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- [00:13]
Kara Swisher
Hi everyone from New York Magazine and the Vox Media Podcast network. This is on with Kara Swisher. And I'm Kara Swisher. Today I'm talking about the incoming administration's approach to health care, especially RFK Jr. President elect Donald Trump's pick for Secretary of the Department of Health and Human Services, and a man who has some extremely unorthodox ideas about public health. HHS isn't the sexiest agency in the federal government, but it is one of the most consequential. I want to focus on it because I think it's critically important to think about public health right now, and it's really critical that we don't have people with questionable theories in charge of it, especially when people's lives are at risk. My guests for this conversation are critically important, too. They're Dr. Zeke Emanuel, Dr. Celine Gounder, and Donald McNeil Jr. Dr. Emanuel has written and edited 15 books and over 300 scientific articles. He has way too much experience to list here, but Emanuel was the chief of the Department of Bioethics at the National Institutes of Health, one of the architects of the Affordable Care act, and he teaches at the University of Pennsylvania. Dr. Celine Gounder is an internist, infectious disease specialist and epidemiologist, a CBS News medical contributor and editor at large for Public health at KFF Health News, and she teaches at New York University. Donald McNeil wrote for the New York Times from 1970 to 2021, where he was a health and science reporter and the lead reporter on the COVID beat. I have huge respect for him. He won the prestigious John Chancellor Award in 2020 and was on the New York Times team that won the Pulitzer Prize for public service in 2021. This is a powerhouse group of experts. They're not just smart and experienced. They're very opinionated and they have plenty of disagreements. And they're not part of what a lot of anti science people think is the deep state. They are smart and interesting people. We should listen. Stick around.
- [02:23]
Crucible Moments
Support for this show comes from Crucible Moments, a podcast from Sequoia Capital. We've all had turning points in our lives where the decisions we make end up having lasting consequences. No one knows this better than the founders of some of today's most influential tech companies. Crucible Moments is a podcast series that lets listeners in on the make or break events that define major companies like Natera, Dropbox, Nubank, and more. Tune into the new season of Crucible Moments now. You can listen@CrucibleMoments.com or wherever you listen to podcasts.
- [02:58]
Lingo by Abbott
Support for On with Kara Swisher comes from Lingo by Abbott. Talking about healthy habits is a lot easier than actually implementing them. The key is finding out what works for you and your body. That's where Lingo comes in. It's a new biowearable that tracks your glucose in real time. It gives you personal insights and recommendations that can help you learn to eat in the way that works for you. What I like about Lingo is the ability to track a lot of different things in your day. Whether it's the stress of dropping off your kid or putting too much sugar in your coffee, which is I do every day and I'm going to continue to do it in any cases. Knowing about the effect is really important and understanding it in a discreet, water resistant way that lasts two weeks and then is available on an app is really helpful so you can really see things in real time. So don't just eat right, eat what's right for you with Lingo. The Lingo glucose system is for users 18 years of age or older, not on insulin. It is not intended for diagnosis of diseases, including diabetes. For more information please visit hello lingo.com.
- [03:59]
Crucible Moments
Support for On with Kara Swisher comes from Elf Beauty. In the corporate world, Elf Beauty is a bit of a unicorn. They're the only US publicly traded company with 78% women and 44% diversity on their board. That goes beyond the boardroom too. They work to instill that ethos across all their efforts to make a positive impact on people, products and our planet. ELF is doing it and now they're calling on the corporate world to dupe that. They believe that doing good is good for business. And you can see how in ELF's 2024 impact report, visit elfbeauty.com impact to learn more.
- [04:36]
Kara Swisher
It is over. Zeke, Celine, Donald, thank you for being on on.
- [04:42]
Dr. Zeke Emanuel
Nice to be here.
- [04:42]
Dr. Celine Gounder
My pleasure.
- [04:43]
Donald McNeil Jr.
Thank you for inviting us.
- [04:44]
Kara Swisher
So as our listeners know, President Elect Donald Trump has said he'll nominate RFK Jr. To be the Secretary of Department of Health and Human Services or hhs. What listeners may not know is that RFK autism comes from vaccines has suggested that COVID 19 might have been ethnically targeted to spare Ashkenazi Jews and Chinese people. And maybe HIV doesn't result in aids. Let's start by getting everyone's take on this selection. So let's start with Zeke, then Celine, then Donald.
- [05:13]
Dr. Zeke Emanuel
I think there's a hodgepodge of positions. You know, some of them have a lot of sense, right? Ultra processed foods and the Obesity epidemic, chronic disease, the need for our health system to empty, emphasize primary care and primary care physicians. All of them make a lot of sense and I think would actually lead to a better, healthier country. Then there's another set of beliefs, vaccines. One of them, his absolutism on fluoridation and some of the other positions like GLP1s are, you know, should not be used, that I don't know where they come from. I don't know why he holds them. I can't see how they fit with the first set. And they're largely incorrect or wrong. Some of them are clearly wrong, like the link between vaccines and autism. Some of them are, I think, misguided, like the GLP one.
- [06:14]
Kara Swisher
Yeah, he seemed to have flip flopped on that a little bit too well.
- [06:17]
Dr. Zeke Emanuel
I think Dr. Oz is pro GLP1s, which is probably the right answer.
- [06:21]
Kara Swisher
Right. Okay, Celine.
- [06:23]
Dr. Celine Gounder
I think what's concerning not only with respect to Kennedy's nomination to head hhs, but also the other nominees is Covid denialism or minimizing as part of their track record and then also skepticism of science and the scientific process. And I think that's really concerning because regardless of what your values are, your partisanship, we should at least be starting with a common set of facts based on science and then using that information to guide policymaking. And I think whether it's vaccines or fluoride or any number of the issues we'll be talking about, the fact that we're not starting with science in these discussions is alarming. It introduces uncertainty for many parties, including for example, the pharmaceutical industry and how they plan what products they're going to develop. It introduces uncertainty for scientists who are trying to figure out what research they're going to do, for trainees to figure out what they're going to study, what fields they're going to go into. So this really does create a very uncertain environment for all of us.
- [07:30]
Donald McNeil Jr.
Donald, I am so glad that we have a polio survivor in a senior position in the US Senate in the person of Mitch McConnell and that McConnell is tough enough to actually issue a threat before the hearings have even started because he's willing to say, you better not come in here and play your anti polio vaccine politics with me because I know what I'm talking about. I had polio as a child, you know, thank God we've got somebody who's that old in the Senate. One may think about his other politics because he's able to stand in the way of really, really dangerous nonsense that is coming out. I mean, the idea that this guy Aaron Seri, who has Gathers is connected to Kennedy, wants to stop the use of polio vaccine or ask for a new placebo controlled trial of it. To me, it's like, you know, asking for a new trial of polio vaccine is like saying, you know what, let's prov that cars are safe by using actual children as crash test dummies rather than building dummies. You don't stick kids of a vaccine trial when you know that the vaccine works. This is really dangerous stuff. And we're likely to start building a giant clinical trial in the United States itself. If enough people fall for vaccine denialism, it's gonna be their kids with a placebo arm of the trial and they're the ones who are going to end up hospitalized or dead in order to prove the vaccines work. Again, that's not the way I wanna do it.
- [08:58]
Kara Swisher
So HHS has 13 operating divisions, including the Food and Drug Administration, the Center for Disease Control and Prevention, the National Institute of Health. So, Celine, explain the role of HHS secretary given how much influence they have over America's health and to what extent would RFK Jr be constrained by existing personnel and bureaucracy or is it very easy to take over and make changes?
- [09:23]
Dr. Celine Gounder
Well, some of this depends on respect for prior institutional norms. So normally the HHS secretary would be getting scientific technical advice from others in across the different agencies. These are traditionally civil servants who have been serving under both Democratic and Republican administrations who are really technical issue experts. What we saw under the prior first Trump administration was an executive order establishing that they could be hired and fired more easily. And the danger there is that that layer of technical experts, scientists who advise people of both administrations, if that layer is eliminated and replaced by partisan people, one, it means that the HHS secretary is not necessarily going to be informed by the science in making decisions and that those roles could very well be politicized. But again, in addition to that, some of this depends on the degree to which the new HHS secretary does follow the scientific advice of people within the agency.
- [10:37]
Kara Swisher
He doesn't have to listen right at all.
- [10:39]
Dr. Zeke Emanuel
There are, I think, two or three broad things to understand about the secretary. The first is the HHS Department is the largest by far in the United States. It's got about $1.85 trillion budget. Compare that to the Defense Department, which is 850 billion. That means it's two and a quarter times larger than Defense. So there's just an enormous amount of money flowing through. The second thing is the Secretary has to sign off on almost everything. Now, a lot of that just pro forma unless you don't want it to be pro forma, in which case appointments to committees like the acip, the Immunization Practices Committee goes through and if the secretary takes an interest and wants to change that, he or she has the power and authority to be able to do that. And I think that's very important. And the last thing is much really depends upon the tone set by the secretary. Is it an open administration where they're open to new ideas and new suggestions, or is it closed where people are, you know, you won't get your hearing there or you'll get persecuted there if you raise the issue. And so self censorship pulls in even if people don't leave, they understand there's no advantage in raising a point. I can tell you the sort of self censorship and hesitation has already begun to set in.
- [12:11]
Kara Swisher
Right, so Kennedy says he isn't an anti vaxxer and he won't take away anyone's vaccine. But he's also spent decades fighting vaccines and has said things like there's no vaccine as, you know, safe and effective. Donald, help us understand the cultural context of this anti vaxx movement. Before COVID it seemed like anti vax attitudes are mostly confined to religious groups like some sex, Orthodox Judaism, as well as crunchy well off parents at Waldorf schools. But now it's mainstream with lots of vaccine skeptics.
- [12:43]
Donald McNeil Jr.
It's, I mean it's always, it's actually always been fringe in the, in that, you know, a minority of people in this country are anti vaxxers or even vaccine hesitant. It's just that it's taken up a completely different fringe. It used to be mostly a sort of left wing, what you called crunchy granola type things, and now it's switched over to the Texans for Vaccine Choice and the things like that. I mean, what people grab onto a combination of true problems and false problems that are blown out of proportion. You know, there's no questions that vaccines are, you know, have side effects and in some cases have bad results. But you always weigh the enormous benefit of getting rid of a disease or cutting a disease down by 99% against the occasional thing like something terrible like the cutter incident where, you know, a bad batch of vaccine actually did give a lot of kids polio or we've had a scary moment just in the last week where it looks like an RSV vaccine that's being tested in Panama is showing what's called a safety signal that suggests that kids who got the vaccine might actually have a chance of having a worse outcome if they get the disease than they would had they not had the vaccine. And that happened before in the 1960s when RSV vaccine was first tested out and it killed the whole field of RSV vaccine. And it looks like Moderna is now dropping their vaccine. I am absolutely sure the anti vaxxers will jump all over that, say C, C C vaccines are dangerous. And the truth is when a vaccine is dangerous, the first thing they do is stop developing that vaccine and go looking for one another way. You know, my biggest fear in all of this is that Kennedy and the skeptics in Congress are somehow going to try to take away the protection that vaccine companies have against liability suits. It's controversial. We have special protection for them that they can't be sued for damage that.
- [14:37]
Kara Swisher
Their vaccines have, much like the tech companies. But go ahead.
- [14:40]
Donald McNeil Jr.
Yeah, I mean they're not completely immune. Obviously if they engage in gross negligence or something like that, then they're still liable. But in the course of correctly trying to make the vaccine, in the very rare cases where somebody is hurt by a vaccine, it goes before a special master who then can award them out of a fund that's created for exactly these situations. If that disappears and they're liable to be sued for a million dollars or $10 million by every who has, you know, even no problem, even imagine problems, they will get out of the field. They will just stop making vaccines, which is what they threatened to do in the 1980s when they faced this the last time. And that's why this whole special vaccine injury program was created. If they stop making those vaccines drop out of the field, we will have vaccine shortages very quickly, very quickly because.
- [15:29]
Kara Swisher
They won't be making.
- [15:29]
Donald McNeil Jr.
And that is gonna create a situation where you not only have vaccine hesitation among some people, but even people who want vaccine can't get the vaccine. That's when you get an epidemic.
- [15:40]
Kara Swisher
Celine, talk about the mainstream aspect. Aaron Rodgers, Kyrie Irving, Nicki Minaj, Eric Clapton, Joe Rogan, Tucker Carlson, Candace Owens are vaccine skeptics. Talk about the infiltration and what's the process of becoming an actual anti vaxxer? Like how does someone go from listening to, I don't know, Joe Rogan's whatever rant he happens to have on to preventing their children from getting vaccinated.
- [16:02]
Dr. Celine Gounder
I think you have a few things at play. I think part of this is identity. And unfortunately over the course of the pandemic while it became a huge political issue for the First Trump administration. And so some of this was politicization of COVID and by extension the vaccines. Because if you acknowledge that you need to be vaccinated, it means you acknowledge that Covid was a big deal. So I think that's part of it. I think another piece is that people are drowning in information, some of it good, some of it bad. A lot of people don't understand the scientific method, which is to say, you formulate a hypothesis, you try to disprove that hypothesis, you continue to evolve, tweak your experiments and repeat experiments, and you incrementally build science over time. That's not an intuitive way of thinking for most people. Most people start with, here's my conclusion, here's the stuff I can use to back it up. What that results in are things like cherry picking of information without looking at the whole body of evidence. Logical fallacies. Some people may oversimplify, may misrepresent. They might make arguments about slippery slope. There's a whole bunch of these different cognitive issues where people are misinterpreting the information. It's really about mental shortcuts, which makes sense most of the time. But when you're talking about really nuanced technical science, it's not necessarily the best way of evaluating that information.
- [17:35]
Kara Swisher
Right.
- [17:36]
Donald McNeil Jr.
And don't forget, there's also the profit motive. An enormous number of the people who are behind the anti vaxx movement, I mean, you have, on the one side you have mothers who are not anti vaxxers. They're mostly hesitant. I mean, you're looking at your child, Dwight. Does he really have to have 18 shots? Look how miserable he is after the shot. I don't know anybody who's had this disease. But on the other hand, the people who are saying to them, sitting on their shoulders and saying, stay away from it, it's dangerous. They're selling vitamins.
- [18:02]
Kara Swisher
Vitamins.
- [18:03]
Donald McNeil Jr.
They're selling chelation therapy, they're selling hyperbaric chambers. There's a whole industry of, quote, of treating, quote, vaccine damaged children. And there are other people who are in it, I presume, simply for the notoriety that Robert F. Kennedy, you know, his children's defense, takes in enormous amounts of money and donations for people and stuff. So people make a living out of being anti vaxxers. And you cannot forget about that motive in corrupting their designs on gullible people.
- [18:34]
Kara Swisher
So, Zeke, is there any kernel of truth though?
- [18:36]
Dr. Zeke Emanuel
Yeah, well, I like to say that there's no medical intervention that doesn't have side effects. Even a simple blood draw can have serious side effects. And so we have to acknowledge there are gonna be some side effects from vaccines. They're not zero problems. And I think Donald mentioned a few of things that go wrong. And all of us have seen some patients who've had serious, serious problems. I know my book editor has had a child who had serious problems from the COVID vaccine. When I was taking care of patients, I knew people who had Guillain Barre and were immobile because of it. Those are tragedies. They're terrible. And yes, we have to acknowledge that they happen. And that's why we have, as Donald pointed out, the compensation scheme, so that we compensate people fairly for a social benefit. Remember, getting vaccinated is good for you, but it's also good for everyone around you. And so it's got a social component. And, you know, parents who don't want to vaccinate their kids often are riding on the fact other people will get vaccinated and my kid will get that benefit, but won't have to take the risk.
- [19:49]
Kara Swisher
Take the very small risk, the non zero chance.
- [19:52]
Dr. Zeke Emanuel
Yeah. So I think we have to acknowledge that and we're not honest if we don't acknowledge it. But the risk benefit, as we have said, the risk benefit is overwhelming, overwhelming to the positive. A small number of unfortunate and look tragic cases for a whole society that no longer has to think about tb, no longer think about smallpox, and before recently, no longer had to think about really whooping cough.
- [20:21]
Kara Swisher
Whooping cough and polio. So let me get to the polio thing. His nomination still wasn't attracting the controversy that Matt Gaetz or Pete Hegseth have. The New York Times reported last week that this lawyer, Aaron Seri, had filed petitions to wrote government approval of 14 vaccines, including the polio vaccines. Seems to have changed it. Mitch McConnell spoke up. He's a polio survivor. He said you should steer clear of any even the appearance of association with such efforts. RFK Jr. Is on the Hill right now talking, recording this on Monday, talking over two dozen senators, including Lisa Murkowski. I want to ask all three of you, do you think he'll get confirmed by the Senate? Let's start with you, Celine, then Donald, then Zeke. Yeah.
- [21:04]
Dr. Celine Gounder
I'm hearing that There are some 10 to 12 Republican senators who are lining up to oppose his nomination. That those are still rumors and how this will play out remains to be seen, but I think there's a lot of reasons to think that Republicans may not support him. Many of his policies would be pro regulation, would be questioned by industry and typically Republicans have been anti regulation and very much supportive of industry interests. And so I am cautiously optimistic that perhaps he will not be confirmed by the Senate.
- [21:50]
Kara Swisher
Okay, Donald, I'm not following.
- [21:54]
Donald McNeil Jr.
I always make an idiot of myself when I try to predict the future and especially where politics are clear. I've been, okay, I got lucky a few times on infectious diseases cuz I understand viruses better than I do politicians. I like viruses better than I like politicians. So I'm gonna stay away from this one. I don't know if he's gonna be accepted.
- [22:12]
Kara Swisher
Okay, Zeke, you did talk to Trump a lot during his first turn about trying to persuade him to keep the Affordable Care Act. Having talked to Trump, do you think he is less radical or that he will be able to rein him in?
- [22:23]
Dr. Zeke Emanuel
My view on that is President Trump has his own skepticism about vaccines. And if we're narrowing it only to vaccines, that's true. I don't think he agrees with some of his other positions, like ultra processed foods, necessarily.
- [22:39]
Kara Swisher
No, he loves those. He loves those.
- [22:42]
Dr. Zeke Emanuel
The last thing I would say is I think HHS and this stuff is probably not front and center of this coming administration. There are, you know, if you say there are three or four things at the top, I think there are three or four other things that are more important to them than these kinds of issues.
- [23:00]
Kara Swisher
These kind of things.
- [23:01]
Dr. Celine Gounder
Well, and more important in terms of. Not even within hhs, I would say it's cutting, you know, budgets is the number one priority, not questions about vaccines or ultra processed foods.
- [23:12]
Dr. Zeke Emanuel
Sure.
- [23:13]
Kara Swisher
And that also attracts a lot of attention. But one of the things he said was he wouldn't give one penny to any schools with vaccine mandates. In an interview with Meet the Press, he opened the door to eliminating some childhood vaccines.
- [23:23]
Donald McNeil Jr.
Every school has vaccine mandates. Every state has vaccine mandates.
- [23:25]
Kara Swisher
That's correct.
- [23:26]
Donald McNeil Jr.
That means you got to withdraw money from literally every public school in the country.
- [23:29]
Kara Swisher
And do you see that happening, Celine or Zeke? Do you think that.
- [23:33]
Dr. Zeke Emanuel
No, it's a state issue.
- [23:36]
Dr. Celine Gounder
Yeah, this is, I mean, this is. The point is public health powers reside at the state. So agencies like the CDC can collect data, can evaluate the science, can make recommendations, provide guidance. But then it's at the state and local level whether they decide to mandate vaccinations like abortion. Yeah. And also what exemptions are available to kids. So some states have only medical exemptions, some have non medical exemptions. But that is not a decision of the federal government.
- [24:06]
Dr. Zeke Emanuel
But here's the complexity that is true. Those decisions are made there. On the other hand, Whether the ACIP makes a recommendation has a big impact on the money supporting the vaccination and whether that's going to be reimbursed. And we should be very clear. Most certainly most childhood vaccines, I'm going to say most, I think it probably is all are very low margins products. They're not the place. The drug companies are making a billion dollars a year in profits like many cancer drugs. And so you need very little fear or very little switching to make it unprofitable for the drug companies to pursue this both in terms of continuing to manufacture and most importantly, continuing to innovate in the vaccine space. And that I think is also where, you know, even if the ACIP slows things or reverses some decision, you could have big, big reverberations, they won't be available or they won't be paid for. And then a lot of people, we know that if you, if vaccines aren't free, a lot of people won't get them.
- [25:17]
Kara Swisher
Yeah.
- [25:17]
Dr. Celine Gounder
So the insurance reimbursement is based on does ACIP recommend. So absent that recommendation, if they pulled that recommendation, insurance companies may not cover anymore.
- [25:26]
Unknown
Right.
- [25:26]
Kara Swisher
And it's usually couched in language, personal freedom and parental rights in a lot of these states. Donald, you've written the hell with it. The anti vaxxers have won. And when American children do start dying of measles, I hope there are pictures. I hope the full weight of the tasteless, abusive, headline hunting addiction of the American media is brought to bear. That's a sentence.
- [25:47]
Donald McNeil Jr.
Yes, it sounds like me.
- [25:49]
Kara Swisher
Yeah, it does. That's why I called you. I was like type, type, type, Donald.
- [25:53]
Donald McNeil Jr.
Yeah, sounds different when it comes out of somebody else's mouth. It sounds sort of radical and I could sing it sensationalistic and a lot of other things. No, no, it's fine, it's fine. Yes, I wrote that.
- [26:01]
Kara Swisher
So explain what you mean and what that would look like. What were you. The point you're trying to make, the anti vaxxers have won.
- [26:07]
Donald McNeil Jr.
So I just find that for years I have been covering efforts by well meaning doctors like those on the podcast right now to try to say to other doctors, look, we have to reach people, we have to become better messengers. We, we have to not speak down to parents, we have to not act like the expert. We've got to find ways to meet them where they are and talk to them. And my feeling now is that sensible point of view has lost. The anti vaxxers are about to take office in this country. The people who push vitamins the people who push Ivermectin are coming into their own. And my fear now is the fallback position is that we're gonna have a giant de facto clinical trial in this showing whether or not vaccines work. And the placebo arm of that trial is going to be the children of the anti vaxxers. They're the ones who are not gonna be vaccinated. And eventually we're gonna have new data when those children begin to get hospitalized and die. And it's not the way I wanna win this debate, but I'm fairly confident that science and Darwinism will win. When people actually see their children sickening and dying and realizing that more of the unvaccinated children sicken and die than the vaccinated children, they'll begin to be convinced again. They'll learn the same lessons we Learned from the 1930s and 1940s and 1950s. They'll go through the same terror we did. I remember as a kid what the fear of polio was like. And my parents worried when they made me stand in those long lines to get a shot and then a sugar cube at the end of it. And sadly, there's also gonna be a lot of completely innocent victims who were turned into roadkill by this because very young children can't be vaccinated because their immune systems aren't mature enough to handle those vacc. And we normally protect them by vaccinating all their big brothers and sisters and cousins and people like that so that they're in effect ring fenced by the people around them who don't have the disease. But pretty soon, if you've got a whole lot of kids coming to school, possibly with measles, possibly with whooping cough, possibly with, you know, God knows, we might see a return of diphtheria.
- [28:17]
Kara Swisher
Celine, what do you think? Do you think this is, as Don said, a de facto clinical trial and do you need a high profile death a to receive a lot of media coverage?
- [28:28]
Dr. Celine Gounder
Well, if you think about what happened with COVID and Covid vaccination, we saw actually a disproportionate number of COVID hospitalizations and deaths in red states because of lower vaccination rates. Will that data convince people, change their minds if they start to see something similar manifest among kids for these childhood vaccine preventable diseases?
- [28:50]
Kara Swisher
I don't know, because last time.
- [28:53]
Dr. Celine Gounder
Yeah, you know, did it shift public opinion in red states where there were higher levels of hospitalizations and deaths? I don't think we have any evidence of that. And people have ways of reconciling, sort of that cognitive dissonance that may override these kinds of incidents happening.
- [29:13]
Kara Swisher
We'll be back in a minute.
- [29:28]
Crucible Moments
Support for this show comes from Crucible Moments, a podcast from Sequoia Capital. It's easy to think that the success of tech giants like YouTube, Dropbox and Reddit was inevitable. I was there and it wasn't. Trust me. One thing these companies have in common is that they all survived the make or break moments that nearly took them down. And each of them had the on this season of Crucible Moments, you can hear the unvarnished histories of some of tech's influential companies told by the founders themselves. Like how Dropbox's disastrous public launch paved the way for the company's viral success. Hosted by Roloff Bota of Sequoia, Crucible Moments provides a behind the scenes look at some of the most defining milestones in tech's history to show the moments of turmoil that can sometimes become great moments of triumph. I have to say Roloffs are really and I've covered him over the many years and I have seen a lot of these companies and it's really great actually to hear from founders of what their problems was. YouTube was very touch and go.
- [30:22]
Kara Swisher
Reddit.
- [30:23]
Crucible Moments
Oh my God, I can't even tell you how many crises they had. Same thing with every company I've ever covered. Tune in to the new season of Crucible Moments.
- [30:31]
Unknown
Now.
- [30:31]
Crucible Moments
You can listen@CrucibleMoments.com or wherever you listen to podcasts.
- [30:40]
Kara Swisher
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Crucible Moments
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Kara Swisher
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- [32:13]
Crucible Moments
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- [32:52]
Kara Swisher
So let's talk a little bit about some other policy positions of RFK. He's called for the prosecution of Dr. Anthony Fauci, as has Elon Musk, who tweeted my pronouns are prosecute Fauci. In 2022 and again last month when he posted on X. My pronouns are still prosecute Fauci. Donald, you've called for Biden to issue a preemptive pardon to Fauci. Talk us through your reasoning.
- [33:13]
Donald McNeil Jr.
I wrote that six hours after Joe Biden pardoned Hunter Biden. I just thought, if he's gonna give his son a pardon, let him give everybody else who's in the sights of the prosecutors of the Ventral Justice Department.
- [33:27]
Kara Swisher
Talk about Fauci specifically. A lot of them don't want them. Some of them don' I don't don't think they should get them themselves.
- [33:33]
Donald McNeil Jr.
There's I have heard I haven't talked to him about it. I have heard that Tony Fauci does not want a pardon because accepting a pardon has a way of suggesting that you're admitting that you've done something wrong. But in this case, I don't think that's necessarily true. If you know that you've got a Justice Department that now is simply out to get people, whether they've done anything wrong or not, whether they've really committed a crime. You can practically always gin up some sort of crime that you can accuse somebody of, starting with jaywalking and going up to anything else. If you know that people are gonna come after you. I don't see that there's any. That accepting a pardon is actually an admission of guilt. I think simply, it's an admission that you need protection. And Tony Fauci has already had Secret Service protection because of the number of threats on his life. And I'm very glad he accepted that protection. If I'd had threats on my life, I would be happy if the Secret Service was watching out for me. I think there are many people who are in the sights of what is likely to be the just. Or Kash Patel, who goes around wearing the punisher logo on his scarf, you know, is the symbol of vigilantism, you know, in Marvel comics. You know, people need protection from that.
- [34:47]
Kara Swisher
Do you think he should get it? Fauci, Zeke and then Celine?
- [34:50]
Dr. Zeke Emanuel
No, I think that is. I was very upset that President Biden pardoned Hunter. I think that's. That's copying the exact, exact thing Republicans do, and it gives them a precedent that they can pardon all sorts of people on. It is a terrible, terrible miscarriage of justice, in my opinion. When we are a country that's supposed to be governed by the rule of law, yes, law can go awry. I agree, and I certainly can imagine it will go awry in some cases. But I don't think preemptive pardons are the way to solve that problem. And I think that's why we have, hopefully, good justices and good prosecutors who take principled stance. And the other unfortunate thing is even a preemptive pardon will not protect someone like Tony Fauci from Rand Paul and Senate hearings that also have no basis. We have to remember, Tony Fauci has been a model public servant. You may not agree with everything he says. There are very few people. I agree with everything they've said or every policy recommendation they've made. But he is a man who has selflessly committed himself to the country when he had lots of other opportunities and always put the interests of the country number one in his consideration. Does that mean you get it right every single time? Absolutely not. But who Trump Elon Musk, RFK Jr. Dr. Ott? Who among us has gotten every single judgment call or prediction right?
- [36:30]
Kara Swisher
Some more than others, some more than others. Celine, what do you should presumpt a pardon or not?
- [36:36]
Dr. Celine Gounder
No, I think it sets a terrible precedent. But I also have other concerns for Fauci, number one being that the Secret Service detail he's assigned is assigned by the Biden White House. And I think there's a very good chance he will lose that under the next administration and his life will very legitimately be at risk. To me, that's a whole other threat.
- [36:57]
Kara Swisher
That's an excellent point to make.
- [36:59]
Donald McNeil Jr.
So I'd like to make a point about preemptive pardons, if I may. I mean, I don't think there's anything particularly religious, you know, sacred about the pardon power. I think it has been abused by almost every president that's ever had it. I mean, preemptive pardon was what was given by Gerald Ford to Richard Nixon. He was forgiven for anything he did or might have done while he was in office. Jimmy Carter pardoned 150,000 draft doctors without even having to name them all. If I remember correctly, Bill Clinton pardoned his brother and pardoned Mark Rich, possibly in return for some sort of consideration towards Hillary. I see the pardon power being abused. The notion of sacred pardon power. Well, no, it's more like I much more fear the kind of thing that I used to see when I was reporter in Africa, where the minute somebody was out of office, the first thing they did was prosecute the previous president and everybody around them. I would rather see the pardon power over. Overused, over generously than I would see it becoming normalized for a president to take office and immediately jail everybody who'd been in office before them because they disagreed with him. That, I think would be really an abuse of power.
- [38:11]
Kara Swisher
All right, so another argument.
- [38:12]
Dr. Zeke Emanuel
We're not choosing between the two. Donald, I hope I feel it. I don't want to become one of those countries where, yes, you don't want to leave office because you're worried you'll be prosecuted and thrown in jail unjustifiably.
- [38:27]
Donald McNeil Jr.
I think Trump had a word for those countries, and I was almost jailed in Zambia for specifically going over and trying to talk to the former president while he was on trial. That's a real fear, and I would not like to see us become another.
- [38:41]
Kara Swisher
One of those 100%, another RFK Jr. Hobby horse is fluoridation. After the election, he said that Trump will recommend removing fluoride from our public drinking water. Dr. Lena Wen, who's a CNN medical analyst and former Baltimore health commissioner, responded with an op ed that pointed out not only do many European countries not fluoridate their water, there's research that shows we might get enough fluoride from our toothpaste. And fluoride can be harmful for fetuses. Is there any point here, Celine, Why don't you start? Just so you know, I didn't have fluoride in my water. I have the worst teeth in America at this point. But go ahead, Celine.
- [39:12]
Dr. Celine Gounder
Yeah, I think this is another one where you have to look at what is under the federal government's control versus.
- [39:18]
Kara Swisher
Local jurisdictions and municipalities.
- [39:20]
Dr. Celine Gounder
Right, Right. So the CDC recommends that communities adjust their fluoride levels up to a certain if it does not naturally occur at that level. The CDC and the EPA also recommend levels that fluoride should not exceed. And then the EPA further has legally binding maximum safe level of fluoride. But what you see is where these higher levels of fluoride exist, which may be of greater concern, whether it's with respect to some of the IQ effects or thyroid, those are generally places where it's naturally occurring at those higher levels. But big picture, you know, the point of public health measures is to really level the playing field for people who may not have access. You know, you have a lot of families who are unable to get dental care. About 70 million Americans lack dental insurance. Dental care is the most common form of healthcare that adults put off because of high cost. And not everybody can afford, you know, to go to the dentist or brush their teeth regularly. So this, this really does make it accessible to everybody.
- [40:30]
Kara Swisher
So Kennedy isn't the only unorthodox choice. For example, he wants Dr. J. Bhattacharya to be in charge of the National Institute of Health. Bhattacharya is one of the authors of the Great Barrington Declaration which called for letting Covid spread among young healthy people in order to achieve herd immunity. And he had a number of controversial ideas for nih, including a plan that would tie the university's university's likelihood of rece research grants to some to be determined score of academic freedom. In other words, it's a way to punish supposedly woke universities. Let me start with you, Donald.
- [41:04]
Donald McNeil Jr.
I've never interviewed Dr. Bhattacharya. I know some colleagues of his at Stanford who are unhappy about him as a choice. I think the Great Barrington Declaration was a short sighted mistake. And I'm bothered by the number of people that I know, including some journalists I otherwise respect who are still defending the idea. I mean the idea that there was some way to make sure that the disease stayed only within the young healthy population and that those people could somehow avoid their grandmothers could avoid their obese relatives, could avoid people with immune conditions who were, avoid people who were undergoing cancer treatment. Think that was always absurd. That's the way we used to reach immunity the old way by letting people, most people survive and other people die off. And we had a better way of handling it. And, and I'm, you know, I thought it was a very bad thing that they put that idea and that people with MD behind their name signed it.
- [42:03]
Kara Swisher
So let's go through another really quickly and anyone can jump in very quickly if we can. Mehmet Oz to run the center for Medicare and Medicaid Services. Who wants to take that one?
- [42:13]
Dr. Celine Gounder
It's a super wonky area and that's just really not something he has researched written on. If you do read Project 2025 and use that as any guideline. You know it's sort of interesting some of the language there. They spell out that since 1967 when Medicare Medicaid got started, the combined cost of both programs was $17.8 trillion and that the U.S. government deficit, national deficit is 17.9 billion or excuse me, trillion dollars in that period. And conclude that Medicare and Medicaid are the principal drivers of the national debt. It's very clear that the incoming administration would like to find ways to cut our spending on Medicare and Medicaid. Some of this may be through privatization of Medicare with Medicare Advantage. I think Medicaid is going to be a lot easier to scale back on, whether that is through state block grants, through work requirements. If you reduce the national or federal funding for Medicaid. Some states that have expanded Medicaid may decide that they don't want to. So I think there are. Even if Oz has not come out with those policies, there is reason to think administration.
- [43:27]
Unknown
Right.
- [43:27]
Dr. Zeke Emanuel
Well, can I take issue with the Medicaid issue?
- [43:30]
Kara Swisher
Sure.
- [43:30]
Dr. Zeke Emanuel
You know the Republicans have been for block granting Medicaid but the idea that you're going to cut Medicaid now in Republic with the Republicans are going to support, I think that is a non starter and I'll tell you why. Because every state that has had Medicaid on the ballot, red states, whether it's Idaho or Utah or Oklahoma or Missouri, the population has voted for it, they think they want it. And I think it would be the kind of thing if people suddenly realized I'm not gonna get it or it's not gonna cover me, they would be very angry about it. So I'm actually more skeptical now than I've ever been that now that they have all three Parts of government, et cetera, that they're actually gonna put the block granting of Medicaid on the ballot.
- [44:20]
Kara Swisher
Maybe we'll get Medicare for all. Who knows? No. Okay, so let's go through a few more. Let's do this one. Donald. Dr. Marty Makary to run the FDA. Dr. Dave Weldon to run the CDC. Pick anyone?
- [44:32]
Donald McNeil Jr.
Donald? I'm much more worried about Dave Weldon than about the other person.
- [44:36]
Kara Swisher
Tell us why.
- [44:37]
Donald McNeil Jr.
Well, he's apparently, from what I've read, continues to be a vaccine denier. Continues to believe that vaccines cause autism, continues to believe that some vaccines don't work. And Mehmet Oz, in charge of Medicare, medicine, Medicaid. Why would he want that job? You know, it's like a thankless, gigantic bureaucracy where everybody's gonna be fighting about money. On the other hand, running the CDC is a very important job as far as, you know, guidance on infectious disease on all aspects of health is concerned. And you really have your hands on all the policy. I don't want somebody who, you know, you know, practically doesn't believe that germs cause disease. You know, from the sound of this, you know, the kind of skepticism on his part, running an agency like that. So that's the one that worries me the most.
- [45:21]
Kara Swisher
Okay, Anybody else? Yeah.
- [45:22]
Dr. Celine Gounder
On the fda, you know, I haven't seen a terrible that much in terms of what Macri's positions are in some of these issues per se. But if you look at RFK Jr. And what he has said, you know, it's pretty clear that the way in which he would like to see vaccines studied is frankly not possible. This idea of having placebo controlled randomized trials is simply not ethical at this point in time because of what you would be exposing kids to. So that bar for evidence is really not a reasonable or ethical one. There's also a real lack of understanding about who does research on what. So, you know, NIH funds the basic science research. Pharmaceutical companies then take that science and translate into that into products, and they do the trials, submit that data to the FDA for approval. It's not that the FDA is trying to prevent certain things from coming to market, for example, generics having expanded approvals or that sort of thing. Thing. It's that somebody has to have the for profit motive to do that research. And that's something that, you know, RFK Jr. Seems to misunderstand. Also, he's criticized the fact that some of the FDA's work is funded by fees on pharmaceutical companies. Well, that is a decision we have made we could have more taxpayer money go into this. If we don't allocate more taxpayer money to manage that shortfall, then it means other work won't happen. It means a slowdown of approvals, right?
- [46:46]
Kara Swisher
It's like merger fees are paid by the right.
- [46:48]
Dr. Celine Gounder
And you know, there's now conversations about food, for example. Why have we not studied food dyes more? Well, you know, again, there's a limited budget. You're going to have to prioritize what is most concerning to the public's health, what is the biggest threat. And that is one example of something where if you had more funding, perhaps we would have more research and more regulation.
- [47:11]
Kara Swisher
We'll be back in a minute.
- [47:16]
Donald McNeil Jr.
Foreign.
- [47:24]
Unknown
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- [47:56]
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- [48:59]
Pilot.Comkara support for this show comes from Google Gemini. Imagine an AI assistant that doesn't just spit out anthem but that you can have a real Conversation with. You can use Gemini to brainstorm ideas, prepare for something big like a test or presentation, or to just learn something new. And the best part is it's easy to use to get started. All you need to do is start talking. And by the way, this script was actually read by Gemini. You can download the Gemini app on iOS or Android free of charge. Must be 18 to use Gemini Live.
- [49:35]
Kara Swisher
It's important to look back and assess what the Biden administration got wrong, too. In reprobate, the mask mandates and the COVID vaccines vaccine mandates might have done more harm than good. Some people think maybe CDC's guidance around school closings led to schools staying closed longer than necessary. I would like each of you very briefly to say your assessment is something you wish had been done differently or something you got wrong yourself. Let's start with you, Zeke, and then Donald and Celine.
- [49:59]
Dr. Zeke Emanuel
Well, I think this school issue actually turns out to be something we, the country in general, got wrong. And I remember arguing that we ought to prioritize teachers for vaccines very early on so that we could reopen schools early in 2021. If you had teachers vaccinated and you had ventilation systems in place, we could have opened schools much earlier. I think having schools closed for longer than a year was a real mistake. There are many other mistakes. And by the way, the CDC got masking all wrong for a very, very long time. And that's another thing. I was one of, I'm proud to say, one of the first people when I was doing my MSNBC show arguing that we should actually have masking. And so I would think that actually one of the biggest problems in our Covid response was the school closure issue. And we made a lot of mistakes there. It was something we could have solved.
- [51:07]
Kara Swisher
And it created a political virus.
- [51:08]
Dr. Zeke Emanuel
Donald that's part of the mistake, yeah.
- [51:11]
Donald McNeil Jr.
Donald the initial worst mistake I think we made was that we failed to produce a test for more than two months in this country. So we had no idea where the virus was. If we had simply adopted the German test, the one that the WHO adopted within days after it was made, and we had started doing large scale testing, we would have been able to figure out where the virus was. So you could shut down New York City because we were having a serious outbreak here, but you wouldn't have to shut down Houston, you wouldn't have to shut down Minneapolis, you wouldn't have to shut down places where the virus wasn't, because you would have had enough testing to know where it wasn't. And all of that Created a giant national shutdown at a time when we probably needed some localized shutdowns was absolutely the wrong way to go about it. It was clear that masks work if everyone wears masks. The countries where everyone wore masks with no problems, places like Japan, places like South Korea, had tiny fractions of our epidemics because people accepted masks. And you had masks on just as much. Not people to protect themselves, but a mask on the person who was actually the super spreader, a mask on the person who was coughing out the virus at the time. That's what's crucial that people don't understand. So had we had better tracing of where the virus actually was and aggressive protection measures, we might have saved a lot of lives. And I absolutely think the Biden administration should have gone after mandates much earlier and much more aggressively, and they should have produced something like an immune passport that said, hey, I've had my vaccine and I can now lead a. A more or less normal life. I think the idea that children don't need to be children have to be kept out of school forever, even though children are not likely to suffer bad consequences of disease, is forgetting about the fact that schools aren't run by children. Children aren't taught by children, Children aren't driven to school by children. Children don't drop off their kids. Schools are actually gathering places for adults. And it was largely the teachers unions that were saying, hey, you know, we don't want the schools to open because our teachers are gonna be in danger. If those teachers had all been vaccinated, you know, we might not have had that problem.
- [53:20]
Crucible Moments
Right.
- [53:21]
Donald McNeil Jr.
And it's so close to me. Yeah, I mean, look, vaccine mandates worked for an awful lot of corporations, including Fox News, for God's sake.
- [53:29]
Dr. Zeke Emanuel
They had one.
- [53:29]
Donald McNeil Jr.
They had 90 whatever percent of their employees vaccinated. That should have been national policy. If it's good enough for Fox News, why isn't it not good enough for all Americans?
- [53:37]
Kara Swisher
Fair. That's why. What I always say. Celine, very quickly.
- [53:40]
Dr. Celine Gounder
Yeah. So I agree with Zeke on schools, and I agree with Donald on testing. In fact, I think we're seeing a similar issue for different reasons with testing for H5N1. We're not. Until just recently, the USDA finally mandated testing of bulk milk across the country. But that only just happened, and it's been almost a year now that the virus has been circulating. So that's not because we don't have the test. It's because we can't get people to use the test. But when you have a gap in your knowledge and your visibility into the problem. You know, it's very hard to come up with good policies to control an infectious disease. I think another major issue was in the summer of 2021, we started to see breakthrough infections despite vaccination. And that was a point where we should have corrected the messaging to get people to understand these vaccines are great. Preventing severe disease, hospitalization and death. They do not prevent infection. They may curb to some degree transmission. And the problem is people have taken that to mean, oh well, see, vaccination is useless because I still got Covid. The point is not that you still got Covid. You didn't end up in the hospital.
- [54:48]
Kara Swisher
Die of COVID That's a really good point.
- [54:50]
Donald McNeil Jr.
Same issue every year with flu vaccine.
- [54:52]
Dr. Celine Gounder
Yeah.
- [54:52]
Kara Swisher
Okay, let's end by taking a 30, 000 foot view on the American health care system. As horrifying as it was, the murder of UnitedHealthcare CEO Brian Thomas Thompson has prompted a lot of reflection about our healthcare system. Some of it quite ugly. Talk a little bit about where we are. Each of you, let's start with you, Zeke, and then Donald and Celine.
- [55:14]
Dr. Zeke Emanuel
Well, I think what we've seen from this is the level of ire. If you follow the polling just before, unfortunately, this terrible assassination happened. Gallup got the most dissatisfaction and the most sense that we have major problems or are a serious crisis in our health care system than it's ever happened. And the least amount of satisfaction with the health care system. The public, despite lots of gains from the Affordable Care act, tens of billions of people with health insurance, actually a flattening of the cost curve. For more than 15 years, the public has found it increasingly frustrating to find a doctor, get services approved, get through the red tape of the deductibles and other things, and they are pissed off. And that's what you're seeing here. It's terrible that someone was murdered, just terrible. I mean, there's no justification for this. And anyone who thinks somehow the just deserts it is just morally obtuse, but the system we have is broken. And let me say, I'm a guy who worked on the Affordable Care Act. I think it's done a lot of good. What it has revealed more than anything is we have a structural problem. The way we've organized our system is broken. And we can do a lot of changes which will get more people coverage, but not get the universal coverage which will control costs, but not bring our costs down to more reasonable levels. We have uneven. We have a structural problem. Actually three structural problems. And until we address those, we're not going to have a system that people are happy with. And the frustration level, I fear is just going to go up and up and up.
- [57:00]
Kara Swisher
So Donald, talk about the press conference. I have nothing to cover. All right. But the public's perception.
- [57:04]
Donald McNeil Jr.
I lived in France for three years and I missed the health care I had there.
- [57:09]
Kara Swisher
Right. But there's a public perception that single payer healthcare to a lot of Americans, those ideas bring up images of socialism, long wait lines, death panels, if you recall. How would you describe the news media's coverage of it in terms of getting the perception that it's not gonna necessarily be that. Cause that really sticks whenever I mention it. That's what I get back. Well, if we had to be in Britain, it would this or if we had to be here.
- [57:34]
Donald McNeil Jr.
The problem is it's like the coverage of history. It's so huge, no one article can take it in. And people are so bored and overwhelmed if they try to read a book about it that they just go, ah, it's too big to understand. I don't have a simple answer for that. But I agreed with everything that Zeke said about the system being broken.
- [57:54]
Kara Swisher
Celine.
- [57:55]
Dr. Celine Gounder
Well, and by the way, Medicare is socialized medicine and people don't want to hear that.
- [58:01]
Donald McNeil Jr.
Keep your government hands off my Medicare and my Social Security check.
- [58:04]
Dr. Celine Gounder
That is government, that is socialized medicine. And if you look at how well does the Canadian system function or the NHS in the uk, that's also dependent on how well you want to fund a private program. So if you underfund it, yeah, you're going to end up with wait lists and care that people take issue with. If you look at, you know, just one tiny part of the outrage that people are having, expressing about the healthcare system in this country. Why are health insurance premiums, premiums rising? There's a whole number of reasons for this. So post pandemic, we've seen a big surge in demand for health services, especially among older people. We've seen a lot more specialty medications, including the GLP1, weight loss drugs. Those drive up health care expenses. So even if a small percentage of members are on those medications, that accounts for a huge proportion of our total health care spending. Then you have mergers and acquisitions among hospitals and health care systems. So that reduces competition. We're dealing with staffing shortages, which drives up higher wages. You know, so there's a whole number of issues. And again, this goes back to what Donald was saying is, yeah, it's overwhelming. It's so many different things. It's super wonky. It seems boring. I think what has been most upsetting to me coming out of that murder of the United Healthcare CEO is it shows that people are at a point of frustration where they do not believe the government can fix these issues, that voting does not matter, that speaking to their elected officials does not matter, that they believe that political violence is the solution. And this is even for somebody who is clearly highly educated from a privileged background background, that this is the only way to affect change. And I think that's a super scary place to be.
- [59:54]
Kara Swisher
Were you surprised?
- [59:56]
Dr. Zeke Emanuel
I was surprised that it was a murder, but I think Selina's right. You know, I've talked to a lot of congressmen and senators. I've talked to a lot of healthcare policy experts. I don't think people have a clear answer or clear understanding of what it would require to switch our system into something that's worse, working better, what the fundamental defects are and therefore what the fundamental fixes are to the system. We can all point to how it's bad, but the solutions are not clearly articulated and have been vetted. And I think we have too many insurance companies, we're offering too many thousands of things and therefore the public makes bad choices. No standardization in all sorts of areas. And so we have a lot of fragmentation and a lot of complications and complexity to the system. And that's what's killing people. Literally frustrating and killing people. And we don't have a focus on the most high value interventions like reducing high blood pressure, reducing diabetes, but getting that through Congress when it's hard for Congress to understand because as both Celine and Donald have said, it's really wonky. It's for people like me who, you know, like this turgid stuff. And that makes it very difficult and very frustrating.
- [61:17]
Kara Swisher
One last question for all of you. Give us your best case scenario for American health system ten years from now. If you could do anything to reform the system. Let's start Celine and then Zeke and we'll end with Donald. Oof.
- [61:32]
Dr. Celine Gounder
I would say a greater focus on preventive care and public. And if you look at how much of health is predicted by health care or health care influences our health outcomes, it's only about 10 to 20%. So what is actually taking a bite out of life expectancy in this country? It's things like opioid overdose, gun violence, obesity. You're not going to solve the obesity issue with GLP1 weight loss drugs. They're just too expensive, not accessible. So we're going to have to think about other solutions. And those are solutions that are not in the clinic, not in the hospital. They're largely policy solutions. Gun control. That's what it. Yeah, well, and I don't say gun control for a very specific reason, because it's not always about controlling access to guns, you know, but there are many things that can help reduce the risk of gun violence, and there's a whole menu of things we should be doing on all these different issues that we are not investing in right now.
- [62:29]
Dr. Zeke Emanuel
All right, Zeke, so if you're gonna talk about improving the American health, I think that there are probably three really important things to focus on. One is hypertension. It's the most common chronic disease. 120 million Americans have it. If you actually control it, which is relatively simple, and we have a lot of generic drugs on it, you get the biggest bang in terms of life saved. The second thing is the obesity epidemic, that 70% of the population of adults are either overweight or obese is causing a lot of the problems, including our huge problem of diabetes. And the last thing is a mental health crisis, which is driven by loneliness, by cell phones, by lots of things. And we need to get our arms around that. That's how you improve the American health and bring more people from dying prematurely to living a full life. The healthcare system is way more complicated to control, but what you really need to do is we need to rationalize how people select health. Healthcare. You can have multiple insurers competing as long as you have standardization on what they can offer, the costs, and other things. And that's the. Germany has that, Netherlands has that, Switzerland has that. And we could get to a situation of multiple insurance companies, but a standardized set of products and a standardized set of low costs that people have to pay, and that would be a way better healthcare system than we have today.
- [63:59]
Kara Swisher
All right, Donald, let's finish up.
- [64:00]
Donald McNeil Jr.
Well, policy is not my area at all, but what Zeke is pointing out is something I'd like to see introduced a little more into the American system, which is sort of traditional American capitalism. I mean, it ought to be possible for the government, as the biggest buyer of drugs, to be allowed to negotiate. And I see that that's actually begun to happen now. There is some control over the price of insulin, which have been completely out of control. I think it's a good thing when the government is allowed to negotiate with the drug companies or to allow more competition among drug companies to produce the same drugs you've got. The patent system is constantly being abused by the drug companies. And I Think it's a good thing when insurance companies can compete with each other in order to produce as long as they're overseen enough so that they can produce, as Zeke said, standard products up to the right standards. The problem is we've got a system in which every aspect of the system has been captured either by the corporate lobbyists for the pharmaceutical companies, or for the pharmacy benefit managers or for the insurance companies. And they're all. And they've created a giant, unworkable system that produces an enormous amount of profits, an enormous amount of money wasted on things like lawsuits, an enormous amount of money wasted protecting doctors against lawsuits for simply trying to do their job and lousy medical care as a result. And unfortunately, a very unhealthy population for a hell of a lot of money.
- [65:25]
Kara Swisher
All right, I do have one quick question. Scariest thing out there medically, would you say, right now, just for people to make them feel bad at the end.
- [65:33]
Dr. Celine Gounder
H5N1.
- [65:34]
Kara Swisher
H5N1.
- [65:36]
Dr. Celine Gounder
Yeah, because we're mishandling it, and we're increasing the risk of it spreading into humans and becoming adapted for human to human transmission.
- [65:44]
Donald McNeil Jr.
So, okay, I'm scared by it. But, you know, people keep asking me, you know, the one question they want to know is, you know, grab your arm and say, are we all gonna die? And the. The answer is, yeah, we are all gonna die. Is it gonna be H5N1? I don't know. I thought so back in 2004 when it killed half the people who got it. And now here it is not. I mean, suddenly every cow in America has got it or has had it or is at risk of getting it. And fortunately, pasteurization kills it. But when it gets into humans, so far, not allowed. Lot of dead humans.
- [66:21]
Kara Swisher
And that's a huge relief to me agreeing to. Celine. Go ahead, Zeke, finish up. What's going to terrify you? Go ahead.
- [66:27]
Dr. Zeke Emanuel
H5N1 is a low probability but very high severity event. If you look at a more high probability and severe event, it's really the obesity epidemic for which we don't have a policy approach in the country at the moment that is going to work. And so that's the way I go.
- [66:50]
Kara Swisher
Okay.
- [66:51]
Donald McNeil Jr.
And antibiotic resistant, you know, microbials or other. There's a lot of things we can worry about.
- [67:00]
Kara Swisher
Aliens. Aliens. That's my issue. Bringing alien diseases. I'm teasing. Thank you so much. This was so substantive, and I really appreciate each of you. Celine, Zeke, and Donald.
- [67:09]
Donald McNeil Jr.
Thank you.
- [67:10]
Dr. Zeke Emanuel
Thank you, Cara. This has been great.
- [67:16]
Kara Swisher
On with Kara Swisher. Is produced by Kristin Castor, Russell, Kateri Yocum, Jolie Meyers, Megan Burney and Kalyn Lynch. Nishat Kirwa is Vox Media's executive producer of audio. Special thanks to Kate Gallagher. Our engineers are Rick Kwan and Fernando Arruda and our theme music is by Trackademics. If you're already following the show, Avian flu will not kill you. If not, shut up. Elon are my pronouns. Go Wherever you listen to podcasts, search for on with Kara Swisher and hit follow. Thanks for listening to on with Kara Swisher from New York Magazine, the Vox Media Podcast Network and us. We'll be back on Monday with more.
- [67:57]
Unknown
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- [68:20]
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