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Notes -
Did y'all talk about this story by Aaron Sibarium earlier this month?
Meet the Little-Known Activist Group That Has Tens of Thousands of Doctors Registering Patients To Vote
The article starts by describing a psychiatric institute in Pennsylvania that started an initiative to register voters.
Since the initiative is in a medical institution it must be justified, because you can't just waltz into medicine and decide voting is important. No, these institutes are bound to a sacred oath that commits their staff to the health of patients. By necessity, voting must become good for patients.
After the starting the voter registration initiative, the Pennsylvania hospital "has turned to the nonprofit Vot-ER, which develops "nonpartisan civic engagement tools" for "every corner of the healthcare system." This is where my lack of strong objection turns into a fully committed objection.
The basic gist is that medical staff wear a QR code around their neck and point patients to it in order to register. A 2021 executive order encouraged this behavior, but Vot-ER's site only cites the National Voter Registration Act of 1993 in its FAQ page as its legal reason to exist. Medical professionals have the greenlight to seek out patients and proactively attempt to register them to vote.
I did not vet every link in the article, but I did look at a few, and as far as I can tell most of the quotes are presented in a fair enough, if biased, context. There are professionals willing to say stuff like these bits:
I think if voting cures depression that's great, but I suspect voting does not cure depression and Debra Koss is not offering a medical opinion.
I watched most of a 20 minute talk from the founder of Vot-ER from 2023. It was very heavy on the voting aspect, the benefits of voting, and the benefit of voter registration. Not so much attention given to the medical aspect, ethical questions, or potential impacts. I briefly trolled through Vot-ER's site and, as far as I could tell, they don't provide any studies supporting the idea their program has significant positive medical benefits to patients. Which I would have figured would be necessary. If a doctor is doing something to me as a doctor it should improving my health.
If a person comes in with a broken arm and you offer to register them to vote on their way out I think this carries ethical questions but, fine, whatever. When the program extends to mental health institutions and picks up a motto of Voting Is Great For You Actually Because Anecdote this seems like it should be made an issue.
I'm no expert, but I am not under the impression that dedicating more attention to politics is the best path to a healthy mental state. I am under the impression that politics, particularly of the national sort, in this day and age appears to degrade many people's mental well being. Encouraging people to vote is not necessarily damaging to their psyche, but a focus on voting might be a gateway drug. An organization, staffed by party operatives or affiliates, pushing a political non-profits goals onto medical staff in hospitals is wrong.
Like ballot harvesting I think it's sleazy. I can accept sleaziness in politics. People accept that politics is not holy and sacred, but dirty. Importing it into medicine, which I know is not new, seems particularly bad though. Initiatives like this drives resentment when, on the other hand, I am inundated by messaging that claims one party is holy, good, and joyous democracy lovers-- while this party engages in what appears to be deeply cynical, irreverent electioneering. I guess I'll accept sleazy politics in medicine as well.
In 2020 slate or salon had an article about therapists who saw "toxic whiteness" as the cause of their patients' problems, and told them to give money to BLM riot bail funds as a step towards confronting and atoning for it (as well as Paying Black Women to Educate Them via zoom courses)
Just about every ethical line in the medical profession has already been crossed, and the mentally and emotionally ill are just easy marks when you have no ethical concern about exploiting them for The Greater Good.
It turns out there's very little you can do against a political machine that absorbs every neutral institution like borg assimilators, because it sees no value in the existence of any social good that doesn't serve the party.
How can you argue against or reason with a totalitarian system?
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I think the issue here is really just the honesty of presentation.
A while back, I was feeling a bit unmoored and ahedonic, a uni counselor said (among other advice) "drink lots of water and take a walk outside every day". I asked if that would really help and he said maybe not, but in any event it was a good idea to drink water and take a walk outside.
Encouraging patients to do the things they need to do even if (and I agree) it very likely won't help with their condition seems OK if done with candor.
If you had to ask "does it really help", it was not with candor.
Things that people do involve tradeoffs. If the doctor doesn't properly communicate which measure has which effect, the patient can't properly decide the tradeoffs. Taking a walk outside is low on the scale of burdens, but it still isn't free, and implying that it helps with the patient's condition when it doesn't is dishonest, even if the doctor admits it when questioned.
He didn't say it definitely wouldn't help.
For a college age kid with a vague complaint like "I feel disconnected from my life and don't take pleasure in a lot of things", it's completely sane advice. And, as you said, it's certainly lower on the scale of burden than "spend $$$ on in depth psychotherapy to discover what it is".
It's the mental health equivalent of "take two advil, get a good night sleep, and call me in the morning if it's not better". Treatment proceeds from least invasive to most, even if the former has somewhat lower probability of success (if only because many health issues, mental and physical, abate on their own anyway).
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People with depression should be encouraged to do normal person things. How far up the list would you put voting? High enough to start a major non-profit? There's plenty of functional, healthy people that don't find voting necessary or worth worrying about. At least when it comes to the psych patients it screams predatory to me.
What would a more candid presentation look like to you?
This is what it might look like to me: "yes we are a D political advocacy group that aims to register more Ds. We offer registration resources to other non-D voting demographics. As this allows us to call ourselves non-partisan and more effectively recruit potential doctors to help our political cause. We will not try nearly as hard to reach non-D voting demographics, either through resource allocation or messaging, but that is not our mission."
My candid description might be uncharitable. If it is I encourage you explain why it might be. I don't believe a truly non-partisan voter registration non-profit for hospitals goes national. It definitely doesn't creep into inpatient mental health treatment centers. Not enough juice to squeeze there. "You can register to vote here" sign in a waiting room doesn't have the same pizazz as massive non-profits with a mission and culture aligned with the interests of one party. The goal is to leverage trust in doctors on one end and hope the correct type of votes come out the other end. It's not even trying to obfuscate, really.
Addressing ethical questions should be more than half the battle in doing anything non-medicinal in medicine. That's a good standard to have in a high stakes profession.
I would probably put it reasonably high given that they have to do it literally once in a year and then feel good they have performed their civic duty. Especially for people that likely feel significant sadness about not fulfilling many of their other duties.
Traditionally we've described this as a minor abdication of duty.
Sure. That seems like bread and butter stuff in the advocacy world.
Maybe the disconnect is, I don't see non-partisan to be the same as non-political. Obviously any kind of GOTV is political in nature.
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Time to kill some of my opsec. I have personally argued with Deb Koss at a conference in D.C. telling her to cut this shit out.
I won't say much about it but she (and others like her are) exactly as you'd expect.
It's not as worrying in the disciplines like Psych (hers), ID, and Peds where people are overwhelmingly left leaning but these advocacy people are still DEMANDING trainees participate in advocacy and politics (and it's always one specific kind of advocacy). Trainees who can't say no without negatively impacting their careers. It's gross and deeply unethical.
Furthermore these idiots seem fundamentally incapable of understanding how damaging this is to the long term health of the profession.
It's no different than any woke ideological capture but with a very damaging set up levers (ensuring incoming medical students are very left leaning, brainwashing them during vulnerable periods like residency, and mandating leftist political advocacy as part of educational curricula).
I hate it.
These pediatricians committing themselves to lefty advocacy understand that right wingers are the ones having babies and you do need to get parents to trust you to do your job?
Like normiecons used to never skip shots. Now my coworkers who only go to church when they're on call(widely believed that you can't be compelled to leave church early to go to work. I have no idea as to the accuracy of that belief per employment law but managers mostly respect it.) discuss it openly. The deep red tribe loss of trust in institutions is mostly from actions of those institutions that they can point to and it's driving radicalism and there is no outreach to these people to try to rebuild that trust. Just spinning bullshit to call us evil.
They expect, correctly, that trust is conferred by the degree. They expect to convert the right-wingers...or at least the children.
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Yup, when I started working the only anti-vaxxers were hippies, woo-moms, and low income blacks.* Now it is a mix of everybody.
Also the left hates doctors because they hate people who make money, now the right also hates us for lockdowns and political advocacy. Both sides are fucking doctors but it's impossible to have a discussion about this with most of my colleagues.
*Well and nurses are anti flu shot for reasons I have never really been able to get.
It's not complicated; the flu shot makes you sick and by the CDCs numbers (which I suspect are rather optimistic), is pretty poor at reducing the chances of getting the flu.
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Knowing a few nurses, there's a bunch of them that are anti-flu shot because it's an annual PITA with Christmas-level season creep and doesn't really have the efficacy to justify its hype.
I get the "I don't want to put in the effort to go get it" but I've seen them like actively hide from the roving flu shot team like children hiding under a desk. Sit still for 15 seconds and move on with your life for fucks sake.
I think it's the principle of it being an incredibly annoying theatrical production for a vaccine with so-so efficacy. Not saying nurses shouldn't get flu shots, obviously, but relentless overhyping gets irritating fast.
Most people get mild side effects if any and while the efficacy is low people in healthcare get the treat of watching people actually die from the flu (which is why most doctors seem to not give a shit).
Nurses are crazy though so....sigh.
Again, not saying it’s a rational decision as much as a bunch of women who feel put-upon(rationally or not) and overrate their own importance throwing a fit about a predictable annual annoyance.
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If it's any consolation, I'm sure right-leaning students handle this the way we always have: go through the motions, then make fun of it all behind their backs when we're hanging out on our own time.
But it is worrying. What separated us from the Soviets during the Cold War was you didn't have to be an activist to do things like medicine.
I highly recommend reading “Everything Was Forever, Until It Was No More: The Last Soviet Generation” by Alexey Yurchak. You can fully ignore Yurchak’s own postmodernist ranting, but at the same time he collected a fascinating account of what it was like to live in post WWII Soviet Union. In short, it’s a myth that you had to be an activist or even a believer. Regular people despised both true believers and open critics of Soviet Union. This sentiment is even more true for the STEM professions.
It's not a myth, it's a simplification, and it's still accurate when contrasted with the pre-awokening West. Yeah, they'd let you work as a lower rank doctor / engineer / whatever, but that doesn't mean they'd let you advance beyond a certain level without enough displays of party loyalty, or that the lack thereof wouldn't get you shitcanned even if you were incredibly talented.
The important part is "displays of party loyalty". You did not want "true believers" next to you, when some high ranking general or other party member wanted something not exactly communist-like, such as expensive western gadget or other contraband. I think it is similar to HR ladies today - you want to have good activist cred by posting the right flag on your social media and all that, but you should also not interfere if the CEO has some fun with his assistant on his business trip. It's the same logic why Trudeau surfed through his blackface episode so easily - everybody just pretended it does not matter, because if you said anything, then maybe you would garner some level of (whispered) sympathy, but then find yourself suddenly redundant and replaced.
This is what is so comical about all the activists: the corruption and nepotism is not the bug, it is the feature of all these stupid systems. Communism was tried so many times and it always devolves into some kind of nightmare, often of fascist variety. It is because it is baked into the system.
Yeah, it was the "actiivist" part I was taking an issue with, not the "true believer" part. I'm also prepared to concede it's a peculiar definition of "activist" that I'm using, that the Western mind might not quite be able to grasp, but I struggle to find another word for someone who participates in all these totally spontaneous shows of support. "Ass kisser" communicates the level of cynicism and opportunism, but I think it only tells half the story.
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Yeah, not being a party member certainly was a career barrier, but it’s not the case that you had to become a true believer if you became a party member. In fact, in the book author describes a guy who became a party member just so that he had more leverage to do really important things in his profession (sorry I’m fuzzy on details, read it a while ago) and privately even condemned the party. That’s also the case for the people in my life.
Condemned?
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They do still exist but changes to the pre-matriculation "requirements" have decreased their numbers, and being "outed" as conservative or woke-questioning will kill your social life so they tend to be super locked down.
Add on the requirements to publicly go through the motions during times of profound stress and exhaustion.... you get people who legitimately convert or experience permanent changes.
Remember that medical school clinicals and residency is not far off from outright torture in a lot of ways and people get 1984'ed while going through this.
Salary and taxes walk some people over a few decades but it is less than it used to be.
Ok, ways to find a conservative doctor?
From the layman’s perspective it’s pretty simple- antivaxxers and the prolife movement will both give you a list of doctors sympathetic to their ideas. The former have been swimming right and the latter already were.
What’s the insider perspective?
Male, old, rural or otherwise red tribe location, etc etc all point more conservative in just the ways you'd expect.
Certain specialties are more or less conservative. Psychiatry, Pediatrics, Infectious Disease are extremely liberal, surgical stuff more likely to be conservative. Anything higher paying more likely to be conservative.
We are supposed to keep our noses clean and stay out of politics....but as usual the left doesn't listen, people who do more likely to be moderate or conservative.
More or less what I’d expected. Whites more likely to be conservative, or do they have to be ultra-woke to overcome the lack of affirmative action? I can see both possible worlds.
It's not worth worrying about.
Ultimately the politics of your doctor isn't going to matter 95 times out of 100, putting aside the more complicated issue of the COVID vaccine all the doctors are going to want you to get recommended vaccines, it's just conservative ones will add a heaping of "I support your right to be a fucking moron" on top of "you are a fucking moron." If it's about child healthcare well then no, they are all woke liberals (IDK maybe some of the ones over 55 aren't?).
If you go specifically looking for people contra narrative you run the risk of finding charlatans catering to that market or actual people. Neither provide good care.
A more practical concern is "does the demographics and background of this person suggest something about their proficiency. I won't comment on this here but it's more important than political leanings.
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Explain
For a few decades Medicine has felt angsty about claims of bad bedside manner in practicing physicians (never mind that this is as much about inherent pressures in the field and foreign trained doctors as it is about individual physician temperaments). The solution was to deemphasize grades, MCAT, and other traditional measures of academic success (and also research prowess). As we've pushed into the woke era this has turned more into looking for students to be engaged in specific types of volunteering and political advocacy. About ten years ago the MCAT was heavily updated to include woke content (although obviously this was pre "woke" era).
Additionally affirmative action* has gotten more and more egregious - troublesome given drop out rates and early retirement/exit from the field in some of those demos. On a less official note you'll schools pushing for "does this student match our mission" behind closed doors in admissions committee meeting. Of course this primarily impacts people from less affluent backgrounds and less prominent schools, since people with good backgrounds manage to slide in as usual.
Between affluent American children naturally becoming more woke and deliberate fingers on the scale with respect to who gets admitted theirs been less complaints about explicitly woke curriculums (sometimes removing traditional educational content and replacing those content hours on more trans health or whatever) some of which gets to the point where even the supporters are like...eesh man that's a lot.
The first part of the medical boards (Step 1) was also made pass/fail, which was sold as a way to increase diversity since minorities didn't do well on it, but was basically a move by top tier medical schools to make the bottom of their class look better, which absolutely worked leaving talented people from mid and low tier medical schools unable to differentiate themselves and move up a tier for residency. Anti-meritocratic bullshit.
*I'm going to throw women in here even though they are better candidates by most metrics but the problem is that they have a tendency to eat a training slot and then get pregnant a year or two into their career and then never return to the work force or work reduced hours, which is a huge issue with doctor allocation and shortage problems.
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Why do they torture students so?
A lot of things are going on here, some of which are a bit more complicated to get the full picture on like the historical issues with hierarchy and abuse.
Two simpler bits:
-You don't decide where you work and learn during training and if you leave, quit, or get fired you are done. Sometimes with upwards of 500k in debt. Programs know this and will mistreat trainees knowing they can't vote with their feet and their lives are pretty close to over if they don't suck it up. Suicides and deaths from things like sleep deprived car accidents aren't common per se but are frequent enough that we all know multiple people who went out those ways.
-Unlike most high education/high skill labor you need a lot of 24/7 coverage and physicians are very expensive and in high complexity specialties like surgery you have to do a FUCKING LOT of stuff to become independently proficient in a reasonable number of years. The solution is typically to rely on trainees and long hours. On paper Residents aren't allowed to work more than 80 hours a week, must get at least 4 days off in a month, and aren't allowed to work more than 24+4 hours in a row. On paper. Very common for people to violate one or more of those in an easy specialty at an easy program. In something harder like procedural specialties? You might work 80-100 hours a week with an average of four days off a month.
For 5 years.
Shockingly!!! Substance abuse, mental illness, and medically measurable premature aging (fun study that one) are rampant.
This breaks people down and I think could be reasonably considered torture.
Add on the fact that you can't leave, and many other aspects of the training can be considered abusive (said things that are a bit harder to explain)...
I can't believe we even have doctors, given this system. I wouldn't live like that for 5 years even if the payoff was a trillion dollar lump sum.
This is why you'll frequently see us claiming the ability to easily retrain into other jobs if healthcare collapses. Effort substitutes well for a lot of talent and getting through medical education is tremendously difficult and outright traumatic, but if you can do it you'll be able to do most things.
This year a U.S. medical student got two olympic gold medals. She had to pause training to do it but that is the kind of aspirational insanity you'll often see in the field.
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Wow I had no idea the state of medicine was so bad. Jesus.
So are you saying that the state of residency is sort of justified by the difficulty of the profession?
How would you do it differently if you had the magic wand of 'fix up the medical training system'?
/images/17246063318586245.webp
Plenty of other crap is going on and much of that presents easier targets - excess regulatory burden, administrative overreach, wellness modules, U.S. malpractice environment, etc.
A large swathe of the central problem is that Americans doctors are expensive (so hiring more staff for instance is...difficult) and at the same time Americans won't work in American healthcare without those salaries (because of things like the American patient population, malpractice and so on). It makes bigger fixes extremely hard.
Many kinds of surgeons are just fucked - medicine has improved, which means we do surgery less often and the types of surgeries we do are more complicated and harder to learn. It's an order of magnitude or more easier to learn how to remove something from an option approach (think just cutting someone open) than a laparoscopic approach but the latter is much much much better for the patient. Finding ways to make this not extend training time is a nearly intractable problem.
However, a sensible target is malpractice insurance. Doctors do fuck up and do fuck up in ways that should involve penalties but functionally these seems to be entirely separated from who actually pays and gets penalized in our current system. Malpractice insurance alone for OB can be over 150,000 dollars a year. That's insane.
Stronger unions for residents and attendings is probably also a good idea. Unions can absolutely be bad but we are far off from the point where that's an issue.
Likewise kill some various forms of rent seeking and other bad behavior like egregious non-competes, physician boards that costs of tens of thousands of dollars, substance abuse programs that also costs tens of thousands of dollars if you somehow manage to get caught smoking weed, etc.
On a structural level you can probably free up money that can be use to improve healthcare and reduce burden on doctors by targeting various middlemen and administrative horseshit. Fire the front desk staff to pay for an extra useless diversity or infection control administrative and the doctor just adds that job to the list of things they do.
Walk that back, the ratio of clinical to administrative staff is insane and grows worse every year.
I'll try not to blather too much but however bad you think it is it's a lot worse. A classic example is the fact that the population of people we've selected to be doctors might be offered the option of working in NYC or getting paid 300k more a year to work 2.5 hours to the northwest and they'll pick the city. Shit's fucked.
Sidebar: 24+ hour shifts were taken away and then brought back because most people (including residents) thought they were better than the alternative. Which sounds insane and is.
Do you know how the medical system ended up in this fucked state in the first place?
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Wait but you were saying earlier that it's hard to hire people and doctors need more support because it's expensive. Wouldn't the admin staff help with this??
Oh trust me I am pretty severely blackpilled on the Western medical institution, although I do admit that modern medicine has miracles aplenty. My mother's life has been saved on three different occasions by relatively recent medical inventions. So I'm grateful.
But I also wasted over $20k in my early twenties trying uselessly to figure out my chronic pain issues with TMJ, sciatica, RSI, and other various health stuff. Was told by multiple doctors I'd need surgery if I ever wanted to use a keyboard and mouse again. I'm pretty close to recovered now but... anyway that's a story for another day lol.
I didn't realize they were taken away! Ugh yeah it's so fucked. I've seen studies on like the efficacy of doctors based on how long they've been on shift and it's terrifying. Going to the hospital seems like such a crapshoot luck of the draw type situation in some respects.
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Given the low income urban persons they’re interacting with plus the political correlates of anxiety/depression, I suspect this initiative it strategic in getting more democratic votes. 50k registrations is huge! Doubtful that many will come close to voting but that’s easily Enough to sway the state and thus win the election for the Dems
I do feel like republicans just don’t have near the strategic thinking necessary for this sort of thing - does Trump have a Karl Rove who can help find a path to victory?
IME rather than a lack of thinking capacity it's a stubborn belief that "doing something like that would make us just as bad as them!" The right is still unaware that this a Culture War and I'm increasingly certain that this ignorance is willful and cowardly.
I don't know how difficult getting democrat favoring non-voters to turn out is. But getting republican favoring non-voters to turn out makes pulling teeth look like cutting your toenails.
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Everyone says this all the time. Both party supporters believe they have the moral high ground in whatever area they are incapable.
If Republicans could muster up a non-profit network that would do their bidding, they would do so without a second thought about the high ground. But they don't have this capability and dont have people willing or interested in building it. I think that lack of interest goes beyond "it is dirty and wrong."
Partly why I don't understand why @TracingWoodgrains gets so much push-back (on Twitter at least) on his Republicans Are Doomed piece. Maybe the conclusion is wrong, but the observations regarding disparity in human capital and reach are correct.
Think it mostly just goes back to Republicans with power caring about wealth generation and Democrats with power caring about power generation. AT least that is my theory.
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Maybe they already do that!
I had a relative in a nursing home with dementia during the Trump/Hillary election. Someone was going room to room IN THE DEMENTIA WARD OF A NURSING HOME "helping" people fill out absentee ballots. My relative voted for Clinton because he recognized the name. I only know this because another relative happened to be visiting at the time and watched it happen. That other relative is extremely liberal and said that despite the extra vote for Clinton, she found the whole thing very disturbing.
That sounds like it could be a conspiracy... but towards what end? This happened in a solidly Republican town, and old people are even more Republican than baseline, so this could have been some kind of scheme from Republicans to turn out the vote.
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Unless I read it wrong, the 50,000 number references the number of doctors they signed up to register voters. According to Google this is between 4-5% of all doctors in the United States. This number sounds unbelievable as I write it, but I'm no longer in a position to double check stuff at a screen. Did I quote that correctly?
Perhaps it is just the number of voter registrations and Aaron was sloppy with his writing? I can look tomorrow.
Are all of these people doctors, necessarily? One can well believe there's vast numbers of nurses who signed up.
Correct. The actual source says "healthcare professionals". This is much more believable.
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Actually I suspect that a lot of them if examined would not be mentally fit to vote anyway. If someone is in the ER for a mental health episode, it’s obviously pretty severe, with either heavy drugs or commitment as real possibilities. Add in that a doctor, if you’re in acute distress, hold a lot of power and authority over them. I’d love to be a fly on the wall, because I have a suspicion that it’s at least somewhat implied that help is contingent on them registering to vote.
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That's where ballot harvesting comes in. Or straight up fraud; intercept the ballots coming for the patients, fill 'em out, send 'em in.
Yeah it’s a shame the right doesn’t seem to have the will to engage in more aggressive ballot harvesting.
The right doesn't have the penetration into the right professions to pull it off -- this magnifies what Nybbler is saying, in that even if there is a right-wing social worker/doctor/whatever who wants to go around 'encouraging' people to fill out ballots, the other 99% of his cow orkers will be lined up around the corner waiting to rat him out.
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The right can't do it for the same reasons they can't riot. The right can make 100 plausible accusations of ballot harvesting or fraud, and this will be "John Righty said, without evidence..." or "John Righty falsely accused..." and the courts will just dismiss the case. The left will respond with one accusation (true, false, or in one case a stunt to show how easy it is) and it will be taken entirely seriously, the media will crow about how this proves the right are the real cheaters, and the rightists involved will be prosecuted. For some reason even judges on the right prefer cases against the right than the left, perhaps feeling the right should be held to higher standards because they know better.
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I’m not convinced it would work out well without the sort of institutional cover the left gets, even in its currently decaying state.
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I remember discussion on right wing election twitter- so this would be much closer to the GOP establishment than the dissident right- in 2022 that Wisconsin had more white men with hunting licenses unregistered to vote than Biden's margin of victory in 2020, and complaints that there was no plan to register them.
These people would, if successfully registered, probably vote 95%+ republican. Based on my hunting buddies, though, convincing them to do something they don't want to do is a much steeper climb than it would be for depression patients. I suspect that unregistered natural republicans are, in general, much harder to register than unregistered natural democrats.
That Scott Pressler dude who has apparently been doing work registering voters in PA has definitely mentioned trying to reach out to hunters specifically for this reason.
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