The Professions are Becoming Party-Aligned Guilds
Doctors are shifting left. Politico explained this last year with the blunt blue good / red bad stupidity that characterizes most media product: “The GOP Turned Its Back on Science. So Science Turned Its Backs on the GOP.” The subhed got to the actual point: “A political realignment around health care is reshaping state politics.”
Politico focused on Derry Township, in Hershey, Pennsylvania, where a giant hospital is changing local demographics. “By the early 2010s, though, the med center was making Derry Township suburban and transient — and more Democratic…Today, the municipality (population 25,000) has never been bluer.” More health care workers, more Democrats.
A report at KFF Health News a few years ago used similar framing: “Events of 2020 Moved Medical Students to Political Activism.” Orange Man bad, so future doctors turned into leftists. Click the link if you want to see the too-perfect photo they used to illustrate this claim. Quote from a medical school administrator: “When it comes to public health issues, the covid crisis, racial issues, there is a role of the clinician to speak up. Our society wants to hear from us. Some people call this a political role.” Your cardiologist has your test results, but first he’d like to share a few thoughts on institutional racism. As an expert on medical care, you see. “Our society wants to hear from us.”
But then get some context for this shift by returning to the Politico story, which notes that pre-Obamacare doctors were more likely to be small business owners with their own medical practices, while doctors are now increasingly likely to be employees of a health care system. Let’s do this with a screenshot to soak up some context:
An independent profession of highly credentialed professionals is turning into…cogs in the machine. So it’s aligning more reliably with the Democratic Party, because cogs are Democrats. Starts to sound a bit less like the righteous political fervor of science-minded crusaders, yes? Structural change in the profession is realigning its politics.
Now consider the experience of Bill Brown, a conservative attorney and former Navy SEAL who worked in Newark for McCarter & English, a corporate law firm with offices in twelve cities. When I say that McCarter & English is a corporate law firm, I mean that they’re a corporate law firm. Look at the list of practice areas on their website: venture capital, tax law, corporate bankruptcy, commercial litigation, real estate and energy law, and so on. This is not a crusading civil rights firm in the Bronx; these are the people in gray suits who represent Fortune 1000 companies.
Remember that as you look at “A Message of Unity from McCarter’s Leadership Team,” which offers the thoughts of the firm about the “recent horrific manifestations of racism and violence” in America. Here’s a sample:
Saint George Floyd, a corporate DEI committee, the Southern Poverty Law Center. All boxes checked.
Doing commercial litigation in a corporate law firm, Bill Brown did things like this on the side:
He was also, as someone who had clashed publicly with Governor Chris Christie while attending law school, relentlessly outspoken. When he disagreed with something, he just said so. Attending a continuing legal education session taught by a judge, Brown expressed disagreement about the judge’s discussion regarding the way a lawyer should address a jury to avoid the use of gendered language: “People of the jury…”
Just say ladies and gentlemen, Brown argued. "I think reasonable people can disagree with gender fluidity. Because that's a political issue."
During his seven years at the firm, Brown began to notice a shift in the way he was treated. He asked to join the DEI committee, noting that no members were military veterans (correction: only one member was a veteran); the firm offered a cold and flat no. Then his work began to change: He was assigned to less and less corporate litigation, and assigned to represent child molesters in lawsuits against the Catholic church. Over time, he says, child molesters became most of his work. He was getting a message. As he puts it, using a military term, "They were trying to get me to drop out on request."
After the January 6 protest, Brown was uniquely situated as a lawyer and a military veteran — and so began to hear from other military veterans who had entered or been near the Capitol. A friend got in touch to say that the FBI had visited him to ask about his presence outside the Capitol, and he asked for advice about getting a lawyer. Brown emailed partners in the firm: a former federal prosecutor in Newark, and the head of the Washington, D.C. practice group. He asked if they could recommend a lawyer who they would trust to do criminal defense for a J6 defendant. The response, he says, was unusually hostile. They had no help to offer for a person like that — while the firm was assigning Brown to represent clients who were accused of child molestation. The legal profession will represent Gitmo detainees and sexual predators, but recoils in distaste from military veterans who walked outside the Capitol on January 6.
Brown’s experience calls to mind the anguished stories about law firms representing Donald Trump after the 2020 election. The Cleveland law firm Jones Day, the New York Times reported, had been comfortable representing giant tobacco companies and the bin Laden family, but was being torn apart by internal dissension over representing a client as horrible as the outgoing President of the United States. Similarly, a law firm in Pennsylvania, Porter Wright, withdrew as Trump’s lawyers there after associates staged an internal protest, with at least one threatening to leave the firm.
For a highly credentialed young corporate lawyer, the values are clear: You can represent Mohamed Atta, sure, but you can’t represent a real monster like some Republican.
Brown’s career at McCarter & English finally ended after he posted a discussion of Islamist violence on LinkedIn, having fought in Iraq. He was quickly called in by a partner and an HR manager and fired.
Looking back, Bill Brown thinks McCarter & English made a business decision. "They get a lot of work out of New York City, a lot of the big banks,” he says. And people who work in corporate offices in Manhattan sound a particular way, with particular values and a carefully shaped rhetorical style. "Every major industry in our nation has been saturated,” Brown argues, by the demand to signal progressive identity or get out.
Robert Conquest’s Second Law of Politics: “Any organization not explicitly and constitutionally right-wing will sooner or later become left-wing.”
This cultural narrowing, the way that cogs in the machine learn to signal the correct opinions in the correct tone — you say “George Floyd” with the right doe eyes and tight mouth, displaying the correct mix of sadness and anger, which tells observers that you’re upper-middle-class and a professional — is becoming our politics by default. The restriction of acceptable opinion as social fashion becomes legal and medical policy by default, as we saw during the pandemic with Lysenkoist epidemiology and doctors who reliably performed “science,” purging wrongthinking colleagues. Are you a credentialed professional, or are you some right-winger? Whole avenues of choice are closed by assumption and habit, undiscussed. That’s just not the kind of thing that we say in this firm.
One of the implications of this behavior is that the professions are building blue islands in red seas. Montana has banned the child mutilation euphemistically known as “gender-affirming care,” but remember the recent story of the parents whose trans-declared child went to the hospital in Montana: Ignoring the wishes of the minor patient’s parents, the doctors and nurses addressed their daughter by “his” new name, and then arranged a medical transfer to a hospital in a trans-affirming state. The laws say X, but the medical profession says Not X, so Not X is what happens. This is just what we think in this hospital, so.
If you live in a deep-red place but go to the hospital, you’re climbing onto a blue island. If you live in a deep-red place but find yourself hiring BigLaw lawyers to deal with a legal problem, you’re climbing onto a blue island. A choice is being made for you, by cultural default.
This issue is a problem. Chris is correct about the dichotomization that occurred with the structural economic and regulatory changes that have taken place in healthcare since the introduction of Medicare. There are a goodly number of books about healthcare economics from dissenting voices including Scott Atlas, MD and others, but the gist of the issue is that since the 1960's and the injection of government payment into the healthcare equation, there has been progressive consolidation in allopathic ( meaning not alternative) healthcare in terms of corporate takeovers and buyouts and the inevitable enmeshment of the government agencies with the big corporations - hospital systems, health care insurers, big pharma. This has been no accident. Those of us who can recall the 1990's, besides parachute pants, remember Hillary's ill fated attempt at Hillary Care, which was basically what Obama got done with a questionable assist from the SCOTUS to enact Obamacare. The goal at one level is consolidate and incentivize the industry into a manageable ( for the government ) number of large players through regulatory and financial mechanisms. While they tell you they want to save you money, they don't really care about costs. They keep going up rapidly. And after all it's not their money. It's your money. So the cost savings argument made by the socialized medicine crowd is a misdirection play. At that point, you can do many things to the industry. You can mandate behavioral changes through carrots and mostly sticks. If a doctor rolls his eyes or sighs because a nurse or somebody at the corporate healthcare facilty screws up, and that doctor is a little too independent, they can force him/her into disciplinary proceedings. There is a draconian process with very little if any due process. If they want to make your life miserable, they can do it. The process is the punishment. So the doctors are disincentivized from sticking up for themselves or their patients when it conflicts with the corporation's objectives. They have them by the short hairs. We have also seen the state medical boards and specialty certification boards bully doctors during COVID for standing up for truth in science and questioning the dominant narrative. Thus we end up with a semi-seamless integration between the government and big healthcare. The formula is pretty simple. They buy off the big guys and they punish the small guys. In this way healthcare was a canary in the coalmine for other sectors of the economy.
So the corporate and academic physicians who are employed by large systems and incentivized financially and in other ways by the systems adopt the ideology promulgated by the system. If they don't, they keep their mouth shut. Failing that, they get the message to quit or get fired for being a pimple on the ass of the hospital system. This is identical to the big corporate law firms, and academia in general.
So in private practice where I live, many docs are conservatives. But we are a minority. It's uncomfortable for a lot of reasons, because even if we are not employees, we are subject to hospital bylaws and threats from government and insurance companies. There are plenty of levers that these entities can pull if they want to which will drop you in the shit. This is a significant reason for me to practice with as little exposure to the system as possible.
Just like many lay people I talk to, I no longer trust many of my colleagues to do the right thing under duress. I no longer trust the results of a lot of research that has come out or the pharmaceutical industry, or the orthodox medical structure ( although I've thought them to be a bunch of ponces for as long as I can remember). Medical schools are indoctrinating DEI crap into the students. And the schools absolutely do not want original thinkers. They want to produce a uniform product. It's a scary situation. The political evolution and capture of US healthcare is shameful because it has resulted in dead and injured patients, and a total DISREGARD for real science and independent inquiry. On the patient side, suffice it to say that you need to be your own advocate. The other massive problem is that the cost structure, again like everything the Feds do, is totally unsustainable. It's ridiculously expensive to get sick or buy medications. The system will collapse at some point. I don't know when, but it's not possible to continue like this. We either end up like Canada or the UK, which suck btw, and go broke more slowly while denying care, or go bankrupt. Cash pay, which seems anachronistic, may turn out to be the most efficient and honest way to buy healthcare. Everything is transparent and if a genuine marketplace emerges, costs would come down. Don't hold your breath.
I'm a librarian, go ahead and ask me about ideological capture in my profession. But before you do, I and my few like-minded colleagues have to attend to our cellar samizdat printing press and HAM radio in our isolated cabin in Northern Ontario in order to question placing Blow-Job How To Books in the kids' section of the library. Be right back...