It is also tempting to rest on the laurels of tradition, to refer back to the eighteenth century, to say that the Founding Fathers did not imagine modern public health. There are many things, of course, that they did not imagine. It is impossible for me to believe, as a citizen and as a historian, that the Founding Fathers wanted an America where people would live shorter and worse lives than necessary, where the sickness of the many would become a zone of profit for the few. The optimism in the preamble of the Constitution rings down the centuries: good government means justice, tranquility, welfare, liberty. A common defense. If we take pride in our Constitution and know its purposes, we apply the aspirations of its authors to our own times.
Toughing things out and avoiding doctors might have made sense two hundred years ago. I was released from the hospital into the coronavirus pandemic, shelter-at-home, and remote learning with two kids in elementary school, and have been reading about the history of the Revolutionary era with my son. Together we learned that George Washington died after three doctors bled him four times; he would have been better off not calling for them. Benjamin Franklin once wrote to John Jay that he feared the medicine more than the malady, which at the time made sense. A quick way to rub the romance from the Revolutionary War is to learn how the wounded were treated. Nothing was understood about infection then, so doctors did not wash their hands or sterilize their cutting tools. Brutal amputations were common, pus and swelling were misunderstood as signs of healing rather than infection, and burns were treated by bleeding the patient. Life expectancy for colonists was about forty years, and for the Africans they enslaved much less. Diseases brought from Europe, such as smallpox, drastically shortened the lives of the continent’s native peoples.
I find it inconceivable that the founders of this country, the men who valued justice, tranquility, and welfare, would have wished for us to relive their wretched moment in the history of medicine. Certainly they never said any such thing. Indeed, much of the sadness in their correspondence with one another concerns personal sickness, the illness of friends, and the plagues that wracked the cities of the young republic. It was impossible to summon Congress one year because of an epidemic of yellow fever, a disease that was not then understood. We now know that it is transmitted by mosquitoes, and have a vaccine. Benjamin Franklin, Thomas Jefferson, and their peers were interested in saving Americans from yellow fever, smallpox, and other diseases against which we now have vaccinations or treatments. Jefferson thought that health was the most important element of a good life, after morality.
Now that we have better knowledge of the natural world, we can consider health care as a human right. The Constitution does not prevent us from doing so. On the contrary: its authors had the wisdom to specify that “the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” This leaves room for a right to health care. If we accept Jefferson’s famous trio of rights to “life, liberty, and the pursuit of happiness,” the case for a right to health care is made. If we have a right to life, we have a right to the means of living. If we have a right to pursue happiness, then we have a right to the care that allows us to do so. Without health, said Jefferson very sensibly, there is no happiness. The right to liberty implies a right to health care. We are not free when we are sick. And when we are in pain, or when we are anxious about illness to come, rulers seize upon our suffering, lie to us, and strip away our other freedoms.
LESSON 2.
Renewal begins with children.
In my hospital diary I have notes about what my children were doing in January. “Soccer practice harder.” “Friends E and A over.” “School starting.” I was proud of my son and daughter for getting up in the morning and going to school when they knew what was wrong. When I was too sick for them to visit me, my wife told me about their days. My children also wrote me notes and drew me pictures, which I taped to the wall or folded up and kept in my diary. When I could move around, they started to visit me, one at a time. My daughter wanted hugs and gave me food. “Daddy,” said my son, “I keep dreaming you die.”
In the hospital, and then after I was released from the hospital, in my office, and then after pandemic shut me out of my office, I kept thinking of my children. The rage and the empathy I felt when I was sickest had to do with them; but even after these emotions slowly cleared, a tearing sensation remained. The enormity of what could have been their loss, my loss, our loss, was too great to hold within a few days. Even after school was closed and I saw them at home all day every day, the anguish kept radiating through my days and nights, expressed in anxious searches for them around the house, and in my dreams.
One night I woke from a nightmare to the realization that my photographs of their first few years of life were not backed up. I sat straight up and got out of bed. My dream had revealed to me a small remedy of my sense of separation; keeping the past recorded was a way of binding the children to me, one that I could manage in my weakened state. I found the old computer, rigged it up, got a hard drive, and went to work. As I backed up the photographs, each of them flitted over the screen in reverse chronological order, milliseconds and memories. They ended, or began, with images of my newborn son, tiny in a blue blanket and mittens.
* * *
Those photographs were of my children, but the anguish I felt could have been felt by anyone. The beginning of life is particular to each parent and yet general to parenthood, an experience distinct from everything else in life, and yet shared across the planet. As those 14,810 images wound me backward through the last decade, I thought about the renewal of life that comes along with birth, and about what makes the passage easier, or harder. That blue blanket and those mittens belonged to a public hospital in Vienna, Austria, where my son was born. That hospital and that city certainly made things easier for us. That pregnancy and birth, the first for Marci and me, created a sense of what good health care felt like from the inside: intimate and inexpensive.
During all the months of obstetrical care in Vienna in 2009 and 2010 we paid almost nothing: small fees for doctor visits, on top of a modest monthly insurance premium. We were paying extra (although not much) to see a private doctor who had been recommended to us; we could have seen an obstetrician at no cost. Throughout the pregnancy (and after the birth) my wife carried a handy “mother-child passport,” recognized throughout the country, where doctor visits, test results, and inoculations were recorded. Rather than looking at a screen when my wife entered the hospital or doctor’s office, a nurse or physician would greet us and ask to see the “passport.”
The city of Vienna offered us subsidized (and entertaining) birthing classes. Austrians usually speak a neutral version of German to foreigners, but in intimate settings switch to dialect, which is harder to understand. I found myself on a mat performing routines with balls and bells for reasons that were less than clear. But birthing class was fun and made the rhythm of pregnancy more social. Because the couples had all conceived at about the same time, we kept seeing familiar people in the same stages of pregnancy. We made friends whose children have grown up with ours.