In his landmark 1984 book, The Therapeutic State, author Thomas Szasz explored the mindset of the more forthright advocates for a nationalized health-care regime. One prime example, health-policy expert Dan Beauchamp, was admirably honest about his objectives, and they had little to do with individual outcomes in hospitals and doctor’s offices. His goal was to “transform everything.” Converting “health care from a private to a social good” would change not just politics but people, too. In crafting health-care policy, Beauchamp sought “to translate the public health viewpoint into the language of social justice and equality, suggesting that ‘public health,’ not ‘health care’ should be the primary or basic good.”
As Szasz notes, this point of view is fundamentally incompatible with the existing American social compact, even though it may roughly comport with the nation’s byzantine health-care regime (which is in no way independent from the public sector). In its ideal form, the “therapeutic state” is dedicated to the protection of the public from themselves. This becomes what Szasz called “coercive paternalism” and what one of the subjects of his criticism more sympathetically described as “using coercion to enable people to carry out their own goals.”
COVID-19 has taught us that the American crowd is not particularly interested in preserving public health, even if the American individual is more conscientious. But it has also taught us that our public health experts, and the elected officials who empower them, are equally fallible.
The same people who are prone to scold the public for failing to abide by their high-minded restrictions on social and economic life are also liable to ignore their own advice if it interferes with their social lives or impedes the advancement of their preferred political projects. The nauseating hypocrisy engaged in by some of the most outwardly concerned advocates of pandemic-related restrictions remains underexplored in the political press. The stuff that gets saturation treatment is pandemic pornography: Average Americans behaving badly—not like you, enlightened reader. You’re one of the good ones.
This is especially relevant now, on the eve of the post-pandemic period. The themes Szasz explored a generation ago are on full display today. As we approach the point of liberation, a growing cast of public health officials are standing athwart history, yelling “stop!”
NBC News contributor and faculty member at the University of Washington, Dr. Vin Gupta, is a prime example. In a recent on-air appearance, Gupta upbraided an elected official who planned on traveling after receiving the second and final dose of an effective and FDA-approved COVID vaccine. “Just because you get vaccinated with that second dose does not mean you should be traveling in the middle of an out-of-control pandemic,” he said. “Or that you’re liberated from masks. Everything still applies until all of us get that two-dose regimen.” Gupta did not base this assertion on a relevant study—no such study exists. And that alone is what led him to render a maximally cautious admonition that would also preserve for the foreseeable future the onerous conditions under which we’ve all labored.
This is, at the very least, a deeply misguided messaging strategy. If our goal is to achieve vaccination rates sufficient to arrest the spread of this disease, telling people that they must continue to wear masks, maintain their distance from others, and avoid social engagements even after they’ve been inoculated is a dumb way to go about it. That is, if the public health objective is public health and not, as Szasz observed, the collectivization of the body, rendering it yet another sector of society to be managed. Gupta is not a radical–his advocacy when it comes to health-care reform has long erred on the side of incrementalism. But his advocacy here, and it is advocacy, is revealing of a technocratic tendency to see the public not as individuals but as one big problem to be fixed.
Gupta is not alone. National Institute of Allergy and Infectious Diseases Director Anthony Fauci recently expressed similar sentiments. “I feel very strongly that we’re going to need to have some degree of public health measures to continue,” he recently asserted. What “public health measures?” and for how long? Fauci was specific: Though they “may not be as stringent” as they are now, social distancing guidelines, masking mandates, hectoring people for attending “intimate gatherings” of friends and family, and perhaps even punishing restrictions on commerce like the closure of indoor spaces will continue well into 2021 and even early 2022. Only then can we hope to see a “profound degree” of herd immunity achieved.
The severity of the pandemic notwithstanding, the physician’s remedy could very well be worse than the disease. The profound toll America’s experiment with varying degrees of lockdown has taken on the public’s mental health, economy, and children’s education could only be dismissed by the most myopic and callous. The prospect of a lost decade of economic growth, lifelong psychological scarring, and increasing social unrest directly or indirectly attributable to these conditions may not concern the public health expert—perhaps they shouldn’t. But they should and do loom large over voters and the politicians to whom they are responsible.
Aspiring social engineers have occasionally given in to the sordid impulse to see the pandemic not as just an unspeakable tragedy but as an opportunity, too. “There is no getting ‘back to normal,’ experts say,” one CNN headline read. “The sooner we accept that, the better.” For some, the reduced productivity, consumerism, and general human interaction aren’t so bad. This is a chance to “reorder society in dramatic ways.” It’s a chance to divorce American political culture from its “romance with market society and hyper-individualism,” to foster “interdependency and community,” and to acclimate the public to a much more active central government. Only a public health expert could tell you what any of that has to do with public health.
When most Americans just want a way out, many in positions of prominence seem fixated on ways to keep us in. That could, indeed, create the conditions for profound societal shifts. But they are unlikely to be the kind that our public health experts would welcome.