Reviewed in the United States on September 10, 2020
Bev Veals, a three-time cancer survivor in North Carolina recently feared she could no longer afford her health care. She reached out to her Senator, Thom Tillis, for help, and when she got scorn, she recorded her phone calls with one of his staffers.
BEV VEALS: “You’re saying that, if you can’t afford it, you don’t get to have it, and that includes health care?”
STAFFER: “Yeah, just like if I want to go to the store and buy a new dress shirt. If I can’t afford that dress shirt, I don’t get to get it.”
BEV VEALS: “But health care is something that people need, especially if they have cancer.”
STAFFER: “Well, you got to find a way to get it.”
I read that interchange when I was taking a break from Timothy Snyder’s short (146 pocket-sized pages) “Our Malady: Lessons in Liberty from a Hospital Diary.”
“Our Malady” isn’t a book Snyder intended to write.
"Late at night in Munich on December 3, 2019, I was admitted to a hospital with abdominal pain and then released the next morning. In Connecticut, on December 15, I was admitted to the hospital for an appendectomy and released after less than twenty-four hours. In Florida on vacation, on December 23, I was admitted to the hospital for tingling and numbness in my hands and feet but released the following day. Then I began to feel worse, with a headache and growing fatigue."
"When I stood before the lectern in Munich on December 3, I had appendicitis. That condition was overlooked by German doctors. My appendix burst, and my liver became infected. At the time of my appendectomy, the doctors in New Haven had noted a lesion in my liver but had neglected to treat it, or examine it again, or order another test, or even mention it to me. I was discharged from the hospital the day after that surgery, December 16, with too few antibiotics and no information about that second infection. When I was admitted to the hospital in Florida on December 23 with tingling and numbness in my limbs, I had not known to tell the doctors about my liver. Again, I was discharged after a day."
"In the emergency room in New Haven on December 29, everyone dismissed the possibility that my condition had to do with my appendix or my recent surgery. It seemed unthinkable to the doctors in New Haven that their colleagues had done something wrong. This sort of clan thinking is an elementary error, the kind we all make under stress."
Seventeen hours later, surgeons operated on his liver. He developed sepsis. It wasn’t treated. He almost died. He left the hospital “with nine new holes in me: three from the appendectomy, three for liver drains, two from spinal taps, and one in my arm for the tube that channeled the antibiotics I inject.”
This isn’t your garden variety personal memoir: how I almost died, how I managed to survive. Snyder is a Yale professor of History at the top of the first tier. He can speak and write French, German, Polish, and Ukrainian, and read Czech, Slovak, Russian, and Belarusian. He has a cast a steady eye on the political and personal histories of the darkest period of the 20th century. Even in the shadow of his own death, he takes notes. And what he concludes is the reason to read this book: it’s not just about him. “My own malaise has meaning only insofar as it helps me understand our broader malady I remember places where I should not have been, things that should not have happened, not to me nor to anyone else, and I want to make sense of them.”
The sense he makes is about a totally backward health care system. “Our malady “is physical illness and the political evil that surrounds it.” He does not say “evil” carelessly.
"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. If birth is not safe, and is less safe for some than for others, then something is wrong. If more money is extracted from young adults for health care, but they are less well than older generations, something is wrong. If the people who used to believe in the country are killing themselves, something is wrong. The purpose of medicine is not to squeeze maximum profits from sick bodies during short lives but to enable health and freedom during long ones."
The idea that dividing people, making some sub-human by denying them health care, connects this book to “On Tyranny” — and to the Nazis. “[People like] Trump want people staggered by suffering, and so they oppose health care. Pain is their politics; their propaganda is a death trap.”
Make no mistake, this is a political book.
"America is supposed to be about freedom, but illness and fear render us less free…. The word freedom is hypocritical when spoken by the people who create the conditions that leave us sick and powerless. If our federal government and our commercial medicine make us unhealthy, they are making us unfree…. Rather than pursuing happiness as individuals, we are together creating a collective of pain."
Health care as a shirt you can’t afford, health care that serves only corporate profit — Snyder forces those of us who can afford the shirt to consider how badly it fits, how expensive it is for what we get. But health care managed by doctors for the benefit of their patients — something like that happens in other countries. How can it happen here? Put a stake in the heart of it. Timothy Snyder makes that case.