Our Malady - Book Summary

Unearth the harsh truth of American healthcare and its impact on human rights

In the land of the free and the home of the brave, America advertises itself as the symbol of liberty. Its core ideologies — as seen in the Pledge of Allegiance and reflected by the imposing figure of Lady Liberty — present it as the beacon of democratic virtues, a place where each individual is assured their rights.

However, what is freedom without health? A state of illness thwarts us from leading fulfilling, productive lives. Tragically, the American healthcare system is failing to safeguard its citizen's health. Yet, hope isn't lost. This narrative will unfold the stark contrasts between America's healthcare and those of other nations, revealing how necessary changes can make America a nation of not just theoretical, but practical freedom.

Through this narrative, you will explore:

- The profound connection between parental leave policies and emotional self-regulation;

- How political affiliations can be linked to opioid abuse; and

- The wisdom of the fictional character Gandalf the Grey, and what he can teach us about the state of American politics.

The American healthcare system is falling short of its duty.

Let's rewind to December 29th, 2019 — a day that could have easily become author Timothy Snyder's last. Right after the clock struck twelve, Snyder found himself in a New Haven hospital's emergency room, experiencing frightening symptoms. He was barely mobile; he felt an eerie tingling sensation in his hands and feet, coupled with severe trembling. Unbeknownst to him, a liver abscess was stealthily releasing a flood of infectious bacteria into his bloodstream.

The frustrating narrative took a full nine hours to unfold before someone finally accurately read Snyder's medical records — records that he had the sense to bring along. Two weeks prior, he'd had his appendix removed at the same hospital, where his surgeon noticed a liver lesion but failed to mention it. Had this critical piece of information not been overlooked, immediate and effective treatment could've been arranged. Instead, Snyder's worsening symptoms were casually brushed aside as signs of the flu, causing him to teeter dangerously on the brink of life and death from sepsis.

This brings us to our key insight: The American healthcare system is significantly failing its citizens.

Despite being one of the wealthiest nations globally, America has a dismal health report. In a shocking deviation from the norm among affluent countries, America's average life expectancy is witnessing a downward trend. A 2019 study by Moody's Analytics predicts a gloomy future for the millennials of America, suggesting they are likely to have shorter lifespans than their parents or grandparents, despite spending more on healthcare. Clearly, something is gravely amiss.

Ideally, medical advancements should be directly proportionate to an increase in life expectancy. However, the harsh reality is that Americans are expected to live four years fewer on average than their counterparts in similar economies. In a surprising twist, even citizens of lower-income nations such as Barbados, Costa Rica, and Chile are expected to outlive them. The reason doesn't lie in superior medical knowledge or better doctors, but rather in these countries' more effective healthcare systems that strive to prolong human life.

The crippling impact of the COVID-19 pandemic further exposed the glaring inadequacies of America's healthcare system. Wealthy nations like Germany and Japan prioritized citizens' health, leading to a broader access to treatment and information, subsequently resulting in a lower death toll. While these countries put their focus on health, America's emphasis skewed towards profits.

When a nation places profit over the health of its people, the grim reality is that the citizens pay with their very lives. By June 2020, the American government's approach to the pandemic had led to an appalling loss of 150,000 lives. In the following sections, we'll further delve into how and why this happened.

Inequalities thrive when governments fail to ensure healthcare for all.

Historically, health has been a potent tool for political manipulation and dehumanization. In the 1930s, Hitler spun a narrative around the Jewish community, portraying them as health hazards for Germans. Subsequently, Jewish people, confined in ghettos with inadequate medical aid, succumbed to illnesses. These circumstances were conveniently weaponized by the Nazis to further their abhorrent agenda of sending them to concentration camps.

Meanwhile, in Stalin's Gulag — the agency that ran the infamous forced labor camps — a chillingly similar perspective prevailed. Here, the inmates' access to medical attention depended on their potential productivity. If a sick prisoner could return to labor after medical treatment, they'd receive it; otherwise, they'd be discarded at the gates, left to face a certain death. Here, health wasn’t seen as a universal human right, but rather as a privilege to be selectively granted at the authorities' convenience.

This leads us to our primary insight: When governments fail to ensure healthcare for all citizens, society bears the brunt.

Post World War Two, America championed the cause of healthcare by signing the Universal Declaration of Human Rights. This declaration established access to adequate resources and care — in essence, the right to good health — as a fundamental right for every individual. Ironically, America, despite its instrumental role in drafting this document, does not have a universal healthcare system. Consequently, not every American can afford the necessary health services.

However, the repercussions of unavailable or unaffordable healthcare don't stop at the poorer demographics. Politicians opposing quality public healthcare argue that it could lead to exploitation by undeserving individuals, implying that respectable citizens should endure pain privately and that seeking help is a sign of weakness. This leads to an alarming dependence on pills, which partly explains the rampant opioid abuse in counties that politically support President Donald Trump.

In the commercially-driven American healthcare system, doctors, under pressure to handle high volumes of patients, often resort to prescribing pills as a quick-fix solution. Contrast this with the more empathetic European model where doctors invest time in understanding a patient's conditions before deciding the treatment course. European doctors, despite healthcare being cheaper and more accessible compared to America, are trained to provide care, not merely to rush patients through a procedure.

Therefore, a government that fails to ensure universal healthcare perpetuates societal inequalities. A truly egalitarian society should prioritize accessible healthcare for every citizen, irrespective of their socioeconomic background.

When a society prioritizes the wellbeing of its children, it flourishes.

When Snyder and his wife, Marci, were anticipating their first child's arrival, they resided in Vienna, Austria. There, the Austrian government provided free birthing classes as a part of its healthcare support, a stark contrast to the American healthcare landscape. Snyder had initially believed his employer to be generous, offering him three months of paid paternity leave. However, he soon discovered that his Austrian counterparts received two years of paid parental leave, significantly more than what an American mother would typically get!

In Austria, the healthcare system places a significant focus on child health, going beyond just medical care. Parents are not only encouraged to arrive early at the hospital for childbirth but also receive packs brimming with essential clothing items for newborns — all these services, mind you, are provided free of charge. Why does the Austrian government do this? Well, the answer is simple: they recognize that investing in the health of their youngest citizens today will lead to massive societal benefits tomorrow.

So, our core insight today is: When a society prioritizes the wellbeing of its children, it flourishes.

True freedom is about having the autonomy to make personal choices. Fear often impedes this freedom, reducing thought processes to simplistic dichotomies such as "us versus them" or "fight versus flight."

However, adults who were taught to manage their emotions during their formative years are more likely to retain an optimistic outlook even in stressful situations. This ability — known as emotional regulation — allows them to explore multiple possibilities and find better solutions in any given scenario.

Emotional regulation isn't an instinctive skill that children pick up on their own or from their peers. It demands intentional and extensive involvement from an adult figure, particularly during the crucial first five years of a child's life. This individual plays a pivotal role in teaching the child about social interactions, the value of delayed gratification, and dealing with disappointments, thereby shaping the child's cognitive abilities and emotional resilience.

Countries like Austria appreciate the importance of nurturing a healthy relationship between parent and child. Hence, provisions like paid parental leave aren't treated as luxuries but rather as essential aspects of their societal framework. By investing in infant healthcare, these nations cultivate a more balanced society with reduced medical necessities and lower crime rates.

On the other hand, an American parent, compelled to return to work sooner, may struggle to provide the same level of emotional and developmental care. Without adequate governmental support, the burden becomes too heavy for most parents, leading to societal consequences that extend beyond individual families.

Democracy suffers when leaders choose falsehood over truth.

J.R.R. Tolkien's "The Lord of the Rings" presents a narrative where the wizard Gandalf is disdained by many in his fictional society. They balk at the grim truths he relays about the looming danger posed by a malevolent power, preferring to live in blissful ignorance. When calamity strikes, threatening their very existence and freedom, they conveniently feign shock, claiming they never saw it coming. Instead of owning up to their role in the disaster, they prefer to remain willfully ignorant.

Facing a crisis requires an honest assessment of the situation, even if the truth is harsh. It demands the courage to seek out information to strategize effectively. Failure to do so can result in catastrophic outcomes. For example, if former President Trump had valued truth over power during the COVID-19 pandemic, perhaps countless American lives could have been spared.

Thus, our fundamental insight here is: Democracy suffers when leaders choose falsehood over truth.

Political leaders who sidestep distressing news and propagate disinformation end up exacerbating problems. Rather than initiating necessary corrective measures, they disseminate falsehoods to placate the masses. This avoidance doesn't address the real issues, and the destructive cycle continues. When people are denied the truth, they lack the information required to make vital decisions, such as safeguarding their own health.

From the outset of 2020, Donald Trump was instrumental in spreading disinformation about the novel coronavirus. Instead of implementing a robust testing strategy, he claimed in February that the virus would miraculously disappear. Later, he recommended administering hydroxychloroquine, a malaria drug, without sufficient scientific evidence to support its effectiveness against the virus. The official who dared to challenge Trump's recommendation was promptly dismissed, as was the one who reported a lack of necessary medical equipment. This marked the beginning of a series of misinformation and silencing of those daring to speak the truth.

Trump's strategy for managing the pandemic hinged on keeping the reported infection numbers low. In May, he expressed that extensive testing painted him in a negative light. By June, he boasted about slowing down the testing rate. Ignoring testing meant the virus spread unchecked, demonstrating Trump's concerns were more about maintaining his image than safeguarding the lives of the citizens he was elected to protect.

Trump's handling of the pandemic — denying reality, nurturing fear, and silencing critics — mirrors the characteristics of an authoritarian regime, not a democratic government.

Undervaluing doctors harms entire communities.

In April 2020, Snyder received a distressing email from a neighboring doctor, asking if he had any extra medical masks. Despite working at a hospital that was better-equipped than most and treating COVID-19 patients, she was only given a single disposable mask per week. Now, the hospital had exhausted its supply of masks in her size.

Remarkably, this doctor was one of the luckier ones. Several medical professionals in the US were dismissed for providing their own protective gear, as this revealed their employers' failure to guarantee their safety. The hospital chose to endanger its staff rather than endanger its reputation. The fallout? Fewer doctors available to treat the ailing.

Our pivotal takeaway here is: Undervaluing doctors harms entire communities.

Scores of American healthcare professionals contracted COVID-19 due to exposure at their workplaces. Some tragically lost their lives at a time when their services were most needed. While President Trump labeled the crisis a “war,” the alarming number of fatalities indicated that the leader was thrusting troops into the fray without basic protection.

In an attempt to rescue the country from the pandemic, the US federal government spent a staggering $2 trillion in 2020. However, not a dime of this hefty sum was allocated to procure personal protective equipment for healthcare workers. Until March 2020, the government continued to export locally manufactured masks to China without importing any in return.

Instead of frontline medical practitioners with firsthand experience and knowledge, private equity firms and insurance companies were the ones influencing American healthcare policies during the pandemic. If doctors were given a say in healthcare policymaking, no medical personnel would ever be left to work without necessary equipment, such as masks and gowns.

Commercial interests also dictated hospital operations. American hospitals, primarily run for profit, began to incur losses during the pandemic. As a result, many chose to cut costs by letting go of doctors, adding further pressure to an already overburdened system.

This behavior isn't unexpected in a society that values profit over health. If doctors were recognized as the authorities on healthcare and permitted to exercise that authority, the overall health of Americans would inevitably improve — and they have the right to that.

The profit-driven approach of commercial medicine undermines public health.

While convalescing from a sepsis attack in early 2020, Snyder decided to pore over his medical records. He was appalled to find that his doctors frequently recorded what was expedient rather than what was accurate. He recognized that they weren't entirely to blame. Digital record-keeping forced them to select from predefined entries—entries tailored to maximize the hospital's profits. Consequently, the purpose of medical records shifted from documenting symptoms and observations to a tool for billing.

This is a byproduct of America's commercialized medical system. Hospitals are managed not with the aim of healing the sick, but to turn a profit. The decision of how many patients can be seen daily is determined by an algorithm that balances revenue against costs, not by doctors. Health, once the purview of medical experts, is now the terrain of profit specialists.

The crucial learning here is: The profit-driven approach of commercial medicine undermines public health.

Lobbyists and public relations specialists assert that the present system is functioning well. Yet, if it were the paragon they claim, why are Americans shelling out more for healthcare than citizens of comparable nations while receiving inferior services from doctors and hospitals? These lobbyists counter that overhauling the system would prove prohibitively expensive. As a result, they'd rather have American health subjected to the whims of profit-driven powers.

However, their argument is fundamentally flawed. A system that millions of Americans can't afford is a system that's broken. Uninsured Americans often forgo necessary treatment because they can't afford medical bills. This leads to avoidable suffering and the spread of undiagnosed diseases in communities.

Even before the pandemic, the situation was dire. With the onset of the pandemic, it took a dramatic turn for the worse. In the initial weeks of the pandemic, 20 million Americans lost their jobs — and with it, their health insurance. Amid financial uncertainty, many avoided seeking medical help even if they experienced coronavirus symptoms. Without a diagnosis, they were more likely to transmit the virus to others or become seriously ill themselves.

While initial costs of overhauling the system to ensure every American has access to quality healthcare might be steep, it would result in long-term savings. A healthier nation incurs lower medical costs. Its citizens are less vulnerable during a pandemic, thus shielding the economy. By treating healthcare as a right and ensuring it's affordable, governments reduce suffering and free people to lead their lives.

Summing it all up

The principal insights from the discussion:

The American health landscape was already plagued by issues before the onset of 2020. Due to the commercialized nature of healthcare and policies driven by profit, even those who could afford insurance weren't guaranteed access to quality care. The coronavirus pandemic has shed light on the glaring shortcomings of the current healthcare system — a system that fails to adequately safeguard its medical staff, and one that so undervalues its doctors that it dismisses them for striving to protect their own health. As long as health isn't recognized as a worthwhile, long-term investment and doctors are denied the authority they deserve, needless loss of American lives will continue, fueled by power and profit.