Doctors and Democracy: Why Vote-By-Mail is Good Public Health

Rob Palmer
Josh Hyman
Isaac Freedman


Suppose tomorrow you were informed that patients could no longer have medications delivered to their homes. Thus, in the midst of the worst pandemic in recent history, your patients would have to go to pharmacies to get essential medications. Undoubtedly, you’d be puzzled, wondering why your patients must needlessly put themselves and others in harms’ way to care for their own health. In light of the change, you might even debate if it’s worth the risk of getting your own medications. 

Thankfully, the common-sense practice of delivering medication to people’s homes seems here to stay. Yet many people will face a similar issue on election day this November: Fifteen states severely restrict who can vote by mail. In these states, millions of citizens will be forced to choose between exercising their right to vote and safeguarding their own health. 

So long as SARS-CoV-2 remains a threat, in-person voting is a public health crisis. Unless we want to risk a spike in new COVID-19 cases, with the concomitant deaths and strain on the healthcare system, it is critical to ensure that anyone who wants to vote in the upcoming general election can use mail-in voting. Indeed, a peer-reviewed study published in May found a statistically significant increase in COVID-19 cases in the weeks after the Wisconsin primary, specifically in counties with higher in-person votes per voting location. The study also found a decrease in COVID-19 cases in counties with the highest rates of absentee ballots. Unsurprisingly, the study’s authors exhort policy makers to “expand the number of polling locations or encourage absentee voting for future elections.”

Though this analysis of the Wisconsin election has been contentious, the fact remains that we have little confidence about how SARS-CoV-2 will manifest itself in the coming months. If the virus follows a trajectory similar to that of the 1918 Flu, then we could witness a second—and more deadly—wave of COVID-19 infections this fall. It’d be a tragedy and, frankly, an embarrassment to spend the fall scrambling to implement patchwork solutions for problems that could have been managed with proper planning. 

Healthcare workers have already been instrumental in the response to the COVID-19 pandemic, and we can play an important role in protecting the health of our patients in the coming election. Given our medical expertise and the trust of our patients, it behooves us to continue to encourage and enable patients to act in ways that protect, rather than potentially undermine, their health, which includes how they vote. 

Leading up to elections, there are many ways healthcare professionals can help their patients: if you’re in one of the 34 states, plus the District of Columbia, that allows qualified voters to request an absentee ballot without an excuse, then please encourage patients at each visit to request an absentee ballot by going to Vote.org; in other states, residents need a valid excuse to receive an absentee ballot, and advocating for the COVID-19 pandemic to be designated as a valid excuse (e.g., by writing op-eds or your elected representatives), as many states did for primary elections, could positively affect millions of people; and in the five states in which citizens are lucky enough to automatically be mailed a ballot, please encourage your patients to vote by mail rather than go to the polls on election day. Institutional and organizational action can complement individual action, and we hope that medical institutions and organizations will create structural changes and policies to uphold and strengthen their loyalty to their patients. 

A two-fold critique commonly levied against mail-in voting is that it’s prone to fraud and partisan. Indeed, some have argued that having people go to polls as usual is the best way to ensure a fair election. Though the claims of high rates of fraudulence may seem compelling intuitively, the best available data suggests that vote-by-mail has extremely low rates of voter fraud. Indeed, in June, the Brookings Institutes published an analysis of data spanning 19 years, five states, and nearly fifty million votes. The report found a total of fifteen cases of voter fraud with vote-by-mail. For comparison, a person is nearly five times more likely to be struck by lightning than they are to commit voter fraud with vote-by-mail in a given year. The experiences of other countries that have used vote-by-mail, including Australia, Germany, and Switzerland, also corroborate its efficacy and feasibility for nationwide adoption.

And while some have claimed that mail-in voting is partisan, simple reflection upon the last few months disproves this argument: this spring, states across the political spectrum adopted vote-by-mail for their primary elections to protect their constituents from this pandemic. The Republic National Committee sent registered Pennsylvanians Republicans applications for mail-in ballots, and Utah, one of the five states that conducts all elections by mail, is historically Republican. Given that SARS-CoV-2 remains a public health crisis, then does it make any sense for states to reverse the prudent policies they enacted when the pandemic began?

Independent of this evidence, however, is a simple argument that cuts through the noise and lays bare the path forward: the sanctity of the relationship between healthcare workers and patients transcends political ideology. To claim that partisanship is motivating healthcare workers to look out for their patients’ best interests ignores the ubiquitous heroism and self-sacrifice we’ve seen the last few months. In light of what has transpired in hospitals across the country during the pandemic–and what will likely continue for months to come–helping our patients vote in a safe manner is the only sensible thing to do for them, our communities, and ourselves. 

We ask fellow healthcare workers to honor the trust your patients have bestowed in you. Please encourage patients to register for mail-in voting, please pressure elected representatives to endorse common-sense public health policies that will protect our patients’ lives, and please partner with any of the myriad organizations that are working locally and nationally to help American citizens vote safely in the coming elections. Now, more than ever, the voices of healthcare workers matter, and people are listening.

Rob Palmer is a fourth-year medical student Yale whose research has included novel treatments of addiction and various applications of mindfulness meditation.

Isaac Freedman is an M.D. candidate at the Yale School of Medicine. His research is focused on healthcare outcomes, utilization, and disparities.

Josh Hyman is an M.D. candidate at the Yale School of Medicine. His research is focused on the impact of the Medical-Legal Partnership model on healthcare utilization and patient outcomes.