Consumptive Capitalism
A historian of totalitarianism has turned his gaze on a more insidious system: one that sells hope to the well and the sick alike, and profits from both. Timothy Snyder reaches back a century to the tuberculosis sanatoria of central Europe, where patients chased cures that never came, and finds an uncanny blueprint for America's trillion-dollar wellness economy today. The parallel is unsettling because it works on multiple levels — medical, economic, and deeply psychological.
Snyder opens with Professor Sara Silverstein's forthcoming work on Eastern European health history and lands on a simple historical correction: tuberculosis was once normal. It infected a quarter to a third of all humans who have ever lived. Whether you fell sick depended less on biology than on the social and economic conditions shaping your immune system. Before antibiotics, only about one in five who developed active disease recovered permanently. Snyder uses this baseline to expose the romanticization of the pre-medical past — a fantasy currently driving health policy. The current administration's approach, he writes, "rests on nostalgia rather than knowledge" and "romanticizes a harsh past, a time when few and desperate choices were available to Americans."
The Sanatorium as Business Model
Kazimierz Kelles-Krauz, a Polish political thinker, spent his final years cycling through mountain sanatoria in the Tyrol and Galicia. Treatments gave him hope. They were also expensive, and his family — generally able to make ends meet — struggled until illness emptied their savings. He died in 1905, still sick. Kafka's experience was more harrowing. At a low point in 1921, he described the sanatorium as a place where "the torture goes on for years, with pauses for effect so that it will not go too quickly, and — the unique element — the victim himself is compelled by his own will, out of his own wretched inner self, to protract the torture."
"Hope was the problem. The unpredictable course of the disease, the sense that a recent improvement just might be related to the treatment, drew people in and drew people back."
This is the core mechanism Snyder identifies. Hope, weaponized by commerce. The sanatorium sat somewhere between a hospital and a hotel — there was medical staff, there were interventions (surgically collapsing a lung was one of the more common "treatments") — but many patients went for the reassuring routines and the promise of nature. Nature, it turned out, was very expensive. Blankets for fresh-air resting. Special foods. A thermometer so you could monitor your own fever. The ethos was unambiguous: you would spend money if you cared about your own health.
For readers familiar with Kafka's biography — the years spent in疗养 institutions, the laryngeal tuberculosis that eventually made swallowing so painful he essentially starved to death in 1924 — the connection between creative brilliance and physical deterioration is haunting. But Snyder's point is not literary. It is economic. The sanatorium industry was consumptive capitalism in its literal sense: it consumed the wealth of the sick while the disease consumed their bodies.
The Wellness Industry's Century-Long Echo
Fast forward a hundred years. The American wellness industry now exceeds $1 trillion annually. The recommendations have barely changed: nutrition, exercise, clean air, personal hygiene, skin care. You can still travel to Austria for a luxury health retreat following in the footsteps of Kelles-Krauz and Kafka — except this time the diagnosis is "a taste for sugar" rather than tuberculosis. Dietary supplements alone represent a $69 billion market. Wearables and apps prescribe sleep optimization. Subscription services coach weight loss. Influencers sell routines.
Snyder identifies the psychological continuity precisely: "Worry about being ill, and spend money to show that you care." The wellness industry makes "a virtue of investing financially in your health, suggesting that the virtue of prevention is only accessible to people who can afford it." Nothing about exercise or nutritious food is wrong. The problem is structural. The profit motive tends to promote anxiety about health rather than the thing itself, creating more demand rather than delivering satisfying solutions. It does nothing about access — precisely the opposite.
The Profit-to-Profit Shell Game
The piece's sharpest critique targets the "Make America Healthy Again" movement and its leadership. Snyder argues that the movement's attack on pharmaceutical industry profits is not a critique of capitalism but a competitive maneuver — an effort to divert profits from one set of businesses to another. "MAHA leadership criticizes the pharmaceutical industry's profit motives in order to promote the wellness industry, which of course also operates according to the profit motive." By directing its energies against a competitor rather than against the underlying structure — commercial medicine replacing public health — the movement "only strengthens and consolidates the status quo it claims to be critiquing."
Then there is the collateral damage. Undermining belief in vaccines and antibiotics — practices that actually work — doesn't just harm individuals. It dismantles the only institutions capable of population-level health policy and opens new sectors to what Snyder calls "an infectious economy." Measles elimination status is at risk. Tuberculosis remains the leading cause of death by a single infectious disease globally, curable but untreated where pharmaceutical pricing outstrips what global capitalism assigns to human life.
Critics might note that Snyder's dismissal of the "Make America Healthy Again" movement as purely a capitalist faction may underplay genuine public concern about pharmaceutical pricing, food industry influence, and environmental toxins — issues that predate and exist independently of any political movement. The wellness industry's excesses and the pharmaceutical industry's excesses are both real problems; rejecting one does not require embracing the other. A serious critic might also argue that Snyder leans too heavily on historical analogy — the tuberculosis sanatorium economy and the modern wellness market operate in fundamentally different regulatory and informational environments, even if the psychological dynamics overlap.
Critics might also push back on the framing of the pre-antibiotic past as universally dire. Some aspects of historical health — stronger community ties, less processed food, more physical activity in daily life — were genuinely beneficial, even if the absence of medical science was catastrophic overall.
Bottom Line
Snyder's essay is a reminder that the monetization of health anxiety is not a new invention — it is a recurring feature of capitalism when public health infrastructure is weak or absent. The sanatorium sold fresh air and hope at a premium. The wellness industry sells optimization and belonging at an even higher one. Both depend on a simple trick: convincing people that spending money is synonymous with caring about their bodies. The difference is that we now have the science to do better, and the political choice not to.