We see health care as a concern of the Left and liberty as the turf of the Right. We have the mistaken impression that we must choose between them. But the two values rise and fall together. We need them both, and we could have them both.
Late last year, as I was writing a book about freedom, I fell very ill. In the hospital, I quickly realized that I had no freedom of speech when I was too weak to talk, nor any freedom of assembly when I had tubes in my body. I had insurance, but my care was expensive and uneven, and I nearly died. When I was discharged from the hospital for the fourth time, I emerged into a world of lockdowns, quarantines and masks. Just as my illness had compromised my freedom, our national failure in public health had compromised everyone’s.
Should we resist health measures in the name of liberty? Such “liberation,” in Donald Trump’s term, made the pandemic worse, forcing still greater restrictions on freedom, and killing more people. Violating rules of hygiene also means violating the freedom of other people — you have no more right to exhale your pathogens into my lungs than you do to punch me in the face.
The pursuit of happiness, as Thomas Jefferson understood, has to do with the body. The only way to preserve our freedom is to accept that it depends upon our health, individually and as a nation. If we forget our bodies and those of others when we speak about freedom, we fall into a trap. Others find ways to profit from our illness.
There is no reason why so many of us had to die of COVID-19. There is no good reason why our life expectancy peaked six years ago, why so many of us avoid care for reasons of cost, and so many others are addicted to opioids. The pandemic, and our response, are symptoms of a deeper malady, a misunderstanding of freedom. We imagine that freedom is brought by markets. True, markets bring us the objects that we want. But the tables are turned when we get sick: Suddenly we are the objects, and others are making choices about us, choices often about money rather than health.
Thus, we are often admitted too late to hospitals (as I was), discharged too soon (as I was), not told about inexpensive treatments that we need and urged to undergo expensive ones that we don’t. Our doctors system keeps records of a system that maximizes profit but minimizes care, and they are forbidden by gag rules from telling us what is going on. We need health to be free; our doctors need freedom to keep us healthy.
After I left the emergency room, colleagues berated me for not calling powerful patrons to help me. We have a system based upon privilege; we need one based upon rights. Unequal access to medicine not only fails our bodies but also ruins our patriotism. We know that the care we get is at the expense of others, who have worse insurance or no insurance at all. Those of us with less-bad access benefit as others have less. We fail to see that everyone could and should have much better care.
A system based upon a right to health care would support our best traditions of freedom. A right to care strengthens all other rights: without our health, as Jefferson knew, other freedoms are meaningless. It would not clash with the rights of others: on the contrary, if all of us enjoyed a right to care, that would enable reforms, such as a single-payer system and the liberation of physicians, that would leave all of us healthier and freer. We would also be stronger as a people.
Naturally, a right to health care will be opposed by those who profit from commercial medicine. It is too expensive, they will claim, to regard health care as a right. In fact, our system of privilege is ridiculously wasteful. One of my children was born in Europe and the other in America, and I have been ill on both continents. In Europe my family spends less money and gets better care. Americans in general spend far more on health care than people in comparable countries, and we get far less. Americans pay a premium to die younger.
This year, our failure in public health crashed the economy and destroyed tens of millions of jobs. This, too, was a cost of a system of privilege. Shifting from a system of privilege to one of rights would save money as well as lives. Most importantly, it would make us more free, as individuals and as a people.
The pandemic is our chance to learn a deeper lesson. A right to health care would make us more capable of living life, enjoying liberty and pursuing happiness. America could be the land of the free, but only if we choose to heal.
Timothy Snyder is a history professor at Yale University. His most recent book is “Our Malady: Lessons in Liberty From a Hospital Diary,” published last week.
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