What Does Abdul El-Sayed Believe?

26:35Abdul El-Sayed:I really loved the clinical care part of things. I really did. I love people. I love hearing their stories or something, a gift that people give you when you talk to them in a clinical encounter where they bring you their worst problem on their worst day. And they're willing to share that vulnerability with the belief that you can help them. And so often you'd be in those clinical encounters and realize that I actually am not being given the tools to help you fully. And this institution gives those tools to some people and not others. And if you're concerned with the idea that not everybody gets to live a long, healthy life and you start wondering why, and you spend a whole lot of your life learning how to be a solution to that in part, and then realize that you're in this institution, you've got these skills, but the institution itself hamstrings you from actually doing the thing that needs to be done.

27:37Abdul El-Sayed:You start to get really frustrated. And I'm never going to forget a patient while I was at a small satellite hospital. So I went to med school in the city in New York and small satellite Hospital, the tip, northern tip of Manhattan. So a lot of the patients are from the Bronx and upper Manhattan. And there was this patient who would fall and hit her head on the subway stairs. She didn't want to be there. They didn't want her there. I'm in a sub-internship, a rotation where I'm getting ready to do my internship in medicine. And my job is to be a liaison between the emergency room and the hospital wards.

28:17Abdul El-Sayed:And this woman had fallen, hit her head, clearly had a welt forming, yelling at everybody there. She's inebriated. And it's early in the morning, which, you know, pathognomonic for having substance use and alcohol dependency. And I go to talk to the resident who was in the emergency room. I was like, what did the CT show? And that's, you're going to get a head CT if you fall and hit your head and you wind up in an emergency room. It's like the number one thing you do to rule out a brain bleed. And he's like, oh, we didn't do one. I was like, why not? He's like, well, he looks at me and he almost has this like pitiful look in his eyes.

28:51Abdul El-Sayed:Like she'd be a social admin. And at this point I'm like, oh, hell no, man. Like clearly has a well-known on her head. I don't care whatever her social circumstances are. If she has a brain bleed, she is going to die. I want to say what a social admin is. This is the old wallet biopsy. Exactly. Meaning we're going to, if we admit her, we're going to run into so many social issues with her that at the end of the day, we're not going to be able to help her. There's really nothing we can do for her. And the hospital is going to lose money. And, you know, where do we, how do you even discharge a patient like this?

29:25Abdul El-Sayed:So I call up my attending and I'm like, look, like even do a head CT. This is ridiculous. Like no real H and P, no history and physical. Like this is absurd. And my attending is like, okay, like if you think we should admit her, we should admit her. Turns out she has full-blown AIDS, actively bleeding pelvic mass. Her blood sugars are all over the place. One of the things I learned is that HIV can infest the adrenal glands, which manage your blood pressure. So despite having been hypertensive her whole life, she's now got low blood pressure because basically the hormone system that manages her blood pressure is shot, okay?

29:59Abdul El-Sayed:Took care of her for two weeks. Worked with the social work team. We found her the only rehab facility that took HIV-positive patients. Then got her hooked into her Ryan White housing, which he had access to because of her HIV status. And I was like, all right, great. Right. And we've reviewed the plan over and over and over again. Last day, I'm like, all right, today is the day you're headed off to rehab. And then you're going to, and she's like, I'm not doing that. I was like, I'm sorry, what? She's like, I'm not doing that. I was like, why not? She's like, well, I'm going home with my daughter.

30:25Abdul El-Sayed:I was like, I didn't know you had a daughter. She's like, you didn't ask. I was like, I definitely asked. But she's like, yeah, well, you know, I reconnected with my daughter and my daughter wants to pick me up. I said, that's great. It's great that you're, you had this relationship with your daughter. It's fantastic. What happened last time? Like, it seems like you hadn't talked to her for a while. She's like, oh, I started drinking. I was like, well, you know, what makes you think you're not going to start drinking again? She's like, I haven't had a drink in two weeks. I was like, well, we've had you chemically, you know, on a, on a benzodiazepine taper.

30:51Abdul El-Sayed:Right. So, uh, and you know, maybe you go to rehab, get your housing in order, you can rebuild that relationship. It's clear that you, you got a relationship there. And she's like, don't tell me what to do. You're not better than you. And if this is what you want to do, you know, I just got to tell you, I think it would be, if she's like, she's like, no, I'm going home with my daughter. I had just finished putting in my residency application like a couple of weeks later. And I'm, I'm getting on the A train going downtown Columbus circle area to have a meal at a Turkish restaurant with a friend.

31:24Abdul El-Sayed:I'm never going to forget. I get on the subway and my patient is laid out on the subway seats. and it was like a gut punch. So I go and check up on her to make sure she's like, okay. The same person, you just ran into her. Same exact patient. Flat on the subway. Flat on the subway seats. And I, you know, shake her a little bit. She didn't remember me, didn't know who I was. She was alive and breathing and everything. She just passed out. So I go have my dinner. I come home and I pull my residency application. Because at the end of the day, she became a referendum on my entire clinical career. Like she was the kind of patient I wanted to take care of.

32:01Abdul El-Sayed:And the thing that I hate most about that experience is that that resident was right. And our system is not built to take care of those kinds of patients. And if it was a just system, it would be. And it's almost like she knew. Say what you mean on that, because to go back to what we were saying a little bit ago about circumstance and luck, somebody else might look at the story and say, you can't help everybody, right? This is on some level on her. She's drinking. She chose not to go into rehab. The state did, the state through the person of you, did everything it possibly could for her, right?

32:31That hospital spent a lot of money over those two weeks. Taxpayers paid for that. And she still didn't want the help.

32:38Abdul El-Sayed:in that moment, correct. But think how many times you think she's interacted with the healthcare system only to learn the same script. How often has she been let down by some bureaucrat somewhere so that she doesn't really trust when I tell her that this is all lined up for her? This is a woman who dropped out of schooling in the eighth grade. She was abused by her mother's boyfriend when she was a kid. She fell into alcohol dependence. And you're right, no one individual can help everybody. But we want to live in a world, in the richest, most powerful country in the world, where you have structures and institutions that A, prevent the worst things that happen to her, and B, can catch you when you fall into those cracks.

33:34Abdul El-Sayed:and arguably a hospital is supposed to be that. Like when you look at the history of the institution of the hospital, it was that place. It was. We have stopped it from becoming that, or being that place anymore, because what we have are billing machines that are very, very good at billing. The irony of it is just downtown from that hospital, you have the main New York Presbyterian hospital. You go up to the top pavilion, and you've got carpeted rooms, which is a terrible idea, but you've got pianists who play piano for patients who come from all over the world to get care from some of the most talented surgeons and physicians in the world.

34:13Abdul El-Sayed:And the difference is a couple of floors. Our healthcare system has no longer become the thing which is supposed to give us ease in our pain. It has become just another industry for the minting of money. And it mints a ton of money for folks. It's also why it's way too expensive. It's deeply inequitable. the experience of it, whether you're a patient or a provider, is not satisfying. And this one patient became emblematic of that for me. Before I go into the whole healthcare system, when you say she became emblematic of that for you, and you move the direction of your own career, what are you imagining you could do for her specifically?

34:53Because what you're just saying about hospitals is true enough, but I think the point I understand you as making is that once she showed up at the hospital, I mean, somebody did try to help her in that case. You did try to help her. You did get the rehab set up. The resources were there if she wanted it, but too much had happened before then. Yeah. So what did you think you could go out and change or you could be part of changing?

35:18Abdul El-Sayed:I mean, frankly, it's generational, right? I mean, she was a black woman in America. You could take that all the way back, right? So what do you imagine we could do? Build far better schools where you have all of the paraprofessionals around teachers. Invest in students with special needs or students who are struggling. Build more pathways for students that it's not just two year, four year college or bust, but that you have apprenticeship and training. invest in small business opportunities for folks in communities like the one that she's from build out the the kind of mental health services that we need the kind of substance use treatment that we need those are all things that could have helped her could probably helped her mom and change the household in which she grew up and so i wanted to be a part of of addressing those challenges and also a part of trying to fix our health care system so that we actually could do the thing that people wanted to do.

36:19Abdul El-Sayed:And I'll just go back to it like a clinical interaction. There's something really precious about a moment that somebody tells you that they're in pain or discloses something that they're really embarrassed about. And as a doctor, you want to be that person who can help. You really do. And the problem right now is I think about all my clinical colleagues. They're like, I have eight minutes, eight minutes. This person has just disclosed this terrible moment. I got, okay, that's, that's like one minute. And I've got seven minutes. You've got a problem list that's like seven problems long. And meanwhile, the patient's super frustrated because they're like, well, I just, I just, I just told you this big problem in my life.

36:53Abdul El-Sayed:You can't help me. And then on the back end of it, they're going to get a bill for this terrible interaction. And you're going to have to fight the insurance company as the, as the provider to being like, wait a second, wait a second. I didn't write my note, right? Okay. Let me, let me just change this word in my notes. So you actually get the money for the interaction that I had for the eight minutes that I had with this patient. The whole thing is just deeply broken. Um, but it makes a lot of money for a few people who run a whole bunch of industries.

37:24If you're not a subscriber to The New York Times, we have some news for you. You can now explore The Times for free without any paywalls at all during your first month in The New York Times app.

37:44YouTube Premium enhances how I use YouTube with awesome features like offline downloads so I can download my favorite training videos before I hit the gym. So no Wi-Fi doesn't turn leg day into loading day. Plus, I get ad-free videos, background play, and so much more. YouTube Premium is like YouTube got some extra gains. Try YouTube Premium for two months free at youtube.com slash premium.

38:06Abdul El-Sayed:Hey, what's up, guys? It's Haley Bailey. Okay, I need to tell you about something. I just got YouTube Premium. It's got tons of awesome features like offline downloads, so I can download my favorite videos before I travel and watch them whenever I don't have Wi-Fi. Because we all know airplane Wi-Fi is the worst. I get ad-free, I get background play, and there's like a ton more in there. You should try it. If you like YouTube, you'll love YouTube Premium. So try YouTube Premium for two months free at youtube.com slash premium. Trial eligibility varies. Terms apply. Cancel anytime. That's a mouthful.

38:36Abdul El-Sayed:This podcast is supported by Mercy for Animals. Mariano's sells an upscale image, but behind the polished branding lies a harsh reality. Eggs from hens trapped in cages so small, they can't even spread their wings. Mariano's pledged to go 100 % cage-free, but continues to profit from cage cruelty and our stolen trust. Chicago deserves better. Learn the truth and hold Mariano's accountable at marianosunmasked.com. That's marianosunmasked.com It's been interesting to me to watch your primary this year and sort of watch the way that, like, American politics began to understand you because this is a version of you that I'd sort of been aware of for some time before this, which is a Medicare for all advocate, right?

39:26Somebody who's, like, kind of fundamental entrance into American politics is coming through health care reform. And so I want to spend some time on that because I think healthcare reform is coming back is one of my theses about the next couple of years. And you got some of it there, but you've written a full book on Medicare for All. It's a good book. It's not too many books from politicians worth reading, but if you want to sort of get the case for this, this one is. What do you find to be specifically dysfunctional about American healthcare compared to pure nations?

40:01Abdul El-Sayed:right now you have a system in which we think of ourselves as the customer but if you think about it Ezra if you get sick tomorrow you are the reason for a financial transaction between your health insurer and your provider and every single part of that financial transaction every player in that transaction except for you has a financial incentive to maximize the amount of money they get to pick. So your insurer makes money when you pay more into that insurance than gets paid out for your healthcare. The clinic or the hospital makes money because they provided healthcare and can bill for that healthcare.

40:44Abdul El-Sayed:The device company or the pharmaceutical company makes money when you use that product, whether in the context of a clinical interaction or the context of you taking medication. and for that reason there is no actual incentive for any one of these players to look out for your well-being there is no perfect solution to any human problem but if you were to design a system that was maximally painful for the patient it would be this one because you're getting extracted from at every level so let me just turn the page okay our experience of having private health insurance now is this. You pay every two weeks or four weeks.

41:26Abdul El-Sayed:I assume you're a W-2 employee of the New York Times company, right? Every two weeks or four weeks, the first group that eats is FICA. That's the government. Uncle Sam eats first. And then after that, your insurance company eats. Some premium for you, your family, right? The New York Times company pays for some of that. You pay for some of that. Chances are you probably have a deductible, unless the New York Times is like gray ladies particularly. No, I got a deductible. Okay, you got a deductible. If you think about it, that deductible is what you pay for to get the health care. You already paid for every paycheck.

41:55Abdul El-Sayed:And if you're doing the math, that means you're losing a whole nother paycheck for that health care. And then that's health care that sits behind a network, a network that's negotiated between your insurance and a provider, both of whom are using that opaque negotiation to try to maximize their market position relative to others of their type. An insurance company wants to gobble up other insurance companies. A provider wants to gobble up other providers. And you're paying to see a small group of doctors that have a sweetheart deal with the insurance company that pays for your insurance or doesn't quite pay for your insurance.

42:34And then you get sick.

42:36Abdul El-Sayed:You get a bill. The bill goes to your insurance company. And because the insurance company is incentivized not to pay for your health care, then you probably have to fight them. A certain amount of institutionalized churn. that you just have to put time into beyond the money you already put into it. And ultimately, to get less and less time with providers, because the way the providers deal with this is to parse out less time. So what would Medicare for All do? Rather than this situation in which you have an insurance company that is profit motivated, managing a lot of this transaction, you have one payer, who is the federal government, who by the way does this for people over the age of 65, Albeit not as efficiently as it should be.

43:18Abdul El-Sayed:That's a whole other money in politics problem. Well, it is and it isn't. I think it's worth stopping before we go fully into Medicare for all. I'm going to take some of the other side of this. Please. Partially to be the devil's advocate here. Which is the description you're giving of the fault of the American healthcare system is fundamentally that every player is interested in profit and not interested in you. And you could say that about any market-based transaction, right? In the supermarket, they want to make money on food. They sell you food. They sell you food in a markup and they're profiting from the difference.

43:54And the question in healthcare is whether the market incentives are getting you something that's worth it. If you're getting innovation from the pharmaceutical companies, from the device manufacturers, that they're incentivized to kind of come up with new ways of treating you. And to some degree, they are and they do. We have a kind of incredible pharmaceutical industry in terms of innovation. Now, the prices are a much more live problem. You know, whether or not the hospitals have an incentive to kind of attract you by getting the best care. The insurers, in theory, have some reason to attract your business.

44:33And I always take that the problem of American health care is that in a set of these transactions, two things have happened. One is that the prices we pay are way higher. You expect that the market will bring down prices. It hasn't. You talk a lot about this. I'd like you to explain to people why. The other is that people are supposed to be more efficient when disciplined by the market. It's not clear that's happened here. And maybe the third is that healthcare is a weird good. Where I always feel like this is very undersold. But I'll spend a lot of time deciding, you know, which computer to buy.

45:11I'll walk out of the store if I don't like the jackets they have that day and I want a jacket. My kid's sick. We're in the ER. I don't go down the street. But I'd like you to talk about that dimension of pricing because I think it's not just about there being profit. There's profit in a lot of things in our life and they work, you know, to some degree or another fine. But why isn't the profit incentive here getting people what they want?

45:34Abdul El-Sayed:So I love how you broke down that problem. Let's just start actually with the third point. That is, it's just a weird good. nobody actually wants health care they want health yeah when you need it you will do whatever it takes to do it and so we rely on other institutions to discipline the market from being able to price gouge us when we need health care here's the problem though insurance usually insurance markets don't work when you know you're going to need the outcome like if you if you insure your home you're not assuming your house is going to catch fire. Chances are you pay insurance, pay insurance, pay insurance.

46:10Abdul El-Sayed:You never actually get any payout from the insurance because, well, that's just how it is, right? So insurance is not really the right mechanism because at the end of the day, all of us are going to need some healthcare. Some of us are going to need a lot more healthcare and none of us know when that's going to happen. So we have this insurance market that was created to try to ease us from the financial burden of healthcare calamity. The problem though is once that health insurance system then starts to scoop some money off the top, the question becomes, well, how much and how? And herein lies the issue.

46:45Abdul El-Sayed:The moment somebody created a deductible, the idea of private health insurance became useless. Because if you know you're going to get sick and you have to pay your deductible anyway, and that deductible is unaffordable, at this point, you are now being hit with the financial calamity of your healthcare consequence or issue. like I don't begrudge the pharmaceutical industry for needing to charge for the innovation it creates I begrudge them charging as much as they do and charging us for stuff that's created innovation that was created 100 years ago but it's understandable in a market that you want to make something and then you want to sell something I get that but the insurance industry actually has no has no real purpose they don't innovate anything and they're failing the responsibility, which we pay them for, which is buy me out of financial catastrophe.

47:34Abdul El-Sayed:So that's why when I talk about Medicare for all, I'm not talking about reform of of the health care provision side of things. Talking about reform of the insurance side of things. But that's not true. Hear me out. Yeah. Discipline the rest of it. I think you're getting at what you're saying there. But what I was about to draw you out on is that Medicare for all, we can argue there are a lot of analyses about how much it would cost. It depends on what you cover and how you cover it. But the main thing it does, aside from simplifying administration, is it's a massive payer who can bargain down prices.

48:13And guarantee everybody health care. And guarantee everybody health care. But I mean that the way it would change what providers are doing. Like if you imagine you have Medicare for All and probably the kind of expansive versions of it that say Bernie Sanders has proposed and you don't change what anybody pays for a drug, for a good, for whatever, there's no way you can afford that. The theory here is that you have Medicare for All bargaining down how much the hospital can charge for an MRI. Medicare for All bargaining down how much Eli Lilly can charge for trisepatide. Medicare for All pushing down the prices of healthcare, which in other countries, they are lower.

48:51Canada, UK, France, per service, per drug, per all of it, they just pay less because the government negotiates it. The trade-off that people worry about there is innovation. Like there's this theory that the whole sort of world is free riding on how much America pays for drugs because it creates this incredibly robust market in drug innovation. I sort of agree with you that private insurers don't justify their existence all that well. We can talk about the arguments for them in a second, but I don't think they're doing a great job at really anything. But the real money is coming from negotiating down providers.

49:26And the reason insurers are failing us is they don't negotiate down provider prices very well.

49:31Abdul El-Sayed:Let me push on a couple of things. I think that is true from a system's view of the healthcare system. From the average person's view, I just want to have healthcare when I need it. And just the fact that it would guarantee everyone coverage at the minimum is such an incredible value above and beyond the current system that from a political standpoint, that alone is worth it. I lose my job, I still have my healthcare. That's huge. Without having to pay some insane amount of money for the health insurance I thought I had. That's huge. Now, I want to push on a couple of the pieces here. I happen to be a huge fan of Costco.

50:12Abdul El-Sayed:If there's one corporation I like, it's Costco. Now, some people might hate me for it, but like, you know, everybody's got to have their, as a, as a famous anti-corporatist, Costco, me and me and Kirkland. Um, but one of the things that people like about Costco is that they have sort of made a commitment to themselves that they are not going to make a margin of more than 15 % on any product. A lot of the innovation in our system, first, the riskiest research we subsidize as a government through things like the NIH, well, maybe not under Trump anymore, but like the NIH is intended to create the opportunity to de-risk the riskiest research.

50:47Abdul El-Sayed:You and I both know this. And almost every prescription drug that has made it all the way through the process has had some foundation in NIH-funded research. So that's number one. Number two, imagine prescription drug companies just said, listen, you know, we are going to charge 15 % above and beyond the rate of what it costs us to research and develop this drug. And we go from there. There's a world in which not that innovation doesn't go away. Costco is still a very profitable corporation. They're just not insanely profitable. And even then, pharmaceuticals and their business model tends to be more focused on the way they trade on a stock market than their actual profitability.

51:31Abdul El-Sayed:So to be clear, the day you pass Medicare for all, you would have to be able to sustain the system as it is. Otherwise, you'd in effect give the whole healthcare system the equivalent of a stroke. Over time, you have this disciplining feature. But imagine you took all the pharmaceutical companies and just said, you know what? None of you can be publicly traded. All of you have to stay private. and you are allowed to make 15 % over the top for a 20-year period of every medication you had. And then we are going to discipline through real generics and publicly funded generics to compete with you.

52:08Abdul El-Sayed:You would still get serious innovation because a lot of the riskiest research is already publicly funded. Yeah, but the riskiest research has a portion of public funding, and then it gets taken up by the pharmaceutical industry, and a huge amount of it fails. A huge amount of it fails. Sure. And it's funny because I almost want to separate these two thoughts a little bit. I think you can be a supporter of Medicare for All or Medico for Most. And then there's this question of what should policy towards the pharmaceutical industry be? But I think that there is one version that you'll sometimes hear people talk about with Medicare for All, which is putting a floor on the healthcare system.

52:50Which is, you were saying this a minute ago, that part of the value of it is that everybody knows they have health care all the time. And then there's a version which is putting a ceiling on it, too. Which is everybody's got the same health care, right? It's Costco, but Costco for everyone. There's no Trader Joe's. There's no Walmart, no Target, right? You're all Costco. What Costco thinks is worth it to stock, you can have. What Costco doesn't think is worth it to stock, you can't. So when you think of it, because there are countries that have, in Canada, for instance, much harder to get private health insurance in Canada, right?

53:25There are other countries like France that have a baseline public insurer and then supplemental insurance on top of that. So when you think about the ideal healthcare system, do you think about a floor and a ceiling? Do you think about a floor and not a ceiling?

53:39Abdul El-Sayed:I think about it as a floor. And to get at the question explicitly, imagine it to be like public schools. No matter where you live, you have a public school system that is there for your kid. You pay taxes into that system. That system is always going to be there for you. You may enroll your kid. You may not enroll your kid. That is still there for you, right? You are guaranteed a public education. Medicare for all is that guarantee. Everyone's enrolled. Everyone pays in. If you would like to have a private insurer above that, you're welcome to do that. But our goal is to build a floor so high that most folks would be like, why would I?

54:18Abdul El-Sayed:this covers everything I possibly could need. The other important differentiator here is that when we're talking about Medicare for All, we're not talking about healthcare, we're talking about health insurance. One of the things that people don't appreciate about our current system is that the current system actually chokes off innovation in the healthcare provision side. So just to put in perspective, if you're a private practice GI doc, you're reimbursing at substantially lower rates than the same GI doc who is a part of a larger healthcare system because the healthcare system has negotiated a bundled deal with the health insurer.

54:51Abdul El-Sayed:That itself is a problem. People don't appreciate that if you're on Medicaid, which is a really important safety net program, Medicaid reimburses at about half the rate of private health insurance, substantially lower rates than Medicare too. And so people don't compete for Medicaid patients. If anything, they usually discriminate against them, which has a huge problem for people on Medicaid. So if you really want choice in the healthcare system, Medicare for all does two things that are really valuable. Number one, it sets a very, very clear rate for what the reimbursements are and enables the rest of the market to go and innovate on who can get the customer base, the client base, the patient base.

55:32Abdul El-Sayed:And then the second thing it does is that it repatriates a whole bunch of people into the system. So it's not just Costco for all. It's like, well, what happens when you create this floor and now all the providers are set to compete. And you actually have the enablement of a real market because you have paying customers who can choose where they want to take their Medicare reimbursement. One of the things I think I'm seeing here is something I'm sort of seeing more broadly in the Democratic Party right now, which is I remember watching this form in 2006, 2007, before the Affordable Care Act, where you had a lot of parts of the party beginning to converge on roughly what was the health care vision that might be pursued next time.

56:15And over and over and over again, it was based on what Mitt Romney did in Massachusetts, because Democrats are very scarred by failure after failure of health care reform, most recently then Hillary Clinton and Bill Clinton in 94. And they're like, well, this got some Republican support. Maybe we can do this. And sort of Obamacare is different than Romneycare, which is what had been done in mass. But it was sort of built on the same set of theories, individual mandates, private insurance, a kind of like a set of moving parts. And what I see happening now is sort of another convergence, which is sort of on the left, there's been a Medicare for all vision.

56:51And one version of that vision was much more maximalist. And this was endlessly litigated in 2020 Democratic primaries, which was it has to abolish all private insurance. And I hear you saying, I've heard AOC saying, I hear others saying, I think there's a sense that maybe that's not the first step. On the other hand, the sort of more moderate side of the party, the idea that what you want in health insurance, that the great goal is competition between private health insurers, I don't think people hold to that anymore. The idea that you're going to get Republican support for Democratic health care reform, nobody believes that for a second, or at least they shouldn't.

57:26And so it feels to me like there is a converging, I don't know exactly what its shape is going to look like yet. I don't think anybody does. But it's Medicare for more. You've used this analogy that I think is a good analogy, that Medicare for all, the place you want to go is climbing Everest. But to climb Everest, you need to go to base camp. You need to get over to some smaller hills and mountains. What do you see as the most promising kind of steps between here and there? People want to go towards more Medicare. Where do you start?

57:55Abdul El-Sayed:So let me say the fastest way to get to Everest would probably be to drop out of an airplane onto the top of Mount Everest. So I don't want to give up on the idea that we might have momentum into the first day of 2029 with a new president who's like, I'm ready to go on this. The nature of the debate has changed so much because the nature of private health insurance has become so porous and so frustrating for so many. if we can't then the steps even if you were to say we passed medicare for all on you know in january of 2029 where would we go from here well the steps would kind of be the same because you're not gonna there's no light switch in the white house that like turns on medicare for all so you would make medicare whole because right now medicare is extremely porous you talk to seniors and they're like well there's all these different parts and it doesn't cover vision dental and hearing and, and, and so you, and a lot of them are in Medicare advantage plans and that whole situation, private plans and they like them.

59:00Abdul El-Sayed:I mean, that's going to, that would be hard to take away. I mean, the whole, the whole gambit on Medicare advantage is we give you some things on the front. So we, we lobby to keep Medicare porous. So then we can offer you quote unquote advantages like vision, dental and hearing, which normal Medicare doesn't offer. So you'd, you'd, basically sew up all the parts. You would include a full robust part D. You would have vision, dental, and hearing. It would go to zero copay deductible premium. Done. At this point, if you offered that as traditional Medicare, the speed with which everybody would jump from advantage would turn your head.

59:38Abdul El-Sayed:That's number one. Then you start extending it to more people. I think kids are obvious, right? Children, thank God, are uncommonly healthy. And if they're not healthy, they're very sick. And so extending it to children is obvious. Extending it downward, right? From 65 eligibility age to 60, and then down into the 50s, 40s. That's kind of what needs to happen, right? All of that articulates better Medicare for more people. What I'm articulating is great Medicare for everyone. And if we can do that in one piece of legislation, amazing. If we can't, then my rubric is very quite simple. People ask me, they're like, oh, well, if you can't get Medicare for all, what would you vote for?

1:00:22Abdul El-Sayed:I said, the rubric is simple. It gives more people healthcare through public dollars and disempowers corporate health insurers. If it meets those three things, I'm for it. I'm going to vote for it. I think getting into the politics of this for a minute, right? We kind of walked out on the policy sign. So we make this mistake on the Democratic Party of assuming that their pushback is going to be consummate with the degree of policy change. The ACA was originally hatched as an idea by the Heritage Foundation in 1989, which you well know. It was a Republican idea. And then this is the individual mandate structure.

1:00:59Abdul El-Sayed:Individual mandates, the three-legged stool. That becomes Romney Carrier. Then it's passed by a Republican governor in Massachusetts. And then they attacked the hell out of the Obama administration. And that same governor runs for president on a promise to repeal it. Exactly. It's insanity. So just assume that you're going to get maximal pushback for anything. So then the question becomes, how do you get maximal momentum in the right direction? And the problem that I also often have with Democrats is that we mistake policy discussions for political discussions. it's not enough to tell people we're going to solve some of your problem.

1:01:34Abdul El-Sayed:It's not enough. And we assume by saying we're going to solve some of your problem, then they're going to have some of the pushback. No, you tell people you're going to solve some of their problem and you get all the pushback. So how come you lose the fight? Well, because you didn't create that much excitement about actually doing the thing you wanted to do and you got all the pushback from the industry. I think everybody always wants to believe that, and I don't mean to totally dismiss it, but that you get this kind of constant level of pushback. And so it sort of doesn't matter what you propose.

1:02:00And I think a lot of the people who got really battle scarred here, like have a different view on this. I mean, Vermont tried to do single payer. They tried to do it in a blue state where Bernie Sanders is a senator just a couple of years ago when they had a Democratic governor. It's a fiasco. And it was a fiasco because when people were told what it was going to cost them and they were going to have to move that to taxes, they rebelled against it. California's tried single payer a bunch of times. We've watched this on ballot initiatives. The point I'm making on this is simply that I think a lesson a lot of people who have been scarred in these wars have learned is that people don't trust the government that much.

1:02:40And so when the government comes and says, don't worry, we're taking away what you know. You can trust us, the people who brought you healthcare.gov, that we're going to run this next one perfectly. You can trust us, the people who like just had Donald Trump in charge of everything and Doge was gutting the entire government that we can run this. Don't worry about it. And meanwhile, as you've sort of written about, you get a bunch of health care stakeholders, potentially doctors, definitely hospitals coming out and saying, you know, this is going to close rural hospitals or whatever it is. It gets really, really hard.

1:03:11So you do get the Republican opposition, but the fear of just seeing the whole thing collapse in on itself because people fear having too much taken away from them, you know, abolishing private health insurance and that kind of thing. Like that comes from somewhere.

1:03:24Abdul El-Sayed:Let me, let me, let me push back. It's not the Republican opposition I'm worried about. It's the industry opposition. Industry spends huge amounts of money to push back on all of this. They spend it in electioneering, they spend it in lobbying and they spend it on ads, right? Mis and disinformation via ads. So I think there are three things that, that we really need to be learning from those wars, right? With all due respect to the people who fought them before. Number one, the war doesn't start the day you decide to do health reform. The war starts the day you start thinking about doing health care reform.

1:03:58Abdul El-Sayed:And you have to have a broad national conversation early. Number two, understand how they gin up public discourse. Understand what you're actually dealing with in the ways that they work to try to manufacture public dissent. Politicians who've championed a lot of these reforms have not actually gotten a running start on them, have not pushed in the way that we need to, to build the public momentum and discussion around what exactly we're trying to do. There's this, almost this fear of explanation in politics. Whoever came up with the statement, when you're explaining you're losing, has done a deep disservice to our whole political system.

1:04:35Abdul El-Sayed:I prefer Bill Clinton's summary. He said, explanation is eloquence. This job is an explanation job. He really failed at that on healthcare. When it comes to the health care, but also, again, it wasn't the thing he was running on. It was like, we got here, let's do health care. Rather than, let's have a big national conversation about health care and build a head of steam around the politics of this, knowing full well that they are going to hit with a whole bunch of missing disinformation ads. I mean, you know, the Harry and Louise ad. Find more you like in the president's plan? Yeah. And? Well, it just doesn't have the choice we want.

1:05:10Look at this. the government picks health plans then we have to pick a plan from their list that's the choice we get but what if we don't like their choices right that was a classic of

1:05:22Abdul El-Sayed:the genre brought to you by what is the partnership for america's health care future whatever the one uh i think it was a organization for institution or health care choices whatever it was right that's what they do a lot of those astroturfed obama era town halls that we saw there were people paying for that stuff, right? And you've got to be thinking in the same attentional space as they're going to be thinking. And then number three, I think the infrastructure, like the political infrastructure of this moment has changed. In the past, when we talked about health reform, it usually was a conversation about how you provide health care for lower income people.

1:05:56Abdul El-Sayed:Today, it's not that. It's how do you provide health care for the median? And I think what's happened is that the industry has gotten so greedy that the floor underneath which we are having this conversation has so far shifted that we need to have the courage to be able to say, actually, this moment requires that kind of change. Also, the tactics on which we are going to have this debate have changed entirely to the power of the industry to drop in with 30 second ads. That's just not as powerful as it used to be anymore. And so I think they are losing power quickly. And we really could actually get this done in 2029.

1:06:32Abdul El-Sayed:That's what I'd like to do. But part of the reason I'm excited about this, I know I'm going to be one U.S. senator if I get elected. Part of my job, though, is to be the first Democratic doctor in the U.S. Senate since 1969 who wrote the book on doing this and to be moving that conversation in the space in which we are now electing the next president.

1:07:00Abdul El-Sayed:If you like YouTube, you'll love YouTube Premium. It's destroying athlete, creator, and YouTube Maxer. YouTube Premium enhances how I use YouTube with awesome features like offline downloads so I can download my favorite training videos before I hit the gym. So no Wi-Fi doesn't turn leg day into loading day. Plus, I get ad-free videos, background play, and so much more. YouTube Premium is like YouTube got some extra gains. Try YouTube Premium for two months free at youtube.com slash premium. Hey, what's up, guys? It's Haley Bailey. Okay, I need to tell you about something. I just got YouTube Premium.

1:07:35Abdul El-Sayed:It's got tons of awesome features like offline downloads, so I can download my favorite videos before I travel and watch them whenever I don't have Wi-Fi. Because we all know airplane Wi-Fi is the worst. I get ad free, I get background play, and there's like a ton more in there. You should try it. If you like YouTube, you'll love YouTube Premium. So try YouTube Premium for two months free at youtube.com slash premium. Trial eligibility varies. Terms apply. Cancel anytime. That's a mouthful. This podcast is supported by Mercy for Animals. Mariano sells an upscale image, but behind the polished branding lies a harsh reality.

1:08:09Abdul El-Sayed:Eggs from hens trapped in cages so small, they can't even spread their wings. Mariano's pledged to go 100 % cage-free, but continues to profit from cage cruelty and our stolen trust. Chicago deserves better. Learn the truth and hold Mariano's accountable at marianosunmasked.com. That's marianosunmasked.com. So if you had told me a couple years ago, Abdul Syed is going to win the Democratic primary for Michigan Senate in 2026. What are people going to be debating around him? Like this. I've watched this guy for a while. This is, they're going to call him a communist, a socialist. Ezra, you're a sweetheart.

1:08:53You do know my name. I do know your name. But what's interesting, the Washington Post did an analysis of social posts on the right around you. And in the primary, they were about you being a communist and a socialist, the bulk of them. And since you won the primary, they're about you being Muslim, about your name, about you being, you know, you're getting called an Islamic jihadist who wants to impose Sharia law. And it was a sharp change, right? They went from being about your ideology to who you are, like a real effort to otherize you. Let's start here. What have you made of it?

1:09:30Abdul El-Sayed:I saw it coming a mile away. In fact, I'm betting on it. I knew the day that I won, you were going to hear my name in the mouth of Donald Trump and J.D. Vance and Mike Rogers all day, every day. And I know, I bet you, there are Republican consultants out there being like, shut up about his name. Stop talking about his name. Stop. But they can't help themselves. Because I hate to say it, like they bought into the sort of pickle brain version of politics brought to them by News Nation or Newsmax or whatever the hell that is. and Fox News that tells them that everybody agrees with them. And most people don't.

1:10:06Abdul El-Sayed:This is what they don't understand. People are good. You know, I've been Abdul my whole life. And most people take my name as an invitation. Who are you and what are you about? It's curious. I've never met somebody like you. I want to have a conversation. What do you want to do? What are you doing here? What are you about? Right? People are good. So all of the other people watching the bully in the room, go after me because of my name, and then watching me give as good as I get, they're like, what am I learning about him? Number one, they hate him because he's just different. And that's not fair.

1:10:38Abdul El-Sayed:And number two, he's not afraid. And number three, what's he talking about? Wait, money out of politics, money in my pocket, Medicare for all. I kind of like that. And what has he done? Oh, he's a doctor. He wrote a book on getting people healthcare, rebuilt that Detroit health department, put glasses on kids, took on corporate polluters, eliminated medical debt. He doesn't seem that bad. Why do they hate him so much? And so I've always had a front row seat to seeing how this, this works out. And so what happens is all of their attacks are going to congeal into this, like very hideous, ugly kind of thing.

1:11:12Abdul El-Sayed:And most of us are going to be having a conversation about exactly what you and I talked about. Hey, uh, can you forge your gas? Can you order your groceries? Can you pay your rent or afford a mortgage? Can you see a doctor without being so afraid of the bill that comes afterwards? Because that's what I'm trying to talk about. That's what I'm focused on. My name, not raising your gas prices. Donald Trump is. We are in a moment on the right that it's, I'd say, worse than I've seen it since immediately post 9-11, where just the level of Islamophobia has sort of escaped containment and become something really big.

1:11:49We've seen Congresswoman Nancy May say that every single Muslim holding public office in America is a Trojan horse. Congressman Andy Ogles saying Muslims don't belong in American society. Pluralism is a lie. Congressman Chip Roy wrote that Islam is incompatible with Western civilization. This was, I thought, crazy. He said, recognizing that as horrific as the attacks on 9-11 were, a much more aggressive war is being waged against us right now throughout America. It's really, really vicious. It's all over News Nation, Fox News. I guess it was a why now question, right? Like 9-11, you sort of see what led to the kind of viciousness of that.

1:12:28But the sort of reemergence of this as a kind of master narrative, it's now hooked to like great replacement theory kind of ideas. It's hooked to a lot of ideas about Europe. Why do you think that is?

1:12:40Abdul El-Sayed:It's not working as well. I mean, it's like, you know, you push a button and you get a particular outcome. And then the button starts to stick and you don't get the same outcome. So what do you do? You push it harder. so you know i think that this is the last gasp of a whole mega movement and you have an aging wannabe monarch whose grip on public discourse is starting to fade a lot of the folks around him have so clearly tied their horse to his and now they're trying to figure out what do we do so they found out that they're not as charismatic as he is when they go after the same enemies he tries to go after.

1:13:21They can't do it with the same verve and showmanship that he does.

1:13:25Abdul El-Sayed:And so it comes out as uglier and more hideous. And that tends to be how these movements fizzle out because people look at that and be like, yeah, that's really ugly. And there's a sort of effort to sand off the edges of your complex identity, especially when you walk into politics. You know, I probably have the most politicized beard in the country. But I have a beard since I was 19. I always tell people like, Like, look, if I shaved my beard, I'd look like I'm 19. But also, I'm not going to pretend like somehow I can be anybody I'm not, right? People are like, well, you could change your name.

1:14:02Abdul El-Sayed:You might be late for that. Yeah. But I'm like, no, I've been Abdul since I was in kindergarten, you know? And part of what I want to do is not just like, what's the point? I think sometimes in our political system, we give prizes to having gotten into the arena. But the question is not, are you in the arena? The question is, what are you doing in the arena? At the end of the day, people are looking at you and saying, what do you really believe? There's this problem we have in the party generally. It's like, we tell people we're going to fight for, and then there's this secondary question of, how do I know you're going to fight for it?

1:14:32Abdul El-Sayed:It's like the political moral hazard test. You say you're going to do a thing. How do I know you're going to do it? And at some point, as Democrats, that's where we've been failing. You say you're going to do a thing, but I don't know you're really going to do it. And I think it's important for us when you lay down a marker, you stand 10 toes down on the marker, come what may. So if I can help our party sort of recognize you don't have to just take it, that actually these people can be beat at their own game. And everything they're saying is ridiculous. I hope we can learn something. I mean, let's stop here.

1:15:03Abdul El-Sayed:J.D. Vance is a walking hypocrisy. You know, like this whole little bit he has about his long past, may he rest in peace, Papaw. I'm like, so you had to invent caricature of your grandfather from the past to make an argument about what America should be in which you yourself and your own choices wouldn't be included. What kind of ridiculousness is that? It's just such a ridiculous... What do you mean in his own choices? His own family choices, right? I mean, this is the thing about it. It's like, I believe that my parents and my in-laws who are immigrants from India are as American as I am or you are or he is.

1:15:42Abdul El-Sayed:He clearly doesn't. Which forces a very odd set of questions I'm sure he has to sort of navigate in his own mind. And at the end of the day, again, the emperor has no clothes. I'm going to leave J. DeVance to the side for a minute, the vice president. It's a rich psychology that you can get lost in. One thing that sort of broke your primary open this year was Israel and Gaza. And so I wanted to start with a very open-ended question, which is, in your view, what should America's position towards Israel, towards Palestinians be? It should be the same approach that we should take to all other countries.

1:16:24Abdul El-Sayed:And our approach, I mean, go back to the post-World War II era. We fought this terrible war against terrible people. and coming out of it, we realized that we needed to build these institutions to protect the world from having to do this again. And we codified these institutions by way of a system of international law. And then we emerged as the global hegemon and then proceeded when it was in our own real politique interest to violate those rules. But we still expect everyone else to play by the rules of the international order. And my foreign policy views are very simple. I just think we should be the first among equals to enforce international law.

1:17:13Abdul El-Sayed:I would argue that Israel is the greatest outlier when it comes to the behavior of the government of Israel relative to the approbation you would expect them to get versus what they actually get. They've been able to sustain a apartheid system, which is the only thing you can call sustained nearly six decade long occupation of a people in Gaza and the West Bank. They did a genocide in Gaza. they led us into a war Benjamin Netanyahu came to the situation room made the argument for a war he finally had a duke big enough who was willing to do it but think about war aims we had no clear war aims for that war Israel had clear war aims and one of those big war aims seems to be setting up for the annexation of southern Lebanon and we do all of this and all of this has been done.

1:18:23Abdul El-Sayed:While our stated policy in the region is that we believe in a two-state solution, which is wild because we're aiding, arming, and abetting the very government that is attempting to foreclose on the possibility of a second state openly. And so I'm just saying that we should treat Israel the way we treat any other country that did the same stuff. On top of that, I come from a state where there are communities where the median income is$14 ,000 a year. I remember going to an elementary school, Spain Elementary in Detroit, two weeks after the boilers broke, watching first graders try to learn in a room without a boiler.

1:19:02Abdul El-Sayed:And the idea that we send billions of dollars abroad, not just to Israel, but to Egypt, where my family came from, to Jordan, to Pakistan, to UAE, to Qatar. The idea that we send billions there while our babies can't read in a classroom should violate every sense of basic fairness. And finally, too often in our politics, when you have a political consensus, that's one place, and a bipartisan consensus, that's another, the difference is somebody's money. AIPAC spent$32 million in my primary. $32 million for one U.S. sentencing. Set a record in that race. They were big fans of yours. I mean, they showed it in a very interesting way.

1:19:46I'm going to hold the question of money to the side of this for a minute because I'm more interested in your policy here. So in what you said, I think there are sort of two levels on which a policy like that could operate. One is to shut off the money that America sends to an Israel, to an Egypt. But in this case, let's keep the focus on Israel. And I think inside the Democratic Party, you're getting to a fair amount of consensus on that. I think that it is unlikely the next democratic administration is going to be selling arms to Israel. Now, Israel's pretty rich at this point. There might have been a time when our money was essential to the functioning of that state.

1:20:26I think that time has passed. So then there's this other question, right? You know, when you talk about the apartheid system, when you talk about rights of Palestinians, which is whether or not America engages in trying to change the status quo among Israelis and Palestinians. You know, you can imagine a world where the money shuts off and Benjamin Netanyahu wins again, or, you know, Eisenkotter, whoever it might be, says, you know, fine, like, well, you know, we'll replace, you know, our budget hole, whatever it might be. But, you know, this is our policy. And then in your view, what should America's policy be towards that?

1:21:07Abdul El-Sayed:So let's start from a philosophical standpoint of where, what ought to be. I believe in equal rights to peace, dignity, and self-determination for Palestinians and Jewish Israelis. I believe that it is up to a free Palestinian people and free Jewish Israeli people to decide how to maneuver the inconsistencies of that. Whether that's a two-state solution, or a one-state solution, or land for all, as you had a discussion about on your show, or a 23-state solution.

1:21:44Abdul El-Sayed:Me, as a U.S. policymaker, I would be fine with any of those. It's about the process, not the outcome. And I think the problem right now is ultimately we've often had too much hubris to think that we get to dictate what happens rather than trying to enable the circumstances to allow for that discussion to happen. And the problem that I have is there is a deep power imbalance here. Israel is a state that actually exists. There is no Palestinian state. the state of israel has openly and very directly tried to destroy any coherent movement for palestinian self-determination and has often kept people divided on purpose or arbitrarily jailed people or you name the thing and then there's the policy of mowing the lawn as they talk about and so from where i sit my responsibility is the 10 million people in michigan and making sure that our money does not make other people's problems worse.

1:22:51Abdul El-Sayed:And as the first among equals of enforcing international law, when the actually existing state violates international law, I think it's important for us to hold the actually existing state accountable to international law. Also, if other people violate international law, Hamas, hold them accountable to international law. but to do so without fear or favor, which is why it's hard not to talk about the money side. Because the reason that our policy is the way that our policy is, is because of the massive power of internal spending in our elections to try to shape outcomes to make sure that there is a bipartisan consensus around the existing status quo, which is in direct contraposition to what we say we want the status quo to be, two-state solution.

1:23:36Abdul El-Sayed:AIPAC is a big spender in politics. And I think AIPAC has been, I mean, I've said this for a very long time. I think AIPAC has done terrible damage to both Jews in America and Israel. And I'm not a fan of AIPAC. I do think less of this is about money than sometimes you make it out to be. Joe Biden was not. The issue for him was not AIPAC. Joe Biden had his beliefs. And many people formed their beliefs on Israel in a very different era. and they remember, or at least believed in, a very different Israel. The reason I ask you about this question of what would you actually make the policy into is because I think there's an analogy here to your Everest analogy on healthcare.

1:24:23One place I really agree with you is that this idea where people sit around and imagine what the long-term settlement that will fully solve the Israeli-Palestinian conflict would be from where we sit right now, when there's no preconditions for that kind of settlement, is more than I think it's a distraction. I think it's a way of not apprehending reality as it is. It's more fun to imagine a world in which it is all solved than to try to think about the base camps, the hills that get you there. international law is slow you know even if the u.s was not blocking its application to the israeli-palestinian conflict it's long it's years it's court cases it's easy for countries to ignore as many around the world do the icc doesn't command a expeditionary military force and so you know you do get into this question of right on the one hand there are jewish Democrats in Michigan who the thing they worry about for you is not that they don't like the thing you just said, but that they suspect that at your heart, you don't think Israel should be a Jewish state, that it's like the one state in the world that should no longer exist.

1:25:42On the other hand, the thing that oftentimes many, I think, Jewish Democrats don't think about is the thing you just described, the power imbalance, that if you just let the conflict run from here, the imbalance does not get you anywhere good. It does not. There's no preconditions. it's easy to say I don't like Benjamin Netanyahu, but you're not going to get an actual movement here just through a change of that government. So do you think there's policy here? Or do you think it's simply America no longer making things worse?

1:26:15Abdul El-Sayed:I take very seriously that policy sits downstream of politics. You can't get policy in a democratic society unless you're willing to engage in politics. And so a lot of what I need to do for our children in Detroit, And also, for all of the kids whose lives should be free and clear without having to worry about inheriting all of the disaster of the past, is about trying to move our conversation to a place where things that you cannot say need to be said. when it comes to the fact that our country is subsidizing genocide it needs to be said when it comes to the fact that our country is misusing our tax dollars it needs to be said when it comes to the fact that we are incoherent if not hypocritical about our stated aims and what we're actually allowing to happen it needs to be said and once it gets to be said maybe it could be voted on and once it gets voted on maybe we can find our way to policy i told you that i actually I'm somewhat agnostic to the outcome as long as the process that enables peace, dignity, and self-determination for both peoples is enabled.

1:27:24Abdul El-Sayed:But from where we sit right now, we're not moving. So my job is to move us, take the first step. Because right now, everybody. And the first step is what? To challenge the status quo about what we can talk about when it comes to American politics. I mean, I always get the question, does Israel have a right to exist? And it's such an interesting question. Yeah, but I purposely haven't asked you this. You haven't. You haven't. Because I think this is crazy. Exactly. Israel does exist. We're way past this. But here's the thing. Ezra, you're right. And you're a very thoughtful interlocutor on this issue.

1:27:57Abdul El-Sayed:How many interviews have you seen with me where that's the first question? I've seen them. So what that says is that the status quo of this debate in our civics starts there. that I have to accept the existence in its current form with its current power structure under its current policy framework for me to even engage in a conversation. And I just don't accept that right now we are getting what we want. We want equal rights of peace, dignity, and self-determination for all people. If that manifests in a state for both peoples, I'm fine with it. But it is those peoples who get to make a decision, not us.

1:28:32Abdul El-Sayed:And right now, we are stopping that decision from happening. Well, I agree that we're in a very unstable equilibrium. And I also think that the conversation on this is blown wide open, but to a different degree in different places, right? I've seen some of these interviews with you. And then, of course, there are other places, right, where it's almost taken for granted that Israel does not have a right to exist. I mean, you can now in American life, the thing that many people, including me, said 15 years ago, which is that you have a wider range of debate in Israel over Israel than in America over Israel.

1:29:02It's not really true anymore. But what I wonder, one reason I think the equilibrium here is unstable is, you know, people with a variety of degrees of views on Israel itself, from people who believe very much in its existence as a Jewish state to people who don't have watched and been quite horrified by the last three years. And one way that issues become very unstable is that there's a lot of feeling that doesn't know how to translate itself into action. So maybe America just takes a step back. Maybe being in this conflict as a funder and as a protector and at times as kind of a lawyer, maybe we just made things worse.

1:29:57but you could also imagine things getting worse from here and right now i think that the within the democratic party i mean this was a you know a tough fight inside your primary the question of how you hold a party together where maybe there's a lot of agreement that what is happening right now is not good but there's not a lot of agreement of like what is a stable policy point on which Democrats have many different perspectives, ranging from liberal Zionists to less liberal Zionists, to people who are skeptical of Israel at a much deeper level. What is an actual policy place where they can kind of stand together, not because they all believe in the same eventual deal, but because they can agree on the next set of steps, that it makes sense for America, which is not Israel, to take.

1:30:51Abdul El-Sayed:And that's frankly the conversation I want to have, right? And there are a couple of principled points I think we need to establish to be able to take a principled step that most people probably agree with. Number one, that the well-being of the Jewish community is different than good faith criticism of a foreign government. Those are different things. You can stand with the Jewish community, guarantee their safety, guarantee their right to advocate for things that you disagree with. And that has to be held separate from the question of our foreign policy toward this country. Second is the question of what are our principles?

1:31:30Abdul El-Sayed:And this is the part where I think we sometimes wrap ourselves around the axle a little too much, which is to say, what do we actually believe in and how do we beget those beliefs? And I just think it's a lot easier for us to say, all right, here's the next step. We probably shouldn't be funding this military. We probably shouldn't be unconditionally funding any military. We probably shouldn't be running cover for the actions of this particular government, which at the minimum were war crimes, at the maximum were genocide in the courts of law. And we probably shouldn't be buying an added level of security that basically buys an electorate out of having to make democratically rational decisions about how to protect and how to behave.

1:32:14Abdul El-Sayed:I think those things are things we should agree upon. Now, not everybody is going to agree with me. I get it. And I also understand on both the sides of this debate, we're also dealing with a lot of trauma, a lot of trauma. I understand that for a lot of Jewish Americans, there's the trauma of the Holocaust and the need to have a refuge. I understand that. And I also understand that for a lot of Palestinian Americans and Palestinians everywhere, there's the trauma of the Nakba and the great displacement of people told that they were just going to be able to come home in a couple of days, never ever to be able to go back.

1:32:47Abdul El-Sayed:We've got to be able to create the circumstances within which both of these deeply traumatized people can have a conversation built on principle. But to me, the answer has to be principle. It has to be. That's where we'll end. Oh, this is our final question. What are three books you recommend to the audience? So I thought this through, and maybe this is a child of immigrant overachiever thing, but I've got four if that's okay. So the first one is the best and the brightest, David Halbush, Sam. And I think it's just an incredible observation on the nature of elitism, institutional priorities, groupthink.

1:33:28Abdul El-Sayed:It's about the Vietnam War and the ways that we bungled our way through it with the best and the brightest. Folks who had all their credentialing but none of the common sense and none of the moral engagement with what we were actually doing. The second is amusing ourselves to death. I know you talk about it all the time, but you know, Neil Postman, Neil Postman, I shudder to think what Postman would make of TikTok. Like he was writing this in the era of TV, this idea that the medium, this message, and by juxtaposing two completely contradictory messages next to each other, you dumb down both of them.

1:34:01Abdul El-Sayed:TikTok is literally that, right? It's just a machine that like flows, you know, on one hand, it's a dance craze and the other one, it's a political analysis. And then the third one is trying to sell you a hat, right? And, but at the same time, it does really clearly explain the nature of our political conversation right now and understanding attention. You know, politics is the alchemy of turning attention and power to democracy. So you have to understand how attention attention moves to understand how to move it and to try to get people to think about things. Like at our best, we're infotainers, you know, and I wish it was just more informers, but we're infotainers.

1:34:39Abdul El-Sayed:You have to be able to say something meaningful, but say it in a way that people want to keep looking because there's so much to look at. The third is The Some of Us, Heather McGee. I think you've had her on the show. A really great book about the way that division and racism in particular keeps us from being able to build collective public goods. And I think, you know, when you think about Medicare for all, you think about the questions that get asked at the political level, it helps to guide us on the questions we're going to have to answer. And then the fourth one is the autobiography of Malcolm X, as told to Alex Haley.

1:35:13Abdul El-Sayed:And I picked that one because his coming of age in a particular moment, his willingness to be a Jeremiah, the conversation that we often have about the nature of the civil rights movement and how much truth to power you can actually share is worth revisiting right now. But there's also something about truth to pain. And I think we talk a lot about truth to power, but I think it's actually a lot harder to speak truth to pain. And I say that as someone who went to medical school, realizing that a lot of our politics right now, we've got to get a lot better at speaking truth to pain if we're going to get through some of these challenges that we have.

1:35:48Abdul El-Sayed:What does truth to pain mean? It's one thing to look power in the eye and say you're wrong about this. But there's a way in which pain is very difficult to reason with. Because when somebody's in their pain, they're in their trauma, they see that pain and they may not see what's causing it. So I remember very explicitly being in a trauma ward with a gunshot wound patient. and watching this doctor, this guy was just, I mean, this big guy with his hand on his gunshot wound. In the emergency room doctor, all the folks are trying to pull his hand off of his pain, that point of his gunshot wound, this clear vulnerability.

1:36:32Abdul El-Sayed:And this doctor had the presence of mind like everyone stop. And she looks in the eyes like, I get that really hurts. And I'm so sorry that you're here. You don't want to be here. We don't want you to be here. But if you don't let us fix this, you could die. So I'm going to take your hand and I'm going to move it off. Okay. Because I need to get there so that you can live. And she was speaking truth to pain, which is he understands he's at the hospital. He needs care, but he also doesn't want anybody to touch the wound, which is a natural thing. And I think it is a, is a really great metaphor for how we think about a lot of these challenges we talked about today.

1:37:09I'd be all set. Thank you very much. Thank you.

1:37:31Abdul El-Sayed:Best-selling author and suspense master James Patterson returns with a World War II-era thriller that's also based on a chilling true story. In The Munich Affair, a brilliant detective must chase down a heartless murderer. The murderer is Adolf Hitler. A masterclass in tension and a perfect historical thriller raves Martha Hall Kelly. The Munich Affair by James Patterson is available now in hardcover, e-book, and audio wherever books are sold.