America, the intolerant – The Health Care Blog


Historically, the great tension between liberty and authority was between government as embodied by the ruling class and its subjects.  Marauding barbarians and warring city-states meant that society endowed a particular class within society with great powers to protect the weaker members of society.  It was quickly recognized that the ruling class could use these powers for its own benefit on the very people it was meant to protect, and so society moved to preserve individual liberties first by recognizing certain rights that rulers dare not breach lest they risk rebellion.  The natural next step was the establishment of a body of some sort that was meant to represent the interests of the ruled, which rulers sought agreement and counsel from, and became the precursor to the modern day English parliament and the American Congress.  Of course, progress in governance did not end with rulers imbued with a divine right to rule being held in check by third parties.  The right to rule eventually ceased to be a divine right, and instead came courtesy of a periodical choice of the ruled in the form of elections.  The power the ruled now wielded over those who would seek to rule lead some to wonder whether there was any reason left to limit the power of a government that was now an embodiment of the will of the people.

But the reality of government-of-the-people as realized by the emergence of the democratic republics across Europe and particularly America, quickly made a mockery of the lofty ideas of self-government that people thought they were signing up for.  It turns out that the “people” who exercise power in this system may be completely separate from those power is exercised over.  Self governance was not government of each by himself, but of each by all the rest (JSM, On Liberty).  The threat of the majority to the individual was well known to America’s founding fathers, and the early implementation of the American experiment did not disappoint. 

Alexis de Tocqueville, a Frenchman who toured a young America in the early part of the 19th century, and wrote a volume widely regarded as the greatest critique of the American Democratic experiment titled “Democracy in America”, noted:

In America the majority raises very formidable barriers to the liberty of opinion: within these barriers an author may write whatever he pleases, but he will repent it if he ever step beyond them. Not that he is exposed to the terrors of an auto-da-fe, but he is tormented by the slights and persecutions of daily obloquy. His political career is closed forever, since he has offended the only authority which is able to promote his success. Every sort of compensation, even that of celebrity, is refused to him. Before he published his opinions he imagined that he held them in common with many others; but no sooner has he declared them openly than he is loudly censured by his overbearing opponents, whilst those who think without having the courage to speak, like him, abandon him in silence. He yields at length, oppressed by the daily efforts he has been making, and he subsides into silence, as if he was tormented by remorse for having spoken the truth.

This was an America that allowed freed slaves to vote in the North, but yet saw no blacks vote in elections lest they be maltreated if they had the temerity to actually show up at the polls.  This was an America that in 1812 saw a mob destroy the offices of a Federalist newspaper because its editors were against the war of 1812 against Britain and published an anti-war screed.  The mobs massed, destroyed the offices of the paper, killed one of the editors, and left the other editor badly beaten.  

In this world, legal protections or rights ‘protected’ by the government matter not.  The more fearsome power society wields is its ability to ostracize the individual by practicing a social tyranny that extends well beyond the political and legal system.  After all, what good are legal protections if the penalty for thought crimes may be your livelihood?  

The new wrinkle relates to the growing social media fueled power of an intransigent minority in making society bend to its preferences.  It turns out you don’t need the majority to control society, a small number of intolerant virtuous people will do.  The phenomenon was referenced by John Stuart Mill in his classic essay from 1859 as the will of the most active portion of society, but best described recently by mathematician/philosopher Nassim Nicholas Taleb as the Dictatorship of the small minority.  On the relatively benign front, the apathy of the flexible majority means that most everything you buy to drink is kosher.  On the more concerning front, it means moral values of society derive not from consensus of the majority but from the virtues of the most intolerant minority.  

Sites like twitter, facebook, and reddit allow these factions to coordinate in a matter of minutes.  In 1812 Baltimore it took a mob to leave the comfort of their houses, take up arms, and travel to the headquarters of the Federalist newspaper to unleash mayhem on the hapless editors who held an unpopular opinion.  In 2020, it takes a few taps on a keyboard and tagging an employer in a tweet to cancel a life and tarnish a reputation, or organize a violent mob to target a federal building.  

While all ideological stripes may use these tools to create mayhem in civil society, it is always the out group that bears the brunt of opprobrium.  In a prior age the social institutions were used to censure Jews and those with too much melanin.  Today, there’s a new sheriff in town, and there’s a new group that influencers and their sheep label as revolting and unfit for polite society. For four years the elite of society were free to label the Republican president an illegitimate stooge of Russia, attend political rallies and participate in marches that devolved into riots by some extremist minority with no fear they may not be let into work the next morning. But attending a Trump rally on January 6th and going back to your hotel to watch the violent shenanigans that followed runs the very real risk of leaving you destroyed and  destitute. 

The tyranny of the Democratic Republic is all encompassing precisely because it doesn’t require a government with camera’s tracking your every move, it enlists your even more ubiquitous virtuous neighbors to do its dirty work.  Putin may manufacture charges against his political opponents to put them in jail, but it isn’t some repressive government that gets Google engineer James Damore fired.. It is his colleagues who leaked his internal memo, and then demanded he be eliminated.  According to Damore, the penalty for thought crimes at Google were severe –  “employees who expressed views deviating from the majority view at Google on political subjects raised in the workplace and relevant to Google’s employment policies and its business, such as ‘diversity’ hiring policies, ‘bias sensitivity,’ or ‘social justice,’ were/are singled out, mistreated, and systematically punished and terminated from Google”.

Even the long venerated medical institutions of America are over-run. Publishing a peer-reviewed descriptive paper on the history of affirmative action in medicine lead to the cardiologist author of the article being immediately demoted and removed from interacting with trainees at a teaching hospital because a Twitter mob labeled the article’s views ‘racist’.  In the middle of the great pandemic that the experts told us was so bad that everyone had to isolate in a basement for two years, the Center for Disease Control (CDC) drafted a vaccine allocation strategy that suggested the consideration of race to “promote justice” and “mitigate health inequities”, despite the fact that prioritizing this particular factor over race neutral risk factors like age and health status would result in more overall deaths. 

After all, the goal of the CDC now isn’t just to maximize benefits versus harms, it is to also mitigate health inequities as the ethics table from that document makes clear.  It would be a laudable goal to improve health care for everyone, of course, but the practical translation of this ethos is to purposely and systemically treat certain racial groups in a poorer manner to balance the scales. Apparently, to the people that write these guidelines, more people dying of COVID is less of a concern if the deaths are more racially balanced.

It’s important to understand that the rationale for this overtly racist endeavor comes not from some fringe group, it comes from the seat of our most respected institutions because the fringe groups are in control of the institutions.

“Older populations are whiter,” public health expert Dr. Harold Schmidt of one of our esteemed universities told The New York Times in early December. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

There is little surprise why these messages go unchallenged at these institutions.  Unless you are independently wealthy or have tenure, keep your mouth shut about opinions that go against the consensus of the day if you value your job.  While some may take solace that the contemporary price paid in the civilized democratic republics for opinions that fly against the prevailing winds is different than that meted out to Socrates by his fellow Athenians (death by drinking hemlock), or to Christians by the Romans (thrown to the lions),  it should be reasonably obvious that these are far from enlightened times.

Anish Koka is a cardiologist. Follow him on twitter: @anish_koka

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