The Public Health Mirage, Part 3
Neutering Voter Registration as Critical Health Praxis
The face of Vot-ER, Alister Martin, MD—now Assistant Professor at Harvard’s Center for Social Justice and Health Equity—is an activist-doctor. To Alister, activism is a doctor’s paramount function; more so than the practice of medicine, which is just his basic function. In a 2021 article, he quotes sixth-century Chinese physician Yi He: “The superior physician rescues the state, whereas the inferior one merely attends to the sick.” Alister understands the physician’s vocation as having “dual roles of treating both patient and nation…” (Martin et al. 2021). “[I]f physicians truly are to be stewards of our nation’s health, they must not only vote, but also help their patients vote too.”
If the enemy seeks to co-opt voting to wield it against the very concept of a free society, should our response be restrictions on voting, up to and including exclusive ballot access for something like a landed gentry? I do personally have reservations about universal suffrage. I am not certain, for example, that in a proper constitutional republic it would be unjust to limit voting rights to property owners, as early American states did. (Although what that means in practice is ambiguous. Ownership is not as straightforward as possessing title to a home or plot of land. Renters, in a sense, own property to whatever extent they are permitted in a rental contract, and ownership in a free society of delineable non-land existents, such as waters and airspace, further muddles the concept.1)
Additionally, our reaction is the Marxist revolutionaries’ real action. An irrational response to any one provocation is tinder for the next. Thus, non-universal suffrage is not something I advocate; and if the Constitution were properly applied, the vote would have so insignificant an impact on our day-to-day lives, property, and incomes that it would make little difference. Under the American system, institutional safeguards are supposed to mitigate the impact of the vote, such as the pre-1913 system for indirect election of senators, which we should certainly return to.
Since voting as such is not our target, the laws enabling this Marxist offensive must be. There are four options in dealing with such laws: neutering them with amendments, encumbering them with narrow restrictions, defunding them through the appropriations process, or overturning them altogether. If voter fraud were my focus, I might propose amending the NVRA to strengthen criminal penalties. Under current law, individuals face fines and imprisonment up to five years for knowingly procuring or submitting fraudulent voter registration applications or ballots. Increased penalties may disincentivize ballot harvesting, which is a questionable practice, but probably not. Five years in prison is already a steep penalty to the average American and some well-meaning people could be caught in the crossfire. Additionally, for penalties to deter criminal behavior, would-be perpetrators must expect them to be enforced.
If noncitizen voting were my focus, I might amend the NVRA to enhance voter roll cleanup by allowing states to remove non-citizens, which is not a reason for which voters can be removed from states’ voter rolls for federal elections. Legislation to amend this was introduced in the 118th Congress but never voted on.2 I might also propose legislation to prohibit states from registering individuals to vote in federal elections without proof of U.S. citizenship. Some members of Congress tried in the 118th, to no avail.3
In fact, the NVRA proscribes states from requiring proof of citizenship, although there may be a state-level remedy. As noted in Arizona v. Inter Tribal Council of Arizona, Inc., “while the NVRA forbids states to demand that an applicant submit additional information beyond that required by the Federal Form, it does not preclude states from ‘deny[ing] registration based on information in their possession establishing the applicant’s ineligibility.’” In other words, our friends in state politics must get to work on cross-referencing applications with any information that could demonstrate an applicant’s ineligibility, thereby subverting the statute.
Neither voter fraud nor noncitizen voting are at issue in this article, however. What confronts us is the Marxist mobilization of voter registration in all state offices offering public assistance, solicitation of voter registration that is biased toward certain demographics, and tacit counseling of said demographics to sway individual votes, all of which are enabled by the NVRA. The first, most obvious strategy is wholesale repeal of the NVRA. This would avert the possibility of a federal pressure campaign against the states to effectuate the requirement that all offices providing public assistance be designated as voter registration agencies. Unfortunately, such legislation has been introduced but never advanced. Rep. Greg Steube (R-FL-17), for example, introduced H.R. 959 in February 2023, which would repeal everything in NVRA, save some statutes relating to voter roll cleanup and criminal penalties for fraud. It never left committee.
If Republican legislators, by and large, considered the NVRA to be unconstitutional, legal challenges could gain momentum, perhaps led by various state Attorneys General. However, the Elections Clause grants Congress broad authority to legislate on voter registration, with merely implied checks on congressional power. The question of unconstitutionality arises from Congress forcing states to shoulder the financial burden of implementing the NVRA. Specifically, the NVRA has been questioned with reference to the Supreme Court’s ruling in New York v. United States, in which the majority found that the Tenth Amendment prohibits the conscription of states as regional offices or administrative agencies of the federal government. Greene (1996) makes a compelling constitutionality argument for the NVRA that I will not delve into here. The Supreme Court further buttressed the law in Arizona v. Inter Tribal Council of Arizona, Inc. In my view, arguing the NVRA’s unconstitutionality is a dead end, and so is any legislative effort to overturn it.
Because the NVRA affords states no federal dollars to cover implementation costs, defunding NVRA programs through the appropriations process is also a dead end. There is nothing to defund. There were efforts to divert spending from the implementation of Biden’s EO14019, however. Last July, Rep. Claudia Tenney (R-NY-24) introduced amendments to the FY2025 Energy and Water Development and Related Agencies Appropriations Act, and the Department of the Interior, Environment and Related Agencies Appropriations Act, that would prohibit funds from being used to implement EO14019. Both amendments were included, and both bills passed the House. A short-term fix that is now meaningless with the change of administration.
The preferred strategy for dealing with the NVRA rollout in clinics, in my opinion, is encumbrance via restrictions on its implementation. Below are three methods by which Congress could burden these initiatives, such that clinics may be deterred altogether from participating in programs like Vot-ER.
Prohibit Medicare graduate medical education (GME) dollars from being used for voter registration activities. As a taxpayer, I want the money Congress spends on supporting medical residency to be effectively deployed, not squandered on things like voter registration that don’t actually redound to health outcomes. And if I were a patient, I'd hope to be treated by doctors whose overriding passion is medicine qua medicine (as opposed to ‘rescuing the state’), unlike the majority responding to the survey in Degrazia et al. (2022), who "indicated that the COVID-19 pandemic has affected the way [they] view themselves in society and has increased the perceived need for physicians to engage in politics and advocacy." While this method would not preclude medical residents from participating in voter registration, and while money is fungible and funding will ultimately find its way to voter registration activities, it would thin the availability of such funds and signal congressional disapproval of voter registration in medical settings.
Prohibit the use of federal health center funding for voter registration activities. Likewise, we want federal dollars spent on health to affect actual health outcomes. Junior, et al. (2023) write of Vot-ER implementation in pediatric settings, “Badge, printing, and lamination expenses could be paid for using hospital discretionary funds and/or small departmental grants.” Let us ensure those grants are not appropriated from federal coffers. (This item was already proposed as an amendment to Labor, HHS during the FY2025 appropriations process but did not make it through to final passage.)
Require privacy disclosures at every point of engagement with would-be voters in medical settings. Because Vot-ER data is volunteered by patients, it is not subject to Health Insurance Portability and Accountability Act (HIPAA) regulations. I contend, however, that because voter registration conversations occur amid the administration of health services, patients and caretakers may have a reasonable expectation of privacy with respect to information volunteered through something like a Vot-ER QR code. In order to burden the active recruitment strategy, Congress could mandate that medical providers preface every instance of voter-registration engagement by disclosing that volunteered information is not subject to HIPAA protections and can be retained and shared. This, I believe, would amplify the discomfort on both sides of such conversations and may effectively dissuade participants. (It’s possible that another layer of encumbrance will be added by the fact that Vot-ER is powered by TurboVote, which has applications outside of Vot-ER. If Vot-ER had to add a digital privacy disclosure, it may force them to add it to TurboVote, in which case every TurboVote user, medical patient or otherwise, could be greeted by a privacy disclosure that may deter some of them from participating.)
A while ago I discussed these proposals with attorneys specializing in voting rights and privacy law, who said I’m barking up the right tree. While this effort is dead in the water due to the change of administration and changing congressional priorities (I was told before the election that Oversight would home in on unscrupulous nonprofits, which has not materialized), I will quietly and deliberately shop my draft legislation around when the time is right.
In their 1848 Manifesto of the Communist Party, Karl Marx and Frederich Engels wrote, “the first step in the revolution by the working class is to raise the proletariat to the position of ruling class to win the battle of democracy.” Setting aside the fact that “class” is a false concept, it is essential to recognize democracy in Marxist doctrine as both a means to totalitarian ends and the first obstacle to be surmounted in a communist putsch. As noted earlier in this series, the activists pushing Public Health/Health Equity are malevolent individuals seeking to exploit American law, including civic processes like voter registration, to foment revolution. Ultimately, instilling the values of reason, purpose, and self-esteem in all men is the only way to ensure mystics like Plato, Kant, Hegel, Marx, and their Critical disciples–Sartre, Foucault, etc.–are perennially discredited.
In the interim, because I do not anticipate a new American Enlightenment in my lifetime,4 I hope to use my position as a legislative professional to counter the Marxist onslaught at every opportunity. I encourage lowercase republicans at all levels of government to do the same. Paternalists like Sir Michael Marmot do not believe in individuals’ ownership of their own lives. They do not believe poor health, poverty, addiction, homelessness–tragic as they are–can ever be earned outcomes of individual behavior. They do not believe man should try to live in accordance with his own values or flourish by his own thought and labor. Hence why Marmot in his thesis singles out, as a feature of individualistic societies, a “high likelihood of an individual finding himself in a situation for which his world-view has left him unprepared” (implying the whims of the collective would render him better prepared); and hence why a man like Martin Skladany of the Pennsylvania State University can shamelessly write an article calling on first-world nations to stop “stealing” doctors from the third world, effectively demanding an “equitable distribution” of human beings.
For every devoted individualist, no matter his profession, it will take countless man-hours and boundless creativity to keep our Republic. This series took many hours of research and writing, conversations with legal scholars, congressional staff, and a protracted dialogue with legislative counsel, the culmination of which are three policy recommendations to stymie just one miniscule aspect of the Marxists’ inversion of republican processes. But as small as the net contribution of voting as a Social Determinant of Health may be to the Marxist putsch, it required these five thousand or so words to be properly addressed. And the actual legislative work, the lawmaking, has yet to be done.
If there is inspiration to be found in this sort of work, remember: To keep your liberty, learn your enemy. Understand their methods of infiltration and devise a strategy to rationally combat provocations everywhere you can affect change–be it your workplace, school board, city council, et cetera. As Leonard Peikoff once said, addressing the American university student: ‘I am not suggesting that you become a martyr, but speak up when appropriate.’ Object to unreason whenever and wherever you can, without crippling your ability to do so again. Even an unelaborated “no” is affirming of reality. It disturbs the mind of the anti-reason parasite and plants a seed of confidence in the benevolent and honest observer.
Citations
DeGrazia, R. J., Ogunwole, S., Lorigiano, T.-J., Bienstock, J., & Pollack, C. E. (2022). What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and Health Advocacy Survey. American Journal of Medicine Open, 8, 100023. https://doi.org/10.1016/j.ajmo.2022.100023
Junior, J. A., Ha, Y. P., Ruxin, T. R., Moore, Z., Grade, M. M., Stewart, A. M., Murray, A., & Martin, A. (2023). A national voter registration campaign. Pediatrics, 152(2). https://doi.org/10.1542/peds.2022-059501
Economist David Friedman addresses this in his book Law’s Order: What Economics Has to Do With Law and Why It Matters. The following passage is from chapter ten of the pre-publication, online version of the book, linked here: “The idea of a thing belonging to a person is fairly clear when the thing is an automobile or a pair of pants. It is less clear when the thing is a piece of land. What rights does my ownership give me? Almost certainly I can farm the land, or build on it, or keep off trespassers. But can I prevent airplanes from flying over it, miners from tunneling under it, neighbors from making loud noises near it? If it is my land, does that mean I can forbid radio stations from broadcasting without my permission, on the theory that if I can pick up the signal, the radio waves must be trespassing on my property? What I own is not a thing called land but a bundle of rights. Some rights almost always go in the bundle associated with a particular piece of land… Other rights associated with the land, such as the right to forbid trespassers at various distances above or below it and the right to have the surface stay put instead of sliding into someone else's coal mine, may or may not be found in the same bundle.”
Unfortunately, we are far from it. In response to Marxist agitations, a pernicious and anti-American mystic movement, Christian Nationalism, is gaining steam. Its pop-culture progenitor is Dr. Stephen Wolfe (a reaction/real action that is very much welcome by Marxist provocateurs).