Podcast Summary: The New Yorker Radio Hour

Episode: Trumpcare Revisited
Date: July 14, 2017
Host: David Remnick
Featured Guests: Dr. Ezekiel Emanuel, Jill Lepore, Edgar Keret

Episode Overview

This episode of The New Yorker Radio Hour, hosted by David Remnick, revisits the ongoing debate around healthcare reform in America, focusing on Republican attempts to repeal and replace the Affordable Care Act (ACA), known as "Obamacare," during the Trump administration. The discussion features perspectives from Dr. Ezekiel Emanuel, one of the ACA’s architects, and a historical context provided by New Yorker writer and Harvard historian Jill Lepore. The episode closes with a lighter conversation about Israeli literature and musicals with writer Edgar Keret.

Key Discussion Points & Insights

1. Inside the Healthcare War Room: Dr. Ezekiel Emanuel on Trumpcare

Timestamps: 01:20 – 13:13

• Emanuel’s Role & Meetings with Trump:
  Dr. Ezekiel Emanuel, former Obama advisor and one of ACA's architects, recounts his closed-door discussions with President Trump and his top advisors about the Republican health care repeal bill.

  • “The last time I met with him was the end of March, just before Paul Ryan pulled the bill because he didn’t have the votes. And I basically told him it was a terrible bill and would leave many people uninsured.” (Dr. Ezekiel Emanuel, 02:31)

• Evaluation of the Senate GOP Bill:
  Emanuel strongly criticizes the Republican bill, labeling it harmful and regressive:

  • “This bill is cruel, throwing 22 million people off insurance, creating uncertainty so that premiums go up.” (Dr. Ezekiel Emanuel, 03:10)
  • Only two positives: keeping young adults on their parents’ plan until 26 (benefiting mostly the upper middle class) and marginally increasing subsidies for the Medicaid gap.

• Critique on Policy Motivation:
  Emanuel points out the bill is focused more on tax cuts than health care:

  • “Well, actually, this bill is a tax cut for the wealthy. Forget down the line. You don’t need down the line. You’re getting rid of taxes where the rich have to pay an added 2.9% on their Medicare bill…” (Dr. Ezekiel Emanuel, 04:02)
  • He questions the motivations: "There isn't the logic that is focused on health care. That's quite clear. It's a logic focused on something besides health care." (Dr. Ezekiel Emanuel, 04:53)

• Challenges in U.S. Health Reform:
  Emanuel discusses "path dependence"—why the U.S. can't simply copy foreign health models, and the focus should shift from payment models to care delivery quality.

• Personal Perspective on Aging and Medicine:
  Emanuel shares his controversial view on aging and end-of-life care, reiterating that after 75 he would not take medicine solely to prolong life:

  • “I’m not trying to prolong my life after 75… My just hanging on and being a burden on my kids just to have more years. That does not seem valuable to me.” (Dr. Ezekiel Emanuel, 10:17)

• Audience Pushback:
  Remnick notes inevitable emotional responses, to which Emanuel replies:

  • “I would challenge them if that really is meaningful or if what they have done is narrow down what constitutes meaningfulness for them to accommodate their limitations…” (Dr. Ezekiel Emanuel, 12:11)

2. A Century of Healthcare Reform Battles: Jill Lepore’s Historical Lens

Timestamps: 13:13 – 28:58

• Early U.S. Healthcare Reform Efforts:
  Lepore traces the roots of the debate to the early 20th century, with U.S. reformers inspired by European models:

  • “Universal access to health care in the United States was first seriously considered in the 1910s…” (Jill Lepore, 14:23)
  • Failure attributed to constitutional concerns and anti-German xenophobia post WWI.

• Rhetoric of Opposition:
  The attack on “socialized medicine” evolved, often stoking xenophobia and fears of statism:

  • "But the arguments against it always are xenophobic. First it's the Germans… then it's socialism, communism, Europeanism…" (Jill Lepore, 16:25, 17:01)
  • “It grants too much power over the individual to the state. So it’s statism, it’s collectivism…” (Jill Lepore, 17:01)

• Obstacles in the 1940s:
  Coordinated opposition by AMA and PR consultants Whitaker and Baxter turned public opinion against Truman’s universal care plan:

  • Example of successful messaging: “Nine months later they looked at the mail again and Americans were opposed to Truman's plan 4 to 1. And that was pretty much just the money that they spent making their argument…” (Jill Lepore, 23:38)

• AMA’s Shift & The Rising Cost of Delay:
  Doctors, once supporters of universal insurance, grew opposed as medical income soared, making reform costlier over time.

• Johnson’s Success with Medicare & Medicaid:
  LBJ’s politicking and the legacy of Truman’s efforts led to these landmark programs, described as flowering “into care for the sick and serenity for the fearful.” (Harry Truman archival, 24:42)

• Healthcare Backlash & Contemporary Crisis:
  Lepore notes the unprecedented nature of current efforts to strip away benefits, with political confusion and lack of clear advancement toward universal coverage:

  • “What I think is kind of terrifying about this current moment is that the enemy is now no longer foreign. The enemy is within the United States.” (Jill Lepore, 27:18)

• Hope for the Future:
  A challenge to Democrats: to reframe the argument for universal health care around the common good:

  • “…they would need to reclaim an argument about the common good… until they do, they cannot defeat even a weakened argument against health care.” (Jill Lepore, 28:18)

3. Cultural Wrap-Up: Edgar Keret on Israeli Literature & Musicals

Timestamps: 29:03 – 35:13

• Israeli Literary Scene:
  Keret discusses new voices in Israeli fiction, highlighting a novel (“Waking Lions” by Ayelet Gundar-Goshen) and its complex moral questions.

• Musicals and Fatherhood:
  A personal reflection on taking his son to a musical (“Groundhog Day”), which challenges Keret’s skepticism about the art form:

  • “I've seen the movie and really liked it. The musical is kind of... different in a good way because... it actually is different and makes sense… because the premise is very philosophical.” (Edgar Keret, 31:55)
  • “When the show was over, he said, you know, dad, you were right. This was better than a film.” (Edgar Keret, 34:44)

Notable Quotes & Moments

• On Healthcare Policy:

  • “This bill is cruel, throwing 22 million people off insurance, creating uncertainty so that premiums go up.”
    – Dr. Ezekiel Emanuel (03:10)

  • “Well, actually, this bill is a tax cut for the wealthy. Forget down the line.”
    – Dr. Ezekiel Emanuel (04:02)

• On Historical Rhetoric:

  • "But the arguments against it always are xenophobic. First it's the Germans… then it's socialism, communism, Europeanism…"
    – Jill Lepore (16:25, 17:01)

  • “Nine months later... Americans were opposed to Truman's plan 4 to 1. And that was pretty much just the money they spent making their argument.”
    – Jill Lepore (23:38)

• On the Arguments for Universal Care:

  • “…they would need to reclaim an argument about the common good... until they do, they cannot defeat even a weakened argument against health care.”
    – Jill Lepore (28:18)

Timestamps of Important Segments

• 01:20 – Introduction to health care debate and interview with Ezekiel Emanuel
• 02:31 – 13:13 – Emanuel on ACA, GOP bill, personal medical philosophy
• 13:13 – 28:58 – Jill Lepore on the century-long history of universal health care debates
• 29:03 – 35:13 – Edgar Keret on Israeli fiction and discussing musicals with his son

Tone & Style

The episode blends sober policy discussion and historical storytelling with moments of humor and personal reflection. Dr. Emanuel’s critique is direct yet measured. Jill Lepore’s analysis is detailed, theoretically rich, and delivered with a wry historical perspective. Edgar Keret’s segment is light, witty, and introspective, typical of his literary reputation.

Takeaways

• The fight over health care in America is as much about identity, ideology, and history as it is about policy details.
• Efforts to establish universal coverage have been stymied more by powerful interests and rhetorical strategies than by lack of public support.
• The current debate reflects a century-old struggle—one that will require a new political rhetoric aimed at the common good to move forward.
• Even in moments of political turmoil, culture and family life continue, offering reminders of broader human concerns.

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