Our Malady: Timothy Snyder on America’s Dystopian Healthcare
In Our Malady, historian Timothy Snyder shares his personal journey of struggling to navigate America’s healthcare system during a serious illness, providing shocking insights into racial and income inequality that continue to plague Americans. This book serves as a warning to citizens everywhere that greed can corrupt medicine and produce a decline in life expectancy. Don’t think of this as an American crisis; think of it as a greed crisis that can happen anywhere.
Rep. Katie Porter:
What I'd like to do now, Mr. Bradway, is I'd like for you to please explain to the American public why you and four other executives deserve to pay yourselves tens of million dollars each year. I've got an empty whiteboard ready to take down your justifications.
Amgen CEO Robert Bradway:
I recognize that that's a considerable sum of money. I would, of course, point out that I don't have any direct input to my compensation: that's derived by the board, and it’s the board to a vote of the shareholders who overwhelmingly supported the compensation package for me and the other main executive officers–
Rep. Katie Porter:
Reclaiming my time, sir. Do you not know why you're getting hundreds of millions of dollars, tens of millions of dollars a year? What is the justification? I'd like to show the American people.
Amgen CEO Robert Bradway:
Our compensation is consistent with competitive positions at other companies-
Rep. Katie Porter:
Mr. Bradway, reclaiming my time. “The other guy gets paid too much too” isn't a justification. I'd like to hear what you do to deserve $124 million in salary–you and your top five executives–over a three year period?
Amgen CEO Robert Bradway:
Well, more than 90%-
Speaker:
Gentlelady’s time has expired. The gentleman may respond to her question.
Amgen CEO Robert Bradway:
More than 90% of my compensation is based on performance measures that include how our shares perform relative to the market, and our compensation program is aligned with that of our owners, our share owners. So, a large part of my compensation reflects the fact that we've been creating value for our share owners by advancing innovative medicines like those that we have on the marketplace today.
Rep. Katie Porter:
I wish you would focus on creating value for sick patients, Mr. Bradway, not just your shareholders. I yield back.
Sarah Kendzior:
I'm Sarah Kendzior, the author of the best selling books, The View From Flyover Country and Hiding in Plain Sight.
Andrea Chalupa:
I'm Andrea Chalupa, a journalist and filmmaker, and the writer and producer of the journalistic thriller, Mr. Jones. And today we are back... Oh, wait, do want to say what the show's about?
Sarah Kendzior:
Sure. And this is Gaslit Nation, a podcast covering corruption in the Trump administration and rising autocracy around the world.
Andrea Chalupa:
And we are back with our special guest, Timothy Snyder. I think Tim is the one guest ever in Gaslit Nation history to be a repeat guest.
Sarah Kendzior:
That's true.
Andrea Chalupa:
Which makes perfect sense for these times. Tim is back to talk about his latest book–which is extraordinary–called Our Malady: Lessons in Liberty and Solidarity. Welcome to Gaslit Nation, again.
Tim Snyder:
It’s so nice that you didn't forget about the last time. Glad to be here.
Andrea Chalupa:
I have to start off on a personal note, because 2019, which of course, your book gets started with a horrible medical experience that you had at the very tail end of 2019, and I have to start on this personal note. I obviously, as you know, because you were the historical advisor of Mr. Jones, directed by Agnieszka Holland, the film that I wrote and produced, a film that would simply not exist, if it weren't for you at all. That's just the truth.
Andrea Chalupa:
You introduced me to Agnieszka, you were our historical advisor, all of it. I was going back and forth with you a lot over email, and on December 20th, I got the most beautiful, warm-hearted email from you. It was just so thoughtful. It was one of those just deeply sincere and touching emails that I had to set aside time to respond to you, because I was in the middle of hunkering down for the holidays and catching up on work, having just had a baby.
Andrea Chalupa:
I responded to you on January 4th, which is when I crawled out of my cave, and by then I was too late. You were already in the hospital, and I was so shocked to learn from your book coming out that you had this horrific illness and experience in the hospital. This overall theme that we've all been grappling with, that Sarah and I talked a lot about on this show, in our bonus episodes on Patreon and the conversation we had with another special guest Tori Amos, about loss and how precious and fragile life is, how precious and fragile democracy is.
Andrea Chalupa:
So, for me, reading Our Malady, I was really shaken to the core of how close I came from losing you. Whether I know you personally or not, doesn't matter. I think I speak on behalf of countless people around the world of how many lives you've touched by giving a voice–such a clear, moral voice–to all the atrocities happening in the world today, and over the last 100 years or so, and how to understand them and how to confront them.
Andrea Chalupa:
I just was really, to my core, so shaken by this book, and I strongly urge everyone to read it and to not take anybody in your life for granted whether you know them or not. I just wanted to say that to you personally, how your book touched me.
Tim Snyder:
Oh, thank you. That's so kind. It's so kind that you remember that. When I wrote to you, that was between my second and third hospital stays, so it was after my first operation and before the second round of operations. It was during the phase in the book that I described-I don't know if you noticed the coincidence–but it was during the phase of the book that I described where, as the infection of my liver was growing unaccounted for and unnoted, I began to feel this expanded sense of empathy towards people in general.
Tim Snyder:
I wrote a few emails like the one that I wrote to you to people who I thought, in some way, I had been slightly unfair to or I hadn't responded to in the right way or something like this. With you, I was thinking, oh, well, we've been in touch about all these different things over the years, and sometimes I've tried to stop you from doing something or tried to change what you were doing or given you some advice. Sometimes I can be very quick and short over email.
Tim Snyder:
I also realized, I was looking back at the last couple of years that you had spent–it was dawning me on just how tough that time must have been for you. So the email that I wrote to you actually fits into the story that I'm telling in the book. I wrote to a few people at that time that I wanted to make sure I wrote to. Let's put it that way.
Andrea Chalupa:
Oh, my God, now I'm even more touched. Thank you so much, Tim. I know this is hard... Sarah's like the third wheel here. [laughs] I'm just kidding.
Sarah Kendzior:
No, I'm just taking this all in.
Andrea Chalupa:
No, that meant a lot to me because our whole being in the trenches goes back to Bloodlands coming out, Europe Between Hitler and Stalin, and how those monsters influenced each other. You were the first to really popularize Gareth Jones on a mainstream level. All those years that followed, I felt like you and I and so many others were in the trenches, fact checking the Kremlin's massive propaganda war against the West in real time, and it felt like an emergency room at times, the energy.
Andrea Chalupa:
Your support has been tremendous to me, personally, my family and democracy as we know it in the West. I'm glad we got that out there. I'm glad that I was in your fever dreams in those hospitals that we were able to-
Tim Snyder:
That can be taken out of context right there. [laughs] It's nice to hear you say all that. Particularly, if you think back to late 2013, early 2014, when there were just so few people who realized that what the Russians were doing with respect to Ukraine was part of a larger change in how relations with the West were going to look and how social media was going to look–and there were so few people who were actually attending to what was happening in Ukraine, as opposed to Russian propaganda about it–I felt very alone at that time. You were one of the people who were out there in the world that I felt I could send things to and would understand. That was important for me, too.
Andrea Chalupa:
I feel like this is what COVID has brought us to, is zero time anymore for any pretense. Let's just get down to what matters and just say what matters. Your book very much captures that honest conversation that you need to have with Americans, especially, because what Our Malady is about is self destruction– America's self-destruction–and how especially some of the most... Oddly enough, the most vulnerable to the corruption, the malpractice, the propaganda, are white men, white people. You go into the counties that have suffered greatly from opioid. Am I saying that... Opioid addiction.
Sarah Kendzior:
Opioid.
Andrea Chalupa:
Yeah–largely voted for Trump. This underlying pain was there. The self-destruction was there, and it just is so incredible that they furthered it by voting for their own demise. I know I'm jumping ahead thematically because your book goes into so much, but could you just try your best with what I just said to jumpstart your discussion of what you try to accomplish with Our Malady?
Tim Snyder:
Yeah. There are a lot of points of departure. The way I tried to write the book is that I talk about specific moments during my own hospitalization where something happened to me or something dawned on me, or I observed something which I realized had a larger significance. You're right about COVID and you're right about what it's like to be very sick. All of a sudden, things were very stark and there was no point messing around with the analysis.
Tim Snyder:
The bit of book that you're talking about, I'm starting from my own problems with pain, basically. By a problem with pain, I don't mean that I have a lot of physical pain. That's true. But, what I meant is my inability to talk about it.
Tim Snyder:
In the story of my illness, a lot of things go wrong and a lot of them weren’t the fault of individual doctors or nurses. I think generally, they were the fault of a system which makes it impossible for doctors and nurses to work, and maybe we'll go into some of those details and some of that structure. But some of the problem was that repeatedly, I was unable to tell people that I hurt a lot.
Tim Snyder:
When my appendix burst, for example, I basically shrugged it off, and that's not the right thing to do. All you Midwestern white guys out there, that's not the right thing to do. If you're in intense pain, you should try to talk about the intense pain. That got me thinking about the sociology of all this and the history of all this. Let's try to be historically sympathetic for a minute. There was a time when you could think pain was productive if you were a farmer–and that's where I come from, that's my family comes from–or if you work in a factory, you could think, okay, well, I'm suffering physically, but there's a point to all this, because I'm doing labor, and my farm is doing well, or my union is making sure I get treated all right, and my kids are going to live better than I do.
Tim Snyder:
And that thing which is called the American dream, which was a result of post-war prosperity but also a result of the welfare state, that thing no longer holds. That thing no longer obtains. There are a lot of people who have that story about how pain is supposed to make sense because it leads somewhere, right? I sympathize with that. I think there are definitely times when you should close your mouth and take some pain because you're doing something that matters. But the problem is that when over and over again it doesn't matter, where do you end up? You end up, instead of with a sense of satisfaction that you've suffered some purpose, you end up with the sense that nothing makes sense. You're somehow doing your part, you're suffering, but nothing's happening.
Tim Snyder:
That's not the fault of the individual people who have this mindset; it's a result of the fact that we no longer... Factory jobs peaked in this country in 1979. Small farming is basically untenable now in most of the country, but that mindset is there. What I'm thinking about in the book is, okay, where does it take you if you just pull that to its logical conclusion? If you pull that to its logical conclusion in the country that doesn't have a proper medical system–where no one's going to counsel you about pain, where no one's going to talk to you about physical therapy, or physical exercise–where that leads you is to the pills. That leads you to the pills. You go from being someone who never talks about pain to someone who never talks about the pills that you take for your pain. There's that switch, and that switch has happened.
Tim Snyder:
You go from being someone who is proud, to being someone who is resentful. I'm trying to follow that. I'm trying to look at my own weaknesses and failures and trying to explain how we got to where we are with some sympathy for people who...as I agree with you, people are making terrible mistakes, we obviously need to have more health care rather than less. But I'm trying to see a little bit where that came from. This is another point in the book: when there's a lot of pain in the system, which there is, our politics starts to be about pain. It's no longer so much about the pursuit of happiness and opportunity, it's now about all the pain in the system, the physical pain, the emotional pain, the anxiety and the fear that we have, not just because of the pandemic, but for many other reasons.
Tim Snyder:
It's about politicians like Mr. Trump, who will never create opportunity for anyone, who don't care at all about the pursuit of happiness except possibly for themselves, but who are very good at taking that pain that's already in the system and moving it around and manipulating it and directing it the way they want it to go.
Sarah Kendzior:
Yeah, I have some questions about this because I live in a part of the country that was hit very badly, very disproportionately by the opioid crisis, in Missouri, and it's also a part of the country where right now we're seeing this reaction to coronavirus, not uniformly, but more so here where people are refusing to wear masks, refusing to cooperate with some protocols. I've wondered if that is not rooted so much in the gleeful, violent attitudes that are portrayed in the media, but out of fear—out of fear of abandonment, out of fear of nobody recognizing pain, recognizing death and no trust in the people who were supposed to stop the pain.
Sarah Kendzior:
That's the thing that I witnessed here firsthand over the last 10 to 15 years, was this erosion of trust in institutional systems. It didn't matter if it was Bush, or Obama. It often doesn't matter if it's Trump; not all of these people are Trump supporters. It's just this kind of suspicion that no one is really out to help you, no one is really out to protect you, so ‘veyou got to get life while you can. It's going to end, it's going to collapse, you better go out, enjoy it while it lasts. Don't bother at the mask.
Sarah Kendzior:
It's viewed as selfishness and to a large degree it is because you obviously are risking infecting other people. But what I see at the heart of it is just such intense fright. I don't know, I was wondering if you saw that as well?
Tim Snyder:
I agree with that. I agree with that completely. I think some other things are going on, but I think that's a very important part of it. Let me try to talk about that by way of what the opposite looks like. I'm in Vienna now, I'm in Austria now. In the book, I try to counterpoint experiences that I've had in the US with experiences that I've had in Austria, or in Europe more broadly, because my adult life has been roughly split between the two places, and one of my children was born in Europe, one of my children was born in the US.
Tim Snyder:
I've been quite sick in Europe, I've been quite sick in the US. What strikes me is how that thing that you're talking about doesn't have to exist, you know? You can have trust in the institutions, but only if the institutions are really there. That's the reasonableness of the phenomenon you're describing. Austrian men–Austrians in general–are not more reasonable than Americans, you know? The way they talk about coronavirus is not all that different than the way Americans do, at a bar or whatever. The level of paranoia and so on is not really very much different. But the institutions are there, and that means that everybody takes for granted that if they get sick, they're going to be taken care of, and everyone takes for granted that they're not going to be treated worse than other people.
Tim Snyder:
It's taken for granted to such an extent that you have to really fight hard to try to explain to people who live in a welfare state like this one, what it's like not to have that basic level of security. I think security is the right word for it. When we use the word security, we immediately are thinking about weapons and wars and things. But people's base level of security has to do with things like this: if I get sick, will someone take care of me? If I get sick, will I be treated well or will I be treated badly?
Tim Snyder:
The US system is set up in such a way that everybody knows that it's a competition, and it is. Everybody knows that it's private and everybody knows that people get treated ahead of other people for absolutely the wrong reasons. So, the suspicion of the system is justified, and if you make the system bad enough, people will start to jump off the system at some point.
Tim Snyder:
You can tell them, you know, this particular thing you're doing–not wearing masks–is deadly for you and for your family, and you'll be right. But the underlying suspicion of things comes out of the underlying disaster of the institutions. Then what follows from that is that if you want people to behave in a more reasonable way, or if you want people to think that they're part of a larger society which takes care of itself, you have to help them by giving them the basic institutions, whether it's public hygiene, or public health, or anything else. If those institutions are there, many of the same people who are behaving in this way now will behave in a different way in the future.
Andrea Chalupa:
You came out with this book, and as you were writing it, the world was hit with a pandemic. It's just extraordinary to me, the timing and the urgency and the stunning statistics that you give that capture this extremely dangerous moment in time for Americans, with, right now as we're recording, 200,000 dead to COVID. That number could be low for all we know, because the institutions, right? We don't know who we can trust anymore, and we don't know how many more we may lose before the year is over, but the projections look terrifying. So, could you talk a little bit about... I want to get into this autocratic danger that we're under and how COVID is being exploited by Trump, but I also want to start with just a general idea from you–based on what you go into in the book–on how the US healthcare system compares to other parts of the world, including Belarus, which beats us on some things.
Tim Snyder:
Yeah. Okay, let me start then with that. When I call the book, Our Malady, I have a lot of things in mind. One of the things I do in the book is I list some of what I think of as the basic symptoms of Our Malady, surrounding the most fundamental issues: life and death, birth and death. If you're an African American woman, and you're pregnant, there are 70 countries you can go to where your baby is less likely to die than the US. 70. If you're an American woman in general, there are 40 countries that you can go to where your baby's less likely to die. That's a conservative estimate. It's probably more than 40.
Tim Snyder:
At the other end, we are living shorter lives than we were promised. Our oligarchs have been talking for the last five or six years about immortality, whereas in general, US life expectancy peaked in 2014, six years ago, which if you happened to be born around the year 2000, it's a pretty gloomy prospect. You're now looking forward to living a shorter life perhaps than your parents or your grandparents or even your great grandparents.
Tim Snyder:
Those kinds of things are fundamentally wrong, but those are just the symptoms. Then we have to ask how we got there. My basic diagnosis of this system–and of course, I'm coming to this as a historian and as someone who's lived in different places around the world, and as someone who's thought about rights and about survival and different kinds of more drastic circumstances–but my basic analysis of this is that it has to do with thinking about freedom in the wrong way.
Tim Snyder:
One of the interesting reactions to this book is that a lot of Americans have read a fragment of it, or they've heard me talk about it, and they write me and they say, essentially, “I don't feel comfortable being that free. I don't feel comfortable having that.” I argue in the book, the first of the four lessons is that healthcare is a human right. American reaction to that is, "I don't really think I deserve... "–People use the word deserve.–"I don't think I deserve that right. I don't think other people deserve that right"
Tim Snyder:
I think here, Americans are making a basic mistake. I think we're defining freedom so narrowly that we're turning it into a ghost, we're turning it into a shadow, because if freedom only means the free market, or freedom only means the things that we can do when we're already healthy, well, a lot of us aren't healthy, and not just during a pandemic.
Tim Snyder:
There's a basic connection here, which came very clear to me. When I was too weak to talk, when my lungs were collapsed, I did not have freedom of speech. When I was too weak to leave my bed, I did not have freedom of assembly. When I was thinking about the future lives of my children, and of everyone I knew, without me alive, I was not free at all because freedom is about imagining different unpredictable futures, and how you might influence them along with other people in their own unpredictable, beautiful, unique ways.
Tim Snyder:
Personally, I could see that the freedoms that we have don't make any sense without health. The funny thing is, the founders weren't so far away from this. Jefferson, when he talked about the pursuit of happiness, was actually talking about the physical pursuit of happiness, which involved healthy bodies, and the founders were very preoccupied with health.
Tim Snyder:
So, what's happened in the US is that we talk about freedom in a narrow way which excludes our bodies. Of course, there are exceptions, right? When people are working for women's rights, there are people who think about the body, of course, philosophers, but in general, in America, when we talk about freedom, we're not talking about the body. What that means is that the body, instead of being a subject–that is something that has rights–has slowly become an object. It's become just one more object in the market.
Tim Snyder:
That free market, which is supposed to bring us freedom–and it does when we're talking about other objects, it brings us choice of objects, that's fine–but when our body becomes an object, that means we are no longer free. When we become a thing, we're no longer free. We are literally a thing. Our healthcare system is mainly about wealth transfer. It's secondarily about healthcare. It's mainly about wealth transfers. Healthcare is the surface under which wealth transfer takes place.
Tim Snyder:
This means that women are kicked out of the hospital too soon after birth, and that's why they die, and their children die, or they're admitted to the hospital too late and that's why they die and their children die, and that's all economics. It means that after I had... We're telling my story in bits and pieces here, and I hope not to tell it all. But after I had my appendix removed, I left the hospital a few hours later, which in places as far afield as Bulgaria or India–it doesn't really matter where–would be considered outrageous. In pretty much anywhere around the world, you'd be on fluid antibiotics for three to five days. If I had been on fluid antibiotics for three to five days, the liver infection, which the doctors noticed but forgot to mention, and which almost killed me, it wouldn't have killed me if I'd been around. It wouldn't have been so dangerous if I've been on my antibiotics. But I was taken out of the hospital immediately because hospital beds are expensive. That's all there is to it. We can tell ourselves other stories, but that's all... I mean, my life was put at risk on these trivial financial grounds, just like everybody's is.
Tim Snyder:
This leads us to the situation where, you know, we don't know how to talk about freedom anymore. It's become so ingrained in us that health care is a benefit or a privilege or something that black people or immigrants are going to abuse, right? Those are our mental habits. If we don't think about it as freedom, then we lose the other freedoms too, which we're seeing this year. As health spirals down, then freedom spirals downward. Whether on the left or the right, I think you can agree on that. The two things are obviously connected, and the only way to be more free is to get the health piece. I think it works the other way around as well. The only way to get the health is to get the freedom piece right. Because if we truly were a democracy, people would be voting for the kinds of things that I'm talking about. The kinds of things that I'm talking about are actually popular, they're just blocked by the institutions.
Sarah Kendzior:
I'm curious what you do think about Trump and the pandemic. When we first spoke to you, it was a bit earlier on in the pandemic, the death toll was lower. I know we talked somewhat about grief and loss, but just thinking of this, thinking of the pandemic in the context of this broader institutional collapse–the collapse of institutions that were weak already–I don't know, there's so many things I want your opinion on. But I guess one of them, to go back to what you originally said earlier about empathy, is that we have not really had as a nation a kind of collective mourning for the victims of this pandemic. We haven't had a lowering of the flag. We haven't had any of the symbolic actions that bind a country together during a time of tragedy.
Sarah Kendzior:
What do you think about that? Is that unique to Trump and to America? Is that part of a broader loss of empathy and respect for life?
Tim Snyder:
Yeah, it's terrible, isn't it? It's terrible. I've been thinking about this, too. I've been thinking about it in connection to truth. I keep thinking back to January and February, which was when I was in the hospital, and which was also when the coronavirus was identified and its DNA was logged and released. I was still in the hospital when the South Koreans were starting to get their minds around this and starting to do the right thing. Even proportionate to population, their deaths are about 1% of ours, 1%.
Tim Snyder:
The thing which struck me at the time with truth is the empirical truth, that we're a country which doesn't have the authorities to trust and doesn't have trust in authorities. In particular, we don't have local news anymore, and we don't notice that we don't have it, but if we had local news, people would have had an inkling of what was happening around them, instead of just listening to Washington D.C. or listening to Russian-Chinese propaganda.
Tim Snyder:
It's a horrible, horrible thing that in dinner tables, whether it's Missouri or Ohio or anywhere around the country, you hear people repeating things that they get from Facebook, which come from other countries, even though COVID itself was actually right around the corner, but there was no one to report on it. This is one of the chapters in the book. One the chapters in the book is called The Truth Will Set You Free. I'm thinking about local news there, but I'm also thinking about testing.
Tim Snyder:
Truth is about courage, right? This is a big theme, obviously of Andrea's work with Gareth Jones. Truth is about courage. Truth is not about accepting the obvious or the apparent or what other people think. Truth is about courage. Truth is about saying the thing which people don't want to hear, and that's what testing is. You never want to get a positive result. You don't want to be tested for COVID and find out that you have it. But to take that attitude of putting your head in the sand and raise it to the level of federal policy is just the purest of tyranny.
Tim Snyder:
As tyranny was diagnosed by Plato, the tyrant doesn't want to hear the bad news. We created this situation where the tyrant explicitly says he wants to see low numbers. So, we get low numbers. But the way we get low numbers is by not testing. I think by the end of February, we had tested 352 people, that's one in 1 million Americans had been tested. That's stunning. Everybody did better than that, everybody, including countries which are far, far poorer than we. Everybody did better than that. But it's an attitude, that it's better not to know. If you don't know about it, it's not happening.
Tim Snyder:
Then that kind of indifference to truth is related to another kind of truth, the moral truth that you're talking about, that each of us is alive once and each of us can die, and there's a specific tragedy each time someone dies, especially unnecessarily. That basic truth, that truth of empathy, that truth of empathy has gone missing. It's been absent at the top of our government. Partly because we're confused about what's happening and partly because people disagree politically about the causes of it, we just don't have it. To me, it's horrifying.
Tim Snyder:
We take for granted that several hundred people or 1,000 people or 2,000 people can die every day of something which wasn't, at this point entirely preventable, and it just rolls on. But I guess what I want to say, Sarah is I think those two kinds of truths are related, because to face the facts about risk and disease takes a tiny bit of courage. Just like empathizing with someone else takes a tiny bit of courage. That tiny bit of courage was the one thing which was just absolutely lacking at the top of our government.
Sarah Kendzior:
Yeah, and there's almost a punitive factor involved in that they've made it so difficult to get that truth, to be tested. In so many places, if you suspect you have symptoms, there's not only the stigma around it, the natural fear of having it, but the inability to actually get the test and to get the results in a prompt way, and the fear in the meantime that you might be infecting others. Do you see a solution to this? It's both a matter of policy, but it's also a matter of political culture. Do you think it's possible for the US to change?
Tim Snyder:
I want to bear down on the premise of your question, because… then I want to go back to Andrea's question which I never quite answered. The book is about pain and anxiety inside American society, and where they come from and how they can be politically manipulated. What's happened with this pandemic is, unfortunately, just a perfect example of all of this. The way that Trump reacted...I mean, putting it as a lack of courage is the nicest thing that one can say about it. So, I tried to say the nicest thing first.
Tim Snyder:
But if we follow the chronology now, what we see is that there was essentially a deliberate attempt to allow more pain out into the system. We all knew. What Bob Woodward reports was not a revelation, right? We all knew, of course, that the president knew that this disease was contagious and lethal. How could he not have known that? But when the president says he didn't talk about it because he didn't want to cause panic, what panic is he talking about? Because his entire discourse is about causing panic, both for people who like him and people don't like him. We're both supposed to panic.
Tim Snyder:
I think what he meant was panic in the stock market. The first few days or a few weeks of silence and misleading, allow senators to change their stock profiles and allow people who are in the know–as, of course, many people were–to rearrange their finances. So that billionaires, for example, do very, very well in the first six to eight weeks of this pandemic while everyone else is going to do terribly. Then there's the next stage where there's the disease, and they make the decision in late March, early April, that they're going to let New York die. They're going to let Washington die. They're going to blame the Democratic governors. There's going to be no federal policy–which is just shocking–no federal contact tracing, no federal testing initiative, because they see it's in the blue states. They see it's Black and Brown people. Let them die, then blame the Democrats.
Tim Snyder:
That's horrible, and of course, it backfires, in the sense that the Democratic governors and Democratic mayors figure out more quickly what to do in public health and cut loose from the federal government. They eventually come up with sound local and state level policies, and the disease is not vulnerable to propaganda, and it spreads to the other states where it's now raging out of control in places like North Dakota, where the governor had declared her people basically immune because of personal responsibility and so on.
Tim Snyder:
Then you really do have this thing that Trump talked about when he took the oath of office, you really do have carnage, and it's created by a series of deliberative decisions. This is the thing: when Europeans ask me about the situation in America, they don't ask about inefficiency. It's obvious from the outside that disaster of this magnitude can only be political. Now, people put in the active voice, they say, "How could he have done this? How did you do this to yourselves?" They don't say, "How could it happen?" They say, "How did you do this?" In a horrifying way, the death of 300,000 Americans–which is what it's going to be by the end of the year–that's an achievement, right? That's something which is a result of deliberate policy choices.
Tim Snyder:
Where we are now is... I mean, one of the reasons why we're in an election which is about regime change, is that, of course, the pandemic, despite everything that we've said about how Americans process pain and so on, the pandemic has made Mr. Trump less popular, and he understands that. He's not a fool. He's quite intelligent in his way. He knows that he's not going to win the election in a conventional way, and he knows he has to win, for all the reasons the two of you talk about all the time. Every autocrat wants to die in a comfortable bed and not in a prison cell. So, he has to win.
Tim Snyder:
So, this means that this election is all or nothing for him. Since he doesn't care about democracy anyway, he has to win. We're now facing a situation where we have the head of state who is going to try to spoil the election, or who's going to try to deny the results or try to create chaos in some way to stay in power. That is all a natural result of what's happened with COVID thus far. His attempt to say, “it's not about COVID, it's about Black people riding in cities”, this is all one ploy. This is all one politics. It all fits together in the end.
Andrea Chalupa:
Yeah, absolutely. What I love about Our Malady is how, as you walk us through this American healthcare dystopia, you also present solutions. For instance, with the horrific decline of local news, which has allowed propaganda/disinformation to flourish–and as a result we have QAnon and people voting against their own interests–you recommend a tax for social media giants that have been profiting off of all this labor of newspapers. Facebook is essentially now a publisher for newspapers. People blast out those articles on Facebook and so forth, but without having to pay for all that investigative work that goes into producing those articles.
Andrea Chalupa:
So you recommend a tax for the social media giants to pay their fair share to go towards restoring local news across the land.
Tim Snyder:
Thanks for that prompt because I didn't get around to the nice part of Sarah's question which was, can we recover? And I think we can. So many of these things are negative spirals with a couple of factors where if you change one of the factors, you can get a positive spiral. I believe that for the general issue of health and freedom. I think we're in a downward spiral where decline of health brings about the decline of freedom. But I think if we had, for example, more democratic elections, we'd have better health care. If we had better health care, we would be free.
Tim Snyder:
It's possible to have a positive interaction as well. To answer Sarah's question directly, some of these things are actually quite easy. Just for example, if in the next presidential administration, we really have very quickly, massive, inexpensive, shame-free, rapid testing, we can get on top of this particular disease pretty quickly. That can be done. That's not a matter of technique; it's a matter of wanting to do it. So there are things that can be turned around very quickly.
Tim Snyder:
I tried to make the book about lessons. The point of writing the book was to see what I could learn that might have general relevance, and then how we can look at the general issues and turn them around. The four general lessons in the book are that healthcare is a human right, that freedom begins with children, that truth will set us free and that doctors should be in charge.
Tim Snyder:
There are little things that are common sense things along the way. With the truth setting us free, those companies should also be broken up, they should be broken up
Andrea Chalupa:
Yes
Tim Snyder:
Hayek, no one can fault as a crazy socialist. Friedrich von Hayek, the Bard of American libertarianism, thinks that competition is the point, and he's right. In his realm of analysis, you should have competition. We don't have competition, we have monopolies. We have monopolies, both in information and in healthcare.
Tim Snyder:
It doesn't matter if your local hospital kills you because–even if you're just a free market thinker, all you libertarians out there–it doesn't matter if your local hospital kills you, because it has no competitor. It can kill your wife and your brother and your child too because there's no competitor, unless you feel like driving to the next state, or you have the resources to go to another country. We're increasingly trapped in a system of regional monopolies.
Tim Snyder:
Monopoly is a problem but it's a problem that governments can solve, whether it's about information or whether it's about the healthcare system. The doctors–who we haven't talked about–the doctors play this odd role in the book, because...Individual doctors do some pretty outrageous things to me, and the people around me, but at the same time–with a couple exceptions–it's very hard for me to be angry at them, because you see the untenable pressure that they're under. They're just people. During the pandemic, we want to talk about them as heroes? No, let's not do that. As soon as you talk about people as heroes, what you're saying is that you're accepting that the system is a wreck. As soon as that hero language emerges, it's because you're saying, “well, the general system is a total mess. We can't do anything about it. So, let's celebrate the heroes.”
Tim Snyder:
I think that's wrong. From this pandemic, we should be drawing the conclusion that our doctors were already in an impossible situation where they don't have the authority they need (because they're too much like employees), where their time is not their own (they can't have appointments that are long enough because they're not their own bosses), where they're plagued by debt, and the people who want to do the right thing, which is do family practice, and geriatrics and pediatrics, can't pay off their loans. So, they go into specializations which are important, but of course, much less important than primary care.
Tim Snyder:
Doctors are gagged because they're private employees, and therefore, during the pandemic, and in general, they can't speak up to the country about what's actually going on. These things should also be changed and there are specific ways that we could change these things. I try to go into some of them in the book.
Andrea Chalupa:
Yeah, and that's such an important point, the antitrust laws that could be used to break up all of these monopolies. Reading your book, I'm reminded of this phrase I heard when I was living in Ukraine in 2005, that the oligarchs saw the people as the shit they grow their money in. That's what comes up again and again in reading about our health care system.
Tim Snyder:
I wish it were otherwise. What's happened is that people in private equity companies–perfectly understandably, following their own way of thinking–see medical care as an industry which won't go away. But the problem is that when you approach medical care from the point of view of profit, you don't care about whether people live or die. You don't. That has nothing to do with it. The only thing that matters is whether people are sick in the right way, and for the right length of time.
Tim Snyder:
So, medical care–as it becomes privatized and monopolized–is going to focus more and more on things like implants, just to take an example of a surgery where you can make a lot of money. It might not be necessary. In a lot of cases, implants probably are just going to kill you. But they're quick, they're easy, and you make money from them. If it's all on the market logic, you're going to move away from the stuff like basic hygiene, physical therapy, physical exercise, prevention–the things that help us, especially when we're young, to have a chance for a long, happy and free life–we're going to move away from those things and we're going to move towards the things that are in the middle of life and the end of life, which just happen to be profitable.
Tim Snyder:
Following market logic, that, of course, makes perfect sense. If you're taking part in a private equity company, that's the logic that you're going to follow. That's why we have to follow a different logic. That's why we have to say, no, we can't allow our bodies to be the thing that other people make their money from. Our bodies are part of us, and we have rights, and one of those rights has to be a right to healthcare, because otherwise none of the other rights are going to make sense.
Andrea Chalupa:
One of the solutions that you present in the book is this exotic concept here in the US of paternity leave, and why it's important for fathers...Well, first of all, we have a crisis of maternity leave in America compared to most industrialized nations, as we all know. And your comparison of what it was like to have one of your children born in an EU country versus the US, it's quite stark. Could you talk a little bit about that whole section of birth, in your own personal story, of how important that support is for families. It's so extraordinary and eye opening, because you talk about how what happens in those early years for a child, for families, sets the course of the rest of that person's life. It's that important and impactful. Here in America, because of this profit motive, we're essentially setting up these families–these babies born in the world–for a harder time, because they don't have the resources and support they need, including time for the parents away from work. Could you talk about that generally, and then also specifically about this exotic concept of paternity leave and why that's essential?
Tim Snyder:
A whole chapter of the book is about children and, like the bits of the book that are about illness and death, the parts that are about children are comparative, and they start from my own experience and then they move into the statistics and the comparisons. My own experience in Austria with the birth of my first child was really instructive. It was one of these things, like a lot of my experiences in Europe, which taught me just how much of an American I was, and how some of the things that I internalized and took for granted as natural as an American were harmful and strange.
Tim Snyder:
My wife and I went to birthing classes in Vienna, which was free, because it's a welfare state, and which was maybe useful. It was kind of a funny situation, there were lots of tennis balls and things involved. We did learn some useful things about breathing. But in the birthing classes, they separated, at one point, the men from the women. First, the couples were together, then they separated the men from the women, so you were talking with these guys. So we're already, I think, in a pretty unAmerican situation. And the guys were talking about their two years of parental leave, because in Austria, then is now. The deal is basically that you have two years, and the two partners are going to decide how to split up those two years.
Tim Snyder:
Maybe you'll take three months, while your wife is taking... You know, you have two years total, and you can take some of it together, and some of it apart, you have these various options. But the thing that I want to get across is the two years. The two years!
Tim Snyder:
I was talking to these guys, and I didn't want to feel bad about myself, I didn't want to feel bad about my country. I was saying, “well, yeah, we have good maternity leave, too. My wife is going to have three months”. Then, they made fun of me, and totally correctly. Then it dawned on me, as it's dawned on me in other situations, how much of a trap we're in in the US. Because this is all competitive, you can have something which is bad, but because it's less bad than what everyone else has, you think you've got it good, right?
Tim Snyder:
So I thought that the three months for my wife was good, because it's better than what a lot of other people have in the US. But that just shows how trapped I was in this competitive logic. There's just no reason why Americans should have less parental leave than people in other countries. There are lots of reasons, now moving to the essential, why we should.
Tim Snyder:
In this book, I take really seriously the idea of freedom. Freedom is a concept. It's a word that we toss around an awful lot. With the lightest provocation, we start talking about our freedom. And the way we talk about freedom is freedom means that I can do what I want to do. Freedom is being left alone, but birth–and anybody who's been a parent knows this–birth is where that story or freedom goes to die. You cannot say to an infant, "Okay, we're going to leave you on your own and you're free because you can just make your choices." That's ridiculous. In order for that infant to become a free person, there has to be all kinds of time and attention and thought devoted to that infant, especially as you say in the first five years.
Tim Snyder:
One of the things that I've been reading about for other reasons is the first five years of life. So much of what we need to become a free person, like the ability to name and restrain emotions, the ability to act independently, the ability to resist and defer gratification, the ability to trust, all of these things are developed–or not, sadly–in the first five years.
Tim Snyder:
The science on this in the last 30 years is really strong. That has enormous implications for freedom. It means that if you want to have a chance of having a next generation that's free, you have to build in the structures so that small children can get the attention they need to develop those capacities, which will allow them later to be free.
Tim Snyder:
What does that mean in practice? It means parental leave. It means maternity leave and paternity leave. It means giving parents a chance to spend time with their children, which of course, we should have anyway. Insofar as parents want that and can't get it, it's a violation of their freedom. But fundamentally, it's about the freedom of the child, allowing the child to be a free person. If America is going to be a free country over generations, that's the way that we have to think.
Tim Snyder:
Again, going back to both of your questions, this stuff can be changed. If you change the policy, you also change the mentality. European countries also did not always have paternity leave. But once you have paternity leave, and you see... I talk about this in the book, but when you have paternity leave, and you see other men out there with their little kids, that immediately makes it normal for you, and you think, oh, that's cool, that guy got to take three months off, and now he's with his kid. That's actually pretty great.
Tim Snyder:
Then when you can do it with your kid, and you're out there, and you see the other guys with their kids, you think, wow, this is actually pretty fantastic. If you change the policy, then you change the norms and the way people think and behave, what they think is normal changes really quickly. What we have now, with respect to parental leave, is barbaric. It's utterly barbaric. No one can understand how we can possibly create a situation like this for the women and for the men who have to raise kids and above all, for the kids themselves.
Andrea Chalupa:
Yeah, and it helps explain just one component of declining life expectancy in America. I have to also point out because in your book, you talk about your wife quite a bit and your wife is the great historian, Marci Shore, and I have to give Marci Shore a big shout out, because when we were on set in Poland, Agnieszka Holland gave me Marci's book to read overnight, Caviar and Ashes: A Warsaw Generation's Life and Death in Marxism.
Andrea Chalupa:
Marci's book went into helping create the final version of Ada, in our film, Mr. Jones, played beautifully by the great Vanessa Kirby. So Marci's DNA–her mind, her DNA–went into creating that character. I just wanted to give Marci my gratitude for that, and how much fun I had staying up until 4:00 AM in Warsaw reading that book overnight before working on script changes for countless hours. [laughs]
Andrea Chalupa:
I just had to say that because any opportunity to bring up Marci, I'm going to seize, of course. So, I wanted just to get your comment because this news came out today about the shocking statistics of how a substantial number of young Americans have Holocaust denial, or they haven't heard of the Holocaust, and there's just this crisis level of lacking of Holocaust education in America. Could you comment on that?
Tim Snyder:
It's distressing, but it's not surprising. Look, as someone who teaches history, I'm not naive about how difficult it is to get any basic body of knowledge across. But the Holocaust is a particularly important body of knowledge to get across, precisely because it's so revealing, not just about what people can do to people in general, but about some of the possibilities of our modern world. So many things which go into the Holocaust–the question of whether they're universal values or not (Hitler says not), the question of whether there are scientific solutions that can help the world as a whole, or whether we have to compete all the time for territory and take from others (Hitler obviously says the second), the question of whether globalization is a challenge or whether globalization is a plot (obviously, Hitler said it's a plot, in his case, a plot of the Jews)–all of these things are terribly contemporary. In addition to the other basic lessons about how we use language and how we treat our neighbors, the history of the Holocaust is really important.
Tim Snyder:
It's one of our chances to make the 21st century better than the 20th. Even little things like how Hitler came to power with the Reichstag fire, the emergency which you exploit to change the political system, that's a concept which I would venture to say all Americans could really use this October or this November, this December and during the Trump presidency in general. The danger of emergency politics, emergency politics as the way par excellence that you turn a republic into something else. All of that is in the history of the Holocaust. Those are some of the reasons, not all, but some of the reasons why we need it so much.
Tim Snyder:
I'm going to speak now from my own parochial point of view: a lot of it comes down to history. If you lose history in general, you can't have the history of any one thing. You can try to teach the Holocaust, but if you don't have history around it, it's going to be hard for people to remember it and hard for people to make sense of it.
Tim Snyder:
I'm all for the initiatives to teach the Holocaust, but the reason I think they don't get so much purchase is that young people don't have history as such. We've let history as such fall away. We've let the humanities as such fall away in favor of the idea of useful knowledge or technical knowledge, or knowledge that will make you a useful employee for someone else.
Tim Snyder:
Then, of course, to say the obvious, knowledge about the Holocaust is hard. We talked a little bit earlier about testing, and truth being about courage. It takes a little bit of courage to face not just what Germans did, but what Europeans did, and what human beings did, and what we can all do. That takes a little bit of courage. That's the exact opposite of the way that the algorithms on social media work. The algorithms on social media work not to encourage your virtues but to find your vices, to find your cowardice, to find the things that you would maybe like to think because it makes you feel immediately better in that moment.
Tim Snyder:
The algorithms help you to dismiss the suffering of others. They help you to think that your position is the only position which could possibly be right, that your suffering is the only suffering that could possibly matter, right? We used to think that machine plus man was going to make God, but it turns out machine plus man makes beast, in the sense that the algorithms make us heartless. They make us less sensitive, unfortunately, to other human beings.
Tim Snyder:
The details are also there, that if you ask young people, they'll say, well, I've heard this Holocaust denial story, I've heard this other Holocaust denial story on Facebook, on the internet. But in general, I think the way that social media works pushes us away from understanding the suffering of others, or even an attempt to try to understand the suffering of others, let alone what the suffering of others might mean for us.
Sarah Kendzior:
One of the things that was really striking about this article about people's level of knowledge about the Holocaust is that it was mostly younger people who really didn't know, or they had views like, it was the Jews’ own fault, or things like that.
Sarah Kendzior:
I agree with you that we've lost education, we've lost history, people are simply not taught at the level that they used to be. But of course, you also have these disinformation campaigns over the internet. And that's something I'm very concerned about, as a mother of two kids who can read, who go online, who search for things, I'm always trying to steer them away from accidentally stumbling into some sort of cesspool of disinformation. Do you have advice for parents or for teachers as to how to simultaneously encourage young people to be independent thinkers, independent researchers, but to be able to identify disinformation, particularly when it's related to an issue like the Holocaust, where you're going to find conspiracy theories, you're going to find hate rhetoric, and so forth?
Tim Snyder:
Sarah, I'm glad you mentioned disinformation, because that's something that I forgot and it's really important. Sadly, there are entities, foreign and domestic–including Russia–which actively seek those weak points. Whether it's American history of racism, or whether it's the Holocaust, the things where, just by teaching people the wrong lessons, they know they can stir up trouble, right? There’s this totally amoral approach that if we get Americans to deny the Holocaust, we don't care... It's not that we care one way or the other (we the provocateurs) about the Holocaust, it's that we care about making people upset. We care about breaking down trust. We care about destroying the possibility that the American society can learn something from history.
Tim Snyder:
I don't have any super smart answers to this. My own approach with my own kids is that we read books. My own approach to screen time with my kids is very conservative. As far as there is screen time, it tends to focus on films as opposed to things where you search, because it's the rabbit hole, right? It's the YouTube algorithm which always leads you to the more extreme thing, and you can get very extreme within about 15 seconds if you just click from one thing to the next.
Tim Snyder:
I try, in teaching my own kids, to explain how the algorithms work in language that they can understand. This business of truth being courageous is something that I try to instill in them too, which means that the truth isn't the thing which is going to find you, right? If it's finding you, you should be suspicious. The truth is something you have to go out and find for yourself. It’s going to take a little work. It's going to involve listening to people, right? In this context, it means Jewish people. In US history in general, it often means African Americans. That's going to involve listening to people whose experiences are maybe different than your own. It's going to involve books, and it's going to involve people.
Tim Snyder:
It frightens me too, Sarah, because kids and everyone, they reach these levels of certainty after the repeated reinforcement, the repeated behaviors for reinforcement they get online. Those levels of certainty–even when we're not talking about the most crucial issues like the Holocaust–those levels of certainty are what's frightening, because if you're so sure about things, if your emotions have been solidified to such a point that you can't listen to other people, then right or wrong, important issue or not important issue, then we can't really talk as a country. I'm afraid that's all I've got.
Sarah Kendzior:
No, thank you. That's actually very helpful.
Andrea Chalupa:
A point we're always making on the show is to try to bring the Left and the Right together to understand how we got here. For instance, historically, the Left has sort of overlooked the threat of the Kremlin and Kremlin aggression. They call out America as imperialism but not so much when it comes to Russia, and you've had a lot of Left thinkers, politicians and writers appear on Russian state propaganda, like RT, namely RT. Meanwhile, you have on the Right, they look at the social safety net as handouts, entitlement, the welfare queen and all that other horrible propaganda that they've been spreading around since Reagan, if not earlier.
Andrea Chalupa:
What we try to do on the show is say, "Hey, everybody, you need to come together because Putin is very real, Russian imperialism and aggression is very real, and they're able to come into our country and weaponize our own weaknesses against us. That's why it's important to have the social safety net. That’s why it's important to pass these taxes to avoid being an oligarchy–well, too little too late for that–but in order to publicly finance healthcare and newsrooms and strengthen–literally strengthen–the bodies and the minds of our citizens so we can become a fully healthy democracy.
Andrea Chalupa:
From a lot of your writing, the recent books you've done from On Tyranny and now, Our Malady, it seems like you would be really the person to write the book on how we Trump-proof and Putin-proof our democracy. Coming with a 12-step program for our democracy. Here's the social media giant tax that you got to pass in order to bring back local news. You've got to break up the big healthcare giants and all of it. I'm basically treating you like a DJ at a party and putting in a request for your next book. That has to be done because our global nightmare isn't going to be over if Biden should get sworn in safely. It's not over then. We still have this demon unleashed. Putin is still alive, and there'll be somebody to replace him.
Andrea Chalupa:
Putinism is going to be with us for some time. Trumpism is going to be with us for some time. What are your thoughts and writing a Tim Snyder pocket guide on all the things we need to do to Trump-proof and Putin-proof our democracy?
Tim Snyder:
Yeah, let me agree with the premise, and then do what you tell me, which is what I always do. [laughs] It's less true than it was, I think, but it's so true about Russia on the Left, and it's so puzzling for me. I was on German television the other day, and one of the participants was asked directly if Russia... He's from the Die Linke, the people that are supposed to be on the Left. He was asked if, given that Russia's an oligarchy, is it not a problem for the left? He didn't have a clear answer to that.
Tim Snyder:
Russia is an oligarchy. If you're on the Left, you've got to be against the oligarchy. Russia's exporting oligarchy. You've got to be against that. I accept much of the critique of the Left of the United States, but when I look at Russia, I see a number of the tendencies that people are properly upset about pushed to their logical conclusion, and then pushed back out into the rest of the world. If we're against invading countries, we’ve got to be consistent about that. If we're against wealth inequality, we’ve got to be consistent about that, and not say that it's okay in Russia, because somehow...To say that it's only bad if America does it is a weird form of inverted nationalism, which isn't going to get you anywhere.
Tim Snyder:
Another thing which I think you said, which is really right and I'm going to rephrase, is that we can't deal with these foreign challenges without dealing with the domestic challenges. To all of my conservative and Republican friends out there, you can't deal with China–you cannot deal with China–without rebuilding America. And we can't rebuild America without the kinds of things that we've been talking about. If you want to have a long Cold War with China, be my guest, but you have no chance if you hollow out America in the meantime.
Tim Snyder:
The same goes with Russia and the same goes with foreign affairs in general: if we do not fix the country internally, we will not have a foreign policy. Both of them will decline at the same time. Another thing I want to pull out of what you said is this connection between the creative and the conservative. If you want to conserve America as a country with the value of freedom, then you're going to have to be creative about the policy solutions in the next few years. If you want to keep America as a country at all, with a national identity at all, with the rule of law at all, with the ability to resist foreign threats at all, you're then going to have to be really creative about social media and about healthcare. If you just sort of say, "Well, the institutions are fine, and the American spirit and all that”, you're going to get crushed.
Tim Snyder:
Defending the basic values that a lot of conservatives sincerely hold requires creative and even radical policy. That's a paradox, or it's an apparent paradox, but it's true. Anyway, going back to how I always do what you ask me to do, when I got sick in December of last year, the thing that I was doing was that I thought I was finishing a book about freedom. A book which was called Land of the Free, which was precisely beginning from the idea of freedom, and then ending with exactly the policy recommendations that I thought America needed to consider and implement to become a much freer country in the 21st century.
Tim Snyder:
Going back to pain, even when I was very sick, I was working on that. The night after I almost died, I texted myself with an idea which I thought was really good for this book. I’ve put the book aside for now, because I had the idea of Our Malady, and this is what is important to me now, health and freedom. But health and freedom is part of a larger book that I do want to write in the next year, which is about how I think America could be a free country again. So, thanks. I'm glad that I'm doing what you want me to do.
Andrea Chalupa:
Well, we've survived this long, thank God, and I'm so, so grateful that I had the opportunity to have another conversation with you because it's so scary reading your book. It really is. My heart stops. With that said, everyone should go out and read it [laughs], because it is eye opening and it needs to be... Copies of Our Malady need to be airdropped, airlifted or whatever, across the Midwest, especially in time for the election. It's just essential reading. Thank you so much for putting your heart and soul into yet another Tim Snyder classic. We will have you back on for your next book. You're already pre-booked for that conversation.
Tim Snyder:
Thanks so much to both of you for the conversation. It's such a pleasure, and it helps me think and I'm really glad we can do it. Thank you.
Andrea Chalupa:
Our discussion continues and you can get access to that by signing up on our Patreon at the Truth Teller level or higher.
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Andrea Chalupa:
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