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Culture War Roundup for the week of August 19, 2024

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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.

Located in a swing state that could decide the 2024 election, the hospital asks psychiatric inpatients, regardless of diagnosis, if they would be interested in "voter registration tools" that let them check their nearest polling station and register to vote online. Patients can also request a mail-in ballot with "assistance" from hospital staff, according to a pair of papers about the project, which began in 2020.

...as the institute puts it, [voting] is a "therapeutic tool" that "helps empower patients and makes them feel good."

"Voting is an important part of the recovery process," Julie Graziane, a geriatric psychiatrist

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.

Founded by an emergency room physician at Harvard Medical School, Alister Martin, who served as an adviser to Vice President Kamala Harris, Vot-ER has helped more than 50,000 doctors register their patients to vote. Vot-ER claims to be nonpartisan, it is staffed by progressive operatives, funded by progressive foundations, and run by an umbrella nonprofit, A Healthier Democracy, that has referred to DEI as "the bedrock of fair healthcare." And ahead of the 2024 election, it is leading a movement—backed by top medical groups and an executive order from the Biden-Harris administration

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:

Debra Koss, a professor of clinical psychiatry at Rutgers... described a patient who, depressed by the poor conditions in her Section 8 apartment building, gained an "internal locus of control" by registering to vote. "Ultimately, she became less anxious and depressed," the doctors wrote in an op-ed last year, "and for the first time in 15 years, her intrusive suicidal thoughts ceased to exist."

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.

At the Pennsylvania Psychiatric Institute, Graziane, the geriatric psychiatrist, has argued that voting can "increase life satisfaction, decrease risky behaviors and increase mental wellbeing."

Their argument echoed what [the founder of Vote-ER] told the New York Times in a 2020 interview... The time for doctors "being impartial and apolitical," he said, "is over."

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.

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 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.

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.

People with depression should be encouraged to do normal person things. How far up the list would you put voting?

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.

There's plenty of functional, healthy people that don't find voting necessary or worth worrying about.

Traditionally we've described this as a minor abdication of duty.

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

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.