A peer-reviewed study of 63 million U.S. deaths found that nearly 12.7 million Americans died between 1999 and 2022 who would have lived if U.S. death rates matched 17 comparable wealthy countries. The two biggest killers: heart disease and metabolic disease (running at 1.63x and 2.25x the peer-country rate by 2022), and deaths of despair — drugs, alcohol, suicide — which topped 130,000 excess deaths in 2022 alone, hitting men and workers under 45 hardest. Some say this is a lifestyle problem. The deeper issue is a food system rigged for cheap processed garbage, a healthcare industry that profits from treating disease rather than preventing it, and working folks ground down until despair looks like the only exit.