In the book "Mountains Beyond Mountains," Dr. Paul Farmer expresses a critical view of democracy in relation to wealth and privilege. He believes that people with vast resources may easily define themselves as democratic but miss the point of true democracy, which should focus on the well-being of all, especially the sick and less fortunate. Farmer identifies more with being a healer than simply an American, illustrating a commitment to global health rather than a nationalistic perspective.

Farmer is proud of the opportunities his American identity provides, such as freedom to travel and the ability to initiate projects. However, he emphasizes that these advantages are a form of privilege rather than an inherent right of democracy. His perspective suggests that real progress comes from addressing the needs of the underserved, rather than from the comfortable position of wealth, challenging the common perception of what democracy means in a society where inequalities exist.