The entirety of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) has been fired by Robert F. Kennedy Jr. in his capacity as secretary of health and human services, and this dramatic action is fully in his purview.
As many people commented, it could have been a sketch from “Saturday Night Live.”
I encourage you to watch the clip at your leisure. It underscores a point that has overwhelmed me for five years: We hardly understand how government truly works in the United States today. For example, how many people even know that the ACIP exists and what it does? I would guess about 1 percent of the public.
Once you look at it, you find something very different from the civics textbooks.
In U.S. political life, for most of the 20th century, conceptions of the state (or government, words used interchangeably here) are two.
First, there is the view generally held on the left side of the political spectrum, which is usually but wrongly referred to as liberal. This is the view articulated by the likes of Bill Clinton and Barack Obama. It is that the state is another word for what we do together as a people. We vote for people who carry our values to civic institutions who work out policies that benefit the people that we could not otherwise carry out on our own.
To call this view naive is a dramatic understatement. It amounts to blessing anything and everything the government does as an extension of some mythical general will.
Second, there is the view generally held on the right side of the political spectrum, which is usually but wrongly referred to as conservative or libertarian. This is the view articulated by Ronald Reagan and most attendees of conservative conferences. It posits the state as something outside of society, exogenous to our lives. It is the necessary evil. It should stick to using the police power but otherwise refrain from being a parent or guardian. It is external to our lives in most ways.
That second view is one I’ve long held, but it is also incomplete, based on what we know.
We need only consider the U.S. medical system here. It is run by industry at all levels, but includes vast amounts of trillions of transfer payments in addition to huge bureaucracies to regulate the industry. The regulators and industry do not work in opposition to each other but generally in tandem, often in hiding.
In addition, there is a range of professional associations that also work with the industry and with government. These often have professional journals that thrive on copyright royalties and advertising from industry, and the editorship of those journals is drawn from industry and government, between which there is a revolving door. This door includes not only personnel but shared patent rights to pharmaceuticals and equipment, which, in turn, feeds the commercial end of the whole.
These companies and associations have a close relationship with science journalism and the mainstream media such that story placement is routine. Mainstream media depends on advertising mainly from these very companies, which causes a strong editorial bias to rarely report on misdeeds and also to lash out at any serious critics of the system.
Then you have the intellectuals and seemingly outside professionals who are called up to bless the whole with their expertise. But they too are financially dependent via grants to universities, ostensibly private labs, and nongovernment organizations that are very often in the pay of government. They apply the veneer of respectability, research, and science that it would otherwise lack.
How do the politicians fit in? They require campaign donations from political action committees, or PACs, to stay in office. All of the industries mentioned earlier have political arms that both lobby and support candidates in a quid pro quo relationship. The people we elect are very often there to arrange for the transfer. These people are also the oversight arm of the agencies that they regulate, and, in addition, grant permission for new political appointees to head the agencies that they barely have time to control.
This crazy, complicated, well-funded machine works well for the insiders but rarely for the public at large, who have very little voice in shaping how it works. The exceptions are well-heeled campaign donors who can make a dent sometimes.
Now, look at this whole and return to the original question: What is the state? The answer is that it is a combination of sectors in society that work in tandem: the civil service, industry, media, contractors, service providers, retailers, politicians, professors, technicians, and so many others. We traditionally speak of the “public sector” and the “private sector,” but how much difference is there really between the two in this case? Which is the hand, and which is the glove?
These are profound questions. Consider that what you have just read above pertains to public health and describes only one sector within it. The same complicated networks of payola and influence exist in every sector. The same analysis could be done on banking and finance, housing and development, food and agriculture, technology, and every other industry that government touches, which is all of them.
The possibilities of corruption at the expense of the public are vast. Become an expert in any of the above areas, and you too will be shocked at what you find. More than that, you will realize just how simplified our civic narratives truly are.
This is what has fundamentally shifted about public life in our time, not just in the United States but all over the world. This is the reason for the rise of “populism,” which is neither left nor right but rather stems from a perception that the people are being robbed and controlled by a system that lives and thrives without their consent. That is certainly true.
On a philosophical level, I’m not prepared yet to describe all that we have learned over the past five years. Like you, I’m still processing it all. But this much I know: Things are not as they once seemed.
