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June 20 - July 8, 2022
When I stood before the lectern in Munich on December 3rd, 2019, I had appendicitis. That condition was overlooked by German doctors. My appendix burst, and my liver became infected. This was neglected by American doctors. That is how I ended up in an emergency room in New Haven, Connecticut, on December 29th, bacteria racing through my bloodstream, still thinking about freedom.
A visit helps us to be alone. Being together in solidarity permits a return to solitude in tranquility. Just by appearing, my friends set off memories, chains of association back into our past.
I imagined what would change without me, beginning with the daily details that mark the mental calendar of a parent: soccer practice, math homework, reading out loud. I recognized with pain that my vision of my son without me, of my daughter without me, were just as real as my previous life with them. I watched their future unfold without me, in my mind’s eye, and then I reeled it back.
The empathy, though altogether different from the rage, worked together with it. Each mood revealed a truth, an element of me. Neither was enough; I needed both. I needed the torch and the raft, the fire and the water, the solitude and the solidarity, to get well, to be free. And what is true for me, I suspect, is true for others.
Our system of commercial medicine, dominated by private insurance, regional groups of private hospitals, and other powerful interests, looks more and more like a numbers racket. We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care.
In 1980, when I was ten, Americans lived on average about a year less than inhabitants of countries of comparable wealth. By 2020, when I was fifty, the difference in life expectancy had grown to four years. It is not that other countries have more knowledge or better doctors. It is that they have better systems.
The permanent distraction of doctors and nurses is a symptom of our malady. Each patient has a story, but no one is following the story.
After I was discharged from the hospital in New Haven, I heard that colleagues were astounded that my wife and I hadn’t called in powerful patrons to protect me when I was in the emergency room. That had not occurred to us. If the system does work that way, it should not.
When everyone has access to decent care at minimal cost, as is true for almost all of the developed world, it is easier to see fellow citizens as equal.
As I stepped back from death, I was looking for easy ways to bridge the gap between what I wanted to do and what I could do, and getting my library and my documents in order was one.
In Hitler’s first antisemitic letter he referred to Jews as “racial tuberculosis.” In the middle of an influenza epidemic, Hitler was calling human beings a contagion. After Hitler came to power, Nazis accused Jews of spreading disease among a healthy German population. During the Second World War, Nazis called Jews “typhus bacteria.”
Americans helped to establish health care as a human right around the world. 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 lives than we do? Many of us seem to find that acceptable. Why?
When I saw neurologists for my migraines in Europe in the 2000s and 2010s, after medication became available, I wanted them to just write me a prescription and let me go. Yet the European doctors liked to talk to me about the kind of life that I led, not just about the triggers of the migraines, but also about my priorities and practices.
The downward spiral from pain to desperation and from pride to resentment is something that politicians like Mr. Trump understand and accelerate. They want people staggered by suffering, and so they oppose health care. Pain is their politics; their propaganda is a death trap.
In the United States one has to have good insurance or spare cash to see a lactation consultant, and most people do not. In this way, inequality affects the biology of babies from their first hours. It does no honor to the idea that “all men are created equal” to mandate an unequal start of life.
In America, birth is where our story about freedom dies.
The paradox of freedom is that no one is free without help. Freedom might be solitary, but freedom requires solidarity.
A motto of the Enlightenment was “dare to know.” Some of the most valiant people who followed that motto were the men and women of the nineteenth century who overturned folk wisdom and explained the principles of contagion.
No social platform can improve health, since any algorithm with such a goal would alert people to shut down their computers, wash their hands, and get some exercise. No social platform can promote freedom, since social platforms aim at addiction. No social platform can promote truth, because truth, as Euripides realized twenty-five hundred years ago, is about human daring. We care about free speech not because a machine can dump endless garbage into the maw of our worst instincts, but because an individual human being can say something true that others do not know and that power wants hidden.
The death of truth brings the death of people, since health depends upon knowledge. The death of truth also brings the death of democracy, since the people can rule only when they have the facts they need to defend themselves from power.
The problem is that doctors have very little say in what happens around them, and waste their time and energy pacifying greater powers. They no longer have the authority that patients expect and need. Every day, physicians have to pretend to patients that they matter more than they do. If patients understood how enserfed doctors have become, they would be less likely to come to hospitals, and less money would be made.
A source of our malady is the drastic inequality of wealth that separates the experiences of a very small group from everyone else. As Plato knew, this is how democracy becomes oligarchy, rule by the rich. When money becomes the only goal, values disappear, and people imitate the oligarchs.
When we indulge the daydreams of the ultra-wealthy, we create what Plato called “a city of the rich” and “a city of the poor.”
Most of the insurance industry simply collects rents from disease, like trolls on a bridge demanding a toll. The trolls’ profits misleadingly count in gross national product, though they are supplying no good and performing no service.
Economic logic says that the middleman should be removed when possible, and we know how it is possible in this case: with a single-payer system at the center of things, and private insurance at the margins. Countries where people live longer have shown that this works.
A market economy such as ours works better when people are cared for. If it is liberty that we want, then we do not sacrifice human freedom to market dogma, but rather make markets work for freedom.
