Timothy Snyder is Yale University professor and a famous historian of Hitler’s Holocaust and Stalin’s terror, which took place from early 1930ies till 1945 mostly on the territories of Ukraine and Poland. Snyder’s books on the topic, Bloodlands and Black Earth, are extremely informative and chilling, I strongly recommend to read them. The book I review here however, is a small new book by Snyder called “Our Malady” and is about the dysfunctional perversion which goes as healthcare in US, and how it uses and abuses people for profit, where human lives mean nothing but billing statistics.
An inhuman murderous system does not appear overnight from nowhere. Snyder makes clear in his past books that Hitler’s (and Stalin’s) mass murders were not a kind of uncontrolled bloodthirsty rage, unique and untypical of a human society, but quite the opposite, and this is exactly why it can happen again, as the historian constantly warns. These mass murders in the first half of 20th century were the outcome of what appeared to their executors as the perfectly reasonable, logical and inevitable methods to achieve a higher socio-economic and political goal for the benefit of their nations.
Stalin’s reasoning for the 1932-1933 mass-starvation of farmers in Ukraine (Holodomor, which took between 3 and 12 million lives) was rather straightforward: post-revolutionary USSR had to be industrially modernised, but there was no money to buy the equipment for new factories from abroad. At the same time, the Ukrainian countryside population was seen by Moscow as counter-revolutionary kulaks who refused to surrender their family farms and become state-employed loyal communists. This is why to Stalin, impounding all their grain to sell to USA for the much-needed dollars while mass-starving the farmers and their children to death was an elegant solution to the two problems his vision for USSR faced. The deadly purges, mass executions of Poles, and mass deportations of other ethnicities (which also had many causalities) which followed the Holodomor in the 1930ies and during WW2, were merely implementations of same concept, that certain ethnicities, social groups or families stood in the way of the communism, or the victory over Nazi Germany which unexpectedly (for Stalin) turned from friend to foe in 1941.
In Hitler’s case, it was the absolute need for the Lebensraum for the German people (explicitly modelled on the historical conquest of the American West) which would never be possible with the presence of Jews (seen as the antithesis to Nazi human race struggle theory). When conquering Poland, Ukraine and the Baltics, Hitler faced the situation that his new German Reich suddenly had an enormous Jewish population. Nazis’ initial half-hearted attempts to get all Eastern-European Jews deported to Palestine or Madagascar failed (also due to reluctant colonial powers, especially UK), so a Final Solution was devised and implemented. First in the occupied Poland and USSR, and then, because nothing mattered anymore, extended to Germany itself as well as France, Netherlands, Italy and the rest of Europe, with 6 million Jews murdered (including my own great-grandparents). Meanwhile, masses of Soviet prisoners of war were systematically starved to death, for no particular reason but to save the food rations for the German army. These POWs’ only way to escape starvation was to join the Nazis in the Holocaust.
Now Snyder, a US-born and raised expert in deadly systems which murder people to achieve their bizarre goals, suddenly ended up in a somewhat similar situation. Less dramatic for an outsider, but the historian almost died when, shortly before the last New Year Eve, he ended up in a US hospital. A less insured and a less white patient in his place would not have survived, Snyder understood that as he helplessly suffered undiagnosed blood poisoning, trapped in the American healthcare system which serves a very different purpose than providing health or preventing disease. That real purpose is to make money from the disease, and the patient is treated accordingly, with doctors and nurses being merely cogs in a money-making machine.
In this regard, Snyder mentions that “Stalin’s Gulag was run according to this logic of reverse health care“. Similar to what actually happened in Soviet Gulags, the US hospitals throw their economically useless patients out, to die outside the gates as not to spoil the statistics. Thinking of state policies which resulted in “shooting, starving, gassing“, Snyder writes:
“It occurred to me- as it occurred to others long before me- that the deliberate deprivation of health was a related harm.“
Indeed, as Nazi Holocaust was gearing up, Jews were also let to die from preventable infectious diseases while cramped into ghettos without access to medical care, or food for that matter. The survivors were eventually rounded up and gassed or shot. It is not such a big step for a state from intentionally denying medical care to certain groups to directly murdering them.
Even as a Yale professor with a very solid health insurance, Snyder almost died from sepsis. Despite his insurance, he received bills of several thousands of dollars, with fines on top because he was still in the hospital when the payment was due. If the famous American historian was not in a privileged position, he would have most certainly died. Sent home, because the hospitals always need the beds:
“To understand the shortage of beds it helps to think of just -in-time delivery. […] There should never be too many bodies, or too few bodies. There should be just the right number of bodies on just the right number of beds. […] A body creates revenue if the body is the right kind of sick for the right length of time“.
But Snyder was well insured, and he survived, and wrote this small book, which is a very personal call for a healthcare system which serves the patient, or rather the public, instead of commercial interests. Because the historian understood:
“If pure capitalist logic is applied to health, the bacteria win.“
The book compares the healthcare and the social system of USA versus Europe. While in the latter, public healthcare, but also childcare and parental leave are (nowadays) standard part of social structure, in US the individualism and materialism rules. Snyder notes the irony that German and Japanese right to healthcare was enshrined in these nations’ postwar constitutions under US pressure, while America itself wants nothing to do with it. This is also why the European healthcare is built on principles of solidarity and delivering health benefit to everyone, while in USA it is build on the “politics that deals out pain“, as Snyder puts it, referencing to main tenet of fascism he described in his previous book “On Tyranny“. He writes:
“We would like to think we have healthcare that incidentally involves some wealth transfer, what we actually have is wealth transfer that incidentally involves some health care.”
Snyder has no illusions that European healthcare is perfect. After all, German doctors in Munich overlooked his inflamed appendix in December 2019. Doctors make mistakes, but Snyder wants to show you that in USA, it is the entire healthcare system which is the mistake. His real trouble started in the US, when the medical staff in Florida ignored the signs of sepsis and sent him away without treating a secondary liver infection (which they did notice), a complication from an appendectomy operation done shortly before in Connecticut. Back at that Connecticut hospital, Snyder checked in nearly dying on 29 December 2019, and there it took dangerously too long before his deteriorating situation was taken seriously. Even then the doctors first went for the wrong track of spinal tap, before noticing a liver cyst which was spilling bacterial infection into the blood, causing sepsis which almost killed the historian. A doctor friend who arrived to help, was not taken seriously by the doctor peers, Snyder quickly understood it was because his friend was a Black woman.
The time spent helpless and in sepsis fever, listening to racist policemen at a neighbour’s bed refer to Black Americans as “unpeople” and “unperson”, made Snyder think about the wider picture of USA. In particular of the state and purpose of the US healthcare, especially since just at that time, COVID-19 has arrived in USA. Snyder himself experienced symptoms of a weird airway infection while treated for liver infection and blood sepsis in the Connecticut hospital in January 2020, and saw other patients experiencing similar. But back then, there was officially no coronavirus in the USA yet, and of course nobody was tested for it. Snyder eventually became aware how profiteering US healthcare industry kills and cripples countless Americans with the (often not even diagnosed) COVID-19, and before that, with medically-prescribed opioids, which long became a US-own epidemic in itself. For Snyder, this American addiction to painkillers is also political:
“People who lived in places wracked by opioids voted for Donald Trump. The one piece of information that best predicts whether Mr. Trump won or lost a county in November 2016 was the degree of opioid abuse“.
USA has the biggest and the most expensive healthcare in the entire world. But Snyder reminds the readers that
“The mortality rate of babies borne by African American women is higher than in Albania, Kazakhstan, China and about seventy other countries. America as a whole does worse than Belarus […] not to mention forty other countries.“
Blacks, LatinX immigrants, Native Americans and other financially destitute groups are particularly vulnerable to these policies of pain, especially those lacking health insurance:
“Nearly half of Americans avoid medical treatment because they cannot pay for it“.
It got much worse when COVID-19 arrived in USA:
“In America, the people who died first and fastest were African Americans, who as a rule did not vote for Mr. Trump. […] Trump made it clear that resources purchased with taxpayers’ money would be distributed according to governors’ loyalty to him […]. Governors who tried to save lives were called disloyal. African Americans kept dying at catastrophic rates“.
The medical personnel, whom the US healthcare machinery uses as billing automatons commandeered by computer algorithms of profit-making, was knowingly exposed to lethal danger, because costs mattered more than human lives:
“Even in better-equipped hospitals […] doctors were getting a mask per week, when a mask was supposed to be disposable. […] Throughout the country, people working in hospitals were exposed to the virus far more than they shoudl have been […] They could not speak openly about these dangers […] Doctors and nurses were fired for bringing their own protective gear to work…“
The American attitude to healthcare kills, and not just those it deems expendable. Snyder writes:
“If health care is a privilege rather than a right, it demoralizes those who get it and kills those who do not. Everyone is drawn into a sadistic system that comes to seem natural. Rather than pursuing happiness as individuals, we together create a collective of pain.“
All Trump policies are about delivering pain, and a universal health care is the anathema to American fascism. Snyder writes:
“Such politicians tell white people that they are too proud and upstanding to need insurance and public health, which, they say, would only be exploited by others less deserving (blacks, immigrants, Muslims)“.
As the medically catastrophe of COVID-19 artificially exacerbated into an economic meltdown, many Americans lost their health insurance, in the middle of a pandemic. Snyder clearly blames President Donald Trump and his abettors, in fact his previous book, “On Tyranny“, is a point-by-point guide on how Americans must defend themselves from Trump power grab if they want their country to remain a democracy, instead of a totalitarian racist kleptocracy. Meanwhile, the official US death count from COVID-19 reached 200 thousand. Snyder’s book uses the then-current number of 150k, while reminding that many are dying without any testing done, at home, hospitals and nursing homes, that “there are large numbers of unexplained excess death every month“, and that despite states like Florida suppressing the actual death statistics.
Historians will eventual find out how many Americans really will have died from COVID-19 and its side effects. Snyder writes about the deliberate policies of pain which is American healthcare capitalism which led to Trump’s COVID-19 mass murder:
“The lack of equipment killed those infected by the coronavirus and those who treated them. Our shortages also killed countless people who did not have their cancer surgeries or organ transplants – or those who just needed to see a doctor at the beginning of some malady… […] Because hospitals could not perform profitable operations during the pandemic, they fired doctors when patients needed them the most“.
Fighting for his life in a US hospital, the historian of Stalinism and Nazi mass murders understood:
“Our failure during a public health crisis is a sign of how far our democracy has declined”.
Snyder wants doctors to have more say, and reminds his readers to support journalism, especially local ones, also because it was the journalists who uncovered the US opioid epidemic and environmental pollution scandals, and now forced Trump to confront the reality of the coronavirus. The book “Our Malady” is also a call to action, this time a very personal one of someone who himself suffered and barely survived an inhumane system. Snyder writes:
“The struggle begins when we claim health care as a human right.”
Disclaimer: as always, I am not paid for this review, but I did receive the book gratis from the publisher. The article was corrected after publication to fix a mistake about the hospital sequence.
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This is a case of lack of basic human rights. Any country of the world should have a national health system who treats citizens equally regardless of wealth and race.
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At the R1 research university/medical school that I worked at, the doctors were not the ones who lost their jobs when the for profit regular treatments (cancer treatments, general surgeries, etc) were put on hold due to COVID. It was the lesser paid staff (nurses, nurse practitioners, physical therapists, etc) that lost their jobs–and it was (I think) almost a 1000 of the staff in the hospital where I work. The parking lot I park at every morning went from being filled at 9:00 am every morning to be only a 1/4 full. Yet, the highly paid 6 fig a year doctors and administrators kept their jobs. Notably, the MBA / administrator in my department who makes 6 figs got rid of several people (and will be no doubt rubbing her hands together and cackling when I go, she is obsessed with cutting costs even if it means firing people) kept her job. The MD CEO of the hospital makes 3 million a year, and all the upper level staff, of course, kept their jobs.
Its remarkable to me the conservatives seem to think that market forces will solve this problem, when this has been going on for so long and it just gets more expensive. The main source of the problem I have read from a book (below) is the hospitals. They grossly overcharge, and the insurance companies tend not to fight it and pass the expense to the people who buy the insurance. Additionally, certain organizations (like Medicare) cannot negotiate drug prices, so they keep going up as the drug companies (that Shneider and Smut work for, haha) can charge whatever they want, and this increases the federal deficit. When I lose my job, by far my biggest expense will be health insurance.
All I can say is that if you are in the USA, you better pray that you will get a great job with good insurance, never lose it, and not get sick. Especially if the Republicans continue to hold power, who want to get rid of any state support for health care. Welcome to the exciting competitive world of neo-liberal post-Reagan capitalism in the USA. Its great if you are on top (a doctor, administrator or a tenured prof), sucks for the rest of us, and get render you destitue.
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