Why RFK Jr. Might Be Right About the Wrong Thing
The U.S. Preventive Services Task Force task force “is an independent, volunteer group of national experts in prevention and evidence-based medicine that makes recommendations about clinical preventive services such as screening tests, counseling services, and preventive medications.” Its recommendations “must be covered in nearly all health insurance plans under the Affordable Care Act.” In general, this committee is a good thing: it “works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.” However RFK Jr plans to remove all 16 members of the US Preventive Services Task Force because he views them as “too woke.”
This is a terrible idea. Of all the excesses of the modern administrative state, public health is one of the least objectionable. The reasons cited are equally dumb: that the task force has become a hotbed of ‘woke’ ideas; that it requires religious employers to cover treatments that they find objectionable; and the members of the task force are dedicated to embedding “critical race and gender theory into every facet and stage of its operations.”
These objections are silly. The American Conservative article I’m referencing simply picks some quotes out of several of the most boring reports, and then interprets them in the least generous way possible. (I mean, we take it for granted that people are experts on their own health, so who else would be experts on gender-affirming care other than representatives of the trans and intersex communities?)
However I’ve got to say that, in general, I am opposed to such committees. It’s a difficult idea to get behind, so I will give it my best. First I’d better give a little introduction of sorts. What’s relevant about me to this story is that
I went to a technical university. So I met a cohort of future doctors as they were training. This has given me what I think of as a justified skepticism in their qualities and abilities. Once you have gotten drunk with medics, or seen them fail and resit exams, or seen them naked, it’s difficult to come to a view of them as infallible professionals.
I really despise going to the doctor, mainly because it’s a relationship of supplication to people I can’t trust because of 1.
The case against
One of the defining features of modernity is the creation of a class of university educated public administrators. Their primary interest is in the administration of civil society. I.e. all the bureaucratic tasks required to keep society running.
I live in Germany and the sheer amount of things the state does is impressive. I recently needed the PIN on my electronic identity card to be reset. So I had to go the Landesamt für Einwanderung to get it reset. My parents are currently driving their camper van from Wales to Berlin to dog sit for some friends and visit me. When they get here they plan to park the van on the street whilst they stay. So they just email the Bürgeramt (town hall) of the part of Berlin they’re staying in and they were issued a parking permit for the duration. It took two days. Two days. It goes without saying that some guy’s whole job was to sit in an office somewhere in Berlin and change the PIN on people’s identity cards, or to issue random travelers parking permits. This is a good idea! The minute functions of the modern state need labour to be accomplished, and having a pool of workers willing and available to do that work makes society tick over.
This class of people are distinctly modern. They differ from entrepreneurs in that the market acts as an ideological check on what entrepreneurs can do. Public servatns are not dependent upon the discipline market to sell goods to feed themselves. And they differ from the class of private sector employees and workers in that they do not really have the discipline of the employer to structure their lives. Finally, they are different from the aristocracy in that they don’t inherit their office. This class of people doesn’t really have any apparent check on them, ideological or material. Much of the furore around political correctness, or woke, or whatever, going back the last few centuries can come down to the problem of how can a demos manage the people it puts in charge of administering the state?
This is why an ethos of public service (and low but steady wages) have been developed: they are a (blunt) tool of political discipline.
As this pertains to Public Health Officials™ we have to think through the ways in which these officials create norms around what constitutes “healthy.” Most people (I’m painting in broad brushstrokes here) think that sickness is a biological phenomenon. Disease is caused by germs and requires special chemical compounds to reverse. But in addition to this there’s the social role of sickness — you get time off work, people care for you etc. Which suggests that sickness is more than just what’s going on with your body: even if you have a bodily condition, that condition is the basis for a social entitlement.
To give an example from my life : in Germany doctors don’t just issue sick notes: they issue notes that say that the patient is sick and unable to work. Since a lot of Germans head to Majorca for their holidays, quite a few of them have gotten sick whilst abroad. In Germany, if you are sick on your PTO then you can claim it back, as long as you provide a doctor’s note that states that you are sick and unable to work. Spanish doctors typically issue sick notes which state that the patient is merely sick. So a lot of German employees were disgruntled to find that they were not entitled to claim their PTO back due to sickness. In some concrete sense, the meaning of sickness differed socially between Spain and Germany, and it intersected in an interesting way with the bureaucratic apparatus of the state.
For a preventative medicine task force, they decide what tests must be covered by insurance companies. In doing so they change the epistemic (for want of a better word) status of citizens. They are now all potentially unhealthy, and ‘brought in’ to the medical apparatus. The USPSTF ends up defining, almost by default, what exactly ‘healthy’ consists of, without any sort of democratic debate.
But that’s exactly what should happen! We can’t leave what are democratic decisions to technocratic bodies. No matter how mand RFK Jr may sound, he’s bringing politics back to healthcare.