The ‘Health Care Heroes’ and the 2020 Election

Just a few minutes into the April 23 broadcast of the National Football League’s virtual player draft, NFL commissioner Roger Goodell got to a very important point. The most valued people in America right now are not football players, he said, but those working in the hospitals and nursing homes to help fight the coronavirus pandemic.

“We have been thinking of those fighting bravely on the front lines,” Goodell said. “We marvel at the compassion and courage of our health care heroes and first responders.” This praise of health care workers was followed by a moment of silence that featured back-to-back images of the Statue of Liberty and a female nurse with a mask on her face. And when, minutes later, Harry Connick Jr. was singing the national anthem, he reached “the land of the free and the home of the brave” just as the screen showed hospital staffers waving signs that read “Heroes work here.”

Just hours earlier, President Donald Trump was stumbling into his infamous disinfectant-injected-into-the-lungs imbroglio. It was obvious that day how distant Trump is from the health care workers on the front line: Even the most violent and macho sports league made a point of showing empathy toward caregivers, while the president noodled about disinfectants and picked fights about whether doctors and nurses have enough masks and gowns.

Even though the president routinely pays lip service to health care workers, it is easy to doubt his sincerity. He has not yet visited coronavirus patients at a hospital (and when his vice president made  such a visit, he did it disrespectfully). And it is widely believed that Trump is backing, at least tacitly, the protesters who want stay-at-home precautions to end—despite the recommendations of health care workers, who have felt forced to stage their own counter-protests.

“The nurses and the physicians and the respiratory therapists, and the cleaning crew, and the people providing us with food . . . they have been trying so incredibly hard to serve their community, without the support of the powers that be . . . just so that they could have the rug taken out underneath them,” said Dr. Mehrdod Ehteshami, an emergency-room physician in the Atlanta area, when Georgia started to “reopen” in April.  “It is essentially a slap in the face of all my nurses, and therapists, and people in the front lines.”

Because the coronavirus caregivers have for now been elevated to something like the status of New York’s police and firefighters after 9/11, they could have an outsized influence this political season, given their numbers and their less than thrilled reaction to the Trump administration’s response to the pandemic.

Polling indicates that the American public is siding with the health care workers more than with the president on most policy issues: shortages of protective equipment, a lack of testing, the schedule of states’ “reopening,” and treatment disparities for different racial and income classes.

“I’m typically not one to share my views with the public, especially political views,” wrote ER nurse Kristen Czekanski in the Providence Journal. “But the fact that Americans are rioting because they have to stay home—while my mom is offering to pay me to stay home, to not go to work, in fear of me being exposed to this virus every time I walk through the door—is heartbreaking.”

A hospital physician in Georgia expressed similarly depressed sentiments to Politico: “To feel that you can’t do your job without begging, especially if you’re putting your body on the line, that you can’t get the tools you need without being gaslighted or interrogated, there’s something belittling and patronizing about it.”

At this remove, it’s impossible to gauge with exactness how these attitudes and concerns will translate into voter numbers in November. But one thing is obvious: Trump is facing an issue he will have difficulty in coming out on top with among undecided voters.

And health care workers could such an important bloc of voters, for several reasons. First, consider the employment numbers. In 2016, there were 15,674,000 healthcare workers in America. That number has now risen to 16,866,000. So more than 1 million healthcare workers have been added since Trump was sworn in, which means they now constitute 12 percent of the national workforce. This is not surprising, given the aging of the population and the need for more healthcare. Health care is now the largest and fastest-growing employment sector in the country. And the effect is not just national: In some key swing states, the largest percentage of workers are in health care and related fields.

If Trump and his advisers once thought that they could campaign against Obamacare, that ship has sailed. Polling shows no significant drop in support for Obamacare since Trump took office—if anything, the law has become considerably more popular. Meanwhile, health care workers keep appearing on news shows citing the problems they face fighting this pandemic, and images of doctors and nurses squaring off against protesters—like the shots of nurses in Denver getting screamed at—continue to go viral. (Grotesquely, one Arizona GOP official recently recommended that protesters dress in scrubs, both to get attention and to suggest—falsely—that health care workers want states to “reopen.”)

And the grim coronavirus tallies continue to rise. The number of COVID-19 deaths in the United States will cross 70,000 this week, with documented cases now around 1.2 million. In an interview Sunday night, the president said deaths in the United States could reach 100,000, double what he had forecast just two weeks ago. But according to forecasts leaked to the New York Times, the government now projects the death toll to far exceed 100,000 by the end of summer, and predicts 3,000 deaths per day by June 1, nearly double the current daily death toll.

Why have the projections risen? In a conference call with reporters on Monday, Dr. Christopher Murray, the director of the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine—which the White House had repeatedly used as its go-to model when the numbers were lower—blamed states’ “premature relaxation of social distancing,” according to Politico.

To summarize: Health care workers are struggling to save lives, at tremendous risk to themselves because of protective equipment that is still sparse. They feel that the Trump administration made the pandemic worse and has failed to provide them with adequate support. And they associate with Republicans the push to “reopen” states—a push that is expected to drive up death rates.

Health care workers are likely to be more front and center as we get closer to the election. Their electoral heft—both as voters themselves and in terms of their effect on the general populace—could be enormous, especially in states that were very close wins for Trump in 2016.

Take Florida, for example. In the nineteen counties that run along Interstate 4 from Tampa/St. Petersburg to Orlando to Daytona Beach, Trump won by about 217,000 votes in 2016. He lost the rest of the state by about 100,000.

That I-4 corridor has had 155 deaths and about 4,500 confirmed coronavirus cases to date. As those numbers grow in the months ahead, both the aging population and the health care employees that serve it will likely become much more frustrated with the incumbent president. As of May 2019, according to the Bureau of Labor Statistics (BLS), nearly 300,000 health care workers are employed in the I-4 corridor, so it is quite possible a large number might vote with health care being their prime issue. Considering that Trump only won the state as a whole by about 113,000 votes, there is a good likelihood that he could lose its 29 Electoral College votes this time around.

Trump won Michigan by only 11,000 votes. Genesee County (home of Flint) and Saginaw County helped him: Hillary Clinton received 67,000 fewer votes in these two counties than Obama got in 2008, while Trump was close to McCain and Romney in the number of votes he got in both counties combined. According to BLS, there are about 31,000 health care workers in these two counties. And as of today, in those two counties—where the combined population is just 600,000—there have been an astounding 267 COVID-19 deaths and 2,375 confirmed cases.

There are other areas where voters employed in health care may have a big influence. Trump wants Virginia to flip his way, but the Washington, D.C. metro area—including populous northern Virginia’s city of Alexandria, Fairfax, Arlington, and Prince William counties (which have a combined 303 deaths and 8,840 cases)—has close to 250,000 health care workers, according to BLS. Pittsburgh, Pennsylvania has about 150,000. The Charlotte, North Carolina metro area has about 100,000.

All these states were in play in 2016, and all have a higher percentage of their populace working in hospitals and nursing homes now than they did four years ago. Democrats seem to be noting this already, and former vice president Joe Biden has a relevant ad he is already airing in battleground states. “This is a war, and these are our soldiers,” he says over footage of paramedics and nurses. The ad is titled “American Heroes.”

Trump this week launched a new re-election ad campaign as well, titled “America’s Comeback.” While the ad does show health care workers in masks and gowns working in hospitals and holding up pro-Trump signs, the president never mentions them by name in his recorded campaign response to the pandemic. He instead focuses on the economy: “We’ve built the greatest economy the world has ever seen and we’re going to do it again,” he says.

But in many parts of the country, the hard-hit economy cannot be separated from COVID-19 pandemic deaths. In Arizona—another state in play—Maricopa and Pima counties (respectively home to Phoenix and Tucson) have been hit hard, with a combined 257 deaths and 6,097 confirmed cases so far. These two counties alone—which accounted for 75 percent of the state’s vote total in the 2016 presidential race—have more than 250,000 health care workers. When you add up both counties, Trump and Clinton basically ran neck and neck. Considering that Trump won the state by only about 90,000 votes, it is definitely within the realm of possibility that health care workers could be a decisive factor in 2020.

There are plenty of other urban areas with huge numbers of health care workers and big death counts and case numbers—Denver (130,000 health care workers), Minneapolis/St. Paul (220,000), Atlanta (210,000), Milwaukee (110,000), St. Louis (150,000), and Las Vegas (75,000). It may be that the best Trump can hope for is that the anger among big-city hospital workers does not move out to the small towns as well.

Sources within the Republican party have indicated to me that their best approach right now is to hope the focus on health care workers diminishes. They apparently think they have time on their side.

That seems like a long shot. The public wants courageous leadership during tough times, and voters are not seeing any from this president. The heroes are in scrubs and masks, and not standing behind a lectern bickering with and insulting reporters. Voters are seeing empathy in the hospitals, not coming from the White House.

Presidential rhetoric matters. After 9/11, George W. Bush made his way to Ground Zero and got on a bullhorn and inspired the American public. Ronald Reagan, the “Great Communicator,” told the Soviets to “tear down this wall” in Berlin—and his firm and defiant tone did help to topple it, and Soviet communism. In Franklin Delano Roosevelt’s first inaugural address, he told Americans that “the only thing we have to fear is fear itself,” and through the long Depression and the world war that followed, his words sought to inspire and unite Americans. These presidents were all partisans. But each of them also sought to rise above partisan politics to lead the nation as a whole. Each of them seemed to come out to the public, instead of demanding the public come to them.

Trump is utterly failing in this regard. His canned rhetoric seems phony. His impromptu rhetoric, which seems genuine, is barbed and self-aggrandizing. Whatever the reason he has not yet been seen for photo-ops in hospitals and nursing homes—maybe experts have advised him to stay away or maybe his self-admitted “germophobia” is keeping him away—he is coming across as someone who lacks empathy.

Empathy, it should be noted, is a quality Joe Biden is especially known for.

To the health care workers and much of  the general public, COVID-19 isn’t some vague policy issue. It’s real. It’s dangerous. It’s deadly. Nurses and doctors have had to watch as patients—including colleagues-turned-patients—have suffocated and died. A candidate who fails to understand that reality, or who fails at least to be seen empathizing, will have a difficult November.