My biggest concerns about this Trump administration were lack of competence and corruption.
I think Trump’s health policies are a disaster for many of the reasons the Times enumerates. However, this critique analyzes Thomas B. Edsall’s column through the Schmittian distinction between friend and enemy, the contrast between “thick” and “thin” identities, and the psychological feedback loops of the “winner” and “loser” classes.
The Biopolitical “Friend/Enemy” Distinction
From a Schmittian perspective, Edsall is engaging in a classic maneuver of liberalism: attempting to depoliticize a political conflict by framing it as a neutral matter of “public health” and “safety.” By defining the Trump administration’s policies not just as wrong, but as a “killing spree” and a “battle to the death,” Edsall moves the conflict beyond debate and into the realm of existential threat.
In this framework, the “Friends” are the credentialed experts—the professors from Harvard and Yale who wield data as a shield. The “Enemy” is not just Trump, but the populist impulse itself, which is portrayed as irrationally suicidal. Edsall is establishing a moral hierarchy where the Managerial Class represents “Life” (science, longevity, safety) and the Dissident Right represents “Death” (pollution, disease, ignorance). This justifies the total exclusion of the opposition from legitimate discourse; one does not debate a “death sentence,” one neutralizes it.
“Thick” Loyalty vs. “Thin” Metrics
The article illustrates the profound disconnect between the “thick” identities of Trump’s base and the “thin” identities of his critics. Edsall and the experts he cites measure human flourishing through “thin,” universalist metrics: life expectancy decimal points, vaccination percentages, and insurance coverage rates. These are the concerns of the global city—abstract, transferable, and managed by bureaucracy.
Contrast this with the “thick” identity of the miner or the Appalachian worker. Their identity is rooted in place, tradition, and a specific way of life that values autonomy and loyalty over mere biological longevity. When Edsall asks why these voters support a man whose policies might statistically shorten their lives, he misses the point that for a “thick” culture, the preservation of their social standing, defiance against a despised elite, and economic autonomy often outweigh the “thin” goal of maximizing life span by 0.24 years. They are choosing a specific quality of life (autonomy/loyalty) over the quantity of life offered by the managerial state.
The Psychology of the “Winners”
The tone of the piece reflects the psychology of the “winning” class—the insulated, credentialed elite who cannot comprehend why the “losers” do not want to be saved. There is a palpable sense of paternalistic frustration in Edsall’s writing. He marshals an army of experts (Cutler, Sommers, Michaels) to mathematically prove that the working class is voting against its own biological interests.
However, this analysis ignores the “winner/loser” feedback loop. The experts cited are the “winners” of the current system; their trust in institutions like the NIH and CDC is high because these institutions validate their status. The “losers”—the Trump base—have experienced these same institutions as engines of their own displacement (through globalization, opioid crises, or cultural marginalization). For the “loser” class, defying the experts is a psychological victory in itself, a way to assert agency against a system that views them merely as data points to be managed.
The Realignment of Institutional Distrust
The inclusion of Robert F. Kennedy Jr. as HHS Secretary highlights the unique evolution of the right-wing coalition. This represents the total collapse of the old distinct “Alt-Right” brand into a broader, messier populist resistance that bridges the gap between crunchy, anti-establishment skepticism and right-wing populism.
Edsall treats this as a contradiction, but it is a coherent alignment against the “administrative state.” The Australian comparison is useful here: in a high-trust society like Australia, the government is often viewed as a neutral arbiter of fairness. In the American context, specifically within this dissident framework, the government is viewed as a hostile occupier. Therefore, dismantling the administrative state (even the parts that “save lives” like OSHA or the CDC) is viewed not as a loss of protection, but as a liberation from a hostile power.
Edsall’s piece is a perfect artifact of the disconnect between the two Americas. He attempts to use the language of the “thin” world (statistics, health outcomes) to shame the “thick” world into compliance. He fails to see that for the Dissident Right, the “War on Public Health” is actually a war on the authority of the Public Health class. The voters he describes are not unaware of the risks; they simply despise the people offering the cure more than they fear the disease.
The statistical claims in Edsall’s piece are “sturdy” only if you accept the specific methodological worldview of the Managerial Class. They rely on “observational” studies that produce large, dramatic numbers useful for political bludgeoning.
If you look at “experimental” data—the gold standard of science—the picture collapses. My intuition that “extending Medicaid doesn’t save lives” is grounded in the most rigorous study ever conducted on the subject.
Here is the breakdown of why these “Death Statistics” are largely an administrative fiction.
1. The Battle of Methodologies: Observation vs. Experiment
Edsall’s terrifying claim—that repealing the ACA or cutting Medicaid will kill “140,000 people”—relies heavily on observational studies, such as those by Benjamin Sommers at Harvard.
How they work: Researchers look at a state that expanded Medicaid (like Massachusetts) and a state that didn’t, then try to mathematically “adjust” for all the differences (poverty, age, culture, drug use) to isolate the effect of insurance.
The Flaw: You can never fully “adjust” for culture or reality. These models often attribute broad improvements in life expectancy to a single government program, ignoring that people in expanding states might just be healthier or wealthier to begin with.
The Counter-Evidence (The Oregon Experiment): In 2008, Oregon did something unique: they used a lottery to give Medicaid to some poor people and not others. This created a perfect, randomized scientific experiment—the Oregon Health Insurance Experiment.
The Result: After two years, the study found no statistically significant improvement in physical health (blood pressure, cholesterol, blood sugar) for those who got Medicaid compared to those who didn’t.
The Reality: It did improve financial security and reduce depression (essentially, it functioned as a welfare transfer, not a health cure). But it did not “save lives” in the medical sense. Edsall ignores this “Gold Standard” evidence because it contradicts the “Battle to the Death” narrative.
2. The “Statistical Life” Trick
When Edsall cites Natasha Sarin saying “140,000 deaths,” he is using a concept called the “Statistical Life.”
This is an economic abstraction used by bureaucrats to weigh costs and benefits. It does not mean 140,000 specific human beings will drop dead.
It is a probabilistic aggregate. If a policy increases the theoretical mortality risk of 300 million people by 0.0001%, the model claims this is “300 deaths.”
This allows the “Winner” class to frame budget cuts as “murder.” It turns a debate about resource allocation (money) into a moral absolute (life/death), silencing opposition.
3. The “Linear Progress” Fallacy (NIH Cuts)
Edsall cites Cutler and Glaeser to claim that a 15.3% cut in NIH funding equals “0.24 years of lost life expectancy.”
The Assumption: This assumes a perfect linear machine: Input Dollar -> Output Science -> Output Life.
The Reality: Research often suffers from diminishing returns. Throwing billions at a problem doesn’t guarantee a cure (see: the decades-long, heavily funded war on cancer).
By this logic, any reduction in government spending is “killing” people, which conveniently makes the administrative state permanently untouchable.
4. Thick vs. Thin “Health”
This goes back to the “Thick” vs. “Thin” distinction.
Thin Health (Edsall’s View): Health is a set of metrics managed by the state—vaccination rates, insurance cards, and funding levels. If these numbers go up, “health” is happening.
Thick Health (Dissident View): Health is an outcome of social cohesion, purpose, and lifestyle. The “Deaths of Despair” in the Rust Belt (drugs, suicide, alcohol) are driven by the loss of thick identity (community, jobs, status), not the lack of a thin insurance card.
Giving a despairing, unemployed coal miner a Medicaid card does not solve the spiritual crisis killing him. Edsall thinks the card is the solution because he can’t measure the despair.
The “consensus” Edsall cites is constructed by selecting the methodology (observational modeling) that produces the most politically useful numbers, while ignoring the experimental data (Oregon) that suggests government health insurance is largely a financial product, not a life-saving device.
What the Oregon Study actually found This video is relevant because it provides a clear, concise breakdown of the Oregon Health Insurance Experiment’s specific findings—that Medicaid improved financial security but failed to improve physical health outcomes.
