A very American, choose-your-own-adventure pandemic

Published 13 Dec 2020, last modified 13 Dec 2020

A row of cloth facemasks hanging from hooks on a wall

Those who choose inadequate healthcare

In spring 2020, when the Democratic presidential primary election was still an open contest, I briefly wondered whether the COVID-19 pandemic would nudge candidate Joe Biden to soften his opposition to the “Medicare for All” universal healthcare plan championed by his opponents Elizabeth Warren and Bernie Sanders. With the unemployment crisis created by the pandemic, millions of people had lost their health insurance coverage and could potentially be on the hook for many thousands of dollars if they had to be hospitalized for COVID-19 or anything else. Surely, if nothing else, I thought the specter of public opinion in the midst of this disaster would compel him to take a more conciliatory tone on this particular policy issue. But all we got from Biden was the same status quo policy position on the country’s semi-regulated private healthcare system adorned with a few new promises specifically limited to COVID-19-related healthcare. He said when a COVID-19 vaccine was produced it should be available to all Americans at no cost, but said no such thing about, say, the influenza vaccine. He said no one should be bankrupted by the bills for a COVID-19 hospitalization, but said nothing about the many people who are bankrupted by their cancer treatment bills every day.

Biden’s stance remains that “all Americans should have access to affordable healthcare.” But having “access to affordable healthcare” is not at all the same thing as having healthcare. The Biden position on healthcare says nothing about what standard of affordability should apply to healthcare, nor what is to be done about people who, for any reason, have failed to enroll in subsidized health insurance during the annual open enrollment period. We have a healthcare system that is built so as to preserve the choice to opt out, a choice that many people make by accident or out of privation, because the “affordable” options aren’t affordable for everyone.

The paradox of choice in American politics is that so often our increased choices relative to other industrial nations afford us less actual, practical freedom. Who is really more free, the UK citizen whose National Health Service care is guaranteed, or the American who missed the open enrollment deadline and now has a choice between racking up a bunch of medical debt consulting a doctor and just hoping their medical issues go away on their own? The dominant position in American government today is that the American has greater freedom in this situation, but common sense tells me otherwise.

When public health policy relies on personal choices

In June 2020, when a reporter asked U.S. Vice President Mike Pence why the President’s reelection campaign had organized large, public events where people were people stood shoulder-to-shoulder indoors and mask-wearing was tacitly discouraged despite the recommendations of the Centers for Disease Control and Prevention, he implied that the decision to follow or ignore mask-wearing or social distancing public health guidelines is not only a personal choice but also a form of Constitutionally protected speech:

I want to remind you again freedom of speech and the right to peaceably assemble is in the Constitution of the U.S. Even in a health crisis, the American people don’t forfeit our constitutional rights… I think it is really important that we recognize how important freedom and personal responsibility are to this entire equation…

By framing cooperation with public health guidelines as a protected personal choice and not as an area of public policy, the presidential administration shifted public ire away from its own failed response to the pandemic—the utter failure to build proper national testing infrastructure during the first months of domestic viral spread, the lack of a comprehensive strategy to pay people to stay home from work or otherwise temporarily reduce financial imperatives to go out in public so the country could have a real and effective lockdown as others did—and onto the emerging culture war over COVID-19.

Spurred on by the rhetoric of public figures inside and outside the government, mask detractors paint themselves as strong, independent thinkers, at times explicitly casting those who wear masks for public health as weak-willed and inappropriately effeminate. Those who advocate mask-wearing, meanwhile, paint their position as the enlightened, common-sensical, and prosocial choice. But that it is even a personal choice and not simply the dominant practice nationwide, given all that we have learned by now, is emblematic of our country’s failure to face this pandemic with a coherent, united front. The consequences of emphasizing personal choice in the area of mask-wearing alone is surely responsible for thousands or tens of thousands out of the now nearly 300,000-and-counting U.S. COVID-19 deaths.

Americans are now awash in choices for which they have not good options. To go back to work waiting tables in restaurant while cases climb, or to take your chances when your unemployment insurance runs out and the rent is due? To send your children back into their classrooms, or to supervise their strictly-arranged videoconference classes at home during your own demanding remote workday? When people don’t have any good options, they don’t tend to make good choices.

The freedoms we choose to defend

We should be angry that it’s like this, but we shouldn’t be surprised. Throughout modern American history, opportunities to address the housing, food, educational, and healthcare needs of Americans have been subsumed under a maxim of personal choice.

In the era of the New Deal, U.S. President Franklin Roosevelt (guilty as he was of human rights violations like the internment of Japanese-American civilians during World War II, but nonetheless interested in the social welfare of at least large segments of the population), proposed that there were “Four Freedoms” essential to functional societies:

  1. Freedom of Speech
  2. Freedom of Worship
  3. Freedom from Want
  4. Freedom from Fear

Of these, only the first two are enshrined in the Bill of Rights and actively revered by mainstream American politicians today, and the second is defended far more forcefully on behalf of Christians than for anyone else. Few people in the halls of Congress will admit that their government has any real responsibility in ensuring the latter two Freedoms; from food stamps to Medicare, the prevailing philosophy has been that the government’s profile in these areas should be as diminished as possible.

In the spring of 2020, I felt that perhaps we were at a crossroads where this country would be forced to reassert a demand for Freedom from Want and Freedom from Fear. Now, in the winter, that hope is fading.


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