Follow this authorEduardo Porter's opinions

Subsequent work by economists David Autor at MIT, David Dorn at the University of Zurich and Gordon Hanson, now at Harvard’s Kennedy School, documented how the surge in imports from China since roughly the early 1990s had devastated communities across the United States that relied on manufacturing for sustenance.

Princeton University scholars Anne Case and Angus Deaton made the case that these dynamics were deadly, producing an epidemic of suicides and overdoses that they called “deaths of despair.”

“Inequality and death are joint consequences of the forces that are destroying the white working class,” they wrote. “It is the deeper forces of power, politics and social change that are causing both the epidemic and the extreme inequality.”

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This narrative is consistent with a constellation of data documenting the poor health of American society — from the nation’s short life expectancy and high infant mortality rate to a poverty rate that exceeds that of other wealthy democracies.

And yet, the straightforward story might be wrong.

Critics have left some dents in the “deaths of despair” thesis: The availability of opioids, they point out, does a better job explaining the overdose mortality patterns than socio-economic despair. The mortality trends look different when adjusted by age. The rise in mortality among the less educated is mostly about cardiovascular disease, not suicide, alcoholism or drug abuse. And it afflicts a small sliver of deeply disadvantaged Americans, not the working class writ large.

The accepted story of America’s intertwined ills has been challenged from a more fundamental front by new research suggesting inequality might not have evolved as most of us thought. The most prevalent story among economists, following the seminal work by Piketty and Saez, has argued that the rising concentration of income in the hands of the richest Americans has drastically shrunk everybody else’s share of the pie.

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But a recently published alternative estimate, by economists Gerald Auten of the Treasury Department and David Splinter of Congress’s Joint Committee on Taxation, suggests that the share of income going to the top has remained roughly flat since 1960.

Inequality has increased, for sure. Yet once they include the effect of redistribution, adding taxes and government programs such as food stamps, Medicaid, Social Security and the like, the academics find that the poorest one-fifth of Americans drew roughly the same share of income in 2019 that they did about 60 years ago.

The new analysis has fueled a scholarly mini brawl over the true depth of American inequality. And it raises a prickly but critical question: How can we explain the fraying of the social contract if inequality hasn’t soared? The inverse can’t be true: It’s tough to fit the short life expectancy, the suicides, the extreme obesity and the high incarceration rates in a story in which inequality is tamed and desperation isn’t deadly. It leaves the United States littered with a trail of scattered ailments without the connective tissue of a narrative.

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In an honest effort to find a workable new synthesis, here’s a suggestion: Inequality might not cause these symptoms on its own. Instead, many of America’s social maladies stem from the strategies it has chosen to mitigate the lopsided distribution of income, which leave its citizens singularly........

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