MAHA Is a Bad Answer to a Good Question

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Earlier this month, the Department of Health and Human Services, under the leadership of Robert F.

Kennedy Jr., announced it would be cutting nearly $500 million in funding for mRNA vaccine development.

And it's not just mRNA vaccines.

The Trump budget proposal cuts more than $33 billion from health and human services.

Trump's proposed budget for the next year includes cutting nearly 40%.

I'm going going to say that again, 40% of federal funding allocated to the National Cancer Institute.

His cuts to scientific funding and grants and institutions broadly have thrown just a huge amount of possibly life-saving research into chaos.

Is any of this, is all of this really going to make America healthy again?

I doubt it.

Obviously, I doubt it.

But what it does do is reveal what Make America Healthy Again was really, is really

about.

I feel about that movement the way I felt about the Department of Government Efficiency.

I'm fundamentally sympathetic to what it is promising to do.

A Department of Government efficiency, an effort to make America Healthy Again, these are good ideas.

Somebody should actually try them.

But Maha, like Doge, isn't even attempting to do what is promised in the name.

So what is it attempting to do?

What are its actual ideas?

How did a pandemic that was largely ended by vaccines lead to this policy regime?

How did the president who presided over Operation Warp Speed, that was Donald Trump's great success?

How did he become the president who appointed RFK Jr.

to lead our most important health institution?

How is it possible that five years after the COVID pandemic, experts now say that we are less prepared for the next pandemic than we were?

for the last one.

My colleague David Wallace-Wells has done incredible reporting both on the pandemic in the sort of fast-moving scientific and social moment that was, and since on how it has deformed our politics and our society.

Rachel Beddard is a physician and a writer who's been trying to think through where Maha is and where it and its critics might find common ground.

As always, my email is reclined show at nytimes.com.

Rachel Bedard, David Wallace-Wells.

Welcome to the show.

Thanks for having me.

It's great to be here.

So, David, I want to start with you.

There's a quote from Michael Lewis, the writer, where he says: The problem with pandemics is that people want to forget them.

So, we're four plus years on from COVID's onset.

What have we forgotten?

I would say the biggest thing is the death.

1.5 million Americans died, 30 million people globally, tens of millions hospitalized, probably some number in the millions who are disabled by experience with COVID.

And we now look back on the experience focused on all of these secondary questions: whether we close schools too long, whether we mask toddlers, exactly what kind of sterilizing immunity vaccines could deliver.

And those are all important questions.

We should be asking them in any good retrospective.

But I think fundamentally, almost all of us have basically forgotten or are overlooking the basic medical trauma that we lived through, which was direct to people who got sick and died and indirect in that it produced in us a kind of panic reaction, which really deranged our entire society.

We want to believe that it was all a fantasy, that it was all pushed on us.

Liberals want to blame it on Donald Trump.

Conservatives want to blame it on Dr.

Fauci.

But we're so eager to get away from the central lesson about our own fragility, our own vulnerability as individuals and as a society that we're playing a blame game rather than really reckoning and grieving with what we went through.

Rachel, I assume as a doctor, you had a quite different pandemic than me and David did.

I did.

So the same question to you.

What have we forgotten?

So in March of 2020, I was a physician on Rikers Island.

I was working in the New York City jail system.

There was a point in March of 2020 when Rikers Island had the highest COVID, known COVID prevalence in the world.

Jails are like cruise ships, but worse.

They are locked spaces that are dense with bodies.

There's a huge amount of excess human contact, and there's very, very little that you can do to change that in that environment.

So it was incredibly scary.

And if you were involved in policy discussions at that time as a healthcare provider, you were making a lot of educated guesses

under really difficult, very urgent circumstances that involved a lot of trade-offs.

An example is in our context, we advocated strongly for everybody who right becauseland's a jail, not a prison.

Most people who are being held there are in pre-trial detention.

So they're in the innocent until proven guilty phase.

They're being held at the discretion of the court.

We advocated really strongly to say everybody who doesn't need to be held during this time should leave.

We should decant this system so that there are fewer bodies in these spaces together.

The degree of uncertainty and the sense of urgency around decision making at that time was so extreme.

And you had to pick the variable that you were going to preference over other also very urgent concerns.

And it was full of so much fear, too.

I mean, that fear was pervasive.

And I think one of the real features of that early period was about how many people were just so worried.

Yeah.

And I mean, all of my colleagues, like we would, you know, I was working 100 hours a week.

We would go in to see patients in the jails.

and go home and everybody would strip their clothes right before they went into the house.

I sent my family away because I was like, I'm going to get it and I don't want you guys to be here.

So you talk about the way we haven't looked back in any systematic way, right?

There's been no equivalent to the 9-11 commission for COVID, but there has been a lot of research going back and trying to think through what did we do that worked?

What did we do that didn't work?

What would you say, David, that research has found?

Well, I think when you look globally, it's important to acknowledge that basically no country avoided the pandemic.

No country won this war.

There were degrees of victory and degrees of defeat.

And generally speaking, the most important factor for a country's outcome was the age structure of the population, since old people were so much more vulnerable.

But when it comes to policy, what we could actually control, it was a matter of how many people got infected before they got vaccinated.

By the time the clinical data was released from the vaccines that told us that they were going to be safe and rolled out soon in November, something like 10% of the American public had gotten COVID.

By the time shots were really going to arms in January, it was something like 20 or 25%.

And that is the main determinant of our outcome because those shots basically cut individual risk by a factor of 10.

And you could manage that outcome by speeding up vaccination, which we did by historical standards in a miraculous way.

The Moderna vaccine was designed in two days, fully designed before the first confirmed case in the US, U.S.,

fully designed before China even confirmed that there was human-to-human transmission of this disease.

This vaccine was designed.

It was manufactured within a couple of months.

It took a little bit longer to get out to the public, but even so, by historical standards, this was incredible, getting it into people's arms before the end of the year.

We didn't get pickup as dramatic as across Europe, but we did relatively well by the end of 2021.

95% of seniors were vaccinated.

And then there's the other side, which is how many people got the disease before that happened.

And you can control that in a variety of different ways or try to control that in a variety of different ways.

And there's, as you suggest, a lot of debate and back and forth about what policies worked and what policies didn't.

If you look at Russia, Russia did nothing to stop the spread of the disease and their death toll was twice as high as the U.S.'s.

In other countries, they did a much better job of controlling transmission in 2020.

Canada had half as many deaths in the end as the U.S.

did.

We need to take seriously the idea that while there were some things that sort of worked and some things that sort of didn't, all of this was variable.

And if we had had a slightly more aggressive transmission of the disease, we would have had a much, much higher death toll.

But I do want to push at least on part of that, which is to say that different places did do different things in terms of the pre-vaccine policies.

I remember being involved in these debates at the time.

And the level of fury, say, liberals felt at what Florida or Texas was doing was huge, right?

It was deeply irresponsible.

When I look at the research afterwards, when they do all the things they do to try to control for deaths and the age distribution of the population and all the other things we know,

it's surprising to me how different places look.

So Massachusetts and Florida kind of both look pretty good.

California and Texas both look pretty bad.

And it doesn't sort of fit.

the policies or the narratives we had before.

How do you think about that?

Like what else aside from vaccination mattered here?

When you do comparative stuff about the states, I actually think the policies were less different in that period than you're suggesting.

But, you know, there was not a big difference between red states and blue states.

School closure, schools were closed at roughly the same time all across the country.

There was some variation in how they reopened, but that was really starting in the fall.

And when you think about, you know, social distancing guidelines, retail policies, and even if you look at the behavior of individuals that can be tracked on phones, there wasn't much of a difference between the way that people behave.

So, we had a kind of a discourse fight.

We had Republicans and conservatives who were saying, We need to reopen, we need to get back to our lives.

And we had liberals who were yelling, No, we can't do anything, we can't let a single person die, we need to get all the way to zero COVID.

That was happening in social media, it was happening to some degree in our politics, but that the level of lived experience, actually, there was considerably less variation in behavioral response to the pandemic than we think and often remember, misremember.

And that means that any comparison there is a little bit complicated.

In New York, we we had a huge initial spike that was, you know, anomalous that transformed our COVID experience.

Other states didn't have that.

Certain places encountered the disease for the first time when they were doing pretty aggressive lockdowns.

Other states didn't really see it when those policies were in place and encountered it much later.

And so the signal is pretty idiosyncratic.

So is that your sense also, Rachel, that in some ways our retrospective on how divided we are, our sort of memory of it, is actually different than what was happening at the time when there was a lot more unity and red states and blue states kind of looked alike.

And a Trump administration, you know, accelerated the vaccines and had their own lockdown proposals.

I think so the data that David cites around sort of how we actually know how people behaved versus just what the policies were is correct.

The place where you start to see blue states and red states divide, right, is post-vax, not pre-vax.

Post-vaccine, what you see is that Blue states do much better than red states.

And that's because vaccine delivery was more successful in those states, in part because there was higher trust in the vaccine at that point.

Vax hesitancy didn't start the day the vaccine came out into the community, right?

Vaccines reflected months prior of stewing mistrust and resentment and anger amongst people who felt as though they were being asked to do things that were interrupting their lives.

And just to be really clear, in the nine months between August 2021 and April, May 2022, many more Americans died of COVID than died in the first nine months of the pandemic.

So by the time that we were all over it, you know, all the seniors were vaccinated.

By the time that we were all screaming and trying to move on, actually, there were many more American deaths in that period than in the previous period.

And that complicates a lot of our simplistic, moralistic narratives.

And why was that?

Because

especially middle-aged people didn't get vaccinated and some pocket of vulnerable elderly people also didn't get vaccinated and when delta came and omicron came it was much more punishing to the american public than it had been in the uk or in europe why did vax hesitancy become a more right-wing red-coated phenomenon so the trump administration drives operation warp speed republican governors across the nation are broadly very pro-vaccine This seemed like a very classic shared policy, a policy that both parties are bought into.

I also remember if you go back a couple of years before COVID, vax hesitancy is understood as a crunchy liberal hippie thing, a thing that is happening, you know, among people who only shop in the parts of the health food store that have bins of dry goods.

And then again, it becomes very right-wing coded.

Why?

I think because vacc hesitancy is, in the COVID and post-COVID context, gets polarized as part of an anti-establishment, anti-institutional, anti-expert sentiment that is stewing on the right.

And vaccines are part of that and they aren't necessarily the focal point.

They're one of the flashpoints.

But one of the sort of main underpinning ideas is this concern about big pharma, right?

And this idea that government and pharma are sort of in cahoots to make you sicker for profit.

What's interesting about Operation Warp Speed is that right from the beginning, we knew the companies involved and we were celebrating this public-private partnership to rush this to market, right?

And that was obviously a colossal accomplishment in terms of actually getting the vax produced and out into the community.

And also, it could not have been a better setup for playing into anti-vax anxieties.

But shouldn't that have set the left up to be skeptical?

I just have always found this to be an interesting wrinkle.

And I agree that it has something to do with attitudes towards the establishment.

It's just this is all happening under Donald Trump.

I think it's attitudes toward the establishment.

I also think it's fundamentally about tensions between

liberty and autonomy and collective safety.

And I think that the participating in COVID mitigation strategies voluntarily became this way of demonstrating solidarity, right?

And of putting the collective above yourself, right?

There was like, you know, at the beginning when we said, you're not doing this for you.

You're doing it to flatten the curve for other people.

You're trying to protect other people.

That messaging, I think,

speaks to left-wing values in a way that really connected for liberals and felt

hard, I think, for people who felt as though it was infringing upon their freedom.

And so it flipped.

I mean, I would say that it made right-wingers actually kind of excited to demonstrate their risk tolerance, that they were sort of showing themselves to be independent adventurers in the world and not liberal safetyists.

One thing that I always felt confused the politics here is that the relationship between the vaccines and the pandemic changed pretty fast.

That the initial vaccines actually did prevent prevent transmission.

And so the idea that the vaccine was a collective decision where we're trying to achieve herd immunity made some sense.

If you could get it high enough, you could maybe stamp this thing out.

And then the virus mutated around the vaccines and you had, you know, Omicron and Delta waves or delta and Omicron waves.

And the vaccine really became much more a form of individual protection.

It felt like the politics had trouble keeping up with that and people felt like they were sold a bill of goods.

It wasn't true.

And so ideas about vaccine mandates, it it maybe made sense at one point, made less sense later on for a bunch of different reasons, but one being that the vaccines had changed.

How do you think about that playing into this?

Well, I think that at a sort of historical level, the story that you describe played out.

You know, the vaccines were somewhat oversold.

There was, in terms of providing long-lasting sterilizing immunity, that had not been tested in the trials.

They could have been tested, but it was not tested.

And so when they were introduced, we didn't really know how long the protection would last and we didn't know how perfectly it would protect against transmission i don't think the people making you know those pronouncements the public health officials were hysterically overpromising but they probably gave the impression a little too strongly that we knew that this was going to be the end game for the pandemic interestingly many of the people who are making that case most strongly are now rfk's deputies in the public health administration you have jay bhattacharya marty makari vinay prasad these are people who in early 2021 were like get those shots and it's over for you you don't have to worry about visiting your grandma.

You don't have to wear a mask.

Forget it.

It's over.

Because their primary impulse was on moving past the pandemic.

I wish the public health officials had been a little more humble and especially were more open to breakthrough infections and indeed breakthrough deaths when they arrived in the spring and summer of 2021.

It would never have been the expectation that vaccines were going to prevent every death.

from COVID ever.

That would have been unprecedented.

But

people's expectations, I I think, were not effectively managed in a way that let them think, okay, some people are still going to die from this, probably.

This is a very serious virus.

There are people who are going to be vulnerable and they might get it.

You can't protect every single person.

You can't prevent every single death.

So there was very little expectation management.

There was very

few goals actually articulated that could guide the public in a way that would make them say, okay, I actually understand that this has made it safer for me.

It's not guaranteeing safety to everyone I ever interact with for the rest of my life, right?

And the other thing that I would say that I try to say when I talk about this is that bodily autonomy is a big deal.

And so there was all of this sort of creeping infringement on autonomy that happened before the vaccine came along.

Then the vaccine came down.

It came down with mandates that applied to people who were in low-risk groups, right, across the board.

And those people were doing their own research and they were thinking like, I don't think I need this.

You're going to make me do this.

You're going to fire me from my job or whatever it is.

And I think it's a little reductionist to think about that as selfish alone.

I think it's actually quite a big deal to ask people to accept things being put into their body that they don't want.

And vaccines are one of the places where that plays out.

Yeah.

I mean, we're living in this risk landscape.

We're worried about how infections are going to come into our bodies and change our lives.

Bodily autonomy is in certain ways a kind of rational response.

I'm not going to let anything in.

I think the thing that I would say about the pandemic is that I don't think of it so much as a catalyst for these dynamics so much as an accelerant.

So there were already all of these tensions about collective safety versus individual autonomy and freedom that were emerging in medicine, right?

Where we didn't have good, clear, evidence-based frameworks for resolving them.

I'm thinking about trans care for minors is one of these, right?

Aid in dying is one of these.

Reproductive rights, which has come to a head much more post-2020, but was barreling towards that Supreme Court case.

Vaccines already were a total flashpoint in some communities.

And the valence of who's on which side in those various debates, who's on the freedom side, who's on the collective safety anxiety side, who thinks you should have more regulation, who thinks you should have less regulation, it flips issue to issue, right?

So the idea that COVID created those dynamics, I think, is not quite right.

I think what it did is it accelerated people's sense of intensity about them, but it wasn't

the pandemic didn't start it.

The way I've come to think about this, so my first book is on political polarization.

And one thing I always say about this is that people always get the term political polarization wrong.

They seem to think it means something like political disagreement, but it's actually how well sorted multiple coalitions are by different ideas.

So in American politics, we are very well sorted around the idea of abortion.

If you are pro-life, you are probably a Republican.

If you are pro-choice, you are probably a Democrat.

And that has gotten much more true over time.

This was a set of ideas

that was not well sorted between the parties.

RFK Jr.

was a Democrat.

He had been considered for a high up environmental cabinet level post in the Obama administration.

He spoke at the 2004 Democratic National Convention, as we were talking about earlier.

There was a deep strain of vaccine hesitancy.

of

body purity on the left in the sort of the hippie left that I grew up near, right?

Like in my household, you could not have food with synthetic dyes in it.

I could not have colorful cereal growing up, right?

And that was a sort of, I understood that as a kind of liberal thing.

And what the pandemic does in a very, in a way that I think you can imagine having gone the other way, but it sorts the parties around this set of issues.

And you see people leave one party and join the other over them.

So R.F.

Kid Jr., I think, is the most obvious case of this, but I think there's actually a lot of it.

And you watch individuals who were very mixed in their views sort themselves.

Trump decided to be on the side of the vaccine hesitant, even though it was his best policy ever that helped accelerate the vaccines.

R.F.

Jr.

joined the Trump coalition, despite having been a lifelong Democrat.

You had, I think, people also move the other way out of kind of fury over what they felt was increasingly anti-science coalition, although that had begun happening over climate change quite a bit before.

And so these ideas were always there in the electorate, but they didn't have clear expression in the parties.

And now this has become a pretty central cleavage in our politics.

Yeah, when you ask people about their confidence in vaccines, Republicans' confidence is lower and it's going down relative to Democrats.

That's true.

And at the same time, more than 90% of parents get their kids vaccinated still.

So we are polarized, again, I think, a little bit in the discourse and in the politics around this more than people actually are polarized in their lives about it.

And that's different and interesting and important to me because it makes me think that those folks are still sort of up for grabs more than we talk about them as being.

It's important to sort of right-size the scale of the problem here.

The U.S.

did much worse than our peer countries, but we did get 95% of American seniors vaccinated in 2021, which means the people who are by far the most vulnerable to this disease overwhelmingly.

got the shots.

And the fights that we were talking about before, the discourse fights, were often among people who are not in the most vulnerable groups.

It was the middle-aged and the young.

And really, ultimately, those people were facing a different kind of risk landscape, had different considerations to make.

And, you know, I'm 43 years old.

I was vaccinated.

I got a couple of boosters before I stopped doing that.

I think that was wise.

But if someone who was in my same position decided not to, I would have, at the time, I think, understood, and I know some people who did this, so I had these conversations with them.

I would have understood that if they were choosing to go unvaccinated, the main burden being imposed was on them, not on me.

I think this picks up on something really important, Rachel said, which is the way this activated differing frameworks of morality around the collective and then around individual autonomy.

That conversation you just described hypothetically or actually happening with you and your friends, that is not how liberal politics was working in that period.

What sort of emerged around masking, around vaccines, and I think for very reasonable reasons, but was a

extremely aggressive push towards a sense of collective responsibility backed up by social dynamics, particularly online, of shaming, and then in some cases backed up by state power.

I think about the like overwhelming assault, say, on Joe Rogan.

And like, this is when the left really loses Joe Rogan over the fact that, you know, in their view, and I don't think wrongly, he's spreading vaccine misinformation on a show.

But these also categories of misinformation, disinformation, info hazards, right?

It's not just like you're not being responsible, but you become a kind of hazard to the collective.

And that really radicalized a bunch of people who felt themselves on the receiving end of it.

I'm not saying it was totally without merit, but I think it has really reshaped our politics in the aftermath.

And I think you can see the same pattern applying to the management of disinformation, misinformation, which was essentially a hygienic effort by liberals to like decontaminate the space.

I mean, it was a symbolically consonant approach that we took to limit bad information and promote good information.

Like Republicans were more about individual management of risk, navigating the world according to your own values and not worrying nearly enough as much about the collective well-being.

And liberals were much more safetyist and collective in their approach.

But I see a lot of increasing self-interest, mercenary thinking, loss of solidarity on the left, too.

When I think about how angry people were in 2021 that certain people in red states weren't getting vaccinated, there's a kind of like, let me live my life, don't burden me with your bad choices logic.

You know, in 2015, 2017, 2019, we saw all of these solidaristic movements on the left, which were built on the idea that we should protect the most vulnerable, attend to the most vulnerable.

And I don't think that that's the central organizing principle of American liberals today.

I think we've taken a path that is also towards a more acquisitive, avaricious, individualistic path, not nearly as much as the American right has.

But I think that the pattern that you're describing, where liberals went in one direction and conservatives went in another direction, I think conservatives went really far in one direction and liberals went a little bit in the same direction.

And that just gets to me to the big fundamental story here, which is like, this is about our psychological response to a rampaging disease that none of us felt prepared for, and that our psychological, cultural, emotional responses are less about what advice Anthony Fauci gave in the spring of 2021 and less about exactly how successful Joe Biden was in promoting vaccine mandates and much more about the fact that we quivered in fear in 2020, almost all of us.

And then we tried to make sense of that experience in somewhat different ways, but almost always in ways that pushed us towards prioritizing our own well-being and the well-being of our nuclear units.

And even the most solidaristic of us made us walk away from the solidarity that had guided so much liberal politics through the 2010s.

Do you buy that?

I'm thinking about it.

I'm wondering, I think I buy it up to a point.

So in 2020, the other thing that happened, right, was George Floyd and that summer of protest.

Liberal public health establishment figures said, it's okay to go out and protest after we've said you had to be home all this time.

Now, Anthony Fauci didn't say that, but people said that on Twitter.

That was part of sort of the discourse at the time.

And it really angered conservatives who sort of thought that they had been being good team players by staying home even when they didn't want to or kept their businesses closed or not been in church.

That was, I think, a pretty bad pivotal moment.

And there were sort of a lot of opportunities for liberals to demonstrate outwardly to each other that they cared about one another, that they were committed to the cause.

Wearing masks, I think, became this like gesture of solidarity well past the point when masks were really indicated, even when people weren't necessarily doing them out of anxiety for their own risk or others.

They were doing them to show that they cared about other people's risk.

And in a way, that was a really inspiring performance.

I mean, putting aside its efficacy, which we could talk about, just the fact that so many people, not just in the U.S., but around the world, were like, I'm going to upend my life.

I'm going to, you know, my kids are not going to go to school.

I'm not going to go to work.

I'm not going to see my girlfriend.

You know, all these things out of...

some combination of fear and concern for one another.

Kind of an unprecedented, in my imagination, unprecedented gesture.

You know, I'm still mulling the point you made a minute ago about whether or not both parties moved in an individualistic direction and that there were these big solidaristic movements on the left that began to fade.

And when you first said it, my instinct was it was wrong.

And as I think about it, I think it's right.

But I think that it's right for possibly a different reason, which is I wouldn't say the left has gotten more avaricious.

That's not my sense of sort of where liberal policy is going or.

At the political level, no, I meant sort of personal.

Yeah.

But I think there's a sense that that politics failed.

That you look around, particularly after 2024, but you look around at

the way kind of communal shaming worked.

You look at the way people look back on the pandemic.

You look at the backlash now to what gets called wokeness, Me Too.

And whatever you believe about the underlying arguments being made,

that the

effort to shame your way

to a better world was a political failure.

Not a small political failure, but a political failure that has empowered the absolute worst people, the people you feared the most, like a murderous row of who you did not want to have power in the year 2021.

And the move, I'm not sure if I would call it towards individualism, but away from

this heavily enforced solidarity of both action and language,

very, very aggressive on speech and info hazards, that that was part of what went wrong.

I want to make a distinction between what I think you're describing, which I would call orthodoxy and solidarity.

So I don't think that those things are quite the same.

And I would say that.

Although often conflated.

Often conflated, absolutely.

And I think what you're just, and in that moment, perhaps conflated, right?

But I think what you're describing is orthodoxy that was deployed like as a tool to sort of get everybody on board with not just pandemic mitigation, but also a political program to police each other's speech, everything that you're saying.

That does feel very different to me from what I consider to be solidarity, which is a positive vision for what it's like when people come together and work with one another on behalf of each other, but also the vulnerable.

And I think that the failure of solidarity is a failure of leadership.

And I feel less so about the orthodoxy question.

I think that might be right.

And I'm not, I think, as negative on all the impulses here as I'm probably sounding, but I am trying to think through why things changed.

And sort of some of the intuition of this whole episode is that 2020 still deforms our politics in very profound ways.

And I think the distinction you draw here between solidarity and orthodoxy is a really good one.

But the way you understand solidarity, and probably the way I understand solidarity, is as a positively motivated pro-social concern for others.

But

what

many were doing in this period, and often what you have to do in politics on some level, is enforce that same concern on people who don't share it.

And one thing that I think happened in this period that is still very present in our politics, although in strange ways, is that the left became extremely comfortable with the deployment of state state power on behalf of institutions and so on, in a way that really radicalized the other side.

And the other side didn't become libertarian.

In a strange way, they became authoritarian.

But there was something here about the relationship between cultural and political power that I think really reshuffled the parties in important ways and was very, very radicalizing for people who ended up on the other side of it.

So I think orthodoxy is enforced and solidarity is built.

And that's a really important distinction.

And for solidarity to be built, you need leadership.

I remember very distinctly this moment in March of 2020 thinking like, oh my God, this is the worst month of my career.

And we're on the precipice of a new world and a bunch of, right, the government was throwing money at people.

I was like, maybe we're going to get single payer out of this, right?

There was this moment that I was almost hopeful and then it all fell apart.

And I think

that that reflects a lack of attention to the political sentiment and the emotional sort of Daniel Offrey, the doctor describes emotional epidemiology, which is basically like the vibe, right?

Like there was sort of a lack of attention to the vibe in the way that leaders were thinking about making their decisions.

There was very little attention to the emotional experience.

Who was the best communicator during that time?

It was Andrew Cuomo.

And when you think about Andrew Cuomo's

New Yorker thing to say, well, you should watch the videos because they're real good because they're just Andrew Cuomo sitting there beside a PowerPoint and the PowerPoint says, I hate this or I'm tired of this.

We're all over it.

He sat every single day and spoke directly to people in his state and spent a significant portion of each day's press conference talking about how difficult this was, how valuable it was that people were participating in it.

This is not an Andrew Cuuomo endorsement on any level, but I do think he did this one thing very, very well.

And we had an absence of similar leadership elsewhere or communication from leadership elsewhere.

And so that solidarity curdled into something else.

And I actually think it's important just to be really clear that like, you know, May, May 4th, I think Anthony Fauci's on TV saying, we can't do this forever.

We got to go back to our lives.

He's publicly saying we should get kids back in school.

He may not be doing everything that he can do to get kids back in school, but the policies that we live through in the summer and fall of 2020 are often remembered as imposed.

from on high by liberals and maybe even by Fauci himself.

Of course, like Donald Trump was the president then.

Many states were controlled by Republicans.

Most of the decisions that we're talking about were imposed by governors or mayors.

There are some people who got some tickets here and there, but we basically gave guidance and then enforced that guidance through social pressure.

And that meant that the enforcement mechanism was social rather than state power.

I was just looking this morning.

You know, France, in their lockdown, they deployed 100,000 officers to police people's movement around the country.

The U.S.

did not do that.

So to me, the thing that happened was less about liberals becoming comfortable with deploying state power and more about liberals becoming comfortable shaming each other.

Yeah, although I do think these things combine.

It's so funny because I think I'm sort of ventriloquizing an argument I only 50% agree with, but I do think it's very important.

So much of this played out on the level of speech and what you could and couldn't say.

And it is true that the primary power deployed there was social.

It's not true that the only power deployed there was social.

Like, if you go listen to what appears to have radicalized Mark Zuckerberg, it has to do with going back and forth with the Biden administration on what could and could not be said, right?

There was a lot of efforts to criminalize certain kinds of arguments,

make them things you could not have on social media as disinformation, right?

There was a real effort to get Spotify to cancel its contract with Joe Rogan.

And I agree with you, we didn't deploy a gigantic police force.

But one thing I take seriously from just a lot of interviews I have done with people who were not big Trump people in 2016 or 2020 and were by 2024 is that they were incredibly radicalized by debates over speech.

I find this incredibly ironic and grim because the Trump administration is policing speech and using state power to punish speech in a way the Biden administration never would have even considered, right?

So it's like you have summoned the thing that you feared.

I mean, I think the lab leak story is a really interesting one here.

You had surveys showing something like one-third of Americans already believed that the virus came out of a lab.

Then we got, you know, the famous proximal origins paper, which was the first effort by the sort of epidemiological establishment to say that we know where this came from and it came from nature.

You had the sort of coordinated action by epidemiologists to sort of manage that message through the media.

To the extent that there was an effort to really control speech on the lab leak, it was in that period, spring of 2020.

By May of 2020, 49% of Americans believed that COVID had escaped from a lab.

So this period of a couple of months, which is the most intense control of the narrative that was ever undertaken, actually we saw an explosion of support for the lab leak theory.

And that, I think, is the basic dynamic with a lot of this stuff.

It wasn't that speech was truly controlled.

A lot of the people who built their social media followings most aggressively during the pandemic were.

Look, if it was truly controlled, you couldn't have had the backlash.

Right.

Right.

That's always the irony of these things.

It's, it, it could, it could actually be so enraging to people and be so politely damaging because they weren't doing, I think, what the Trump administration is increasingly thinking of doing.

Absolutely.

You actually could just be Joe Rogan with your $100 million Spotify contract, having vaccine weirdos on your podcast, but it radicalized people.

It was the sort of final experiment, I think, in the liberal elite trying to moderate content in a way that would keep people in line with a particular program.

So,

and it failed utterly, right?

So, like RFK's Instagram was taken down and it absolutely only served to make him stronger because the suppression affirmed everything he said about what they don't want you to know, right?

And that happened over and over again.

And that I think is really significant because it sort of signaled, I think, the end of an era of expert authority that we're not going back to.

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I want to hold on RFK Jr.

because his trajectory is genuinely interesting.

He goes from being a Democrat in extremely good standing, right?

An Air America host, for those who remember that somewhat ill-fated exercise,

to whatever he is now.

And in this period, he is held in, even as he is still a Democrat and runs for president as a Democrat,

he is held in extreme ill repute by mainstream Democrats and liberals.

Did he change?

Did

liberalism change?

What is your sense of

what happened here?

Did he become much kookier over time?

Or was this kind of always how he was, but it was on things that maybe liberals felt more comfortable with a more conspiratorial view on?

I think that R.

F.K.

Jr., his entire career since 1985 has been about fighting contamination.

The thing that this guy really, really cares about is pollution.

So his, he finishes law school and sort of his first real job after law school is working for the Riverkeepers, right?

About suing polluters, people who are polluting the Hudson River.

And his whole career from then on is all about fighting contamination.

It's fighting contamination in the water, in the air, from factory farms.

And as time goes on, he sort of widens his aperture and picks up issues where contamination is a factor in other contexts.

So his anti-vaccine activism, I think, is best understood as another strain of his like obsessive anti-contamination thing.

He doesn't like when toxins or chemicals are introduced into what he thinks should be pure and natural bodies or environments.

In that sense, I think he's actually been very consistent for like 40 years.

And the pandemic provided a ton of opportunity for that kind of thinking to take purchase, right?

He's also always been conspiratorial.

That's been true forever.

So he's always been very sort of anti-corporate, like, again, in a way that was dovetailed with democratic ideas, but very anti-corporate, always about suing corporations for things.

So that also becomes relevant with vaccines and then gets accelerated during COVID.

That's also very consistent.

He's also always been very politically ambitious.

So he was considered free EPA under Obama.

In 2009, he was on the short list to replace Hillary Clinton for her Senate seat when she was made Secretary of State.

He had thought about running for Congress earlier than that, like maybe in 2000.

Like Trump, he is a person who

by virtue of his family and his privilege and everything else, has always led a life that sort of had a public service element to it, has always been public and has always been thinking about running for office.

So I think that what happened is the pandemic put his issues at the forefront of the American consciousness.

He built a much bigger following than he'd ever had before.

He's incredibly adept at using mass communication tools now in a way that very few politicians are, in a way that's frankly very similar to Trump, I think.

And he seized his opportunity to run.

I like your framework of him as being concerned about contamination.

There's another framework that's helped me think about him and Maha more generally.

So I'm a big fan of this book by a writer named Charles Mann.

And the book is called Wizards and Prophets, or Wizards with Prophets.

Great book.

And the book is tracking this divide in ways we think about environmentalism and solving environmental problems.

And Mann basically argues that there are wizards who want to solve them technologically.

His big example is Norman Borlaug, who is the father of the Green Revolution in agriculture.

And there are prophets their argument is

mankind has grown beyond its wisdom.

It is out of alignment with the natural world.

It needs to rediscover limits.

We are going to destroy everything.

We are going to destroy ourselves.

And the only path forward is, in a way, going backwards, like going backwards to a more holistic human form of

living in this place and at this time.

RFK Jr.

is a prophet.

Like in everything he has ever done, the guy, aside from social media, is very, very, very skeptical of technology.

He, you know, thinks climate change is a huge problem, but he's part of the left that hates nuclear energy, for instance.

In him, and in Maha more generally, something that I see repeatedly is an intuition that trying to solve problems of modernity with the tools of modernity is just going to create more problems.

People believe correctly that a lot has gone wrong in our population level health.

They blame, possibly correctly, modernity, but also commercial decisions by companies and capitalism.

And their set of ideas around it are about going, you know, back to a more natural form of living, of eating, of moving.

This is canonically a left-wing set of use, right?

This is small as beautiful environmentalism.

And there's a lot of appeal in it.

But you spent a lot of time thinking about Maha.

How does that track for you?

I think that's largely correct.

You know, so the first thing I think to say about Maha is Maha didn't exist until last summer.

Neither the term, which was hastily

something that he slapped on his website after he joined the Trump coalition.

That wasn't something that that's not what he called his campaign before, obviously, or the coalition, frankly.

Like under the Maha banner and sort of loosely around Kennedy's candidacy, there are lots and lots of different subgroups.

There are small farmers, and there are parents who are anti-vaxxers for various reasons, and there are people who are really interested in nutrition policy.

And there are people who are worried about pollution.

So it's a complex network of people who sort of like loosely see in him somebody who wants to focus on a set of issues that have been left out of the political discourse for a very long time.

When we talk about healthcare, traditionally in politics, we talk about healthcare access.

We don't actually talk about health and bodies.

He is obsessed with health and bodies.

That's what he talks about.

He talks about the chronic disease epidemic as the major problem facing the future of America, right?

And that really speaks to a group of people who sort of form around him.

Some of them, I think, share what I would call sort of the degrowtherist tendencies that you're talking about, but not everybody does.

And that's a political challenge for him, frankly.

He has a lot of different constituencies to respond to right now and a lot of different bosses because of his relationship with MAGA.

And he's in a really complicated, cross-pressured place.

I want to pick up on one other part of this before we even get into what he's been doing, but something that pulls together, as you say, a lot of different people into one coalition is also, I think, a sense of being deeply failed by institutions.

Yes.

And

I think this set of feelings is very, very legitimate and also very complicated.

But anyone who has, I've in my family, people with,

you know, autoimmune diseases that we just don't understand and cannot cannot effectively treat.

And it's very frustrating and enraging.

And it's not like chronic health issues were not a part of political discourse before R.F.

K.

Jr.

became HHS secretary.

Like I covered Obamacare.

We talked about chronic health issues all the time.

They made preventive care functionally free or heavily, heavily subsidized under the terms of that law.

But it...

It was always done in both, I think, you know, liberal politics, which is very connected to sort of scientific institutions and doctors and others, and conservative politics, which is much more entwined with corporations.

It was always done with a lot of respect for institutions in a sense that these are just hard problems and modernity is tough.

And one thing that I think yokes together a lot of the Maha world,

not always in a way that holds together, but nevertheless is there, is one, a true level of fury about it.

not the technocrats disappointment or pledge to work on incremental solutions, but an actual level of like horror that people who are touched by these diseases actually feel.

And second, a profound skepticism of mainstream institutions, be they for-profit, be they governmental, and a sense that a lot of our problems are the result of some form of corruption and villainy, right?

That there was a fundamental level of being willing to say rightly or wrongly, you are being failed, you are being screwed.

The fact that everybody's so sick and, you know, so many Americans are obese and have type 2 diabetes diabetes and all these things are happening is not your fault.

It's their fault.

I remember talking about preventative care in the Obamacare conversations as who's going to have access to these things that we all agree we all want.

What Maha does is it doesn't just question institutions.

It questions medicine itself.

So it says,

It's not just that you have this diabetes because you've been fed the wrong food and the system has put you in this position where you don't have your body and whatever.

He says, You can solve that problem a different way than they're telling you.

And we have a better way for you to do it.

And they've been telling you the wrong way.

And the way that they've been telling you has been making profit for other people and keeping you sick.

And that's very different.

I think debates at the level of what should we actually be doing to our bodies, not should we have access to the care that we all sort of agree we need, that's really new, I think.

How do you take Maha?

Like, how would you edit this sort of emergent sense of it?

I think that they perceive a lot of real problems about our world and our health.

And I think they have a very narrow, often confused, even diluted approach to what the solution set should be.

I mean, I think at a core,

you know, kind of reptilian level, I do think it is primarily about defending one's body from the invasions of the outside world, contamination, as you were saying, and empowering individuals to navigate that risk landscape on their own.

And I think that is a lesson that many people took out of the pandemic, that we were told what to do, and the problem was imposed on us in certain ways and the solution was imposed on us in other ways.

And we really just wanted to navigate that landscape on our own.

But I also think that it's the wrong lesson to take from the pandemic because a disease that spreads through a population in unpredictable ways requires health solidarity beyond what Americans showed themselves really capable of in 2020 and 2021.

And I've been saying lately: you know, I could imagine RFK in an alternate universe where he had ended up at EPA and like Vivek Ramaswamy ending up running HHS.

That actually doesn't seem like a very bad outcome for either of these impulses.

You could imagine, you know, some streamlining of drug approval and, you know,

a kind of abundance approach to drug production in a Vivek

HHS.

And you can see possibly somewhat conspiratorial, but nevertheless, directionally correct policy change at EPA, where we're trying to do something to get more pollutants and contaminants out of our food system.

But I think when we're talking about all of this, it's illustrative to me of the bigger story here, which is like we're asking ourselves, how did this man of the left end up on the right?

And I think the real obvious answer is just the pandemic.

Like that is when we're talking about these things scrambling and flipping, it was the experience of the disease, our experience of fear through that that really changed so much of the valence of all of these questions.

I enjoy the counterfactual you just posed, where Vivek Ramaswamy is at HHS and because he has a biotech background and

RFK Jr.

is at EPA.

And here's why it could never have worked.

And

I do think this is really important for understanding what Maha has become and why what is happening is, in my view, extremely, extremely bad, which is

Trump is transactional and coalitional.

RFK Jr.

could not be put to EPA where he would want to do something about climate change and probably make it through the Senate and then like get anything done because Trump gets a huge amount of money from oil companies.

And there's a lot, there are a lot of people making transactions with Donald Trump who do not want RFK Jr.'s set of views at EPA.

So what has he actually been doing at HHS?

What has Trump been doing?

And you see huge holdups in NIH grant making, holding up $1.5 billion in funding.

You see the evisceration of cancer research funding.

You see the evisceration of mRNA vaccine research funding.

Because this fits two things.

It fits RFK Jr.'s view of the world, where he's very skeptical, the scientific institutions, very skeptical of these kinds of pharmaceutical interventions.

And it fits the part of the Republican Party that just hates government and wants to slash it, needs the money it will save by slashing it to give tax cuts to rich people.

RFK Jr.

used to be very much about healthcare access and believed in it, but in fact, they are gutting Medicaid as part of the big, beautiful bill.

To me,

one of the great tragedies of all this is Trump, in his first term, in my view, had functionally one good policy, which is Operation Warp Speed.

When you look back at the pandemic data, one thing worked, which is vaccines.

And what they've done in office is not outlaw school closures in the future.

It's cut into vaccine research.

It's like we are taking the one thing that really worked and disassembling it to the best they can.

COVID was in many ways a very modern kind of pandemic.

It was accelerated by international travel and all the things we know.

The vaccines were a very modern solution and particularly how fast they worked and some of the new forms of them like mRNA vaccines.

RFK Jr.

is not super excited about GLP-1s.

He's very worried about obesity, but not super excited about GLP-1s, even though that is the most effective treatment we have ever found on obesity by many, many, many miles.

I can imagine a version of Maha I'd be excited about.

I feel about it the way I always felt about Doge, which is like, good idea.

Somebody should actually try it.

But we're being governed by,

you know, these prophets of naturalism.

And they make some good points, but they're trying to take out all the technological solutions that we've been building and that actually are the sort of countermeasures to

problems and threats we face that, yes, are part of technological society.

You like don't get to undo it.

I do perceive him as extremely politically cross-pressured in a bunch of different ways.

It is not a natural marriage, the Mahamaga coalition.

And it's not guaranteed to him that he keeps that job in the same way that Elon got to come in and

do Doge and cause a lot of damage.

But actually when Elon became inconvenient to Trump, right, like he was pushed out of the nest.

So

NIH cuts.

a lot of that is Doge, right?

Doge did a lot of the sort of the agency cuts and the NIH cuts and the research cuts in its sort of characteristically ridiculously sloppy way.

So you've got all these cuts of cancer and all these cuts in Alzheimer's research and all this stuff that wasn't remotely intentional, right?

It doesn't actually reflect very much about anyone's worldview other than we can break it and worry about it later.

And that that's not an RFK thing really so much as a Elon thing and therefore it's a thing RFK has defended.

But a thing that he'll defend because he's an incredibly canny, ambitious political actor.

I think

he is playing a pretty long game.

He wants to keep that job.

He does not want to be kicked out of the nest.

And I think he probably potentially wants to run in 28.

So

he takes the Doge cuts.

He supports OBBB.

He writes an editorial in May in the Times supporting Medicaid work requirements,

something that he never could have done 10 years ago, right?

And he has to deliver wins for his coalition early.

And so he's doing all of this like ticky-tacky stuff, right?

He's like getting corporations to voluntarily take the food dye out of their ice cream or whatever.

And then he's like, you know, appearing at press conferences saying, like, thank God now your ice cream is saved from that food dye.

It's not that he thinks that he has done something amazing there.

He's just, he's just trying to rack up a couple of wins that satisfies coalition.

And then the last thing I would do is.

But the mRNA vaccine, that is him, right?

Cutting $500 million.

So that's what I was going to say, which is that I think absolutely

his anti-vax stuff is very, very sincere.

But even on vaccine policy, I think he's quite cross-pressured.

In the anti-vax universe, there is a real distinction between people who are sort of what I'll call traditionally anti-vax, who are like moms worried about the MMR causing autism, right?

People who are anti-vax before the pandemic, and then people who are specifically obsessed with the COVID vaccine and with mRNA, who have this whole set of theories about what MRA, mRNA as a technology did to people, the idea that the COVID vacc killed all these people, all this stuff.

He has to deliver wins to his anti-vax base.

He is actually, I think, trying to do things in some ways that split the baby a little bit.

He is really going hard on COVID boosters.

He's cut the mRNA, which is very much a win for his base.

They're thrilled about it.

And at the same time, he quietly approved flu vaccines for the fall last week.

His new ACIP approved RSV shots for the next year for babies.

When he took mRNA away, he said, it's because we don't think it works well enough and we want to go back to other models of vaccination.

We're going to come up with other vaccines that will work better for respiratory diseases.

He didn't say we don't need vaccines at all.

That's not to defend any of those choices, right?

That's not to say that any of those things were good decisions or to suggest that he's not himself very sincere in his anti-vax aspirations.

But I think he's in a complicated place where he can't actually wholesale get rid of vaccination access in this country because I don't think that that's what Trump wants.

I think if we have hundreds of dead kids from measles next year, that's a problem for RFK, and he's aware of it.

So I agree with that to the extent that he's cross-pressured and can't maybe do everything he would like to do.

But I think that the thing that I am getting at, the sadness of all this to me, that the place where

the

very reasonable critique of Maha, of the big manifesto they published under the Trump administration, and the very grim outcome of the policies is going to be the thing that they are really exercising a lot of state power to do,

whatever the coalitional dynamics are, is gutting scientific and medical research, firing huge amounts of people on that, and

taking away from the development of future drugs and treatments that were in a very promising place.

We were doing a lot towards a vaccine for HIV.

You know, Maha is very worried about the rise in cancers.

The mRNA vaccine research we were doing and that was really, that is really showing promise is around a bunch of different cancers.

My partner is kept alive by medical technology, right?

If she didn't have insulin, right, that's that.

But they have used the actual power of the state to kneecap a huge amount of basic research.

Totally.

It's not like they have outlawed the advertising of sugary cereals and processed foods to kids.

They've not outlawed processed foods.

They've not mandated exercise.

They have done some jawboning of corporations on food diets, which I'm for.

I don't think there should should be food dies and everything.

I don't think it's valuable.

You know, there's a lot I would love if the Trump administration or any administration would do on ways in which profit deforms what my kids are exposed to, what I'm exposed to.

Like I wish my kids never saw paw patrol on a package of gummies in the supermarket ever.

Like I just don't think that should be legal.

Like I would use state power to like curb a lot of advertising towards kids, right?

And I think things like that would actually help.

But instead, what we're getting is this attack on wizardry.

We're getting an attack on the technological foundations of how we might treat diseases that are everywhere right now.

We don't know what treatments we will not have because of this.

It is hard to blame anybody for a medicine that doesn't exist until five years later than it might otherwise have because you never knew you could have had it.

Like that seems, David, to be where we're going.

Yeah.

And I think it's interesting to think about, you know, the way that the Trump coalition shifted since 2016.

One of the major changes is that we have a new tech right component.

And many of those figures do want radical technological change and want to see the government not kneecapping that, but getting out of the way of that progress.

The truth is that America is in a much worse place health-wise than all of our peer countries, even though we're richer, even though our medicine is quite advanced.

Something like 500,000, 700,000 Americans are dying every year above the levels that would be dying if we we matched our peer country's mortality rates.

These are huge, huge amounts of suffering and ill health that we're staring at.

And we are throwing away the tools that we have to help us there.

I mean, the thing that makes the most concrete difference in, or is likely to make the most concrete difference in health outcomes for Americans is the one big, beautiful bill, right?

Like the most important thing that has happened is the Medicaid cuts and the staff cuts.

And his turn there, his sort of like relinquishing of any concern for entitlements, he likes Medicaid, you know, supporting Medicaid work requirements, getting up and doing press conferences in which he's talking about taking away the ability to use snap money to buy junk food, right?

Like as he's also supporting a bill that is effectively going to make children go hungry in this country.

That's the most concrete thing that this administration has done on health.

Yeah, this year, you know.

The technological stuff is really devastating.

The research stuff is really devastating.

It's not totally unprecedented.

George W.

Bush put a pause on stem cell research, which was a huge issue when he came into office.

Absolutely delayed discoveries potentially, right,

in a major way.

And at the same time, stem cell research did continue in the private sector and then was resumed in 2009.

So I do think it is devastating.

On no level do I think that anything that they are doing at HHS is good.

And I don't think it means certain doom for our ability to continue to do meaningful biomedical research in this country or to resume biomedical research that's supported by the federal government in the future.

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It's nature's original blueprint for health.

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I said a few minutes ago that Maha is a good idea.

Somebody should try it.

What would it look like to try it?

Taking seriously, David's point a second ago, that we are sicker than our peer countries, taking seriously everything we know about chronic illness in America, which is devastating and endemic, and taking seriously that cancers are rising among young people, taking seriously that there are unusual forms of pollution all around us, including microplastics, which we don't really understand what they do to the human body.

I have to think that Maha is like the wrong answer to the right question.

How would you think about beginning to formulate the right answer to that question rather than just counterpolarizing into a defense of the institutions or policies as they exist?

Well, I think one really important thing is that RFK is really driving liberals away from public health guidance too, and that's quite damaging.

You know, the repopulation of his vaccine advisory panel, I don't think many liberals are going to trust the advice of that panel going forward.

I think that that is quite damaging.

I think the changes to the vaccine compensation program he proposes are, you know, quite problematic.

But I would sort of emphasize your point, which is that on a lot of these questions, why are Americans less healthy?

We don't know all of the answers in total detail, but we know the broad strokes.

We know that we're a more violent society.

We know that we have more guns.

We know that we drink and do drugs more.

We know that our diets are unhealthy.

We know that we don't exercise enough.

These are not questions that we don't know the answers to.

The problem is, you know, how do we manage to encourage good behavior, discourage bad behavior, and support it through funding and public policy?

And

I don't know that the answers there are obvious.

And I don't know how much progress even an ideal figure in RFK's position would have because we are so in all of these areas fighting against one another, animated by resentment towards elites and institutions, trying to navigate and find new ways around old guidance towards new wisdom.

It just feels to me like, you know, we're in a bit of a free-for-all brawl and that we are in a phase when we are going to be repolarizing and repolarizing and repolarizing.

I'm curious what you'd add to that.

I think that there are a few different things.

So I think to hammer home about entitlements again, first, I think you could do Medicare for all who want it.

If you're not going to be able to do Medicare for all, you could do Medicare for all who want it, and you could expand healthcare access in this country.

You could do more generous entitlements rather than less.

That would go a huge distance, right?

Chronic disease in this country is a colossal issue.

It is not born equally amongst classes.

People who are poorer have a much greater disease burden.

You could do things that he sort of said he wanted to do, which is invest in both on the research side, trying to understand

the role of some of these contaminants

in human health, but also just like, we have questions about chemical additives.

There are lots of things we actually don't understand that well that we could use a lot more research on.

And he could invest in that.

You could totally change the way that you pay for healthcare in this country.

And this is something that they sort of maybe are doing.

They are looking at reimbursement schemes so that Right now, we relatively overimburse procedures versus talking, right?

You get paid much, much more to go do a colonoscopy than you do to go talk to your primary care doctor for the same amount of time, or the doctors get paid much more.

And it incentivizes certain kinds of types of care being used more often than others.

And it also just makes it very hard to meet the demand for certain types of care.

So we make it easier to prescribe.

antidepressants than it is to find a therapist who can see you and who can be paid for that time.

You could totally change the way that you think about reimbursing all of these non-pharmacologic interventions in in ways that would incentivize their use.

There's lots of good evidence for doing that.

We don't do that right now in the system.

And then, you know, I think the question about

how to manage this breakdown in trust is also really interesting, right?

I think it's critical that we don't counter-polarize.

I think we're really in danger of doing that, and we have to be very, very careful about it.

I don't think that on any level, Democrats want to be the party that's defending pharma, right?

Like that's a huge trap for us.

Well, one way I hope we don't repolarize is part of the abundance book out of Derek Thompson.

I mean, we have two chapters in that book that is fundamentally about the bureaucratization of science, the amount of time that goes into NIH grant writing.

It's like 40%

of the researchers' time.

Derek has this good line, Derek Thompson in the book.

It's like we gave all the researchers chronic fatigue syndrome, right?

We're making them spend all this time on paperwork.

They are really doing a lot of damage to the NIH,

to the FDA,

to these institutions that are in many ways remarkable and are also flawed.

And one of my concerns is the rallying around the institution as it was.

But there's also going to be this question of, well, what could it be?

And during the pandemic,

there were some marvels, right?

As you said, how quickly the mRNA vaccine was developed.

And there's questions of could the process by which it was approved have been faster?

Should we have had more things like human challenge trials?

There was fury, I think correctly, about the wide availability of rapid testing in Europe that it took us a long time to approve it here.

So there's also that side of it, right?

I mean, I actually think we should embrace a huge amount of what, you know, Maha at least claims to embrace around nutrition and health and other things.

But I also think that the reality is one way you cure diseases is through technological treatments for them.

And

I would like to see a Democratic Party that took more seriously that we could get a lot more out of the NIH, the CDC, the FDA, et cetera, that they had become institutions that in many ways discouraged risk-taking.

And that's one of the counterpolarizations here that really worries me, that in trying to correctly defend institutions that we don't want to see burnt to the ground, that the impulse to reform them, which was a good impulse and a needed impulse, will dissolve.

The idea of reforming clinical trial processes is a really good one and something that absolutely a democratic administration should take on.

It's not necessarily something that they should run on, right?

I saw a polling this week from Tavern Research and from Blue Rose separately, actually, that both affirmed

the Maha take on food policy, the food dye stuff, the idea of being able to use health insurance to pay for the gym, the idea that we are potentially over-prescribing medications to kids, those things pull very well.

There are places where, when Democrats talk about them, they get points.

Voters like it.

Those messages test very well.

When the public's much more mixed on the vaccine stuff that he's done and on the mRNA choices and on the agency reorganization, on all of those things, RFK slightly underwater.

But when Democrats talk about them,

voters don't respond.

This is a different episode, probably.

I am so skeptical of this kind of issue-by-issue polling.

One thing I will say for the Maha types is I think people react to when you have, you seem to have a theory and a conviction that is internally consistent about how the world works.

And I think at their worst, politicians generally, Democrats in particular, it's like you can feel them ticking down the issues as opposed to having a theory.

So that same polling, right?

Shows that a big anti-corporate message polls very high here, right?

If that's your view on health, that the problem is the pharmaceutical companies and others, that actually really works.

I think it's one reason that Bernie Sanders really is good at talking about and messaging healthcare.

He has a theory, it's a very populist theory of healthcare.

Ma has a theory.

And very simple, too.

And very simple theories.

I actually think to something you said earlier, Democrats, they know how to talk about health insurance, they don't know how to talk about health.

My major concern is that vaccines do become polarized in a way that is similar to climate or guns or abortion, where

they get associated, different positions of them get associated with different parties in a way that makes it hard for people to think about them on their own.

It makes a lot of sense to me that we should talk about what's good in the Maha agenda and not talk as much about some of this other stuff out loud.

while absolutely opposing it, opposing it in the courts.

States should be doing tons of vax policy in the states, right?

Like we can do stuff around it, absolutely.

It's not that we abandon the fight at all, but I do think that we have to win the elections.

And that means being interested in which parts of this agenda are effective and which parts are less effective when you're talking to people about what they care about.

I think one thing that is worth reflecting on is why the most dominant political figure of our time is somebody who says lots of unpopular things in Donald Trump and pushes pushes and pulls his coalition and changes it and absorbs outrage and absorbs.

One of the things Trump did that was very effective is he brought into his coalition people who did not agree with him.

And he didn't actually force agreement in that.

But there is this question of how do you treat people who hold views you don't?

Like something I think is very destructive.

I see the number of Democrats who are liberals who will like pick up something like woo

that one of the mean siblings tweeted and like paste that up as like a reason to not take them seriously.

That kind of policing, I think, is a really bad politics.

Totally.

And I do think, I mean, if you have any sense of culture at all, the level of prevalence of just concern about health, concern about nutrition, concern about food, right?

People are like, how did the Democrats lose the podcasters?

Like, have you ever listened to a podcast, right?

What the big podcasts talk about, the amount they talk about, the gym, about the supplements, about

and i agree with you that food is a much more potent dimension of politics than almost any politician but corey booker understands or some of the people on the right and i think this gets to the way 2020 is still shaping our politics very strongly the battle lines that got formed out of that are our battle lines now

and one of the questions i think going forward is how do you soften those how do you bring people back in who maybe are going to be very disappointed by what this administration does maybe don't like the set of things I'm talking about around vaccines, around cancer research, who don't want to see people kicked off of Medicaid, who are going to be disappointed in what this administration does, but are not going to agree with where liberal orthodoxy is on these things 100%.

I think we talk about a lot of these questions as though they are strategic choices for political leaders, when in fact what we're talking about is something much messier at the social level.

Like when I think about people being frustrated by wokeness, I don't think they're mad at Kamala Harris or Joe Biden.

I think they're mad at their HR department.

I think they're mad at something they saw on social media.

And it makes it very hard for someone who is putatively in charge of and answering for that coalition to take charge of that.

If there's a mess of people who are still trying to police speech, still trying to punish dissidents in areas that are not controlled by national political leadership.

And I think this is a basic problem for politics today, which is like, how do we prevent you know, voters open to messaging from the left from being turned off by unofficial messengers who are attacking them wherever they look?

But I think on some level, it just returns me to a basic observation about this whole experience, how the pandemic transformed us, which is that, you know, we talk about it in terms of policy and leadership, and that does play a role, but there's also something very basic and deep and human happening between individuals, in families, in social groups.

And it doesn't line up exactly with national political conversation.

It doesn't line up with partisan orthodoxies, but it's still like the basic way that all of us are interacting with these stories.

I think that basic disconnect between the social life of liberals and the liberal leadership class is a really, really important one.

Yeah, I think you have to mean what you say.

I think the question of how do you make connections across lines is you have to be sincere in your desire to, and you have to be able to express that sincerity.

So you have to find the places where you can do it authentically and start there and then try to connect with people where they can authentically meet you.

There is tons of consensus around some of the Maha agenda.

There's tons of consensus around the food stuff.

There's tons of consensus around some of the anti-pharma stuff.

And from there, you can move outward.

So that's the first thing.

The second thing is I think you have to have some emotional self-awareness.

And

David has said this now several times today, like that, the sort of unspoken fallout of the pandemic is that everybody's in a bad mood, right?

Everybody's incredibly guarded, that we went through this incredibly traumatic thing together, that there was an enormous amount of grief, collective grief, individual grief experienced, and we never quite articulated it that way.

We sort of skipped from those feelings.

They calcified into anger and then we talked about policy.

And it seems to me like what I want right now is I want people to get the MMR vaccine.

So I don't need to defend things that are not in service of that goal.

I can let those things go, even if it's painful for me on some level to acknowledge that the world has changed in ways that I didn't choose.

And I think we could all do with more of that.

Everybody I know who studies pandemics says we are, if anything, in worse shape for another one than we were for COVID.

What would it mean to not be in worse shape?

What did we learn such that if we saw the same thing happening again, that same beginning of exponential spread,

we would be prepared to have a much better outcome?

Well, I think we would not be walking away from mRNA technology, which allows us to develop new vaccines very quickly.

I think we would not have passed laws in, I think, 30 or more states prohibiting public health officials from offering guidance in the future.

We would not be banning mask wearing except for ICE agents.

You know, I think that's so grim, man.

No, I mean, we're now in a place where it is functionally in many parts of the country

not allowed to wear a mask to protect yourself from health threats, but it is allowed for agents of the state to wear masks to round up brown people they suspect of being here illegally.

That is an incredibly ugly development, which on both sides, honestly, I think is a result of the pandemic.

And I think that we would be, in general, doing more testing, more surveillance work, looking at wastewater.

There are a lot of technological solutions that allow us to track the disease much more more closely than even we were able to in 2020.

And instead, the avian flu, the bird flu threat is a really good illustration.

We're doing much less of that because our public health officials learned from the public, probably rightly, that the public didn't want to hear more about pandemic threats.

They wanted to live more in ignorance.

And that is an incredibly uncomfortable and distressing social outcome of this experience.

And maybe in five years, if the bird flu starts ripping human to human with with a fatality rate as high as it has been in other parts of the world,

we will be pushed back into a place of greater vigilance.

But I think at the moment, so much of what we're seeing coming out of HHS, so much of what we're seeing out of Maha, and to some extent, I think so much of what we're seeing on the American left about this is just wanting to put it all out of sight, out of mind, and move on.

We are so uncomfortable with the basic human lessons of the pandemic that we'd prefer not to learn them rather than to learn them.

Then always, our final question.

What are three books you'd recommend to the audience?

David, let's start with you.

I wanted to start with Naomi Klein's Doppelganger, which I think is about the best book about the psychic distortions of our experience living especially online in the first year or two of the pandemic, having so much of our external world withdrawn and the sort of, you know, crash course in

libertarianism, lack of society, living entirely online, everything that does to our minds.

I also wanted to recommend a book called The End Doesn't Happen All At Once by Key Rainer Born Free and Raghunithor Srinivantson, which is an epistolary account of the first couple of years of the pandemic, very moving, very personal, two friends writing back and forth through the experience.

And then I also wanted to recommend Kyle Harper's Plagues Upon the Earth, which is a history of disease and the way that it has shaped history and politics, social life, civilization for the whole of human history.

So those are my three.

Rachel?

Making the atomic bomb by Richard Rhodes, which I think reads like a blockbuster movie, but it is an 850-page book about physics, all about how scientific breakthroughs and discoveries happen and very much about how they're shaped by social forces, political events, and government priorities.

Teaches you everything a girl could want to know about the atom.

Calling the Shots, which is a book by the sociologist Jennifer Reich that was published in 2016.

And it's an ethnography and a history of the anti-vax movement that I found incredibly useful and illuminating and helping me think about this.

And then a book called Wave by Sonia Derena Yagala, who is an economist.

It's a memoir that she wrote.

She lost her entire family in the 2004 Sri Lankan tsunami, her husband, her two children, and her parents all at once.

That sounds like it would be an excruciating memoir to read.

It is an unbelievably beautiful book, and it is the best thing I've ever read about grief and resilience and optimism after hard things have happened.

David Walswells, Rachel Beddard, thank you very much.

Thank you for having me.

Thanks.

This episode of the Astral Clown Show is produced by Annie Galvin and Jack McCordick.

Fact-checking by Michelle Harris with Kate Sinclair and Mary Marge Locker.

Our senior audio engineers Jeff Geld with additional mixing by Amin Sahuta.

The show's production team also includes Marie Cassione, Roland Hu, Elias Isquith, Marina King, Kristen Lin, and Jan Koble.

Original music by Isaac Jones, Amin Sahuta, and Pat McCusker.

Audience strategy by Christina Samoluski and Shannon Busta.

The director of New York Times Opinion Audio is Annie Rosstrasser.

Special thanks to Dr.

Sunil Patel and Andrew Gabrielson.

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