In 2016, poor health strongly predicted Trump voting. A county's rate of diabetes, alcohol consumption, obesity, etc. predicted its propensity to vote Trump *even better* than race/education. https://thehealthcareblog.com/blog/2017/01/04/americas-health-and-the-2016-election-an-unexpected-connection/

I think of that grim relationship between Trump and sickness as I read the latest stories about how so many Republicans continue to refuse COVID vaccines. 2/x
https://www.washingtonpost.com/health/2021/04/20/vaccine-hesitant-republicans/

As @DKThomp points out, vaccine refusal is especially strong among younger Republicans 3/x https://twitter.com/DKThomp/status/1384858951540486144

The self-harm of Trump voters should concern us all. They are fellow human beings. And because their self-harm also drives them to dangerous political extremes, their self-harm is also an important civic matter too. BUT ... 4/x

... there's an issue of personal responsibility here too. A heroic scientific effort - achieved at huge cost - has delivered vaccines that are astonishingly effective at protecting life from COVID. So effective that we may not need to worry about herd immunity. If so ... 5/x

... If so, if the vaccines work as well as they seem to work, then vaccine refusal really does become a personal decision, like a motorcyclist refusing to wear a helmet.

I believe we ought to try to save people from self-harm. But there are practical limits to paternalism 6/x

Trump and the Fox leadership have vaccinated themselves of course. But they have a different message for their followers. They have persuaded them that it's a test of identity and loyalty to refuse COVID protection. 7/x

Just as Sarah Palin once waged culture war against healthy eating https://www.theatlantic.com/culture/archive/2010/11/in-war-against-the-obamas-palin-drops-cookie-bomb/343471/ and as Senator Joni Ernst has done the same more recently. https://www.iowafieldreport.com/congress/joni-ernst-in-the-lefts-war-on-meat-ill-stand-up-for-iowa-farmers/ 8/x

The gun issue is also one of self-harm and harm to loved ones. Almost 25,000 Americans a year use guns to end their lives. Thousands more are horribly injured in gun accidents that would never have happened without a firearm in the home. 9/x https://www.pewresearch.org/fact-tank/2019/08/16/what-the-data-says-about-gun-deaths-in-the-u-s/

The people who voted Trump and watch Fox are victims of a slow-rolling national tragedy. But they are not *only* victims. They bear responsibility too for the harm they do themselves and their families. 10/x

In the earlier phases of COVID, we were all in it together. One person's reckless behavior endangered his or her more prudent neighbor. As highly effective vaccines spread, however, the harm of COVID denial increasingly falls almost wholly on the denier. 11/x

Eventually a free society reaches the limits of its ability to protect the ignorant and careless from themselves - and what a society cannot do, it can have no duty to do. END