On September 3, 2020, we posted “What Ails America,” an excerpt from the new book by Timothy Snyder, Our Malady: Lessons in Liberty from a Hospital Diary, which is published next week. As he recounts in our adaptation, the historian became gravely ill late last year after several medical mistakes, including botched post-operative care. In the book, Snyder uses his own near-death experience to illuminate the systemic problems of profit-driven American medicine.
“I almost died because I was released too soon from the hospital after an operation,” he told me this week via email. “The reason I was released too soon is money.”
In the months of treatment he needed to recover, he was often in the hospital through the peak months of the pandemic in the northeast, an experience that sharpens his analysis of what’s wrong with US health care. “We can see the same problem on a larger scale with corona,” he said. “An epidemic is not profitable.
“We like markets and we rightly think that markets can deliver us the choice of objects that we want,” he went on. “But in our system of commercial medicine, our bodies are the objects. The private equity company that owns your hospital cares not at all whether you are well; it cares whether profit can be made from your illness. If we think of health care as a human right, then we realize that our bodies are not objects, but us, and that we cannot have the freedom we want without care.”
He sees doctors, as well as patients, as victims of these grossly distorted priorities. “Our interactions with them are deeply false, because we do not recognize just how disempowered they are in commercial medicine,” he said.
There was a moment, of course, when health policy was a big issue in the Democratic primary contest—“Medicare for All” became the slogan that divided candidates. With Biden’s nomination, the party’s platform has reverted to a more centrist norm, of restoring all the measures of the Affordable Care Act. Is that remedy enough for Snyder, I wondered.
“Obamacare is, of course, far, far better than no Obamacare,” he said. “But America’s malady is too deep to be reached by a policy that connects insurance to employment. We should all have access to health care. They should be running on the idea of a single-payer system.”
Snyder was born and brought up in Ohio, near Dayton. Because, in recent years, the Yale professor has become such a high-profile and outspoken opponent of Trump (his 2017 book On Tyranny: Twenty Lessons from the Twentieth Century is a nonfiction bestseller), I was curious about what insights he might have from his Midwest background for why a state like Ohio, once a purple bellwether, had turned not just red, but distinctly pro-Trump.
“Something is going on with pain, which I also write about in the book,” he said. “There is an idea, with which I sympathize, that pain is not to be talked about, but endured. I think for a lot of people in the Midwest and elsewhere pain could once be associated with hard work, with factories, with farms, and so also with earning a living, supporting a family, thinking of a better life for the children. For about forty years, none of that has really been true.
“And I think opioids come in here,” he went on. “The connections are complicated and intimate, but Trump basically took Pennsylvania and Ohio in 2016 because he took counties that were in public health crisis as a result of opioid addiction. Trump is like a narcotic, I think, but when I say that, I want to stress that people have gotten beat around for reasons that are not their fault, and they have not been given good explanations as to why the world changed and what comes next.”
In part because of Snyder’s insistence on the idea that health should be a human right, I wanted to ask him what he thought of the call made recently by the editor of The Lancet, Richard Horton, in his book The Covid-19 Catastrophe, that President Trump should be charged with crimes against humanity for pulling the US out of the World Health Organization in the midst of the pandemic. Snyder said he could go along with that idea, and elaborated:
“If the Vanity Fair reporting is correct, the decision not to expand testing was made with an eye to allowing some Americans to die and then blaming the governors. That verges on ethnic cleansing. Like other forms of ethnic cleansing, it bounced back against the perpetrators. If the Washington Post reporting is correct, Trump’s advisers tried to get his attention by arguing that the virus had gotten beyond the blue states and was now killing ‘our people.’ The notion that death is acceptable for some citizens for black people, brown people, Democrats, but not for ‘our people’ verges on genocidal. Genocide includes allowing defined groups people to die for reasons of politics.”
These observations naturally led me to a question I’ve long wanted to ask Snyder—about his account of the mass killings in twentieth-century Eastern Europe that I first encountered in his extraordinary 2009 essay for the Review, “Holocaust: The Ignored Reality,” which encapsulated the thesis of his 2010 book Bloodlands. By placing the Holocaust in a larger context of both Nazi and Soviet mass murder on a vast scale across Eastern Europe, was there not a risk of undoing an idea of exceptionalism about the genocide of Jews, an idea on which Holocaust memory and memorialization depends?
“I think it is very important not to begin from the idea of exceptionalism,” he responded. “It is knowledge about the Holocaust that demonstrates what is specific about it. That knowledge can only come from sources from the time, from the survivors and the documents. Once you have the sources, you have a wider world, one where you can try to see how such a thing was thinkable and possible. In that wider world are the other mass atrocities of the period, often importantly so. It is important I think to embrace history rather than fearing it.”
As for fearing history, I recalled that, in an interview in 2017, Snyder had said it was “pretty much inevitable” that Trump would produce a Reichstag Fire pretext to seize dictatorial power. Amid a public health emergency creating chaos around an extremely consequential election, and with mass unemployment and escalating street-fighting spilling into armed conflict, one could be forgiven for thinking once more about the last days of Weimar. Has that fire started, I asked.
“We are in it now, in slow motion,” he said. “From the moment in June when Trump tried to get the military to intervene against protestors, or, at the very latest, from the July tweet that called for the elections to be delayed, we have been in that moment. The way Trump talks about Black Lives Matter is very similar to the language that Hitler used after the Reichstag Fire. There are two differences. One is that Trump is slower, less coherent, and works less hard than other people who use the politics of emergency. The other is that we have the reference of the Reichstag Fire, understand something about the politics of exception, and can prepare ourselves.
“It’s easier not to lose when you know the game, and history can help with that,” he concluded. “How this all turns out depends on what we do between now and then, on whether people in law enforcement and in state and federal office heed the law or heed the siren of emergency politics, and, above all, on whether citizens are ready to mobilize to protect their basic right to vote.”