What Does Abdul El-Sayed Believe?

The Michigan Senate race has emerged as perhaps the most important proving ground for some of the key fights in the Democratic Party right now. How will left populism perform in a Rust Belt state? What should the next Democratic idea for health care reform be? Is it time to rebuild Obamacare? Or is it time finally for Medicare for all or Medicare for more or many? And what should the Democratic Party's relationship to Israel and to the Palestinians be? What should America's role in that conflict be? Dr. Abdul El-Sayed is a Democrat's nominee in Michigan. He's running against Republican Mike Rogers, up by a few points in most polls. Very few candidates this cycle have been argued over as much or clipped around the internet as often as him. But I wanted to talk to him myself to hear who he is and what he would actually do in the U.S. Senate. He joins me now. Abdul El-Sayed, welcome to the show. Thank you for having me. So I want to start a bit in your family story. Your parents are Egyptian. Your stepmother is Egyptian. Your stepmother is a distant relative of Abigail Adams. Tell me about them. So my parents had me and got divorced. But stepping all the way back, my dad, his mother is still to this day the smartest, wisest person I've ever met in my life. Never got to go to school. She had eight babies. Two of them died before their first birthday. So my father was her eldest. He actually watched two of his siblings pass before he turned five. And I never really appreciated this. I actually interviewed him for my own podcast. And I was, it was a episode about infant mortality. And I asked him about his own experience. I've seen my dad cry twice. Once when his mom passed. And once when he was recounting the passing of his second sibling. My dad really wanted to be an automotive engineer. His dad sold vegetables in a fish market, had an eighth grade education. And, you know, he would literally study on the rooftop of their building in Alexandria, overlooking the fish market by the light of a lamp across the street. I'd spend a lot of my time there. Childhood summers there. My dad comes to America, 1978, six years later, I'm born. But that was after the passing of the Immigration Act in 1965. And it undid the quota system, right? So it enabled a kid like him to actually come here. Goes to Wayne State University, becomes an automotive engineer, and builds the, you know, the opportunity set that, you know, I get to live in. My mother comes over a couple years later. She was in Alexandria, trained as a physician, and then realized they had some very serious creative differences after they'd created the one thing they created together, which was me. And so they got divorced, both remarried. How old were you? I was three. And my dad marries my stepmom, Jackie, who's a daughter of the American Revolution. Like you said, traces her lineage back to Abigail Adams from the middle of the state of Michigan. Her father was an engineer who trained at GMI, now Kettering University. And her mom was a nurse who was raised in Flint and trained as a nurse in Flint. So I was raised in the house built by Muhammad and Jackie. And I grew up in a house, you know, where the, you know, we talk about code switching. I was code translating my whole life, right? Between my dad and his understanding of things as an immigrant from Egypt, who always sort of told himself, like, it was only temporary. He was going to go back at some point. And my stepmom, who. I was born and raised in mid-Michigan. You've talked a bit about the political work your father did in Egypt and the role that had in bringing him to America. Tell me about that. He was a student activist. And, you know, what he was agitating for was democracy. Egypt has been, post the king, it has basically been a military dictatorship for all but a year, post-Arab Spring. And he was not only just a prominent student, right? So in Egypt, anybody who knows the Egyptian education, education system, you take these exams and they rank on the exams. And the top students either go to engineering or medicine every year. And then way down the list are the folks who go to the army now. Egypt's a military dictatorship. So you literally have your worst students who are funneled into the leadership of the country. And for a lot of reasons, my dad found this absurd. But then, you know, when it came to any sort of advocacy or freedom of speech, they didn't have that. And because he was a prominent student, he was basically the. equivalent of a TA. And because he was an activist, the authorities at the. both at the university and then generally were kind of hounding him. And so when he got the opportunity to leave, he was like, "All right, I'm out." And for him, it was always this sort of notion of, "Why can't I say what I think?" He's still that way. I love him for it. And America to him was always just this, this place where you would have real freedom and there are not that many things that my dad beams with pride when he talks about, but having rights and voting and the ability to be a part of democracy is one of those things. I don't think he ever thought I would end up running for office, but you know, this idea that you could go to a place and it didn't matter the color of your skin or how you prayed that you could be American. He took that very seriously. And I remember watching him naturalize. I was quite young and I remember. my mom, step-mom, Jackie telling me, you know, Bubba's going to become American tomorrow. And I'm like, "So he's going to be blonde and blue-eyed?" No more accent. And so I'm watching him get naturalized. And she's like, "You know, Bubba's an American now." America is not what you look like or what you sound like when you speak English. America is a set of ideals. It's beliefs. He just wore an oath to the country that we have democracy in. And, you know, it was a moment I've thought about quite a bit because he became American and nothing about him changed, but everything about him changed and everything about his opportunities had changed. And that's still the beautiful thing about this country. I remember watching my father get naturalized. My father's from Brazil. And it's a very moving and, as you say, very unusual to think, you know, on one side of this, you're American, on the other side of it, you're not. We're actually in this moment, of course, where there's so many fights over what it means to be American and such an effort to renegotiate the question of what it means to be an American. So I'm curious what it means to you. This is a country where there is no ethnic identity. There's no religious identity. There is just a national identity. And I didn't appreciate it as much until I went to grad school in the UK where I'd meet third generation, like Pakistani kids. And I'd be like, you're British. They're like, I'm not British. I'm Pakistani. I was like, yes, but you're British. Like you, you have a British citizenship. Like, yes, I'm a citizen of the United Kingdom, but I'm not British. They're British. I'm Pakistani. And the amazing thing about America is that we not only have the civics that enable us to become fully and foundationally American, but we also have a culture of that where, yes, there are some people who want to define America. America is being smaller than, that it can't include certain groups of people, whoever the outgroup is that they want to point to. But we are constantly in this process of negotiating a bigger America. And so America to me is the notion that we can come together around our differences to build something that's greater than the sum of its parts because we believe in the process by which we do that thing. It's funny. You know, my dad, I don't think he's been to Egypt in like 20 years and he still has an accent. He still looks the way he looks. And you watch him watch the lions on Sunday and you're like, that's a full-blooded American. Or, you know, somebody that we were, you were teasing, uh, we were teasing him and he was like, well, you know, if I went back to Egypt, I was like, you would leave in like three weeks because you got opinions and in Egypt, you can't share them. And here you can, whatever they are. That to me is America. You talk very movingly in your memoir about a trip. So back to Egypt, I think when you were an adolescent and seeing the difference in how your life worked and how the lives of your cousins worked, and it seems like it was quite formative for you. So tell me a bit about that. So I was, I was sent off to Egypt with another family. You know, my, my folks really wanted me to have an understanding of just what it meant that I had the opportunities I had in America and they wanted me to, you know, speak the language, et cetera. And so there was. There was another family going and they sent me off. And I remember being greeted by like all of my aunts and uncles, cousins, grandparents, everyone at the, at the, uh, airport, you know, and I, when you, when you go to visit whatever the, uh, the, the nation of your, your, your family's ancestry is, you always take gifts. Right. So I had two suitcases, one with my stuff for the summer and one with all those gifts and, you know, pulling up and meeting all these folks who are my flesh and blood. And had you been, had you met them before? And this was the first time I had gone. since I was a toddler, um, you're held 13, 13, and just sort of taking in all, all of this and marveling at the fact that like, I, my whole experience growing up, I always was very aware of my differences. I was very aware of my name and very aware of my skin color and very aware, uh, that I had to explain myself. But I had thought that like, when I was going to go back to Egypt, that I would be in a place where I didn't have to explain myself only to find myself constantly explaining myself sometimes to myself, which is like, what are these, what are the differences? How is life lived here? And it wasn't just differences in the material lives that people led, but differences in the way that people process life. You know, how do you value different things? What is important? Right. Um, I remember after I gave out, all these gifts, my grandmother pulls me aside and, you know, I, I, my, my, my grandparents had come to the United States before. So I, I had a pretty good relationship with them. I knew them really well. It wasn't like the first time I was spending time with them. And, you know, I was feeling big about myself. I just brought all these gifts. I was like the, you know, adolescent version of a, an American Santa Claus. And my grandmother pulls me aside and she points to one of my cousins. That one's smarter than you points to the next one. I don't even have to tell you it's taller and better looking that one. She works harder than you that one. She's nicer than you. He he's more athletic than you. And by the end of this, I'm like, okay, so Tata, what do I have going for me? She's like, you're the best thing of all. I was like, okay. It's like, you get to go back to America at the end of the summer. The rest of your cousins stay here. And it was that moment that actually thought a lot about as we spent the summer that summer, you know, when it's all the sites, but most of the time I was just spending time with my cousins, my aunts and uncles, my grandparents living life. Like I would have lived, but for the accident of history that allows me to be born here and thinking a lot about what it meant. And I remember going back at the end of the summer, you know, getting caught up in all like the latest music and all the stuff, but also as I, what is it that I'm supposed to learn about myself from that four months that I spent there? And more than anything else, it was just the appreciation for not everybody gets this. And I think my dad had been trying to explain that to me. And look, I, I got in trouble when I was in high school and whatever, but the appreciation that like, I can put in work and my work turns into something. And so at some point there's two questions that you ask is like, you don't actually get the privilege of just coasting when you know that there are a lot of people who are going to work a lot harder than you and not get where they, where they need to go. And then two, what are you doing it for? Because, you know, growing up, people are like, oh, you're smart and you work hard. I was like, my grandmother was smart and worked hard and never got anything out of it. So what's the point of this? And I think a lot of the way I've sort of come to public service and I think about my responsibility set is to say, look, the responsibility is to take whatever opportunity you had, put all the chips back in the middle of the table to make sure you're building opportunity for the folks who don't have it. I think in the end, all of our output build something for somebody, right? There is always output. And the question is, do you build it for you or other people around you or other people already have capacity? Or are you trying to build it for folks who don't? And that to me is the sort of great moral divide of the specific ethical or moral choices we make in our lives about how we spend our time. I always think one of the most foundational questions in a person's politics is how much of a role do you think luck and circumstance play in success and in failure, right? And in struggle. But I think so much of where people end up, uh, on the political divide just comes down to at a very, fundamental level. Do you believe that everybody deserved it or not? And I think the great gift that I had was to get a front row seat to the life that I, but for an accident of history would have led meeting cousins who are just as smart, just as capable. I had a cousin who died in an auto accident when he was 27 in a cab driving it. That's not my life. And so it's just a reminder that you're like, Hey, you know, that question of, does everybody deserve it? I mean, no. And I sometimes wonder, it's like, if my grandmother had my opportunities, what should we do? I mean, when I think about like, am I, am I doing the right thing? The question I always ask is like, if I asked my grandmother, what is the right thing? She'd have a very clear answer. And what's amazing about it is, you know, we spend all these times in these institutions and we don't really quite appreciate the way that those institutions bend your morals around them, around their needs. In some respects, living and working in institutions is allowing them to dictate what shiny objects you're supposed to pursue. And my grandmother never spent a day in an institution at all. Like we don't appreciate the day you walked into preschool. There was an institution you were part of. It had its own incentive sets. It was trying to engage you about what you ought to be doing, what the right thing to do was. And if you deviate from that right thing to do, then you, you know, that you'd get in some, some kind of trouble. Usually you expect the leaders of the institutions to connect the right thing to do is in preschool. That's not that difficult. But then you start looking at the universities now, right? These places that are supposed to be these moral arbiters. And you look at their collapse in the face of all this pressure. And you're like, so what is this institution supposed to maximize? Donor engagement? The biggest possible endowment? Is that the goal? What is it supposed to do? And I, I think the questions that matter most for us right now are not where do you follow the incentive of the institution? It's when do you challenge the incentives of the institutions? When do you ask them why we're doing what we're doing? And whether or not we're actually aligned to the things we think we're doing? Because a lot of us get off saying, well, if the institution said I did a good thing, then I did a good thing. And I think sometimes it takes courage, especially in moments like this, to force us to ask. And if Donald Trump has done something for our civics, he's like the mirror opposite. He could give a damn about whether or not institutions are doing the right thing, which force us then to ask, well, if we know that he sort of sets this North Star for the sort of convergence of narcissistic self-serving behavior, and these institutions are powerless in front of them, is following the institutional incentive actually the right thing? And I think we all ought to be asking those questions. You and I are about the same age. So you were in high school, as was I, 25 years ago when 9-11 happened. And you've written a lot about how that changed your space in your high school, the way people treated you after that, the way that led to some amount of political awakening for you. So given that we're kind of in this anniversary period, and you're on the other side of it right now, talk me through that. You know, I have a little brother whose name is Osama. It's funny because, you know, I told you my parents, they were thinking about going back to Egypt. And so they gave me in the Muslim tradition, there are three names that are, you know, the most beloved, right? One of them is Muhammad, for obvious reasons, the name of the prophet. The second one is Abdullah and Abdurrahman. So my name is Abdurrahman. So they were thinking they're giving me this beautiful, beloved name. And then, you know, they got divorced and I lived my life out in the United States. So Abdurrahman, tough name, you know? And I remember very specifically this conversation about, I was about to start kindergarten. And in pre-K, we kind of got away with it, right? Because most of the time people give you a little nickname in pre-K, but I had to go introduce myself to people in kindergarten. And they're like, what are we going to call them? And I remember my mom very gingerly raising this with my father, which is like, "Honey, I think we got to talk about his name." And, you know, they had spelled it, A-B-D-U-L-R-A-H-M-A-N. And at this point, Paula Abdul was- And this is Jackie here. This is Jackie, right? I refer to both my moms as mom, but because I was raised by Jackie since I was three. And so Paula Abdul was topping the charts that summer, was straight up. And Kareem Abdul-Jabbar had just retired. So I became Abdul, right? And fast forward to 1992. And my parents very wisely are like, we have to give this next child a name that's pronounceable. So they're like, how about Sam with O on the front and A on the back? It's easy. And then that asshole in Saudi Arabia went and ruined it. But I remember, you know, the planes hitting the Twin Towers and just being horrified by what I was seeing, like literally what I was seeing. The loss of life. I remember it was wall-to-wall coverage and it was what was on in our house. But I remember that day, my mom swinging by to pick up Osama from school and, you know, they were horrified. And they asked, do you want to get picked up? I was like, no. And they asked why? I was like, well, you know, there's a couple of, you know, there's not that many Muslim kids in my school, but there are some. And, you know, I'm a junior at this point, so I'm just going to stay back and just make sure everybody's okay. I go home as usual that day. And so you that quickly felt that the- You felt that the energies would turn. Immediately. I remember a kid walking up and just be like, well, your people did this. I was like, why my people? He's like, your people did this, right? And in some respects, the overwhelming experience of it was just this loss of innocence about everything. That somebody could attack our country like this, using airplanes that are supposed to get you to where you need to go. This sense that the things that happen thousands of miles away, can impact your life. And this sense of kind of always having to answer for myself and to explain. And, yeah. for better or worse it was always the experience of like hey when you do something you don't just represent you you represent everybody who looks like you and everybody who prays like you um and i think in some respects like that it became a fixture i was also just really proud of my little brother i mean i remember they were like you know we could just change your name to sam it'll be okay he's like no my name is osama i didn't do anything wrong and i like my name and i'm gonna go by osama and he still to this day goes by osama and at this point you know he was in elementary school uh and so i think there was also this sense of this broader testing of like who are we and who do we want to be one thing that struck me reading your memoir is you have this very unusual insider outsider experience of the american institutions right you you talk about having to change your name when you're young starting preschool or i guess kindergarten you talk about the very direct racism you experience right after 9-11 there's sort of more stories of you're also captain of three different sports teams at your high school um so good athlete uh your commencement speaker i worked hard i wouldn't say i was a good athlete but yeah yeah people or good athletes always say they worked hard at it i worked hard at it but i was not a good athlete wasn't captain president clinton singles you out for this extraordinary praise um after your commencement speech at the university of michigan he tells you privately you should run for office i don't want to embarrass your senior speaker but i wish every person in the world who believes that we are fated to have a clash of civilizations and cannot reach across the religious divides could have heard you speak today i just wish every person in the world could have heard you speak today you become a road scholar which is how you end up studying in the uk so tell me a bit about this kind of dual experience of both you know somebody who can move through these institutions sort of on the constant verge of either being at the very center right captain road scholar commencement speaker or you know other being you know called slurs on the football field uh you know all the things that you experienced on the other side of that first i just loved sports i mean they're the they're the thing that like got me through childhood and school you know i i for most of my life i only got good grades because my dad was very clear it's like if you slip below an a you don't play so i was like i gotta get a's because because that's the only way um and sports were for me one of those places where you where there was a real meritocracy and so there were always a place for me where i could where the where the rules felt clear you're a wrestler right i was a wrestler i to this day i think i've never done a pure thing yeah exactly it's you and the other individual and you you got the same experience and you got the same experience and you got the equipment which is nothing right and you know you're you're bounded by weights so can you pin that other person before they pin you and so a lot of the way i engaged all the rest of my life i think started with this this experience playing sports and then i think in in college i kind of realized actually i like to think and thinking is fun and um i'm i'm much better at thinking than i am at at running uh and so um and so i i started to apply a lot of the same practices the same discipline the same sort of commitment um to to school and what's interesting about it is that i had this incredible you know i want to adjust for this like i got to go to amazing public schools i a lot of kids never never have those opportunities get to go to the university of michigan and then i get to start applying these skills in this place and you start getting invited to places and to do different things and be a part of it and then you also exactly the bounds at which meritocracy ends right the ways that decisions get made about who's part of it and who's not that you start to get really sensitive to and you know you learn how to achieve on the merits of the institution or at least the way the institution divides itself and then you start to appreciate that a lot of a lot of times who succeeds and who doesn't that gets predicted in ways that have less to do with hard work sheer capacity etc and the rules by which people access aren't always clearly written it's not like an athletic field it's not like the pure experience of wrestling somebody and that matters a lot for who gets and who doesn't get and also there is this emperor has no clothes aspect to all of this which is just like hey there are a whole lot of super capable people who will never get in here and meanwhile we ascribe a certain level of talent ability hard work etc to having been in this particular room when i don't know that that is entirely fair or true and the amount of power that people willingly wield from inside of these spaces against often a lot of these other folks is is so far beyond what should be fair i'm always interested at the level at which people think naturally and one thing i notice with you is your mind goes very naturally and quickly to structures and institutions and circumstance and i guess that connects to to a move you make which is that you go to medical school and you pretty quickly move from that to public health and the way you describe it as somebody who covered health care you know a lot back in the day is you sort of move from medicine to the social determinants of health but but tell me about that decision because training be a doctor is a lot but what is it that you saw that made you think i have to move towards the structure of this not the person-to-person service i really loved the clinical care part of things i really did i i love people i love hearing their stories or something a gift that people give you when you talk to them in a clinical encounter where they bring you their worst problem on their worst day and they're willing to share that vulnerability with the belief that you can help them and so often you'd be in those clinical encounters and realize that i actually am not being given the tools to help you fully and this institution gives those tools to some people and not others and if you're concerned with the idea that not everybody gets to live a long healthy life and you start wondering why and you spend a whole lot of time thinking about it and you spend a whole lot of your life learning how to be a a solution to that in part and then realize that you're in this institution you've got these skills but the institution itself hamstrings you from actually doing the thing that needs to be done you start to get really frustrated and i'm never going to forget a patient while i was at a small satellite hospital so i went to med school in the city uh in new york and small satellite hospital the tip northern tip of manhattan so a lot of the patients are um are from the bronx and upper manhattan and there was this patient who'd fallen hit her head on the subway stairs she didn't want to be there they didn't want her there i'm in a sub-internship a rotation where you know i'm getting ready to do my internship in medicine and my job is to be a liaison between the emergency room and uh the hospital wards and this woman had fallen hit her head clearly had a welt forming yelling at everybody there she's inebriated uh and it's early in the morning which you know pathognomonic for uh for having substance use uh and alcohol dependency and i go to talk to the resident who was in the emergency room i was like what did the ct show and that's you're gonna get a head ct if you fall and hit your head and you wind up in an emergency room it's like the the number one thing you do to rule out a brain bleed and he's like oh we didn't do one i was like why not he's like well he looks at me and he almost doesn't know what he's talking about he's like why don't you give me a head ct i don't know why he's like why don't you give me a head ct i'm like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's like why don't you give me a head ct he's meaning we're gonna if we admit her we're gonna run into so many social issues with her that at the end of the day we're not gonna be able to help her there's really nothing we can do for her and hospital's gonna lose money and you know where do we how do you even discharge a patient like this so i call up my attending and i'm like look like they even do a head ct this is ridiculous like no real h and p no history and physical like i this is absurd and my attending is like okay like i'm gonna do a head ct and i'm like look like they even do a head ct this is ridiculous like no real h and p no history and physical like i this is absurd and my attending is like okay like i'm gonna do a head ct this is ridiculous like no real h and p no history and physical like if you think we should admit her we should admit her turns out she has full-blown aids actively bleeding pelvic mass her blood sugars are all over the place one of the things i learned is that hiv can infest the adrenal glands which manage your blood pressure so despite having been hypertensive her whole life she's now got low blood pressure because basically the hormone system that manages her blood pressure is shot okay took care of her for two weeks worked with the social work team we found her the only rehab facility that took hiv positive patients then got her hooked into her ryan white housing which she had access to because of her hiv status and i was like all right great right and we've reviewed the plan over and over and over again the last day i'm like all right today is the day you're headed off to rehab and then you're gonna and she's like i'm not doing that i was like i'm sorry what she's like i'm not doing that i was like why not she's like well i'm going home my daughter i was like i didn't know you had a daughter she's like you didn't ask i was And she's like, yeah, well, you know, I reconnected with my daughter and my daughter wants to pick me up. I said, that's great. It's great that you're, you have this relationship with your daughter. It's fantastic. What happened last time? Like, it seems like you hadn't talked to her for a while. She's like, oh, I started drinking. I was like, well, you know, what makes you think you're not going to start drinking again? She's like, I haven't had a drink in two weeks. I was like, well, we've had you chemically, you know, on a, on a benzodiazepine taper. Right. So, uh, and you know, maybe you go to rehab, get your housing in order. You can rebuild that relationship. It's clear that you, you got a relationship there. And she's like, don't tell me what to do. You're not better than me. I was like, you're, you're right. I'm not better than you. And if this is what you want to do, you know, I just got to tell you, I think it would be, and she's like, she's like, no, I'm going home with my daughter. I had just finished putting in my residency application like a couple of weeks later. And I'm, I'm getting on the A train going downtown Columbus circle area to have a meal at a Turkish restaurant with a friend. I'm never going to forget. I get on the subway and my patient is laid out on the subway seats. And it was like a gut punch. So I go and check up on her to make sure she's like, okay, the same person, you just ran into her patient flat on the subway, flat on the subway seats. And I, you know, shake her a little bit. It didn't remember me. Didn't know who I was. She was alive and breathing and everything. She just, um, passed out. So I go have my dinner. I come home and I pull my residency application because at the end of the day, she became a referendum on my entire clinical career. Like she was the kind of patient I wanted to take care of. And the thing that I hate most about that experience is that that resident was right. And our system is not built to take care of those kinds of patients. And if it was a just system, it would be. And it's almost like she knew. Say what you mean on that, because to go back to what we were saying a little bit ago about circumstance and luck, somebody else might look at the story and say, you can't help everybody, right? This is on some level on her. She's drinking. She chose not to go into rehab. The state did the state through the person of you did everything it possibly could for her, right? That hospital spent a lot of money over those two weeks. Taxpayers paid for that. And she still didn't want the help in that moment. Correct. But think how many times you think she's interacted with the health care system only to learn the same script. How often has she been let down by some bureaucrat somewhere? So that she doesn't really trust when I tell her that this is all lined up for her. This is a woman who dropped out of schooling in the eighth grade. She was abused by her mother's boyfriend when she was a kid. She fell into alcohol dependence. And you're right. No one individual can help everybody. But we want to live in a world in the richest, most powerful country in the world where you have structures and institutions. That a prevent the worst things that happen to her. And B can catch you when you fall into those cracks. And arguably a hospital is supposed to be that like when you look at the history of the institution of the hospital, it was that place. It was. We have stopped it from being coming that or being that place anymore because what we have are billing machines that are very, very good at billing. The irony of it is just downtown from that hospital. You have the main New York Presbyterian hospital. You go up to the top pavilion and you've got carpeted rooms, which is a terrible idea. But you got pianists who play piano for, for, for patients who come from all over the world to get care from some of the most talented surgeons and physicians in the world. And the difference is a couple of floors. Our healthcare system has no longer become the thing which is supposed to give us ease in our pain. It is. It has become just another industry for the minting of money and it mints a ton of money for folks. It's also why it's way too expensive. It's deeply inequitable. The experience of it, whether you're a patient or a provider is not satisfying. Um, and this one patient became emblematic of that for me. Before I go into the whole healthcare system. When you, when you say she became emblematic of that for you and you move the direction of your own career, what are you imagining you could do for her specifically, because what you're saying about hospitals is true enough, but I think the point I understand you as making is that once she showed up at the hospital, I mean, somebody did try to help her in that case. You did try to help her. You did get the rehab set up. The, the, the resources were there if she wanted it, but too much had happened before then. Yeah. So what, what did you think you could go out and change or you could be part of changing? I mean, frankly, it's generational, right? I mean, she was a black woman in America. Yeah. You, you, you could take that all the way back. Right. So what do you imagine we could do? Build far better schools where you have all of the paraprofessionals around teachers, um, invest in, in students with special needs or students who are struggling, build more pathways for students that it's not just, you know, two year, four year college or bust, um, but that you have apprenticeship and training invest in small business opportunities for folks in communities like the one that she's from. Um, build out the, the, the kind of mental health services that we need, the kind of substance use treatment that we need. Those are all things that could have helped her, um, could have probably helped her mom and change the household in which she grew up. And so I wanted to be a part of, of, of addressing those challenges. Um, and also a part of trying to fix our healthcare system so that we actually could do the thing that people wanted to do. And I'll just go back to it, like a clinical interaction. There's something really precious about a moment that somebody tells me. That they're in pain or discloses something that they're really embarrassed about. And as a doctor, you want to be that person who can help. You really do. And the problem right now is I think about all my clinical colleagues. They're like, I have eight minutes, eight minutes. This person has just disclosed this terrible moment. I got, okay, that's, that's like one minute. I got seven minutes. You got a problem list. It's like seven problems long. And meanwhile, the patient's super frustrated because they're like, well, I just, I just, I just told you this big problem in my life. You can't help me. And then on the back end of it, they're going to get a bill for this terrible interaction. And you're going to have to fight the insurance company as the, as a provider to being like, wait a second, wait a second. I didn't write my note, right? Okay. Let me, let me just change this word in my note. So you actually get the money for the interaction that I had for the eight minutes that I had with this patient. The whole thing is just deeply broken. But it makes a lot of money for a few people who run a whole bunch of industries. If you're not a subscriber to the New York Times, we have some news for you. You can now explore the Times for free without any paywalls at all during your first month in the New York Times app. It's been interesting to me to watch your primary this year and sort of watch the way that like American politics began to understand you because this is a version of you that I'd sort of been aware of for some time before this, which is a Medicare for all advocate, right? Somebody who's like kind of fundamental entrance. Into American politics is coming through health care reform. And so I want to spend some time on that because I think health care reform is coming back is one of my theses about the next couple of years. And you got at some of it there, but you've written a full book on Medicare for all. It's a good book. It's like it's a not too many books from politicians worth reading. But if you want to sort of get the case for this, this one is what do you find to be specifically dysfunctional about American health care? Compared to pure nations. Right now, you have a system in which we think of ourselves as the customer. But if you think about it, Ezra, if you get sick tomorrow, you are the reason for a financial transaction between your health insurer and your provider. And every single part of that financial transaction, every player in that transaction, except for you, has a financial incentive. To maximize the amount of money they get to pick. So your insurer makes money when you pay more into that insurance than gets paid out for your health care. The clinic or the hospital makes money because they provided health care and can bill for that health care. The device company or the pharmaceutical company makes money when you use that product, whether in the context of a clinical interaction or the context of you taking medication. And for that reason. There is no actual incentive for any one of these players to look out for your well-being. There is no perfect solution to any human problem. But if you were to design a system that was maximally painful. For the patient, it would be this one because you're getting extracted from at every level. So let me just turn the page. Okay. Our experience of having private health insurance now is this. You pay every two weeks or four weeks. I assume you're a W2 employee of the New York. Times company, right? Every two weeks or four weeks. You, the first group that eats is, is FICA. That's the government. Uncle Sam eats first. And then after that, your insurance company eats some premium for you, your family, right? The New York Times company pays for some of that. You pay for some of that. Chances are you probably have a deductible unless the New York Times is like gray ladies, particularly. No, I got a deductible. Okay. You got a deductible. If you think about it, that deductible is what you pay for to get the health care. You already paid for every paycheck. And if you're doing the math, that means you're losing a whole nother paycheck. For that health care. And then that's health care that sits. behind a network, a network that's negotiated between your insurance and a provider, both of whom are using that opaque negotiation to try to maximize their market position relative to others of their type. An insurance company wants to gobble up other insurance companies. A provider wants to gobble up other providers. And you're paying to see a small group of doctors that have a sweetheart deal with the insurance company that pays for your insurance or doesn't quite pay for your insurance. And then you get sick, you get a bill, the bill goes to your, your insurance company. And because the insurance company is incentivized not to pay for your healthcare, then you probably have to fight them. A certain amount of institutionalized churn that you just have to put time into beyond the money you already put into it. And ultimately to get less and less time with providers, because the way the providers deal with this is to parse out less time. So what would Medicare for all do? Rather than So this situation in which you have an insurance company that is profit motivated, managing a lot of this transaction, you have one payer who is the federal government, who, by the way, does this for people over the age of 65, albeit not as efficiently as it should be. That's a whole nother money in politics problem. Well, it is and it isn't, because I think it's worth stopping before we go fully into Medicare for All. I'm going to take some of the other side of this, partially to be the devil's advocate here, which is the description you're giving of the fault of the American health care system is fundamentally that every player is interested in profit and not interested in you. And you could say that about any market-based transaction, right? In the supermarket, you know, they want to make money on food. They sell you food. They sell you food at a markup. And they're profiting, you know, from the difference. And the question in health care is whether, like, the market incentives are getting you something that's worth it, right? If you're getting innovation from the pharmaceutical companies, from the device manufacturers, right, that they're incentivized to kind of come up with new ways of treating you. And, you know, to some degree, they are and they do, right? We have a kind of incredible pharmaceutical industry in terms of innovation. You know, the prices. Prices are a much more live problem. You know, whether or not the hospitals have an incentive to kind of attract you by getting the best care. The insurers, in theory, have some reason to attract your business. And I always take that the problem of American health care is that in a set of these transactions, two things have happened. One is that the prices you pay are way higher. You expect that the market will bring down prices. It hasn't. You talk a lot about it. I'd like you to explain to people why. The other is that people are supposed to be more efficient when disciplined by the market. It's not clear that's happened here. And maybe the third is that health care is a weird good. Where I always feel like this is very undersold. But I'll spend a lot of time deciding, you know, which computer to buy. I'll walk out of the store if I don't like the jackets they have that day and I want a jacket. My kid's sick. We're in the ER. I don't go down the street. But I'd like you to talk about that dimension of pricing because I think it's not just about there being profit. There's profit in a lot of things in our life and they work, you know, to some degree or another fine. But why isn't the profit incentive here getting people what they want? So I love how you broke down that problem. Let's just start actually with the third point. That is, it's just a weird good. Nobody actually wants health care. They want health. Yeah. When you need it, you will do whatever it takes to do it. And so we rely on other institutions. To discipline the market from being able to price gouge us when we need health care. Here's the problem, though. Insurance. Usually insurance markets don't work. When you know you're going to need the outcome. Like if you if you insure your home, you're not assuming your house is going to catch fire. Chances are you pay insurance, pay insurance, pay insurance. You never actually get any payout from the insurance because, well, that's just how it is. Right. So insurance is not really the right mechanism because at the end of the day, all of us are going to need some health care. Some of us are going to need a lot more health care and none of us know when that's going to happen. So we have this insurance market that was created to try to ease us from the financial burden of health care calamity. The problem, though, is once that health insurance system then starts to scoop some money off the top. The question becomes, well, how much and how? And herein lies the issue. The moment somebody created a deductible, the idea of private health insurance became useless. Because if you know you're going to get sick and you have to pay your deductible anyway, and that deductible is unaffordable. At this point, you are now being hit with the financial calamity of your health care consequence or issue. Like I don't begrudge the pharmaceutical industry for needing to charge for the innovation it creates. I begrudge them charging as much as they do and charging us for stuff that's created innovation that was created 100 years ago. But it's understandable in a market that you want to make something and then you want to sell something. I get that. But the insurance industry actually has no has no real purpose. They don't innovate anything and they're failing the responsibility, which we pay them for, which is buy me out of financial catastrophe. So that's why when I talk about Medicare for all, I'm not talking about reform of of the health care provision side of things. Talking about reform of the insurance side of things. But that's not true. Hear me out. Yeah. Discipline the rest of it. I think you're getting what you're saying there. But but what I was about to draw you out on is that Medicare for all, we can argue there are a lot of analyses about how much it would cost. It depends on what you cover and how you cover it. But the main thing it does, aside from simplifying administration, is it's a massive payer who can bargain down prices and the and guarantee everybody health care and guarantee. Yeah. And guarantee everybody health care. But I mean that the way it would change what providers. Are doing like if you imagine you have Medicare for all and probably the kind of expansive versions of it that say Bernie Sanders has proposed and you don't change what anybody pays for a drug for a good for whatever, there's no way you can afford that. The theory here is that you have Medicare for all bargaining down how much the hospital can charge for an MRI, Medicare for all bargaining down how much Eli Lilly can charge for terzapatide, Medicare for all pushing down the prices of health care, which in other. Countries, they are lower Canada, UK, France, per service per drug, per all of it, they just pay less because the government negotiates that the trade off that people worry about there is innovation, like there's this theory that the whole sort of world is free riding on how much America pays for drugs because it creates this incredibly robust market in drug innovation. I sort of agree that insurers don't private insurers don't justify their existence all that well. We can talk about the arguments for them in a second, but I don't. They've been doing a great job at really anything, but the the real money is coming from negotiating down providers and the reason insurers are failing us is they don't negotiate down provider prices very well. Let me let me push on a couple things. I think that is true from a systems view of the health care system from the average person's view. I just want to have health care when I need it and just the fact that it would guarantee everyone coverage at the minimum is such an incredible value. You. Above and beyond the current system that from a a political standpoint that alone is worth it, I lose my job. I still have my health care that's huge without having to pay some insane amount of money for the health insurance. I thought I had that's huge now I want to push on a couple of the pieces here. I happen to be a huge fan of costco if there's one corporation I like it's costco now some people might hate me for it, but like you know, everybody's got to have their as a as a famous. Anti corporate man costco. So me and me and Kirkland, but one of the things that people like about costco is that they have sort of made a commitment to themselves that they're not going to make a margin of more than fifteen percent on any product. A lot of the innovation in our system first the riskiest research we subsidize as a government through things like the NIH will maybe not under trump anymore, but like the NIH is intended to create the opportunity to de risk the riskiest research you and I both notice and. Almost every prescription drug that has that has made it all the way through the process has had some foundation in the NIH funded research. That's number one. Number two, imagine prescription drug companies just said, listen, you know, we are going to charge fifteen percent above and beyond the rate of what it costs us to research and develop this drug. And we go from there. There's a world in which not that the innovation doesn't go away. Costco is still a very profitable corporation. They're just not. Insanely profitable. And even then, pharmaceuticals and their business model tends to be more focused on the way they trade on a stock market than their actual profitability. So to be clear, the day you pass Medicare for all, you would have to be able to sustain the system as it is. Otherwise, you in effect give the whole health care system the equivalent of a stroke over time. You have this disciplining feature. But imagine you took all the pharmaceutical companies and just said, you know what, none of you can be publicly traded. All of you. All of you have to stay private and you are allowed to make 15 percent over the top for a 20 year period of every medication you had. And then we are going to discipline through real generics. and publicly funded generics to compete with you. You would still get serious innovation because a lot of the riskiest research is already publicly funded. Yeah, but the riskiest research has a portion of public funding. And then it gets taken up by the pharmaceutical industry and a huge amount of it fails. Sure. A huge amount of it fails. Sure. And it's funny because I almost want to separate these two thoughts a little bit. I think you can be a supportive Medicare for all or medical for most. And then there's this question of what should policy towards the pharmaceutical industry be? But I think that there is one version that you'll sometimes hear people talk about with Medicare for all, which is putting a floor on the healthcare system, which is, you were saying this a minute ago, that part of the value of it is that everybody knows they have healthcare all the time. And then there's a version which is putting a ceiling on it too. Which is everybody's got the same healthcare, right? It's Costco, but Costco for everyone. There's no Trader Joe's. There's no Walmart, no Target, right? You're all Costco. What Costco thinks is worth it to stock, you can have. What Costco doesn't think is worth it to stock, you can't. So when you think of it, because there are countries that have, Canada, for instance, much harder to get private health insurance in Canada, right? There are other countries like France that have a baseline public insurer and then supplemental insurance on top of that. So when you think about the ideal healthcare system, do you think about a floor and a ceiling? Do you think about a floor and not a ceiling? I think about it as a floor. And to get at the question explicitly, imagine it to be like public schools. No matter where you live, you have a public school system that is there for your kid. You pay taxes into that system. That system is always going to be there for you. You may enroll your kid, you may not enroll your kid. That is still there for you, right? You are guaranteed a public education. Medicare-for-all is that guarantee. Everyone's enrolled, everyone pays in. If you would like to have a private insurer above that, you're welcome to do that. But our goal is to build a floor so high that most folks would be like, why would I? This covers everything I possibly could need. The other important differentiator here is that when we're talking about Medicare-for-all, we're not talking about healthcare, we're talking about health insurance. One of the things that people don't appreciate about our current system is that the current system actually chokes off. Innovation in the healthcare provision side. So just to put in perspective, if you're a private practice GI doc, you're reimbursing at substantially lower rates than the same GI doc who is a part of a larger healthcare system because the healthcare system has negotiated a bundled deal with the health insurer. That itself is a problem. People don't appreciate that if you're on Medicaid, which is a really important safety net program, Medicaid reimburses at about half the rate of private health insurance. It's substantially lower rates than Medicare too. And so people don't compete for Medicaid patients. If anything, they usually discriminate against them, which has a huge problem for people on Medicaid. So if you really want choice in the healthcare system, Medicare-for-all does two things that are really valuable. Number one, it sets a very, very clear rate for what the reimbursements are and enables the rest of the market to go and innovate on who can get the customer base, the client base, the patient base. And then, the second thing it does is that it repatriates a whole bunch of people into the system. So it's not just Costco-for-all. It's like, well, what happens when you create this floor and now all the providers are set to compete and you actually have the enablement of a real market because you have paying customers who can choose where they want to take their Medicare reimbursement. One of the things I think I'm seeing here is something I'm sort of seeing more broadly in the Democratic Party right now, which is, I remember watching this form in 2007 before the Affordable Care Act, where you had a lot of parts of the party beginning to converge on roughly what was the healthcare vision that might be pursued next time. And over and over and over again, it was based on what Mitt Romney did in Massachusetts because Democrats were very scarred by failure after failure of healthcare reform most recently then Hillary Clinton and Bill Clinton in 94. And they're like, well, this got some Republican support. Maybe we can do this. And sort of Obamacare, it's different than Romneycare, which is what had been done in mass. But it was sort of built on the same set of theories, individual mandates, private insurance, a kind of like a set of moving parts. And what I see happening now is sort of another convergence, which is sort of on the left, there's been a Medicare for all vision. And one version of that vision was much more maximalist. And this was endlessly litigated in 2020 Democratic primaries, which was it has to abolish all private insurance. And I hear you say, I've heard AOC saying, I hear others saying, I think there's a sense that maybe that's not the first step. On the other hand, the sort of more moderate side of the party, the idea that what you want in health insurance, that the great goal is competition between private health insurers. I don't think people hold to that anymore. The idea that you're going to get Republican support for Democratic healthcare reform, nobody believes that for a second, or at least they shouldn't. And so it feels to me like there is a converging, I don't know exactly what its shape is going to look like yet. I don't think anybody does. But it's Medicare for more. You've used this analogy that I think is a good analogy, that Medicare for all, the place you want to go is climb an Everest. But to climb Everest, you need to go to base camp. You need to get over to some smaller hills and mountains. What do you see as the most promising kind of steps between here and there? People want to go towards more Medicare. Where do you start? So let me say the fastest way to get to Everest would probably be to, to drop out of an airplane onto the top of Mount Everest. So I don't want to give up on the idea that we might have momentum into the first day of 2029 with a new president who's like, I'm ready to go on this. The nature of the debate has changed so much because the nature of private health insurance has become so porous and so frustrating for so many. If we can't, then the steps, even if you were to say, we passed Medicare for all on, you know, in January of 2029, where would we go from here? Well, the steps would kind of be the same because you're not going to, there's no light switch in the, in the white house that like turns on Medicare for all. So you would make Medicare whole. Cause right now, Medicare is extremely porous. You talk to seniors and they're like, well, there's all these different parts and it doesn't cover vision, dental and hearing. And, and, and so you, and a lot of them are in Medicare advantage plans and that whole situation, these private plans and they like them. I mean, that's good. That would be hard to take away. I mean, the whole, the whole gambit on Medicare advantage is we give you some things on the front. So we, we lobby to keep Medicare porous. So then we can offer you quote unquote advantages like vision, dental and hearing, which normal Medicare doesn't offer. So you'd, you'd, you'd basically show up all the parts. You would include a full robust part D. You would have vision, dental and hearing. It would go to zero copay deductible premium done. At this point, if you offer, if you offer that as traditional Medicare, the speed with which everybody would jump from advantage would turn your head. That's number one. Then you start extending it to more people. I think kids are obvious, right? Children. Thank God are uncommonly healthy. And if they're not healthy, they're very sick. And so extending it to children is obvious. Extending it downward, right? From 65 eligibility age to 60. And then down into the next year, to the fifties, forties. That's kind of what needs to happen, right? All of that articulates better Medicare for more people. What I'm articulating is great Medicare for everyone. And if we can do that in one piece of legislation, amazing. If we can't, then my rubric is very, quite simple. People ask me, they're like, Oh, well, if you can't get Medicare for all, what would you vote for? I said, the rubric is simple. It gives more people healthcare through public dollars and disempowers corporate health insurers. If it meets those three things, I'm for it. I'm going to vote for it. I think getting into the politics of this for a minute, right? We kind of walked out on the policy side. We make this mistake on the democratic party of assuming that their pushback is going to be consummate with the degree of policy change. The ACA was originally hatched as an idea by the heritage foundation in 1989, which you well know it was a Republican idea. And then this is the individual mandate structure, the three legged stool that becomes Romney carry. Yes. Then it's passed by a Republican governor in Massachusetts. And then they attacked the hell out of the Obama administration. And that same governor runs for president on a promise to repeal it. Exactly. It's insanity. So just assume that you're going to get maximal pushback for anything. So then the question becomes, how do you get maximal momentum in the right direction? And the problem that I also have to have with Democrats is that we mistake policy discussions for political discussions. It's not enough to tell people, we're going to solve some of your problem. It's not enough. And we assume by saying we're going to solve some of your problem, then they're going to have some of the pushback. No, you tell people you're going to solve some of their problem and you get all the pushback. So how come you lose the fight? Well, because you didn't create that much excitement about actually doing the thing you wanted to do. And you got all the pushback from the industry. And I think everybody always wants to believe that. And I don't mean to totally dismiss it, but that you get this kind of constant level of pushback. And so it sort of doesn't matter what you propose. And I think a lot of that, the people who got really battle-scarred here. like have a different view on this i mean vermont tried to do single payer they tried to do it in a blue state where bernie sanders is a senator just a couple years ago um when they had a democratic governor it's a fiasco and it was a fiasco because when people were told what it was going to cost them and they were going to have to move that to taxes they rebelled against it california's tried single payer a bunch of times we've watched this on ballot initiatives the the point i'm making on this is simply that um i think a lesson a lot of people who have been scarred in these wars have learned is that people don't trust the government that much and so when the government comes and says don't worry we're taking away what you know you can trust us the people who brought you healthcare.gov that we're going to run this next one perfectly you can trust us the people who like just had donald trump in charge of everything and doge was you know gutting the entire government that we can run this don't worry about it and meanwhile as you've sort of written about it you can trust us the people who like just had donald trump in charge of everything out you get a bunch of healthcare stakeholders potentially doctors definitely hospitals coming out and saying you know this is going to close rural hospitals or whatever it is it gets really really hard so you do get the republican opposition but the fear of just seeing the whole thing collapse in on itself because people fear having too much taken away from them uh you know abolishing private health insurance that kind of thing like that comes from somewhere let me let me let me push back it's not the republican opposition i'm worried about it's the industry opposition industry spends huge amounts of money to push back on all of this suspended in electioneering they spend it in lobbying and they spend it on ads right missing disinformation via ads so i think there are three things that that we really need to be learning from those wars right with all due respect to the people who fought them before number one the war doesn't start the day you decide to do health reform the war starts the day you start thinking about doing health care reform and you have to have a broad network of people who are going to be doing health care reform and you have to have a broad international conversation early number two understand how they gin up public discourse understand what you're actually dealing with in the ways that they work to try to manufacture public dissent politicians who've championed a lot of these reforms have not actually gotten a running start on them have not pushed in the way that we need to to build the public momentum and discussion around what exactly we're trying to do there's this almost this fear of explanation in politics whoever came up with a statement when you're explaining you're losing has done a deep disservice to our whole political system i prefer bill clinton's summary he said explanation is eloquence this job is an explanation job although he really failed at that on health care when it comes to healthy but also again it wasn't the thing he was running on it was like we got here let's do health care rather than let's have a big national conversation about health care and build a head of steam around the politics of this knowing full well that they are going to hit with a whole bunch of misinterpreters and they're going to hit with a whole bunch of misinterpreters and they're disinformation ads i mean you know the harry and louise ad find more you like in the president's plan yeah and well it just doesn't have the choice we want look at this the government picks health plans then we have to pick a plan from their list that's the choice we get but what if we don't like their choices right that was a classic of the genre brought to you by what is the partnership for america's health care future whatever the one uh i think was a organization for institution or care choices whatever it was right that's what they do a lot of those astroturfed obama era town halls that we saw there were people paying for that stuff right and you've got to be thinking in the same attentional space as they're going to be thinking and then number three i think the infrastructure like the the political infrastructure of this moment has changed in the past when we talked about health reform it usually was a conversation about how you provide health care for lower income people today it's not that it's how do you provide health care for the poor and i think what's happened is that the industry has gotten so greedy that the floor underneath which we are having this conversation has so far shifted that we need to have the courage to be able to say actually this moment requires that kind of change also the tactics on which we are going to have this debate have changed entirely to the power of the industry to drop in with 30 second ads that's just not as powerful as it used to be anymore and so i think they are losing power quickly and we really could i don't think we're going to be able to actually get this done in 2029 that's what i'd like to do but part of the reason i'm excited about this i know i'm going to be one u.s senator if i get elected part of my job though is to be the first democratic doctor in the u.s senate since 1969 who wrote the book on doing this and to be moving that conversation in the space in which we are now electing the next president so if you told me a couple years ago abdul said is going to win the democratic primary for michigan senate in 2026 what are people going to be debating around him like this i've watched this guy for a while this is they're going to call him a communist a socialist as well you're debating medicare for all you do know my name i do know your name um but what's interesting the washington post did an analysis of social posts on the right around you and in the primary they were about you being a communist and a socialist the bulk of them and since you won the primary they're about you being muslim about your name about you being you know you're getting called an islamic jihadist who wants to impose sharia law and it was a sharp change right they went from being about your ideology to who you are like a real effort to authorize you let's start here what have you made of it i saw it coming a mile away in fact i'm betting on it i knew the day that i won you're going to hear my name in the mouth of uh donald trump and jd vance and mike rogers all day every day and i know i bet you there are republican consultants out there being like about his name stop talking about his name stop but they can't help themselves because i hate to say it like they've bought into the sort of pickle brain version of politics brought to them by news nation or news max or whatever the hell that is uh and fox news that tells you that you're going to be a muslim and you're going to be a muslim and you're going to be a muslim and you're going to be a muslim and you're going to be a muslim and you're going to them that everybody agrees with them and most people don't this is what they don't understand people are good you know i've been abdul my whole life and most people take my name as an invitation who are you and what are you about it's curious i've never met somebody like you i want to have a conversation what do you what do you want to do what are you doing here what are you about right people are good so all of the other people watching the bully in the room go after me because of my name and then watching me give as good as i get they're like what am i learning from this about him number one they hate him because he's just different and that's not fair and number two he's not afraid and number three what's he talking about wait money out of politics money in my pocket medicare for all i kind of like that and what has he done oh he's a doctor he wrote a book on giving people health care rebuilt that detroit health department put glasses on kids took on corporate polluters eliminated medical debt he doesn't seem that bad why do they hate him so much and so i've always had a front row seat to seeing how this works out and so what happens is all of their attacks are going to congeal into this like very hideous ugly kind of thing and most of us are going to be having a conversation about exactly what you and i talked about hey uh can you forge your gas can you order groceries can you pay your rent or afford a mortgage mortgage can you see a doctor without being so afraid of the bill that comes afterwards because that's what i'm trying to talk about that's what i'm focused on my name not raising your gas prices donald trump is we are in a moment on the right that it's i'd say worse than i've seen it since immediately post 9 11 where just the level of islamophobia has sort of escaped containment and become something really big we've seen congresswoman nancy may say that every single muslim holding public office in america is a trojan horse congressman andy ogle saying muslims don't belong in american society pluralism is a lie congressman chip roy wrote that islam is incompatible with western civilization this was i thought crazy he said recognizing that as horrific as the attacks on 9 11 were a much more aggressive war is being waged against us right now throughout america it's really really vicious it's all over news nation fox news why i guess there's a why now question right like 9 11 you sort of see what led to the kind of viciousness of that but the sort of re-emergence of this as a kind of master narrative it's now right replacement theory kind of ideas um it's hooked to a lot of ideas about europe why do you think that is it's not working as well i mean it's like you know you you push a button and you get a particular outcome and then the button starts to stick and you don't get the same outcome so what do you do you push it harder so you know i think that this is the last gasp of a whole mega movement and you have an aging wannabe monarch who's grip on public discourse is starting to fade a lot of the folks around him have so clearly tied their horse to his and now they're trying to figure out what do we do so they found out that they're not as charismatic as he is when they go after the same enemies he tries to go after they can't do it with the same verve and showmanship that he does and so it comes out as uglier and more hideous and that tends to be how these movements fizzle out because people look at that and be like yeah it's really ugly And there's this sort of effort to sand off the edges of, um, your complex identity, especially when you walk into politics. You know, I probably have the most politicized beard in the country. Um, but I have a beard since I was 19. I always tell people like, look, if I, if I shaved my beard, I'd look like I'm 19. But also I'm not going to pretend like somehow I can be anybody. I'm not right. People are like, well, you know, you could change your name. You're just like, it's something similar. I'd be late for that. Yeah. But I'm like, no, I've been Abdul since I was in kindergarten, you know? And part of what I want to do is not just like, what's the point? I think sometimes in our political system, we give prizes to having gotten into the arena. But the question is not, are you in the arena? The question is, what are you doing in the arena? At the end of the day, people are looking at you and saying, what do you really believe? There's this problem we have in the party generally. It's like, we tell people we're going to fight for, and then there's the secondary question of how do I know you're going to fight for it? It's like the, the political moral hazard test. You say you're going to do a thing. How do I know you're going to do it? And at some point as Democrats, that's where we've been failing. You say you're going to do a thing, but I don't know you're really going to do it. And I think it's important for us when you, when you, when you, you lay down a marker, you stand 10 toes down on the marker, come what may. So if I can help our party sort of recognize, you don't have to just take it, that actually these people can be beat at their own game. And everything they're saying is ridiculous. I, I hope we can learn something. I mean, let's stop here. JD Vance. Is a walking hypocrisy. You know, like this whole little bit he has about his long past, may he rest in peace, Papa. I'm like, so you had to invent a caricature of your grandfather from the past to make an argument about what America should be in which you yourself in your own choices wouldn't be included. What kind of ridiculousness is that? It's just that you're ridiculous. What do you mean in his own choices? His own family choices, right? I mean, this is the thing about is like, I believe in America. I believe in America. I believe that my parents and my in-laws who are immigrants from India are as American as I am, or you are, or he is. He clearly doesn't, which forces a very odd set of questions. I'm sure he has to sort of navigate in his own mind. And at the end of the day, again, the emperor has no clothes. I'm going to leave JD Vance to the side for a minute, the vice president. It's a rich psychology that you can get lost in. Um, one thing that sort of broke your primary open this year, was Israel and Gaza. And so I want to just start with a very open-ended question, which is in your view, what should America's position towards Israel, towards Palestinians be? It should be the same approach that we should take to all other countries and our approach. I mean, go back to the post-World War II era. We fought this terrible war against terrible people, and coming out of it, we realized that we needed to build these institutions to protect the world from having to do this again. And we codified these institutions by way of a system of international law. And then we emerged as the global hegemon and then proceeded when it was in our own real politic interest to violate those rules. But we still expect everyone else to play by the rules of the international order. And so I think that's a very, very important point. And I think that's a very important point. And my foreign policy views are very simple. I just think we should be the first among equals to enforce international law. I would argue that Israel is the greatest outlier when it comes to the behavior of the government of Israel relative to the approbation you would expect them to get versus what they actually get. They've been able to sustain a apartheid system, which is the only thing you can call sustained, nearly six decade long occupation of a people in Gaza and the West Bank. They did a genocide in Gaza. They led us into a war. Benjamin Netanyahu came to the situation room, made the argument for a war. He finally had a duke big enough who was, you know, willing to do it. But think about war aims. We had no clear war aims for that war. Israel had clear war aims. And one of those big war aims seems to be setting up for the annexation of Southern Lebanon. And we do all of this. And all of this has been done. While our stated policy in the region is that we believe in a two-state solution, which is wild because we're aiding, arming, and abetting the very government that is attempting to foreclose on the possibility of a second state openly. And so I'm just saying that we should treat Israel the way we treat any other country that did the same stuff. On top of that, I come from a state where there are communities where the median income is $14,000 a year. I remember going to an elementary school, Spain Elementary in Detroit, two weeks after the boilers broke, watching first graders try to learn in a room without a boiler. And the idea that we send billions of dollars to the school, we're not going to do that. We're not going to do that. of dollars abroad, not just to Israel, but to Egypt, where my family came from, to Jordan, to Pakistan, to UAE, to Qatar. The idea that we send billions there while our babies can't read in a classroom should violate every sense of basic fairness. And finally, too often in our politics, when you have a political consensus, that's one place and a bipartisan consensus, that's another. It's somebody's money. AIPAC spent $32 million in my primary, $32 million for one U.S. Senate seat, set a record in that race. They were big fans of yours. I mean, they showed it in a very interesting way. I'm going to hold the question of money to the side of this for a minute, because I'm more interested in your policy here. So in what you said, I think there are sort of two levels on which a policy like that could operate. One is to shut off the money that America sends to an Israel, to an Egypt. But in this case, let's keep the focus on Israel. Right. And I think inside the Democratic Party, you're getting to a fair amount of consensus on that, right? I think that it is unlikely the next Democratic administration is going to be selling arms to Israel. Now, Israel's pretty rich at this point. There might've been a time when our money was essential to the functioning of that state. I think that time has passed. So then there's this other question, right? When you talk about the apartheid system, when you talk about rights and Palestinians, which is whether or not America engages in trying to change the status quo among Israelis and Palestinians. You can imagine a world where the money shuts off and Benjamin Netanyahu wins again, or Eisenhower, whoever it might be, says, yeah, fine. We'll replace our budget hole, whatever it might be. But this is our policy. And then in your view, what should America do? What should America's policy be towards that? So let's start from a philosophical standpoint of where, what ought to be. I believe in equal rights to peace, dignity, and self-determination for Palestinians and Jewish Israelis. I believe that it is up to a free Palestinian people and free Jewish Israeli people to decide how to maneuver the inconsistencies of that. Whether that's a two-state solution, whether that's a two-state solution, whether that's a two-state solution, or a one-state solution, or land for all, as you had a discussion about on your show, or a 23-state solution. Me as a US policymaker, I would be fine with any of those. It's about the process, not the outcome. And I think the problem right now is ultimately we've often had too much hubris to think that we get to dictate what happens rather than trying to enable the circumstances to allow for that discussion to happen. And the problem that I have is there is a deep power imbalance here. Israel is a state that actually exists. There is no Palestinian state. The state of Israel has openly and very directly tried to destroy any coherent movement for Palestinian self-determination and has often kept people divided on purpose or arbitrarily jailed people or you name the thing. And that's the problem. And I think that's the problem. And I think that's the policy of mowing the lawn as they talk about. And so from where I sit, my responsibility is the 10 million people in Michigan and making sure that our money does not make other people's problems worse. And as the first among equals of enforcing international law, when the actually existing state violates international law, I think it's important for us to hold the actually existing state accountable to international law. Also, if other people violate international law, Hamas, hold them accountable to international law, but to do so without fear or favor, which is why it's hard not to talk about the money side. Because the reason that our policy is the way that our policy is, is because of the massive power of internal spending in our elections to try to shape outcomes, to make sure that there is a bipartisan consensus around the that is what it would be. Two-state solution. AIPAC is a big spender in politics. And I think AIPAC has been, I mean, I've said this for a very long time. I think AIPAC has done terrible damage to both Jews in America and Israel. And I'm not a fan of AIPAC. I do think less of this is about money than sometimes you make it out to be. Joe Biden was not, the issue for him was not AIPAC. Joe Biden had his beliefs. And many people formed their beliefs on Israel in a very different era. And they remember, or at least believed in, a very different Israel. The reason I ask you about this question of what would you actually make the policy into is because I think there's an analogy here to your Everest analogy on healthcare. One place I really agree with you is. Is that this idea where people sit around and imagine what the long-term settlement that will fully solve the Israeli-Palestinian conflict would be from where we sit right now, when there's no preconditions for that kind of settlement, is more than I think it's a distraction. I think it's a way of not apprehending reality as it is. It's more fun to imagine a world in which it is all solved than to try to think about the basics. And so, you know, you do get into this question. On the one hand, there are Jewish Democrats in Michigan who, the thing they worry about for you is not that they don't like the thing you just said, but that they suspect that at your heart, you don't think Israel should be a Jewish state. That it's like the one state in the world that should no longer exist. On the other hand, the thing that oftentimes many, I think, Jewish Democrats don't think about is the thing you just described, the power imbalance. That if you just let the conflict run from here, the imbalance does not get you anywhere good. It does not. There's nothing. There's nothing. There's nothing. There's no preconditions. It's easy to say, I don't like Benjamin Netanyahu, but you're not going to get an actual movement here just through a change of that government. So, do you think there's policy here? Or do you think it's simply America no longer making things worse? I take very seriously that policy sits downstream of politics. You can't get policy in a democratic society unless you're willing to engage in politics. And so, a lot of what I need to do. For our children in Detroit. And also, for all of the kids whose lives should be free and clear without having to worry about inheriting all of the disaster of the past. Is about trying to move our conversation to a place where things that you cannot say need to be said. When it comes to the fact that our country is subsidizing genocide, it needs to be said. When it comes to the fact that our country is misusing our tax dollars, it needs to be said. When it comes to the fact that we are. We are incoherent, if not hypocritical, about our stated aims and what we're actually allowing to happen. It needs to be said. And once it gets to be said, maybe it could be voted on. And once it gets voted on, maybe we can find our way to policy. I told you that I actually, I'm somewhat agnostic to the outcome. As long as the process that enables peace, dignity, and self-determination for both peoples is enabled. But from where we sit right now. We're not moving. So my job is to move us. Take the first step. Because right now, everybody. And the first step is what? To challenge the status quo about what we can talk about when it comes to American politics. I mean, I always get the question, does Israel have a right to exist? And it's such an interesting question. Yeah, but I purposely haven't asked you this. You haven't. You haven't, but. Because I think this is crazy. Exactly. Israel does exist. We're way past this. But here's the thing. Ezra, you're right. And you're a very thoughtful interlocutor on this issue. How many interviews have you seen with me where that's the first question? I have seen them. So what that says is that the status quo of this debate in our civics starts there. That I have to accept the existence in its current form with its current power structure under its current policy framework. For me to even engage in a conversation. And I just don't accept that right now we are getting what we want. We want equal rights of peace, dignity, and self-determination for all people. If that manifests. In a state for both peoples. I'm fine with it. But it is those peoples who get to make a decision. Not us. And right now. We are stopping that decision from happening. Well, I agree that we're in a very unstable equilibrium. And I also think that the conversation on this is blown wide open. But to a different degree in different places, right? I've seen some of these interviews with you. And then, of course, there are other places, right? Where it's almost taken for granted that Israel does not have a right to exist. I mean, you can now in American life. The thing that many people, including me. Said 15 years ago, which is that you have a wider range of debate in Israel over Israel than in America over Israel. It's not really true anymore. But what I wonder. One reason I think the equilibrium here is unstable. Is. You know. People with a variety of degrees. Of views on Israel itself. From people who believe very much in its existence as a Jewish state. To people who don't. Have watched and been. Horrified. By the last three years. And one way that issues become very unstable is that they there's a lot of feeling that doesn't know how to translate itself into action. So. Maybe America just takes a step back. Maybe. Being in this conflict as a funder. And as a protector and at times as kind of a lawyer. Maybe we just made things worse. But you could also imagine things getting worse from here. And right now I think that the within the Democratic Party. I mean this was a you know a tough fight inside your primary the question of how you hold a party together where maybe there's a lot of agreement that what is happening right now is not good but it's not a lot of agreement of like what is a stable policy point on which Democrats have many different perspectives ranging from you know liberal Zionist. You know tough. Less liberal Zionist to people who are skeptical of Israel at a much deeper level. What is a an actual policy place where they can kind of stand together not because they all believe in the same eventual deal. But because they can agree on the next set of steps that it makes sense for America which is not Israel to take and that's frankly the conversation one half right and there are a couple of principal points I think. We need to establish to be able to take a principal step that that most people probably agree with number one that the well-being of the Jewish community. Is different than. Good faith criticism of a foreign government those are different things you can stand with the Jewish community guarantee their safety guarantee their right to advocate for things that you disagree with. And that has to be held separate from the question of our foreign policy toward this. Country. Second is the question of what our principles. And this is the part where I think we sometimes wrap ourselves around the actual little too much. Which is to say what actually believe in and how do we get those beliefs. And I just think it's a lot easier for us to say all right here's the next step we probably shouldn't be funding. This military we probably shouldn't be unconditionally funding any military. We probably shouldn't be running. Cover for. The actions of this particular government. Which at the minimum war crimes of the maximum war genocide. In the courts of law. And we probably shouldn't be buying. An added level of security that basically buys an electorate out of having to make democratically rational decisions about how to protect and how to behave. I think those things are things we should agree upon now not everybody is going to agree with me I get it. And I also understand. On both sides of this debate we're also dealing with. A lot of. Trauma. A lot of trauma. I understand that for a lot of Jewish Americans. There's the trauma of the Holocaust and the need to have a refuge. I understand that. And I also understand that for a lot of Palestinian Americans and Palestinians everywhere. There's the trauma of the Nakba. And the great displacement of people told that they were just going to be able to come home in a couple of days. Never ever to be able to go back. We've got to be able to create the circumstances within which both of these deeply traumatized people. Can have a conversation. Built on principle. But to me the answer has to be principle. It has to be. That's where we'll end. Always our final question. What are three books you recommend to the audience? So I thought this through. And maybe this is a child of immigrant overachiever thing. But I've got four if that's okay. So the first one is. The best and the brightest. David Halberstam. And I think it's just an incredible. Observation. On the nature of. Institutional priorities. Groupthink. It's about the Vietnam war. And the ways that we bungled our way through it. With the best and the brightest. Folks who had all the credentialing but none of the common sense. And none of the moral. uh, engagement with what we were actually doing. Uh, the second is amusing ourselves to death. I know you talk about it all the time, but you know, Neil Postman, Neil Postman, I shudder to think what Postman would make of TikTok. Like he was writing this in the era of TV, this idea that the medium, this message, and by juxtaposing two completely contradictory messages next to each other, you dumbed down both of them. TikTok is literally that, right? It's just a machine that like flows, you know, on one hand, it's a dance craze and the other one, it's a political analysis and the third one is trying to sell you a hat, right? Um, and, but at the same time, it does really clearly explain the nature of our political conversation right now and understanding attention, you know, politics is the alchemy of, of turning attention and power and democracy. So you have to understand how to, attention moves to understand how to move it, uh, and to, to try to get people to think about things like at our best, more infotainers, you know, and I wish it was just yours, but we're infotainers. You have to be able to say something meaningful, but say it in a way that people want to keep looking because there's so much to look at. The third is The Sum of Us, Heather McGee. I think you've had her on the show. Um, a really great book about the way that division and racism in particular keeps us from being able to build collective public goods. Uh, and I think, you know, when you think about Medicare for All, you think about the questions that get asked at the political level. It helps to guide, uh, us on the questions we're going to have to answer. And I think, you know, when you think about Medicare for All, you think about the answer. Uh, and then the fourth one is The Autobiography of Malcolm X, uh, as told to Alex Haley. Um, and I picked that one because his coming of age in a particular moment, his willingness to be a Jeremiah, the conversation that we often have about the nature of the civil rights movement and how much truth to power you can actually share is worth revisiting right now. Um, but there's also something about truth to pain. And I think we talk a lot about truth to power but I think it's actually a lot harder to speak truth to pain. And I say that as someone who went to medical school, realizing that a lot of our politics right now, we've got to get a lot better at speaking truth to pain. If we're going to get through some of these challenges that we have. What does truth to pain mean? It's one thing to, to look power in the eye and say, you're wrong about this, but there's a way in which pain is very difficult to reason with because when somebody is in their pain, they're in their trauma, they see that pain and they may not see what's causing it. So I remember very explicitly being in a trauma ward with a gunshot wound patient and watching this doctor, this, this guy was just, I mean, big guy with his hand on his gunshot wound and the emergency room doctor, all the folks are trying to pull his hand off of his pain, that point of his gunshot wound, this clear vulnerability. And this doctor had the presence of mind, like everyone stop. And she looks him in the eyes. She's like, I get that really hurts. And I'm so sorry that you're here. You don't want to be here. We don't want you to be here, but if you don't let us fix this, you could die. So I'm going to take your hand and I'm going to move it off. Okay. Because I need to get there so that you can live. And she was speaking truth to pain, which is he understands he's at the hospital. He needs care, but he also doesn't want anybody to touch the wound, which is a natural thing. And I think it is a, is a really great metaphor for how we think about a lot of these challenges we talked about today. I'd be all sad. Thank you very much. Thank you.