Jonathan M. Metzl began researching his 2019 book Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland after the Affordable Care Act (ACA) passed. As a physician, he wondered why people who benefited from the insurance and health care changes would oppose them. Along the way, he also researched possible correlations between pro-gun lobbying and gun suicide deaths. Additionally, he considers how lower taxation leads to deficits in school budgets and in achievement scores. All in all, he considers if these political perspectives, heartily supported primarily by white men, actually hurt everyone, especially white people?

Metzl’s premise is simple. He focuses his research on three Heartland states, Missouri, Tennessee, and Kansas. They are places he knows well, having lived in all three. Politically, they lean right and even far-right. And yet, the population of white conservatives is not benefiting from the law and politics they support.

Looking at both quantitative data and more subjective interviews, Metzl builds a case in each state. With Missouri, he looks at suicide deaths by guns as it relates to increasingly pro-gun laws. In Tennessee, his focus is the state’s refusal to expand Medicaid with the ACA and the resulting overall health statistics among poorer white people. And in Kansas, Metzl considers the changes in state income tax laws and funding for public schools during the administration of two conservative governors.

My conclusions

Metzl makes a compelling case in all three situations. He reaches into piles of readily accessible statistical data. And he also talks with people in groups such as “loved ones of those who died by suicide.” He interviews school administrators and “average Joe” kinds of men. Both elements are essential to proving his theses.

As for how it felt to listen for nearly ten hours—it was frustrating and depressing. Over and over Metzl draws a straight line from right-wing, conservative politics to negative outcomes. Having more guns in people’s homes leads to death by guns, especially suicides. When people living at lower income levels have less access to healthcare, their quality of life diminishes and their life spans grow shorter. And children of all races benefit when tax dollars can easily be allocated to public education.

It really doesn’t take a rocket scientist to draw these conclusions. But Metzl discusses not just the statistics but the psychology behind these policies. Of course, the conclusions here are only amplified more in the midst of our current Covid-19 pandemic. And that is a hard thing to listen to the audiobook for hours at a time. I took plenty of breaks for other kinds of listening, despite understanding the importance of the work.

Still, I recommend Dying of Whiteness if you’ve ever had a frustrating conversation with “that conservative” in your life. You may not find more arguments to make, but at least Metzl proves you aren’t alone.

Pair with either The View from Flyover Country: Essays or Hiding in Plain Sight: The Invention of Donald Trump and the Erosion of America by Sarah Kendzior, another Midwestern writer.