The Problem with Wellness Culture, According to Dr. Zeke Emanuel

Summary

Podcast Summary: "The Problem with Wellness Culture, According to Dr. Zeke Emanuel"

Podcast: On with Kara Swisher
Host: Kara Swisher | Guest: Dr. Zeke Emanuel
Date: January 19, 2026
Venue: Politics and Prose, Washington, D.C.
Topic: Debunking wellness fads and outlining practical, evidence-based advice for a long and healthy life
Book Featured: Eat Your Ice Cream: Six Simple Rules for a Long and Happy Life

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Episode Overview

In this episode, Kara Swisher interviews Dr. Zeke Emanuel—physician, bioethicist, architect of the Affordable Care Act, and author—about the pitfalls of the modern “wellness” industry. Throughout their lively, candid conversation, they dismantle longevity obsessions in Silicon Valley, debunk popular wellness claims, and break down Dr. Emanuel’s six “simple rules” for living a long, meaningful life. Conversational, humorous, and audience-engaged, the discussion blends research insights, practical advice, and sharp takes on contemporary health culture.

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Key Discussion Points & Insights

1. Wellness Obsession: Longevity for Longevity’s Sake (02:31–06:10)

• Myth of Life Extension: Dr. Emanuel critiques tech leaders' fixation on living forever, citing conversations with figures like Brian Johnson. He questions the value, asking, “Why do you want to live to 150? What’s the point?” (03:17)
• Quote:

  “It struck me that they were replacing the means to a good life and making that the end. And that’s always a mistake.” – Dr. Zeke Emanuel [04:02]

• Root Cause?: Hypothesizes tech elites may seek longevity out of existential insecurity, lack of fulfillment, or imposter syndrome.

  "I believe they can't imagine the world without themselves in it." – Dr. Zeke Emanuel [04:38]

2. The Toxicity of Modern Wellness Culture (06:10–09:12)

• Information Overload and Simplicity: Wellness advice online is overwhelming and often contradictory—either too complicated in its demands or overly reductive (just eat/sleep/exercise).
• Scorn for Overly Prescriptive Routines:

  "Do you think if he got the right [squat] form, it will make hell or beans worth a difference to the longevity... I can assure you, no." – Dr. Zeke Emanuel [07:47]

• Neglect of Social Wellness: Most wellness advice misses the primacy of social relationships for health.

3. The Most Important Factors: Socioeconomic Status & Relationships (09:12–10:35)

• Big Two for Longevity:

  "After all these years of reporting… the two things: don't be poor…and have friends and family. All the statistical stuff is around that." – Kara Swisher [09:24]

• Causation in Friendship: Strong evidence links social ties to longer, healthier lives.

4. Dr. Emanuel’s “Six Simple Rules” (10:35–47:22)

Rule 1: Don’t Be a Schmuck – Avoid Self-Destructive Risks

• Top Risk Behaviors: Smoking (including weed), excessive alcohol, tanning, avoiding vaccines, missing cancer screenings, and owning guns.
  • On gun ownership:

    "Twice as likely to die." – Dr. Zeke Emanuel [12:06]

  • Mount Everest story: Dying on Everest (1 in 100 risk for climbers) is “schmuckier” than BASE jumping. Over 59? “One in 25. What could be stupider?” [13:13]

Alcohol: Nuanced Advice

• Cancer, sleep disruption, and health risks outweigh touted benefits.
• Quote:

  "Zero [alcohol] is the safest. But let's face it… you're not taking 65% of the population who are drinking alcohol and going to zero. Just not happening." – Dr. Zeke Emanuel [15:22]

• “Responsible” Use: No binge drinking, no drinking alone, use for social interaction.

Vaccines: A Public Health Imperative

• Dramatic decline in vaccine-preventable disease mortality.
• Vaccine safety is exceptionally high (“for every million people…one gets a claim”). [19:42]

Rule 2: Talk to People – Social Health Matters (22:24–29:55)

• Screens vs. Socialization: Phones isolate us; banning them in classrooms increases conversation and engagement.
• Face-to-face Vitality:

  “The more close friends you have, the longer you live.… Mortality rate increases 22–33% for those with fewer social connections.” – Dr. Zeke Emanuel [26:35]

• Practice: Initiate conversation, even with strangers (cab drivers, diners)—it benefits both parties.

Rule 3: Keep Your Brain Young (29:35–35:48)

• Crystallized vs. Fluid Intelligence:
  • Crystallized: Accumulated knowledge, slow to fade.
  • Fluid: Adaptability, creativity—declines from late 30s on.
• Maintaining Fluid Intelligence: Pursue new, challenging tasks; continued education builds neural resilience.
• Ben Franklin Example:

  “He invented bifocals at 79… built a library, invented tools to reach books. Plasticity in his brain like no one’s brain.” [35:19]

Rule 4: Eat Your Ice Cream – A Sensible Approach to Diet (37:25–41:03)

• Rejects Fads: Disagrees with the pro-meat, anti-seed oil stance of certain public figures.
  • Red meat is “heavily associated with cancer, heart disease, stroke, diabetes.”
  • Seed oils (like canola, sunflower) are safe; olive oil is best but expensive.
  • Ultra-processed foods (58% of US calories): “Horrid. Horrid.”
• Positive Food Rules:
  • Prioritize fermented foods for the microbiome (e.g., yogurt, kimchi).
  • Emphasize fiber through fruits, vegetables, and nuts (“More than 90% of Americans do not eat enough fiber”). [39:57]
• Memorable Quote:

  “Just eat your fruits and vegetables. Really crazy.” – Dr. Zeke Emanuel [40:33]

Rule 5: Sleep Well (41:03–44:48)

• Against Wearables for Sleep:

  “Sleep, you get up in the morning, you feel like shit, you know you didn’t have a good night’s sleep… you feel good, you had a good night’s sleep. I don’t need a little, you know, Oura ring to tell me that.” – Dr. Zeke Emanuel [42:01]

• Sleep’s Vital Role: Essential for brain health, memory, muscle restoration; not “wasted time.”
• Pills Don’t Work: Only cognitive-behavioral therapy is proven effective for insomnia.

Rule 6: Exercise – Appropriately, Not Obsessively (45:06–47:22)

• Three Types of Exercise Matter:
  1. Aerobic (for heart/lungs)
  2. Strength (to prevent frailty)
  3. Flexibility/balance (e.g., yoga)
• Sensible Regimen: 20-minute daily routines suffice; over-exercising leads to injury without extra longevity benefit.
  • “What is the opportunity cost there?… There is a plateau, and we don’t recognize that enough.” [46:15]

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Notable Quotes & Memorable Moments

• On Social Media’s Harm:

  "Young people in particular, the isolation... There's been a movement across the world... of isolating kids from... phones." – Kara Swisher [22:50]

• On Initiating Conversations:

  "Initiate the conversation. The other person probably wants to talk and is embarrassed or shy." – Dr. Zeke Emanuel [28:10]

• On the Limits of Wellness Routines:

  "If you got the form a little wrong, it’s not really going to make a difference. Unless you’re going for the Olympics of squats.” – Dr. Zeke Emanuel [08:14]

• On Public Health Interventions:

  “I would mandate through Medicaid that all newborns get nurse–family partnerships… If there’s any higher return for a dollar spent, it’s the highest return for the government spending a dollar.” – Dr. Zeke Emanuel [55:59]

• On Systemic Healthcare Reform:

  “We made healthcare more complicated…One of our mantras going forth has to be simplification and standardization.” – Dr. Zeke Emanuel [50:42]

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Policy & News Segment Highlights

Vaccines Schedule Cuts (47:22–49:25)

• Emanuel is highly critical of the CDC’s reduced schedule, calling it a “Bad mistake” likely to lower herd immunity and increase outbreaks.

ACA Sunset Threat (49:25–55:53)

• Acknowledges ACA successes but regrets lack of built-in adaptability and standardization, leading to complexity and high administrative costs.
• Urges "simplification" and standardized payments/records moving forward.

If He Ran HHS (55:59–56:46)

• First action: Universal nurse–family partnerships for newborns—"highest return government program."

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Audience Q&A and Closing (56:44–57:26)

• Emanuel’s favorite ice creams in D.C.: Dolce (“chocolate hazelnut” and attempts to get “Labneh honey pistachio”) and Happy Ice Cream’s chocolate.
• Laughter, playful banter, and encouragement to “eat your ice cream” as the ultimate, joyful wellness act.

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Timestamps for Important Segments

• Intro to Zeke Emanuel and criticism of Silicon Valley wellness: [02:27–06:10]
• Wellness overload and its problems: [06:25–09:12]
• Socioeconomic/friendship as key to longevity: [09:12–10:35]
• Smoking, guns, and self-destructive “schmuck moves”: [10:35–13:26]
• Alcohol and vaccine realities: [14:07–20:08]
• Social interaction and phone effects: [22:24–29:35]
• Intelligence: fluid vs. crystallized & learning new things: [29:55–35:48]
• Diet, food pyramid, fermented foods: [37:25–41:03]
• Sleep: wearables and importance: [41:03–44:48]
• Exercise: types, duration, moderation: [45:06–47:22]
• ACA/policy questions: [47:43–55:59]
• First HHS act: nurse–family partnerships: [55:59–56:46]
• Closing and favorite ice cream: [57:00–57:26]

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The Conversation's Tone

Clever, irreverent, and evidence-driven, with Swisher’s deadpan humor and Dr. Emanuel’s blend of data, practical advice, and personal anecdotes. The episode offers both punchy quotables and nuanced takes, challenging listeners to abandon health fads in favor of building community, cultivating curiosity, eating sensibly, and finding joy.

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Takeaways for Listeners

• Avoid “schmuck” behaviors (smoking, guns, excessive drinking, anti-vax, unnecessary risks).
• Value and nurture human relationships—friendship is powerful medicine.
• Keep learning and stretching your mind and routines—neuroplasticity is ageless.
• Eat fiber, fermented foods, and real produce; ignore extreme dietary fads.
• Get steady, sufficient sleep; skip the gadgets unless they truly help.
• Exercise regularly, but not obsessively; tailor movement for strength, cardio, and balance.
• Press for health policy reforms emphasizing simplicity and equity—not just longevity but quality, meaning, and access.

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“Eat your ice cream. Don’t worry about beef tallow.” – Dr. Zeke Emanuel, [54:21]

Transcript

[Kara Swisher]

This is my favorite Emanuel. Just so you know, I know all the Emanuels, and they're.

[Dr. Zeke Emanuel]

I tell my brothers that all the time.

[Kara Swisher]

Yes, exactly. Hi, everyone. From New York Magazine and the Vox Media Podcast network. This is on with Kara Swisher. And I'm Kara Swisher. On today's show, I'm speaking with Dr. Zeke Emanuel. He was one of the architects of the Affordable Care Act. He now teaches healthcare management, medical ethics, and health policy at the University of Pennsylvania. He's also an oncologist. Emanuel has a new book out this month. It's called Eat yout Ice. Six Simple Rules for a Long and Healthy Life. He offers some practical advice on eating and living well at a time when all of us are bombarded with dubious wellness content everywhere we look. The Trump administration isn't helping matters right now either. Spoiler alert. Emmanuel doesn't think eating more beef tallow is the solution to a healthier life, and he is 100% right. Do not get your nutrition advice from RFK Junior. All right, let's get into my conversation with Dr. Zeke Emanuel. This interview was recorded in front of a live audience at Politics and Prose bookstore in Washington, dc. Don't go anywhere. This is a Monday.com ad, the same Monday.com designed for every team. The same Monday.com with built in AI scaling your work from day one. The same Monday.comwith an easy and intuitive setup. Go to Monday.com and try it for free. Heated rivalry is a massive hit. Everyone's talking about the sex, but it's just as much about the exquisite pain of having a crush. And I think yearning can provide this sort of like masochistic joy too. And like, we all need more joy in our lives right now. This week on Explain It To Me from vox. Love hurts and it hurts so good. New episodes Sundays. Wherever you get your podcasts. Zeke, it's great to be with you here at Politics and Prose in Washington, D.C. to talk about your new book, Eat yout Ice Cream. Six Simple Rules for a Long and Happy Life.

[Dr. Zeke Emanuel]

Yes, so that is my rules. Yes, I agree.

[Kara Swisher]

All right, so let's get started. One of the main thesises of your book is that life is not a competition to live the longest. Although that is the obsession with much of the tech industry, which is news to these Silicon Valley CEOs. A lot of them are obsessed with achieving immortality, whether through lots of different means, including downloading the brains to various things. Clearly, a lot of people want to live the longest. So in a world full of wellness advice, what Is your point? Why should people listen to you?

[Dr. Zeke Emanuel]

Well, first of all, it's common sense. But here's the problem with all of that stuff. There are multiple problems. One is it makes wellness and living a long time an obsession. And it's the wrong obsession. Just living a long time isn't a fulfilling life. The question is, why do you want to live a long time? What's in it for you? And about, I don't know, six months ago I was at a dinner and yes, one of those brothers sat me next to Brian Johnson, who some of you will know is a guy who wants to live to 150. And I said, why do you want to live to 150? What's the point of your living to 150? Silence. And then he turned to someone and says, you know, I'm the most monitored human ever. Well, that's not an answer to the question of why. Right. The whole point of living a long and healthy life is because we have other things to do. We have a why to our lives. And living a long time is not about. It's not a fulfilling part. And so it struck me that they were replacing the means to a good life and making that the end. And that's always a mistake, as my ethics professors will. You know, you don't need a lot of fancy logic to know that's the wrong thing to do.

[Kara Swisher]

Right? I mean, what do you think? The motivation? Because they think they're the finest people in the land.

[Dr. Zeke Emanuel]

I believe they can't imagine the world without themselves in it. And look, I got the lowest passing score in psychiatry rotation at Harvard Med School my year, okay? So don't listen to me when it comes to it.

[Kara Swisher]

Didn't say Harvard Med School, but go ahead.

[Dr. Zeke Emanuel]

Didn't come to psychiatry. Right. But here's my. There's a hypothesis, unproven. There's something deeply unfulfilling to them. You know, maybe it's they have imposter syndrome. They got rich because they just happened to be lucky. They were at the right place at the right time, whatever it is, right? And they're trying to find fulfillment. And living a long time is the substitute for finding why they're doing what they're doing and what it is. And, you know, I think that there are many of them who are doing great things. But I think if you want to live a long time, right? And there's a title of a book, I'm sure it's here that's, you know, something like, you have to know why you'll die to live a long time, which was Steve Jobs idea by one of the civil rights people. And it seems to me that's the right answer. That's really important. You know, what are you willing to die for that is so important to your life that you're willing to die for it? That'll give your life meaning. And I have a feeling there's nothing that these guys would die for. And anyway, that's a hypothesis. I have no idea. And as I say, I'm just a terrible at psychology and psychiatry.

[Kara Swisher]

But it has sort of infected the society at large, this idea of wellness. It's been driven by these platforms. There's influencers everywhere. Talk a little bit about that because there's so much nonsense, like in gobbledygook and just codswall of it.

[Dr. Zeke Emanuel]

So if you, you know, we're all inundated, whether we read the paper, get newsletters, whatever. And it turns out that even if you're on any of these platforms, you get this stuff whether you want it or not. It's something like 90% of people have gotten wellness or longevity stuff, even when they don't actually look for it. But one of the things that struck me in doing this is there's both too much and too little. It's simplistic now, the too much you, you know, and almost all these books pick them up and they make things so complicated. You have to do this routine in this way, or this is the number of minutes or, you know, exactly this number of grams of protein you have to eat. You know, I had a little tweeting battle with the HHS yesterday, and they listed, I objected to one of their recommendations. And they listed in ground beef all the micronutrients that you get from ground beef, the selenium, the magnesium. It's like, yeah, you don't have to really worry about that. If you eat a healthy diet, you don't have to count on each one of those things. So it's way too complicated. Since we've Talked about Peter Ati, I can say page 269, I believe, of his book grilled into my head. He has himself squatting and talking about the bad form of his squat. Now, do you think if he got the right form, it will make hell or beans worth a difference to the longevity, the wellness, or the meaning of his life? I can assure you, no.

[Kara Swisher]

No squatting.

[Dr. Zeke Emanuel]

Well, no, squatting's good, but, you know, if you got the form a little wrong, it's not really gonna make a difference. To get it exactly right. Unless you happen to be going for the Olympics of squats.

[Kara Swisher]

Right. And then my friend, one of the.

[Dr. Zeke Emanuel]

Issues, the other thing is it's a little too simplistic. So if you pick up these books, they're either mainly about exercise with a little sleep and nutrition mainly about nutrition with a little exercise and sleep. But that's it, it's sleep, nutrition and exercise. And that's just way too simplistic. And one of the important things of my book I think is saying look, it's what we're doing here. It's social relationships, interacting with other people. That is the single most important thing you can do for wellness. Longevity and happiness. And all the rest of this stuff is secondary. And they totally, I mean the wellness industrial complex totally under flinch flips the script.

[Kara Swisher]

One of the things since I've been doing this reporting for so long, it is actually everyone's like what is the secret? Then I go, I have to tell you, there's, there's, you know, eating is good, not, not eating badly, sleeping well, exercise fine, like. And I said but I not living near a cancer culture, you know, like, like an Elon Musk data center which look that up. But one of the things they said, the two things if I have to say after all this year of reporting is don't be poor because the longevity numbers are coming down rather significantly for people below a certain in poverty and have friends and family. All the scientific statistical stuff is all around and you always want, you want causation, not just correlation. There really are study after study showing that. So let's get to the book because it's organized around six rules essentially. The first is don't be a schmuck which you divide to avoid self destructive risks. You list smoking, alcohol, tanning, avoiding vaccines, avoiding cancer screenings and owning a gun as the six top schmuck moves. Interestingly, I don't know which one to go first. Interesting enough, you include weed under smoking. The country's been moving towards marijuana legalization for many years now. Explain the various schmuckitudes, stack rank them.

[Dr. Zeke Emanuel]

Well, smoking we don't have to explain. And yes, vaping may be better, but it is no, as someone says, no free lunch. There's lots of issues with getting addicted to nicotine and whether you actually then go on to smoke cigarettes. It does help some people quit, but there are plenty of other issues with it. You know, from my standpoint there are a lot of things we should avoid. The gun one is interesting. It was based upon following 18 million people in California and looking at, you know, wanting a gun, if there's some violence in your neighborhood, very, very understandable, I think. But it turns out having a gun in your house dramatically increases your risk of dying by gun violence. And it also dramatically increases the risk of any child dying by gun violence. Because about half of the guns are stored, loaded and stored accessible in the night table drawer, in the dresser drawer, where kids can get ahold of them. And then it just turns out that you're much more prone to violence, right? You don't get killed by the stranger coming into the neighborhood a lot, but a relative or a friend, that's actually a lot.

[Kara Swisher]

So that's sort of the Chekhov's gone.

[Dr. Zeke Emanuel]

Yeah, exactly. And so if you take neighbors, one who owns a gun and one who doesn't, the one who owns a gun owns the gun. Twice as likely to die.

[Kara Swisher]

Okay?

[Dr. Zeke Emanuel]

But my real sort of discovery here, I was thinking as I was writing this chapter, what the schmuckiest thing out there? And I thought, gotta be BASE jumping. You know, where you put the Michelin squirrel suit on, you jump off a mountain, there's wind and you don't control anything. There's no parachute, no nothing, right? That's gotta be really the stupidest thing you can do. Turns out, not true. That chance of dying from, you know, a Squirrel jumping is 1 in 2700. Getting injured is about 1 in 250. But dying is 1 in 2700. Turns out spending $100,000 to be a tourist and climb Mount Everest is schmuckier than base jumping. Right? It turns out that the risk for all comers, including expert climbers, Sherpas and all the rest, 1 in 100 chance of dying, right? And by the way, your body doesn't come down. It's frozen up there. And no one is going to spend any oxygen bringing you down. Also turns out if you're over 59, I just scanning the audience here, our chances, one in 25. Now, what could be stupider than to make a lot of money, be 65 and say, I'm gonna celebrate, go up Mount Everest.

[Kara Swisher]

Well, you know, it's so funny you say that. Cause there's so many tech CEOs who always tell me their Everest stories. And by the 50th one, I was like. And they were trying to relate Everest to life. I said, there's nothing relatable about going up a mountain you shouldn't be up and telling me what it means to run a company. I said, so if you mention it, One more time, I'm gonna hit you. So it's like, I think you're stupid if you tell me the story.

[Dr. Zeke Emanuel]

I've been up Mount Kilimanj.

[Kara Swisher]

People are not well, good for you.

[Dr. Zeke Emanuel]

It was dead boring. I would not recommend it.

[Kara Swisher]

Okay, so what of the most people aren't going to Everest. So of these tanning, you know, Dr. Oz today said everybody should have a drink or two.

[Dr. Zeke Emanuel]

Ah, well, yeah, alcohol. So alcohol is one of these complex issues because not too long ago, we were all told red wine. It's the French paradox. You drink red wine, you'll live forever. Flaws. Increasingly, the data are pretty clear from a physical standpoint what it does for the body. It's bad. There are seven cancers associated with it. Esophageal cancer, breast cancer. Not a good thing. It's also associated, obviously with liver problems and cirrhosis. It also disrupts your sleep cycle. So if you drink wine at dinner, you might go to sleep, you might be sleepy, go to sleep. But then it disrupts the cycle so you don't get full night sleep. You don't get too much sleep.

[Kara Swisher]

So why did the government today recommend more dranking?

[Dr. Zeke Emanuel]

I don't know. But so increasingly you've got like the who You've got various officials saying zero is the safest. But look, there's, you know, birds like fermented food without fermented fruit with alcohol. Monkeys like fermented fruit with alcohol. People have been drinking forever. It does a lot of things. People get relaxed, they talk to other people. They like the taste. Plus, we know that 65 to 70% of the American population. I won't survey this group. Drink. You're not taking 65% of the population who are drinking alcohol and going to zero. Just not happening. And actually, when the Surgeon general report came up under Vivek Murthy, I wrote him and I said, you know, I think it's a little too extreme. I don't think people, people are going to tune that report out when you say zero. So be responsible. What's responsible? Okay, here are the no's. No binge drinking, right? No drinking alone. And no drinking to drown out your sorrows. Here's the positives. Use it to facilitate social interaction with other people. Drinking over dinner or, you know, I was in Chicago, I went out with my brother and my wife to a jazz club, and Rahm was regaling us with stories about this is where Al Capone was. And by the way, the, you know, passageways where he got away from the cops when they raided the joint, there are four, and they go to different theaters and blah, blah, blah. You know, that's. First of all, it's interesting. And second of all, you know, facilitated by alcohol. And then we had great jazz. Right, right. That's the reason to do it. And I think under those circumstances, you've got the positives of social interaction and, you know, being with other people and, you know, that's a trade off. But let's face it, you know, we all know life is a trade off. Right. You do some things which are.

[Kara Swisher]

And you pay the price. Right. All right.

[Dr. Zeke Emanuel]

Speaking of which, there's a cost to.

[Kara Swisher]

Some of them, obviously the most controversial. And you work for NIH vaccines.

[Dr. Zeke Emanuel]

I don't think that's controversial.

[Kara Swisher]

Well, I think there.

[Dr. Zeke Emanuel]

I mean, there are some people in this town who don't like the data, but I have a table in the book where I talk about the mortality of vaccine preventable diseases. And when you look at the mortality of all these diseases, they're undetectable. There's no mortality for many of them, you know, and one of the problems, I think, is that we have gotten to a situation where the vaccines have made so much of childhood safe that people now have become, why give my kid vaccine? It's so safe out there. Yeah, the reason it's safe is cause there are vaccines. Right. Parents and our grandparents, right, in the 50s, were nervous every summer because their kids might get polio, they might, you know, end up paralyzed, they might end up in an ER lung. You know, when I was. I was at. At the Dana Farber in Boston, and they exiled me to this outbuilding across the parking lot, a little brick building. You know, I was doing something they didn't think was all that important, like bioethics. Anyway, they put me there and I was on the second floor. And then one day I walked downstairs and I walked into the basement, all these iron lungs lined up. There's a storage of iron lungs. This was like 1995, and it was like these were all the iron lungs for the polio patients from Boston Children's Hospital, which was the other way across the parking lot. And once you see them, you realize, you know, it was really bad. And once that vaccine, the Salk vaccine and then the Sabin vaccine became available, parents were lining up their kids. They couldn't get their kids vaccinated fast enough.

[Kara Swisher]

Right, because where are we now then?

[Dr. Zeke Emanuel]

Well, I'm most. The vaccine situation is most concerning about little kids because, you know, we're getting rid of the hepatitis B vaccine right around, you know, there are going to be some kids who get liver failure, get hepatitis B, have liver failure and are going to die from it. Unquestionably the case. Last year, 288 kids died because of fever, flu. We're going to have probably more this year because of flu, worse ronavirus, diarrhea, you know, same thing. This is a. It's a terrible thing. Vaccines have made our lives so much better. And the data are uncontrovertible that they're safe. Does every medical procedure has some risks, right? Just taking blood has some risk. You might get infected. You might.

[Kara Swisher]

But.

[Dr. Zeke Emanuel]

There are some risks to vaccines. We have a compensation system for that, by the way. You want to know how frequently that compensation system is used? For every million people who get a vaccine, one gets a claim. Now, I don't know anything in life where the chances of getting harmed are less than one in a million. It's pretty obvious that this is a very good thing for all of us.

[Kara Swisher]

Agree? Agreed. We'll be back in a minute. My dad taught me a lot, including how easy it is to forget to cancel things. So I downloaded Experian, my bff. Big financial Friend. Experian could help me cancel my unused subscriptions and lower my bills, saving me hundreds a year. Get started with the Experian app today. Your big financial friends here to help you save smarter. Results will vary. Not all bills or subscriptions eligible. Savings not guaranteed. $631 a year savings with OnePlus negotiations and OnePlus cancellations paid. Membership with Connected Payment account required. See experian.com for details. Experian Some of this video coming out of Minneapolis is telling a story about the surge of ICE agents that started last week after Renee Good was killed.

[Dr. Zeke Emanuel]

Another controversial video has emerged of ice. It turns out the people being arrested were US Citizens.

[Kara Swisher]

These are observers making sure that kids can walk home from school without being taken apart by the horrible Gestapo that we have here. A group of men approached a woman at a bus stop, pulled her aside, and then walked her into a vehicle. The polling is also telling a story.

[Dr. Zeke Emanuel]

Support for ICE is dropping, and more Americans than ever before, 46% told economist YouGov pollsters they want ICE abolished.

[Kara Swisher]

Meanwhile, the messaging from the White House.

[Dr. Zeke Emanuel]

Is that ICE has immunity. So what does that mean for the people, some of them citizens, that ICE agents are dragging out of cars and.

[Kara Swisher]

Workplaces and off of streets around Minneapolis?

[Dr. Zeke Emanuel]

That's on today. Explained we air every weekday what turns unrest into a revolution and where could it lead the big open question is whether this set of protests that are currently underway is the end or the beginning of the end of this third phase of sort of modern governance when it comes to Iran, the end of clerical rule. Jake I'm Jake Sullivan. And I'm John Finer, and we're the hosts of the Long Game, a weekly national security podcast. This week we cover the massive nationwide protests in Iran and the US Response. The episode's out now. Search for and follow the Long Game wherever you get your podcasts.

[Kara Swisher]

So rule number two, talk to people. As you noted just a second ago, maybe not drinking as much, including strangers, but we're living at a time when young people are habituated to living on the phone. So are adults. Let's be clear that talking to a stranger feels rude. College students say that trying to start a conversation with a fellow student that's sitting next to them before class starts, for example, would be weird. Many of them are scared of being rejected. Talk about this social awkwardness and how to get over it. There's more substantive ways to do it. I, for example, walk behind people in San Francisco who are looking at their when I'm ever there and I, I go look up and someday you're going to hear of me murdered in the streets of San Francisco. I have to tell you, every person looks up and goes, ugh, I'm such an idiot. Like, they do not blame me for being extraordinarily rude. They feel like they're in the grips of this. But young people in particular, the isolation. There's been a movement across the world, including in this country, more of isolating kids from both social media and phones themselves. I think the problem is adults 25 to 45 myself, but talk a little bit about that, the meeting of people and what the phone environment does to that well.

[Dr. Zeke Emanuel]

So last year, in the fall of 2024, I banned all phones from my classroom. I also banned computers and taking notes by computers from my classroom. And two remarkable things happened. One was I came in and the classroom was a lot louder. When I walked into the room, people were actually talking to each other. And it was pretty amazing. They began before they were just looking at their phone. And the second is I actually got way better evaluations. And the reason isn't because I was doing anything different. The reason is they were paying attention and makes all the difference. Every time you talk to a professor who's banned the phones in their classroom, suddenly the classrooms get way better because people are not on the phone. They're not worrying about what's on the phone, they're actually worrying about what is.

[Kara Swisher]

Talk about socialization because it does feel social in some ways, right? Of course these things feel social. But talk about the importance of socialization for living longevity. It's very clear that we're in a problematic situation.

[Dr. Zeke Emanuel]

Absolutely. So people will say, well, look, I can connect with my friends, you know, who are living in Australia or living in California via the phone. 100% true. The problem is you made those friends face to face. You did not make them over the phone. Over social media, you can continue the conversation once it's made. Now the data on making friends and interacting, very, very interesting. So many of you will know the Dunbar number. This is an English anthropologist at Oxford and he looked at the brains of various animals, including people. And it's like we can have about 150 friends. That's all our brain can handle. Now, most of them are acquaintances. They're casual. You might have them over for dinner, you would recognize them, you'd have coffee with them. But five or so of them are. Five to ten are close friends who you're very intimate with. Many of them are, you know, family. Many of them are people you got to know in college where you were talking deeply at midnight with them. And then we have about 15 or 20 more who are people we have over to dinner we see regularly, we talk to about once a month. And those are really important for our psychology. So if you look at the data, people who have more close friends versus people who have one or two or zero. Increasingly we have a huge number of people. About 20% of the population now have zero to one close friends. That's it very, very clear that the more close friends you have, the more the longer you live. As a matter of fact, the difference between people who are lonely and have fewer social connections and people who don't is increase the mortality rate if you have fewer social friends between 22 and 33%.

[Kara Swisher]

I just recently for this series and Sherry Turkle about the increase in the chatbot relationships and she said it was an outlier. She's at mit. Was an outlier before and now it's regular that people are consulting their chatbot date. Google just settled with the parents. I've done a lot on the parents, the kids committing suicide with these relationships in general, these chatbot relationships seem they're no substitute.

[Dr. Zeke Emanuel]

They're no substitute. So look, my father was extreme extrovert. I relate in the book. We used to take road trips. He loved driving and we would take road trips out to we lived in Chicago and go out west, Montana and Wyoming and Colorado. And every time he stopped in a diner, right, he would start talking to the next table, or if there was no next table, he talked to the waitress. And he would ask them all sorts of questions, like, you know, why are you here? You know, how did you come here? What do you do here? All those kind of questions. And he didn't do it like that. You know, this is an FBI interrogation. I want to know name, rank and seal. He would, you know, he's just curious. And he was endlessly curious. He did the same thing in parks. Now his kids, right? We were always embarrassed by this. He's off again. You know, can we crawl under the table? But it turned out people loved it. And I learned from him several really important things. First of all, initiate the conversation. The other person probably wants to talk and is embarrassed or shy. We're all like that. I'm still like that. But initiate. Ask the other people questions, and they'll talk about themselves. And what happens if you get rejected? Happens all the time, right? Nothing will happen to you. There's no big issue, right? Absolutely nothing. So I have a practice here. All of you, you're Washingtonians, you know, right? All the cab drivers, the Uber drivers, they're from Ethiopia, right? So I get into a cab. You recognize people, that they're from Ethiopia. But I ask them, where are you from? And they tell me, ethiopia. I said, you know, I've been to Ethiopia five times. Suddenly they light up. They love it, right? Someone's been to their country. And so they asked me, where have I been? And I said, well, you know, I've been to Gundar, and I hiked mountains there. I've been to Addis Ababa. I've been to Lalibela to see the churches carved out of the rock. And then I say, so where are you from? And they tell me, I said, how much family do you still have back there? And we're in a conversation already. And it makes their day, and it makes my day. This is one message from my dad, right? I'm being virtuous, right? Not only am I having a good conversation, right? I'm having them have a good social interaction. It's good for their health, too.

[Kara Swisher]

Especially these ones that aren't friends like that. They're actually. The health benefits are rather like just speaking to people you don't know. Totally is really interesting. Now you also another way to stay sharp mentally, because a lot of it is about mental sharpness. Explain the difference between Crystallized intelligence and fluid intelligence. And how people can maintain what you want is fluid intelligence. Yeah.

[Dr. Zeke Emanuel]

So crystallized intelligence is all you crossword puzzle people who know all these words or your Scrabble people. You got crystallized intelligence, you know a lot of words and they're going to stay with you for a long time. I was just talking to 85 year old wife of my former dissertation, of my former, former. My dissertation advisor for my PhD who unfortunately passed away. And she said to me that she has gone back to playing ping pong. And I was curious, well, is ping pong kind of like bicycling that you know, you never forget it? You know how to ride a bicycle as a kid, you don't ride it for a long time, you get back on the bicycle, you know how to ride it. She says, absolutely, yes. And my serve is killer. Right. So, you know, that's crystallized intelligence. Knowing the muscle movement or knowing, you know, your old telephone number, your old home address, where an event happened a long time ago. Crystallized intelligence. The last thing to leave fluid intelligence, on the other hand, is, you know, being able to keep something in your head and concentrate on something, something else come back to remember it. It's decision making or fixing a pattern that you see or solving puzzles. That is fluid intelligence. And it's really important in new circumstances that you haven't seen before to bring all your information back together.

[Kara Swisher]

So doing new things. The reason I have honey here is this seeks honey. This guy's a famous scientist, but he decided to make honey. And by the way, it is the most delicious honey you've ever seen. But he Learned how to.

[Dr. Zeke Emanuel]

20 bucks for you after this.

[Kara Swisher]

Okay. He learned to make honey because it was hard for him. Right? Anything that's hard, whether it's you learn to make chocolate.

[Dr. Zeke Emanuel]

Correct.

[Kara Swisher]

He and I, in the video, he made me put on colonial garb and march. I had never marched in a colonial parade and never will again.

[Dr. Zeke Emanuel]

As a minute man.

[Kara Swisher]

As a minute man. Which was fun. It was actually fun and interesting. So doing things different is fluid.

[Dr. Zeke Emanuel]

It's part of fluid intelligence. Yeah. And it declines. Beginning in the late 30s, early 40s, our fluid intelligence declines. And it's the thing that is really, really important that allows us to be creative, allows us to continue anything, anything.

[Kara Swisher]

It can be physical, mental.

[Dr. Zeke Emanuel]

Exactly, totally. And there are things you can do to keep it going. And the first thing is get a lot of education. Turns out raising your baseline really, really important. And this movement that really had university professor has me shuddering, is you know, university's not worth it. Well, may not be worth it to you from money standpoint, but it's worth it to you from a brain standpoint. Why is that? Well, getting a lot of education makes more neural connections. Bringing together, you know, learning Dostoyevsky and connecting him to other writers, other messages. Right. Really, really important. Because once you start high, the decline seems to be pretty similar for people, and you start from a higher baseline. And so the thing.

[Kara Swisher]

It doesn't have to be just. Yes. Knowing how to do a carburetor.

[Dr. Zeke Emanuel]

Right. Okay, you'd be a fantastic trumpet player. Whatever. And then as you grow, trying new things, trying to establish those connections and trying to do things that challenge your mind and make you. Force you to make new connections.

[Kara Swisher]

Well, beyond crossword puzzles and things like that. Whatever. It. Something that's.

[Dr. Zeke Emanuel]

Well, crossword puzzles are probably the same thing. They're relying on the same store of knowledge.

[Kara Swisher]

Knowledge rather than like.

[Dr. Zeke Emanuel]

I was talking to Walter Isaacson the other day, and he was interviewing me, and he said that he's been learning French for the last four years. Cause he's writing a book about Marie Curie.

[Kara Swisher]

He is. And he's moved on to better people, dead ones.

[Dr. Zeke Emanuel]

And then he's learning French so that he can report on her. And that is spent a lot of time. No, you don't do these things passively or like, transiently. I mean, not passively. Transiently. You've got to actually stick to it to make those connections. Those are what keep your brain young. Now, one of my big heroes who appears in this book several times is Ben Franklin. He is the model of this. He was endlessly curious about everything, always thinking, and, you know, what is he famous for? If I ask you, you'll say bifocals, right? Almost everyone. That's the Aminius.

[Kara Swisher]

I'm not gonna say that at all.

[Dr. Zeke Emanuel]

What were you gonna say?

[Kara Swisher]

The lightning rod or drinking.

[Dr. Zeke Emanuel]

Oh, conservation of electricity. No, he was not a big drinker. Not a big drinker.

[Kara Swisher]

I'm teasing you. I'm teasing you.

[Dr. Zeke Emanuel]

And when did he invent the bifocals? He was 79 years old. Yeah. Wow. And he had two more inventions after that. That was. He invented them just before he left France to come back to the United States the last time. And then he built an addition to his house, a massive library for his 4,000 books, so he could stay curious looking at books. And he had to get the books high up on the shelf. So he's the guy who invented that arm. Do you have any of those Brad that gets the books from high shelves and then he invented a chair where you fold down the seat and there are steps there so you can climb up three or four steps to get a high book.

[Kara Swisher]

All of this after 79 because he had neural connects. All right.

[Dr. Zeke Emanuel]

He had plasticity in his brain like no one brain.

[Kara Swisher]

Plasticity is a lot of neuroscientists use. I played a lot of games. We did a lot of games which another poker and different. I just we just my wife and I took a mah jong. Listen just recently it's the trend thing so everybody get on it. 2026. We'll be back in a minute.

[Dr. Zeke Emanuel]

Is the American Dream still possible? And it shouldn't be a wake up that if you work hard, play by the rules, we're going to make the American Dream accessible and affordable to you. You're not going to struggle. You're going to strive to achieve something. For those who think that the system is rigged. Breaking news. You're not paranoid. I'm Preet Bharara and this week, former Chicago mayor and U.S. ambassador to Japan Rahm Emanuel joins me to break down the affordability crisis, education, why Trump supporters feel betrayed, and what a Rahm Emanuel presidential campaign might look like. The episode is out now. Search and Follow Stay tuned with Preet Wherever you get your podcasts.

[Preet Bharara]

This week I'm chatting with Jerry Lee, the career wizard and co founder of Wansulting, who left Google to help millions land their dream jobs. Jerry, brutally honest about the career myths that are keeping you broke, why six figures may not be the flex it used to be and the exact three steps you need to take right now if you're dreading your job search in this spooky market. Plus, he's spilling the tea on the worst resumes he's ever seen, his biggest money lesson, and why he's giving away free career resources to his 3.5 million followers when he could be charging for everything. Whether you're hoping to lock in that promotion, pivot to something new, or finally crack six figures, Jerry's breaking down the real strategies that actually work. Get ready for an unfiltered conversation about building the career and the bank account you actually want in 2026. Listen wherever you get your podcasts or watch on YouTube.com YourRichBFF the next chapter.

[Kara Swisher]

Should be everyone's favorite. It's titled Eat yout Ice Cream, which is the title of the book. In it, you give advice on food that mirrors, in some cases, the newly inverted food pyramid that was published by The FDA and or rfk. Sometimes a broken clock is right. There may be a surprise to. Some people tell us should eat our ice cream, but he does not think. Well, maybe he does because of whole milk. But compare and contrast your advice on food and RFK juniors.

[Dr. Zeke Emanuel]

Yeah, So I would say I was. There are positives in yesterday's. Yesterday. Yesterday's announcement. Okay. And I was very pleasantly surprised. The positives are mostly on the what not to do. Don't eat so much ultra Processed Foods. 58% of the American caloric intake is ultra processed foods. It's horrid. Horrid. Don't drink sodas. Cut down on your sugar. All of that's in his recommendations. It's also the top couple of Zeke Emanuel's recommendations. He's also against packaged cakes and cookies and things like that. All of that I agree with. Okay. He doesn't emphasize fermented foods, which is my big. The positive thing to do, eat fermented foods. Good for the microbiome. In the case of. Probably the thing I push the most in the book if I had to, with no financial conflicts of interest, by the way, yogurt, good dairy associated with a drop in type 2 diabetes. Great for the microbiome because it's fermented. Kefir is the same Kimchi, sauerkraut. Really, really good. The thing I vehemently disagree with in that book is they're pushing more red meat. We know we've got tons of studies about red meat. High in saturated fats, heavily associated with cancer, heart disease, stroke, diabetes. We could go down the list. There's a much longer list, you know. You like that? I like it. Every so often, you know, maybe once every two months, I'll have some red meat. I like a hamburger too. Not way too much emphasis on that. You know, don't use seed oils. Use beef tallow.

[Kara Swisher]

Wrong.

[Dr. Zeke Emanuel]

Seed oils are actually quite good. You know, canola, sunflower oils. You know, the best oil, if you want, is olive oil. It's very expensive these days. But, you know, so there are many good things.

[Kara Swisher]

Beef tallow is a no.

[Dr. Zeke Emanuel]

Yeah. Definite, definite no. Yes. So I. That's the recommendation. Now, of course, I deal with a lot of other things. If there's one other big positive thing you have to do that Americans are terrible at Fiber. More than 90% of Americans do not eat enough fiber every day. We don't eat fruits and vegetables. Which is main source or nuts? Main source of fiber. And that is bad because the fiber is basically the prebiotic. So we Spend a lot of money on those stupid prebiotics. Just eat your fruits and vegetables.

[Kara Swisher]

Right?

[Dr. Zeke Emanuel]

Really crazy.

[Kara Swisher]

The surprising one. Avocados.

[Dr. Zeke Emanuel]

Yes, avocados.

[Kara Swisher]

One avocado will give you almost all the fruits.

[Dr. Zeke Emanuel]

That's right. Absolutely. So my big breakfast recommendation is a bowl of berries, some granola with oats in them, yogurt and kefir on there, and throw in some hemp hearts for additional protein. Nothing could be better.

[Kara Swisher]

All right, last chapter is on sleeping. Well, I don't sleep a lot.

[Dr. Zeke Emanuel]

None of us do.

[Kara Swisher]

But I wear this, and I now am very much tracking it. This is the Oura ring.

[Dr. Zeke Emanuel]

Does it help?

[Kara Swisher]

I have to say, I used to call all of them unwearables. They're called wearables. But this one actually gives me some interesting information, especially around sleep.

[Dr. Zeke Emanuel]

More information than, say, getting up and feeling good?

[Kara Swisher]

Yes. No, you're correct. You are. But it's just interesting to me. And we're doing this thing. So I wanted to find out. But I did interview a bunch of sleep experts. And of course, you don't quite need as much sleep as they say. Chew at the same. Like, it's more like seven hours. It's the time that you wind down sleeping on cold, having a cold, cold room. And so there's some typical things. But talk about. Because there's a lot of people who don't sleep. A lot. High achievers. Martha Stewart, Tom Ford, Bill Clinton. I hate to say it. Donald Trump doesn't sleep very much.

[Dr. Zeke Emanuel]

Wait, wait. You talked about high achievers.

[Kara Swisher]

All right, okay, okay. I said he's achieved a lot.

[Dr. Zeke Emanuel]

So let me first talk about the wearables, because I am, in general against the wearables and especially for sleep. I should note very carefully, in my household, I'm the minority opinion. My wife, who has a PhD from MIT, very quantitative. She loves the numbers. It really motivates her. Now, if the numbers motivate you, good. But I've never understood the wearables, especially for sleep. Sleep. You get up in the morning, you feel like shit. You know, you didn't have a good night's sleep. You feel good, you know, you had a good night's sleep. I don't need a little, you know, aura ring to tell me that. And that's what I told the CEO of Aura. I was giving a talk somewhere, and he was sitting right next to me. And I said, you know, I think that thing you're selling is like. Anyway, did you.

[Kara Swisher]

You Larry David in him? You Larry Dave? You went.

[Dr. Zeke Emanuel]

Anyway, I don't Quite understand that. But sleep is a huge problem. Mainly because of what you said is that we have this sort of, you know, Protestant ethnic work ethic in America and we think, you know, less sleep is better. I had my debate partner when I was, you know, 15 years old, he had this idea, I'm wasting a third of my life sleeping. It's got to. No, sleeping is really important for you. How do we know that? Because we do sleep. Sleep is really, just think about it, really dangerous. You're knocked out for eight hours. You are the most vulnerable you could possibly be to the cheetah next door. Right. And yet it's preserved. It must be important, right? Nothing would have been conserved through evolution like that that made you so vulnerable unless it were really. Really.

[Kara Swisher]

It also cleans out your brain.

[Dr. Zeke Emanuel]

Very important to clean out your brain.

[Kara Swisher]

REM sleep.

[Dr. Zeke Emanuel]

It also allows you to restore your muscles and lots of other things. It moves the memories from short term memory to long term memory. That the short term memories have campus long term. That's why I'm pointing to. This is a biology lesson and including everything else anyway, really, really important. And we do a terrible job because we think less is better. No, less is not better. And we have to change our attitude now. We Americans like quick fixes. So we reach for the pills. Terrible idea. They don't work. And this isn't Zeke Emanuel talking. The American Academy of Sleep Medicine is like negative on all of them. You go to like the Cleveland Clinic webpage, You go to Mayo Clinic, they all say the same thing. The only thing proven to work besides setting the bed is cognitive behavioral therapy for insomnia, which is to figure out what's going on, you know.

[Kara Swisher]

So there are some new classes of drugs that they're looking at, correct?

[Dr. Zeke Emanuel]

Yeah, yeah. I would not. Kara, you can invest.

[Kara Swisher]

I would invest it. I'm not investing. So very last. And then we're gonna get to questions in a second. But exercise. And then I have two newsy questions.

[Dr. Zeke Emanuel]

Exercise. The answer is yes. You gotta do all the kinds of exercise. There are three kinds of exercise. Aerobic, right? For your heart, lungs, vasculature, reduces cardiac problems and stroke risk and things like that. You got to get your heart rate up. Strength training, really important. So you're not. The fragility is you're not fragile and really, really important. And then balance and flexibility. Yoga. So, you know, I start my day, my wife and I start our day, 20 minutes of yoga in the morning followed by about five minutes of core exercise. And then we go off and so it's not a lot.

[Kara Swisher]

You don't have to do a lot, like obsessive.

[Dr. Zeke Emanuel]

That's the yoga. I ride a bike in the winter. You do three or four times the inside bike three or four times a week for 20 minutes. Just 20 minutes. Get it in again. You can fit 20 minutes into any day.

[Kara Swisher]

Excessive exercise is not. Is proven not to be that much beneficial unless you like it. Correct?

[Dr. Zeke Emanuel]

Yeah. Right. So one of the interesting things is we all have 75 minutes a week of vigorous exercise, 150 weeks of moderate exercise. And if you push that up, you do more and more. There's a plateau and you don't get any more. And then you just increase your risk of getting repetitive motion injury, you know, tennis elbow, whatever. You know, problems with your knees doesn't decrease your mortality at all. And the other problem I find is, you know, just think about it. Ten hours a week. What is the opportunity cost there? What aren't you doing in that time that you could be doing now? Sometimes there's a good excuse. You know, when I'm writing, I usually come to some problem. I can't say it right. I don't know exactly what I want to say. And then when I go out, I go out for a run, you know, and I think about it, and it usually solves my problem. But there is a plateau, and I think we don't recognize that enough. Don't overdo it because you're either wasting time or you're risking serious injury.

[Kara Swisher]

Right. And don't tell everyone about your exercise routine because it's exhausting. We wanna end very quickly on some newsy questions. The CDC recently dropped childhood vaccine recommendations for six diseases. Seems schmucky to me, but the CDC said we're now more in line with other developed nations that recommend fewer vaccines that have similar, better outcomes. Where do you come down on the schedule?

[Dr. Zeke Emanuel]

Look at your face. Wrong. Okay. All right. Okay. I mean, you know, Denmark. Just think about Denmark. Right? A country of 6 million people.

[Kara Swisher]

Denmark does not want us to think about them right now.

[Dr. Zeke Emanuel]

That is very true. A country of 6 million people. Universal healthcare coverage, where when you go to the point of service, you go to get care. Copay zero. Right. And they've got nurses that pay attention to kids to make sure they get all their vaccines. They actually are doing well and they actually follow a little more paternalistic, you might say, than America. That contrast. Right. They're down at 11, by the way. They're the outlier. They are very short on the vaccine. That is a Bad mistake. And I can tell you the most difficult or the worst thing about it is the call I got from my three daughters, Right, which is, dad, what should we do about vaccines for the kids? Right now, they have a doctor they can consult, but most people don't have that. I said, you just tell your pediatrician you want the old vaccine schedule and no screwing around. Okay? But I think it's going to sow a lot of uncertainty. And we've already seen this. The vaccination rate, not just for MMR, but for diphtheria and tetanus is down. 65% of the counties in the United States now have the herd immunity level, which is 95% for MMR. They're below the herd immunity level. We're going to see lots of outbreaks, lots of kids hospitalized, and lots of deaths. That is not a good thing for the next generation. The wrong direction.

[Kara Swisher]

The wrong direction. Okay, last question. Republicans in Congress are refused to reauthorize the Affordable Care act subsidies, but now they did tonight. They voted. They went against Trump and the others. Yeah, but.

[Dr. Zeke Emanuel]

Well, it's been passed.

[Kara Swisher]

Didn't pass, but it passed in the.

[Dr. Zeke Emanuel]

Representative House of Representatives.

[Kara Swisher]

It might pass in the Senate. You were instrumental in creating the aca. If you could go back to those negotiations, knowing what you know now, what would you have done differently to make the law harder to undermine?

[Dr. Zeke Emanuel]

How long do you have, Kara? So let me. It's a complicated story. One of the things. Look, the Affordable Care act has been a tremendous success. 25 million people or so got health insurance, and we know that giving people health insurance actually decreases their mortality. We actually plateaued on health care costs as a percent of GDP for 15 years, unprecedented in American history. I unfortunately can't say that our quality has gone up, and I also can't say that our satisfaction has gone up in that time. One of the problems, the biggest problem, is you put in place a bill and there was no mechanism to make moderate changes without going back to Congress. No company, no company would put in a strategic plan, operationalize it, and then not reexamine it for 15 years. You just wouldn't do it. And that's basically what we did with the Affordable Care Act. There are many modifications that need to happen and couldn't happen because of the political polarization. Republicans just uninterested and trying to make it better. There are many things to make it better. If I had to go back, go back. There are two big changes, sort of themes of changes that I would make. I'm not Going to talk about the particular details, except for one. We made healthcare more complicated. We added the exchanges, and we added a bunch of stuff that made healthcare more complicated. I think one of our mantras going forth has to be simplification. We have to simplify things, not make them more complicated. We have to mean, all right, either you get insurance through your employer or you get insurance. Everyone else gets insurance this other way, which I think ought to be a small exchange, only six plans on it, reduce the number so that people can make rational choices. The other thing we needed to do was to make much more standardization, Standardization of medical treatments, standardization of electronic health records. So, you know, you go to two different hospitals, you can actually get them move back and forth. Standardization of what we pay. You know, there's no price for anything in health care. There are a million prices for, you know, you go to the hospital, you know, there's a Medicare price, there's a Medicaid price, and then every private insurance company and individual plans in those companies has a different price. It's nonsense. It's one of the reasons we have so much. It's so costly and we have so much administrative cost. 20% of all health care spending is administration. And one of the reasons is we haven't standardized things. So simplification and standardization is where I would go. Now. My plan. Okay, I'm running my plan is, you know, we need to do something about affordability now. Right now, everyone, when insured people are afraid to go to the doctor or to the emergency room. You know, you have a serious problem when deductibles are $5,000 and most people can't afford that serious problem. So we have to do things and everyone has to be taxed. Hospitals, insurance companies, drug companies, all have to suffer something to keep get the costs down. But that's not comprehensive reform. We have to move to more comprehensive reform and get a plan. And the problem is, you know, and just as much a problem for us liberals who've been working on healthcare, we haven't got a lot of plans out there. And, you know, there's a lot of depression among, I think, most health policy people. It's like, you know, we're not gonna get anything, so why think about anything? No, we have to work now. And I like to remind people, you know, Medicare was first proposed 1957, enacted 1965. You have to develop an idea, vet an idea, socialize it with people. And healthcare is particularly hard because no one knows how the hell it works. It's just so complicated and so it takes a lot of time to socialize people and you have to talk to them. My first action, by the way, on the road to affordability is cap deductibles and out of pocket payment. They should be no higher than $1,700, which is 2% of the median income of American households. And that should be it. That's what they do in Germany. That's what civilized countries do.

[Kara Swisher]

Okay, if your brother runs for president and wins, we'll see if he made you. HHS thing, what's the first thing you would do? You say buy RFK and your beef tallow. Move along.

[Dr. Zeke Emanuel]

What's the first thing I would do? That's a really good question. There's so much that needs to be done there. I don't know. Actually, you've got me stumped. I think this issue of healthcare reform, and the reason I keep coming back to it, is fixing the healthcare system is because we're spending $5 trillion a year. You know the American healthcare system is the third largest economy in the world, right? Only the United States and China are bigger. Our healthcare system is bigger than Japan, bigger than Germany's. Total economy. So why would I focus on. We need to take money out of that system so we can do two things. One is spend it on other things. Education, fixing our grid, lots of priorities in America. The second thing we have to do is give some of that money back to families. If we took the American health care spending from 17.5% of GDP down to 15% of GDP, 2.5% drop, that's $3,000 per family. Just imagine what most Americans could do with 3,000 extra dollars. I now know what I would. My very first action. Thank you for.

[Kara Swisher]

All right. I can't.

[Dr. Zeke Emanuel]

Give me time to bullshit filibuster while I was thinking.

[Kara Swisher]

All right, okay, excellent.

[Dr. Zeke Emanuel]

My very first.

[Kara Swisher]

Go ahead.

[Dr. Zeke Emanuel]

My very first thing is I would mandate through Medicaid that all newborns. Right. Get nurse family partnerships so they have early childhood interventions for the first two years of life. If there's any higher return for a dollar spent. Right. It's the highest return for the government spending, a dollar. University economists estimate between $7 return to $15 return. Because what we do early on is the most important thing for brain development, for socialization, for all sorts of things. So you gotta work with parents, you gotta make sure kids have a strong, healthy start. That would be my first thing.

[Kara Swisher]

Because that's what it takes to live long.

[Dr. Zeke Emanuel]

It's an investment in the future. Yeah. All right, all right.

[Kara Swisher]

Well, the book is called Eat yout Ice Cream. And by the way, there's ice cream all around this area. Six Simple Rules for a Long and Healthy Life. What is your favorite ice cream?

[Dr. Zeke Emanuel]

I've got two favorite ice cream places in Washington D.C. dolce, where Rob Duncan is a very dear friend and makes special ice cream for me, the chocolate hazelnut and trying to get him to make a Lebna honey pistachio ice cream. Just heavenly and happy ice cream has a wonderful chocolate as well and I eat them all.

[Kara Swisher]

All right. On that note, Zeke Emanuel, everyone. Thank you so much. Today's show was produced by Christian Castro, Roselle, Michelle Aloy, Meghan Burney and Kalyn Lynch. Nishat Kirwa is Vox Media's executive producer of podcasts. Special thanks to Rosemarie Ho. Aaliyah Jackson Perez engineered this episode and our theme music is by Trackademics. Thanks again to politics and pros for hosting this event. If you're already following the show, you're eating ice cream. If not, you're drowning in beef tallow. Go wherever you listen to podcasts, search for on with Kara Swisher and hit follow. Thanks for listening to on with Kara Swisher from Podium Media, New York Magazine, the Vox Media Podcast Network, and us. We'll be back on Thursday with more.