Turn Off, Tune Out, Drop In, Die Off: Medicaid Funds the White Death

Medicaid is gently carrying tens of thousands of healthy Americans to their early deaths each year, according to analysts who are trying to explain the massive and unprecedented spike in deaths among middle-aged Americans in post-industrial America.

When I last wrote about the increased mortality rates among lower- and middle-class whites, I suggested the welfare state played a significant role in creating the death wave.  Now, in a massive and extensively researched article for Commentary, Nicholas Eberstadt shows how Medicaid is funding the gateway drugs — opioid prescription painkillers — which lead people towards deadly heroin and early death. 

Eberstadt quotes from the award-winning 2016 book Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones. As one passage in Dreamland explains:

[The Medicaid card] pays for medicine—whatever pills a doctor deems that the insured patient needs. Among those who receive Medicaid cards are people on state welfare or on a federal disability program known as SSI. . . . If you could get a prescription from a willing doctor—and Portsmouth had plenty of them—Medicaid health-insurance cards paid for that prescription every month. For a three-dollar Medicaid co-pay, therefore, addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.

“In 21st-century America, ‘dependence on government’ has thus come to take on an entirely new meaning,” Eberstadt sardonically observes.

Keeping in mind that one of Obamacare’s undeclared goals – arguably the only part of the program that actually “worked” – was the radical expansion of Medicaid, Eberstadt’s citation of 2013 Census Bureau data is sobering: 21 percent of all civilian men between 25 and 55 years of age are now Medicaid beneficiaries.

Further, a jaw-dropping 57 percent of non-working white males in the same age bracket are now collecting disability benefits. Some of them are receiving benefits from multiple government programs. Almost half of the men who have dropped out of the labor force are taking some form of pain medication on a daily basis, according to a 2016 study cited in the article.

Eberstadt explains what that means in socio-economic terms:

Disability checks and means-tested benefits cannot support a lavish lifestyle. But they can offer a permanent alternative to paid employment, and for growing numbers of American men, they do. The rise of these programs has coincided with the death of work for larger and larger numbers of American men not yet of retirement age. We cannot say that these programs caused the death of work for millions upon millions of younger men: What is incontrovertible, however, is that they have financed it—just as Medicaid inadvertently helped finance America’s immense and increasing appetite for opioids in our new century.

Princeton economics professors Angus Deaton and Anne Case “calculate that if the death rate among middle-aged whites had continued to decline at the rate it fell between 1979 and 1998, half a million deaths would have been avoided over the years from 1999 through 2013. That, they note, is about the same number of deaths as those caused by AIDS through 2015,” writes the New York Times.

Perhaps the major reason that the White Death has been so baffling for the experts is that they can’t believe that their benevolent government programs are playing a central role in this national catastrophe.

Elsewhere in Eberstadt’s article, he looks at the failure of the Obama economy to provide opportunities for advancement – which in turn was the acceleration of job-market trends that date back to the end of the dot-com boom in the Nineties – and the calcification of both social and physical mobility. As other sources cited in my previous article argued, the welfare state has largely eliminated the incentives for people to move away from disadvantaged areas.

At the same time, the boundless opportunity represented by the pursuit of the “American Dream” doesn’t look so boundless anymore. The lower-middle-class man no longer fears hunger and deprivation, nor does he see a glittering prize to reach for with extraordinary effort. Nothing to run from, and nothing to climb towards: it’s no surprise that so many have stopped running or climbing.

Eberstadt also briefly touches on the hollowing out of the civil society resources which normally cope with stress and loss:

We already knew from other sources (such as BLS “time use” surveys) that the overwhelming majority of the prime-age men in this un-working army generally don’t “do civil society” (charitable work, religious activities, volunteering), or for that matter much in the way of child care or help for others in the home either, despite the abundance of time on their hands. Their routine, instead, typically centers on watching—watching TV, DVDs, Internet, hand-held devices, etc.—and indeed watching for an average of 2,000 hours a year, as if it were a full-time job.

The Left has largely accomplished its grand 50-year mission, destroying the nuclear family, organized religion, and masculine values such as self-reliance, leaving many dependent on government functionaries for sustenance and hope. We aren’t supposed to be competitive anymore, and we aren’t meant to feel even a twinge of shame about long-term dependency on welfare programs or about dropping by the local Medicaid clinic for more pain pills. We have been strictly instructed to place no particular value on traditional marriage — not for its role in healthy child-rearing, or for the vital and different benefits it brings to men and women.

The old-fashioned civil-society resources of church and family have withered under relentless assault from the Left, which seeks to replace all other social institutions with the worship of and dependency upon the benevolent State. The result is a wave of young and middle-aged people with nothing in their lives to inspire or sustain them, leading to a growing dependency on drugs, often beginning with prescription medication and moving on to illicit substances like heroin.

The result is a wave of young and middle-aged people whose adult prospects are turned off, who tune out from their local civic society, who have nothing in their lives to inspire or sustain them, so they accept the federal government’s invite to drop by the Medicaid clinic for the temporary fix of cheap prescription medication, until they eventually kill themselves with stronger, deadlier heroin. 

The entire government-funded sequence is a grim update of Timothy Leary’s infamous 1966 advice for the counter-culture: turn off, tune out, drop in, and then die off.