“Dog-Whistles” That Subvert Healthcare Reform

2022.03.10 McGhee - Desmond - Hannah-Jones


Some of the arguments made by opponents of healthcare reform, though false, still hold sway by tapping into racial resentment. This post looks at five such “dog-whistles,” calls out their veiled racist message, and disputes their assertions.

  1. “Reform is bad for the economy.”
  2. “Reform tramples on states’ rights.”
  3. “No need to reform – nothing will happen to you.”
  4. Zero sum: “If reform gives an unearned benefit to one group, it will necessarily subtract that benefit in equal degree from another group who did earn it.”
  5. “Reform is un-American socialism.”

This blog concludes that confronting racism is a necessary precondition for reforming healthcare and will be an integral component of reform.


Fixing U.S. Healthcare blog has claimed that healthcare reform is being blocked by power concentration and greed, and by tactics used by the powerful and greedy to tamp down opposition.

One of the most effective of these tactics is the use of race-baiting “dog whistles.” This post will look at five such covertly race-tinged messages. They superficially appear to be good-faith rational claims. But in fact they are thinly veiled bigoted tropes that tap into racial resentment. This rhetorical ploy clouds the issue of healthcare reform, fragments principled reform efforts, and subverts solutions that could benefit all.

We conclude that the debate on reforming healthcare cannot get very far unless we simultaneously ferret out how racism affects the healthcare system and how it creeps into our assumptions about how to fix it.

This blog has not shied away from racial issues surrounding healthcare reform. Previous posts have looked at

Five “Racist Dog-Whistles” Against Healthcare Reform

Let’s look at five “racist dog-whistle” messages masquerading as principled arguments, and how to debunk them. We will draw on recent writings of Heather McGhee, Matthew Desmond, Nikole Hannah-Jones and others.

1. “It’s bad for the economy”

True meaning: It’s bad for my (privileged) economy (McGhee, p. 201)

Racist message: Non-white persons are undeserving to share in the benefits of the economy.

Ulterior motive: To promote a political alliance, first, between the super-rich and the middle class, falsely based on the ostensibly ideological principles of free markets, frugal public budgets, and reduced government “interference.” And to promote an alliance, second, between the wealthy and the impoverished white people by using the psychology of “last place aversion” (McGhee, p 125). Psychologists find that poor white persons can be persuaded to vote based on maintaining their “place” in the white social hierarchy, even at the expense of policies that would directly benefit themselves (such as healthcare), They would sooner give up the benefit altogether than to share it with Black persons.

Structural racist effect: Curtails grassroots support among all constituencies on raising taxes for all services, on funding public goods (including healthcare), on regulating corporate behavior, and on protecting civil rights, which in turn has a disproportionate effect on minoritized communities. (Desmond, p. 185)

Fact checks:

  • A 2020 Citi Group report estimates a $16 trillion U.S. economic output loss over 20 years attributable to race-based economic inequity in housing, education, wages, policing and voting. Structural racism is bad for the economy.
  • The same Citi Group report notes that the racial wealth and income gap created a starkly evident higher vulnerability of minoritized groups to COVID infections, hospitalizations, and deaths.
  • Pervasive disparities are correlated between race and a wide range of other health outcomes, as well, including diabetes, hypertension, obesity, asthma, heart disease and cancer.
  • Healthcare reform would bring wealthy and powerful special interests to heel. This could reduce waste and cut exorbitant spending. And this would benefit the economy as a whole
  • A government-financed single-payer system (shifting healthcare from the commercial sector to the public sector) would actually reduce total spending, not to mention leverage government power to negotiate lower prices
  • Employer-based health insurance results in “job lock,” skewing employees to seek jobs on the basis of benefits, and keeping them from seeking the best-fit for their skills and preferences. Although health insurance was not the only factor, its expanded availability coincided with the Great Resignation, showing that workers were willing to transition from old jobs once freed from dependence on employer-based health insurance.
  • Universal healthcare would have other beneficial effects on the labor market.
  • Lack of healthcare insurance affects numerically more white citizens (11.9 million white, 3.9 million Black, 10.9 million Hispanic – 2019 data) and thus ripples through the economy and society as a whole.

2. “It tramples on states’ rights”

True meaning: It tramples on the power of the wealthy, which they have shored up over decades with legal protections (‘moats’) and institutional structures (structural racism) (Klein, 2021)

Racist message: Minoritized persons are unworthy of exercising political power; only the wealthy and the white privileged in-group have the ‘legitimacy’ to do so. (McGhee, p. 160)

Ulterior motive: To justify the efforts to target voter suppression at minority communities and to nullify their votes; to inflame fear and hatred and thereby gin up voter turnout for themselves. (Bouie, p. 208)

Structural racist effect: When successful, voter suppression disenfranchises the targeted group and reduces its political power. (McGhee, pp. 154 – 155) Scare tactics and hatemongering bleed into other social and economic arenas, thereby marginalizing, ostracizing, and degrading minoritized groups.

Fact checks:

  • The states’ rights argument has been invoked consistently throughout our 246-year history in support of slavery, segregation, discrimination and other blatantly race-targeting policies.
  • The suit brought in 2021 by Republican attorneys-general from Texas and 19 other states against the Affordable Care Act was essentially a states’ rights case. Invalidating the ACA would have disproportionately affected minorities – and also uninsured white communities, as well – but the suit failed.
  • Voting measures implemented during the election of 2020 to promote safety and to facilitate participation resulted in the highest voter turnout since 1900.
  • Seemingly in response, between January 1 and December 7, 2021, more than 440 bills with provisions that restrict voting access were introduced in 49 states in the 2021 legislative sessions. Thirty-four of these were voted into law in 19 states. In a new trend, legislators introduced bills to allow partisan actors to interfere with election procedures or even reject election results entirely in five key states.
  • In defense of state-level voter suppression bills, and against federal-level voter protection bills politicians point to the Article I, Section 4 provision that elections “shall be prescribed in each State by the Legislature thereof” but then fail to acknowledge the next clause “but the Congress may at any time by Law make or alter such Regulations.”

3. “Not to worry, it won’t happen to you”

True meaning: White privilege will protect you; only minoritized groups will bear the full brunt of “externalities” (McGhee, p.  202)

Ulterior motive: Divide groups from each other so that they will not present a united front against the irresponsibility of the powerful. Lull vulnerable white groups into complacent denial of their own actual risks.

Racist message: Whites are ‘naturally’ stronger, and non-white communities are not worth protecting.

Structural racist effect: Leaves racial minorities unprotected, and weakens common cause with other vulnerable groups who together face clear and present dangers.

Fact checks:

4. “Zero sum: If we grant more to another group, it will correspondingly take away from our own group.”

True meaning: We have a privileged position in our nation’s social hierarchy, and we must protect our privilege (McGhee, p. 15)

Ulterior motive:  Divide groups from each other so that they will not present a united front against the powerful. Thereby to promote a political alliance between the super-rich and white groups, especially with impoverished white people using the psychology of “last place aversion” (See 1., above) (McGhee, p 125).

The phenomenon of “last place aversion” was vividly on display in case studies about public swimming pool desegregation in the 1950s (McGhee, pp. 25, 27)

In Montgomery, Alabama, the Oak Park pool was the grandest one for miles… [T]he entire public parks system was segregated… [W]hen a federal court deemed the town’s segregated recreation unconstitutional, … [t]he reaction of the city council was swift – effective January 1, 1959, the Parks Department would be no more. The council decided to drain the poor rather than share it with their Black neighbors… Uncomprehending white children cried as the city contractors poured cement into the pool, paved it over, and seeded it with grass that was green by the time summer can along again.

Draining public swimming pools to avoid integration received the official blessing of the U.S. Supreme Court in 1971… [T]he Supreme court, in Palmer v. Thompson, held that a city could choose not to provide a public facility rather than maintain an integrated one, because by robbing the entire public, the white leaders were spreading equal harm… If benefits can’t be whites-only, you can’t have them at all. And if you say it’s racist? Well prove it.

Ironically, by subscribing to the “zero-sum theory” (the belief that giving to them will subtract it from me), leaders subtracted enjoyment of swimming pools from everyone.

Racist message: Black persons and other minoritized persons are dirty, threatening, hyper-sexual, morally depraved, etc., and otherwise socially objectionable, and thus need to be excluded from society and from the social contract. (McGhee p. 124; Roberts p. 55)

Structural racist effect: Foments the hollowing out the public goods we all should share – public services, infrastructure, education, healthcare, etc. Since the well-to-do can afford to compensate for some of these losses through their own private purchases, the impact falls hardest on minoritized and impoverished groups (McGhee, p. 15)

Fact checks:

  • A previous post, featuring the views of Nobel economist Joseph Stiglitz, challenged the notion that the economy is a fixed-size pie that needs to sliced up among rival groups. Rather, especially in our post-industrial, digital, service-oriented economy, the whole economic pie has wide room to grow, not a zero-sum. The main challenge now should be how equitably to allocate slices from a pie that is big enough for all to enjoy. The economy can and should reward the value-added by all from the “essential worker” up to the CEO.
  • The fallacy of the zero-sum concept is especially evident in today’s job market, in which hiring a Black worker does not equal firing a white worker. Burning Glass labor market analysis firm produced a report of Feb. 22, entitled “The Demographic Drought: Bridging the Gap in Our Labor Force.” “All of our gaps in the supply chain are because people aren’t there to make the goods. There are 11 million job openings in the U.S. right now, and only 6.5 million people who are unemployed.” In addition, some of the 11 million jobs require skills that the 6.5 million people don’t have. By our past failures in ignoring barriers to employment such as transportation and child care, and in condoning inadequate schools based solely on ZIP code, our system has robbed not only the people of color but has backfired on everyone. Coming together to solve those problems would yield what Heather McGhee calls a “Solidarity Dividend” for all. (McGhee, pp. 255-289)
  • Sharing the Prize [by economist Gavin Wright]… details the economic benefits the civil rights movement brought to the entire South, white persons included, not just to Black citizens. “What the Black political leadership got, and economic leadership, was a seat at the table.” With that seat, they won investments in public infrastructure, including hospitals, roads, schools, and libraries that had been starved when one-party rule allowed only the southern aristocracy to set the rules. (McGhee p. 159)

5. “It’s un-American socialism.”

True meaning: Government overreach, driven by voting blocs of ‘illegitimate’ selfish hordes, will confiscate money from productive “makers” and give it to undeserving and lazy “takers” in the ghettos, thereby sucking the vitality from our rich capitalist system.  (McGhee, p. xxii) 

Ulterior motive: To promote a political alliance between the super-rich and the white middle class, by falsely appealing to the principles of free markets, frugal public budgets, and freedom from government “interference.” (Chakrabarty & Lynn, 2022)

Racist message: Minoritized persons themselves — not past government policies and residual structural disadvantages — are to blame for their own economic plight. Minoritized persons are lazy and inferior. Efforts to compensate for disparities or even to describe history from the perspective of their disadvantage will be condemned as unworthy of citizenhood, much less of public goods. (Hannah-Jones, p. 32)

Structural racist effect: Undercuts funding of social supports such as child care, parental and sick leave, health insurance; abets underinvestment in the common good like housing and education; hollows out of public goods like infrastructure and research, to the detriment disproportionately of minoritized communities, but also of the whole economy and of all citizens.

Fact checks:

  • This blog has called out “socialism” as a loaded term and as a specious argument against healthcare reform. This post now identifies the term as a “dog-whistle” evoking thinly veiled racial resentment.
  • This blog has acknowledged the unquestioned ascendency of free-market capitalism, not only in America but now throughout the world, including autocratic economies like China. This blog claims, however, that invocation of “socialism” is not a good-faith principled debate about political economics but rather a term intended to inflame, not inform.
  • This blog agrees with Joseph Stiglitz that a vibrant post-industrial, digital, service-oriented economy requires a labor policy that provides all workers an equitable share of income, with full dignity, and with opportunity. It also agrees on the need for free-and-fair government to balance competing interests in society and the economy (See our most recent post). And it agrees that a rich economy should finance public goods that invigorate the economy, provide high quality of life, and promote social cohesion – including healthcare.


The premise of Fixing U.S. Healthcare blog is that thoughtful debate about healthcare is useful and necessary, drawing on all relevant perspectives from all stakeholders. This blog now recognizes that in the realm of healthcare reform, as with most other issues facing America, reckoning with race will be imperative as part of the discussion. As Brennan Center policy expert Theodore R. Johnson put it,

… [W]hite grievance on the right… and [o]n the left, partisan racial resentment… [bog] down long overdue and critically important political debates—debates that must contend with the continued presence of racism and its deleterious effects—with disingenuous and superficial takes on race relations that distract from the systemic reforms that two-thirds of Americans desire.

It is time to reach across racial and other societal divides and to have genuine dialogue across differences. One model for cross-racial dialog is the W.K. Kellogg Foundation’s Truth, Racial Healing and Transformation project. Healthcare reform would be a good place to start the discussion.

Take Action

Now, take action.


  • Bouie, Jamelle (2021). Politics. In N. Hanna-Jones, C. Roper, I Silverman, J. Silverstein (Eds.) The 1619 Project (pp. 195-208). New York: One World.
  • Chakrabarty M. & Lynn B (2022 Feb 17) More than Money: Defining American anti-trust laws, from Bork to Khan. Part III [Radio broadcast transcript]. NPR – WBUR Boston. https://www.wbur.org/onpoint/2022/02/17/more-than-money-antitrust-monopolies-are-defined-from-bork-to-khan
  • Desmond, Matthew (2021). Capitalism. In N. Hanna-Jones, C. Roper, I Silverman, J. Silverstein (Eds.) The 1619 Project (pp. 165-185). New York: One World.
  • Hannah-Jones, Nikole (2021) Democracy. In N. Hanna-Jones, C. Roper, I Silverman, J. Silverstein (Eds.) The 1619 Project (pp. 7-36). New York: One World.
  • McGhee, Heather (2021). The Sum of Us – What racism costs everyone and how we can prosper together. New York: One World.
  • Klein, Ezra (Host). (2021, February 16) Ezra Klein Interviews Heather McGhee about the Cost of Racism [Audio podcast transcript] In The Ezra Klein Show. The New York Times. https://www.nytimes.com/2021/02/16/podcasts/ezra-klein-podcast-mcghee-transcript.html
  • Roberts, Dorothy (2021). Race. In N. Hanna-Jones, C. Roper, I Silverman, J. Silverstein (Eds.) The 1619 Project (pp. 45-61). New York: One World.

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Image Credits

Title:  Heather McGhee

By:  Citizen University, CC BY 3.0, via Wikimedia Commons

URL: https://commons.wikimedia.org/wiki/File:HeatherMcGeeCitizenUniversity.png

Title:  Matthew Desmond

By:  United States Library of Congress, Public domain, via Wikimedia Commons

URL: https://commons.wikimedia.org/wiki/File:Matthew_Desmond_at_2017_National_Book_Festival.jpg

Title:  Nikole Hannah-Jones

By: Associação Brasileira de Jornalismo Investigativo, CC BY 2.0, via Wikimedia Commons

URL: https://commons.wikimedia.org/wiki/File:Nikole_Hannah-Jones_(43277605032).jpg

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