Sciency! Study Says, Voting Republican Kills!


The British Medical Journal is, by all accounts, a credible scientific journal. I wouldn’t know. I’m not a medical or health expert or a scientific researcher, except for a handful of food safety and nutrition issues.

But I know someone: Doug Badger, former Special Assistant to President George W. Bush and my deputy at the Senate Republican Policy Committee during the early 1990s. Doug succeeded me as Staff Director of the Senate GOP’s in-house “think tank.” Doug helped craft the Senate GOP’s major alternative to “HillaryCare” during the early years of the Clinton Administration, the Consumer Choice and Health Security Act of 1993.

The bill’s major sponsors, then-US Sens. Don Nickles (R-OK) and the late Orrin Hatch (R-UT) also relied on the Heritage Foundation’s estimable Stuart Butler (now at the Brookings Institute) for philosophical inspiration and guidance. Doug’s major accomplishment, arguably, was bringing Health Savings Accounts to reality. He is my go-to expert on all things health care reform.

That legislation shaped GOP alternatives to Democratic health proposals for several years. I’ll grotesquely oversimply, but it would have made buying health insurance a lot like car insurance. You don’t rely on your employer for car insurance, but you do for health insurance, thanks to a World War II tax code change insisted by unions in exchange for limiting wage increases.

Imagine being able to keep the money your employer spends on insurance for you. Imagine you owning and choosing your health insurance, not your employer. Imagine being able to customize your health insurance, so you only pay for what you need. Where have I heard that before?

Some people, mostly Democrats, think Americans are too stupid and gullible to make such decisions. That pretty much defines the major difference between the two political parties. One party trusts you with your life’s choices and money; the other gives you Obamacare. You remember Barack Obama promising, “if you like your health care plan, you can keep it.” Even left-wing Politifact called that “Lie of the Year” in 2013. Republicans trust you. Democrats have a different message. How’s that been working out for you lately?

But I digress. The British Medical Journal published a “study” that concluded this: “The mortality gap in Republican voting counties compared with Democratic voting counties has grown over time, especially for white populations, and that gap began to widen after 2008.”

With that introduction, please read Doug’s excellent missive for yourself. It geeks out a bit on the details, but like the best researchers, Doug is precise with his terms. Thanks to him, I don’t think we have to worry about the Centers for Disease Control slapping “Voting Republican Kills!” warnings on Dominion voting machines. Then again, given the Biden crowd’s politicized performance on the Covid pandemic, stay tuned.

Voting Republican could be hazardous to your health, especially if you live in a county that Donald Trump won.  

That’s the latest contribution to junk social science, this one brought to us by the distinguished British Medical Journal.

The authors tell us that counties that voted for GOP presidential candidates between 2000 and 2016 had smaller reductions in age-adjusted mortality rates over the past two decades than counties that backed their Democratic rivals.

Before the Biden administration requires presidential ballots to bear a surgeon general’s warning (“Voting Republican kills!”), it’s worth giving the study a closer look.

Its first and most obvious flaw is that hundreds of counties switched party preferences over the course of those five presidential elections. Then-Vice President Al Gore may have carried a given county in 2000, followed by then-Sen. John Kerry in 2004, and then-Sen. Barack Obama in 2008, but if Trump prevailed in 2016, its age-adjusted mortality reduction for the 2001-2019 period would be assigned to the GOP column.

This is a significant defect. Democrats carried 673 counties in 2000, but just 490 in 2016. Trump carried 2,622 in 2016, according to the study. Thus, the study classifies 183 counties that voted for Gore in 2000 as Republican in 2019 in measuring mortality changes over the 2001-2019 period.

The list of counties that backed one party or the other fluctuated over the five election cycles. Democrats won 673 counties in 2000 and 874 in 2008 before plunging to 490 in 2016. The list of counties the study compares is thus wildly inconsistent, rendering its findings suspect.

The authors also looked at a subset of counties that voted consistently for Republicans or Democrats in all five presidential contests. The results of that analysis were underwhelming.

Age-adjusted mortality in large metro counties fell by an identical 1.4% of residents between 2001 and 2019, whether those counties voted Democratic or Republican in all five elections. Small to midsize metro areas that backed Democrats in those five races had declines of 0.9% over that period, compared with 0.8% in comparable areas that voted Republican.

That difference isn’t statistically significant. The differences in rural counties are larger, but the confidence intervals (similar to the margin of error or plus/minus in public opinion polls) intersect, suggesting that the differences may be due to chance.

The increased urbanization of the Democratic Party and the GOP’s growing appeal to rural America might well explain the differences in mortality rate changes.

Despite Democratic nominees carrying 183 fewer counties in 2016 than in 2000, Joe Biden won more large urban counties than Gore. He prevailed in 156 large urban counties with a combined total of nearly 134 million residents, compared with just 46 million in such counties that backed Trump, giving Biden almost a 3-1 advantage in that category.

More than three-fourths of residents in counties that backed Biden lived in large metro areas, compared with just 32% for Trump.

Residents in rural counties that Trump won outnumbered those in rural Biden counties by nearly 8 to 1. Just 5.4 million lived in rural counties that backed Biden, making up just 3% of the residents in counties he carried.

In short, the differences the authors cite may well be explained by something we already know; namely, that Trump’s strength is in rural counties, where health status is poorer and life expectancies are shorter, while Biden’s power base is in urban centers, where medical care is generally state of the art.

Looking at the counties that voted consistently for the same party over all five presidential election cycles yields other anomalies. For example, average age-adjusted mortality for blacks declined by an identical 1.4% in both Democratic and Republican counties. Mortality among Hispanics fell by 1.6% in GOP counties, compared with just 1.3% in Democratic counties, although the confidence intervals overlap.

The only statistically significant difference is in mortality rate reductions among whites, which dropped by 1% over the period in Democratic counties, compared with 0.6% in Republican counties.

Do the authors believe that voting patterns produce reverse health inequities?

Design flaws and anomalies aside, the study is—at best—silly. It deploys dodgy statistical legerdemain to make a political point.

Absurdities abound. Are people who vote for a Democrat more likely to die because a Republican carried his or her county? Is it safe to vote Republican so long as you live in a county that reliably backs Democrats?

To their credit, the authors acknowledge that they could not “explain the link between political environment and mortality, and the direction of this association.”

Or whether there is any such link at all.

The British Medical Journal has published many studies that have advanced human knowledge and contributed to better medical care.

This isn’t one of them.

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There are 4 comments.

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  1. Stina Member

    A lot of this was known before Trump. There was an increase in death rates in rural, white, rust belt cities. It was investigating this that really pulled Tucker Carlson into the limelight. It was this that saw so much surge in 2015 for Trump in those areas. It was this that prompted Kevin Williamson’s highly questionable “let them die” editorial.

    I don’t think the death rates were why they voted for Trump, but they are symptoms of the same disease – forgotten and despairing people turned to the outsider for help because the status quo has written them off as below caring, not worth it, and good riddance.


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  2. TBA Coolidge

    Americans reside in states and are loosely arranged in counties. 

    We live in towns and cities. That is where we do what we do, that is where we are most governed and policed (or not). Towns and cities are where the rubber meets the road and the bullet hits the bone. 

    Small wonder then that the liberal press in its various forms wishes to shift the conversation away from Democrat murder cities. 


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  3. Paul Stinchfield Member
    Paul Stinchfield

    Kelly D Johnston: The British Medical Journal is, by all accounts, a credible scientific journal. I wouldn’t know. I’m not a medical or health expert or a scientific researcher, except for a handful of food safety and nutrition issues.

    The professional journals have been growing increasingly corrupted by leftist political dogma. Theodore Dalrymple, among others, has been writing about this now and then for a number of years. See his recently book  False Positive: A Year of Error, Omission, and Political Correctness in the New England Journal of Medicine, See this longer review which also mentions Dr. Sally Satel’s excellent 2002 book PC, M.D. which is still in print after 20 years. Dalrymple has been writing about medicine and the medical profession for many years, and many of his essays have been collected in A Pinch of Salt, Anything Goes, Romancing Opiates, Fool or Physician, and If Symptoms Persist.

    How did this corruption come about? Presumably in the same way that professional organizations like the AMA were corrupted: by the slow infiltration of the hierarchy by individuals who were more interested in politics than in the professions which the journals were established to serve.

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  4. I Walton Member
    I Walton

    Let’s keep it really simple.  It’s a lot easier to cheat in urban areas and urban districts where your party dominates.  Here is an even more simple minded  observation, Biden, inarticulate even when he had a functioning brain, from the basement without campaigning, got more votes than anyone in history.  Give me a break.  If some of it wasn’t outright fraud, it was well oiled massive vote accumulation from folks who either didn’t care, were easily bought or weren’t paying attention.   Can’t be true? So they’ll fix it?

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