Donald J. Trump can be brilliant. On the campaign trail, his diagnosis of the raw anger and disillusionment among white working-class Americans bested the most sophisticated analyses from the professional political class.
His description of “American carnage” in his Inaugural Address — complete with “rusted-out factories scattered like tombstones across the landscape,” impoverished mothers and children, crime, drugs that “robbed our country of so much unrealized potential” — struck a nerve with millions of voters who feel left behind by a country buffeted by demographic, technological and social change.
But something must have happened between then and now.
President Trump cannot possibly believe that nixing the health insurance of 24 million poor or nearly poor Americans to pay for tax cuts at the very top of the income distribution would serve the white Everyman he promised to defend.
It’s also hard to fathom how whites without a college degree would benefit from Mr. Trump’s proposal to cut $54 billion from the civilian discretionary budget — slashing projects to help low-income families pay for heating in the winter or move to better neighborhoods; cutting nutrition assistance for mothers and help for low-income students to enter college.
Indeed, his initial forays into social and economic policy making raise an uncomfortably raw question: Was his appeal to the troubled working class a con? If anything, his proposals look like a scheme to make the carnage worse.
Last week, the Princeton economists Anne Case and Angus Deaton unveiled new research offering a bleak portrait of Mr. Trump’s base of white men and women without a bachelor’s degree: They are, indeed, dying in droves, committing suicide and poisoning themselves with drugs and alcohol at much higher rates than blacks, Hispanics, or men and women in other advanced countries.
“Deaths of despair,” Professors Case and Deaton call them. From 1998 through 2015, the mortality rate of white non-Hispanic men and women with no more than a high school diploma increased in every five-year age group, from 25-to-29 to 60-to-64, they found.
The desperation took time to build — 40 or 50 years maybe, as automation and globalization killed jobs on the factory floor. Squeezed into insecure, low-wage jobs in the service sector, many workers lacking the higher education required to profit from the new economy simply left the job market.
Others soldiered on. But the changes nonetheless took their toll. Marriage declined and families weakened. The prospects of working-class children deteriorated. And successive governments, Republican and Democratic, avoided looking too hard at the plight of modernity’s losers.
These economic changes affected all workers with scant education, of course. But whites suffered a deeper blow: In 1999 mortality rates of whites with no college were around 30 percent lower than those of blacks as a whole, Professors Deaton and Case found. By 2015 they were 30 percent higher. It seems that blacks and Latinos, whose memories of the halcyon days of manufacturing in the early 1970s are colored by the stain of discrimination, suffered less of a loss.
This is hardly a fitting picture for one of the most affluent societies in human history. But there you go. Other research has documented how mortality has declined more slowly for less-educated Americans over the past 20 to 25 years. From 1990 to 2008 the life expectancy of white men and women without a high school degree decreased.
They are, in fact, killing themselves. One study published in 2004 found that the mortality rate of adults with only a high school education for causes that were tough to prevent — like multiple sclerosis and cancer of the gallbladder — was no higher than for adults with a bachelor’s degree. But it was about 25 percent higher for highly preventable causes of death — like homicides, lung cancer and accidents.
Mr. Trump doesn’t have it entirely wrong when he blames trade for this. In a study published last month, the economists David Autor, David Dorn and Gordon Hanson found that shocks that reduced job opportunities for less-educated Americans, such as that delivered by the surge of imports from China since 2000, unleashed an array of unhealthy responses.
These include: “an increase in the rate of male mortality from risky and unhealthful behaviors; a reduction in the net availability of marriage-age males in affected labor markets; a reduction in the fraction of young adults entering marriage; a fall in fertility accompanied by a rise in the fraction of births to teen and unmarried mothers; and a sharp jump in the fraction of children living in impoverished and, to a lesser degree, single-headed households.”
Can Mr. Trump do anything for these people? A lot of them voted for him.
Perhaps he has come to believe, as do so many on the Republican right, that American carnage is the government’s fault: Welfare itself has corrupted the poor. So best to cut welfare programs to pay for another round of tax cuts.
As I suggested in a recent column, perhaps he is banking on the white working class’s resentment of poor people, whom they see as moochers entitled to government aid not available to their own struggling families. From a narrow political standpoint, forgetting about his base seems like a counterproductive course to follow.
Mr. Trump’s most prominent campaign proposals — which promised to restore the jobs and the demographics of the 1950s and 1960s by blocking imports and kicking out millions of immigrants — are, of course, unrealistic. A more ethnically diverse America is here to stay. The labor-intensive manufacturing sector will not return to the United States no matter what the president does.
“The trouble with protectionism is that it is not going to bring those jobs back,” Professor Deaton told me. “We can spend a huge amount of money inflicting pain on ourselves, not to mention Chinese and Indian and other people much poorer than we are, and not get anything back.”
But there are more productive ideas around. It is too early for Mr. Trump to simply fold on his promises of a better future for the white working class. Republicans’ failure to approve the plan to end the Affordable Care Act — devised by the House speaker, Paul D. Ryan, and endorsed by the president — offers an opportunity to correct course.
Why not extend the social safety net to cover his distressed voters, offering a lifeline of stability to help them hang on to their lives? This could include training programs to help less-educated workers find new careers in an unstable economy, extended unemployment benefits, or wage subsidies for workers knocked down into jobs with low pay. Even, perhaps, something more generous: truly universal health insurance.
There are real political benefits to this strategy. Mike Konczal of the Roosevelt Institute, a progressive research group, pointed out how, by expanding public health insurance for the poor to cover the working class, the Affordable Care Act created a broader coalition to stop the Republicans’ repeal effort. Public health, he wrote, “was transformed away from a ‘poor program for poor people’ to a broader program in the popular imagination, one that becomes easier for the political class to defend.”
The party the president represents may not like these sorts of proposals. But the relationship is fractious anyway. He was elected to fix the carnage.