POPULISTS AND EXPERTS
Once upon a time, the populist movement in the U.S. fought for social progress - and its critique of elites was anything but anti-science
by Thomas Frank
[This article published in Dec 2020 is translated from the German on the Internet, https://monde-diplomatique.de/artikel/!5710493.]
The real political crisis in this epidemic year, it is often said, lies in the stubborn refusal of ordinary Americans to recognize the authority of experts. There's a pandemic raging - and the masses are frolicking in the swimming pool. They're parroting silly conspiracy theories, spreading dubious medical advice on social media, running their errands without masks, partying in the streets. And then there's the idiot of a president who throws the advice of his experts to the wind, blames everyone but himself for the disaster, and recommends treatment with disinfectant.
This fundamental conflict between the ignorant and the enlightened has been a leitmotif of politics in the United States for years.1 Liberals, we believe, are closer to objective reality, listening to what highly decorated scientists say. Republicans, on the other hand, live in a world of myths and fables, where truth counts for nothing. The club of our opinion makers distributes points accordingly: We're the smart ones, they're the dumb ones.
The pandemic has given the conflict an unprecedented urgency. Sensible Americans solemnly declare their eternal and unswerving faith in science, and Democratic leaders exhort our afflicted country to heed the findings of medical specialists as if they were the word of God.
Our "thought leaders" have also developed a theory for understanding ignorant, disease-promoting behavior: The people who displayed such behavior were not simply stupid, they said, but had fallen for a sophisticated philosophy of anti-expertism called populism. Its representatives - the populists - are uneducated idiots who despise the educated and ridicule experts.2 They believe in premonitions instead of erudition, they disregard the advice of the medical profession, they praise the wisdom of the rabble, and they are all racists. Populism, they say, is the enemy of science, at war with common sense; an enabler of disease, if not disease itself.
So tempting is this syllogism that members of our country's thinking class are only too happy to return to it again and again. Medicine is so obviously right and populism so obviously wrong that celebrating one and lamenting the other has become for them one of the great narratives3 of the age.
But: the reason for our devastating failure to combat the coronavirus lies first and foremost not in the extraordinary stupidity of Donald Trump-although that certainly played a role-but in our health care system, which is indifferent to the health of the population and treats medical care as a luxury good. It bankrupts people with the cost of ordinary treatment, denies them access if they are uninsured, and takes away their insurance if they lose their jobs - and millions are losing their jobs right now because of the pandemic.
That this system is the way it is is for one simple reason: for nearly a century, the organized medical community has used the prestige of its expertise to make a public health care system an unattainable dream. Populism, on the other hand, was once the reform impulse that tried in vain to change the system to serve ordinary people.
Let's start with the term "populism" itself. It was coined in Kansas in 1891 by a new farm and labor party, the Populist Party, which called for a modern currency independent of the gold standard, the fight against monopolies, and the nationalization of railroads. After brief successes, the party withered away again. Nevertheless, Populism's influence was felt for decades afterward. Its ideas shaped the Socialist Party of America, the New Deal of the 1930s and 1940s,4 and the campaigns of Bernie Sanders in 2016 and 2020.
The first populists were by no means opponents of punditry. On the contrary, they wrote tributes to technology, science, and education that were so earnest and artful that today's readers are embarrassed by them. They saw their ideas of state regulation and welfare in full agreement with the scientific findings of the late 19th century.
At the same time, however, they were in constant struggle with the economic and academic elites who believed the established order to be a divine one. The populists viewed all privileges with suspicion, including the prestige that gave authority to the academic professions. In the "Garden of Eden" sculpture garden in Lucas, Kansas, created as an installation primer of populist and socialist principles, respectively, there is a representation of "Crucified Labor." As those who torture the working man to death, the sculpture depicts the honorable leaders of society: banker, lawyer, doctor, and minister.
The populist thinking was radically democratic: man comes first. To the experts, the original populists ascribed the role of serving and informing the people as they went about their day's work as citizens in a democracy.
On health care, the original Populist movement had little to say. In the 1890s, it had not yet coalesced into the exceedingly costly bureaucratic maze we know today. But as medical treatments became unaffordable for most people in the decades that followed, farmers, labor unions, and charities created various alternative structures aimed at making medical care affordable for ordinary, working people.
One such neopopulist initiative emerged in 1929 in Elk City, Oklahoma, a state where there had once been a strong populist current. The idea was to establish a cooperative health care system into which farm families would pay a modest sum each year for guaranteed access to doctors, dentists, and a modern regional clinic. The members, or farmers, would elect the board and take care of the business side of the cooperative.
The Elk City Cooperative Clinic
Conceived by a doctor named Michael Shadid, the system was implemented by the Farmers Union, which had sprung from the old Populist Party. Shadid, an immigrant from Lebanon and one-time member of the Socialist Party, had unusual political views but was by no means a quack. His medical standards were high. What set him apart from his colleagues was his criticism of the predatory methods used to practice medicine in places like rural Oklahoma. He saw himself as a "doctor for the people",5 who wanted to solve the persistent American problem of expensive treatments and a population in poor health.
"In time of war and in time of peace, in time of panic and in time of prosperity, in good weather and in bad, the following incontrovertible facts hold true," Shadid wrote: "Poor people get sick faster, stay sick longer, are most likely to need medical help and least likely to get it. Some are poor because they are sick. Others are sick because they are poor. "6
He was acting, he said in another of his writings, on behalf of the American people who were struggling to "free themselves from the reign of privilege that is leading this country into dictatorship and chaos." By "privilege," Shadid was presumably referring to the American Medical Association (AMA). The AMA had declared war on him after the opening of his cooperative clinic and viciously attacked the neopopulist reformer, arguing that his project was "unethical" because it entrusted laypeople with business decisions. First, his peers tried to have Shadid's license to practice medicine revoked, then they kicked him out of the AMA local association, causing him to lose his professional liability insurance. Physicians he wanted to hire were warned not to join his venture, which actually caused them to stay away as well.
The AMA fought off several attempts to democratize health care. It organized a boycott of a dairy company, for example, to dissuade a charitable foundation associated with the company from its research on medical economics. And when a physician-owned cooperative based on the Oklahoma model was formed in Washington, D. C., reports historian Paul Starr, "the AMA threatened reprisals against any physicians who worked for the project. It prevented these physicians from holding office hours and receiving referrals, and was able to convince every hospital in the District of Columbia not to accept their patients. "7
The U.S. government responded to this egregiousness with an antitrust suit against the AMA. But this did not stop the AMA. After all, it included the greatest medical luminaries who demanded that society show them the respect they deserved. In 1938, for example, the AMA chairman even took issue with a government study on health care reform. All social hierarchies would be overturned if clueless people wanted to dictate to doctors what they should prescribe. "Such medicine makes no scientific or economic sense," he sneered.
Democrat Harry S. Truman won the 1948 presidential election with a campaign much more populist than Trump's in 2016 - with universal health insurance as a central theme. After just a few months in office, he presented his program to Congress, explicitly acknowledging the advances of modern medicine and pointing out that it had become very expensive. "It's no longer just the poor who can't pay for needed medical care-such care is unaffordable for all but the upper income groups. "8
The AMA fired back, calling Truman's plan un-American and a "discredited system of decadent nations." Physicians-highly educated members of a highly honored profession-would come under the thumb of "a gigantic bureaucracy of officials, clerks, accountants, and committees alien to the profession." To put a stop to Truman, this country bumpkin from Missouri, the profession filled its war chest by means of a special levy on its - quite wealthy - members and hired a California firm called Campaigns Inc, the first political consulting agency in U.S. history. The rained down a hail of pamphlets, letters and cartoons on the country. "Socialized medicine," the message went, irrevocably meant the end of individual freedom. Truman's project failed, and so did every subsequent attempt to introduce universal health insurance in the United States.
In neighboring Canada, the populist revolt of the 1890s continued for several decades, as historian Robert McMath reports,9 and led to the formation of a radical farmers' party called the Co-operative Commonwealth Federation (CCF) during the Great Depression. After its 1944 electoral victory in the province of Saskatchewan, the CCF famously formed "the first socialist government in North America." It also won subsequent elections, such as that of 1960, in which it promised to establish universal health care for the entire province. By July 1962, the CCF government was ready to launch Medicare, Canada's first public health insurance plan.
Now the medical establishment brought out the heavy artillery. On the day the fund began operating, the province's doctors went on strike. There were only about a thousand of them: an educated and well-paid minority wanted to teach the rest of the people respect.
This showdown between a small but respected professional group and Saskatchewan's blue- and white-collar workers featured many of the tried-and-true tricks of the AMA, which provided financial and advisory support to the Saskatchewan Medical Association across the U.S.-Canadian border.10 Its members also paid a special levy to pay for propaganda. The provincial Chamber of Commerce and other professional associations supported the doctors' strike. The regional press overwhelmingly sided with the physicians, predicting communism and disease. Even far-right activists joined in the "Keep Our Doctors" movement, which fought against the health insurance company: with mass rallies and targeted agitation against leftists and foreigners - the latter because the neopopulist government replaced the strikers with doctors from Great Britain.
Obviously, the core issue in this conflict was also the place of experts in a democracy. At that time, doctors had the sole right to decide on treatments and costs. They were accountable to no one but their colleagues. The CCF project in Saskatchewan-similar to the Oklahoma model and Truman's plan-threatened to diminish that power by granting the common people some authority over one of society's most senior groups. Doctors were the "high priests" of our world, the Washington Post wrote of the events in Saskatchewan. "And these 'high priests' are not in the habit of taking orders from government officials."
British physician Stephen Taylor, who was appointed to mediate the doctors' strike in the Canadian province, used a medical vocabulary for this: The AMA, he wrote in 1974, "reacted hysterically to Medicare; and it tried, not entirely unsuccessfully, to infect the physicians and the public in Saskatchewan with its hysteria. "11
The result was what I will call "democracy anxiety": members of a high-status social group were convinced that the unleashed mass of the people threatened their privileges. Recurrent symptoms of this fear include the portrayal of democracy as a form of tyranny, the claim that the lower classes were interfering in things they did not understand (economics, foreign policy, or in this case, medicine), and a unanimity in the media.
All these elements could also be observed, for example, in the great outbreak of democracy-anxiety in 1896, when the ruling class in the United States was convinced, with almost unanimous newspaper support, that it was threatened by a bloodthirsty proletariat. The leader was identified as then-Democratic presidential candidate William Jennings Bryan, a supposed radical who also enjoyed the support of the Populist Party. From the gallery of the East Coast press, the educated men of the 1890s denounced the Populist movement as an insurrection of misguided fools and madmen.
The medical fraternity as vested interests
Sometimes the democracy scare certainly serves its purpose. In 1962, however, the big strike by the top one percent in Saskatchewan was a huge flop. After the initial wave of fear subsided, support for the doctors began to wane. The rhetoric of some of their allies - one radio preacher even called for blood to be shed - scared many people away.12 Within a month, the strike was over. Five years later, every province in Canada had a health care system like Saskatchewan's. Today, Medicare is considered one of the greatest achievements of Canadian society.
None of the reform efforts I have outlined here have questioned the importance of research or specific scientific findings. The neopopulists all valued modern medicine. They just wanted to make it accessible to all, including the poorest. Two visions of a society faced each other: Privilege versus equality.
"The central issue in the conflict between the government and doctors in Saskatchewan is not health insurance, but democracy," noted the Toronto-based newspaper The Globe and Mail after the strike began. "The experts, no matter what their specialty, must always ultimately be subordinate to the laity, or democracy can't work."
But that is precisely the problem with democracy, others countered, because it gives uneducated laypeople power over people who are superior to them. U.S. columnist George Sokolsky justified his eloquent support for the striking Saskatchewan doctors by saying that they were "fighting a battle for all experts in this era of mob rule."
In the eyes of Sokolsky, a fierce anti-communist, doctors were struggling to keep their heads above water while the rest of the world was drowning in the sea of sameness. "People used to be respected for what they were worth; today the motto seems to be, 'I'm just as good as you.'" But that is a false and pernicious way of thinking, the columnist raged. Anyone can speak out, he said, but as the world becomes more complex, "only the expert can have an opinion on the increasing number of factual issues."
Sokolsky was on the far-right fringe, an ardent supporter of the Communist-hunting McCarthy; the CCF of Saskatchewan was a left-wing workers-and-farmers party. Today it is the other way around: Harry Truman's Democratic Party has become the mouthpiece for wealthy and highly educated professionals. It dutifully bails out the financial geniuses on Wall Street. It dutifully listens to economists who glorify free trade. And if our modern Democrats are going to plan health care reform, they're going to do it in such a way that they let the experts in all the affected fields redraw the system among themselves. And in the end, they are surprised that the public reacts with outrage.
The parameters have changed in health care, too. The AMA is no longer the powerful bulwark of the medical camp. Others - private hospital operators and insurance companies, as well as pharmaceutical corporations - have eclipsed it in the fight against universal health coverage.
The biggest change, however, has been in the minds of supposed progressives. Their abusive definition of the term "populism" shows how far they have strayed from the democratic traditions of liberalism. They now find even censorship quite reasonable13 and long for the good old days when corporate bosses chose our politicians for us. Democracy, they say, is a problem because it allows ordinary people to ignore the authority of expertise. This disobedient democracy is responsible for Trump, he said. Because of it, nothing can be done about climate change and we can't get a handle on the Covid 19 pandemic. "We the people," as the Constitution calls us, are to blame for everything.
The political landscape is upside down, but the conflict is the same. Punditry, now associated with the icy moral purity of the left rather than the stone-age anti-communism of the right, rages against those who dare oppose its power.
Leaving aside the self-serving fantasies of our modern club of opinion makers, however, one can still discern the old political equation through the fog of liberal self-righteousness. After all, it is the unabashedly populist Senator Bernie Sanders who is most associated with the concept of universal health care these days. And it is the forces of organized punditry and privatized power that have torpedoed the plan time and again. Populism is not the clever new name for what ails us; populism, in its old meaning, may be the means to get rid of it.
1 See Chris Mooney, "The Republican War on Science," New York (Basic Books) 2005, en.wikipedia.org/wiki/The_Republican_War_on_Science.
2 Scott Leigh, "Time to end populism's war on expertise," Boston Globe, April 7, 2020.
3 "Where the Virus Is Growing Most: Countries With 'Illiberal Populist' Leaders," The New York Times, June 2, 2020.
4 See also Bhaskar Sunkara, "The Undaunted. A Brief History of the Democratic Socialists of America," LMd, June 2019.
5 Michael Abraham Shadid, "A Doctor for the People. The Autobiography of the Founder of America's First Co-operative Hospital," New York (Vanguard Press) 1939.
6 Ders, "Doctors of today and tomorrow," New York Cooperative League of the U.S.A., 1947.
7 Paul Starr, "The Social Transformation of American Medicine. The Rise of a Sovereign Profession and the Making of a Vast Industry," New York (Basic Books) 1982/2017.
8 Harry S. Truman, "Special Message to the Congress on the Nation's Health Needs," April 22, 1949, www.trumanlibrary.gov/library/public-papers/85/special-message-congress-nations-health-needs.
9 Robert C. McMath, Jr, "Populism in Two Countries: Agrarian Protest in the Great Plains and Prairie Provinces," Agricultural History, vol. 69, no. 4, Fall 1995, pp. 526-546.
11 Quoted from: Malcolm G. Taylor and Allan Maslove, "Health Insurance and Canadian Public Policy: The Seven Decisions That Created the Health Insurance System and Their Outcomes," Montreal (McGill - Queens University Press) 2009.
12 Gregory P. Marchildon, "Making Medicare: New Perspectives on the History of Medicare in Canada," Toronto (University of Toronto Press) 2012.
13 Jack Goldsmith and Andrew Keane Woods, "Internet speech will never go back to normal," The Atlantic, Boston, April 25, 2020.