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Book Summary: Our Malady – Lessons in Liberty from a Hospital Diary

Our Malady (2020) explores why the American health care system not only fails to keep people healthy but also denies their freedom. It identifies the shortcomings of the present system, the dire ramifications, and why other countries don’t suffer the same fate.


Politics, Social Sciences, Government, Non-fiction, History, Health, Autobiography, Memoir, Medicine, Biography, Medical, Science, Social Issues, Fitness, Public Policy

Who is it for?

  • Truth-seeking Americans
  • Health-care personnel
  • The politically curious

What’s in it for me? Discover why the American medical system is denying people their rights.

America has long touted itself as the epitome of freedom. From its Pledge of Allegiance to the Statue of Liberty, it considers itself an upholder of democracy, a nation where every citizen is free to exercise her rights.

But, freedom means nothing without health. If you’re sick, you can’t pursue a productive life. And America’s medical system is failing to keep its citizens healthy. But it doesn’t have to be this way. These summaries reveal how America’s system differs from other countries, and what needs to change so that its people can finally be truly free.

Book Summary: Our Malady - Lessons in Liberty from a Hospital Diary

In these summaries, you’ll learn

  • the link between parental leave and emotional regulation;
  • how opioid abuse reflects political leanings; and
  • what Gandalf the Grey teaches us about American politics.

America’s health-care system is failing to do its job.

December 29th, 2019, was almost the day the author, Timothy Snyder, died. Just after midnight, he was admitted into the emergency room of a New Haven hospital. He could barely move. His hands and feet tingled, and he had severe tremors. He didn’t know it at the time, but an abscess in his liver was pumping infectious bacteria into his bloodstream.

It took an unacceptable nine hours for someone to read Snyder’s medical records properly, even though he’d had the foresight to bring them with him to the ER. Snyder’s appendix had been removed at the same hospital two weeks earlier. His surgeon had noted a lesion on his liver but failed to mention it to him. If the ER doctors had realized sooner, he would’ve been treated quickly and effectively. Instead, they downplayed his symptoms and suggested he had the flu, even when he started losing consciousness. As a result, he nearly died of sepsis.

The key message here is: America’s health-care system is failing to do its job.

Despite its overall wealth, America is a sick nation. In recent years, life expectancy has actually dropped instead of increasing as it has in many other wealthy nations. According to a study conducted by Moody’s Analytics in 2019, US millennials are set to die younger than their parents or grandparents, even though they’re spending more on health care. Something is terribly wrong.

Medicine should extend people’s lives. Instead, Americans can expect to live an average of four years fewer than people in comparable countries. They’ll even be outlived by people in poorer countries like Barbados, Costa Rica, and Chile. These countries don’t have better doctors or knowledge. They have better health-care systems, which extend people’s lifespans.

The novel coronavirus pandemic highlighted the systemic flaws in American health care. In other rich countries, like Germany and Japan, people received better treatment and had greater access to information about the virus, leading to fewer fatalities. These countries focused on health. America focused on profit.

When a government doesn’t prioritize health, people pay with their lives. In America, the government’s handling of the coronvirus had cost the nation 150,000 lives by June 2020. The chapters ahead will look at how and why this happened.

People suffer when governments don’t provide health care to everyone.

Health has long been used in politics as a way to dehumanize others. In the 1930s, Hitler turned his voters against Jewish people by accusing them of spreading disease to healthy Germans. When they were forced to live in ghettos without any medical care, they did fall ill. Nazis then used their illness as a further reason to send them to concentration camps.

Stalin’s Gulag – the agency that ran his notorious forced labor camps – took a similar view. Prisoners were assessed for their ability to work. If medical attention meant a prisoner could return to the workforce, they’d receive that care. If they were deemed to be an exhausted resource, they were simply dumped outside the gates to die. Health wasn’t seen as something to which every human had a right, but rather as something that the authorities could choose to grant when it suited their agendas.

The key message here is: People suffer when governments don’t provide health care to everyone.

After World War Two, America affirmed the importance of health care by signing the Universal Declaration of Human Rights. It states that all people have a right to adequate resources and care, meaning the right to live in good health. And yet, even though America helped draft this document, it doesn’t have a universal health-care system. This means that not everyone living in America can afford the health services they need.

But it isn’t just poorer communities that suffer when affordable health care isn’t available. Politicians who oppose quality public health care claim it would only be exploited by the undeserving, that upstanding citizens have what it takes to face pain in solitude, and that asking for help shows weakness. As a result, these citizens turn to pills to manage their pain, which accounts for the high abuse of opioids in political counties that support President Donald Trump.

In a system like America’s, where doctors are pressured by commercially run hospitals to see as many patients as possible, prescribing pills becomes an easy solution. This approach contrasts sharply with European systems, where doctors take time to understand a patient’s circumstances before developing a treatment plan. Despite being cheaper and easier to access than in America, European doctors are trained to care, not just hurry patients through a process.

A government that doesn’t provide universal health care promotes inequality in society. A nation that values equality is one in which everyone has access to the care they need, irrespective of their social or economic status.

Prioritizing children’s health creates a more functional society.

When Snyder and his wife Marci were expecting their first child, they were living in Vienna, Austria. As part of the free support offered by the Austrian government, they attended birthing classes. Until that point, Snyder had thought his employer had been extremely generous by offering him three months’ paternity leave. When he told his fellow dads-to-be in the birthing class about this, they were horrified. Austrian couples were given two years of paid parental leave – at least 21 months more than an American mother!

Unlike the American system, Austrian health care is set up to ensure the health of the child. From allowing earlier arrival at hospital for the birth to providing packs filled with clothing for newborns, the government ensures parents are fully supported. And all of these services are free. Why does the Austrian government do this? It understands that investing in healthy children pays huge dividends later on.

The key message here is: Prioritizing children’s health creates a more functional society.

To be truly free, you must be in a position to make your own choices. If you’re living in a state of fear, you lose your freedom because your mind falls into binary thought patterns, like “me” versus “them,” or “fight” versus “flight.”

Adults who learned to regulate their feelings during childhood avoid this trap because they’re more open to positive feelings, even when they’re stressed. This helps them identify multiple possibilities and solutions in any scenario. Thanks to emotional regulation, they can make decisions that yield better results.

Emotional regulation is a skill that children can’t learn on their own or from other children. It requires intensive and conscious attention from an adult during the first five years of life. That adult guides them in learning how to interact with others, how to delay gratification, and how to manage disappointment. This shapes the child into an expansive thinker and an adult who won’t operate from a place of fear.

European countries like Austria understand the significance of relationship-building between parent and child. That’s why paid parental leave is standard practice, not a luxury. By investing in infant health, they grow a healthy and balanced society with fewer medical needs and a lower crime rate.

An American parent pressured to return to the workforce can’t provide their child with the same quality of care. Without the government’s support, most parents won’t manage it, and the whole population will suffer.

Politicians who undermine truth undermine democracy.

In J. R. R. Tolkien’s The Lord of the Rings, the wizard Gandalf is scorned by many members of his fictional community. People don’t like the news he brings – that they are in great danger of a dark power that must be stopped. They’d rather not listen to the truth. When the situation worsens, and their lives and liberty are at stake, they shrug their shoulders and claim that they couldn’t have seen what was coming. Instead of taking responsibility for the role they’ve played in disaster, they choose to be willfully ignorant.

In a time of crisis, it takes an effort to seek out information to form an effective strategy and courage to look honestly at a situation. But without doing so, the consequences can be unimaginable. If Trump had valued truth over power during the pandemic, perhaps hundreds of thousands of American lives could have been saved.

The key message here is: Politicians who undermine truth undermine democracy.

Leaders who spare people bad news by spreading misinformation ultimately make things worse. Instead of taking action to address a situation, they feed people lies to calm them. But that doesn’t fix the problem, and the cycle repeats. When people are denied access to truth, they no longer have the information they need to make informed decisions, like how to protect their health.

Since the beginning of 2020, Donald Trump has spread misinformation about the novel coronavirus. Instead of devising a vigorous testing plan, he claimed in February that the virus would miraculously disappear. Next, he suggested administering hydroxychloroquine, a drug used to prevent and treat malaria. The federal official who questioned the scientific validity of Trump’s advice was fired. So was the official who reported a shortage of medical equipment. This was the beginning of a litany of misinformation and a silencing of truth-tellers.

Trump’s agenda for handling the pandemic was to keep reported infection numbers low. In May, he stated that testing was making him look bad. By June, he was praising himself for slowing the testing rate. But not testing meant the coronavirus spread unchecked. Trump was more concerned about his appearance than the lives of the people he was elected to protect.

Trump’s approach to the pandemic has been to deny reality, cultivate fear, and silence reporters and voters. These are the behaviors of an authoritarian government, not a democracy.

When doctors aren’t valued and respected, whole communities suffer.

In April 2020, Snyder received an email from a neighbor. She was a physician at a local hospital that was treating coronavirus patients. She’d put a call out to ask if anyone had spare medical masks. Even though her hospital was better equipped than many, it could only provide her with one disposable mask per week. But now, the hospital had run out of masks in her size.

This neighbor was one of the luckier doctors. Some American medical workers were fired for supplying their own protective equipment since this exposed the fact that their employer was failing to keep them safe. The hospital preferred its staff to work in unsafe conditions than risk its reputation. As a result, there were fewer doctors to care for the sick.

The key message here is: When doctors aren’t valued and respected, whole communities suffer.

Numerous medical professionals across America caught coronavirus after being exposed to it at work. Some of them even died, right at the time when the country needed them the most. Trump called the crisis a “war.” But with so many fatalities, it’s clear that the commander in chief was sending troops into battle without basic armor.

In 2020, America’s federal government tried to bail the country out of the pandemic by spending $2 trillion. But none of this money was used to buy protective equipment for medical workers. In fact, until March 2020, the government policy was to sell locally made masks to China without importing any of its own to compensate.

During the pandemic, private equity firms and insurance companies were the ones weighing into American policymaking – not those with medical knowledge, working on the front line. If doctors had a voice in health-care policy, no medical personnel would be asked to work without the required equipment, like masks and gowns.

Profit was the focus of hospitals too. Hospitals in America are commercially run. So, when they stopped turning a profit because of the pandemic, some cut costs by firing doctors. This only put more strain on the already overloaded system.

In a society where health is valued less than profitability, this behavior is no surprise. If doctors were seen as the authority on health care and were given the freedom to exercise that authority, Americans would be healthier – as they have the right to be.

Commercial medicine has robbed Americans of their health.

While he was recovering from his sepsis in early 2020, Snyder looked through his medical records. He was shocked to see that doctors often noted what was convenient rather than what was true. He realized that this wasn’t entirely their fault. Digital records forced them to select predefined entries from a list. And those entries were organized to maximize the hospital’s profit. The purpose of medical records has transformed from documenting symptoms and observations into a billing mechanism.

This is because of America’s commercial medical system. Hospitals are run not to heal the sick, but to make money. It isn’t doctors who determine how many patients can be cared for each day – it’s an algorithm that weighs revenue against cost. Health was once the domain of medical specialists. Now, it’s the domain of profit specialists.

The key message here is: Commercial medicine has robbed Americans of their health.

Lobbyists and PR agents insist that the current system works well. But if it were the ideal they claim it to be, why are Americans paying more for health care than people living in comparable countries and yet still not getting the same level of service from doctors or in hospitals? The lobbyists retort that changing the system would be far too costly. Instead, they expect American health to be at the mercy of profit-centric powers.

But their argument is flawed. A system that millions of Americans can’t afford isn’t a system that works. Americans without insurance often don’t seek the treatment they need because they don’t have money for medical bills. This leads to people enduring pain needlessly and increases the spread of undiagnosed diseases through communities.

The situation was dire before the pandemic. Now, it’s significantly worse. In the first few weeks of the pandemic, 20 million Americans lost their jobs. That means millions of people lost their insurance too. Faced with financial uncertainty, many of these people wouldn’t have gone to the doctor if they had coronavirus symptoms. And without a diagnosis, they were more likely to pass the virus on to others or become dangerously ill themselves.

Changing the system so that every American has access to quality health care would be expensive initially. But it would save the nation money in the long run. Overall, a healthy nation has lower medical costs. Its people are less vulnerable during a pandemic, which protects the economy in turn. When health care is considered a right, a government ensures it’s affordable. As a result, people suffer less and are free to pursue their lives.

Final Summary

The key message in these summaries: Before 2020, America was already a nation of unhealthy people. Between commercial medicine and profit-centric policy, even those who could afford insurance didn’t necessarily have access to quality care. The coronavirus pandemic has highlighted the failings of the current health-care system – one insufficiently equipped to protect medical personnel and one that values doctors so little it will fire them for trying to protect their own health. Until health is seen as a valuable, long-term investment, and doctors are given the authority that is rightfully theirs, American lives will be lost needlessly for the sake of power and profit.

Actionable advice: N/A

About the author

Timothy Snyder is an award-winning author and academic who focuses on the history of Central and Eastern Europe. His work has been translated into over 40 languages and has even inspired an opera, a rap song, and art.

Table of Contents

  • Prologue: Solitude and Solidarity
  • Introduction: Our Malady
  • Lesson 1. Health care is a human right.
  • Lesson 2. Renewal begins with children.
  • Lesson 3. The truth will set us free.
  • Lesson 4. Doctors should be in charge.
  • Conclusion: Our Recovery
  • Epilogue: Rage and Empathy.


NEW YORK TIMES BESTSELLER • From the author of the #1 New York Times bestseller On Tyranny comes an impassioned condemnation of America’s pandemic response and an urgent call to rethink health and freedom.

On December 29, 2019, historian Timothy Snyder fell gravely ill. Unable to stand, barely able to think, he waited for hours in an emergency room before being correctly diagnosed and rushed into surgery. Over the next few days, as he clung to life and the first light of a new year came through his window, he found himself reflecting on the fragility of health, not recognized in America as a human right but without which all rights and freedoms have no meaning.

And that was before the pandemic. We have since watched American hospitals, long understaffed and undersupplied, buckling under waves of ill patients. The federal government made matters worse through willful ignorance, misinformation, and profiteering. Our system of commercial medicine failed the ultimate test, and thousands of Americans died.

In this eye-opening cri de coeur, Snyder traces the societal forces that led us here and outlines the lessons we must learn to survive. In examining some of the darkest moments of recent history and of his own life, Snyder finds glimmers of hope and principles that could lead us out of our current malaise. Only by enshrining healthcare as a human right, elevating the authority of doctors and medical knowledge, and planning for our children’s future can we create an America where everyone is truly free.

Read an Excerpt


Solitude and Solidarity

When I was admitted to the emergency room at midnight, I used the word malaise to describe my condition to the doctor. My head ached, my hands and feet tingled, I was coughing, and I could barely move. Every so often I was seized by tremors. The day that had just begun, December 29th, 2019, could have been my last. I had an abscess the size of a baseball in my liver, and the infection had spilled into my blood. I did not know this at the time, but I knew that something was deeply wrong. Malaise, of course, means weakness and weariness, a sense that nothing works and nothing can be done.

Malaise is what we feel when we have a malady. Malaise and malady are good old words, from French and Latin, used in English for hundreds of years; in American Revolutionary times they meant both illness and tyranny. After the Boston Massacre, a letter from prominent Bostonians called for an end to “the national and colonial malady.” The Founding Fathers wrote of malaise and malady when discussing their own health and that of the republic they founded.

This book is about a malady—not my own, though mine helped me to see it, but our common American one: “our public malady,” to borrow James Madison’s phrase. Our malady is physical illness and the political evil that surrounds it. We are ill in a way that costs us freedom, and unfree in a way that costs us health. Our politics are too much about the curse of pain and too little about the blessings of liberty.

When I got sick at the end of last year, freedom was on my mind. As a historian, I had spent twenty years writing about the atrocities of the twentieth century, such as ethnic cleansing, the Nazi Holocaust, and Soviet terror. Recently I have been thinking and speaking about how history defends against tyranny in the present and safeguards freedom for the future. The last time I was able to stand before an audience, I was giving a lecture about how America could become a free country. I hurt that evening, but I did my job, and then I went to the hospital. What followed has helped me to think more deeply about freedom, and about America.

When I stood before the lectern in Munich on December 3rd, 2019, I had appendicitis. That condition was overlooked by German doctors. My appendix burst, and my liver became infected. This was neglected by American doctors. That is how I ended up in an emergency room in New Haven, Connecticut, on December 29th, bacteria racing through my bloodstream, still thinking about freedom. In five hospitals over three months, between December 2019 and March 2020, I took notes and made sketches. It was easy to grasp that freedom and health were connected when my will could not move my body, or when my body was attached to bags and tubes.


When I look at the pages of my hospital journals, stained by saline, alcohol, and blood, I see that the New Haven sections, from the last days of the year, concern the powerful emotions that rescued me when I was near death. An intense rage and a gentle empathy sustained me, and provoked me to think anew about liberty. The first words I wrote in New Haven were “only rage lonely rage.” I have felt nothing cleaner and more intense than rage amidst deathly illness. It came to me in the hospital at night, giving me a torch that ignited amidst kinds of darkness I hadn’t before known.

On December 29th, after seventeen hours in the emergency room, I had an operation on my liver. Lying on my back in a hospital bed in the early morning hours of December 30th, tubes in my arms and chest, I couldn’t ball my fists, but I imagined that I was balling my fists. I couldn’t raise my body from my bed on my forearms, but I had a vision of myself doing so. I was one more patient in one more hospital ward, one more set of failing organs, one more vessel of infected blood. But I didn’t feel that way. I felt like an immobilized, infuriated me.

The rage was beautifully pure, undefiled by an object. I was not angry at God; this was not His fault. I was not angry at the doctors and the nurses, imperfect people in an imperfect world. I was not angry at the pedestrians moving freely about the city beyond my chamber of twisted sheets and tubes, nor at the deliverymen slamming their doors, nor at the truckers blowing their horns. I was not angry at the bacteria celebrating the bounty of my blood. My rage was directed against nothing. I raged against a world where I was not.

I raged therefore I was. The rage cast a light that revealed an outline of me. “The shadow of the solitary is the unique,” I wrote, rather obscurely, in my diary. My neurons were just starting to fire. The next day, December 31st, my mind began to recover from the sepsis and the sedation. I could think for more than a few seconds at a time. My first extended thought was about uniqueness. No one had ever moved through life as I had, making just the same choices. No one was spending New Year’s Eve in exactly the same predicament with just the same emotions.

I wanted my rage to lead me out of my bed, and into another year. In my mind’s eye I saw my dead body, its decomposition. The predictability of rot was horrible. It is the same for everyone who has ever lived. What I wanted was unpredictability, my own unpredictability, and my own contact with the unpredictability of others.

For a few nights, my rage was my life. It was here, it was now, and I wanted more of the here and more of the now. In my bed I craved a few more weeks, and a few more weeks after that, when I wouldn’t know what would happen to my body, wouldn’t know what would play out in my mind—but would know that the person feeling and thinking was me. Death would extinguish my sense of how things could and should be, of the possible and beautiful. It was against that nothing, “that particular nothing,” as I wrote in my diary, that I raged.

The rage was with me for only a few minutes at a time, bringing warmth as well as light. My body usually felt cold, despite my fever. In my hospital bed on New Year’s Eve I wanted the sun to come up, and I wanted it in the room. I wanted it on my skin. After three days of trembling, I needed more than my own warmth, which escaped through the thin sheets that kept twisting around the tubes in my chest and arm. The winter sunrise in New England through a thick window isn’t much; I was living in symbols and desires.

I didn’t want the torch in my mind to be a lonely light. And it was not. People came to visit me. My wife opened the shade, and the wan New Year entered. When other visitors began to arrive, I guessed how they would react at bedside to a helpless me, but I didn’t know. I remembered that some of the old friends visiting me think that patients who are visited get better treatment. They are surely right: health is a matter of being together, in that way and a hundred others.

A visit helps us to be alone. Being together in solidarity permits a return to solitude in tranquility. Just by appearing, my friends set off memories, chains of association back into our past. I remembered a moment when one friend had shared that pragmatic view of why patients should be visited: years before, when it was I who was at her bedside, when it was she who was ill, and pregnant, in the same hospital where I myself now lay. I thought about her children, then about mine. Another mood was coalescing: a gentle empathy.


“[Snyder’s] litany of the many ways the United States bungled the coronavirus response is eloquent and pointed. . . . His cry of rage is certain to get your attention.” – The Washington Post

“Compelling . . . Snyder combines moving personal experience with keen historical and political analysis in Our Malady. . . . A powerful argument for universal health care as a fundamental right.” – Chicago Tribune

Historian Snyder (The Road to Unfreedom) frames this searing critique of the American health-care system around his own recent medical emergency. After a series of medical mistakes related to an appendectomy, Snyder nearly died before undergoing surgery for a severe liver infection in December 2019. Doctors treating the appendicitis had seen a lesion in his liver but did nothing to treat it; a different set of doctors botched a spinal tap and missed clear indications of a liver problem in Snyder’s medical records. These were not isolated mistakes, according to Snyder, but symptoms of a systemic failure in which doctors and nurses are not given enough time to meet with patients and truly assess their needs, and are encouraged to prescribe medication rather than get to the root of the problem. Snyder also contrasts his wife’s medical care during pregnancies in Vienna and the U.S., and sketches the Trump administration’s inadequate response to the Covid-19 pandemic. According to Snyder, the present state of health care violates America’s founding principles: “Freedom is impossible when we are too ill to conceive of happiness and too weak to pursue it.” Though he doesn’t offer much in the way of specific solutions, Snyder draws valuable context and insight out of his harrowing personal experience. The result is a troubling portrait of a system in which the patient is the last priority. (Sept.)

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