrace of a highly unequal education system, tax giveaways to tycoons, zillionaire-friendly court decisions, acceptance of growing inequality, and systematic underinvestment in children and community services such as drug treatment.
Government authorities too often sided with capital over labor, undermining unions and weakening wages for unskilled workers in particular. If the federal minimum wage of 1968 had kept up with inflation and productivity, it would now be $22 an hour instead of $7.25 (many states and localities have higher minimums). There have been intelligent debates about what the optimal minimum wage should be, how it should vary between cheaper and more expensive parts of the country and at what point it begins to undermine employment significantly, but almost every labor economist believes it should be substantially higher than it now is at the federal level. Many companies also subject hourly workers to unpredictable job schedules, sometimes working late one evening and then early the next morning, in ways that interrupt sleep and make it impossible to plan childcare, doctor appointments or parent-teacher visits. A 2019 study found that this kind of scheduling caused workers even more unhappiness and psychological distress than low wages, and it often seems unnecessary and callous.
A harshness and at times a nastiness have crept into American policy, rooted in the misconception that those who struggle with unemployment, finances, drugs and life’s messiness are fundamentally weak, in danger of dependency, in need of hard lessons. During the Great Recession of 2008–09 and its aftermath, the government rescued Wall Street banks but approved an inadequate stimulus so that millions lost their jobs. The housing bubble reflected an orgy of white-collar greed and criminality, but the people who paid the price were the 10 million families who lost their homes.
The third theme we pursue is more hopeful: the challenges are not insurmountable, and we can adopt policies that are both compassionate and effective. While there are no magic wands, we will outline policies that can mitigate suffering and provide traction for struggling families. Early childhood programs for at-risk kids pay for themselves seven times over in reduced spending on juvenile detention, special education and policing, according to the Nobel Prize–winning economist James Heckman. Programs to help low-income teenage girls with family planning also save public money many times over, for an IUD is one-fifteenth the cost of a Medicaid birth. And initiatives like the Earned Income Tax Credit cover most of their own costs by nudging people into the labor force so that they become taxpayers.
We as citizens must also hold all politicians’ feet to the fire. This is not a Democratic issue or a Republican issue; it is an American issue, and too many of our elected representatives have failed to grapple seriously with the humanitarian crisis unfolding in our own country. There has been a dereliction of duty by politicians of both parties. This is an appeal for a more responsible and compassionate, evidence-based and accountable approach to governance.
To achieve these smarter policies, we must transcend the customary narrative that focuses only on “personal responsibility” and on glib talk about lifting oneself up by the bootstraps. Wiser policy requires our country to possess a richer understanding of why people fall behind, a deeper comprehension of how many children grow up with the odds stacked against them. Yes, they make mistakes, but in some cases we fail them before they fail us. Self-destructive behaviors are as real as autoimmune disorders, but both can be treated. We aim to nurture understanding, empathy and a willingness to offer helping hands rather than pointed fingers.
The power of empathy can be formidable. Take a high-school dropout named Mary Daly. She grew up in a small town near St. Louis and was mostly a good student. But then her dad lost his job as a postal worker, her parents fought and eventually divorced, and Mary found it impossible to concentrate on school. She dropped out at fifteen, moved in with friends and went to work at a doughnut shop operated by her grandparents; she aspired to be a bus driver. The high-school guidance counselor mentioned the case to a local college teacher, Betsy Bane, who spoke to Mary and urged her to get a GED. At seventeen, Mary passed the GED, earning a top score without much study, and Bane urged her to consider college. Daly had never thought of university and said she couldn’t afford tuition, but Bane offered to pay for the first semester.
At the University of Missouri, Daly immediately excelled and earned a degree in economics in 1985, then a master’s and a PhD. After postdoctoral work, she became a research economist in the Federal Reserve System in 1996, where she was mentored by another woman economist, Janet Yellen. Daly worked her way up, often focusing on inequality, and in 2018 was named president of the Federal Reserve Bank of San Francisco. In that role she is, as Heather Long of The Washington Post put it, “one of the most powerful shapers of economic policy in the United States.” Daly set up a scholarship at the University of Missouri to honor Bane, who says that there are “a lot of little diamonds” who go unnoticed.
AS PAIN SEEPED ACROSS America, Yamhill became a microcosm of America’s working-class dysfunction. The small high school in Yamhill endured two student suicides in a single year: a boy hanged himself at home, and a girl shot herself in her car in the school parking lot. Nick’s successor as student-body president lost a son, greatly admired and much loved in the community, to a drug overdose.
One of Nick’s schoolmates, Stacy Mitchell, a vivacious cheerleader and volleyball player while in high school, wrestled with alcoholism and ended up homeless, living in a tent. She froze to death on a cold winter night, at age forty-eight. The idea that a popular girl from a local family with deep roots in the community could freeze to death while homeless was shattering. It wasn’t just Stacy who died that night; something in all of us perished as well.
Plenty of kids from Yamhill did just fine, and we’ll later explore the lessons of some of these escape artists. But it isn’t just the dropouts who struggled. In high school, Nick’s rival to be valedictorian was Donna King, an exceptionally bright girl whose father was a truck driver for the county. Donna and Nick were neck and neck, and then she became pregnant. She explained to us that she knew about the county clinic that offered family planning but also knew that the clinic wasn’t good at keeping secrets and that if she asked for contraception word might filter out to her dad and scandalize her family. The pregnancy caused a scandal anyway. Donna married her boyfriend, Marvin, and managed to finish school by force of discipline and intellect. Donna and Marvin didn’t go to college, partly because of the baby and partly because of the cost, but they are smart, hardworking and law-abiding. They haven’t abused drugs but have still struggled every step of the way. Marvin worked in a factory making trailers until it closed down. Then he worked as a logger until his back went out. Now he has reinvented himself as an information technology professional, working on computers on the Nike campus. Donna has likewise worked in a tax preparation office, in a hotel and for Amway. Mostly, she gets by cleaning people’s houses.
In the end, Donna raised a wonderful, strong family that she is rightly proud of. But if she had grown up in an affluent home in New York, or if she had had some help with family planning when she was a teenager, she might have ended up a doctor. The problem wasn’t Donna’s ability, but limited opportunities for the working class.
There’s sometimes an impulse to pit the suffering of the white working class against that of African Americans or members of other minority groups. That is a mistake. Government policies have poorly served the working class of every complexion, and we need solidarity rather than strife among those so overlooked. The challenges faced by Donna in a rural white community aren’t always so different from those faced by brilliant working-class black kids in urban areas across the country. The Boston Globe tracked down ninety-three valedictorians who had appeared in its newspaper between 2005 and 2007 in a “Faces of Excellence” series. These were hardworking, smart, outperforming kids, mostly of color, and nearly one-quarter had aimed to be doctors. Yet not one has become a doctor, and one-quarter failed to earn a BA within six years. Four became homeless, one spent time in prison and one died. The Globe described “an epidemic of untapped potential,” which seems about right whether one is talking about black neighborhoods in Boston or rural white communities in Oregon, not to mention Latino parts of Texas or Native American country across the West.
Some Americans assume that the grim difficulties affect only those on the bottom rung of the ladder, but that’s incorrect. The economic and social fabric for much of America has been ripped apart, and this is expensive for everyone: the White House estimates that the opioid epidemic costs the United States half a trillion dollars a year—more than $4,000 per American household annually.
One mechanism by which pain on the bottom is transmitted throughout the nation is the political system. Some 60 million Americans live in a rural America that is suffering, and the U.S. political architecture gives the frustrations of these rural Americans disproportionate political influence. They have particular weight in the Senate, where each state has two senators, so a Wyoming voter has sixty-eight times as much clout in choosing a senator as a California voter. This baked-in bias in the Senate and Electoral College in favor of small, rural states will continue to give rural voters outsize influence for the foreseeable future, and rural America has for decades endured economic decline and social turmoil that have left voters angry and disillusioned. The political consequences are visible: Working-class Americans helped elect President Trump. The reasons they backed Trump were complicated and sometimes included nativism, racism and sexism, but about 8 million of these voters had supported Barack Obama in 2012. Many cast ballots for Trump as a primal scream of desperation because they felt forgotten, neglected and scorned by traditional politicians.
Yet once he was in office, Trump cold-shouldered the working-class voters who had supported him. He gave lip service to jobs in coal and manufacturing but took no significant step to assist workers, and he made things worse by chipping away at the Affordable Care Act. It was one more scene in a long drama of politicians’ betrayal of America’s working class.
A popular critique laments the indolence, irresponsibility and self-destructive behaviors of the working class. National Review in 2016 urged “an honest look at the welfare dependency, the drug and alcohol addiction, the family anarchy—which is to say, the whelping of human children with all the respect and wisdom of a stray dog” and concluded that “the white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles.” It’s true that too many working-class students drop out of high school and then have babies out of wedlock and that this is a prescription for poverty. Ron Haskins and Isabel Sawhill of the Brookings Institution have found that of people who follow three traditional rules—graduate from high school, get a full-time job and marry before having children—only 2 percent live in poverty. So play by these rules, called “the success sequence,” and by and large one can avoid poverty. In contrast, of those who do none of those three things, 79 percent live in poverty. Overall, one-quarter of girls still become pregnant by the age of nineteen, so clearly there has been irresponsible behavior, by boys and girls alike.
Yet the irresponsibility is not entirely with adolescents. American kids have sex at the same rates as European kids, but European girls are one-third as likely to get pregnant—because European countries offer much better comprehensive sex education and easier access to reliable forms of contraception. So, yes, teen births reflect individual irresponsibility, but also collective irresponsibility on the part of society. If we’re going to blame the kids, we should also acknowledge our collective failure to do a better job creating safety nets so that teenagers overcome by hormones don’t damage their futures, not to mention their children’s.
Something similar to today’s malaise and falling life expectancy has happened before in the world, in the Soviet Union. In the 1980s, the USSR was still a superpower with a space program, magnificent orchestras and operas, impressive science and mathematics, an empire in Eastern Europe and the capacity to blow up the globe. It was easy for tourists visiting the Hermitage in Leningrad or Red Square in Moscow to be dazzled. Yet all of this rested on an economic and social foundation that was cracking because of the Soviet Union’s disastrous policy choices.
Alcoholism and discontent were rife there, with men reaching for vodka by late morning and disappearing into a haze by afternoon. The old joke in the factories was, They pretend to pay us, and we pretend to work. Soviet officials knew of these deep and complicated social and economic problems but chose to ignore drunkenness, drugs and workforce absenteeism, which they believed wouldn’t affect the Kremlin. Their solution was to stop publishing Soviet mortality data.
When substance abuse became inescapable, General Secretary Mikhail Gorbachev declared a war on drunkenness and closed liquor shops, viewing the problem as a moral one of personal weakness and irresponsibility. In fact, alcoholism and drugs were a symptom of far deeper structural problems, of policy mistakes such as agricultural collectivization, a dysfunctional command economy and the invasion of Afghanistan. These mistakes went back decades and finally became impossible to cover up. Hope had dissolved. When life expectancy declined in Russia, just as it has in America today, that was a sign of systemic troubles that patriotic rhetoric could no longer conceal. It should have been a wake-up call, just as America’s declining life expectancy today should be our own alarm bell.