When I rested and looked at my shelves, I began to reconsider the experiences of people I had written about, the victims and survivors of mass murder. I have written books about policies that directly, and without ambiguity about intentions, took human life: shooting, starving, gassing. It occurred to me—as it has occurred to others long before me—that the deliberate deprivation of health was a related harm. People could be treated as inhuman sources of disease rather than as fellow humans to be treated and cured. People could be sorted by health and worked to death in the name of some greater good for some other group.
One shelf in my office is devoted to Nazi Germany and the Holocaust. A book there collects the correspondence, writings, and speeches of Adolf Hitler. In Hitler’s first antisemitic letter he referred to Jews as “racial tuberculosis.” In the middle of an influenza epidemic, Hitler was calling human beings a contagion. After Hitler came to power, Nazis accused Jews of spreading disease among a healthy German population. During the Second World War, Nazis called Jews “typhus bacteria.” Confining Jews in ghettos without medical care did in fact make them sick. German tourists who visited the ghettos made a spectacle of malady. As Jews fell ill, Nazis treated that as an argument for killing them quickly. Hitler boasted of cleansing Europe of Jewish bacteria, of “lancing the boil.”
If we think that the Nazi Holocaust is the depth of malevolence, what then is the height of good? If we decry Hitler’s language and actions, what follows for what we ourselves say and do? The Nazis treated health care as a way to divide the humans from the subhumans and nonhumans. If we see others as bearers of ailments and ourselves as healthy victims, we are little better than they. If we truly oppose the Nazi evil, we will try to think our way to its opposite, to the good. A part of that effort is to understand that all humans are subject to malady, and have an equal claim to care.
Another shelf of books in my office is dedicated to studies of concentration camps. Usually those who run concentration camps treat healthier people better and sicker people worse. When concern for human dignity and human life is absent, all that matters is the labor that can be extracted. Stalin’s Gulag was run according to this logic of reverse health care. Because Soviet administrators regarded prisoners as economic units, health care was distributed according to calculations about productivity. Medical attention meant figuring out who could be exploited for longer and who should be discarded sooner. Stronger prisoners might be cared for so long as they were productive, but weaker ones were allowed to die, often released from the camp to perish beyond its gates—so as not to be counted, so as not to figure in the record.
If we think that the Gulag is the depth of horror, what then is the summit of good? Part of the answer is to recognize that all people have an equal right to health care, regardless of how productive or profitable they are judged to be. That is a conclusion that a number of wise people, including Americans, drew from the horrors of the twentieth century.
The idea that health care is a right can seem strange to Americans today. Yet officially the United States has been committed to such a right for more than seventy years. After Nazi Germany was defeated in the Second World War, and as the United States engaged the Soviet Union in a long Cold War, Americans helped to draft and Americans signed agreements that articulated a human right to health care.
The constitution of the World Health Organization, founded in 1946, states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” The Universal Declaration of Human Rights of 1948 states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” Most nations’ constitutions enshrine a right to health care. The list includes Japan and Germany, whose new constitutions the United States influenced after defeating them in the Second World War. Today Germans and Japanese live longer and healthier lives than Americans.
Americans helped to establish health care as a human right around the world. Why then is health care not seen as such in the United States? Why are Americans not protected by the agreements that our government signed? Should we accept that citizens of other democracies enjoy a right that we are denied, and live longer and healthier lives than we do? Many of us seem to find that acceptable. Why?
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I think that our death wish has to do with a growing imbalance between solitude and solidarity, with a rage that, when not balanced by empathy, undermines rather than affirms our freedom. When I think back to where I come from, and to the ways I was ill before my crisis, I get an inkling of one of the sources of this imbalance.
In my hospital diary I have a sketch of the house where my children were waiting for me, and a sketch of a barn in Ohio. I was born fifty-five years after my father’s father, a farmer. I was a reasonably athletic kid, but my grandfather’s forearms were twice as thick as mine. The veins stood out on his hands and up his arms. When he took my wrists in his hands, I could not move. He was missing a finger or two as a result of accidents with farm machinery, but this didn’t seem to make a difference. My other grandfather, my mother’s father, was also a farmer. Though he never talked about what he could make and repair, it was seemingly everything. He died on his tractor. Perhaps my grandfathers complained about pain during their working lives. But I can’t imagine their doing so. No one ever told me directly not to talk about pain, but I took this in very young. When at the age of eight I greensticked my left wrist trying to stiff-arm an ancient oak on my father’s wooden sled, I didn’t make a sound (until I saw the x-ray).
A decade or so later, I sprained, or perhaps broke, my left ankle playing basketball on a playground in Washington, D.C. I taped the ankle up around a brace, lay low for a few days, and went to work with a cane for a summer. I didn’t see any x-rays then, since I had neither money nor insurance. I broke the same ankle later, when I did have insurance, and got treatment. I broke seven ribs in my twenties and thirties: five on other people’s elbows on the basketball court, two on my own elbow while falling in a Paris church complex known as the Valley of Grace. I dislocated a finger getting a rebound, and long ago stopped counting the broken toes. All this was before I broke my back and was diagnosed with osteoporosis. I am older now, but my bones have improved, thanks to some sensible medical advice.
I got my first migraine headache as a sophomore in college, after staying up all night working on a research project. By the time I went to England to study history in 1991, the migraines were regular. Ignoring this pain seemed not to work; it is impossible to get distance from one’s own head. Before there were medicines that worked to halt migraines (triptans), I found myself in the emergency room every few weeks, everywhere I lived and worked, in Europe and America. Occasionally I passed out from the pain. Once there was medication I took it, and the frequency of visits to the emergency room decreased to once every few months.