M4A as a swing problem – The Health Care Blog


Over therethere is a common ground there – perhaps not the warm bond of a full faith, but a place, even a hospitable place, where we can stand together.’ Ian Marcus Corbin, researcher, Harvard Medical School

Most Americans would be happy to believe this statement. But political reality intervenes. An analysis by the Pew Research Center in March 2022 found that our two main parties are “ideologically further apart than at any time in the past 50 years.”

Take, for example, Presidential Hopefuls, Florida Gov. Ron DeSantis and Senator Marco Rubio (R-Fla.). They see political wage dirt on the erratic crests of America’s culture wars, with the governor taking on Disney for defending LGBTQ workers through his “Stop WOKE Actwhile Rubio goes one step further with his “No tax breaks for radical corporate activism law”.

In academic circles you will find more and more references to “what’s going on with … debates.” The phrase is derived from a 2004 book “What’s the Matter with Kansas?” written by historian Thomas Frank, who was on the New York Times Best Seller List for 18 weeks.

In the book, Frank describes Kansas’ transformation from a “hotbed of left-wing populism” to a center of “anti-elitist conservatism in the United States” and revealed the state’s remarkable ability to vote against its own economic self-interest.

The title itself originated in an August 15, 1896, editorial in the Kansas Emporia Gazette. It was written by a political leader, William Allen White, who accused the state’s slide into economic stagnation (compared to neighboring states) was the result of overly aggressive progressive policies that unnecessarily restricted small businesses. William McKinley, who ran for president in 1896, picked up on the theme and distributed hundreds of thousands of copies of the editorial as part of his campaign.

In modern times, select academics argue that working-class social conservatives have left the Democratic New Deal political coalition and have landed on the rocky hills of Republican shores, entangled in conservative ideology and ravaged by religiously intertwined cultural storms.

Others, such as Vanderbilt political scientist Larry Bartels, disputed these assumptions. As he summarized in 2005: “Has the white working class left the Democratic Party? No. White voters in the lower third of the income distribution have become more reliably democratic in presidential elections over the past half-century, while middle- and upper-income white voters tend to go Republican.”

A recent publication by two political scientists — Duke’s Herbert P. Kitschelt and Ohio State’s Philipp Rehm — says no one should be surprised at what happened in 2016, because it was a long time in the making.

What makes white Americans vote the way they do, they say, lies at the intersection of economics and education. Using a four-quadrant analysis chart, they tracked the presidential preferences of white voters from 1952 to 2016 in four groups: I. Low Education/Low Income, II. Low education/high income, III. Higher education/low income, IV. High education/high income.

Using a version of this chart, they concluded that there is a “polarity reversal… the New Deal voters of the two major US parties — low-skilled/low-income voters for the Democrats and highly educated/high-income voters for the Republicans — have become swing groups; the former swing groups are the new core voters of the parties (high-education/low-income voters for the Democrats and low-education/high-income voters for the Republicans).”

Specifically, they believe that:

  1. The Democratic Party is being let down by lower education/higher income white voters. (Think small entrepreneurs/local Chambers of Commerce), while higher education/higher incomes are slowly moving towards a neutral “swing” status.
  2. Lower-income workers also segregate on the basis of education. Those white voters with little income or education are moving away from Democrats to neutrality — “drifting into right-wing politics” and exploring militarized “social governance, racism, and xenophobia.” In contrast, low-income, high-educated whites are now safe in democratic territory.

What does all this mean? It seems that as we have transformed from an industrial society to a knowledge society, the traditional New Deal core groups (Dem-LE/LI; Rep-HE/HI) that anchored the two sides have become swing groups full of divided, volatile” independents” up for grabs.

How do you reach these new swing voters. Is there anything programmatic that could enjoy the support of large numbers of swing voters?

What about those individuals with high education/high income. In 2020, 68% of Fortune 1000 CEOs were Republicans. What could the government offer the workers under their care?

What about those people with low education/low income. Many manage to rise to middle incomes, only to fall back when faced with predatory debt often associated with a family illness or tragedy.

Programmatic solutions that would unite us should appeal to swing quadrant members on multiple levels. A concrete example is ‘Medicare for All’.

It would free the HE/HI CEOs from managing employee health care while trying to run their businesses. It would also help LE/LI fighters by boosting health and productivity, avoiding crippling medical debt and creating new jobs.

So, in fact, as Dr. Corbin suggests, “There is a common ground…a welcoming place, where we can stand together.” Programs and services that create jobs, strengthen community ties, and equitably promote compassion, understanding, and opportunity are political wage dirt.

Democrats and Republicans would help themselves, and help America, by seeking “common ground” under the banner of “Medicare-for-All”.

Mike Magee MD is a medical historian and author of “CODE BLUE: Inside the Medical Industrial Complex.”