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.