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

23:54Kara Swisher:And 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, oh, 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.

24:33Well, 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, you know, began to be 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.

25:20Every 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 the professor saying.

25:34Kara 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. 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. A hundred percent 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.

26:11So 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, you know, 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 10 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.

26:48And 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. It's very, very clear that the more close friends you have, right, 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 percent.

27:38Kara Swisher:I just recently for this series in Sherry Turkle about the increase in the chatbot relationships. And she said it was an outlier. She's at MIT. It 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 kids committing suicide with these relationships. In general, these chatbot relationships are seen. They're no substitute. They're no substitute. So look, my father was an 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 to Montana and Wyoming.

28:24in 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 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?

28:58But 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?

29:40So 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.

30:11And it makes their day and it makes my day. And 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.

30:27Kara Swisher:Especially these ones that aren't friends. Like 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 as fluid intelligence. Yeah. So crystallized intelligence is all you crossword puzzle people who know all these words are your Scrabble people. You've got crystallized intelligence. You know a lot of words, and they're going to stay with you for a long time.

31:00I was just talking to an 85-year-old wife of my former dissertation, of my former, my dissertation advisor for my PhD, who unfortunately passed away. And she said to me that she has, you know, 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.

31:44crystallized intelligence, the last thing to leave. Fluid intelligence, on the other hand, is being able to keep something in your head and concentrate on 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.

32:11Kara Swisher:So doing new things. The reason I have honey here. This is Zeke's 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 - 20 bucks for you after this. 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. 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. As a minute man. As a minute man, which was fun. It was actually fun and interesting. So doing things different is part of fluid intelligence.

32:48And 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 with things.

33:04Kara Swisher:Anything that can be physical, mental. Exactly. Totally. And there are things you can do to keep it going. And the first thing is, you know, 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 is 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 Dostoevsky and connecting him to other writers, other messages, right?

33:50Really, really important. Because once you start high, the decline seems to be pretty similar for people. And you start from a higher baseline. It could be anything.

34:02Kara Swisher:It doesn't have to be Dostoevsky. No, no, no. Learning how to do a carburetor, right? Okay. It would 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. Well, beyond crossword puzzles and things like that. Yeah, well – Just whatever. Something that's – Well, crossword puzzles are probably the same thing. They're relying on the same store of knowledge. Knowledge rather than like – Yeah. 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 because he's writing a book about Marie Curie.

34:41He is. He's moved on to better people, dead ones. And then he's learning French so that he can report on her. And that is – and he spent a lot of time. No, 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. Connections. But 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?

35:19Almost everyone, that's the immediate connection.

35:21Kara Swisher:I was not going to say that at all. What were you going to say? The lightning rod? Drinking. Oh, conservation of electricity. No, he was not a big drinker, not a big drinker. I'm teasing you. And when did he invent the bifocals? He was 79 years old. Yeah, wow. And he had two more inventions after that. 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.

35:57Do 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. All of this after 79.

36:14Kara Swisher:Because he had neuroconnects. Go ahead. He had plasticity in his brain like nowhere. Brain plasticity is a word a lot of neuroscientists use. I played a lot of games. We did a lot of games, poker and different things like that. My wife and I took a mahjong lesson just recently. It's the trend thing, so everybody get on it. We'll be back in a minute.

36:43Kara Swisher:Support for On with Kara Swisher comes from the Freedom From Religion Foundation. The First Amendment exists so no one gets to hard code their beliefs into law. So when the government tries to enforce religion, that's not morality. That's an attempt to control its citizens. The Freedom from Religion Foundation is one of the few organizations actually enforcing that boundary in courts, schools and in state houses. This is about power, not piety. When the government and religion merge, power always wins. If you care about personal freedom, real equality and keeping the state out of your conscience and your business, you can support them.

37:18Kara Swisher:Visit ffrf.us slash cara or text my first name cara to 511-511 to learn more or to join. Text cara to 511-511 or go to ffrf.us slash cara. That's cara to 511-511 and help protect a country that belongs to all of us. Text fees may apply. Eczema is unpredictable, but you can flare less with Epgliss. a once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking EBCLIS achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year with monthly dosing.

38:01Kara Swisher:EBCLIS, LibriKizumab, LBKZ, a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems.

38:29Kara Swisher:You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit EBCLIS.lily.com or call 1-800-LILY-RX or 1-800-545-5979. My day kicks off with a refreshing Celsius energy drink, then straight to the gym. Pre-K pickup, back home to meal prep. Time for my fire station shift. One more Celsius, got to keep the lights on. When the three alarm hits, I'm ready. Celsius. Live. Fit. Go. Grab a cold refreshing Celsius at your local retailer or locate now at Celsius.com. The next chapter should be everyone's favorite.

39:06Kara Swisher:It's titled Eat Your 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 FDN or RFK. Sometimes a broken clock is right. There may be a surprise to some people. Tell us why you 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. Yeah. So I would say I was, there are positives in yesterday's, is it yesterday? Yesterday's announcement. Okay. And I was very pleasantly surprised. The positives are mostly on the what not to do.

39:48Don't eat ultra processed, 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 positive thing to do. Eat fermented foods, good for the microbiome. In the case of, you know, probably the thing I push the most in the book if I had to, with no financial conflicts of interest, by the way, yogurt.

40:32Um, good dairy associated with a drop in, uh, um, uh, type two diabetes. Great for the microbiome because it's, uh, it's fermented. Keep kefir is the same kimchi, uh, sauerkraut, uh, 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 at high and 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.

41:18Not way too much emphasis on that. You know, don't use seed oils, use beef tallow. Wrong. 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.

41:38Kara Swisher:Beef tallow is a no. Yeah, definite. Definite no. Yes. So 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. Right. The surprising one, avocados. Yes. One avocado will give you almost all the fiber.

42:20That'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.

42:40Kara Swisher:All right. Last chapter is on sleeping well. I don't sleep a lot. None of us do. But I wear this, and I now am very much tracking it. This is the Oura Ring. Does it help? 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. More information than, say, getting up and feeling good? Yes. No, you're correct. 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, too.

43:15Kara Swisher:It's more like seven hours. It's the time that you wind down. sleeping on cold, having a cold room. And so there's some typical things. But talk about sleep, because there's a lot of people who don't sleep a lot. High achievers, Martha Stewart, Tom Ford, Bill Clinton, and I hate to say it, Donald Trump doesn't sleep very much. Well, wait, wait, wait, wait, wait. You talked about high achievers. All right, okay. No, I said he's achieved a lot. 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.

43:56My 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.

44:29Kara Swisher:You Larry David in him. You Larry Dave. You went, eh. 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 Protestant worth ethic in America, and we think less sleep is better. I had my debate partner when I was 15 years old. He had this idea, I'm wasting a third of my life sleeping. 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, you know, the cheetah next door, right?

45:14And 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 important.

45:25Kara Swisher:It also cleans out your brain. Very important to clean out your brain. REM sleep. It also allows you to restore your muscles and lots of other things. It moves the memories from short-term memory to a long-term memory that the short-term memories have campus long-term. That's why I'm pointing to this is a biology lesson by 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 to quick fixes. So we reach for the pills. Terrible idea. They don't work.

46:06And 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.

46:29Kara Swisher:You know, so. There are some new classes of drugs that they're looking at, correct? Lots. Yeah. Yeah. I would not. If Kara, you can invest, I would be skeptical. I'm not investing. I'm not investing. So very last, and then we're going to get to questions in a second, but exercise. And then I'd have two newsy questions. Exercise. The answer is yes. You got to 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.

47:05So 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.

47:31Kara Swisher:You don't have to do a lot, like obsessive. Well, that's the yoga. I ride a bike in the winter. You do. Four, three, four times, the inside bike three or four times a week for 20 minutes. Just 20 minutes, get it in and get it. You can fit 20 minutes into any day. The obsessive exercise is not, is proven not to be that much beneficial unless you like it. correct? Yeah, right. So one of the interesting things is we all have 75 vigorous exercise, 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.

48:14And 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. 10 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.

48:52Um, 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.

49:03Kara Swisher:Right. And don't tell everyone about your exercise routine. Um, we want to end very quickly on 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 and have similar, better outcomes. Where do you come down on the schedule? Look at your face. Wrong. Okay. I mean, you know, Denmark, just think about Denmark, right? A country of six million. Denmark does not want us to think about them right now. Well, that is very true. A country of six million people, universal health care coverage, where when you go to a point of service, you go to get care, co-pay zero, right?

49:49And 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, you know, a doctor they can consult, but most people don't have that.

50:28I 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. Your own daughters. 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.

51:04Kara Swisher:The wrong direction. The wrong direction. Okay. Last question. Republicans in Congress have refused to reauthorize the Affordable Care Act subsidies, but now they did tonight. They voted. They went against Trump and the others. Yeah. But the Congress. Well, it didn't pass. It didn't pass, but it passed in. The House of Representatives. It might pass in the Senate. it. 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? How long do you have, Kara? So let me, it's a complicated story.

51:43One 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 healthcare 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 re-examine it for 15 years.

52:32You 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 in 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 forward has to be simplification.

53:11We 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 moved back and forth. standardization in what we pay.

53:45You know, there's no price for anything in healthcare. 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 costs. 20 % of all healthcare 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.

54:20My 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 cost 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 health care, we haven't got a lot of plans out there.

55:07And, you know, there's a lot of depression among, I think, most health policy people. It's like, you know, we're not going to 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. 65. 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 capped deductibles and out-of-pocket payment.

55:49They 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.

56:02Kara 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. 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 health care reform, and the reason I keep coming back to it is fixing the health care system, is because we're spending$5 trillion a year. The American healthcare system is the third largest economy in the world. Only the United States and China are bigger.

56:46Our healthcare system is bigger than Japan, bigger than Germany's, total economy. So why would I focus on that? 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. I now know what I would, my very first action. Thank you for giving me time to bullshit.

57:36And filibuster while I was thinking. All right. Okay. Excellent. My very first thing is I would mandate through Medicaid that all newborns 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. It's a university economist estimate between$7 return or 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 got to work with parents. You got to make sure kids have a strong, healthy start.

58:24That would be my first thing. That's what it takes to live long. It's an investment in the future. Yeah. All right. All right.

58:30Kara Swisher:Well, the book is called Eat Your 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? I've got two favorite ice cream places in Washington, D.C. Dolceza, where Rob Duncan is a very dear friend and makes special ice cream for me, the chocolate hazelnut. And I'm trying to get him to make a Ledna honey pistachio ice cream, just heavenly. and happy ice cream has a wonderful chocolate as well. And I eat them all. All right. On that note, Zeke Emanuel, everyone. Thank you so much. Today's show was produced by Christian Castro-Russell, Michelle Alloy, Megan Burney, and Kaylin Lynch.

59:19Kara Swisher:Nishat Kerwa is Vox Media's executive producer of podcasts. Special thanks to Rosemary 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.

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