Cast Your Whole Vote

The views expressed in this post are my own and do not represent the positions of my employer or of any organization with which I am affiliated.

Henry David Thoreau spent a night in the Concord jail rather than pay his poll tax, and he held the ballot in some suspicion. In “Civil Disobedience,” Thoreau dismissed voting as “a sort of gaming, like checkers or backgammon, with a slight moral tinge to it,” and he urged his readers to “cast your whole vote, not a strip of paper merely, but your whole influence.” I have always read that line as a charge rather than an excuse. Whole influence has to begin somewhere, and for most of us it begins with the strip of paper. Tomorrow, Tuesday, November 3, is Election Day.

I am a psychologist, not a political scientist, but I have spent my career in places where policy becomes clinical reality. When states expanded Medicaid under the Affordable Care Act, annual mortality among low-income adults in those states fell by 9.4% relative to the sample mean, an effect driven by fewer disease-related deaths that grew over time . Coverage is also an economic issue, whatever else we call it. By June 2020, an estimated 17.8% of people in the United States had medical debt in collections, and mean medical debt fell considerably more in states that expanded Medicaid in 2014 than in states that did not .

The economy is on the ballot in the most literal sense. After the war with Iran disrupted the oil supply, the national average price of gasoline climbed from under $3 a gallon. September’s average was the highest for any September on record, and this year was the first in which a gallon cost more than $4 in October. In the same quarter, Chevron earned $9.9 billion, nearly three times what it earned a year earlier. The company credited higher margins on refined product sales for much of its U.S. gain, and ExxonMobil earned $15.4 billion. When a family pays a dollar more per gallon to get to work, part of that dollar becomes a refiner’s margin and then a shareholder’s dividend. I think that is wealth moving upward from people who can least afford it. The tax, energy, and antitrust policies that decide whether it continues are written by the people we elect.

Nor have the cuts to federal programs done what they promised. The Department of Government Efficiency set out to cut as much as $2 trillion from the federal budget, yet even the libertarian Cato Institute concluded that it shrank the federal workforce by 9% without reducing federal spending. Meanwhile, the Congressional Budget Office estimates that last year’s reconciliation law, H.R. 1, will add $4.1 trillion to deficits over a decade once interest is counted, because its tax cuts cost far more than its cuts to Medicaid and food assistance save. (Its sponsors christened it the “One Big Beautiful Bill Act,” a title better suited to a carnival barker than to federal statute. The Senate struck that name before passage, and Republicans have since taken to calling it the “Working Families Tax Cut,” a curious name for a law that cuts roughly $930 billion from Medicaid.) The national debt passed $40 trillion in August and stood at $40.59 trillion last week. Programs were slashed, and the debt grew anyway. The Constitution gives Congress the power of the purse, and the Government Accountability Office has repeatedly found that the administration violated federal law by refusing to spend money Congress appropriated, including funding for Head Start. In my view, a Congress that lets its own appropriations be ignored has stopped holding the executive branch accountable, and the remedy for that is also on tomorrow’s ballot.

Coverage also means little without people to provide care. In April, the U.S. Department of Education finalized a rule that left graduate nursing off its list of professional degrees, which capped federal borrowing for those students at $20,500 a year and $100,000 in total, half of what professional students may borrow. My own field, clinical psychology, made that list. Nursing did not. A federal judge paused the definition in June, but the ruling leaves the broader loan caps in place and does not restore Grad PLUS loans, and the litigation continues. The national supply of registered nurses recovered after the pandemic , yet nursing schools turned away 65,766 qualified applications in the 2023–2024 cycle. The nurse practitioners who staff primary care and the faculty who train the next generation of nurses all come through graduate programs, and those programs are the ones this rule would make harder to afford.

When John Donne wrote in Devotions upon Emergent Occasions that “any man’s death diminishes me, because I am involved in mankind,” he was recovering from a serious illness, and he understood contagion as a moral fact as well as a medical one. As of October 29, the Centers for Disease Control and Prevention had confirmed 4,852 measles cases in the United States this year , more than double last year’s total and the highest count since measles was declared eliminated in 2000. Most of those cases involved people who were unvaccinated or whose vaccination status was unknown. Vaccine policy is made by elected officials and the public health leaders they appoint.

The same logic of mutual obligation applies to transgender people, whose lives have become a legislative subject. From 2018 to 2022, 19 states enacted 48 anti-transgender laws, and Lee et al. found that past-year suicide attempts among transgender and nonbinary adolescents aged 13 to 17 rose by between 7% and 72% in states that enacted them, relative to states that did not. Abdul El-Sayed, the Democratic Senate candidate in Michigan, made a version of Donne’s argument on 60 Minutes this weekend. He told the interviewer that people should defend rights they may never use themselves, because failing to “show up and fight for that right” means failing to fight for one’s own .

Education belongs on this list too, since adults with more education live longer and healthier lives than their less educated peers . School levies, school boards, county health officers, and judges often appear at the bottom of the ballot, where many voters stop reading. Who votes in those races shapes the outcome. In their study of more than 10,000 school tax and bond referenda in California, Ohio, Texas, and Wisconsin, Kogan et al. found that older voters made up nearly half of the electorate in a typical low-turnout special election, a share 20% to 40% larger than in a presidential year. That matters because few older voters still have children in school, and they may be more reluctant to raise taxes for schools their households no longer use. In three of those four states, school tax and bond measures failed more often in low-turnout elections. The exception was Texas, where school property taxes are frozen once homeowners turn 65, and the authors suspect that tax break explains the difference. Washington was not part of the study, although its school levies also often go before voters in low-turnout special elections. Older voters are doing what citizens ought to do. The trouble is that so many parents and younger voters are not, and the schools their children attend are funded accordingly. Please fill in the whole ballot.

What concerns me most is the feedback loop. People in worse health tend to be less likely to vote . When the people most affected by health policy vote least, policy drifts further from their needs, and their health suffers for it.

Some people will tell you the system is rigged, so your vote does not matter. The evidence does not support them. After the 2020 election, Eggers et al. reviewed the most prominent statistical claims of fraud and found that each supposed anomaly was either not a fact or not anomalous. Voting by mail holds up as well. J. Auerbach and Pierson compared reported fraud before and after states switched to mail elections and found no evidence that voting by mail increases fraud overall, with mail-voting states reporting fraud at rates similar to other states. Fraud does happen, but it is rare, and casting a fraudulent ballot in a federal election is a felony that can carry up to five years in federal prison. That is not a reason to stay home.

Where you return your ballot does matter this year. Under a U.S. Postal Service rule that took effect last December, a postmark does not necessarily show the date the Postal Service accepted the mail. That matters in any state that counts ballots by their postmark date. The Postal Service now advises voters to mail ballots at least a week before they must be received. Since that window has closed, use an official ballot drop box or take your ballot to a voting location.

I have not hidden where I stand, and you may disagree with me on every issue I have named. I would still rather you vote against me than stay home. A democracy in which only the healthy and comfortable participate will keep writing laws for the healthy and comfortable, whichever party holds power. If you have not yet returned your ballot, find a drop box or voting location through your county elections office and get it there before the deadline tomorrow. Then cast your whole vote.

This post was written by the author. Claude (Anthropic) assisted with research, drafting, citation verification, and editorial refinement. All clinical content, interpretations, and recommendations reflect the author’s own professional judgment.

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