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Sick People: How ‘Personal Choice’ Destroys Freedom

Sick People: How ‘Personal Choice’ Destroys Freedom

The reddest corner of America’s most militantly libertarian state just implemented emergency rationing of health care. Idaho’s “don’t tread on me” residents stood their ground against the tyranny of mask mandates and vaccines, maintaining one of the lowest vaccination rates in the US. In exchange, they lost the right to chose certain kinds of health care. Freedom isn’t free.

In El Campo, Texas this week, ER doctor Hasan Kakli railed in frustration at wait times soaring into 4-digits, over 1000 minutes. One of his patients sits unresponsive, unable to get access either to a needed cancer screening or an ICU bed as Texas hospitals bulge with COVID-19 patients. Not far away in Bellville, Afghan war veteran David Wilkinson died of gallstones while waiting for access to treatment. It took seven hours of searching across neighboring states to find a hospital that could accept him. By then, it was too late. However, thanks to Texas’ Republican Governor, his surviving family at least won’t be forced to wear a mask at the grocery store.

Meanwhile, Denmark lifted all pandemic restrictions this week. Their vaccination rate has topped 75% and still climbing, meaning the population carries enough collective protection to render these constraints unnecessary. This country of 5 million people has been running roughly one or two deaths a day from COVID since April.

Our commitment to a hyper-individual vision of liberty is leaving us with fewer, lousier choices than people elsewhere enjoy. A willingness to share burdens opens up a wider range of personal choices, a policy calculus Americans seem unable to perform.

My vaccine isn’t about me. Neither is my mask. Social distancing isn’t about protecting me. All of these measures are primarily about protecting us, which in a public health or pandemic setting, is the only way to protect me. Why has COVID-19 produced an absolutely unique disaster in the United States? Americans don’t understand the calculus of collective freedom. Though this weakness is more pronounced in places infected with Republican brain worms, it is a broadly American problem.

Successfully protect everyone from COVID-19 by sharing the burden of mitigation and my personal risk drops to nearly zero. Along the way, I end up living in a much healthier, saner, happier place. Focus entirely on my own personal needs, my personal risk factors, and my personal protection, and I end up living in a Third World nightmare where I die from a treatable gallstone condition. Freedom isn’t free.

Math might shed some light on this puzzle.

Introduce a highly infectious virus into a village of 1000 people. If uncontained, this virus will infect 80% of population within 6 months, killing about 4% of those infected. Do nothing, you’ll get 800 sick and 32 deaths.

If everyone in that scenario wore masks and embraced social distancing, the disease would only infect 20% of the population over 12 months and thanks to better availability of detection and care, would only kill 2% of those infected. As a result, 200 people would get sick and only 4 would die.

Add a vaccine. If 90% of the population got vaccinated, the vaccine delivered, say 85% protection from infection, and the population retained masking and social distancing, only 10% of the population would still function as a vibrant breeding ground for the virus. If those 10% who were unvaccinated maintained masking, the infection rate among them might only be 20%, meaning only 2 would get sick. With ample resources for detection and treatment, it is likely no one would die. Sustain this vaccination rate, along with testing and tracing, for maybe a year, and the disease might cease to be a serious threat. It would lose the environment needed for mutation and adaptation, only appearing in rare cases with little pandemic potential.

Take the vaccination rate to 98% (there are always outliers), and not only does the disease become a minor threat, you have a platform from which to launch eradication. There’s no reason to maintain pandemic precautions like masking and social distancing. In that village, citizens enjoy the freedom to go on with life with no risk of either dying or of killing their neighbors by neglect.

Collective action can produce much a wider range of individual choice, including the choice to go about my life with no threat of getting sick or getting others sick. Collective action can make health care cheaper, reduce my risk of gun crime, improve educational outcomes and eliminate mass homelessness. Those choice aren’t available in an environment that emphasizes personal responsibility. Let’s revisit the math from the village scenario above.

If only half of the residents of that village get the vaccine, that leaves the other 500 as a fertile breeding ground for disease. In that breeding ground the virus will continue to mutate and evolve, throwing up new variants which will eventually undermine resistance. An 85% reduction in my odds of contracting the disease, delivered by my vaccine, doesn’t mean I won’t get it. If I’m faced with new exposures every day, it merely means it will take longer for the disease to overcome that resistance.

Masks, social distancing and the vaccine reduce my individual risk of contracting the disease or dying from it, but the degree to which they reduce that risk varies based on the extent of compliance by those around me. In other words, in a setting in which personal choice is emphasized, the disease cannot be controlled. Absent collective action, I’ll never get the choice to go on with my life without worrying about this disease of dysfunction.

No purely individual approach can resolve an inherently collective problem like pandemic response. In an environment where individual choice yields incomplete protection, even vaccinated people must maintain precautions because the disease remains a threat. Even if their individual risk of becoming seriously ill has diminished dramatically, by remaining vulnerable to illness they remain available as a potential disease vector. Citizens in that scenario cannot drop pandemic protections without taking on risk of either getting ill personally or infecting others. Shared facilities like hospitals and public venues will remain burdened by the impact of the pandemic almost indefinitely.

Consider the impact of a vaccine that offers 85% efficacy in different environments. Where 95% residents are vaccinated, odds of infection for vaccinated people drops virtually to zero, because encounters with the disease become very rare. In an environment where people are willing to collaborate for the common good, that vaccine yields nearly 100% protection. Meanwhile, in an environment where an emphasis on “personal freedom” delivering insufficient vaccination, the exact same vaccine delivers far lower protection. Some problems cannot be solved by hyper-individual policy choices.

Now instead of analyzing this pandemic scenario from the perspective of public health, let’s see it purely through the lens of individual risk.

In that first scenario with no disease containment measures in place, anyone’s personal risk of dying from this disease runs about .3%. Someone could promote an honest position against containing the disease referencing its very low death rate and still not be lying. Among people who can only conceive of problems in individualized terms, this choice might appear compelling.

Why burden individuals and businesses with masks, social distancing, shutdowns and vaccine mandates for a disease that will only run a .3% chance of killing you? As we have all witnessed first-hand, a policy template based on this individual risk assessment produces devastating consequences.

To place this in context, New York City had 8,000,000 residents in 2001. About 2,600 people died in the 9/11 attacks there. By the oversimplified calculus of personal risk, an individual New Yorker’s risk of death on 9/11 was less than .0035%. An American’s individual risk of death in World War II was barely .35%. By comparison, the raw risk of any Mississippi resident dying from COVID-19, based on deaths logged by September 9th, is .29%. To date, almost 34,000 New York City residents have died of COVID-19, equal to roughly 13 9/11’s. Couching a collective disaster in terms of individual risk creates catastrophic distortions.

Choose the first of those scenarios laid out above and the individual risk of death is only .3%. However, your odds of living in a cesspool of dysfunction rise to 100%. Our weak understanding of collective interest breed not only disease, but misery. It is impossible to maintain a successful modern civilization without collaboration.

America became the developed world’s most terrifying pandemic hellscape because we possess a 3rd grader’s concept of collective interest, where the only freedom that matters is my right to grab all the cookies from the class holiday tray. While other countries got the freedom to go on with their lives with minimal concern of dying from this disease, we insisted on our freedom to poison the world around us, suffering a cataclysm with nearly 700,000 dead and still climbing.

My path to the greatest possible range of personal choice, any intelligent libertarian’s goal, depends on a lot of collective mandates. Perhaps our pandemic catastrophe can awaken Americans to the importance of protecting each other.


  1. A blogger I follow said, “We’re at the point in the pandemic where whatever your life is like won’t ‘return’ to normal but is your new normal. Accept or make your changes accordingly.”

    Despite the fact that collectively we may trend towards i.e. not wearing masks on planes etc, I think there’s some value in looking around right now and deciding what’s going to be normal for you and plan for what may be normal in culture.

    And the implications are… complex. If “red state hospitals” become a thing, wherein regular health care is permanently inaccessible due to constant glut of covid variant patients, it will turn the “flyover country” meme into a whole new level of Balkanization, including and probably not limited to “build the wall” type thinking between states. Because think about it. If you’re a busy businessperson trying to get shit done, and you literally cannot visit Idaho for the risk of disease (the same way you never felt safe visiting Chad for risk of violence), then you’ll derisk your entire global and national supply chain to areas you can find a hospital if you step on a nail.

    That’s just one glutted hospital norm, there’s a million more to think about.


    I’d also like to point out that another way to solve the glutted hospital problem would be to build more hospitals, but red states ain’t gonna do that either.

  2. Shrug….

    How many americans die annually due to lung cancer, heart disease, and gun deaths, all preventable if smoking, guns, and foods that drive obesity were banned? And tell me what the odds are that smoking, guns, fast food and sugared drinks will be ever be banned outright.

    This virus is simply not lethal enough to trigger a fear factor for the stupid and insane. Maybe the next one will be more lethal, and big pharma can bundle a covid vaccine with the next “big one”.

    And I guarantee you this is no longer a “once every hundred year” event. Thanks to Global Warming, it is no just “once a century weather events” that are now a regular thing. All kinds of plants, insects, and animals that have never been in contact with one another are now mixing. Or perhaps, some 10,000 year old virus that has been lying dormant in the permafrost is going to appear as that ice melts.

    All we can do with the stupid and insane is let them die off. The faster the better. Encourage, rather than discourage, mass events for the stupid, while at the same time getting everyone else their 3rd shot, and 4th shot, since it is obvious we will need annual or bi-annual boosters. Thin the herd as quickly as possible.

  3. I could detect some philosophy in this piece. Good explanation of how to merge a libertarian philosophy and social responsibility. It is in our personal interest to deal with community issues as a community. I think we need vaccine mandates in this situation. We have them for plenty of other diseases. Also mask mandates. If you cannot do that stay home.

      1. Taking a talking point from YouTuber Beau of the 5th Column, this pandemic was the golden opportunity for the libertarian crowd to show just how well their philosophy could work, to demonstrate their personal responsibility. Major fail. My default assessment of anyone claiming to be a libertarian is now selfish asshole until and unless they can demonstrate otherwise.

      2. “If libertarians were serious about their goals and weren’t primarily just a bunch of immature narcissists, this reasoning would be obvious.”

        I use the word ‘libertarian’ in two senses, there are self-described libertarian people I know who bother to argue for their ideology, and then there’s the underlying vein of libertarianism in the culture around me that dismisses the public or community needs in favor of their own self-gratification.

        The self-described libertarians who bother to argue their ideology are all vaccinated, by the way. No I’m not here saying “they’re different” because the arguments they make and the policies they choose to support lead to the underlying vein that causes the cultural libertarianism to crash. But it’s enough of a difference in activity to see that there is a difference between active and passive libertarianism that must be accounted for when taking on the principles discussed thereof.

        That said, what I’m NOT arguing against here is your narcissism comment. Even the self-described thoughtful libertarians seem to be under the impression that they alone can “do the research” regarding protecting their own welfare against the power of giant corporations and other governments etc. Like as if they’re “properly informed”, they can somehow know that lead poisoning is bad and fix the problem by not buying lead-based paint without the efforts and collaboration of other individuals and organizations; or that non-lead based paint would spontaneously sprout up and replace all lead-based paint on the basis of demand rather than regulation.

        It’s easy from there for the libertarian and someone like me to argue back and forth about the state of lead-based paint and its effect on the welfare of everyone in society on and on, but my point isn’t just that one example: but that that example would stretch into LITERALLY EVERY SINGLE GOOD AND SERVICE BEHIND EVERY SINGLE ECONOMIC TRANSACTION ALL DAY EVERY DAY. It’s not just narcissistic, it’s straight-up solipsistic to believe you can have a handle and edge on every last social interaction and specialist knowledge every hour of every day for your entire life. No one has the mental capacity to protect themselves against every organization on the planet all the time.


  4. Chris, you are dealing with Americans. Americans are not good with collective action problems. Particularly, conservatives who are about me, mine, and who cares about anyone else plus a lot of spite. Your argument is logical, reasonable and conclusive. It is unfortunately useless when people refuse to cooperate for the common good.

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