Before he died on Sept. 4 at the age of 99, psychologist Robert Jay Lifton left us with stark warnings about President Donald Trump and the American right. One of the country’s leading experts on how societies succumb to authoritarianism and collective cruelty, Lifton’s theory of “totalism” — an extreme, absolute devotion to a particular group or ideology — is essential for making sense of our present moment.

Writing about Lifton’s passing, New York Times columnist M. Gessen noted his observation that totalism “propels participants toward acting in the name of their ideology.” Lifton saw Trumpism, Gessen wrote, as “a totalist movement that promised to envelop its participants in a secure, closed universe of lies.”

But the psychologist knew that totalism encompasses more than authoritarian tendencies. It can help to explain social inequality, the culture of cruelty and how individuals treat one another in a society.

Trump and the larger right-wing’s revolutionary project has been called “Robin Hood in reverse,” where public money and resources are taken from the poor and vulnerable and given to the rich and powerful through legislation, such as the “Big Vile Bill,” and other policies that will make poverty, homelessness, hunger and other forms of social inequality worse.

According to a new poll released by the University of Chicago and The Associated Press-NORC Center for Public Affairs Research, Americans are sharply split along partisan lines over what causes poverty and homelessness — and what responsibility, if any, the federal government bears in addressing them. “Republicans are more likely than Democrats to cite personal choices as major factors for both poverty (77% vs. 49%) and homelessness (77% vs. 51%),” the survey found. “In contrast, Democrats are more likely than Republicans to cite lack of government support as major factors for both poverty (61% vs. 21%) and homelessness (63% vs. 26%).”

This divide is stark, and it backs up a recent observation by New York Times columnist Jamelle Bouie that the American right sees the market as the ultimate decider of survival. “The maintenance of a particular moral order in which survival — to say nothing of comfort — is earned in the market,” he wrote. “Those who can’t swim, or at least float, will sink.”

Since Trump’s return to power, this right-wing moral economy has become even more hard-hearted. Today’s conservatives and members of the right increasingly view human empathy as a weakness, something wholly alien. This attitude was reflected in Fox News host Brian Kilmeade’s suggestion on the Sept. 10 episode of “Fox & Friends” that mentally ill homeless people should be executed. After facing widespread condemnation, he apologized on Sunday for what he called his “extremely callous remarks.”

Decades of social science research shows that poverty — especially intergenerational poverty — is driven largely by structural and institutional forces beyond an individual’s control. A person’s family wealth, their access to education and even the zip code they’re born into shapes their chances at economic mobility. The myth of individualism and “pulling oneself up by the bootstraps” rarely stands a chance against those realities.

But there’s another issue at play that’s not addressed in the survey, at least not in the form of a question: Whether the American people are capable of connecting poverty, inequality and homelessness to the collapse of democracy and civil society under Trumpism. Sadly, the aggregate findings from the poll — and decades of other research — suggest the answer is no.

Americans have historically been hyperfocused on individualism, which can make community-oriented thinking difficult. Europeans, by comparison, are better able to connect their individual troubles to larger systems of power and institutions. 

For example, while 76% of those surveyed — including 80% of Democrats and 72% of Republicans — believe the federal government should be responsible for addressing poverty, 6 in ten cite personal choice as why people remain in poverty or are homeless. 

Summarizing the findings of the new poll, Bruce D. Meyer, a professor at the University of Chicago Harris School and one of the lead researchers on the project, told the Associated Press that “people are a little conflicted…[about] the complexity of what leads people to get in trouble in terms of their economic circumstances. And I think a lot of people are generous at heart and will help people out and think the government should as well, even when individuals aren’t blameless.”

This conflict is shown in other research, including a recent Pew poll that found approximately half (51%) of American adults want a bigger government that provides more services. But 47% desire a smaller government that does less. There are huge partisan divides: 75% of Republicans want a smaller government and 24% want a bigger government. Democrats want the opposite: 79% support a bigger government, and 20% want a smaller government.

Today’s Republicans are driven by a small government ethos. President Ronald Reagan famously articulated this vision: “I think you all know that I’ve always felt the nine most terrifying words in the English language are: I’m from the government, and I’m here to help.”

But as Trump expands his power and control over all areas of American life, those same so-called principled conservatives who spent decades howling about “states’ rights” and “big government” have fallen deafeningly silent. When Democrats like Barack Obama and Joe Biden were in office, these people waved their pocket Constitutions and wrapped themselves in the American flag as “patriots” and “defenders of individual rights and liberties.” Now, their values have been revealed as a sham — and about obtaining power to impose their will on other people.

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Research shows that today’s Republicans — especially the white working-class people who form the base of Trump’s MAGA movement — hold some alarming ideas when it comes to the social safety net.

They support government assistance primarily for white people like themselves, whom they deem deserving and to be “real Americans.” When they use programs like welfare or food stamps, they see it as temporary and justified. But when Black and brown people — especially women — use the same programs, they are labeled lazy, undeserving takers or “welfare queens.” They are ready, if not eager, to elect leaders who are willing to “break the rules” to “get things done.” Federal power, they believe, should be wielded to punish those they dislike.

Undergirding these notions, as well as Trump’s appeal to the white working-class, is how that group “resents professionals but admires the rich,” as Joanne C. Williams pointed out in a much-cited 2016 article published in the Harvard Business Review: “The dream is not to become upper-middle-class, with its different food, family, and friendship patterns; the dream is to live in your own class milieu, where you feel comfortable — just with more money.” 

While noting that “[p]rogressives have lavished attention on the poor for over a century,” Williams argued that the government’s focus on means-tested programs to alleviate poverty have excluded the middle class and “are a recipe for class conflict.”

But a society’s values are, in large part, reflected by how it treats its most vulnerable members — and America in the 21st century is growing increasingly Dickensian. In many cities today, it is a crime for the homeless or poor to use public spaces. Recently, Trump signed an executive order directing the federal government to use its resources to forcibly place homeless people in camps, institutions or otherwise remove them from society. Under Trumpism, America’s prisons and mental health facilities are in danger of becoming de facto poorhouses. “Ugly laws” could soon follow. 

As American society continues to fracture, the public and their leaders must broaden their understanding of how poverty and other forms of social inequality are directly linked to structural — and political — violence.

“[W]hen a pregnant woman dies of sepsis in a hospital that could have helped her but is legally prevented from doing so, that’s political violence,” author Jessica Valenti recently wrote. “It’s political violence when a child is shot in their classroom because lawmakers refuse to take action on guns. An abortion provider being assassinated after years of conservatives calling them ‘baby-killers’ is political violence, as is the death of a person who had their medical claim denied by companies more interested in their bottom line than people’s lives.”

She concluded, “We live with this kind of violence, we experience it, every single day. We just don’t call it ‘political.’ To conservatives, it’s not even violence.”

Healthy democracies have a strong social safety net that helps to prevent and alleviate poverty and other forms of social inequality. Autocrats, authoritarians and demagogues, though, have little — if any — sense of obligation to the public good. They view power as a way of accumulating more wealth and resources for themselves and for their loyalists. These leaders have an interest in keeping their constituents vulnerable. Economic insecurity breeds malleability, and an increased willingness to seek out the protection of a strongman. Inequality, they know, is a dagger to the heart of democracy — and it’s one they enthusiastically wield.

A government’s budget is about much more than numbers: It’s a moral document that reflects a nation’s values. Chief among those should be providing for the most vulnerable. This includes guaranteeing health care for Americans; shoring up Medicare, Medicaid and the Affordable Care Act; providing food assistance to needy people, including the elderly and children; funding science and medical research; and requiring the very richest to pay their share of taxes.

Within this framework, it’s clear that Donald Trump and the GOP’s One Big Beautiful Bill Act is a moral failure in the making, where values of greed, cruelty and sociopathy masquerade as responsible public policy. In a recent interview with “Democracy Now!,” Rev. William Barber correctly described it as the “Big, Ugly, Destructive, Deadly Bill.”

If enacted, the legislation will further tear apart an already weak social safety net and strip health care from millions of Americans. Medicare, Medicaid and the Affordable Care Act (ACA) will be cut by more than 1 trillion dollars. The massive tax cuts from Trump’s first term will be extended. Hundreds of billions will be spent on defense and the administration’s mass deportation campaign against undocumented immigrants. The legislation will create one of the biggest transfers of wealth in American history: hundreds of billions of dollars — and likely trillions — of dollars will be taken from the poor, working class, and the middle class and given to the wealthiest Americans and corporations. According to the nonpartisan Congressional Budget Office, the bill will cause the federal deficit to explode by at least $3.3 trillion over 10 years.

The very richest Americans already have more wealth than they could reasonably spend in several lifetimes. For example, the top 10 percent of Americans control approximately 70 percent of the nation’s wealth. By comparison, the lower half of the American population controls a pitiful 2 to 6 percent of the nation’s wealth. The amount of wealth owned by the American middle class is less than that owned by the top 1 percent.

Wealth and income are directly correlated with how long a person lives and their quality of life. At its core, the “Big Beautiful Bill” will help the rich to live longer and be happier while everyday Americans will live even shorter and more miserable lives.

In early June, Dr. Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health, joined with other public health and policy experts at Yale and the University of Pennsylvania in signing an open letter to Democratic Sens. Ron Wyden of Oregon and Bernie Sanders of Vermont, both of whom serve on the Senate Finance Committee. The group, in warning about the bill’s potential impacts, predicted the unnecessary deaths of at least 51,000 people each year in the United States.

In a recent conversation, Dr. Galvani explained how public health is directly connected to the health of American democracy and why authoritarian governments cause sickness, death and shorter lives for the people who suffer under them.

America’s democracy crisis is not just one discrete thing. It overlaps with most, if not all, areas of society and life. What do we know empirically about the impact of authoritarianism on public health and well-being?

Authoritarian regimes often suppress scientific inquiry, censor data and discredit experts, which is devastating for public health. Accurate data and open scientific discourse are fundamental for identifying health threats, developing effective interventions and responding to crises (e.g., pandemics). Politicizing science leads to a misinformed public, hindering effective health behaviors.

Resources may be diverted away from essential public services, including health care, toward security apparatuses or to benefit favored elites. Corruption can siphon funds meant for health infrastructure, drug procurement or service delivery.

Authoritarian systems often exacerbate existing social and economic inequalities, which are direct drivers of health disparities. Vulnerable groups may lose protections and access to services.

Science used to be a nonpartisan issue. It’s disheartening that public health has become so politically polarized.

Republican-led red states and regions of the country have much worse health outcomes than Democratic-led blue states and regions. This is a type of experiment where we can literally see how divergent approaches to public health and the social can impact a person’s life.

There’s a clear divergence in health policy choices. “Blue” states generally embrace policies that expand access, such as Medicaid expansion under the ACA, more robust social safety nets, higher minimum wages and stronger environmental regulations. “Red” states, conversely, often resist Medicaid expansion, pursue more restrictive reproductive health policies and may have less stringent environmental or worker protection laws.

These policy differences frequently correlate with significant disparities in health outcomes. States that expanded Medicaid tend to have lower uninsured rates, improved access to care, better management of chronic diseases and reduced mortality from conditions like heart disease and cancer… States with more restrictive policies often see higher rates of uninsured individuals, worse maternal and infant mortality rates and greater burdens of preventable diseases.

Beyond direct health policy, differences in approaches to education, social welfare and economic equity also contribute to health disparities. “Blue” states often invest more in these social determinants of health, which ultimately yield better health outcomes.

What of the much-discussed claims about the “deaths of despair” among “working class” white people (and now Black people and First Nations and other marginalized communities) in the long Age of Trump, and how the country arrived at this point?

Deaths of despair highlight the critical need for comprehensive policies that address economic insecurity, ensure equitable access to quality healthcare (including mental health and substance abuse treatment), rebuild community infrastructure and combat systemic racism and discrimination.

Trump’s “big, beautiful bill” is, like other public policy, something that can be evaluated in terms of its impact on public health and well-being, life chances, life outcomes and literally how long a person will live. What do we know?

The proposed budget prioritizes fiscal austerity and reduced government spending over a robust social safety net and access to health care. It suggests a view where health care is primarily a market commodity rather than a fundamental right, shifting responsibility from collective provision to individual burden.

Loss of health care access is a primary concern, as millions would lose essential health insurance, leading to delayed or forgone care, increased financial hardship and worse health outcomes.

While intended to save money, neglecting preventive and early care often leads to more expensive emergency room visits and hospitalizations for advanced, preventable conditions. Families face devastating medical debt from uninsured care, depleting savings, increasing poverty and perpetuating intergenerational cycles of disadvantage. Families bear an increased burden of care for sick relatives who cannot access formal health care, impacting their own health, finances and ability to participate in the workforce. Cuts to Medicaid and subsidies disproportionately affect those with limited financial resources.

51,000 is a very conservative estimate of the unnecessary deaths that will occur if Trump and the MAGA Republicans’ 2025 budget is enacted. What of shortened lives? Community impact from lost income, wealth, social capital and other resources and supports? Trauma from this type of shock to norms, and the anxiety and extreme stress that will result? These are not just abstractions. We have to connect systems and institutions to individuals.

The 51,000 deaths figure represents outright mortality. However, for many more, the lack of care or delayed treatment would lead to preventable illnesses, chronic conditions getting worse, increased disability and years of life lived in poorer health. This represents a significant loss of healthy life years and a reduction in overall well-being.

Premature deaths mean lost contributions to the workforce and economy. Illness and disability due to a lack of care also reduce productivity and earning potential for individuals and their families.

Iowa Republican Sen. Joni Ernst recently [spoke to] her constituents who were worried about what will happen to their lives if [the bill] is enacted and Medicaid, Medicare and health care more broadly is cut. “We are all going to die,” she told them. What would you tell Ernst if you had a chance to have a conversation with her?

The callous suggestion that cuts to life-saving programs simply accelerate an inevitable outcome ignores the vast body of evidence showing how these services add years of quality life, reduce suffering and allow individuals to contribute meaningfully to their families and communities.

When this vile bill is forced on the American people, what will it mean for the overall well-being and quality of life?

Short-term: Millions would immediately lose health coverage, leading to higher rates of delayed or foregone medical care. Individuals and families would face immediate, drastic increases in out-of-pocket medical costs and medical debt, pushing many into poverty. Widespread fear and uncertainty about health care access and financial security will immediately impact mental well-being. Patients with chronic diseases would see their conditions worsen due to a lack of access to medications and ongoing care. As primary care becomes less accessible, emergency rooms would likely see an increased burden of preventable conditions, which is a far more expensive and less effective way to deliver care.

Mid-term: The 51,000 projected deaths would become an annual reality, steadily increasing the nation’s mortality rate from preventable causes. National health metrics (e.g., infant mortality, life expectancy, rates of chronic disease management) would likely decline. A sicker, less productive workforce, coupled with increased medical debt, could depress economic activity and further strain state and local budgets.

Long-term: Decreased Life Expectancy. The U.S. life expectancy, already lagging behind many peer nations, could further stagnate or decline.

Children who grow up without adequate health care suffer long-term developmental and health consequences, perpetuating cycles of poor health and poverty.

Cuts to scientific research and public health infrastructure would cripple the nation’s ability to respond to future health crises (e.g., pandemics, emerging diseases) and diminish its capacity for medical breakthroughs.