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Introducing: Assembly Required with Stacey Abrams · Pod Save America

0:00
Speaker 1: Hey guys, it's Tommy. We're taking a break for the
0:01
Speaker 1: holiday season, but we've got something special for you today.
0:04
Speaker 1: Instead of our usual episode, we're dropping a new one
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Speaker 1: from Assembly Required, hosted by the one and only Stacey Abrams.
0:10
Speaker 1: In this episode, she talks with Celine Gowder, an infectious
0:13
Speaker 1: disease specialist and epidemiologist, about the threats to public health
0:16
Speaker 1: with the incoming Trump administration. They dig into what's at
0:19
Speaker 1: stake with appointees like RFK Jr., how to bring science
0:22
Speaker 1: back into policymaking, and the path forward to driving real change.
0:26
Speaker 1: If 2024 is leaving with a lot of questions about
0:28
Speaker 1: the future, or if you've also found yourself shouting at
0:30
Speaker 1: the TV more than usual, stay tuned for this great episode,
0:33
Speaker 1: because if anyone knows something about not giving up, it's
0:36
Speaker 1: Stacey Abrams. Don't forget to subscribe to Assembly Required wherever
0:39
Speaker 1: you get your podcasts and on YouTube.
0:50
Speaker 2: Welcome to Assembly Required with Stacey Abrams from Crooked Media.
0:54
Speaker 2: I'm your host... Stacey Abrams. Since the election, we've been
0:59
Speaker 2: unpacking how the incoming administration and Project 2025 will actually work,
1:06
Speaker 2: what's possible, and how can we respond. As a reminder,
1:10
Speaker 2: Project 2025 is the 900-page-long policy blueprint published by the
1:16
Speaker 2: conservative think tank, the Heritage Foundation. With a complicit Congress
1:21
Speaker 2: and a compromised Supreme Court, their to-do list could undermine
1:25
Speaker 2: everything we rely on for a just society, from civil
1:29
Speaker 2: rights protections and environmental defenses to public education, free speech,
1:35
Speaker 2: and today's topic, healthcare. When we think about human rights,
1:39
Speaker 2: when we think about the core of what makes us
1:42
Speaker 2: who we are, there is nothing more relevant and more
1:46
Speaker 2: fundamental than healthcare. The ability to participate in society begins
1:53
Speaker 2: with good health. I grew up in a family without
1:56
Speaker 2: health insurance. I grew up knowing that if I got hurt,
1:59
Speaker 2: if it wasn't major, it was going to be treated
2:02
Speaker 2: as minor, not because my parents didn't care, but because
2:05
Speaker 2: they simply didn't have the resources to get access to healthcare.
2:10
Speaker 2: And in fact, since I grew up and got access
2:12
Speaker 2: to healthcare, since my parents finally have health insurance, I
2:16
Speaker 2: can see a night and day difference in the way
2:18
Speaker 2: our lives are lived. And I also feel an incredible
2:22
Speaker 2: degree of privilege because I know what it means to
2:25
Speaker 2: not have healthcare and to have it now. I am
2:29
Speaker 2: also deeply annoyed and sometimes outraged because the fight over
2:34
Speaker 2: healthcare is a fight that the people stopping it don't
2:37
Speaker 2: have to have. Every elected official in Washington, D.C. has healthcare.
2:43
Speaker 2: And it's the height of hypocrisy to deny it to others.
2:47
Speaker 2: And in the wake of COVID-19, Now more than ever,
2:50
Speaker 2: we should understand how vital and essential healthcare as a
2:54
Speaker 2: human right is. So while fighting to protect and improve
3:00
Speaker 2: healthcare in this country is not new, here are some
3:03
Speaker 2: of the ways that healthcare may be impacted by the
3:05
Speaker 2: next administration. One, there is an intent to dismantle or
3:10
Speaker 2: gut the Department of Health and Human Services, which is
3:13
Speaker 2: one of our nation's core agencies. And let's be clear, HHS,
3:17
Speaker 2: as it's called, has a very broad mandate. It's in
3:20
Speaker 2: charge of Medicare, Medicaid, the healthcare marketplace, the Children's Health
3:25
Speaker 2: Insurance Program, the Food and Drug Administration, the National Institutes
3:29
Speaker 2: of Health, the Centers for Disease Control and Prevention. They
3:33
Speaker 2: also cover the human services side. So TANF, the Temporary
3:37
Speaker 2: Assistance for Needy Families, Head Start, Child Care, and Child Support.
3:42
Speaker 2: And that's not an exhaustive list. HHS is under attack.
3:48
Speaker 2: Number two, they want to split the CDC into two agencies,
3:51
Speaker 2: one for data collection and one for public policy recommendations.
3:55
Speaker 2: And this effectively takes away the already limited authority of
3:58
Speaker 2: the CDC to provide public health guidance. It slows emergency response,
4:04
Speaker 2: and it could hurt state and local governments that rely
4:06
Speaker 2: on the CDC for public health guidance, for example, in
4:10
Speaker 2: the case of another pandemic. Number three, they want to
4:14
Speaker 2: tinker with the Food and Drug Administration's drug approval process.
4:17
Speaker 2: For example, take away the approval for mifeprestone. And number four,
4:23
Speaker 2: at the state level, the goal is to turn Medicaid,
4:27
Speaker 2: the vital national health care program that covers the poor,
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Speaker 2: the elderly, the disabled, and some children, to turn that
4:35
Speaker 2: program into block grants, which means that states would have
4:39
Speaker 2: further permission to deny access to health care to the
4:42
Speaker 2: most vulnerable in our society, because states would have less
4:45
Speaker 2: money and limited federal accountability. Okay, so I've just done
4:50
Speaker 2: a very long list of what's at stake. And it's
4:53
Speaker 2: not just about what's in the proposed policy papers from
4:56
Speaker 2: Project 2025. It's about who Trump wants to put in
5:00
Speaker 2: charge of that vast agency.
5:03
Speaker 3: In the words of 77 Nobel laureates in medicine, chemistry, physics,
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Speaker 3: and economics, RFK Jr., at the helm of the Department
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Speaker 3: of Health and Human Services, would put the public's health
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Speaker 3: in jeopardy and undermine America's global leadership in the health sciences.
5:17
Speaker 3: This in a letter addressed to members of the United
5:19
Speaker 3: States Senate, listing off the health secretary nominee's most sensationalist
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Speaker 3: conspiracy theories on public health.
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Speaker 2: The incoming president's decision to nominate Robert F. Kennedy Jr.
5:29
Speaker 2: to be the Secretary of Health and Human Services is
5:32
Speaker 2: indeed a source of much anxiety in the medical and
5:36
Speaker 2: scientific communities. So much so that Nobel laureates, a group
5:41
Speaker 2: that usually tries to stay out of politics, felt compelled
5:44
Speaker 2: to speak up. But there are other nominees. As I mentioned,
5:48
Speaker 2: HHS is huge. So among the list of people whose
5:52
Speaker 2: names are being put forward include Mehmet Oz to lead
5:55
Speaker 2: the Centers for Medicare and Medicaid Services and Marty Makary
5:59
Speaker 2: as the head of the FDA, both of whom have
6:02
Speaker 2: been controversial, to say the least, in their respective medical practices.
6:07
Speaker 2: I've just given you a lot of information. And right now,
6:11
Speaker 2: like almost every day, listening to what's to come can
6:14
Speaker 2: feel like daily doom scrolling. And unlike 2016, when people
6:19
Speaker 2: talked about resistance, this time people have responded by saying
6:24
Speaker 2: they need to protect themselves first. I totally get that.
6:28
Speaker 2: The rule is, put your own mask on first. But
6:32
Speaker 2: we're not on this trip alone. So eventually, we'll need
6:35
Speaker 2: to help our fellow travelers. I'm here to help us
6:39
Speaker 2: prepare for when and how we engage and insist. That
6:44
Speaker 2: begins by understanding what's really at risk versus what's just hateful,
6:49
Speaker 2: wishful thinking. What impact can these proposals have and what's
6:54
Speaker 2: not being said? And as always, how do we fight back?
6:58
Speaker 2: So let's get straight into it with our interview today.
7:05
Speaker 5: Dr.
7:05
Speaker 2: Celine Gounder is an infectious disease specialist, epidemiologist, and a
7:10
Speaker 2: science communicator. She is the editor-at-large for public health at
7:14
Speaker 2: KFF Health News. She produces podcasts and other content to
7:19
Speaker 2: help us understand what's going on in public health, and
7:23
Speaker 2: she was a regular guest on news shows during COVID-19,
7:26
Speaker 2: bringing us grounded, reasonable, and actionable information when misinformation and
7:32
Speaker 2: disinformation are met a wave of panic and worry. Does
7:36
Speaker 2: that sound familiar to anyone? So here to keep us
7:39
Speaker 2: all informed and sane is Dr.
7:41
Speaker 5: Gounder.
7:42
Speaker 2: Thank you so much for being here.
7:44
Speaker 5: It's great to be here. Thanks, Stacey.
7:46
Speaker 3: Dr.
7:46
Speaker 2: Gounder, I have a public health crisis question for you.
7:50
Speaker 2: Are American politicians and policymakers allergic to science?
7:56
Speaker 4: I think this is something that is very much on
7:59
Speaker 4: the mind of those of us working in science, in medicine,
8:03
Speaker 4: in public health and related fields right now. What we
8:07
Speaker 4: saw during the pandemic was really an attack on science
8:10
Speaker 4: and public health because many of the conclusions of the
8:15
Speaker 4: science were politically inconvenient. did not reflect well on certain
8:19
Speaker 4: politicians and leaders. I do think there is room for
8:23
Speaker 4: discussion if we start from a place of shared understanding, facts, science,
8:29
Speaker 4: and then to weigh what are some of the trade-offs,
8:31
Speaker 4: how do you weigh different values, whether it's value of
8:34
Speaker 4: human life, value of an elderly person's life, value of
8:38
Speaker 4: a young student's schooling, et cetera. But I think we
8:41
Speaker 4: have gotten to the point in some of these conversations
8:44
Speaker 4: where instead of having a conversation about values, we are
8:49
Speaker 4: attacking the science, or some of us are attacking the science,
8:54
Speaker 4: because they don't want to have that honest conversation about
8:57
Speaker 4: what they actually value.
9:00
Speaker 5: It's more convenient. It's easier to say the science is wrong.
9:04
Speaker 2: That language is perfect, that it's when science is politically inconvenient.
9:10
Speaker 2: And it's actually a perfect encapsulation of one of the
9:12
Speaker 2: reasons I started with that question. There was the letter
9:15
Speaker 2: from the over six dozen Nobel laureates about RFK Jr.
9:19
Speaker 2: 's appointment to lead the Department of Health and Human Services.
9:23
Speaker 2: And then there's just the incoming Trump administration's overall approach
9:26
Speaker 2: to public health, which seems to be laser focused on
9:30
Speaker 2: finding those who reject science as a foundation for policymaking
9:34
Speaker 2: and giving them the highest appointments possible. These Nobel laureates, though,
9:38
Speaker 2: these chemists and medical professionals and economists, are very deliberate
9:42
Speaker 2: about pointing out that RFK Jr. has no credentials or
9:46
Speaker 2: relevant experience, quote unquote, in science, public health, or medicine,
9:51
Speaker 2: or administration. And as you pointed out, this is a
9:55
Speaker 2: question of value. So how important is it to not
9:58
Speaker 2: only have values decision-making and science-driven decision-making, how important is
10:04
Speaker 2: it to have science and scientific knowledge and experience to
10:09
Speaker 2: be the Secretary of Health and Human Services?
10:12
Speaker 4: I do think Could you be a secretary of health
10:15
Speaker 4: and human services without being a scientist? I mean, we
10:17
Speaker 4: have one right now, Javier Becerra. But he has other
10:20
Speaker 4: skills he brings to the table, being able to manage
10:23
Speaker 4: a large administration, understanding sort of institutional norms and practices.
10:27
Speaker 4: So he does bring a certain skill set. And this
10:30
Speaker 4: is where... your career civil servants are really important, which
10:34
Speaker 4: is to say the scientists, the technical experts who work
10:38
Speaker 4: under numerous different administrations, who are not political appointees, who
10:42
Speaker 4: are not partisan, you can rely on those people to
10:46
Speaker 4: help inform your decision-making, take the science, the expertise that
10:50
Speaker 4: they are using to advise you, and then make decisions
10:54
Speaker 4: that may be partisan decisions, but at least informed by
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Speaker 4: that science. Now, what we're seeing is are conversations coming
11:03
Speaker 4: from the incoming president and his team about eliminating some
11:08
Speaker 4: of those civil service protections to make it easier to fire,
11:12
Speaker 4: hire whomever they want in those scientific technical expert roles.
11:17
Speaker 4: And the problem is if those roles are filled by
11:20
Speaker 4: people who do not have the qualifications, the scientific medical skills,
11:24
Speaker 4: public health expertise, then the person at the top is
11:27
Speaker 4: not going to.
11:28
Speaker 5: Be appropriately counseled.
11:30
Speaker 4: So you don't necessarily yourself as the leader of HHS
11:33
Speaker 4: need to have that expertise, but you do need to
11:36
Speaker 4: have people who have that expertise to advise you.
11:39
Speaker 5: And if we don't have either, then we're in real trouble.
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Speaker 2: Well, that brings us to the other nominees. So while
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Speaker 2: a lot of attention has focused on RFK Jr. heading HHS,
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Speaker 2: The two of the top jobs are also under consideration.
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Speaker 2: And one of the pending nominees is Mehmet Oz. The
11:58
Speaker 2: other is Matt McCurry, both of whom are physicians, but
12:02
Speaker 2: who each have had controversial behaviors. And there have been
12:09
Speaker 2: questions about their fealty to scientific principles in their work
12:13
Speaker 2: or the implications of their policy proposals. So what do
12:17
Speaker 2: their nominations tell you about the incoming administration's thinking about this?
12:22
Speaker 2: So to your point about combining the need for science
12:27
Speaker 2: and for policymaking, what happens when you have a scientist
12:32
Speaker 2: who doesn't seem to believe or at least live those beliefs?
12:37
Speaker 4: You can have differences of opinion as to whether you
12:41
Speaker 4: should mandate masking or vaccination or whether schools should be
12:45
Speaker 4: closed in the context of a pandemic. But you should
12:48
Speaker 4: start at least with a common understanding of what the
12:51
Speaker 4: science is. What we saw, Jay Bhattacharya, who's nominated to
12:56
Speaker 4: head the NIH, and some of his colleagues, Marty Macri,
13:00
Speaker 4: who's now nominated to run the FDA, They came up
13:04
Speaker 4: with estimates of what they thought the infection and death
13:08
Speaker 4: rates for COVID, their estimates were really flawed and very
13:12
Speaker 4: small compared to, very low compared to.
13:15
Speaker 5: What actually played out.
13:16
Speaker 4: And so we do need to start with people who
13:18
Speaker 4: understand how to make these estimates, who understand how to
13:22
Speaker 4: advise us.
13:22
Speaker 5: And say, you know, these are the trade-offs.
13:25
Speaker 4: You with your values, your politics, your partisanship may make
13:27
Speaker 4: different choices, but at least start with that basic level
13:31
Speaker 4: of understanding. And I think that's also what's scary because
13:35
Speaker 4: we may have another pandemic.
13:37
Speaker 5: On our hands before too long. Unfortunately, we in this
13:40
Speaker 5: country have.
13:40
Speaker 4: Not been managing the H5N1 bird flu situation.
13:46
Speaker 5: As well as we could.
13:47
Speaker 4: And that is putting us at risk for a pandemic
13:49
Speaker 4: sooner than later. So these questions are really quite pressing
13:53
Speaker 4: and imminent.
13:54
Speaker 2: And you just pointed out that we are already on
13:58
Speaker 2: shaky ground and this administration is not only rejecting expertise
14:03
Speaker 2: or bringing in people who have demonstrated a flawed use
14:08
Speaker 2: of their expertise, but there's also, as you said at
14:11
Speaker 2: the top of the conversation, this intent to replace civil
14:14
Speaker 2: servants who have that expertise with hires who are based
14:17
Speaker 2: on loyalty and not capacity. You mentioned H5N1 as one
14:22
Speaker 2: of the possible outcomes. Can you talk a little bit
14:25
Speaker 2: more about the implications of this lack of capacity when
14:29
Speaker 2: it comes to public health, not just in terms of pandemics,
14:32
Speaker 2: but just the larger public health universe?
14:35
Speaker 4: Well, one of the things that I think was made
14:37
Speaker 4: very clear during the COVID pandemic is we've very much
14:40
Speaker 4: underinvested in public health. Some of the areas of real
14:45
Speaker 4: need are data systems. When we were dealing with public
14:50
Speaker 4: health departments faxing their data into the CDC to Debbie
14:54
Speaker 4: Birx's team at the White House, that is not something
14:58
Speaker 4: where you can get real-time data, quality data online. Part
15:02
Speaker 4: of the challenge here is, and this is something a
15:04
Speaker 4: lot of people don't understand still, is that public health
15:06
Speaker 4: powers reside at the state level. There's only so much
15:10
Speaker 4: the government, federal government can do. Yes, the federal government
15:13
Speaker 4: provides funding, technical expertise, advice, guidelines, but they're not the
15:17
Speaker 4: ones actually that institute mandates, requirements. Or do the boots
15:21
Speaker 4: on the ground work? And so this creates issues in
15:25
Speaker 4: terms of how well health departments are funded at the
15:28
Speaker 4: state level. Do they have the capacity and funding from
15:30
Speaker 4: their state legislatures to do what's needed, including the data
15:34
Speaker 4: modernization issues? And then do they report that to the CDC?
15:39
Speaker 4: So they can choose not to report. They can choose
15:42
Speaker 4: to report only certain things. The CDC has some levers
15:45
Speaker 4: it can use, tying some of that reporting to funding.
15:48
Speaker 5: But in general, they're not usually too.
15:50
Speaker 4: Aggressive with that because of the potential harms of withholding funding.
16:01
Speaker 2: Can you talk a little bit more about state and
16:03
Speaker 2: local public health preparedness? Because that's one of the issues
16:06
Speaker 2: we try to focus on here on Assembly Required. We
16:10
Speaker 2: have a lot of attention... that necessarily needs to be
16:14
Speaker 2: turned towards the federal government. But often the real levers
16:18
Speaker 2: of power, and particularly the accessible levers of power for
16:22
Speaker 2: our listeners, happen at the state and local level. So
16:24
Speaker 2: can you talk a little bit more about how state
16:27
Speaker 2: and local public health works and how public health preparedness
16:30
Speaker 2: works at that level?
16:32
Speaker 4: Yeah, so the Constitution does not provide public health powers
16:37
Speaker 4: to the federal government. Again, the federal government has the
16:41
Speaker 4: right to tax and spend, to regulate interstate commerce, but
16:46
Speaker 4: that's really the limits on federal powers, and all of
16:51
Speaker 4: the other federal powers really derive from those too. So
16:54
Speaker 4: if you're somebody who's concerned about public health, yes, you
16:58
Speaker 4: should pay attention to national politics, but it really is
17:01
Speaker 4: at the state level and to some degree the local
17:03
Speaker 4: level that you can have the most impact. So, you know,
17:06
Speaker 4: that's where I would say pay attention to what's happening
17:08
Speaker 4: in the state legislature, what your local health department is doing.
17:12
Speaker 4: At the state level, we've seen increasingly public health powers eroded.
17:18
Speaker 4: We've seen some of the recommendations around vaccination being eroded,
17:25
Speaker 4: where you have increasing non-medical exemptions around vaccination, so what
17:30
Speaker 4: vaccines kids need to get to go to school. Another
17:35
Speaker 4: area that you should be paying attention to is public
17:38
Speaker 4: health versus the economy, public health versus industry, it will
17:42
Speaker 4: always be a theme. And so it's sort of balancing
17:46
Speaker 4: those different trade-offs, values. But you do see this play
17:50
Speaker 4: out very concretely, as it is right now with H5N1.
17:54
Speaker 5: There's a reason.
17:55
Speaker 4: Certain states have reported a lot more cases of humans infected.
17:59
Speaker 4: It is very much related to how much testing is happening,
18:03
Speaker 4: also how much testing of the herds, of the milk,
18:06
Speaker 4: This is all related to how aggressive the states have
18:08
Speaker 4: chosen to be.
18:09
Speaker 5: So you have states like Michigan, Colorado, California.
18:11
Speaker 4: Yeah, they're reporting a lot of cases, but it's because
18:14
Speaker 4: they're testing so much. And so we don't have a
18:17
Speaker 4: clear view into what's happening in other states.
18:19
Speaker 5: And why does it play out differently?
18:21
Speaker 4: Well, this is a question of values to some degree
18:25
Speaker 4: and wanting to maybe protect industry from what some of
18:30
Speaker 4: the economic impacts might be of realizing they have a
18:32
Speaker 4: bigger problem on their hands than they want to know.
18:36
Speaker 4: And this is also about the impact of influence of
18:41
Speaker 4: industry in certain states on what happens, right? So if
18:44
Speaker 4: you have a very powerful dairy industry lobby in that state,
18:48
Speaker 4: that's going to be very different from a state where
18:51
Speaker 4: your political interests might be a lot more diverse and varied.
18:53
Speaker 2: Can you think of an example or a time when
18:58
Speaker 2: citizens or local citizens sort of raised the alarm and
19:02
Speaker 2: had an effect at the local or state level Because
19:04
Speaker 2: sometimes it can feel like industry is too big and
19:07
Speaker 2: the problem is too big. We can't do anything about it.
19:10
Speaker 2: You've spent a lot of time advising local and national policymakers.
19:14
Speaker 2: When have you seen citizens actually take what you use
19:18
Speaker 2: and have an effect?
19:19
Speaker 4: We did see a very real impact of citizens in
19:23
Speaker 4: communities on COVID mitigation measures. And this played out differently
19:27
Speaker 4: in different communities. There were communities where people wanted to
19:31
Speaker 4: reopen businesses.
19:33
Speaker 5: They wanted their kids back in school as quickly as possible.
19:36
Speaker 4: There are places where parents had good reason to be
19:39
Speaker 4: very concerned, for example, here in New York City. You
19:42
Speaker 4: had a lot of parents and families of color, lower
19:45
Speaker 4: income neighborhoods, multi-generational households, where they were concerned not just
19:48
Speaker 4: for their kids, but for other family members in the household,
19:51
Speaker 4: what it would mean if their kids were.
19:53
Speaker 5: Back in school before.
19:56
Speaker 4: a lot of people had been vaccinated, what that would
19:59
Speaker 4: mean for elderly relatives living at home. And so what
20:04
Speaker 4: we saw, this sort of patchwork reopening, reflected a lot
20:09
Speaker 4: of those local values. And, you know, some of that
20:14
Speaker 4: was the parents, some of that was teachers who were
20:16
Speaker 4: concerned for themselves. And, you know, whether you agree or
20:21
Speaker 4: disagree with those particular decisions different communities took, you know,
20:25
Speaker 4: regardless of that, aside from that, that was the local
20:29
Speaker 4: community that was the local communities that were dictating those decisions.
20:33
Speaker 2: Well, let's stay there for a second, because, you know,
20:36
Speaker 2: I talked about the allergy to science among policymakers. But
20:40
Speaker 2: there's a second strain that seems to have affected segments
20:44
Speaker 2: of the general public. And, you know, Project 2025 and
20:47
Speaker 2: its acolytes, they tend to harp on the uncertainty of
20:50
Speaker 2: COVID and the changes we adapted to. And as you describe,
20:55
Speaker 2: the uneven and sort of patchwork response, which seemed to
20:58
Speaker 2: prove that nothing was true, therefore nothing would ever be true.
21:02
Speaker 2: You know, there was the, you know, first we all
21:05
Speaker 2: wiped down every surface, and then we realized wiping down
21:07
Speaker 2: every surface wasn't necessary. And opponents of science hold this
21:12
Speaker 2: up as, you know, proof that the public should turn
21:16
Speaker 2: against the scientist. How do you respond to people who
21:20
Speaker 2: might be convinced that no one is right without invalidating
21:24
Speaker 2: how difficult that time was?
21:26
Speaker 4: I think there's a real understanding of what science is
21:29
Speaker 4: and the scientific processes. I think there are people who
21:32
Speaker 4: think scientists are a bunch of liberals who already have
21:34
Speaker 4: an opinion and they just use science to back up
21:37
Speaker 4: that opinion.
21:38
Speaker 5: That is not science.
21:39
Speaker 4: Science is you start with saying, I don't know. Here
21:42
Speaker 4: are some hypotheses. I'm going to try to disprove that hypothesis.
21:47
Speaker 4: And then based on what I learned from that, I'm
21:49
Speaker 4: going to create another experiment and repeat and repeat and repeat.
21:53
Speaker 4: And that means you are going to build your understanding
21:57
Speaker 4: knowledge over time in an incremental way.
21:59
Speaker 5: That's just how science works.
22:01
Speaker 4: You're not going to be able to jump from this
22:04
Speaker 4: is what I think and here's the thing that proves it.
22:06
Speaker 4: It just doesn't work that way. I think most people
22:09
Speaker 4: find that approach to be very counterintuitive.
22:12
Speaker 5: It's not the way we normally think.
22:13
Speaker 4: Normally, we think in what I would call a more
22:15
Speaker 4: lawyerly way, which is to say we already start with
22:18
Speaker 4: this is the conclusion that we want to back up
22:21
Speaker 4: and then we try to find things to support that.
22:24
Speaker 5: And that really does also lead to.
22:26
Speaker 4: Things like cherry picking and confirmation bias and looking for
22:29
Speaker 4: things that will back up what you already believe.
22:33
Speaker 2: So basically, I'm going to translate this into television. We
22:35
Speaker 2: need to be more like Dr. House than we are
22:38
Speaker 2: like Law & Order.
22:39
Speaker 5: I think, yeah, I think that's a great way to
22:41
Speaker 5: put it. Yeah.
22:42
Speaker 2: So as a practical matter, as a practical translation, if
22:46
Speaker 2: I'm having a conversation over the holidays with someone who
22:49
Speaker 2: tells me, well, We didn't get it right in COVID,
22:52
Speaker 2: and that's why I'm not paying attention to H5N1. That's
22:55
Speaker 2: why it doesn't matter who's in charge. What's the pithy
23:00
Speaker 2: response that we want listeners to be able to give,
23:04
Speaker 2: or at least how do they start a conversation in
23:07
Speaker 2: a way that reminds us all of our high school
23:09
Speaker 2: bio classes?
23:10
Speaker 4: Well, I think also to be aware of what your
23:14
Speaker 4: preexisting biases and opinions might be. So to ask them, well,
23:18
Speaker 4: you know, what matters to you? Let's say another pandemic
23:21
Speaker 4: breaks out tomorrow. What would be your number one, two
23:24
Speaker 4: and three concerns and why? What was your experience of
23:28
Speaker 4: the COVID pandemic? And I think starting with that kind
23:31
Speaker 4: of understanding and being aware of why you might already
23:37
Speaker 4: have certain opinions and then also just explaining, you know,
23:41
Speaker 4: what is the scientific process, I think are two different
23:45
Speaker 4: ways to go about this.
23:47
Speaker 2: So part of the genius of Project 2025 and the
23:52
Speaker 2: effectiveness of the Trump administration is approach is that by
23:57
Speaker 2: targeting everything, our attention has nowhere to focus and it's
24:02
Speaker 2: nearly impossible to concentrate. And that is especially true in
24:07
Speaker 2: this assault on health because HHS is such a mammoth
24:11
Speaker 2: agency with so many responsibilities. I gave a little bit
24:15
Speaker 2: of a primer at the top of the episode, but
24:18
Speaker 2: I want to spend a few minutes with you really
24:19
Speaker 2: making sure we understand what the Department of Health and
24:23
Speaker 2: Human Services is and why these attacks matter. So number one,
24:27
Speaker 2: can you break down what we need to understand about
24:30
Speaker 2: the agencies within HHS? And what are you most closely
24:34
Speaker 2: paying attention to?
24:35
Speaker 4: There are many agencies within HHS, but I'll focus just
24:37
Speaker 4: on three. The three big ones are NIH, which does
24:41
Speaker 4: biomedical research, the CDC, which is the nation's public health, well,
24:46
Speaker 4: main public health agency. And then you have the FDA,
24:50
Speaker 4: which is in charge of food and drug safety, most food.
24:54
Speaker 4: You have certain things that fall under the USDA. So
24:59
Speaker 4: why does the NIH matter? NIH is the world's biomedical
25:04
Speaker 4: institution and funder. And a lot of that research actually
25:07
Speaker 4: happens outside of NIH. Some 80-plus percent of the research
25:12
Speaker 4: is actually outside of NIH itself.
25:13
Speaker 5: It's awarded to researchers.
25:15
Speaker 4: At academic medical institutions and other institutions to do that research.
25:20
Speaker 4: And it's a way of really getting a diversity in
25:23
Speaker 4: the kinds of questions being asked, the places where they're
25:26
Speaker 4: being studied. But we have created a system of funding
25:30
Speaker 4: for research where government funds the earlier research, the basic research,
25:36
Speaker 4: And then we leave it to industry to take that
25:39
Speaker 4: research and to turn it into drugs and vaccines and
25:42
Speaker 4: diagnostics and other products. And I think what's unfortunately happened
25:47
Speaker 4: is we as taxpayers fund what the NIH is doing.
25:51
Speaker 4: But if you don't have the pharmaceutical companies, device makers,
25:54
Speaker 4: et cetera, who use that science and then translate that
25:57
Speaker 4: into affordable, accessible products for the population, the general public
26:02
Speaker 4: may not benefit from those investments. And so I think
26:05
Speaker 4: part of what we're seeing is a real frustration with
26:10
Speaker 4: this money being spent on research and people not necessarily
26:14
Speaker 4: feeling the tangible benefits. Now, I would say the COVID
26:17
Speaker 4: vaccines are a great example of a very tangible benefit
26:20
Speaker 4: of 20-plus years of research on mRNA vaccines. We had
26:24
Speaker 4: no idea that COVID was going to come along, but
26:26
Speaker 4: we were very lucky to have had that research already
26:29
Speaker 4: in the can, where we could then pivot to using
26:34
Speaker 4: those for COVID, and we were able to develop vaccines
26:37
Speaker 4: very quickly for COVID. And it's a platform that's really
26:41
Speaker 4: ideal for pandemics because you can so quickly tailor those for.
26:45
Speaker 5: The next pathogen. So you have NIH. Then you have
26:50
Speaker 5: the CDC.
26:51
Speaker 4: The role of the CDC is partly as a funnel, frankly,
26:54
Speaker 4: of funding to state and local health departments.
26:56
Speaker 5: So a lot of the funding does not stay at CDC.
26:59
Speaker 5: It goes down to the ground.
27:01
Speaker 4: But then also to collect data from the state and
27:03
Speaker 4: local health departments to analyze that, to feed that back
27:06
Speaker 4: to the states. We've already talked about some of the
27:08
Speaker 4: data issues there. To also help develop guidelines. And it's
27:13
Speaker 4: not just for vaccination, but for any number of public
27:16
Speaker 4: health issues to provide guidance.
27:18
Speaker 5: And technical support to the states. CDC cannot mandate or
27:22
Speaker 5: enforce any of that. That is, again, at the state
27:25
Speaker 5: and local level.
27:27
Speaker 4: And then you have the FDA, and where people will
27:30
Speaker 4: be most familiar is the FDA's role in approving drugs.
27:34
Speaker 4: This is also something that I think people don't understand
27:37
Speaker 4: is the FDA... Take generics, for example. RFK Jr. has
27:42
Speaker 4: expressed frustration that the FDA is somehow blocking people's access
27:48
Speaker 4: to generic medications for additional indications, so using existing medications
27:53
Speaker 4: for additional uses, those sorts of things.
27:56
Speaker 5: And it's not the FDA.
27:58
Speaker 4: It's essentially a market failure where pharmaceutical companies, again, are
28:04
Speaker 4: the ones that pay for the clinical trials, the studies
28:08
Speaker 4: that determine whether something is safe and effective. They then
28:12
Speaker 4: take that data, they send it to the FDA in application,
28:15
Speaker 4: and they say, will you approve this medication for this purpose?
28:19
Speaker 4: And so if there's not a profit incentive for these
28:22
Speaker 4: companies to do so, the FDA is never going to
28:25
Speaker 4: be able to approve that medication. Now the FDA is
28:29
Speaker 4: partially funded by fees on these companies when they submit
28:33
Speaker 4: an application. That's a decision we've made. So we could
28:37
Speaker 4: decide we're going to use more taxpayer money for vetting
28:41
Speaker 4: these applications. We've decided to partially fund it with these fees.
28:46
Speaker 4: And we've decided that this kind of approach to funding
28:52
Speaker 4: R & D for drugs, diagnostics, vaccines, et cetera, we
28:56
Speaker 4: want that in the private sector. And that is going
28:58
Speaker 4: to have certain implications for what becomes available to people,
29:02
Speaker 4: how accessibly and how affordably.
29:06
Speaker 2: So let's go back to the CDC for one second.
29:09
Speaker 2: When we hear about dividing the CDC, what does that
29:13
Speaker 2: mean and why should we be worried?
29:16
Speaker 4: So this is very much focused on some of the
29:21
Speaker 4: conversations we've had around COVID and vaccines. That's really where
29:25
Speaker 4: this is coming from. So there's a desire by some
29:29
Speaker 4: to divide the CDC into a scientific data gathering institution
29:36
Speaker 4: and then an institution that makes the recommendations and policies.
29:42
Speaker 4: The idea being recommendations and policies may be more political
29:47
Speaker 4: because you are talking about values at that point. How
29:51
Speaker 4: do you value life? At what cost financially? What implications
29:57
Speaker 4: it has on society? And so there's a desire to
30:01
Speaker 4: create a firewall, so to speak, between who publishes the data,
30:05
Speaker 4: gathers the data, and who is making the policy recommendations.
30:11
Speaker 2: When I think about all of these agencies and how
30:14
Speaker 2: they intertwine, one of the conversations then is how easy
30:17
Speaker 2: is it to do this?
30:18
Speaker 5: And I know you.
30:19
Speaker 2: Focus on public health and not necessarily the ins and
30:23
Speaker 2: outs of congressional action, but how easy would it be
30:26
Speaker 2: to divide the CDC or to allow the FDA to
30:30
Speaker 2: rescind the polio vaccination authorization. Are those things that take
30:37
Speaker 2: a lot of time? Are those things that are imminent?
30:39
Speaker 2: Is it something that happens by executive order? Can you
30:42
Speaker 2: talk a little bit about how public health actually gets
30:45
Speaker 2: changed in this country?
30:47
Speaker 4: Yeah, so some of this would need to be congressional action.
30:51
Speaker 4: Some of it could be done by the secretary of
30:53
Speaker 4: HHS and by executive order by the president. This is
30:58
Speaker 4: a very heavy lift to.
31:00
Speaker 5: Do something like this.
31:01
Speaker 4: You've had a number of CDC directors who've tried to
31:04
Speaker 4: reform the agency numerous times, and it is a very
31:08
Speaker 4: time consuming, very challenging thing to take on. you know,
31:14
Speaker 4: in terms of congressional action, you would need that in
31:17
Speaker 4: order to split off certain functions from the CDC and
31:19
Speaker 4: to fund these things independently. In terms of the FDA
31:25
Speaker 4: rescinding authorization for polio vaccines, it really depends on to
31:31
Speaker 4: what degree the incoming president and HHS secretary and FDA
31:36
Speaker 4: commissioner follow what have been institutional norms.
31:40
Speaker 5: Now, do they have the power to.
31:43
Speaker 4: single-handedly do some of these things? Yes, but that would
31:47
Speaker 4: be really extraordinary to see an FDA commissioner or an
31:51
Speaker 4: HHS secretary taking that kind of action, and that there
31:54
Speaker 4: are processes for withdrawing an approval. You would definitely see
32:01
Speaker 4: lawsuits from the pharmaceutical companies that produce these products if
32:05
Speaker 4: there was threat of rescinding of an approval, and they
32:09
Speaker 4: would have standing in terms of, is there actually science
32:14
Speaker 4: to support whether these actions are evidence-based and warranted?
32:20
Speaker 3: Yeah.
32:22
Speaker 2: And I would also throw out there that there are
32:24
Speaker 2: budgetary implications, and that means Congress gets involved. And when someone,
32:28
Speaker 2: let's say Mitch McConnell, flags that he is very unhappy
32:33
Speaker 2: about the threat to the polio vaccine, his lever of
32:36
Speaker 2: power is whether or not something moves through, even though
32:39
Speaker 2: he's not going to be the majority leader, he has
32:42
Speaker 2: a vote in the Senate and a little bit of influence.
32:45
Speaker 2: So I want folks to understand that the straightforward demand
32:51
Speaker 2: for action does not necessarily translate into immediacy of that
32:55
Speaker 2: action being taken. Would you agree?
32:58
Speaker 5: No, I do agree.
33:00
Speaker 4: Because right now you have budgetary lines for the CDC.
33:03
Speaker 4: You do not have budgetary lines for these separate agencies.
33:06
Speaker 5: That they're proposing.
33:07
Speaker 4: So you really do need to have congressional action to
33:10
Speaker 4: implement that kind of split.
33:12
Speaker 2: Fantastic. So health is not simply the ability to know
33:17
Speaker 2: what diseases and threats are out there. It's also about
33:21
Speaker 2: the ability to get help. And that means we also
33:24
Speaker 2: have to pay attention to the health care access side
33:27
Speaker 2: of things. So, for example, Project 2025 proposes to roll
33:31
Speaker 2: back the progress that the Biden administration has made in
33:34
Speaker 2: reducing drug prices. It also wants to accelerate the privatization
33:38
Speaker 2: of Medicare, which older and disabled Americans rely on. And
33:42
Speaker 2: they want to break up Medicaid into block grants, which
33:45
Speaker 2: will set fixed amounts that go to states, regardless of
33:48
Speaker 2: the actual cost of health care or the size or
33:50
Speaker 2: needs of the population. What are you concerned about when
33:54
Speaker 2: it comes to this administration's impact on healthcare access? And
34:00
Speaker 2: how would you process this information as a layperson?
34:03
Speaker 4: Well, if you read Project 2025, they literally spell out
34:08
Speaker 4: that the cost of Medicare and Medicaid combined since 1967,
34:12
Speaker 4: which is when these programs were started, is about $ 17.
34:15
Speaker 5: 8 trillion. And the U.S. deficits for that same time
34:16
Speaker 5: period are $ 17. 9 trillion.
34:17
Speaker 4: So in other words, They are pretty clear in that
34:26
Speaker 4: they think that Medicare and Medicaid are the principal drivers
34:30
Speaker 4: of our national debt. And if we want to eliminate
34:33
Speaker 4: our national debt, we need to dramatically scale back, if
34:37
Speaker 4: not eliminate, Medicare and Medicaid. That's essentially what's implied in
34:41
Speaker 4: what's written in Project 2025. There are several strategies to
34:47
Speaker 4: try to scale back spending, one of which is, as
34:50
Speaker 4: you mentioned, privatization of Medicare. A lot of people who
34:55
Speaker 4: have Medicare Advantage plans may think they're getting a very
34:58
Speaker 4: good deal. They get dental, vision benefits, maybe other perks
35:02
Speaker 4: thrown in. And it's great until they need to see
35:06
Speaker 4: a doctor, they get hospitalized, and then realize that their
35:09
Speaker 4: coverage is actually really inferior to what they might have
35:13
Speaker 4: had if they had traditional Medicare.
35:16
Speaker 5: You mentioned the.
35:19
Speaker 4: Medicare's authority to negotiate drug prices under the Inflation Reduction Act.
35:24
Speaker 4: This is an area where the incoming administration is under
35:27
Speaker 4: pressure to roll back that authority. Then this has very
35:33
Speaker 4: tangible impacts for people. One of the drugs that was
35:38
Speaker 4: likely going to be in the next round of drug
35:40
Speaker 4: negotiations is semaglutide, also known as Ozempic or Wigovi. A
35:45
Speaker 4: lot of people are desperate to get access to that medication.
35:50
Speaker 5: Currently is very expensive.
35:52
Speaker 4: The Biden administration has recommended or has proposed new guidance
35:59
Speaker 4: that Medicare can cover these medications, also known as GLP-1
36:04
Speaker 4: weight loss drugs, for people even if they don't have
36:06
Speaker 4: diabetes or cardiovascular disease, but simply because they have obesity.
36:12
Speaker 4: And it will be up to the incoming administration to
36:16
Speaker 4: finalize that rule.
36:17
Speaker 5: Whether they will or not, we don't know. But then
36:20
Speaker 5: if they do and.
36:21
Speaker 4: They don't make use of that lever to negotiate down
36:25
Speaker 4: drug prices for, you know, including the GLP-1 drugs, that
36:30
Speaker 4: would have huge cost implications for Medicare. So it's a
36:33
Speaker 4: little hard to know how each of these pieces will
36:37
Speaker 4: play out. With respect to Medicaid, you mentioned block grants
36:41
Speaker 4: to the states. That's a great way if you're looking
36:44
Speaker 4: to cut your Medicaid costs, federal spending on Medicaid, to
36:48
Speaker 4: do so. What we're also seeing are conversations about reducing
36:52
Speaker 4: the federal amount that's being provided for that. So both
36:57
Speaker 4: states and the federal government put money in for Medicaid.
37:01
Speaker 4: But if we see a reduction in the federal contribution,
37:04
Speaker 4: some states that have expanded Medicaid may reverse that decision.
37:09
Speaker 4: We've seen more and more red states expand Medicaid, North Carolina,
37:13
Speaker 4: for example, And that's because there was an understanding that
37:16
Speaker 4: this actually was good for their bottom line. And it
37:19
Speaker 4: had an impact not only on patients, but also on
37:23
Speaker 4: rural communities where prior to expansion of Medicaid, many rural
37:28
Speaker 4: hospitals were really in financial trouble.
37:31
Speaker 5: Many still are.
37:32
Speaker 4: But we've seen many of these facilities close. And Medicaid
37:35
Speaker 4: was a lifeline. Expansion of Medicaid was a lifeline to
37:38
Speaker 4: many of these facilities. to keep them open and also
37:41
Speaker 4: to keep many of those jobs at those health facilities
37:45
Speaker 4: still available. So those are some of the things that
37:50
Speaker 4: we could anticipate with respect to Medicare and Medicaid.
37:59
Speaker 2: So you know a lot and you have been all
38:03
Speaker 2: over the world, all over the U.S., You decided to
38:10
Speaker 2: take your experience in epidemiology, but you've really channeled it
38:15
Speaker 2: into sharing information in a way that is extraordinarily accessible.
38:19
Speaker 2: You and I met actually in the midst of the
38:22
Speaker 2: COVID pandemic and you invited me to be on a podcast,
38:27
Speaker 2: but it was such an important conversation because you're just
38:32
Speaker 2: a really fantastic communicator on really complicated issues. Was there
38:37
Speaker 2: an inciting incident for you that made you decide, I
38:41
Speaker 2: not only have to know what I know, I need
38:42
Speaker 2: other people to understand what I know?
38:45
Speaker 4: Yeah, so it was a process of years, really, to
38:49
Speaker 4: come to this point. But I think some of it
38:51
Speaker 4: was what I experienced working in Southern Africa. I started
38:54
Speaker 4: my career working in global health and tuberculosis and HIV.
38:57
Speaker 4: was often asked to moderate town hall meetings, meetings with
39:02
Speaker 4: patient advocates, informing policymakers, both overseas as well as on
39:07
Speaker 4: the Hill in the U.S.
39:09
Speaker 5: So that sort of planted the seed.
39:11
Speaker 4: But then I had pivoted from global health to domestic
39:15
Speaker 4: health around 2012, was an assistant commissioner of health at
39:19
Speaker 4: the New York City Department of Health. And we were
39:22
Speaker 4: dealing with massive cuts to public health funding in the
39:26
Speaker 4: aftermath of the 08-09 recession. And in year one on
39:30
Speaker 4: that job, I was tasked with having to cut essentially
39:33
Speaker 4: 20% of my bureau of 250 people, so 50 people
39:37
Speaker 4: out of 250.
39:38
Speaker 5: That's huge.
39:40
Speaker 4: And what I realized coming out of that was we
39:43
Speaker 4: will not fund public health if people don't even understand
39:46
Speaker 4: what it is.
39:47
Speaker 5: People at least need to understand what it is.
39:48
Speaker 4: And then you can decide, is this something valuable or not?
39:51
Speaker 4: But I would argue that coming out of the pandemic,
39:53
Speaker 4: people still don't understand what public health is. They often
39:55
Speaker 4: confuse public health and health care. And so that's really
39:59
Speaker 4: what motivated me was I wanted people to be armed
40:03
Speaker 4: with the facts, to be informed citizens, and then to
40:06
Speaker 4: make decisions, you know, however they want to based on
40:08
Speaker 4: that information. Okay.
40:10
Speaker 2: So here's your platform. Tell people the difference between public
40:14
Speaker 2: health and health care and how they should describe it
40:17
Speaker 2: when they're sitting around the dinner table.
40:19
Speaker 5: Yeah.
40:20
Speaker 4: So health care is what people are more familiar with, right?
40:22
Speaker 4: It's what happens in the clinic, in the hospital. It
40:25
Speaker 4: is very individual patient focused.
40:29
Speaker 5: Public health is.
40:32
Speaker 4: largely funded by the government, which is in contrast to
40:36
Speaker 4: health care. Much of health care is in the private
40:38
Speaker 4: sector in this country.
40:39
Speaker 5: Not all of it. Medicare is a great example.
40:41
Speaker 4: Medicare, by the way, is socialized medicine, which people don't
40:43
Speaker 4: want to hear, but it is. So you have largely
40:48
Speaker 4: taxpayer money, some philanthropic foundation money, maybe some public-private partnership,
40:54
Speaker 4: but most of public health is taxpayer dollars. It is
40:57
Speaker 4: looking at health from a population, public, hence public health perspective.
41:03
Speaker 4: And so it's not decision-making for an individual patient. And
41:06
Speaker 4: I think this is one area where People got frustrated
41:09
Speaker 4: during the pandemic because you had these blanket recommendations for
41:13
Speaker 4: how do we reduce disease and death at the population level?
41:17
Speaker 4: And some people would say, yeah, but that's not me.
41:19
Speaker 4: And so they would not see themselves at being at risk,
41:23
Speaker 4: for example, and are not necessarily thinking about not just what, say,
41:29
Speaker 4: COVID infection means for them, but what it might mean
41:31
Speaker 4: for the people around them. And so those are just
41:33
Speaker 4: different ways of how do you weigh risk.
41:37
Speaker 5: And benefit of certain different things.
41:42
Speaker 4: Another way to think about public health is it's all
41:44
Speaker 4: the stuff that does not happen in a clinic or hospital.
41:47
Speaker 4: It's all the stuff like what's your air quality, your
41:50
Speaker 4: water quality?
41:52
Speaker 5: What is the safety of your neighborhood? Is it so
41:55
Speaker 5: violent you can't go out for a walk and exercise
41:57
Speaker 5: in your neighborhood?
41:58
Speaker 4: What is your access to healthy food? You know, those
42:01
Speaker 4: are the kinds of things we think about in public health.
42:03
Speaker 4: And that's not something you address with a prescription pad
42:06
Speaker 4: or a surgery. A lot of our levers in public
42:08
Speaker 4: health are really about policy and how do you shift
42:12
Speaker 4: the needle through policy.
42:15
Speaker 2: Which brings us to the doing section of this conversation.
42:20
Speaker 2: You have been such a thoughtful partner to powerful people.
42:25
Speaker 2: But as you pointed out, you've also been doing that
42:28
Speaker 2: work with local organizations, with town hall meetings, helping citizens
42:33
Speaker 2: understand their power. How do we as individuals push back
42:40
Speaker 2: and meet this moment? We know there has been a
42:42
Speaker 2: recent tragedy in where vigilante justice seemed like a solution
42:48
Speaker 2: to someone. But we know that that's not the answer.
42:52
Speaker 2: So how do we think about what else we can do?
42:55
Speaker 2: We know we talk about voting. And for some, that
42:58
Speaker 2: didn't seem to work this time. It does work. It
43:00
Speaker 2: just doesn't work all the time in the ways we
43:02
Speaker 2: want it to work. But how do we talk about
43:05
Speaker 2: starting at the local level, using public health as the
43:09
Speaker 2: point of entry? Give us our marching orders. What do
43:12
Speaker 2: we do?
43:14
Speaker 4: You know, with respect to the UnitedHealthcare CEO's assassination murder,
43:20
Speaker 4: I found that profoundly disturbing because it speaks to how
43:24
Speaker 4: disempowered even this highly educated, privileged young man, how disempowered
43:30
Speaker 4: he felt in fighting the issues with our healthcare system.
43:34
Speaker 4: And yes, our healthcare system is horrible. We spend more
43:37
Speaker 4: than any other country in the world. We have the
43:40
Speaker 4: worst outcomes of any high income country. And by the way,
43:44
Speaker 4: healthcare itself only predicts about 10% to 20%.
43:49
Speaker 5: Of life expectancy of people's health outcomes. And so a
43:52
Speaker 5: lot of what needs to be done to improve people's
43:54
Speaker 5: health is not in health care.
43:55
Speaker 4: Again, it's in public health. It's about 80%, 90% of
43:59
Speaker 4: the game is in public health. What really upset me
44:03
Speaker 4: about that incident was people are so disempowered that they
44:08
Speaker 4: feel like they have no choice but vigilante justice, but
44:12
Speaker 4: political violence. And that's a very scary place to be
44:15
Speaker 4: when people don't believe in voting, in government institutions, in
44:20
Speaker 4: meeting with their local officials. Yes, all of that takes time.
44:24
Speaker 4: It does take time to get informed, to understand the issues.
44:27
Speaker 4: to reach out to those people and to talk to them.
44:30
Speaker 4: But I think that is where we really need to
44:32
Speaker 4: be encouraging people to get involved is do those things.
44:39
Speaker 2: D.C.
44:39
Speaker 4: Might seem very far away. And again, a lot of
44:42
Speaker 4: the action is not in D.C. for these issues. It
44:45
Speaker 4: is in your state It's in your city. Get involved
44:48
Speaker 4: at that level. In New York City, for example, we
44:50
Speaker 4: have these community health boards, and I've met with a
44:52
Speaker 4: bunch of them over the last several years during the
44:54
Speaker 4: pandemic to educate them. These are concerned citizens who are
44:58
Speaker 4: really trying to do what they can to make their
45:00
Speaker 4: communities healthier. And yes, that Again, it takes time, it
45:04
Speaker 4: takes lots of people, but that's where you can have
45:07
Speaker 4: a very tangible impact. So that's really the level at
45:11
Speaker 4: which I would encourage people. The powers are there. These
45:14
Speaker 4: are really kitchen table concerns people have. Like it's what's happening,
45:20
Speaker 4: I don't know, with pollution near the school where your
45:23
Speaker 4: kids goes to school. It's what's happening with gun violence
45:27
Speaker 4: in your neighborhood. It's the opioid overdoses. You know, your neighbors,
45:30
Speaker 4: you're talking about so-and-so lost their son. These are things
45:33
Speaker 4: that are very tangible to people where you can get involved.
45:37
Speaker 4: And it doesn't have to be a partisan thing.
45:40
Speaker 2: Dr. Celine Gounder, thank you so much for joining us
45:43
Speaker 2: here and informing us here at Assembly Required. At Assembly Required,
45:51
Speaker 2: we encourage the audience to be curious, solve problems, and
45:55
Speaker 2: do good through a segment we call Our Toolkit. Now,
46:00
Speaker 2: we're going to fight the allergy to science and information
46:03
Speaker 2: by being curious. During my time in the Georgia State Legislature,
46:07
Speaker 2: I relied heavily on KFF News, and it's still my go-to.
46:12
Speaker 2: KFF News is an independent source with news and health
46:15
Speaker 2: policy research, so sign up for their newsletters at KFF.org.
46:21
Speaker 2: For regular listeners, you're going to notice that today I'm
46:24
Speaker 2: doing things a little differently. You see, we've gotten quite
46:27
Speaker 2: a few listener questions that have a running theme. First,
46:32
Speaker 2: Ed Bogue wrote an email titled How to Be an
46:35
Speaker 2: Activist with Social Anxiety. He writes, Since the election, I
46:40
Speaker 2: have felt energized to help defend human rights, but severe
46:43
Speaker 2: social anxiety has been a major barrier for me. Even
46:47
Speaker 2: when it's just low-stakes small talk, My throat gets so
46:50
Speaker 2: dry that I can barely speak, and years of customer
46:53
Speaker 2: service work hasn't helped me overcome this. How do I
46:56
Speaker 2: get involved and make a difference when so much of
46:59
Speaker 2: the work is about connecting people? Number two, Muyan Chen
47:05
Speaker 2: wrote about wanting to be politically engaged even though she
47:09
Speaker 2: just has a green card. I came to the U.S.
47:12
Speaker 2: from China more than 10 years ago and now work
47:15
Speaker 2: as a researcher in a national lab. Being a foreign national,
47:19
Speaker 2: with a green card now. It's been quite stressful to
47:22
Speaker 2: watch the events unfolding, but it seems difficult to do
47:25
Speaker 2: anything about it legally. I'm wondering if there are anything
47:29
Speaker 2: such as volunteer opportunities that I can contribute to. And
47:33
Speaker 2: number three, a caller whose name I didn't quite catch
47:37
Speaker 2: called in and left a voicemail responding to the Heather
47:40
Speaker 2: Cox Richardson episode. She writes, I've been getting myself and
47:45
Speaker 2: my small online community to call our representative every day
47:48
Speaker 2: and leave messages with them, as well as an email.
47:52
Speaker 2: Just kind of letting them know, you know, what we
47:54
Speaker 2: think and what we need from them. And so I'm
47:57
Speaker 2: just wondering, are there specific folks we could be calling
48:00
Speaker 2: and writing? I like the idea of a bunch of
48:02
Speaker 2: us doing this kind of small thing together. We've been
48:06
Speaker 2: calling individual members that we can, also writing and calling
48:09
Speaker 2: our senators about Trump's nominations to his cabinet, but just
48:12
Speaker 2: looking for any other ideas for folks to call. Now, normally,
48:17
Speaker 2: this is where I'd either answer your questions or give
48:19
Speaker 2: you resources on what to do about what we just discussed,
48:22
Speaker 2: like public health. But today, we're going to begin a
48:25
Speaker 2: capsule course. In grassroots organizing, Ed's social anxiety means we
48:30
Speaker 2: just find a different way for him to contribute to
48:32
Speaker 2: the cause, like setting up agendas or coordinating resources. For Muyan,
48:38
Speaker 2: her expertise can be a major asset in finding information
48:42
Speaker 2: and developing communication systems. And for our phone warrior... you're
48:46
Speaker 2: in the midst of convening advocates to push our agenda
48:50
Speaker 2: for good. Because here at Assembly Required, we know we
48:54
Speaker 2: can start solving problems by showing up and taking action.
48:59
Speaker 2: Over the next several episodes, we're going to use this
49:02
Speaker 2: segment to talk about concrete steps that we can take
49:05
Speaker 2: towards insisting that political leaders do their jobs. Federal action
49:11
Speaker 2: will obviously matter, and absolutely it's important. But what I
49:15
Speaker 2: hope you've heard over these many episodes is that we're
49:18
Speaker 2: here to win. However, winning won't be fast, and it
49:23
Speaker 2: will require many of us across the country to take
49:26
Speaker 2: on different parts of the problem and combine our successes.
49:31
Speaker 2: And that means often working at the local level so
49:34
Speaker 2: we can one day have federal impact. This is not
49:37
Speaker 2: in lieu of federal action. It's in addition to. Let's
49:40
Speaker 2: get started. Our first step is identifying the issue that
49:44
Speaker 2: matters to you most. Is it your state's refusal to
49:47
Speaker 2: expand Medicaid, book bans in your local school district, a
49:51
Speaker 2: food desert that seems to be growing? Do you need
49:55
Speaker 2: to launch a tenant's union? Pick one as your tester pancake,
49:59
Speaker 2: the issue that you want to start with. So over
50:02
Speaker 2: the holidays, your task is to decide on the issue
50:06
Speaker 2: you want to tackle. Be as specific as possible about
50:10
Speaker 2: the problem. And also, be as local as you can
50:14
Speaker 2: with the solution. If the city council can solve it,
50:18
Speaker 2: start there. If it's the county commission, know it. Does
50:22
Speaker 2: the state have jurisdiction? If so, that's your target. Take
50:27
Speaker 2: the time to know who's in charge and who can
50:30
Speaker 2: make the change you want to see. This is called
50:33
Speaker 2: power mapping. So find out as much as you can
50:36
Speaker 2: about the issue... who's responsible, and who else is already
50:41
Speaker 2: working on it. Check social media and Google to see
50:44
Speaker 2: if anyone else is talking about this issue. Write it
50:47
Speaker 2: all down, and let's get ready to go to work.
50:51
Speaker 2: As we close, I want to share one last listener comment,
50:55
Speaker 2: and this is from Emily Drake. She writes, I wanted
50:58
Speaker 2: to thank you, first of all, for answering my question
51:01
Speaker 2: a few weeks ago. After hearing your answer and listening
51:04
Speaker 2: to this week's episode about the education system, I have
51:08
Speaker 2: decided to go back to teaching public school and to
51:11
Speaker 2: get involved as much as possible. I taught public school
51:14
Speaker 2: for seven years and I've had a few years off
51:17
Speaker 2: staying home with my kids. But I think it's a
51:19
Speaker 2: good time to go back and use my skills for good.
51:23
Speaker 2: So thank you. I appreciate all you do. Well, thank you, Emily,
51:26
Speaker 2: for sharing and for telling me how you're getting to work.
51:30
Speaker 2: And if any of you want to tell us what
51:32
Speaker 2: you've learned, how you've solved a problem, or how you've
51:35
Speaker 2: rejoined the fight, send us an email at assemblyrequired at crooked.com
51:40
Speaker 2: or leave us a voicemail. Your questions and comments might
51:43
Speaker 2: be featured on the pod. Our number is 213-293-9509. I
51:51
Speaker 2: wanted to say thank you. Thank you for listening. Thank
51:54
Speaker 2: you for engaging. Thank you for letting us know that
51:57
Speaker 2: we're coming together and we're getting to work. That wraps
52:00
Speaker 2: up this episode of Assembly Required with Stacey Abrams. I'll
52:03
Speaker 2: meet you here next week. Assembly Required with Stacey Abrams
52:11
Speaker 2: is a Crooked Media production. Our lead show producer is
52:14
Speaker 2: Alona Minkowski, and our associate producer is Paulina Velasco. Kirill
52:19
Speaker 2: Poloviev is our video producer. This episode was recorded and
52:22
Speaker 2: mixed by Evan Sutton. Our theme song is by Vasilis Fotopoulos.
52:27
Speaker 2: Thank you to Matt DeGroat, Kyle Seglin, Tyler Boozer, and
52:31
Speaker 2: Samantha Schlossberg for production support. Our executive producers are Katie Long,
52:36
Speaker 2: Madeline Herringer, and me, Stacey Abrams.