Some might say it's been a long time coming—at least since Richard Nixon's appeals to the "Silent Majority" and Spiro Agnew's vilification of the media—but the crisis of conservative intellectualism is coming to a head at the moment. It's a fascinating spectacle to watch, and it is the roiling subtext to the whole debate about health-care reform.

The Republican Party's nomination of the proudly anti-intellectual and ill-informed Sarah Palin to be one 73-year-old cancer survivor's heartbeat from the presidency provoked some soul-searching among previously loyal former Republican presidential speechwriters such as Christopher Buckley (Bush I) and David Frum (Bush II), and spawned a bumper crop of new online publications seeking to build a more intellectually nuanced conservatism. Now conservative talking points on health care are being written by someone who might be characterized as Palin's progenitor: Betsy McCaughey. In 1994 McCaughey published a scathing attack on President Clinton's health-care proposal in The New Republic. The article was widely cited by health-care reform opponents, and considered a major nail in ClintonCare's coffin, even though many of the claims it made were later revealed to be false. McCaughey became New York's Republican lieutenant governor, but her relationship with Gov. George Pataki publicly unraveled, with Pataki's aides sniping about McCaughey's narcissistic and odd behavior. (Sound familiar?)

Now with health care back on the front burner, McCaughey is enjoying her second 15 minutes of fame. In newspaper op-eds, McCaughey propagated the myth of death panels by misreading the provision in the House health-care bill that would reimburse doctors for end-of-life-care consultations. "Death panels" became a conservative battle cry. But just as McCaughey has become a heroine to the same town-hall snarlers who idolize Palin, conservative intellectuals such as former McCain adviser Gail Wilensky and Stuart Butler of the conservative Heritage Foundation have been shunning her.

In this week's New Republic, Michelle Cottle argues that McCaughey is a blue-state Sarah Palin—an argument that on first glance seems too cute. But it's true! McCaughey's ostentatiously wonky presentation actually embodies the conservative populist attack on government and the other elements of a functioning democracy. 

On Monday night, McCaughey debated Rep. Anthony Weiner (D-N.Y.) at the NYU School of Medicine. The claque of conservatives in the audience loudly cheered McCaughey and heckled the pugnacious Weiner with cries of "Be a man" and "Rude man" when he alluded to her "pants on fire" rating for maximum dishonesty from Politifact.com. The angry white men defending a pretty white woman from the slings and arrows of a smarty-pants liberal man with his "facts" reminded me of complaints about Palin's alleged mistreatment at the hands of the media.

McCaughey brought the text of the bill as a theatrical prop (it's not as if the audience could read it, so it was not actually for their edification), and returned repeatedly to the claim that, at more than 1,000 pages, it is too long. This is a curious shibboleth—you often hear the same argument about the tax code in favor of the flat tax. The unexamined assumption is that complexity, and the difficulties of the average voter in understanding the details, is inherently bad. That is a deeply reactionary and anti-intellectual notion. Why get a Ph.D. and work at a think tank, as McCaughey did, if you believe, as she said at the debate, that the bill should be no longer than the 18 pages "the Framers needed to write the Constitution" (should it also be written with a quill pen? That was good enough for the Founders!) and that "it should be short enough for everyone to read it instead of relying on pundits." You know, pundits like . . . Betsy McCaughey.

McCaughey seems to overcompensate for an intellectual insecurity by citing bills chapter and verse the way Pat Robertson quotes Scripture, as if cogitation is irrelevant, even suspect. The Answer is on paper, and the Truth must be revealed. But her distrust of politicians to honestly write a bill, media professionals to fairly interpret it, and bureaucrats to administer it in a moral and efficacious manner—the whole concept of death panels depends on the slightly odd premise that Medicare administrators are any more likely to put Grandma to death than insurance companies, which, unlike Medicare, can actually make a profit by doing so—is the ultimate in embodiment of conservatives' anti-intellectual anger. The essential kernel is a belief that professionalism—be it political, bureaucratic, journalistic, scientific—is illegitimate. That's why the 1994 Republican class put term limits in their Contract With America, why the Bush administration suppressed evidence of global warming, and why conservatives believe the media are lying to them and that bureaucrats go to work for Medicare because they relish killing the infirm.

These types of suspicions of essential institutions such as the press, the bureaucracy, and the scientific establishment are not totally unique to the right. Leftists have grown increasingly mistrustful of the media, and some fear the CIA's alleged covert agendas. Some conspiratorial beliefs are understandable: you cannot blame African-Americans who believe that the government created crack or AIDS to decimate their community when you consider the Tuskegee project, or J. Edgar Hoover's efforts to discredit Martin Luther King Jr.

But the role of political elites—be they  members of Congress, op-ed columnists, or think-tank fellows—is to be interlocutors between their ideological brethren and the realities in Washington. That's why Democrats in Congress push for oversight of the CIA: to find out what it actually does, rather than just irresponsibly speculating. There's a place for conservative skepticism of domestic bureaucracy, just as there is a place for liberal skepticism of the national-security apparatus. The difference is that most conservatives aren't pushing for, say, rigorous independent oversight by patients' advocates and doctors of how a public plan would be administered to ensure efficiency without a loss in the quality of care. Instead they panic over the possibility that any government intervention in the health-insurance market for people under 65 will mean disaster, and their leaders, from McCaughey to Chuck Grassley, fan those fears when they should be redirecting the concern about the size of government toward a helpful contribution to the debate. 

Paradoxically, they also position themselves as defenders of Medicare. Yes, that's the same Medicare that Ronald Reagan got his start in politics by opposing. What would the Gipper make of this?

It's hard to say, but some conservative thought leaders are pretty chagrined by it all. Steven F. Hayward of the American Enterprise Institute argued in Sunday's Washington Post that "the conservative movement has been thrown off balance, with the populists dominating and the intellectuals retreating." Hayward longs for the days when conservative bestsellers were written by the likes of Milton Friedman and William F. Buckley, instead of Ann Coulter and Michelle Malkin. What's the difference? Buckley was skeptical of change, and that is a legitimate political philosophy, but irrational fear of change isn't.