Five years ago, a young woman with stabbing abdominal pain arrived at my emergency department. Her blood pressure steadily dropped as she developed pale, clammy skin. We told her, “You are bleeding into your abdomen. We see blood on your ultrasound. We are worried you are having an ectopic pregnancy.” Within minutes, she was in the operating room getting a life-saving surgical procedure for a ruptured ectopic pregnancy, a type of pregnancy that is considered non-viable for the fetus.
Remarkably, our pregnant patient survived. Yet, what stands out today is that the legality of our care, years ago, was never a concern. The team was centered only on providing the care she needed.
The Political Landscape of Healthcare
Today, the delivery of healthcare has become increasingly politicized. The recent overturn of Roe v. Wade reversed rights for pregnant people, leaving many vulnerable under recent state abortion bans. In states where exceptions for ectopic pregnancies exist within their abortion ban, women have still encountered hospitals that “refused to treat their ectopic pregnancies.” This shift in regulation underscores the intersection of healthcare and politics, a reminder of how both physicians and patients should engage in the democratic process.
While a growing number of politicians have healthcare expertise, many lack a nuanced understanding of medical practice and healthcare delivery. This knowledge gap creates challenges when those who regulate medicine are not the ones providing it. “Doctors and patients should be protected to make collaborative decisions — without the intrusion of politics” says Dr. Sharon Malone, physician, patient advocate, and author. The intertwining of politics and healthcare complicates efforts to address fundamental health issues. “We haven’t agreed on the most basic tenant: does everyone in this country deserve healthcare?” she argues.
Aspects of healthcare influenced by politics extend beyond women’s health. Insurance reimbursement, gun violence, criminalization of illicit substances, pharmaceutical cost-regulation are just a few active political issues that affect patient outcomes.
The Need for Voter Registration
As of 2022, there are approximately 162 million registered voters in the United States, leaving millions without a voice in upcoming elections. The journey toward change begins with voter registration. Politicians, like Elizabeth Warren, are working to streamline this process, recently announcing that patients filling out health insurance forms via HealthCare.gov will receive information about voter registration. “The health of our democracy depends on Americans registering and exercising their right to vote,” Warren stated.
In Minnesota and Pennsylvania, leaders have designated August as Civic Health Month to emphasize the importance of voting on healthcare. And yet, despite the clear push to increase patients’ civic engagement, some critics—including physicians—oppose discussing voter registration in clinical settings.
Stanley Goldfarb MD, has been outspoken against doctors speaking with patients about voter-registration. He argues that “leftists are making the doctor’s office a major cog in their voter-registration and turnout machine.” Why the act of registering to vote at the encouragement of a doctor feels threatening or unwarranted is unclear to me, a physician who routinely witnesses the profound and direct impact politics has on patients. His organization, Do No Harm, states that they are focused on “combating the attack on our healthcare system from woke activists.”
“Many believe that doctors should ‘stay in their lane’ and not become involved in the political process, as [patients] may see this as a conflict and not get care,” Dr. Ayana Jordan, Associate Professor at NYU School of Medicine argues. She clarifies that our role is to be non-partisan and avoid swaying patients in our direction. “Our role is to ensure that patients understand how to register to vote, make this process as easy as possible, and discuss issues most pertinent to them.” she adds.
Critics fear that doctors will abuse their power to sway patients towards their own individual political agenda. “It’s not just “vote”. It is vote for Joe Biden, if we are honest. Inherently, the doctor’s political bias is reflected in the encouragement. What happens if the patient’s father is wearing a MAGA hat. Do you still remind them to vote?” says one physician, Vinay Prasad MD MPH.
I do agree that physicians should certainly not impose their own beliefs onto patients. And that if they ask one patient to register to vote they should indeed ask all, when clinically appropriate. However, it is countercultural to see physicians grossly avoiding the empowerment and education of patients. A physician need only say, “I’m sorry you can’t afford your life-saving medication” once for it to be clear there’s no effective solution in that statement.
Why Clinicians Should Encourage Voting
In 2022, the AMA declared that voting is a social determinant of health. Dr. Alister Martin, physician, CEO and Co-Founder of A Healthier Democracy, a non-partisan organization that is determined to increase voter registration among patients, says that “data demonstrates that across rural and urban regions, when voting rates are high, health outcomes are better.” While he believes the exact cause is hard to pinpoint, he suspects areas with high voter engagement are better able to pull in resources that help patients access healthcare. “These communities have more specialty clinics, hospitals remain open, health centers are available. In the rural areas with less civic engagement, there are more hospital closures.” adds Martin.
Martin emphasizes that voting fosters a sense of agency among patients. “Those who vote generally feel more empowered to effect change in their lives.” He also highlights a concerning statistic: 72 million eligible individuals are not registered to vote, a gap that can influence electoral outcomes and therefore healthcare related policies.
Encouraging voter registration is not only legal but also supported by leading healthcare organizations, such as the AMA. The encouragement should not be invasive, biased, or demanding. Martin advocates for integrating questions about voter registration into patient social histories, asking, “Do you smoke? Drink? Are you registered to vote?” He believes that by enabling patients to exercise their voting rights, we can all contribute to a healthier democracy.
