Timothy Snyder on the Maladies of the US Healthcare System


“The word freedom is hypocritical when spoken by the people who create the conditions that leave us sick and powerless. In our federal government and our commercial medicine make us unhealthy, they are making us unfree.”          Timothy Snyder, Our Malady

The Odyssey of Timothy Snyder

The quote on top is the cry for change that Yale historian, Timothy Snyder gives to the reader in the introduction of his newest book, Our Malady: Lessons in Liberty from a Hospital Diary (Crown, 2020). Snyder had been in three different hospitals at the tail end of 2019. He found himself questioning the worth of the United States healthcare system after rapid visits in Connecticut and Florida, with the last one in New Haven almost costing him his life.

He first had severe pain and was admitted to a hospital in Germany. After being released the next morning, that same pain returned in the middle of the holidays. Snyder found himself in the hospital of New Haven for an appendectomy. In Florida, he was admitted yet again to another emergency room, this time for “tingling and numbness” in his hand and feet. But still, he was released once again without further check-ups.

It was in New Haven once again, that Snyder was finally confronted with life, and with the theme of the book. He entered with a physician friend and waited long hours. Even when his friend warned the staff that it was Snyder’s second visit to the emergency room in less than a week, he was kept in the waiting room. Snyder’s eyes were fading, he barely could keep up. And yet, in his conscious moments, he noticed the broken apparatus that is the United States’ healthcare system. Doctors and nurses were overworked; algorithms and computers dictated most of the decisions; racial tensions were prevalent at the moment of admitting a patient –Snyder’s physician friend was African American, and at times, he heard the staff mocking the idea of her being an actual doctor; and mainly, health services were prioritized not by how the patient’s health was, but how much profit could they get from him.

In the end, it was an infection caused by an appendectomy, causing sepsis that required antibiotics, which seemed obvious, but as Snyder presents, the current healthcare system does not permit such clear analysis. When everything was said and done, Snyder underwent two spinal taps and two liver drains. When explaining his experience with his colleagues, they were shocked and astounded. Why hadn’t they “called in powerful patrons” to protect him in the emergency room. This was the tipping point that made Snyder reflect:

That had not occurred to us. if the system does work that way, it should not. If some Americans have access to healthcare thanks to wealth or connections, they will feel pleased because they are included and others are not. Such feeling turns our human concern about health into a silent yet profound inequality that undermines democracy. […] If healthcare is a privileged rather than a right, it demoralizes those who get it and kills those who do not. 

Without Healthcare We Are Not Free

Timothy Snyder is not known for his expertise in the healthcare system of the United States. He’s an expert on tyranny and totalitarian governments. As a historian, he specializes in XX century history of Europe. His books try to warn the readers of the dangers of authoritarianism, drawing knowledge from different tyrants and events that marked the previous century —“The Age of Extremes,” as the late British historian, Eric Hobsbawm termed it.  His book, On Tyranny (Tim Duggan, 2016), published right after the victory of Donald Trump in 2016, became an instant hit, presenting a guide on how to handle his presidency. Other books, like Bloodlands: Europe Between Stalin and Hitler (Basic Books, 2010), became must-reads of the dangers of totalitarianism in the previous centuries —in the form of Adolf Hitler and Joseph Stalin.

It’s because of that background that readers who are in touch with Snyder’s work found themselves questioning the first pages of his brief book. Most of the conversation in the US about the healthcare system seems to be headed by the left in America, which is not how you would describe the politics of Snyder… He’s a liberal, that prioritizes the values of liberty and democracy, and rejects any ideology considered too “extreme.” People who carry the liberal card that Snyder holds tend to think that a “universal healthcare system” in America is wishful thinking. Moreover, the latest victory by the center-right candidate of the Democratic Party, Joe Biden, proves that the only position towards healthcare during this administration will be an extension of the Affordable Cares Act or Obama Care. If someone presented Our Malady to any liberal or conservative reader in America, with Snyder’s name covered, he/she would think that the writer is a radical leftist from Jacobin or Current Affairs.

Still, the approach from Snyder is not from a radical point of view, but from his liberal roots. His basic argument is that, if our constitution assures us that “all men are created equal,” then our current healthcare system is an aberration that negates that right. “The right to liberty implies a right to health care. We are not free when we are sick. And when we are in pain, or when we are anxious about an illness to come, rulers seize upon suffering, lie to you, and strip away our other freedoms,” says Snyder.

From Europe to America: What Happened?

As Snyder points out, the constitution of the World Health Organization (WHO) includes healthcare as one of its fundamental rights. Moreover, the Universal Declaration of Human Rights also includes it. After the destruction of World War II, countries like Germany and Austria had to be reconstructed. Part of that process involved the Marshall Plan, which helped many countries of the western hemisphere rebuild their nations, and in part, give their people healthcare. “Americans helped to establish health care as a human right around the world,” says Snyder. “Why then is health care not seen as such in the United States? Why are Americans not protected by the agreements that our government signed? Should we accept that citizens of other democracies enjoy a right that we are denied and live longer and healthier than we do? Many of us seem to find that acceptable. Why?”

In Austria, while visiting as a professor, Snyder encountered the first benefits of universal healthcare. His first son was born in Vienna, which proved to be an enjoyable experience. He and his wife were admitted earlier for labor, nurses encouraged and guided the mother to breastfeed, and most importantly, not a single bill during the process. Compared to America, in which even holding the baby after labor comes with a bill, Snyder saw the successes of Austria’s healthcare. He could walk his newborn through the streets of Vienna, because of the parental leave that the country awards. As he remembers during birthing classes:

Each session began with instruction of couples… Then the men and the women were divided and expected to talk amongst themselves about common concerns. I don’t know what American men would talk about at such a moment; the Austrian dads talked about the freedom afforded to them by their welfare state. They had a choice among three parental leave options, all of which seemed impossibly generous to me. The other guys were making decisions about how two years of paid parental leave would be divided between the mother and father. I tried to tell my friend that my wife and I had a relatively good deal, thanks to my university; they found one semester for one partner sadly inadequate. Their expressions turned to horror when I told them about the norm of parental leave in the United States. The idea that a mother might have twelve weeks but might have nothing, and that fathers expected nothing, seemed barbaric. They were right. It is barbaric. And it makes parents and children less free. [emphasis added]

How does this compare to the American healthcare system? A Pew Research presents the vast contrast:  “the U.S. is the only country among 41 nations that does not mandate any paid leave for new parents, according to data compiled by the Organization for Economic Cooperation and Development (OECD) and current as of April 2018. The smallest amount of paid leave required in any of the other 40 nations is about two months.” The study later adds: “In comparison, Estonia offers more than a year and a half of paid leave to new parents – by far the highest benefit provided by any of the countries represented. A number of countries – Bulgaria, Hungary, Japan, Lithuania, Austria, Slovakia, Latvia, Norway, and Slovenia – offer over a year’s worth of paid leave as well.”

Snyder thinks, as many others have pointed out, that the main malady of US healthcare it’s the way the system prioritizes profits and has been taken over by private interests. As Snyder stresses in one of his chapters, “Doctors should be in charge.” Later adding: “Maintaining beds cost money. No hospital in American commercial medicine is going to maintain a reserve of bed when other hospitals do not do so. Since financial logic dominates medical logic, the country must always be unprepared for epidemics.” This of course follows the thread that leads you to what’s profitable for the commercial interests that rule such a system, emphasizing in certain “kind of illnesses, especially ones treatable (or reputed to be treatable) with surgery and drugs” that “make money.”

Snyder’s small book is an eye-opener for those who still have the blindfolds on, regarding how obsolete it’s the United States’ healthcare system. His critique is an indictment of how frightful the state of such a system is, that an argument from a liberal point of view —and not a radical one— can shed a light on its perils. Anyone who is still not convinced that we need a change should pick it up.

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A review of Timothy Snyder, Our Malady: Lesson in Liberty from a Hospital Diary (Crown, 2020). 

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