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May 10 - May 11, 2019
people who reflexively shouted “Gun research doesn’t add up!” were often the same people who supported a ban on effective gun research.
gun advocates overlooked the most glaring problem with the suicide research: its lack of analysis of race.
The focus on race in the 2014 study but not in the 2015 study subtly conveyed the notion that homicide was a race problem but suicide was a policy one. Intended or not, race meant black homicide in Missouri but not white suicide in Missouri, Connecticut, and all other states where white men made up the majority of self-inflicted gun deaths. Blackness, as an analytical category, thereby remained front and center in discussions of violent crime. Whiteness remained controlled for and invisible.
Importantly, the steepest increases occurred in the period after the Crifasi study ended in 2012, when Missouri gun laws became more permissive. In 2015, the state’s gun suicides rose to an all-time high of 10 per 100,000 people. Meanwhile, gun suicide rates in Connecticut followed a slow downward trajectory starting in the mid-1990s and generally hovered in crude rates between 2 and 3 per 100,000 people through the end-period of analysis.
Texas and Florida also promoted open-carry, permitless-carry, stand-your-ground, the Castle Doctrine, and other legislation that loosened gun statutes. Meanwhile, New York, a state with consistently tight gun laws, reflected trends in Connecticut. A comparison of gun suicides in these states between 1999 and 2015 looks like this. Note how Missouri sets the curve:
By contrast, the Connecticut graph showed more varied trends. White male suicides peaked at 9 deaths per 100,000 people in 1994, again right before the state enacted tougher gun legislation, and then jumped up and down for the next twenty years but followed an overall trend of decreased death over time. Gun suicides by other groups of men fell considerably over the same period. For the most part, gun suicides by women, and particularly women of color, remained so low that they barely made it onto either graph.
a quick WISQARS relative risk analysis reveals that rates of non-Hispanic white male death by gun suicide roughly equaled mortality rates for car accidents, diabetes, Alzheimer’s, influenza, and pneumonia. Much has been made about opioid addiction in rural America and its impact on white men. But the aggregate death rate for white males by unintentional drug poisoning in Missouri between 2008 and 2015 was 17.51 per 100,000 people, while the rate for self-inflicted gunshot was 17.82.
white men in Missouri were seven times more likely to turn guns on themselves than to be fatally shot by intruders in their castles or assailants against whom white men needed to stand their ground.10
The allure of this notion of armed white male power makes sense in many ways. Who wouldn’t be tempted by a platform that claimed to increase one’s own privilege, power, safety, and authority?
The data overwhelmingly suggests that more guns mean more deaths, and particularly so for the very people whose privileges and potencies Man Cards and pro-gun policies claim to restore.
White men die by their own guns two and a half times more often than do their nearest demographic, and exponentially more often than they do at the hands of dogs, bears, ladders, carjackers, intruders, terrorists, or other predators combined.
privilege itself becomes a liability. White men themselves become the biggest threats to… themselves. Danger emerges from who they are and from what they wish to be.
There is an undeniable power in this form of us-versus-them logic in places like Missouri. Here, guns function as totems, symbols of belonging and of self- and community protection, revered sources of power.
Guns mark forms of family and privilege that the white Missourians with whom I’ve spoken cling to as an inheritance.
“You know, I do think there needs to be some kind of middle ground, to be honest,” she says. “People here love their guns, but we can’t just have guns everywhere all the time. It’s just creating chaos and, you know, not making us any more safe. “I would never say that in the group, though.”
what’s bizarre about the Republican strategy is that it is likely to cause the most damage where many of Mr. Trump’s supporters live. Rural and suburban areas are more likely to lose insurers and see big premium increases if Obamacare goes down, because companies have less incentive to stay in markets where there are fewer potential customers and where it is harder to put together networks of hospitals and doctors.
The Times piece pointed to trends in several Southern and midwestern states. “In places like Iowa, Nebraska, and Tennessee, companies such as Aetna and Wellmark are so spooked by the uncertainty that they are considering abandoning the market.”2 This argument reflected
the ACA from the outset, refusing to expand Medicaid or promote robust insurance marketplaces, and thus relied on single insurers to provide coverage. Washington’s threats to cut subsidies threw health care for entire states and regions suddenly up for grabs. The result, to understate, was uncertainty. “No one feels optimistic about the market,” Tennessee insurance commissioner Julie Mix McPeak later claimed.3
African American men largely supported the ACA because the legislation potentially helped “everybody” and because they felt that anything would be an improvement over Tennessee’s crumbling health care delivery system. But many white men, like Trevor mentioned in the introduction to this book, voiced a willingness to die, literally, rather than embrace a law that gave minority or immigrant persons more access to care, even if it helped them as well.
the success of anti-ACA politics in places like Tennessee came at high mortal costs for the on-the-ground white Americans who supported, embodied, and paid a heavy toll for their rejection of Obamacare.
A once slave-owning state, Tennessee long mandated separate and unequal health care. White hospitals and clinics refused to treat African slaves and free blacks through the Civil War. In 1881, Tennessee passed the first segregation legislation in the postbellum South, a law that required railroad cars separated by race, setting a template for the Jim Crow era. Reconstruction-era discrimination against African Americans by medical schools and teaching hospitals in Tennessee was so extreme that in 1876, black physicians opened one of the nation’s first African American medical schools, Meharry
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Tennessee is home to large parts of the American health insurance industry. Yet health insurance itself also carried racial valence in Southern states like Tennessee.
Thus, topics of health care and health insurance in Tennessee were already imbued with historical tensions long before the ACA, as questions such as Whose life is worth saving and insuring? or Whose bodies are seen as risky? coursed through larger debates.
Senator Strom Thurmond of South Carolina—as he defected from the Democratic Party to the GOP—menacingly warned that the Civil Rights Bill of 1964 would lead to “upheaval of social patterns and customs,” leading to violent revolt by white Southerners. Similar patterns of Southern opposition emerged when the Truman administration introduced the concept of mandatory national health insurance in 1945 and when the Johnson administration introduced Medicare and Medicaid in 1965, eliciting widespread white concerns that Southern hospitals would have to integrate in order to receive funding.
Conversely, providing equitable, community-based health care historically signaled a form of empowerment in black communities.
African Americans became “overwhelmingly” supportive of the ACA while white Americans increasingly believed that “health care should be voluntarily left up to individuals” rather than the federal government.8
Talking to groups of men in the South is a particular experience if you’re a Northerner. Overt religiosity and conservatism emerge in deep twang. Men often tell you what church they go to when they introduce themselves (“Born and raised here in Murfreesboro, and I go to First Baptist Church, me and the wife too”). A bravado of what sociologist Michael Kimmel calls Southern “muscular Christianity”—crucifix necklaces and forearm tattoos, elaborate facial hair—abuts formal mannerisms and a “yes, sir” or “’preciate that” in every reply. A somewhat contradictory relationship to authority also
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elicits an autonomic peptic response. Like asking about “gun control” in Missouri, phrasing a question about “government” in states like Tennessee hangs heavy with historical inflections. For instance, government invokes the Reconstruction period, when federal forces and Republican governments “occupied” Southern states and pressured them into granting political rights to newly freed slaves.
At the time, redeemers became the term for white Southerners who violently aimed to uphold white supremacy, in opposition to the so-called carpetbaggers and scallywags who promoted Reconstruction governments, black citizenship, and black political activity. Government also implies the bitter legacy of the civil rights era, when many—though certainly not all—white Southerners viewed federal efforts to desegregate schools, lunch counters, voting booths, and hospitals as threats to the so-called Southern way of life.1
The word government gains particular charge when it collides with words and ideas connoting individual autonomy or personal choice, such as guns, money, or health. This was certainly the case for many participants in the white male groups. The words government and health hung in the air like ...
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food with their food stamps and then…” “Yeah,” added a man who owned a lawn-care service. “A lot of the people that I know that are in poverty are not healthy… the vast majority of them are very overweight, and the children are overweight.” “And how do you know they’re not healthy?” I asked. “Well,” the man continued, “just by their physical appearance, generally speaking, although you can look at their facial expressions, their faces and look at the coloring of their skin, that type of thing.”
White men often phrased their anxieties about government through ideological language that described events they feared might happen (“The government could be watching us right now”)—in somewhat the same ways that white gun owners who spoke to sociologist Angela Stroud imagined fictional black aggression toward white people to justify open carry of firearms.
But many African American men did not need to imagine speculative fears—they could recount firsthand experience with governmental intrusion or neglect. The African American men in our groups described being pulled over, hassled, or unfairly surveilled by police. Many lower-income black men also recounted ways that local governments denied basic services to their neighborhoods or failed to provide, support, or improve key infrastructures. Black men of all income levels described the profound generational impact of mass incarceration. “A lot of black fathers been on the street or been in the
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These men, in other words, lived as “outcast[s] and stranger[s] in mine own house,” as W. E. B. Du Bois once described the doubly conscious experience of black America in which internalized identity coexisted with the thousand cuts of everyday restrictions and subliminal racisms.
In other words, where white men reacted astringently to the thought of “intervention” into health care, black men saw health care “expansion” as a net benefit and government as a fail-safe, albeit a far from perfect one, against predatory illnesses, persons, or corporations.
black men narrated health care as a benefit—rather than as what the historian Roediger called a wage.
Resistance to health care reform also reflected venerable Southern traditions of opposition to change and particularly to perceived Northern intervention into racial norms and social orders.
In an age of outsourcing and globalization, this resistance became one of white men’s remaining marketable skills, deployed to guard the old ways through modes of resistance and self-sacrifice that made them perfect consumers and foot soldiers for the Tea Party, the National Rifle Association, and the Trump campaign.8
In an ideal world, effective health insurance plans also reduce mortality rates because they promote preventative care for lower- and middle-income persons, transforming illnesses such as cardiovascular disease, depression, respiratory disease, or neoplasms from death sentences into manageable conditions.
The authors ultimately found that all-cause mortality declined by a whopping 6.1 percent, or 19.6 per 100,000 people, after expansion, including a 4.53 percent decline for white residents and an 11.36 percent decline for nonwhite residents. Sommers concluded that “2840 deaths [were] prevented per year in states with Medicaid expansions” compared to similar states that rejected expansion.1
mortality decreased by 2.9 percent in Massachusetts and by 2.4 percent in the state’s white populations after the implementation of the comprehensive health reform known as Romneycare, a state-run health insurance program that provided the intellectual framework for the ACA. Sommers wrapped up his findings by arguing that more health insurance roughly correlated with less death because insurance “leads to increased coverage, and such coverage leads to better access and more utilization of clinical services, including office visits, with resulting gains in self-reported health status.”2
that if Tennessee had expanded Medicaid, between 1,863 and 4,599 black lives might have been saved from 2011 to 2015. That staggering number is actually conservative: the figures did not account for the many more African American citizens who grew sicker but did not actually die during the time frame.5
between 2011 and 2015, between 6,365 and 12,013 white lives might have been saved had Tennessee expanded Medicaid. Again, this projection does not capture the fact that health benefits from social programs usually grow over time as more people sign up and access preventative care.7
Tennessee’s failure to expand Medicaid potentially cost every single adult black and white resident of the state somewhere between two and five weeks of life.
Cost, in other words, functioned as a metaphor for concerns about a system that gravely threatened the sense of individualism underpinning particular white notions of health. This point is often overlooked by progressives who reflexively argue for government health care for all without taking account of the racial and historical intonations of federal health care networks in places like Tennessee. Here, seemingly self-evident arguments about communal well-being and shared risk engender specific forms of white anxiety.
Trump essentially asked lower-income white people to choose less coverage and more suffering over a system that linked them to Mexicans, welfare queens, and… to healthier, longer lives. And we, as a nation, chose the bottom lines in the charts.
Kansas became a frequent landing place for white flight. Its stronger tax base and significant state investments in education yielded significant results for student outcomes.
Yet more than in any other state on my research quest, I found deep layers of buyer’s remorse. “Kansas used to have such cachet,” an architect from Shawnee Mission told me. “People wanted to live here because our state was progressive, highly educated, and clean. But now, I feel nothing but angry most of the time, angry for what’s been done to our home.”
“They are stealing money from everywhere they can,” a retired postal worker from Prairie Village told me. “From kids. From our pensions. From our health care. From things we need. It’s ridiculous.”
sociologist Isaac Martin penned a column in the New York Times titled “How Republicans Learned to Sell Tax Cuts for the Rich,” in which he lay the answer in good marketing, a rejection of expertise, and the corrupted populism of Andrew Mellon. Mellon found a way to convince the American masses of the faulty proposition that “cutting income tax rates would actually increase tax revenues. In particular, he said, cutting the top income tax rates would encourage rich people to pull their money out of tax shelters and invest in creating jobs.”3
