We are grateful to Maximilian Worth for outstanding research assistance. For helpful comments we thank Paul Novosad, Anne Case, Andrew Cherlin, and seminar participants at the University of Chicago’s Harris School of Public Policy, the Wennberg International Collaborative, the American-European Health Economics Study Group, the 2024 Empirical Health Economics Workshop, the University of Houston, and the 2025 Russell Sage Conference Beyond Deaths of Despair: New Research on the Health and Well-Being of Low- and Moderately-Educated Americans. We thank Paul Krugman for suggesting the title. The views stated herein are those of the authors and not necessarily those of the Federal Reserve Bank of Boston, the Federal Reserve System, or the National Bureau of Economic Research.