The War on Normal People: The Truth about America’s Disappearing Jobs and Why Universal Basic Income Is Our Future
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Fewer men in the workforce means fewer men who are considered marriageable. A working-class woman asked about marriage by journalist Alana Semuels said, “I haven’t run into someone I’d consider doing that with.” For women who don’t have college educations, their male counterparts can’t find jobs and don’t seem like stable partners.
Lower rates of marriage mean that the proportion of children raised by a single parent is rising dramatically; though fertility is declining, people don’t stop having children just because they don’t get married. The share of children born to unmarried mothers more than doubled between 1980 and 2015, from 18 to 40 percent.
Single mothers outnumber fathers more than four to one. Of the 11 million families with children under age 18 and no spouse present, 8.5 million are single mothers. Most of the time, single parent means single mother. If you send uneducated men to the sidelines and turn them into nonproviders, you wind up forming many difficult family situations and parents who then are hard-pressed to raise their kids. “We see a decline in fertility, a decline in marriage, but a rise in the fraction of births that are disadvantaged, and as a consequence the kids are living in pretty tough circumstances,” said poverty researcher David Autor, commenting on a study on how the decline of manufacturing affected men and women.
Boys raised in single-parent households seem to suffer more than girls. A study showed that growing up with stably married parents makes one more likely to succeed at school, but that an absent father had a bigger impact on boys. Boys without fathers are more likely to get in trouble from elementary school onward, and appear to be “more responsive to parental inputs (or the absence thereof) than are girls.” As the authors of one study put it, “As more boys grow up without their father in the home, and as women (especially in… working-class communities) are viewed as the more stable achievers, boys and girls alike come to see males as having a lower achievement orientation and less aptitude for higher education… college becomes something that many girls, but only some boys, do—the opposite of the earlier cultural norm.”
J. D. Vance made the same observation about school being something boys were supposed to ignore: “As a child, I associated accomplishments in school with femininity. Manliness meant strength, courage, a willingness to fight, and later, success with girls. Boys who got good grades were ‘sissies’… studies now show that working-class boys like me do much worse in school because they view schoolwork as a feminine endeavor.”
I have two young boys at home, and I’m not surprised that it’s boys who get less attention as children struggle. ADHD is two to three times more common among young boys than girls, with one 2015 U.S. Centers for Disease Control study finding that as many as 14 percent of boys received a diagnosis. Whereas some of my friends’ daughters seem like little adults, my boys do not. Boys and girls mature differently, with the latter doing so faster and earlier. There is significant evidence that their relative maturity leads girls to be better at school. In 2012, 70 percent of U.S. high school valedictorians were girls, and girls attend college at higher rates in most developed countries.
At the high end of the spectrum, college-educated women don’t like to marry non-college-educated men, quite understandably. As the gender ratio of college graduates becomes nearly three women for every two men, this means that almost one in three college-educated women will not find a male partner to marry if they want one, even assuming ideal matching. Thus, among educated women, an increasing number of women will either raise children without a partner or won’t have them. I see this in my social circles; I know many successful professional women in New York City who either don’t have families or are raising children as single moms. Many of them are brilliant, beautiful, amazing women. In a way it’s fine, but in a way it’s far less than ideal. One mom who attended Harvard Business School confided in me that she constantly feels guilty that her daughter will be an only child, but she can’t imagine trying to raise more than one child on her own.
I understand: having and raising children has been the hardest experience of our lives for both my wife and me. I was cocky going into it; I thought to myself, People have had children since the dawn of time. How hard could it be? Now, I try to caution new parents that whatever they go through it’s perfectly normal and to expect to have their lives changed and their spirits stretched. Having children has tested my wife and me as individuals and as a marriage. Both of us agree that we have no idea how any single mom or dad can make it happen unless they have incredibly supportive family members around.
Data bears this out—outcomes for children raised in single-parent households are significantly more adverse in every dimension: education, income, rate of marriage, rate of divorce, health, and so on, even controlling for income of the parent. It also explains partially why 50 percent of Americans live within 18 miles of their mothers—after you have a child you scramble for family.
Frederick Douglass wrote that “It is easier to build strong children than to repair broken men.” What he left out is that it’s also very hard to build strong children. I thought starting a company was hard, but being a parent is as hard or harder. I realized that there are many similarities between being a parent and being an entrepreneur. Here is a partial list:
• Everyone’s got an opinion. But no one knows what they’re doing.
• The first two years are brutal.
• No one cares as much as you do.
• On its best days it fills you with meaning and purpose.
• People lie about it all the time.
• Choose your partner wisely.
• Heart is more important than money. But money helps.
• It is very, very hard to outsource.
• You find out who your friends are. And you make some new ones.
• Occasionally the responsibility blows your mind.
• If you knew what it entailed you might not get started. But you’re glad you did.
• There will be a thousand small tasks you never imagined.
• How you spend your time is more important than what you say.
• Everything costs more than you thought it would.
• Most of the work is dirty, thankless, and gritty.
• You learn a lot about yourself. You get tested in ways that you can’t imagine.
• When you find someone who can really help you’re incredibly grateful.
• You have to try to make time for yourself or it won’t happen.
• Whatever your weaknesses are, they will come out.
• You think it’s fragile. But it will surprise you.
• You sometimes do things you weren’t sure you were capable of.
• When it does something great, there’s nothing like it.
• You start out all-important. Yet the goal is to make yourself irrelevant.
• People sometimes give you too much credit.
• There is a lot of noise out there, but at the end of the day it’s your call.
• It gives your life a different dimension. You grow new parts of yourself.
• It’s harder than anyone expects. It’s the best thing ever.
Entrepreneurship is defined as pursuing an opportunity without regard for resources currently under your control. Every parent pursues the best possible opportunities for his or her child while climbing over obstacles and limitations each day. So in a way, all parents are entrepreneurs.
My mind almost broke trying to build Venture for America and raise children (and stay married) simultaneously, despite my wife doing most of the hardest work. You never rest. Basically, being a parent is a ton of freaking work, and doing it alone seems inconceivably difficult. That’s what we’re setting up more and more people, most of them women, to face alone. At a time when raising and educating children and forming our human capital is of the utmost importance, we’re heading in the other direction.
THIRTEEN
THE PERMANENT SHADOW CLASS: WHAT DISPLACEMENT LOOKS LIKE
As it turns out, yes, it had happened, and yes, no one had noticed.
As Case and Deaton found, suicides were way up. Overdoses from prescription drugs were much higher. Alcoholic liver disease was commonplace. Historically, African Americans have had higher mortality rates and shorter life expectancies than whites. Now, whites with a high school degree or less have the same mortality rates as African Americans with the same levels of education. What was behind the disturbing trends?
Case and Deaton point the finger at jobs. Deaton explained, “[J]obs have slowly crumbled away and many more men are finding themselves in a much more hostile labor market with lower wages, lower quality and less permanent jobs. That’s made it harder for them to get married. They don’t get to know their own kids. There’s a lot of social dysfunction building up over time. There’s a sense that these people have lost this sense of status and belonging… these are classic preconditions for suicide.” They noted that the higher mortality rates and deaths of despair applied equally to middle-aged men and women in their study, though men experience these at much higher levels.
Many of the deaths are from opiate overdoses. Approximately 59,000 Americans died of drug overdoses in 2016, up 19 percent from the then-record 52,404 reported in 2015. For the first time, drug overdoses have surpassed car accidents as the leading cause of accidental death in the United States. Coroners’ offices in Ohio have reported being overwhelmed as the number of overdose victims has tripled in two years in some areas—they now call nearby funeral homes for help with storage.
The five states with the highest rates of death linked to drug overdoses in 2016 were West Virginia, New Hampshire, Kentucky, Ohio, and Rhode Island. Over 2 million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year, according to the latest government report—more than used tobacco. In 12 states there are more opioid prescriptions than there are people. Addiction is so widespread that in Cincinnati hospitals now require universal drug testing for pregnant mothers because 5.4 percent of mothers had a positive drug test in past years. “Opioids are what we worry about most,” explained Dr. Scott Wexelblatt, a neonatologist at Cincinnati Children’s Hospital Perinatal Institute.
People often think of opioid addiction as originating with prescription painkiller use. OxyContin hit the market in 1996 as a “wonder drug,” and Purdue Pharma, which was fined $635 million in 2007 for misbranding the drug and downplaying the possibility of addiction, sold $1.1 billion worth of painkillers in 2000—a sum that climbed to a staggering $3 billion in 2010. The company spent $200 million in marketing in 2001 alone, including hiring 671 sales reps who received success bonuses of up to almost a quarter million dollars for hitting sales goals. An army of drug dealers in suits marketed addictive opioids to doctors, getting paid hundreds of thousands to do it. Regarding OxyContin, CDC director Dr. Tom Frieden noted that “we know of no other medication routinely used for a nonfatal condition that kills patients so frequently.” A study showed that one out of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after their first opioid prescription.
Now many opioid users have graduated to heroin. One common pattern of addiction is that people use prescription painkillers for pain relief or recreationally as a party drug—they grind up pills and sniff them for a euphoric high that lasts for hours. Then they later switch to heroin, which opioid users cited as more easily obtainable. A study conducted by the New England Journal of Medicine showed that 66 percent of those surveyed switched to other opioids after using OxyContin.
The majority of heroin users used to be men. However, because women are prescribed opioids at higher rates, today the gender balance of heroin users is about 50-50. Ninety percent of heroin users are white.
“We are seeing an unbelievably sad and extensive heroin epidemic, and there is no end in sight,” says Daniel Ciccarone, a medical doctor at the University of California at San Francisco who studies the heroin market. “We are not, in 2017, anywhere close to the top of this thing. Heroin has a life force of its own.” Drug cartels have begun to sell heroin laced with fentanyl, a synthetic opioid that increases both the high and the addiction level and is cheaper than heroin, and carfentanil, an elephant tranquilizer so powerful that simply touching it can cause an overdose when it is absorbed through the skin.
Our drug companies and medical system have produced hundreds of thousands of opioid addicts who are now heroin users buying from dealers. Heroin dealers have become ubiquitous—Ohio police say they’ve seen dealers text their customers to advertise two-for-one Sunday specials and offer free samples set up on car hoods in a local park. Some dealers have scheduled business hours. Others throw “testers” wrapped in paper slips printed with their phone number into passing cars, hoping to hook new business. Said Detective Brandon Connley after arresting a low-level dealer in Ohio, “Everybody and their mom sells drugs these days. There’s always somebody right there to pick back up.” Many dealers are addicts themselves trying to keep a steady supply.
This opioid plague will be with us for years in part because treatment is so difficult. Heroin and opioids are notoriously difficult addictions to break. Withdrawal symptoms include cravings, nausea, vomiting, depression, anxiety, insomnia, and fever. Most people relapse several times on their way to recovery, and many are forced to use opiate substitutes like methadone to manage their addiction. Only about 10 percent of people that had a drug abuse disorder received appropriate treatment, according to a 2014 study. Most people can’t break the habit on their own and require extended rehabilitation. Sally Satel, a doctor and professor who has treated heroin users for years, said, “I speak from long experience when I say that few heavy users can simply take a medication and embark on a path to recovery. It often requires a healthy dose of benign paternalism and, in some cases, involuntary care through civil commitment.” Treatment centers cost between $12,000 and $60,000 for 30-to 90-day inpatient care, with outpatient 30-day programs starting around $5,000, with no assurance of success.
Hand-in-hand with the spike in suicides and addiction has been the incredible increase in applications to Social Security disability programs. Almost 9 million working-age Americans receive disability benefits. That’s more than the entire population of New Jersey or Virginia. The percentage of working-age Americans who received disability benefits was 5.2 percent in 2017, up from only 2.5 percent in 1980. Disability applications started surging in 2000, the same year that manufacturing employment started to plummet. The average benefit size in June 2017 was $1,172 per month, at a total cost of about $143 billion per year. The age of the disabled has gone down—in 2014, 15 percent of men and 16.2 percent of women in their 30s or early 40s were on disability, up from 6.6 percent and 6.4 percent in the 1960s.
Rates of disability track areas of joblessness, forming “disability belts” in Appalachia, the Deep South, and other regions. In a couple of counties in Virginia, fully 20 percent of working adults ages 18–64 are now receiving disability benefits. West Virginia, Alabama, Arkansas, Kentucky, and Mississippi are the top five states for disability beneficiaries, with 7.9–8.9 percent of the workforce receiving income replacement. Disability payments received by beneficiaries in these five states exceed $1 billion per month. In these areas, disability benefits are so widespread that the day that checks arrive is like a monthly holiday. Said one West Virginian who processed disability claims, “They’re a vita
l part of our economy. A lot of people depend on them to survive. [On the days checks arrive] you avoid the pharmacy. You avoid Wal-Mart. You avoid, you know, restaurants… Everybody’s received their benefits. Let’s go shopping.”
Some of the increasing rates of disability reflect an aging population and changing demographics. But many of them represent what one expert called “economic disability.” The biggest growth categories of disability category are “mental disorders” and “musculoskeletal and connective tissue,” which together now comprise about 50 percent of disability claims, nearly double what they were 20 years ago. These diagnoses are also the hardest to independently verify for a doctor.
The number of people who applied for disability benefits in 2014 was 2,485,077. On any given business day, there are 9,500 applicants. There are 1,500 disability judges around the country who administer the decisions, often without seeing the claimants. The waiting period to get a hearing is now more than 18 months in most states. To apply for disability, applicants must gather evidence from medical professionals. They compile notes from doctors, send in the information, and wait to hear back. No lawyer representing the government cross-examines them. No government doctor examines them. About 40 percent of claims are ultimately approved, either initially or on appeal. The lifetime value of a disability award is about $300K for the average recipient.
Because the stakes are so high, representing claimants has become a big business. Law firms regularly advertise for clients on late-night television to help them navigate the process and collect a fee, typically a percentage of the award. Eighty percent of appealing claimants are represented by counsel, up from less than 20 percent in the 1970s. One law firm generated $70 million in revenue in one year alone from representing disability claimants.