Mike Milligan, a Harvard medical student, recently wrote in THCB about the shock felt throughout his medical school upon the election of Donald Trump. Seeking to understand how it may be that ‘equality, service and compassion’ were defeated, Mike settles on the narrative that appears to have taken hold of the elites on the left – Trump did not really win, Hilary lost. While he does not say so in explicit terms, clearly we are to understand that the recent election was lost, and that in order to assure a better outcome the next election, physicians should urge their patients, and particularly their ‘poorer and less educated patients’ to register to vote. Hopefully, these voters can then ensure that access to ‘affordable, high-quality medical care’ through constructs like Obamacare and MACRA are nevermore placed in jeopardy.
What complete hogwash.
Let me start with the factually incorrect parts.
Mike writes that ‘Mr. Trump received fewer votes in victory than the previous two republican nominees garnered in defeat.’ As of today Donald Trump has received 62.2 million votes out of a total of 126.6 million votes cast. Mitt Romney received 60.9 million votes out of a total of 126.8 million votes, and John Mccain received 59.9 million votes out of a total of 129.4 million votes cast. So despite the fact that his opponent raised and spent close to 1 billion dollars on ads promising the literal apocalypse if Trump was elected, no republican candidate in history garnered more popular votes than Donald Trump. While it is true that nearly half of all Americans did not cast a ballot in this election, 3 million more votes were cast in 2016 than were cast in 2012. The percentage of eligible voters casting their vote in 2012 was 55%. The percentage of voters casting their vote in 2016? Also 55%. I realize the desire to deligitimize Trump by arguing this was a low turnout election that delivers no mandate is a very strong one among the millions on the losing side. Unfortunately, wishes and reality sometimes find themselves in conflict.
The real story of the election is that the Donald Trump managed to flip the rust belt states of Michigan, Wisconsin and Pennsylvania by convincing blue-collar, mostly white voters that his party was now the “workers’ party”. Traditionally blue strongholds of towns like Erie, Luzerne, and Northampton counties in Pennsylvania turned red in 2016. A Republican hasn’t won Erie County since 1984! Obama won this county by 16 percentage points in 2012 – Trump won this same county by 2 percentage points. Statewide, Trump performed better than Romney in 58/67 counties while Clinton performed worse than Obama in 65 counties. So it is absolutely true that Clinton performed worse than Obama, but not to focus on the story of the overperformance by Trump is to be willfully blind.
As to the implication that it was the least educated sitting at home that sunk Mrs. Clinton, data would argue the opposite. The poorly educated did vote, and by a wide margin chose Trump. Pre-election polling showed Trump with a 30-percentage point advantage among whites without a college degree – he ended up winning them by 40 points. Indeed, one of the single best predictors identified in counties that swung to Trump is the percentage of non-college whites. The greater the percentage of non-college educated whites in your county, the greater the chance of Trump emerging victorious.
The only metric found to be even more predictive than your race and education? Poor health. You are reading that correctly. In an analysis done by the Economist , a weighted index of obesity, diabetes, heavy drinking, physical exercise, and life expectancy performed even better than race and education level in predicting counties that moved to Trump. The poorer your health, the more likely you were to vote for Trump.
A wonderful interactive version of the graph can be found here.
Apparently, those who stood the most to gain from affordable, high quality health care were also most likely to choose the candidate who called for repeal of Obamacare. It is safe to say that this was a stunning repudiation. To a great many who had voted for the promise of Obamacare, the reality of high premiums, penalties, and narrow networks left a bitter taste. And so it came to be that those uneducated and in poor health – the losers in this economy – chose the candidate who promised change over the candidate whose campaign slogan was grabbed from the recent Lego movie – “Everything is Awesome”. What a complete shock.
There are many story lines that underlie Hilary Clinton’s defeat. She was clearly unable to animate and connect with her base in the way Barack Obama did – but if this is the major narrative rocking liberals to sleep in these cold dark times, I would advise the overworked mental health specialists dealing with the trauma of a Trump election on college campuses to pace themselves for eight years of inconsolable sobbing.
Anish Koka is a cardiologist in Pennsylvania.