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Andrea Fraser on Art, Money, Politics, and Power.

by Andrea Fraser

October 24, 2018

This interview with Andrea Fraser, a performance artist and professor at UCLA, was conducted and condensed by frank news.

Andrea: 2016 in Museums, Money, and Politics started as a publication component of a year-long program of events about my work organized by the CCA Wattis Institute in San Francisco. But it was originally supposed to be a completely different book. It was originally supposed to be a book about something else that I've been engaged in for the last 10 years, which is called Group Relations or the Tavistock Method, a method of experiential learning about groups and leadership and authority, which developed out of psychoanalysis and systems theory.

But then the election happened, and that didn't make any sense to me suddenly. Then I became involved in an action here in LA, about the presence of Steven Mnuchin on the Board of the Museum of Contemporary Art Los Angeles, a museum that has my work in its collection. I had been aware that Steven Mnuchin was on the Board and around the time he became Trump's Campaign Finance Chair. There had been some protests about his presence on the board, both inside and outside of the museum, but these had no effect.

Shortly after the election, I collaborated with a curator named Eric Golo Stone on writing an open letter to MOCA, which we circulated and got a few dozen prominent artists and historians to sign.

We were about to release it to the press when we were told by MOCA that he had stepped down.

frank: You didn't release it anyways?

We didn't release it. The museum knew that we planned to release the letter to the press on a certain day. We got the call the first thing that morning. Part of the discussion was: He's off the board. His name is off the website. Please do not circulate the letter.

Right.

In a sense, I feel like we missed an opportunity with our success.

Of course, his departure from the board wasn't represented as a consequence of activism in the community. It was represented as a consequence of his upcoming appointment as Treasury Secretary.

So that was part of the context for the book. When I became involved in that letter, I thought, "Well, I should find out who the other board members are supporting. What's the context here?" I started looking up the other board members of MOCA and was appalled to find quite a number of contributors to the Trump campaign on the board. Then I started looking up other museums, and that's when the idea for the book developed.

CCA Wattis had approached Thea Westreich and Ethan Wagner about co-publishing a book project with me, and we had discsued the idea for a book about group relations. It was a little odd because they're better known for publishing artists books and that would have been more like an academic book. Thea Westreich was one of the first and perhaps, I would say for a period, most influential art consultants when that line of work developed in the '80s. But they also publish artists books, often very limited edition artists books that are focused on visuals.

I was already wondering whether it made sense to do a more academic book with them. Then, when I had the idea for 2016, I thought, "Oh, my God, are they gonna go along with this?"

The peole on these boards are like their former clients. They just recently retired. I sent them an email about the idea with an exit hatch: I know this isn't what you signed up for. I would totally understand if it wasn't something that you were interested in. The response was, "This is great. We got to do it." They were totally enthusiastic, and from the very beginning I thought, "Wow!"

What I didn't realize is that not only are they politically progressive, but actually Ethan Wagner, before he joined Thea Westreich's art consulting business, was a political consultant.

Interesting.

Then I realized, "Oh, this is perfect. They're the most perfect people to do this book," because they have this expertise in both of these fields. They know that world of collectors and patrons and museum boards. They also know the world of campaign finance. Then I talked about it at an event in New York. Someone from Art Newspaper wrote up the project. Roger Conover at MIT Press saw the write up and emailed me. That's how MIT Press came on as the third publisher.

I took that question as an opportunity to give you the whole background.

[Laughter] No, that's perfect. Is the information you were seeking all public?

Yeah.

Was it easy to find?

There were stages. The first stage was putting together the list of museums, and I needed criteria for that. One of the criterion was that they had to meet a certain budget threshold. For that, I went to Guidestar.org, which is a nonprofit organization that maintains a website with the 990 tax forms of almost every nonprofit organization in the United States. They have other information that they distill from that. That was my first source when I was putting together the list of museums and identifying their total operating budgets, indicating the financial scale of the organizations, which is an important reference for me in the book and for any further analysis of the data in the book.

Then the next step was putting together the list of board members. Now, there might be different sources for that. I could have found that in the 990s as well, but I just basically went to the museums' websites, which I also assumed would be the most up-to-date. There were a couple of cases where the boards were not listed on the museum websites, when we went to 990s, or annual reports, or contacted the institutions directly.

The instances when we had to contact the institutions directly, were mostly instances where the institutions were public, rather than private-nonprofit, or university museums, where the boards have a different status. Some of these organizations are also supported by foundations or private-nonprofits that exist independently of their governing entities or boards but were created to support the museum. In some cases we include board members of those kinds of organizations as well.

The third and biggest chunk of research in the book was in the political contributions themselves. There are a number of organizations with websites that track and publish political contribution data, including the nonprofit and nonpartisan Center for Responsive Politics, which maintains a website called OpenSecrets.org, as well as a few forprofits that serve an industry of political operatives.

But all of that data comes from the Federal Election Commission (FEC), which maintains its own, very user friendly website.

In the end we just used the FEC website. Although then I went back to OpenSecrets.com to determine the partisan affiliation of many of the recipients and the Political Action Committees, which is much harder to get out of the FEC website. OpenSecrets.org collects data on almost all of the registered political action committees and super-PACS, including information about where their money goes and where it comes from. We were able to use that to identify the partisan lean of various PACs, which then influence how we identify the partisan lean of the board members who are giving to those PACs.

I'm surprised this doesn't exist as its own dataset already. It's a massive amount of work though.

Yeah, it is. I had a team. The designer that I worked with, Geoff Kaplan, who is amazing, put together a team that included a programmer who got the data from the FEC website and put it into spreadsheets and another designer-programmer who developed a program to export the spreadsheets directly to the design software.

Most of the book was never a manuscript. It went directly from spreadsheets to design. The fact-checking and copy-editing happened in the spreadsheet stage.

Was the goal to collect all of this so that it existed publicly, for transparency sake? Or was it action-oriented?

It was. Early on I envisioned an appendix for the book with template letters to board members, saying, "Dear so-and-so, as an artist in the collection," or, "As a member of the community," or something like that. And in these letters develop an argument, tailored to the nature of the contributions being made by the board member, about the conflict of interest between their political support and the missions of the organizations they serve.

For example, the conflict between their role in the governance of a cultural institution with a mission to support diversity, and their support of politicians who are, if not advocating for, apologizing for white supremacists and promoting intolerance and xenophobia.

Did you get pushback on that?

No, I didn't. I didn't do it because in the process of developing the book, the emphasis shifted away from the partisan inspiration for the book in finding people like Steven Mnuchin and other supporters of Trump and white supremacist, xenophobic, homophobic, misogynist, politicians on the board of cultural institutions that they're responsible to support and protect.

As the project developed, it became about philanthropy and plutocracy and about the donor class being more than just the class of political donors, but being largely identical with the class of nonprofit donors.

My research for the introduction, more than my research of the political contributions themselves, brought into focus the pay-to-play culture of governance in for-profit institutions, which, I argue, serves to legitimize a pay-to-play culture in public governance.

As it became more about plutocracy, the strategy of influencing the influencers started to feel cynical to me. Artists might have a certain amount of access to the donor class and might be able to use that access to influence the influencers. But if that's where we invest our political energy, aren't we buying into the whole plutocratic system? Aren't we buying into the political influencing machine, to the political inequality that results from economic inequality?

That's why I decided not to do it.

Right.

I didn't want the book to become about that.

What surprised you about the research?

I assumed that there would be more of a correspondence between the political leanings of the board and the political leanings of the state and the district in which the museum was located.

Each museum is listed with its district and with the congressional delegation representing that district. There's a table at the back of the book that lists each museum with the partisan index of the state and district where the museum is located. Each museum is listed with its district and with its congressional delegation representing that district. Then I made a partisan index for the board members of each museum and a partisan index representing the money that we found associated with each board.

I did expect to see more of a correspondence between the boards and the districts, if not the states—most of these museums are in urban centers, which, even in the reddest states, are usually represented by Democrats in congress.

But regardless of the political lean of the district and state, the bigger you get in terms of the financial scale of the institutions, the further to the right they go.

In a way it's not surprising. This is true in New York City, and it's true in LA, and it's true in San Francisco, and it's true in some of the bluest cities and states in the country. And it’s more true of the money than the board members.

Sometimes that has to do with one or two major Republican donors that just swing things way to the right with regard to the money. At the end of the book there are two big pie graphs. One shows the partisan breakdown of all 5,460 board members research, and the breakdown of the partisan breakdown of the money we found, and you see a significant rightward shift.

It shows that right-leaning politics have a close correspondence in many cases to wealth and to financial scale in these institutions.

Do you feel strongly about that money disappearing from the institution? Immediately when I hear this I think of Lincoln Center and the Koch Brothers.

Yeah, there are also Koch spaces at the Metropolitan Museum.

Exactly. You think of the big ones, and what happens in them. I've been to New York City Ballet shows, for example, and it's an incredible experience, made possible by financial contributions like those from the Koch Brothers. Do you think those institutions have a responsibility to reject that money?

I do think so. There's been reporting in The New York Times and a few other outlets recently identifying particular trustees with glaringly obvious conflicts of interests between their political patronage and the mission of the museum they serve.

The most obvious is Rebekah Mercer who is on the board of the Museum of Natural History in New York, which is just obscene. The Mercers are among the biggest funders of science denying, climate-change denying organizations that directly threaten the very mission of the Museum of Natural History, which includes promoting science and conservation. How is that possible? There's also been press about the Sacklers...

Who are the Sacklers?

The Sacklers are major philanthropists of cultural and educational institutions. The Metropolitan has a Sackler Wing and the Brooklyn Museum has a Sackler Center for Feminist Art. The Sacklers' money comes from pharmaceuticals and particularly from Oxycontin.

Their wealth is built on the opioid epidemic.

Do you have a proposed solution? Ways in which you think that these institutions should be financed? Is the answer to collect small donations?

That’s one solution. I have done quite a bit of research on the history, not only of arts organizations in the U.S., but also of philanthropy, the nonprofit sector, and trusteeship. When you take in the whole picture, it gets harder, unfortunately, to envision change. But when you extend that picture beyond cultural organizations and the nonprofit sector to include civic, professional, and other kinds of community organizations, one does find other models. In the visual arts and in the big cultural and educational institutions, the model is self-selecting and self-perpetuating boards who are usually required to make personal financial contributions, which collapse patronage and governance.

But there are many other types of organizations that have board elected by the membership, in a democratic process, and in which all the members support the organizations directly through small contributions and participate in governance.

I know of almost no cultural institutions in America that have that structure. I do know of cultural institutions in Europe that have that structure, such as Kunstvereins, or art associations, in Germany, which have histories that go back to the early part of the 19th century. They are supported by their members, who also elect the board and participate in governance.

There are a lot of organizations that have that structure. Museums have not, for the most part, had that structure, although there are museums in the book that started out as art associations.

Museums in the United States developed as private nonprofit corporations; they did not develop as democratically governed or structured institutions.

When I finishied writing the introduction, I just didn't have it in me to write up recommendations. I needed a bit of distance. I do need to get that out somewhere. One, to diversify museum boards, not only racially and ethnically, but also so they represent the full range of stake holders and community members, and not just patrons. Another is to develop more rigorous guidelines to ensure that patrons and board members are not subveriting or threatening the organization’s mission in their other professional and political activities. Another is to organize to advocate for public funding.

But the most basic recommendation I have for arts organizations based on my research is to draw a clear line between patronage and governance.

More and more museums and more and more cultural nonprofit organizations, generally, nationally, have developed a policy of requiring personal financial contributions from board members.

That's something that a few observers of the nonprofit world have noted and tracked. I've found some data suggesting that it went from less than 50% in the '80s to over 75% today.

That's a big jump.

Yes, it’s a significant jump, and the incidence of board members making contributions is even higher than organizations requiring it, which may indicate that this has become an implicit norm.

Again, this isn't just in museums, but I think museums have among the highest requirements with regard to personal financial contributions. This is largely anecdotal, because most board members have to sign nondisclosure agreements. There's very, very little transparency about this, which is another big issue. In the nonprofit sector we don't have the disclosure laws that are like the last vestiges of campaign financial regulation, the disclosure laws, which is what allowed me to do this book.

Reportedly, it costs $5 million to get on the board of MoMA, and then it's a quarter of a million dollars a year to stay on the board. $10 million for the Met. I'm not sure what it costs to get on some of the other boards that I've looked into, but I have been told that a lot of mid-sized institutions cost about $150,000 a year.

These are serious thresholds of wealth that become a barriers for diversity of all kinds on these boards. It's part of what makes these boards overwhelmingly white, and also overwhelmingly loaded with people in finance.

When you go back to the '70s or the '80s, particularly in smaller institutions, one would find a much broader range of people. You'd find more artists. You'd find more professionals, more academics, more people who are coming out of families with long traditions of collecting, who are knowledgable about culture. At a certain point, the financial structure of museums and the ways they started to fundraise became more and more focused just on wealth, with waves of new board members who reflect the boom industries of the day. First it was the leverage buyout guys. Then it was the hedge fund guys, then the private equity guys. Or in some cities, it's all real estate. It's whoever has that kind of money.

How influential is a board on the space itself?

You mean on the programs?

Yes.

That's a big question that comes up. I did a conversation that just came out in the magazine BOMB with Helen Molesworth, who was the Chief Curator at MOCA and was fired very abruptly by the director. I asked her about this, because I've never heard a museum professional admit publicly that the board has any influence on programs. Everybody pretends, and I would say pretends, that there's a firewall there, because the legitimacy of that world depends on it in some sense.

Right.

But what I say is, if museums have to raise money for everything they do, if they can't do a show or buy an artwork unless they can find someone who's willing to give them the money to do it, that's a tremendous amount of influence. It's veto power, essentially. There are very, very few other sources of funding for programs.

Then there are instances that have gotten a little bit more discussion, such as restricted gifts, like the Fisher Collection which is on long-term loan to SFMOMA with the requirement that the museum show a large percentage of it in a large percentage of their space continuously.

This is incredibly restrictive and imposes the tastes of particular patrons, who in this case were also trustees, on the institution and on its public, restricting not only the art that the public can see and the museum can represent, but the whole narrative of culture the museum presents.

They wield a tremendous amount of power then.

A tremendous amount of power. In that case, the collection consists almost entirely of white men who are either German or American and work in painting or sculpture. It represents a very, very narrow slice of art, even in the period that they're focused on, and excludes most of what has been important in art in the last 50 years. And it’s already very dated. It's basically like going to a very high end art gallery at this point.

It can't serve its purpose as an open forum for culture, or as a center for research. It’s awful. There are other examples of those kinds of restricted gifts, which are the most glaring instances of patorn influence on programs.

What about The Broad?

LACMA thought they were going to get Broad’s collection and built a whole building for it. But then he decided to open his own museum. In some ways I would say that LACMA is probably better off without it. We should note that we are sitting in the Broad Art Center at UCLA, which is my place of employment.

Right. I saw the sign.

The Broad is part of a trend of collectors creating their own museums for their own collections. These are sometimes called private museums. But the history of museums in the United States is that a lot of them started like The Board. There is the Whitney, the Guggenheim the Walker. We have lots of museums that were started by individuals focused on a very specific collection and were originally governed by those individuals and their family members, along with their lawyer and accountant, basically. But they evolved into institutions that we think of as serving a broader public and a broader set of cultural agendas. The Broad may develop in that way.

You've riled me.

Yeah. I know. I've spent my life riled. I'm an artist, and I do a lot of work on museums, but I don't really like them that much. There are a few museums I like.

Which are?

Well, I was just at the Berkeley Art Museum recently. That's a good one.

Do you think if one BIG museum were to take your advice, draw this line, change the way they approached funding, others would follow suit?

No, probably not. We could talk about W.A.G.E., which I think has succeeded in those terms. It started something that had a ripple affect and is now being adopted more widely.

I just joined a board of the ICALA, which is not in the book because it didn't meet the financial threshold when I was doing the research. I know they ask other board members for personal financial contributions. They have a couple of spots for community members who are not asked for that contribution and I have one of those spots. A few other museums have those spots: MOCA does, the Hammer, MoMA has a couple. Often they are used to add racial diversity to the board.

Joining that board, I've taken on fiduciary responsibility along with the other board members, and I don't have an alternative to that fundraising model. I can try to start that conversation, but going in and saying, "You should eliminate this financial contribution requirement," when it's a significant percentage of the museum's budget, is not something that feels doable.

Moving toward greater diversity on boards is something that I can be very vocal about. I think that's a start. I’m also on the board of W.A.G.E., which stands for Working Artists in the Great Economy, which was founded by a group of artists about 10 years ago and became a 501(c)(3) about five years ago. I've served on the board since then.

They've created a voluntary certification program for museums and arts organizations that commit to equitable compensation of artists and others who contribute to their programs, including artists' fees and honoraria as well as support for exhibitions. It was something that there was a lot resistance to initially and a lot of arguments about. But we just had our 10th year anniversary and have been very successful. W.A.G.E. has certified, I think, over 50 organizations, although mostly smaller organizations. We're still working on certifying larger organizations, but we know that many larger museums, even though they're not lining up to get certified, are looking at our fee schedule and are starting to compensate artists for the work that they do in those institutions. They are starting to talk about equity in a way that they haven't before.

On a smaller scale, we did succeed in shifting the terms with the institutions we certified. But even with the larger institutions, I think, we've changed the conversation about equity in relations with artists and beyond that, I think we've also created a space for curatorial assistants and interns and even curators in some of these institutions talk about whether they're being supported equitably.

You think about these structures from the top down, and they influence everything that people entering their institutions see and ingest. What we're allowed to look at, in terms of history and culture, what the narrative is, what we're exposed to.

Yeah. What gets legitimized, presented to us and legitimized as, well, as legitimate culture, as public culture. By virtue of their nonprofit status and often also of land grants for sites in parks and other public support, museum represent public culture.

But, in fact, they represent the culture of their board and patrons and the artists who have developed professionally into specialists in that arena. It needs to be broader than that.

Certainly.

I was just in New York and I went to the Whitney to see the David Wojnarowicz Show. He was an artist that died of AIDS in the early '90s. His work is encreadibly visceral in its politics and in its rage at the genocide that was being tacitly if not explicitly condoned by the politicians of that time. It was a very powerful show. But it was also shockingly cutoff from the broader context of AIDS activism.

But that’s what museums do. They take this person who was also part of a major mass movement and a moment of tremendous collective activism, and represent him almost as an individual alone in a fight, which is then reduced to an artisitc rather than a political struggle.

Nevertheless, I have been impressed by what the Whitney is representing from the collection since they moved. They are presetning a narrative of American art that I’ve never seen on view anywhere, that includes outsider art and artists who are Communists and labor organizers and involved in the Civil Rights Movement. By the time you get to Abstract Expressionism and Pop Art, which was always the pinnacle of the classic narrative, you can see it’s politically conservative as well as it's formally “progressive” aspects. Or at least that’s how I saw it.

One of the other important conclusions I reached by doing the book is that we can’t just complain about the donor class, whether we’re talking about political donors or nonprofit donors more broadly.

We also have to examine ourselves as the donee class, because the power and influence of the donor class works thorugh us, through the people who are constantly pursuing them for donations, and who make themselves dependent on those donations.

Absolutely.

Whether we’re politicians or other political professionals, curators or other nonprofit professionals, artists, educators, or scientists, we give the donor class its power. We can argue that we have no other sources of funding, but very few of us are fighting for public funding. It can't just be about criticizing the donor class.

It also has to be about looking at the ways in which we're complicit in that corruption through our own relentless pursuit of the wealthy to support us and what we do.

We so readily accept these systems as they are, because they feel historic...

They're institutionalized.

We've been working on a new project that's an update of something "old". Everyone keeps telling us we're insane. And the thing we keep hearing is, "Yeah, but it's been this way forever." And I'm like, "No, it's been this way since 1986."

People have short memories.

If I didn't update my computer since 1986 it wouldn't work. We'd all be using...

Floppy disks.

Rotary phones. What are you talking about, since 1986?! Everything in the world has updated since then.

Yeah. Right.

Philanthropists often like to present themselves as innovators, but they're not. They're just further institutionalizing existing relations of power!

Well, this is great. Thank you again.

Managing The Unavoidable

by Michael Brumage

April 1, 2020

This interview with Michael Brumage, the Medical Director of Cabin Creek Health System and Program Director of Public Health/General Preventive Medicine Residency at WVU School of Public Health, was conducted and condensed by frank news.

frank: Thank you for speaking with us Michael. Will you tell us about your background?

Michael Brumage: My name is Michael Brumage, I'm an MD and I have a master's in public health. Currently I'm the medical director for Cabin Creek Health Systems. I'm also the program director for the general preventive medicine residency at West Virginia University in the school of public health.

I am a native West Virginian. I went to undergraduate and medical school at West Virginia University.

How did you get your start working on pandemics?

I started by working in internal medicine for the United States Army and later became a preventive medicine physician. From 2005 to 2007, I was the chief of preventive medicine at Tripler Army Medical Center in Honolulu. While I was in that job, I wore two other hats, one as the public health emergency officer, PHEO, for the Pacific Regional Medical Command, and PHEO for Joint Task Force-Homeland Defense, which covered all the U.S.-affiliated islands in the Pacific. I was up to my neck in pandemic planning.

At the time we were planning for Influenza A H5N1, the “bird flu”, the highly pathogenic avian influenza we worried would become the next pandemic virus. Fortunately, it never acquired the characteristics to spread easily from person to person. While it had a very high mortality rate, it didn’t spread easily. I understood what was at stake from the very beginning of this current pandemic.

This has transpired, largely as I hoped it would not.

How so?

I had hoped that our government would have been more proactive in seeing the danger and expressing that to the American people, and that did not happen. Now we have to make really hard decisions about what price we're going to pay. In places like New York City, Seattle, Boston, we are reaching the capacity of our healthcare system and may soon overrun it.

How will this affect rural communities, like yours in West Virginia?

We have to consider how we can prevent the spread to rural areas of the United States. Where we are in West Virginia, we serve people from all walks of life, but are primarily in underserved areas. We have clinics in formerly very heavy coal producing areas, and we deal with a lot of chronic illnesses like heart disease, lung diseases, and diabetes.

The Kaiser Family Foundation recently did a study evaluating at-risk populations for a pandemic.

West Virginia had 51% of its population over the age of 20 at risk for complications. The national average is 41%.

We are not only dealing with individual human beings that have chronic medical illnesses, but also Hepatitis B and C, and HIV cases related to intravenous drug use. In addition to these problems we now have to address a pandemic that strains our own internal capacity. What's most concerning to me is that we are working with very high-risk populations for complications from coronavirus.

How do you prepare for a pandemic in the face of that reality?

As the medical director, my effort in the last couple of weeks has been almost solely focused on preparing Cabin Creek Health Systems for a pandemic, which includes 11 sites in Kanawha County. We've been preparing to try to segregate people with respiratory symptoms away from other patients, moving toward deferring visits that do not require an in person visit, and trying to shift more to telephone and telemedicine to care for patients. We will still need to see patients in person for a variety of issues.

Yesterday I was in clinic for the first time in a while and actually swabbed someone for COVID-19. He had been on a cruise with two other family members with upper respiratory symptoms. I tested him for COVID-19 after donning personal protective equipment and administered the nasopharyngeal swab. We will find out the results in a few days.

This has been the pressing issue for me: worrying about a pandemic with the background of people in a state that ranks first in almost every bad category of health indicators, and usually bottom three for every good category of health outcomes.

It's a real challenge because our population is sicker than most.

If it hits here the way it does in other places, we're soon going to be out of ICU capacity and hospital bed capacity. There may be difficult triage decisions made for people to access care.

One advantage I think we have is that we are rural. People either live on ridge tops or they live in the hollows and that tends to create its own capability for social distancing. Whether you're in rural America or urban America, you're going to do pretty well if you practice social distancing. The question is whether or not we have the discipline to maintain social distancing, and biting the bullet on economic damage that it is going to do.

The case number is currently low in West Virginia. How are people responding in a place that is not visibly taken by the virus?

_{https://dhhr.wv.gov/COVID-19/Pages/default. | 39 Total Positive Cases as of 11:47PM PST 3.24.20}

First of all, we don't really know how many cases there are. This is a huge blind spot everywhere in the United States, and here in West Virginia as well. While we know we have eight cases [on 3.21.20], I think everybody in public health understands that the real number of cases out there is much, much higher.

We are really like soldiers on a battlefield in a fog. We know the enemy is out there, but we don't know their strength in numbers.

I think many people here, from what I can gather from social media, are still in disbelief that this is as bad as it was because of messaging that came from some conservative media sources and the message that was coming from the White House for some time. I think the lingering effect of that is that there are many people who don't take it seriously. Two days ago, I went to a supermarket and I still saw people walking out with rolls of toilet paper under each arm, which I can't comprehend because there is no toilet paper shortage. And instead of just getting in and out with their toilet paper, I saw people congregating in the parking lot having discussions, which is an anathema to what we should be doing right at the moment.

Right. There is something strange about going to a store right now, without knowing what the future looks like – even with all the information I have, I pause and think, do I need more stuff?

Definitely. That attitude can be very contagious.

When we look to countries ahead of us chronologically, how can we use their experiences as a model?

If we stop and take a look around the world and how different people handled it, we're going to find success stories that could help lead us to a better place. One is China.

China of course, made the fatal flaw of suppressing the information on the virus, and we're all suffering because of it.

Because they have much more authority to enforce disciplined public health measures than we do in Western democracies, they were able to clamp down very rigidly on their population. This sort of radical social distancing and enforcement of quarantine seems to have worked in China. I think they may be out of the woods, depending on how they manage the subsequent waves of disease that are inevitably coming. While there may be no more new domestic cases, China is very connected to the rest of the world and can import cases.

Then you have South Korea. South Korea was an early leader in terms of number of cases and number of deaths. The Korean CDC is a capable and intelligent organization. They rapidly deployed testing kits and identified the people at risk and tested them. Whoever was positive, was isolated immediately. This is very widespread, population-based testing, an aggressive management of the disease seems to be flattening the curve in South Korea. They seem to be a model we can follow. In general, South Korea looks a lot more like Western countries politically, than they do a rigid, authoritarian country like the People’s Republic of China.

If we want to really get a hold of this, we have to expand testing radically.

Part of this is buying time everyday so we can slow the spread and allow industry to catch up, to allow research to catch up, and to implement widespread testing. This will really make a major difference in our response.

What can we expect given our current reality?

My concern is what frequently happens when you start to get success is that you become complacent. I anticipate we will eventually succeed in controlling this in some manner or another. The reality of the situation is going to hit home, even for the people who are still out there in denial. I anticipate that over the summer months, the disease will wane and give us the sense of security that we've kind of got this thing under control.

I really worry about what's going to happen in the fall if we let universities reconvene and schools reconvene.

People from all over the country are going to descend on campuses and share their viruses, which happens every year. This could reignite the whole situation. That’s why we really need to have a much tighter testing regimen in place by fall. We can buy time through the summer months and become very aggressive about developing testing, including point of care testing. There's a difference between what we're doing now with testing, which is the nasopharyngeal swabs and sending it off to a lab for evaluation, and things like the rapid flu test, which we can do in an office setting in about 30-45 minutes. We have a similar test already for influenza. In those cases we test, keep the patient in the office and tell them whether or not they have influenza. A similar test for coronavirus would be ideal. I believe it could be a prerequisite that the student body and the faculty would have to be tested and be certain they were negative before returning to campus.

Coronaviruses are not new to the United States. There are at least three other coronaviruses that show up in our communities and present like a common cold. What we are concerned about here is the more pathogenic and dangerous COVID-19 virus. We need a test that could be easily administered, and then we need to be able to isolate the positive cases that do come back away from the population.

In some ways, it's like when you think you've put out the forest fire, but those smoldering embers lying in wait can help reignite the fire all over again. My greater concern over the long term is that we become complacent and that this disease makes a resurgence in the fall months.

Data is finally emerging, but I feel like data is only as useful as the person interpreting it. How are you reading what comes out of China, Italy, or South Korea?

Data is also only as good as the people collecting it, and what they are collecting.

The Chinese data and the South Korean data especially, are the best gauges for what the real case fatality rate is.

There's a lot that comes into play here. So again, South Korea has done much broader testing, they're identifying the less symptomatic cases, as well as the extremely ill cases. The last time I looked, the fatality rate was 0.8%.

Italy on the other hand, is not doing the broad-based testing. It could be that their case fatality rate is in fact higher because they can't deliver the level of care required to every person coming in because they're making triage decisions – literally who's going to live and die. Because they are in this dire situation where they have outstripped their capacity, people who might have survived previously are no longer given that opportunity because there's not enough intensive care unit beds, ventilators, and intensive care unit staff. We have to look at all the data from a wide variety of angles.

What is the real number? I'm looking at the South Korean model as the most accurate, even though it's probably not perfect. If we can drive the case fatality rate down to 0.8% that means: a), we're doing enough testing and b), we're maintaining our capacity to care for those who are extremely ill.

What else do we need to pay attention to right now?

One is that we have to plan ahead for vaccine distribution. We know when this vaccine is finally produced, we are not going to have enough for everybody, and it's going to be available gradually as production increases. People like health care workers and first responders are going to be among the first in line. People at highest risk of disease are going to be next in line. We have to begin to communicate those priorities well in advance, in order to prevent public panic.

Think about people trying to get vaccine when you see people hoarding toilet paper.

The communication has to be clear.

One of the most touching things I saw in relation to pandemic preparedness was a mass vaccination on Saipan in the Commonwealth of the Northern Mariana Islands. In 2007 and 2008, the Department of Defense received an excess of flu vaccine they were planning on paying a company to destroy. At the same time there were people in places like the Pacific US territories that weren't getting enough. I thought, we have this need in the Western Pacific, so why not use it? I was able to get it shipped out and used as part of the community's pandemic planning.

How do we plan for a mass vaccination?

Ultimately, that's going to come down to planning at the local level. That means local health departments and hospitals and other health organizations will have to collaborate with law enforcement to set up mass vaccination sites that may include drive-through vaccination clinics where you are.

Got it.

I wanted to mention that at the end of this, we have to ask ourselves, “How could we let our public health system fail the way it did?”

When it comes to a pandemic, you see how the system has failed because it was underfunded and under-resourced at the federal, state, and local levels for many years. We often boast that we have the best healthcare system in the world. That myth is busted if we are failing even the doctors, nurses, and other staff on the front lines of this pandemic without adequate personal protective equipment. How could this be allowed to happen when we knew that a pandemic would eventually hit?

I was just listening to NPR on the way to talk to you and I heard somebody talking about how a pandemic bears a similarity to earthquakes, another periodic natural event. If you live in Los Angeles, you know that the big one is coming sooner or later. We knew pandemics were coming. It was inevitable. And yet we were so ill prepared for this.

This is a societal failing to undervalue public health.

We have to reimagine how we view health. We have typically viewed health through the lens of health care, when we know about factors called the social determinants of health that account for 80% of a population’s health. I'm talking about things like employment, economy, education, housing, transportation. All of these things play together in the health of people. The growing homeless problem you have in Los Angeles, in San Francisco, and even here in Charleston, West Virginia is a nationwide phenomenon, and these are people who are at high risk for all kinds of bad health outcomes. We are together only as healthy as the least healthy among us. They are the weak links in the chain of health. We have to have the view that we are interconnected.

We need to be prepared for the next pandemic that will inevitably come, and look at health from a holistic perspective. At the social services, at education. All of these things are crucial determinants of health for our nation and for our planet. If we fail to do that, then we have fundamentally failed to learn the lessons of this pandemic.

You’re so right about LA – it's cognitive dissonance. It's too big to wrap your head around. Right now there’s no looking away. Hopefully we use the opportunity as you suggest.

You nailed it. This cognitive dissonance is so true. We can't ignore it, and we're all paying the price for all of the weaknesses in our chain of health, in our chain of healthcare, and in our failure to plan for the inevitable. I think it's just such a profound quote from Tom Friedman who said, “We have to manage the unavoidable to avoid the unmanageable.”

And I thought, wow, that's really the whole pandemic in a nutshell. We have to face what's clearly in front of us. We can no longer look away, otherwise, we are setting up future generations for a failure on the scale that we see today.

The Politicization of Abortion

by Karissa Haugeberg

March 21, 2020

Hi Karissa, so happy to speak to you today. Would you mind starting by introducing yourself and telling us a bit about your background?

Sure. I'm Karissa Haugeberg. I am an assistant professor of history at Tulane University. I teach courses on US women and the law and also the history of medicine in the United States. My first book was about women's participation in the US anti-abortion movement from 1960s until the early 2000s. My next book project will be about the history of nursing since 1964 in the United States.

Incredible, I was hoping we could begin by framing abortion in a historical context. As far as I understand, it's gone through different legal phases: from unregulated to regulated and then to a reform of that regulation. Is that correct?

Yeah. I'll just begin with this: women have always had abortions. That in and of itself is not a new phenomenon. Women have always sought them no matter what the legal status of abortion has been.

Until the 1820s, women were permitted to have an abortion before quickening. Quickening was the moment a woman recorded that she felt the fetus move. Basically, people had to trust a woman's judgment and what the woman was saying. As long the woman claimed that she hadn't felt the fetus move, no crime had been committed.

And that is until when?

Until about 1821.

Okay, wow. So when did contemportary abortion law come about and why?

The first more contemporary anti-abortion law was passed by Conneticut in 1821. What's interesting about that first wave of abortion laws is that they were largely poison control measures and they did not target women. The laws resulted from concern about unregulated salesmen who were selling abortifacients. These were herbal remedies or pills that were actually unsafe and were sometimes harming and killing women. It could be argued that really the intent of the laws was to protect women's health, protect them from these unlicensed, unregulated entrepreneurs.

There was a really thriving trade of abortion practice in this time. Typically, women just went to their networks of other women, similar to the advice networks set up for figuring out who to deliver your baby. It wasn't uncommon for the midwife to also be an abortion provider. There was just very little attention paid to this.

It was all considered a private issue, personal, medical. The state just wasn't that interested in regulating it.

During the conversation during this time, whether it's between a woman and their physician or amongst the family, is there any moral argument being made or is this something that's detached and medical?

There was not a whole lot of moral discourse about abortion, the exception being the Catholic Church. The Catholic Church has been pretty consistently anti-abortion, but they didn't have a lot of political sway in the 19th century. They weren't politicians for the most part, they weren't influential lobbyists, so this moral argument was pretty small and limited to the Catholic Church. One thing to keep in mind is that Catholicism is associated with immigrants in the early 19th century, and for middle-class white Protestant Americans, this just was not one of the moral issues they were talking about.

Things started to change in the middle of the 19th century. It was physicians who really led the charge to criminalize abortion in the way we now think of there being anti-abortion laws, ones that target both women and providers.

What was the response of physicians?

This coincided with the professionalization of medicine in the United States. We were really late to the game. Physicians in Europe already had to be members of a guild, go to college, pass exams in order to be admitted to practice medicine. In the United States until the middle of the 19th century, a person could go to college for a year, graduate from high school, hang out a shingle and call themselves a doctor. That was perfectly legal. Physicians, beginning in the 19th century, tried to professionalize and have national standards: make everyone graduate from college, make people pass an exam in order to be admitted to the American Medical Association.

In that process of trying to take away business from midwives, but also delegitimize them. They understood abortion and labor to be lucrative. It was a way to establish that relationship with a future client. If a physician delivers a baby, that's perhaps who those women will turn to when those children get sick or when their spouse gets sick. It was a targeted business decision and it was about establishing their authority. To establish their authority, they argued that abortion was profoundly dangerous, which it really wasn't. It was safer than actual childbirth. Physicians also began to use the moral rhetoric that we now associate with ministers. They started talking about how it was just so immoral that these women were making this decision. Several of these prominent physicians would say things like, "Abortion is murder, but it's sometimes necessary. That's why you need a physician to intervene, to figure out if this is an acceptable time to commit this act." They almost provided this moral authority to arbitrate whether it was permissible or not.

What's the response then from women at the time?

A lot of their critique of the way that men were treating women got wrapped up into the way they were talking about abortion. It wasn't until well into the 20th century that marital rape was considered a crime, so a lot of these feminists pointed out so long as men are just entitled to their wives' bodies, these women are always going to vulnerable. It's going to put them at risk of needing abortions if they want to control their fertility because this is before there's reliable birth control. That's part of the context that they're thinking about when they think about abortion. They see abortion as potentially dangerous and that it seems really unfair that women have to subject themselves to this potential danger because of all these factors, these ways in which women lack equality.

Right. Is family planning a part of the conversation at this point, also? Obviously, you're saying there's lack of access to reliable birth control. Is that a consideration from women in this discussion?

That’s a really good question and, in a sense, one could argue that the history of abortion demonstrates that women have always sought to plan their families. We can look from the perspective of 2020 and say, "Yeah, it looks like those women were committed to family planning." They wouldn't have used those words to describe what they were doing, but that's it. That is what they were doing.

In the 19th century, a lot of women who got abortions were married women who were trying to control the spacing in between children, arguing that in order to be good moms, they needed to not have five children under the age of five. Alternately, women who were single often turned to abortion in order to remain marriageable because it was so hard to find a partner who was willing to marry you if you had a child out of wedlock. The rhetoric of family planning really gets popular in the 1910s and 1920s with Margaret Sanger's activism.

That makes sense. By the 20th century, every state in the United States has classified abortion as a felony.

That's correct. Again, it's physicians who drove that campaign. They're the ones who lobbied state legislatures to criminalize abortion. Those criminal abortion statutes were really serious. In a lot of states that made providing or even seeking an abortion was a felony offense. More abortion providers were prosecuted than women, and the reason for that are twofold. One, often the thing that triggered these prosecutions was a woman dying, so there wasn't a woman there to prosecute. The second reason is when a woman did leave, let's say there was a dragnet and the police where criminal abortions were being performed, they would often offer women a plea deal if they agreed to testify against the person who performed the abortion.

They were always after, like in the drug trade, they're after the supplier.

Right. Yeah, they're getting the little guy to slip.

Exactly.

Culturally and, I guess, politically, what propelled us from this place where every state has classified abortion as a felony to Roe v. Wade?

One thing that plays a big role in abortion access is the state of the economy.

When the economy was not doing well during the Great Depression, authorities for the most part turned a blind eye and the abortion rate spiked. This was true globally, people, in todays terms, were attempting to practice family planning when they could not put food on the table. Abortion was still illegal, but authorities really diminished prosecutions because they understood that if people are suffering and then they go after this source of relief, it would be enormously unpopular. Conversely, when the economy was doing well, there tends to be this renewed emphasis on promoting family. Think about the baby boom of postwar America. There was a renewed crackdown on criminal abortion in the 1950s and 1960s. That's really when we see the underground market, the unregulated market really taking off in the United States.

When prosectutions start ramping off, doctors stopped providing abortions because they're afraid of going to jail or losing their practice, so this teeming criminal enterprise opened. Low and behold, you see the death rate just spike because instead of turning to physicians, women are increasingly turning to underground, unlicensed people. This is where you hear these horror stories, or if you've ever seen that photo of the woman who's lying in a pool of her own blood on the floor, that's taken in this era in the 50s and 60s. Hospitals end up having to open up entire wards called septic wards to treat women dying of blood infections, like bacterial infections from using knitting needles or ingesting Lysol, trying to throw themselves down stairs.

It is also coinciding with more women going to college, so they're wanting to delay their pregnancies in order to maybe go to law school or medical school. Women's lives were changing so much after the war, and yet these laws remained unchanged. Suddenly, affluent white people started to see their daughters dying, friend's daughters dying, so there was real public outcry.

One additional factor is that there was an outbreak of German measles. When women contract German measles when they're pregnant, it can result in birth defects or a loss of a pregnancy. Americans came into contact with women who had wanted pregnancies, were mothers, and then were suddenly in this position to want an abortion and couldn't get them. There's something about being, again, affluent white middle-class mothers who want another child need an abortion that suddenly makes Americans more sympathetic to the issue. This propelled state legislatures at the state level to begin liberalizing abortion laws.

During this time, 50s, 60s, I feel like the prespective on abortion was divided along religious lines. There was a section of Catholic voters opposed to abortion access that were a really big part of the New Deal Democratic coalition. You look back at Barry Goldwater, who was staunchly pro-choice. How did it become then contentious along the party lines as we see it today where it seems the GOP takes the conservative, anti-choice stance? I can't really imagine a Democrat being elected to state legislature or senate or anything with a non-pro-choice perspective.

No, absolutely. You hit the nail on the head. There's such a profound realignment that is kind of stunning if you look back at it.

In the early 1960s, in general, Democrats were slightly more anti-abortion than pro-choice. Republicans were slightly more pro-choice than anti-abortion.

This was due to the fact that the Democratic party was the home for many Catholics. How did this all change? A large part of that story has to do mostly with the realignment of the Republican party. In the late 1960s, several of Richard Nixon's strategists knew they had a very close reelection coming up. Their goal was to try to animate new voters to come out and vote for Richard Nixon.

At the time evangelicals were somewhat of an afterthought politically, but Nixon's team figured out if they could mobilize Evangelicals to come out and vote Republican, that would be a significant enough wedge of voters that it could enable Nixon to win. They had to craft Nixon into somebody that could be considered to champion their values. They argued that school prayer was under assault, they decried the legalization of birth control as leading to changes in gender, they pointed to the feminist movement as changing families away from the traditional American family, and they argued that “traditional” America was being upended by programs meant to promote desegreagation. Abortion became one of these issues. An issue that Nixon previously didn't seem to care about suddenly became pretty central.

After Nixon was impeached, Gerald Ford represented the more typical Republican politician over there. He was deeply uncomfortable talking about abortion. That wasn't part of partisan politics, so he signaled a return to how it had been. Some people within the Republican party looked at Ford and his unwillingness to embrace this more Moral Majority right position, and say, "Aha, look what happens when you step away from this emerging coalition. You lose." They made sure that wouldn't happen again, so one of the most robust parts of Ronald Reagan's campaign was to very aggressively court the Evangelical right and the Moral Majority. The Moral Majority was happy to align with him. They saw if they could get out the vote for him, they could maybe help select judges. It's in 1979 that the Republican party for the first time adopts a pro-life plank as part of the Republican platform.

It's so late. That's so crazy.

Yeah, but it took a while to get there. It starts with Nixon, it's really uncomfortable, it gets to Reagan. Even in that time, it's still deeply uncomfortable within the party because you have all these Ford-type people and George H. W. Bush-type people who were either pro-choice or thought it was uncouth to talk about abortion that way.

Right. You deal with that in private, please.

Exactly, that's a private issue. There were a lot of Republican politicians who openly identified as feminists and it wasn't a cynical feminism. They promoted gender equality. They were deeply uncomfortably with what was happening. You just basically see a reckoning unfold in the Republican party. Basically, that very conservative faction won. By the time you get to George W. Bush, there is no question. If you want to win a primary, you basically have to be anti-abortion. As part of that reckoning, they were basically able to take conservative Catholics away from the Democratic party. The degree to which the Democratic self-consciously became the party of choice, one could make that argument, but there's almost a way in which that's what they were left with. They were almost a reactionary party to the party that was taking the oxygen out of the room, which was the Republican party through its realignment.

The Democrats, they then affirmed a pro-choice plank one year after the Republicans did. I want to say it's '79 is the Republican party, then 1980 is the Democratic party. You just see them following suit or following the lead of the Republican party.

Right. The Republican political line, by this time, it is morally reprehensible and it's a moral religious argument that they're making.

Absolutely. In this time period, in the '70s and '80s, you're not hearing as much about abortion is a horribly dangerous thing. You hear that a little bit in the grassroots, but as far as major politicians, they're definitely just using very moral religious rhetoric to make these arguments that they are saving babies.

That makes a lot of sense. Again, by this time, what is the women narrative? How are women talking about abortion and access to abortion and what it means to the feminist movement, obviously, during the same time period?

Right. The feminist movement is just so radically altered by this time, by the 1960s and 1970s. One of the major things we have to remember historically is that the pill had just been made available, an effective form of birth control in the 1960s. Women began to see how the ability to control reproduction meant the ability to complete college. It meant the ability to go to law school. It meant the ability to go get on the career track maybe to becoming a manager in a company. They very clearly saw the links between that ability to control reproduction, the ability to control one's body, and the ability to control one's destiny. You weren't destined to have to get married in order to survive economically.

Abortion in the 1960s became embedded in this rising feminist consciousness in a way that it just wasn't part of the imagination of the 19th century.

By this time, what's the physicians' stance? Has that changed?

That's changed dramatically. Whereas physicians led the movement to criminalize abortion in the 19th century, they were among the groups that were calling for the decriminalization of abortion by the late '60s.

What changed?

They were doing so for two reasons. One was they were getting that uptick in women coming into the emergency room dying of criminal abortions. They were first-hand responders watching criminal abortion was doing to young women, so they were horrified by what they were seeing. But a second reason why they led this campaign is that they were so afraid of being prosecuted for making the wrong decision. For example, if a woman came in suffering from a miscarriage and needed a D&C, there was always this specter of worry, "Will people think I'm really just performing an illicit abortion and using this as a cover?" or, "What do I do when my state only has an exception for the life of the mother, but I know her health may suffer, and I go ahead and perform this. I'm technically not complying with the law. Am I vulnerable to being prosecuted?" Because the law just didn't match ordinary human experiences, these physicians believed that they weren't able to exercise their professional judgment. They resented that and they were afraid, so they worked with the American Law Institute to try to reform state criminal abortion codes so they didn't feel as nervous just doing their profession.

Right. Where do the nurses come in and fit between the two groups. As an overwhelmingly female dominated industry in the medical field, it seems that they would be staunchly pro-choice. But that is not the case at least in the 1970s, could you elaborate on why that is?

When I was writing my first book, I kept coming across all these images of pro-life nurses, or anti-abortion nurses. They formed some of the first anti-abortion groups. I was just so stunned by this because there were all these physicians who were advocating for the decriminalization of abortion. Why were nurses so different when they were working in the same hospital, working with the same group of women? One of the things that I discovered was that in the late '60s and early '70s, many nurses did not have bachelor's degrees. Instead, after high school, they entered 3-year hospital-based nursing programs, like a nursing school. There's a really strong corelation between the amount of education a person has and their attitude about abortion. The more education one has, the more likely they are to be pro-choice. That's one possible explanation for why nurses tended to be more anti-abortion than women in other professions, like social work or teaching, or compared to men in healthcare.

As I investigated more, I learned that it was more commonplace for women to get a second-trimester in the '60s and '70s; that's for a lot of reasons. It's something that's gone down a lot. But at the time, the procedure for performing a second-trimester abortion was called a saline abortion. Among the things that I learned is that the way that that was administered is the physician would often inject a woman's uterus with a saline solution and then leave the room and basically have minimal or no contact with that woman ever again. It was left to the nurse to stay with woman while she labored and eventually had a miscarriage, so delivered a baby that was stillborn, or was dead from the saline. There were ways in which this could be... if a person is not trained to deal with this, it was stressful. Some of these nurses weren't even trained, like given directions about how to dispose of these fetuses. It's not totally shocking that they found this to be upsetting. They resented this new workload that they had because, again, there was a massive influx of women as soon as abortion was decriminalized initially.

These women felt overworked, overburdened, and they were doing traumatic work. I came to be more empathetic to these women who just felt they were left without a net.

Yeah, no. That makes a lot of sense.

Okay.

Do you see a way to decouple the moral religious grievances that come with the abortion conversation from the conversation entirely? Is there a way that this can be something that is less polarized, that is less extreme, that is less difficult? Ultimately, is this always going to be a central stance of the Republican party? Do you see a way that that changes?

In the short term, I don't see the Republican party abandoning this because it's been such a successful strategy for ensuring that they have a very stable, loyal base. Think of Donald Trump. A lot of people wonder how is it that a person who is a philanderer, in many regards pretty immoral in his personal life, definitely not religious, how was he able to garner the support of so many Evangelical Christians? It's because of his promise to nominate anti-abortion judges.

Because there's such a quid pro quo in this relationship, it would be foolish for someone running for Republican office to abandon that loyal group of people who can help push them over the edge and win.

From just a very cynical political calculation, I cannot imagine why a Republican would abandon that base. One thing I often find myself thinking about is, if we're being honest about this issue, in many ways, opposition to abortion is a religious belief.

It's a belief about morality and when life begins. If we were to value a strict separation of church and state, I think it's possible to have political discourse that isn't about this issue. For example, if we agree that this is a moral religious issue, it's then inappropriate for us to have it at the focal point of public policy... to regulate it, to make it go away. Conversely, if we think about the right to abortion as a public health issue, it's inappropriate to take it away on grounds that are religious, right? If we're foregrounding the ways in which this is key to keeping women's health safe, a moral argument is inappropriate. Again, if we can think about our obligation to separate personal moral religious beliefs from issues of the state secular issues about health, I think that would be tremendously helpful and important.

Right.

If we're going to keep our attention on like the medical reasons for abortion, there really are not really compelling reasons to regulate it.

And is that something that you can see happening or are we too sort of...

I do not see that happening because in a variety of contexts, including gay rights, the courts had been more permissive of religion and The Affordable Care Act.

There is more emphasis placed on people protecting religious freedom than there is on protecting freedom from religion.

So, I do not really see there being an end in sight to this so long as the courts continue to value religious expression over the ability to be free from religious controls.

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Andrea Fraser on Art, Money, Politics, and Power.

by Andrea Fraser

October 24, 2018

Managing The Unavoidable

by Michael Brumage

April 1, 2020

The Politicization of Abortion

by Karissa Haugeberg

March 21, 2020