In 2015, according to the Centers for Disease Control, some 33,091 people died as a result of an opioid overdose. The final 2016 figure, there is little doubt, will be even higher. Last year, researchers at the CDC put the “societal” cost of the opioid epidemic at $78.5 billion for 2013. Some of that figure includes spending on healthcare and on criminal justice related to the trade in opioids. But much of the $78.5 billion represents something less tangible: “lost productivity.” The researchers estimated that the lost future economic output of Americans affected by the epidemic—those who were disabled by opioid dependence, who died prematurely, or were incarcerated—amounted to $41.9 billion a year. And in November, the White House made headlines by putting an even bigger price tag—$504 billion—on the opioid epidemic, by adding to this a dollar value for each life lost, the so-called “value of a statistical life.”
The idea of putting a price on health—or life and death—may seem intuitive, even natural, in an age in which the human body is commonly conceived as a sort of investment. “When I’m at a country club or a party and people ask me what I do, I say I’m an asset manager,” said one concierge physician (annual fee: $40,000 and up) whose practice was recently profiled in the New York Times. “When they ask what asset, I point to their body.”
But this was not always so. The view of a human life as revenue-producing capital—the price of which can be computed by years and dollars of “lost productivity”—is a very new development, one that is at the core of historian Eli Cook’s groundbreaking new book. The Pricing of Progress: Economic Indicators and the Capitalization of American Life traces how health, lives, and land came to be seen as “income-generating investments,” a transformation that has not just shaped how we perceive the costs of catastrophes like the opioid epidemic (or how we market boutique medical care), but that also, Cook asserts, propelled the emergence of capitalism itself.
To be sure, plenty of pre-capitalist societies have relied on some of what we see as the trappings of capitalism: money, trade, markets, and even wage labor. But capitalism itself, Cook argues (like many historians and theorists of capitalism, going back to at least Marx), is something very novel. “Markets, commodities, and consumer goods,” he writes, “while certainly necessary components, do not a capitalist society make.” For Cook, it is instead the rise of dividend-producing investments that defines capitalism. First land, and then people, came to be seen not merely as commodities to be bought and sold, but as capital, the price of which was increasingly tied not to some measure of innate value or even to hours of labor committed, but by the promise of future profits.