Assembly Required with Stacey Abrams: Episode Summary

Episode Title: How to Combat Project 2025’s Dangerous Prescription for Public Health
Release Date: December 19, 2024
Host: Stacey Abrams
Guest: Dr. Celine Gounder, Infectious Disease Specialist and Epidemiologist

Introduction

In this pivotal episode of Assembly Required with Stacey Abrams, host Stacey Abrams delves deep into the threats posed by Project 2025—a comprehensive 900-page policy blueprint from the Heritage Foundation aimed at reshaping America's public health landscape. Joined by Dr. Celine Gounder, a renowned infectious disease specialist and science communicator, the discussion underscores the urgency of safeguarding public health against emerging political maneuvers.

Understanding Project 2025 and Its Implications

Stacey Abrams opens the conversation by framing Project 2025 as a formidable agenda that, with the support of a complicit Congress and a compromised Supreme Court, seeks to dismantle key components of America's public health infrastructure. "When we think about human rights, when we think about the core of what makes us who we are, there is nothing more relevant and more fundamental than health care," Abrams emphasizes (01:46).

Threats to the Department of Health and Human Services (HHS)

Dr. Gounder outlines four primary strategies within Project 2025 that threaten the integrity of the Department of Health and Human Services (HHS):

1. Dismantling HHS: Intent to gut HHS, a cornerstone agency overseeing Medicare, Medicaid, the Health Care Marketplace, and more. "HHS is under attack," Gounder states (03:18).

2. Splitting the CDC: Dividing the Centers for Disease Control and Prevention (CDC) into separate entities for data collection and public policy recommendations, thereby undermining its authority to provide cohesive public health guidance (03:16).

3. Altering FDA Processes: Manipulating the Food and Drug Administration's drug approval process, including attempts to revoke approvals for critical medications like Mifeprestone (04:31).

4. Transforming Medicaid: Converting Medicaid into block grants, reducing federal oversight and enabling states to restrict access to healthcare for the most vulnerable populations (04:33).

Controversial Leadership Nominations

A significant concern highlighted is the incoming administration's nominations for key HHS positions:

• Robert F. Kennedy Jr. (RFK Jr.): Supported by Project 2025, RFK Jr.'s appointment has elicited backlash from the scientific community. "77 Nobel laureates... have expressed that RFK Jr. would put the public's health in jeopardy," Abrams relays (05:13).

• Mehmet Oz and Marty Makari: Both nominees for the Centers for Medicare and Medicaid Services (CMS) and FDA, respectively, have controversial backgrounds that raise questions about their commitment to scientific principles (05:55).

Dr. Gounder remarks, "The incoming administration's overall approach to public health seems to be laser-focused on finding those who reject science as a foundation for policymaking and giving them the highest appointments possible" (09:10).

Impact on Healthcare Access: Medicare and Medicaid

Project 2025 targets massive restructuring of Medicare and Medicaid:

• Medicare Privatization: Accelerating the privatization of Medicare could lead to inferior coverage compared to traditional Medicare, impacting elderly and disabled Americans (35:26).

• Medicaid Block Grants: Turning Medicaid into block grants would cap federal funding regardless of states' healthcare needs, potentially forcing states to reduce or eliminate coverage for vulnerable populations (35:40).

Dr. Gounder highlights the fiscal motivations behind these moves: "Project 2025... they think that Medicare and Medicaid are the principal drivers of our national debt" (35:57).

State and Local Public Health Preparedness

The discussion shifts to the critical role of state and local governments in public health:

• Decentralized Public Health Powers: "Public health powers reside at the state level," explains Dr. Gounder (15:44). This decentralization means that state legislatures and local health departments are pivotal in implementing and responding to public health initiatives.

• Challenges: Underinvestment in public health infrastructure, such as outdated data systems and insufficient funding for state health departments, hampers effective response to health crises like pandemics (14:22).

• Examples of Action: States like Michigan, Colorado, and California demonstrate robust reporting and testing practices, contrasting with others where industrial influences may hinder comprehensive public health responses (18:26).

Distinguishing Public Health from Healthcare

A key segment of the episode clarifies the essential differences between public health and healthcare:

• Healthcare: Focuses on individual patient care within clinics and hospitals, predominantly funded by the private sector and Medicare.

• Public Health: Encompasses population-level health initiatives funded largely by taxpayer dollars, addressing issues like air and water quality, neighborhood safety, and access to healthy food (43:30).

Dr. Gounder emphasizes, "Public health is looking at health from a population, public perspective... it's not decision making for an individual patient" (43:21).

Combatting Anti-Science Sentiment

Addressing the growing skepticism towards science among policymakers and the public, Dr. Gounder and Abrams discuss strategies to reinforce the importance of evidence-based decision-making:

• Educational Approach: Encouraging conversations that start with shared facts and scientific understanding before addressing value-based decisions (07:37).

• Countering Misinformation: "Science is... you start with saying, I don't know, here are some hypotheses, I'm going to try to disprove that hypothesis," Dr. Gounder explains, advocating for a more scientific approach over biased, confirmation-driven reasoning (08:50).

Action Steps for Citizens

The episode concludes with actionable steps for listeners to protect and promote public health:

1. Identify Local Issues: Choose specific, local public health concerns to address, whether it's Medicaid expansion, vaccine mandates, or environmental health issues (51:54).

2. Engage with Local Authorities: "Get involved at that level... what's happening with pollution near the school where your kids go to school," advises Dr. Gounder (47:00).

3. Utilize Community Resources: Join or form community health boards and participate in local health initiatives to make tangible impacts (46:24).

4. Educate and Advocate: Distinguish between public health and healthcare in conversations to foster a better understanding and support for public health measures (45:26).

Conclusion

Stacey Abrams and Dr. Celine Gounder underscore the critical need for informed, localized action to counteract the sweeping changes proposed by Project 2025. By empowering citizens to engage at the community level and advocating for robust public health infrastructure, the episode reinforces the message that collective, informed efforts can safeguard America's health future.

Notable Quotes:

• Stacey Abrams (01:46): "There is nothing more relevant and more fundamental than health care. The ability to participate in society begins with good health."

• Dr. Celine Gounder (09:10): "This is a question of value... What matters to you? Let's say another pandemic breaks out tomorrow. What would be your number one, two, and three concerns and why?"

• Dr. Celine Gounder (43:21): "Public health is looking at health from a population, public perspective... it's not decision making for an individual patient."

• Stacey Abrams (26:53): "As we close, I want to share one last listener comment... why it seems difficult to do anything about it legally."

Timestamp Guide:

• 01:46 - Introduction to Health Care as a Human Right
• 03:16 - Threats to Department of Health and Human Services
• 03:18 - Overview of HHS Responsibilities
• 04:31 - CDC and FDA Threats
• 05:13 - Nobel Laureates' Concerns about RFK Jr.
• 05:55 - Controversial Nominees Mehmet Oz and Marty Makari
• 07:37 - Are Politicians Allergic to Science?
• 08:50 - Science as Politically Inconvenient
• 09:10 - Incoming Administration’s Approach to Public Health
• 14:22 - Public Health Preparedness at State and Local Levels
• 15:44 - Funding and Data Challenges in Public Health
• 18:26 - State-Level Public Health Actions
• 26:53 - Listener Comments and Action Steps
• 35:26 - Impact on Medicare and Medicaid
• 43:21 - Distinguishing Public Health from Healthcare
• 45:26 - Public Health as a Point of Entry for Action
• 46:24 - Encouraging Local Involvement and Avoiding Partisanship
• 51:54 - Grassroots Organizing and Citizen Engagement

This summary aims to encapsulate the essence of the episode, providing listeners and non-listeners alike with a comprehensive understanding of the critical discussions surrounding Project 2025 and its potential impact on American public health.