"Un-working" males

The most recent Commentary magazine includes an article by Nicholas Eberstadt, "Our Miserable 21st Century," that does, indeed, paint a very depressing picture of American society today with future prospects even more bleak. One of the subjects he writes about is the impact of opioid use, especially on men. The statistics are terrible — deaths from drug overdoses now surpass those from car accidents, suicides, and firearms. Eberstadt:

.... The opioid epidemic of pain pills and heroin that has been ravaging and shortening lives from coast to coast is a new plague for our new century. The terrifying novelty of this particular drug epidemic, of course, is that it has gone (so to speak) "mainstream" this time, effecting breakout from disadvantaged minority communities to Main Street White America. .... In Dreamland, his harrowing and magisterial account of modern America's opioid explosion, the journalist Sam Quinones notes in passing that "in one three-month period" just a few years ago, according to the Ohio Department of Health, "fully 11 percent of all Ohioans were prescribed opiates." And of course many Americans self-medicate with licit or illicit painkillers without doctors' orders.

In the fall of 2016, Alan Krueger, former chairman of the President's Council of Economic Advisers, released a study that further refined the picture of the real existing opioid epidemic in America: According to his work, nearly half of all prime working-age male labor-force dropouts—an army now totaling roughly 7 million men—currently take pain medication on a daily basis.

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. But Krueger's study adds a poignant and immensely sad detail to this portrait of daily life in 21st-century America: In our mind's eye we can now picture many millions of un-working men in the prime of life, out of work and not looking for jobs, sitting in front of screens—stoned.

But how did so many millions of un-working men, whose incomes are limited, manage en masse to afford a constant supply of pain medication? Oxycontin is not cheap. As Dreamland carefully explains, one main mechanism today has been the welfare state: more specifically, Medicaid, Uncle Sam's means-tested health-benefits program. Here is how it works (we are with Quinones in Portsmouth, Ohio):

[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.

You may now wish to ask: What share of prime-working-age men these days are enrolled in Medicaid? According to the Census Bureau's SUP survey (Survey of Income and Program Participation), as of 2013, over one-fifth (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent). And for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent.

By the way: Of the entire un-working prime-age male Anglo population in 2013, nearly three-fifths (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013. 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. .... [more]

Nicholas Eberstadt, "Our Miserable 21st Century"