Introducing: Assembly Required with Stacey Abrams

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Hey guys, it's Tommy. We're taking a break for the
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holiday season, but we've got something special for you today.
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Instead of our usual episode, we're dropping a new one
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from Assembly Required, hosted by the one and only Stacey Abrams.
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In this episode, she talks with Celine Gowder, an infectious
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disease specialist and epidemiologist, about the threats to public health
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with the incoming Trump administration. They dig into what's at
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stake with appointees like RFK Jr., how to bring science
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back into policymaking, and the path forward to driving real change.
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If 2024 is leaving with a lot of questions about
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the future, or if you've also found yourself shouting at
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the TV more than usual, stay tuned for this great episode,
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because if anyone knows something about not giving up, it's
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Stacey Abrams. Don't forget to subscribe to Assembly Required wherever
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you get your podcasts and on YouTube.
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Welcome to Assembly Required with Stacey Abrams from Crooked Media.
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I'm your host... Stacey Abrams. Since the election, we've been
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unpacking how the incoming administration and Project 2025 will actually work,
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what's possible, and how can we respond. As a reminder,
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Project 2025 is the 900-page-long policy blueprint published by the
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conservative think tank, the Heritage Foundation. With a complicit Congress
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and a compromised Supreme Court, their to-do list could undermine
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everything we rely on for a just society, from civil
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rights protections and environmental defenses to public education, free speech,
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and today's topic, healthcare. When we think about human rights,
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when we think about the core of what makes us
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who we are, there is nothing more relevant and more
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fundamental than healthcare. The ability to participate in society begins
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with good health. I grew up in a family without
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health insurance. I grew up knowing that if I got hurt,
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if it wasn't major, it was going to be treated
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as minor, not because my parents didn't care, but because
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they simply didn't have the resources to get access to healthcare.
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And in fact, since I grew up and got access
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to healthcare, since my parents finally have health insurance, I
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can see a night and day difference in the way
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our lives are lived. And I also feel an incredible
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degree of privilege because I know what it means to
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not have healthcare and to have it now. I am
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also deeply annoyed and sometimes outraged because the fight over
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healthcare is a fight that the people stopping it don't
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have to have. Every elected official in Washington, D.C. has healthcare.
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And it's the height of hypocrisy to deny it to others.
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And in the wake of COVID-19, Now more than ever,
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we should understand how vital and essential healthcare as a
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human right is. So while fighting to protect and improve
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healthcare in this country is not new, here are some
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of the ways that healthcare may be impacted by the
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next administration. One, there is an intent to dismantle or
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gut the Department of Health and Human Services, which is
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one of our nation's core agencies. And let's be clear, HHS,
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as it's called, has a very broad mandate. It's in
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charge of Medicare, Medicaid, the healthcare marketplace, the Children's Health
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Insurance Program, the Food and Drug Administration, the National Institutes
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of Health, the Centers for Disease Control and Prevention. They
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also cover the human services side. So TANF, the Temporary
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Assistance for Needy Families, Head Start, Child Care, and Child Support.
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And that's not an exhaustive list. HHS is under attack.
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Number two, they want to split the CDC into two agencies,
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one for data collection and one for public policy recommendations.
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And this effectively takes away the already limited authority of
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the CDC to provide public health guidance. It slows emergency response,
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and it could hurt state and local governments that rely
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on the CDC for public health guidance, for example, in
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the case of another pandemic. Number three, they want to
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tinker with the Food and Drug Administration's drug approval process.
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For example, take away the approval for mifeprestone. And number four,
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at the state level, the goal is to turn Medicaid,
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the vital national health care program that covers the poor,
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the elderly, the disabled, and some children, to turn that
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program into block grants, which means that states would have
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further permission to deny access to health care to the
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most vulnerable in our society, because states would have less
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money and limited federal accountability. Okay, so I've just done
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a very long list of what's at stake. And it's
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not just about what's in the proposed policy papers from
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Project 2025. It's about who Trump wants to put in
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charge of that vast agency.
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In the words of 77 Nobel laureates in medicine, chemistry, physics,
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and economics, RFK Jr., at the helm of the Department
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of Health and Human Services, would put the public's health
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in jeopardy and undermine America's global leadership in the health sciences.
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This in a letter addressed to members of the United
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States Senate, listing off the health secretary nominee's most sensationalist
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conspiracy theories on public health.
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The incoming president's decision to nominate Robert F. Kennedy Jr.
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to be the Secretary of Health and Human Services is
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indeed a source of much anxiety in the medical and
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scientific communities. So much so that Nobel laureates, a group
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that usually tries to stay out of politics, felt compelled
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to speak up. But there are other nominees. As I mentioned,
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HHS is huge. So among the list of people whose
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names are being put forward include Mehmet Oz to lead
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the Centers for Medicare and Medicaid Services and Marty Makary
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as the head of the FDA, both of whom have
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been controversial, to say the least, in their respective medical practices.
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I've just given you a lot of information. And right now,
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like almost every day, listening to what's to come can
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feel like daily doom scrolling. And unlike 2016, when people
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talked about resistance, this time people have responded by saying
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they need to protect themselves first. I totally get that.
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The rule is, put your own mask on first. But
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we're not on this trip alone. So eventually, we'll need
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to help our fellow travelers. I'm here to help us
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prepare for when and how we engage and insist. That
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begins by understanding what's really at risk versus what's just hateful,
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wishful thinking. What impact can these proposals have and what's
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not being said? And as always, how do we fight back?
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So let's get straight into it with our interview today.
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Dr.
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Celine Gounder is an infectious disease specialist, epidemiologist, and a
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science communicator. She is the editor-at-large for public health at
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KFF Health News. She produces podcasts and other content to
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help us understand what's going on in public health, and
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she was a regular guest on news shows during COVID-19,
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bringing us grounded, reasonable, and actionable information when misinformation and
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disinformation are met a wave of panic and worry. Does
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that sound familiar to anyone? So here to keep us
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all informed and sane is Dr.
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Gounder.
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Thank you so much for being here.
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It's great to be here. Thanks, Stacey.
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Dr.
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Gounder, I have a public health crisis question for you.
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Are American politicians and policymakers allergic to science?
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I think this is something that is very much on
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the mind of those of us working in science, in medicine,
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in public health and related fields right now. What we
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saw during the pandemic was really an attack on science
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and public health because many of the conclusions of the
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science were politically inconvenient. did not reflect well on certain
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politicians and leaders. I do think there is room for
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discussion if we start from a place of shared understanding, facts, science,
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and then to weigh what are some of the trade-offs,
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how do you weigh different values, whether it's value of
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human life, value of an elderly person's life, value of
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a young student's schooling, et cetera. But I think we
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have gotten to the point in some of these conversations
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where instead of having a conversation about values, we are
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attacking the science, or some of us are attacking the science,
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because they don't want to have that honest conversation about
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what they actually value.
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It's more convenient. It's easier to say the science is wrong.
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That language is perfect, that it's when science is politically inconvenient.
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And it's actually a perfect encapsulation of one of the
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reasons I started with that question. There was the letter
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from the over six dozen Nobel laureates about RFK Jr.
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's appointment to lead the Department of Health and Human Services.
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And then there's just the incoming Trump administration's overall approach
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to public health, which seems to be laser focused on
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finding those who reject science as a foundation for policymaking
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and giving them the highest appointments possible. These Nobel laureates, though,
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these chemists and medical professionals and economists, are very deliberate
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about pointing out that RFK Jr. has no credentials or
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relevant experience, quote unquote, in science, public health, or medicine,
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or administration. And as you pointed out, this is a
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question of value. So how important is it to not
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only have values decision-making and science-driven decision-making, how important is
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it to have science and scientific knowledge and experience to
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be the Secretary of Health and Human Services?
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I do think Could you be a secretary of health
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and human services without being a scientist? I mean, we
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have one right now, Javier Becerra. But he has other
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skills he brings to the table, being able to manage
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a large administration, understanding sort of institutional norms and practices.
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So he does bring a certain skill set. And this
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is where... your career civil servants are really important, which
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is to say the scientists, the technical experts who work
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under numerous different administrations, who are not political appointees, who
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are not partisan, you can rely on those people to
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help inform your decision-making, take the science, the expertise that
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they are using to advise you, and then make decisions
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that may be partisan decisions, but at least informed by
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that science. Now, what we're seeing is are conversations coming
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from the incoming president and his team about eliminating some
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of those civil service protections to make it easier to fire,
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hire whomever they want in those scientific technical expert roles.
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And the problem is if those roles are filled by
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people who do not have the qualifications, the scientific medical skills,
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public health expertise, then the person at the top is
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not going to.
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Be appropriately counseled.
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So you don't necessarily yourself as the leader of HHS
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need to have that expertise, but you do need to
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have people who have that expertise to advise you.
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And if we don't have either, then we're in real trouble.
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Well, that brings us to the other nominees. So while
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a lot of attention has focused on RFK Jr. heading HHS,
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The two of the top jobs are also under consideration.
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And one of the pending nominees is Mehmet Oz. The
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other is Matt McCurry, both of whom are physicians, but
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who each have had controversial behaviors. And there have been
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questions about their fealty to scientific principles in their work
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or the implications of their policy proposals. So what do
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their nominations tell you about the incoming administration's thinking about this?
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So to your point about combining the need for science
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and for policymaking, what happens when you have a scientist
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who doesn't seem to believe or at least live those beliefs?
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You can have differences of opinion as to whether you
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should mandate masking or vaccination or whether schools should be
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closed in the context of a pandemic. But you should
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start at least with a common understanding of what the
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science is. What we saw, Jay Bhattacharya, who's nominated to
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head the NIH, and some of his colleagues, Marty Macri,
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who's now nominated to run the FDA, They came up
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with estimates of what they thought the infection and death
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rates for COVID, their estimates were really flawed and very
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small compared to, very low compared to.
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What actually played out.
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And so we do need to start with people who
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understand how to make these estimates, who understand how to
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advise us.
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And say, you know, these are the trade-offs.
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You with your values, your politics, your partisanship may make
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different choices, but at least start with that basic level
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of understanding. And I think that's also what's scary because
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we may have another pandemic.
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On our hands before too long. Unfortunately, we in this
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country have.
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Not been managing the H5N1 bird flu situation.
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As well as we could.
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And that is putting us at risk for a pandemic
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sooner than later. So these questions are really quite pressing
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and imminent.
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And you just pointed out that we are already on
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shaky ground and this administration is not only rejecting expertise
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or bringing in people who have demonstrated a flawed use
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of their expertise, but there's also, as you said at
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the top of the conversation, this intent to replace civil
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servants who have that expertise with hires who are based
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on loyalty and not capacity. You mentioned H5N1 as one
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of the possible outcomes. Can you talk a little bit
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more about the implications of this lack of capacity when
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it comes to public health, not just in terms of pandemics,
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but just the larger public health universe?
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Well, one of the things that I think was made
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very clear during the COVID pandemic is we've very much
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underinvested in public health. Some of the areas of real
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need are data systems. When we were dealing with public
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health departments faxing their data into the CDC to Debbie
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Birx's team at the White House, that is not something
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where you can get real-time data, quality data online. Part
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of the challenge here is, and this is something a
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lot of people don't understand still, is that public health
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powers reside at the state level. There's only so much
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the government, federal government can do. Yes, the federal government
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provides funding, technical expertise, advice, guidelines, but they're not the
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ones actually that institute mandates, requirements. Or do the boots
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on the ground work? And so this creates issues in
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terms of how well health departments are funded at the
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state level. Do they have the capacity and funding from
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their state legislatures to do what's needed, including the data
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modernization issues? And then do they report that to the CDC?
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So they can choose not to report. They can choose
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to report only certain things. The CDC has some levers
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it can use, tying some of that reporting to funding.
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But in general, they're not usually too.
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Aggressive with that because of the potential harms of withholding funding.
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Can you talk a little bit more about state and
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local public health preparedness? Because that's one of the issues
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we try to focus on here on Assembly Required. We
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have a lot of attention... that necessarily needs to be
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turned towards the federal government. But often the real levers
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of power, and particularly the accessible levers of power for
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our listeners, happen at the state and local level. So
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can you talk a little bit more about how state
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and local public health works and how public health preparedness
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works at that level?
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Yeah, so the Constitution does not provide public health powers
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to the federal government. Again, the federal government has the
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right to tax and spend, to regulate interstate commerce, but
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that's really the limits on federal powers, and all of
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the other federal powers really derive from those too. So
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if you're somebody who's concerned about public health, yes, you
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should pay attention to national politics, but it really is
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at the state level and to some degree the local
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level that you can have the most impact. So, you know,
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that's where I would say pay attention to what's happening
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in the state legislature, what your local health department is doing.
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At the state level, we've seen increasingly public health powers eroded.
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We've seen some of the recommendations around vaccination being eroded,
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where you have increasing non-medical exemptions around vaccination, so what
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vaccines kids need to get to go to school. Another
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area that you should be paying attention to is public
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health versus the economy, public health versus industry, it will
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always be a theme. And so it's sort of balancing
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those different trade-offs, values. But you do see this play
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out very concretely, as it is right now with H5N1.
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There's a reason.
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Certain states have reported a lot more cases of humans infected.
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It is very much related to how much testing is happening,
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also how much testing of the herds, of the milk,
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This is all related to how aggressive the states have
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chosen to be.
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So you have states like Michigan, Colorado, California.
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Yeah, they're reporting a lot of cases, but it's because
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they're testing so much. And so we don't have a
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clear view into what's happening in other states.
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And why does it play out differently?
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Well, this is a question of values to some degree
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and wanting to maybe protect industry from what some of
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the economic impacts might be of realizing they have a
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bigger problem on their hands than they want to know.
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And this is also about the impact of influence of
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industry in certain states on what happens, right? So if
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you have a very powerful dairy industry lobby in that state,
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that's going to be very different from a state where
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your political interests might be a lot more diverse and varied.
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Can you think of an example or a time when
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citizens or local citizens sort of raised the alarm and
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had an effect at the local or state level Because
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sometimes it can feel like industry is too big and
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the problem is too big. We can't do anything about it.
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You've spent a lot of time advising local and national policymakers.
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When have you seen citizens actually take what you use
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and have an effect?
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We did see a very real impact of citizens in
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communities on COVID mitigation measures. And this played out differently
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in different communities. There were communities where people wanted to
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reopen businesses.
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They wanted their kids back in school as quickly as possible.
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There are places where parents had good reason to be
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very concerned, for example, here in New York City. You
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had a lot of parents and families of color, lower
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income neighborhoods, multi-generational households, where they were concerned not just
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for their kids, but for other family members in the household,
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what it would mean if their kids were.
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Back in school before.
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a lot of people had been vaccinated, what that would
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mean for elderly relatives living at home. And so what
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we saw, this sort of patchwork reopening, reflected a lot
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of those local values. And, you know, some of that
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was the parents, some of that was teachers who were
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concerned for themselves. And, you know, whether you agree or
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disagree with those particular decisions different communities took, you know,
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regardless of that, aside from that, that was the local
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community that was the local communities that were dictating those decisions.
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Well, let's stay there for a second, because, you know,
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I talked about the allergy to science among policymakers. But
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there's a second strain that seems to have affected segments
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of the general public. And, you know, Project 2025 and
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its acolytes, they tend to harp on the uncertainty of
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COVID and the changes we adapted to. And as you describe,
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the uneven and sort of patchwork response, which seemed to
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prove that nothing was true, therefore nothing would ever be true.
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You know, there was the, you know, first we all
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wiped down every surface, and then we realized wiping down
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every surface wasn't necessary. And opponents of science hold this
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up as, you know, proof that the public should turn
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against the scientist. How do you respond to people who
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might be convinced that no one is right without invalidating
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how difficult that time was?
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I think there's a real understanding of what science is
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and the scientific processes. I think there are people who
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think scientists are a bunch of liberals who already have
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an opinion and they just use science to back up
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that opinion.
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That is not science.
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Science is you start with saying, I don't know. Here
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are some hypotheses. I'm going to try to disprove that hypothesis.
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And then based on what I learned from that, I'm
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going to create another experiment and repeat and repeat and repeat.
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And that means you are going to build your understanding
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knowledge over time in an incremental way.
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That's just how science works.
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You're not going to be able to jump from this
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is what I think and here's the thing that proves it.
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It just doesn't work that way. I think most people
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find that approach to be very counterintuitive.
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It's not the way we normally think.
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Normally, we think in what I would call a more
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lawyerly way, which is to say we already start with
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this is the conclusion that we want to back up
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and then we try to find things to support that.
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And that really does also lead to.
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Things like cherry picking and confirmation bias and looking for
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things that will back up what you already believe.
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So basically, I'm going to translate this into television. We
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need to be more like Dr. House than we are
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like Law & Order.
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I think, yeah, I think that's a great way to
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put it. Yeah.
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So as a practical matter, as a practical translation, if
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I'm having a conversation over the holidays with someone who
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tells me, well, We didn't get it right in COVID,
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and that's why I'm not paying attention to H5N1. That's
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why it doesn't matter who's in charge. What's the pithy
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response that we want listeners to be able to give,
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or at least how do they start a conversation in
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a way that reminds us all of our high school
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bio classes?
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Well, I think also to be aware of what your
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preexisting biases and opinions might be. So to ask them, well,
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you know, what matters to you? Let's say another pandemic
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breaks out tomorrow. What would be your number one, two
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and three concerns and why? What was your experience of
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the COVID pandemic? And I think starting with that kind
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of understanding and being aware of why you might already
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have certain opinions and then also just explaining, you know,
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what is the scientific process, I think are two different
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ways to go about this.
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So part of the genius of Project 2025 and the
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effectiveness of the Trump administration is approach is that by
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targeting everything, our attention has nowhere to focus and it's
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nearly impossible to concentrate. And that is especially true in
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this assault on health because HHS is such a mammoth
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agency with so many responsibilities. I gave a little bit
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of a primer at the top of the episode, but
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I want to spend a few minutes with you really
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making sure we understand what the Department of Health and
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Human Services is and why these attacks matter. So number one,
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can you break down what we need to understand about
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the agencies within HHS? And what are you most closely
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paying attention to?
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There are many agencies within HHS, but I'll focus just
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on three. The three big ones are NIH, which does
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biomedical research, the CDC, which is the nation's public health, well,
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main public health agency. And then you have the FDA,
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which is in charge of food and drug safety, most food.
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You have certain things that fall under the USDA. So
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why does the NIH matter? NIH is the world's biomedical
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institution and funder. And a lot of that research actually
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happens outside of NIH. Some 80-plus percent of the research
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is actually outside of NIH itself.
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It's awarded to researchers.
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At academic medical institutions and other institutions to do that research.
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And it's a way of really getting a diversity in
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the kinds of questions being asked, the places where they're
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being studied. But we have created a system of funding
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for research where government funds the earlier research, the basic research,
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And then we leave it to industry to take that
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research and to turn it into drugs and vaccines and
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diagnostics and other products. And I think what's unfortunately happened
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is we as taxpayers fund what the NIH is doing.
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But if you don't have the pharmaceutical companies, device makers,
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et cetera, who use that science and then translate that
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into affordable, accessible products for the population, the general public
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may not benefit from those investments. And so I think
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part of what we're seeing is a real frustration with
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this money being spent on research and people not necessarily
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feeling the tangible benefits. Now, I would say the COVID
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vaccines are a great example of a very tangible benefit
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of 20-plus years of research on mRNA vaccines. We had
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no idea that COVID was going to come along, but
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we were very lucky to have had that research already
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in the can, where we could then pivot to using
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those for COVID, and we were able to develop vaccines
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very quickly for COVID. And it's a platform that's really
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ideal for pandemics because you can so quickly tailor those for.
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The next pathogen. So you have NIH. Then you have
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the CDC.
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The role of the CDC is partly as a funnel, frankly,
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of funding to state and local health departments.
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So a lot of the funding does not stay at CDC.
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It goes down to the ground.
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But then also to collect data from the state and
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local health departments to analyze that, to feed that back
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to the states. We've already talked about some of the
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data issues there. To also help develop guidelines. And it's
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not just for vaccination, but for any number of public
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health issues to provide guidance.
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And technical support to the states. CDC cannot mandate or
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enforce any of that. That is, again, at the state
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and local level.
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And then you have the FDA, and where people will
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be most familiar is the FDA's role in approving drugs.
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This is also something that I think people don't understand
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is the FDA... Take generics, for example. RFK Jr. has
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expressed frustration that the FDA is somehow blocking people's access
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to generic medications for additional indications, so using existing medications
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for additional uses, those sorts of things.
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And it's not the FDA.
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It's essentially a market failure where pharmaceutical companies, again, are
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the ones that pay for the clinical trials, the studies
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that determine whether something is safe and effective. They then
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take that data, they send it to the FDA in application,
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and they say, will you approve this medication for this purpose?
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And so if there's not a profit incentive for these
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companies to do so, the FDA is never going to
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be able to approve that medication. Now the FDA is
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partially funded by fees on these companies when they submit
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an application. That's a decision we've made. So we could
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decide we're going to use more taxpayer money for vetting
484
00:28:41.099 --> 00:28:45.420
these applications. We've decided to partially fund it with these fees.
485
00:28:46.539 --> 00:28:51.960
And we've decided that this kind of approach to funding
486
00:28:52.819 --> 00:28:56.400
R & D for drugs, diagnostics, vaccines, et cetera, we
487
00:28:56.440 --> 00:28:58.640
want that in the private sector. And that is going
488
00:28:58.660 --> 00:29:02.380
to have certain implications for what becomes available to people,
489
00:29:02.720 --> 00:29:04.480
how accessibly and how affordably.
490
00:29:06.779 --> 00:29:09.200
So let's go back to the CDC for one second.
491
00:29:09.539 --> 00:29:13.500
When we hear about dividing the CDC, what does that
492
00:29:13.579 --> 00:29:15.259
mean and why should we be worried?
493
00:29:16.450 --> 00:29:21.529
So this is very much focused on some of the
494
00:29:21.690 --> 00:29:25.049
conversations we've had around COVID and vaccines. That's really where
495
00:29:25.089 --> 00:29:29.529
this is coming from. So there's a desire by some
496
00:29:29.650 --> 00:29:35.529
to divide the CDC into a scientific data gathering institution
497
00:29:36.670 --> 00:29:41.490
and then an institution that makes the recommendations and policies.
498
00:29:42.329 --> 00:29:47.430
The idea being recommendations and policies may be more political
499
00:29:47.490 --> 00:29:51.170
because you are talking about values at that point. How
500
00:29:51.190 --> 00:29:57.089
do you value life? At what cost financially? What implications
501
00:29:57.150 --> 00:30:01.069
it has on society? And so there's a desire to
502
00:30:01.730 --> 00:30:05.789
create a firewall, so to speak, between who publishes the data,
503
00:30:05.869 --> 00:30:09.829
gathers the data, and who is making the policy recommendations.
504
00:30:11.150 --> 00:30:14.359
When I think about all of these agencies and how
505
00:30:14.400 --> 00:30:17.640
they intertwine, one of the conversations then is how easy
506
00:30:17.700 --> 00:30:18.400
is it to do this?
507
00:30:18.420 --> 00:30:19.400
And I know you.
508
00:30:19.279 --> 00:30:22.960
Focus on public health and not necessarily the ins and
509
00:30:23.019 --> 00:30:26.279
outs of congressional action, but how easy would it be
510
00:30:26.400 --> 00:30:30.789
to divide the CDC or to allow the FDA to
511
00:30:30.869 --> 00:30:37.390
rescind the polio vaccination authorization. Are those things that take
512
00:30:37.529 --> 00:30:39.630
a lot of time? Are those things that are imminent?
513
00:30:39.759 --> 00:30:42.039
Is it something that happens by executive order? Can you
514
00:30:42.059 --> 00:30:45.119
talk a little bit about how public health actually gets
515
00:30:45.259 --> 00:30:46.299
changed in this country?
516
00:30:47.220 --> 00:30:51.039
Yeah, so some of this would need to be congressional action.
517
00:30:51.099 --> 00:30:53.269
Some of it could be done by the secretary of
518
00:30:53.420 --> 00:30:58.369
HHS and by executive order by the president. This is
519
00:30:58.390 --> 00:31:00.720
a very heavy lift to.
520
00:31:00.690 --> 00:31:01.519
Do something like this.
521
00:31:01.559 --> 00:31:04.339
You've had a number of CDC directors who've tried to
522
00:31:04.400 --> 00:31:08.519
reform the agency numerous times, and it is a very
523
00:31:08.779 --> 00:31:14.299
time consuming, very challenging thing to take on. you know,
524
00:31:14.339 --> 00:31:17.339
in terms of congressional action, you would need that in
525
00:31:17.380 --> 00:31:19.930
order to split off certain functions from the CDC and
526
00:31:19.950 --> 00:31:24.730
to fund these things independently. In terms of the FDA
527
00:31:25.549 --> 00:31:31.230
rescinding authorization for polio vaccines, it really depends on to
528
00:31:31.299 --> 00:31:36.819
what degree the incoming president and HHS secretary and FDA
529
00:31:36.859 --> 00:31:40.019
commissioner follow what have been institutional norms.
530
00:31:40.119 --> 00:31:41.960
Now, do they have the power to.
531
00:31:43.809 --> 00:31:47.490
single-handedly do some of these things? Yes, but that would
532
00:31:47.549 --> 00:31:51.039
be really extraordinary to see an FDA commissioner or an
533
00:31:51.099 --> 00:31:54.200
HHS secretary taking that kind of action, and that there
534
00:31:54.220 --> 00:32:01.160
are processes for withdrawing an approval. You would definitely see
535
00:32:01.220 --> 00:32:05.730
lawsuits from the pharmaceutical companies that produce these products if
536
00:32:05.829 --> 00:32:09.630
there was threat of rescinding of an approval, and they
537
00:32:09.690 --> 00:32:13.650
would have standing in terms of, is there actually science
538
00:32:14.069 --> 00:32:20.660
to support whether these actions are evidence-based and warranted?
539
00:32:20.680 --> 00:32:22.000
Yeah.
540
00:32:22.039 --> 00:32:24.299
And I would also throw out there that there are
541
00:32:24.339 --> 00:32:28.619
budgetary implications, and that means Congress gets involved. And when someone,
542
00:32:28.779 --> 00:32:33.319
let's say Mitch McConnell, flags that he is very unhappy
543
00:32:33.359 --> 00:32:36.670
about the threat to the polio vaccine, his lever of
544
00:32:36.730 --> 00:32:39.750
power is whether or not something moves through, even though
545
00:32:39.769 --> 00:32:42.769
he's not going to be the majority leader, he has
546
00:32:42.789 --> 00:32:45.539
a vote in the Senate and a little bit of influence.
547
00:32:45.900 --> 00:32:51.119
So I want folks to understand that the straightforward demand
548
00:32:51.240 --> 00:32:55.619
for action does not necessarily translate into immediacy of that
549
00:32:55.759 --> 00:32:57.819
action being taken. Would you agree?
550
00:32:58.420 --> 00:32:59.500
No, I do agree.
551
00:33:00.019 --> 00:33:03.349
Because right now you have budgetary lines for the CDC.
552
00:33:03.700 --> 00:33:07.049
You do not have budgetary lines for these separate agencies.
553
00:33:06.670 --> 00:33:07.470
That they're proposing.
554
00:33:07.490 --> 00:33:10.309
So you really do need to have congressional action to
555
00:33:10.890 --> 00:33:12.089
implement that kind of split.
556
00:33:12.710 --> 00:33:17.410
Fantastic. So health is not simply the ability to know
557
00:33:17.470 --> 00:33:21.049
what diseases and threats are out there. It's also about
558
00:33:21.150 --> 00:33:24.509
the ability to get help. And that means we also
559
00:33:24.569 --> 00:33:27.069
have to pay attention to the health care access side
560
00:33:27.109 --> 00:33:31.630
of things. So, for example, Project 2025 proposes to roll
561
00:33:31.670 --> 00:33:34.170
back the progress that the Biden administration has made in
562
00:33:34.210 --> 00:33:38.450
reducing drug prices. It also wants to accelerate the privatization
563
00:33:38.470 --> 00:33:42.430
of Medicare, which older and disabled Americans rely on. And
564
00:33:42.470 --> 00:33:45.099
they want to break up Medicaid into block grants, which
565
00:33:45.259 --> 00:33:48.119
will set fixed amounts that go to states, regardless of
566
00:33:48.140 --> 00:33:50.700
the actual cost of health care or the size or
567
00:33:50.759 --> 00:33:54.619
needs of the population. What are you concerned about when
568
00:33:54.700 --> 00:34:00.259
it comes to this administration's impact on healthcare access? And
569
00:34:00.460 --> 00:34:02.799
how would you process this information as a layperson?
570
00:34:03.279 --> 00:34:08.099
Well, if you read Project 2025, they literally spell out
571
00:34:08.219 --> 00:34:12.880
that the cost of Medicare and Medicaid combined since 1967,
572
00:34:12.880 --> 00:34:15.260
which is when these programs were started, is about $ 17.
573
00:34:15.159 --> 00:34:16.800
8 trillion. And the U.S. deficits for that same time
574
00:34:16.860 --> 00:34:17.570
period are $ 17. 9 trillion.
575
00:34:17.590 --> 00:34:26.590
So in other words, They are pretty clear in that
576
00:34:26.789 --> 00:34:30.090
they think that Medicare and Medicaid are the principal drivers
577
00:34:30.170 --> 00:34:33.269
of our national debt. And if we want to eliminate
578
00:34:33.329 --> 00:34:37.650
our national debt, we need to dramatically scale back, if
579
00:34:37.710 --> 00:34:41.730
not eliminate, Medicare and Medicaid. That's essentially what's implied in
580
00:34:41.849 --> 00:34:47.409
what's written in Project 2025. There are several strategies to
581
00:34:47.449 --> 00:34:50.719
try to scale back spending, one of which is, as
582
00:34:50.760 --> 00:34:55.500
you mentioned, privatization of Medicare. A lot of people who
583
00:34:55.960 --> 00:34:58.719
have Medicare Advantage plans may think they're getting a very
584
00:34:58.760 --> 00:35:02.360
good deal. They get dental, vision benefits, maybe other perks
585
00:35:02.400 --> 00:35:06.210
thrown in. And it's great until they need to see
586
00:35:06.230 --> 00:35:09.949
a doctor, they get hospitalized, and then realize that their
587
00:35:09.969 --> 00:35:13.349
coverage is actually really inferior to what they might have
588
00:35:13.389 --> 00:35:15.010
had if they had traditional Medicare.
589
00:35:16.389 --> 00:35:17.630
You mentioned the.
590
00:35:19.300 --> 00:35:23.460
Medicare's authority to negotiate drug prices under the Inflation Reduction Act.
591
00:35:24.219 --> 00:35:27.389
This is an area where the incoming administration is under
592
00:35:27.469 --> 00:35:32.670
pressure to roll back that authority. Then this has very
593
00:35:33.769 --> 00:35:36.969
tangible impacts for people. One of the drugs that was
594
00:35:38.070 --> 00:35:40.059
likely going to be in the next round of drug
595
00:35:40.079 --> 00:35:44.480
negotiations is semaglutide, also known as Ozempic or Wigovi. A
596
00:35:45.019 --> 00:35:48.929
lot of people are desperate to get access to that medication.
597
00:35:50.530 --> 00:35:52.210
Currently is very expensive.
598
00:35:52.840 --> 00:35:59.019
The Biden administration has recommended or has proposed new guidance
599
00:35:59.059 --> 00:36:04.030
that Medicare can cover these medications, also known as GLP-1
600
00:36:04.090 --> 00:36:06.909
weight loss drugs, for people even if they don't have
601
00:36:06.949 --> 00:36:11.530
diabetes or cardiovascular disease, but simply because they have obesity.
602
00:36:12.949 --> 00:36:15.929
And it will be up to the incoming administration to
603
00:36:16.050 --> 00:36:17.139
finalize that rule.
604
00:36:17.360 --> 00:36:20.159
Whether they will or not, we don't know. But then
605
00:36:20.260 --> 00:36:21.920
if they do and.
606
00:36:21.880 --> 00:36:25.139
They don't make use of that lever to negotiate down
607
00:36:25.280 --> 00:36:30.000
drug prices for, you know, including the GLP-1 drugs, that
608
00:36:30.019 --> 00:36:33.650
would have huge cost implications for Medicare. So it's a
609
00:36:33.670 --> 00:36:37.210
little hard to know how each of these pieces will
610
00:36:37.250 --> 00:36:41.800
play out. With respect to Medicaid, you mentioned block grants
611
00:36:41.840 --> 00:36:44.300
to the states. That's a great way if you're looking
612
00:36:44.360 --> 00:36:48.239
to cut your Medicaid costs, federal spending on Medicaid, to
613
00:36:48.280 --> 00:36:51.900
do so. What we're also seeing are conversations about reducing
614
00:36:52.300 --> 00:36:57.679
the federal amount that's being provided for that. So both
615
00:36:57.719 --> 00:37:01.000
states and the federal government put money in for Medicaid.
616
00:37:01.780 --> 00:37:04.699
But if we see a reduction in the federal contribution,
617
00:37:04.860 --> 00:37:08.690
some states that have expanded Medicaid may reverse that decision.
618
00:37:09.449 --> 00:37:13.090
We've seen more and more red states expand Medicaid, North Carolina,
619
00:37:13.130 --> 00:37:16.570
for example, And that's because there was an understanding that
620
00:37:16.610 --> 00:37:19.840
this actually was good for their bottom line. And it
621
00:37:19.880 --> 00:37:22.980
had an impact not only on patients, but also on
622
00:37:23.659 --> 00:37:28.619
rural communities where prior to expansion of Medicaid, many rural
623
00:37:28.679 --> 00:37:31.179
hospitals were really in financial trouble.
624
00:37:31.199 --> 00:37:31.820
Many still are.
625
00:37:32.539 --> 00:37:35.400
But we've seen many of these facilities close. And Medicaid
626
00:37:35.440 --> 00:37:38.059
was a lifeline. Expansion of Medicaid was a lifeline to
627
00:37:38.099 --> 00:37:41.670
many of these facilities. to keep them open and also
628
00:37:41.690 --> 00:37:44.829
to keep many of those jobs at those health facilities
629
00:37:45.369 --> 00:37:50.329
still available. So those are some of the things that
630
00:37:50.349 --> 00:37:54.630
we could anticipate with respect to Medicare and Medicaid.
631
00:37:59.010 --> 00:38:02.659
So you know a lot and you have been all
632
00:38:03.719 --> 00:38:09.949
over the world, all over the U.S., You decided to
633
00:38:10.260 --> 00:38:15.840
take your experience in epidemiology, but you've really channeled it
634
00:38:15.960 --> 00:38:19.880
into sharing information in a way that is extraordinarily accessible.
635
00:38:19.920 --> 00:38:22.280
You and I met actually in the midst of the
636
00:38:22.320 --> 00:38:27.219
COVID pandemic and you invited me to be on a podcast,
637
00:38:27.739 --> 00:38:31.989
but it was such an important conversation because you're just
638
00:38:32.070 --> 00:38:37.250
a really fantastic communicator on really complicated issues. Was there
639
00:38:37.309 --> 00:38:40.969
an inciting incident for you that made you decide, I
640
00:38:41.010 --> 00:38:42.809
not only have to know what I know, I need
641
00:38:42.829 --> 00:38:44.440
other people to understand what I know?
642
00:38:45.019 --> 00:38:49.519
Yeah, so it was a process of years, really, to
643
00:38:49.579 --> 00:38:51.440
come to this point. But I think some of it
644
00:38:51.500 --> 00:38:54.269
was what I experienced working in Southern Africa. I started
645
00:38:54.289 --> 00:38:56.949
my career working in global health and tuberculosis and HIV.
646
00:38:57.730 --> 00:39:02.090
was often asked to moderate town hall meetings, meetings with
647
00:39:02.170 --> 00:39:07.739
patient advocates, informing policymakers, both overseas as well as on
648
00:39:07.780 --> 00:39:08.570
the Hill in the U.S.
649
00:39:09.760 --> 00:39:11.460
So that sort of planted the seed.
650
00:39:11.539 --> 00:39:15.539
But then I had pivoted from global health to domestic
651
00:39:15.599 --> 00:39:19.719
health around 2012, was an assistant commissioner of health at
652
00:39:19.760 --> 00:39:22.590
the New York City Department of Health. And we were
653
00:39:22.659 --> 00:39:26.440
dealing with massive cuts to public health funding in the
654
00:39:26.539 --> 00:39:30.360
aftermath of the 08-09 recession. And in year one on
655
00:39:30.400 --> 00:39:33.320
that job, I was tasked with having to cut essentially
656
00:39:33.320 --> 00:39:37.760
20% of my bureau of 250 people, so 50 people
657
00:39:37.880 --> 00:39:38.139
out of 250.
658
00:39:38.139 --> 00:39:40.239
That's huge.
659
00:39:40.260 --> 00:39:43.469
And what I realized coming out of that was we
660
00:39:43.489 --> 00:39:46.349
will not fund public health if people don't even understand
661
00:39:46.389 --> 00:39:46.829
what it is.
662
00:39:47.250 --> 00:39:48.699
People at least need to understand what it is.
663
00:39:48.730 --> 00:39:50.849
And then you can decide, is this something valuable or not?
664
00:39:51.289 --> 00:39:53.210
But I would argue that coming out of the pandemic,
665
00:39:53.269 --> 00:39:55.909
people still don't understand what public health is. They often
666
00:39:55.929 --> 00:39:59.880
confuse public health and health care. And so that's really
667
00:39:59.920 --> 00:40:03.280
what motivated me was I wanted people to be armed
668
00:40:03.300 --> 00:40:06.119
with the facts, to be informed citizens, and then to
669
00:40:06.159 --> 00:40:08.449
make decisions, you know, however they want to based on
670
00:40:08.489 --> 00:40:10.050
that information. Okay.
671
00:40:10.090 --> 00:40:14.000
So here's your platform. Tell people the difference between public
672
00:40:14.039 --> 00:40:17.469
health and health care and how they should describe it
673
00:40:17.570 --> 00:40:18.829
when they're sitting around the dinner table.
674
00:40:19.230 --> 00:40:19.849
Yeah.
675
00:40:20.230 --> 00:40:22.929
So health care is what people are more familiar with, right?
676
00:40:22.969 --> 00:40:25.929
It's what happens in the clinic, in the hospital. It
677
00:40:25.949 --> 00:40:28.579
is very individual patient focused.
678
00:40:29.260 --> 00:40:31.070
Public health is.
679
00:40:32.190 --> 00:40:36.039
largely funded by the government, which is in contrast to
680
00:40:36.360 --> 00:40:38.460
health care. Much of health care is in the private
681
00:40:38.500 --> 00:40:39.340
sector in this country.
682
00:40:39.389 --> 00:40:41.050
Not all of it. Medicare is a great example.
683
00:40:41.090 --> 00:40:43.449
Medicare, by the way, is socialized medicine, which people don't
684
00:40:43.469 --> 00:40:48.510
want to hear, but it is. So you have largely
685
00:40:48.610 --> 00:40:54.050
taxpayer money, some philanthropic foundation money, maybe some public-private partnership,
686
00:40:54.070 --> 00:40:57.210
but most of public health is taxpayer dollars. It is
687
00:40:57.570 --> 00:41:02.880
looking at health from a population, public, hence public health perspective.
688
00:41:03.420 --> 00:41:06.780
And so it's not decision-making for an individual patient. And
689
00:41:06.800 --> 00:41:09.519
I think this is one area where People got frustrated
690
00:41:09.599 --> 00:41:13.320
during the pandemic because you had these blanket recommendations for
691
00:41:13.760 --> 00:41:16.860
how do we reduce disease and death at the population level?
692
00:41:17.320 --> 00:41:19.190
And some people would say, yeah, but that's not me.
693
00:41:19.210 --> 00:41:23.949
And so they would not see themselves at being at risk,
694
00:41:23.989 --> 00:41:29.230
for example, and are not necessarily thinking about not just what, say,
695
00:41:29.289 --> 00:41:31.469
COVID infection means for them, but what it might mean
696
00:41:31.530 --> 00:41:33.750
for the people around them. And so those are just
697
00:41:33.849 --> 00:41:37.179
different ways of how do you weigh risk.
698
00:41:37.449 --> 00:41:39.150
And benefit of certain different things.
699
00:41:42.099 --> 00:41:44.480
Another way to think about public health is it's all
700
00:41:44.519 --> 00:41:46.960
the stuff that does not happen in a clinic or hospital.
701
00:41:47.610 --> 00:41:50.599
It's all the stuff like what's your air quality, your
702
00:41:50.659 --> 00:41:51.539
water quality?
703
00:41:52.280 --> 00:41:55.239
What is the safety of your neighborhood? Is it so
704
00:41:55.280 --> 00:41:57.400
violent you can't go out for a walk and exercise
705
00:41:57.440 --> 00:41:58.039
in your neighborhood?
706
00:41:58.099 --> 00:42:01.420
What is your access to healthy food? You know, those
707
00:42:01.460 --> 00:42:03.340
are the kinds of things we think about in public health.
708
00:42:03.389 --> 00:42:06.349
And that's not something you address with a prescription pad
709
00:42:06.389 --> 00:42:08.869
or a surgery. A lot of our levers in public
710
00:42:08.909 --> 00:42:12.570
health are really about policy and how do you shift
711
00:42:12.630 --> 00:42:13.829
the needle through policy.
712
00:42:15.449 --> 00:42:19.090
Which brings us to the doing section of this conversation.
713
00:42:20.090 --> 00:42:24.820
You have been such a thoughtful partner to powerful people.
714
00:42:25.300 --> 00:42:27.960
But as you pointed out, you've also been doing that
715
00:42:28.019 --> 00:42:33.559
work with local organizations, with town hall meetings, helping citizens
716
00:42:33.739 --> 00:42:39.519
understand their power. How do we as individuals push back
717
00:42:40.280 --> 00:42:42.690
and meet this moment? We know there has been a
718
00:42:42.869 --> 00:42:48.179
recent tragedy in where vigilante justice seemed like a solution
719
00:42:48.219 --> 00:42:51.789
to someone. But we know that that's not the answer.
720
00:42:52.030 --> 00:42:55.570
So how do we think about what else we can do?
721
00:42:55.929 --> 00:42:58.750
We know we talk about voting. And for some, that
722
00:42:58.789 --> 00:43:00.409
didn't seem to work this time. It does work. It
723
00:43:00.489 --> 00:43:02.110
just doesn't work all the time in the ways we
724
00:43:02.150 --> 00:43:04.929
want it to work. But how do we talk about
725
00:43:05.550 --> 00:43:09.309
starting at the local level, using public health as the
726
00:43:09.409 --> 00:43:12.710
point of entry? Give us our marching orders. What do
727
00:43:12.730 --> 00:43:12.889
we do?
728
00:43:14.929 --> 00:43:18.909
You know, with respect to the UnitedHealthcare CEO's assassination murder,
729
00:43:20.579 --> 00:43:24.389
I found that profoundly disturbing because it speaks to how
730
00:43:24.530 --> 00:43:30.210
disempowered even this highly educated, privileged young man, how disempowered
731
00:43:30.269 --> 00:43:34.250
he felt in fighting the issues with our healthcare system.
732
00:43:34.269 --> 00:43:37.789
And yes, our healthcare system is horrible. We spend more
733
00:43:37.869 --> 00:43:40.469
than any other country in the world. We have the
734
00:43:40.510 --> 00:43:44.449
worst outcomes of any high income country. And by the way,
735
00:43:44.670 --> 00:43:50.420
healthcare itself only predicts about 10% to 20%.
736
00:43:49.400 --> 00:43:52.440
Of life expectancy of people's health outcomes. And so a
737
00:43:52.559 --> 00:43:54.440
lot of what needs to be done to improve people's
738
00:43:54.460 --> 00:43:55.760
health is not in health care.
739
00:43:55.780 --> 00:43:59.309
Again, it's in public health. It's about 80%, 90% of
740
00:43:59.389 --> 00:44:03.429
the game is in public health. What really upset me
741
00:44:03.469 --> 00:44:08.570
about that incident was people are so disempowered that they
742
00:44:08.630 --> 00:44:12.469
feel like they have no choice but vigilante justice, but
743
00:44:12.550 --> 00:44:15.880
political violence. And that's a very scary place to be
744
00:44:15.989 --> 00:44:20.000
when people don't believe in voting, in government institutions, in
745
00:44:20.099 --> 00:44:23.980
meeting with their local officials. Yes, all of that takes time.
746
00:44:24.219 --> 00:44:27.219
It does take time to get informed, to understand the issues.
747
00:44:27.539 --> 00:44:29.559
to reach out to those people and to talk to them.
748
00:44:30.400 --> 00:44:32.300
But I think that is where we really need to
749
00:44:32.360 --> 00:44:35.489
be encouraging people to get involved is do those things.
750
00:44:39.090 --> 00:44:39.489
D.C.
751
00:44:39.530 --> 00:44:42.110
Might seem very far away. And again, a lot of
752
00:44:42.150 --> 00:44:45.170
the action is not in D.C. for these issues. It
753
00:44:45.269 --> 00:44:48.800
is in your state It's in your city. Get involved
754
00:44:48.840 --> 00:44:50.670
at that level. In New York City, for example, we
755
00:44:50.690 --> 00:44:52.530
have these community health boards, and I've met with a
756
00:44:52.550 --> 00:44:54.489
bunch of them over the last several years during the
757
00:44:54.530 --> 00:44:58.829
pandemic to educate them. These are concerned citizens who are
758
00:44:58.869 --> 00:45:00.679
really trying to do what they can to make their
759
00:45:00.739 --> 00:45:04.800
communities healthier. And yes, that Again, it takes time, it
760
00:45:04.840 --> 00:45:07.239
takes lots of people, but that's where you can have
761
00:45:07.280 --> 00:45:11.360
a very tangible impact. So that's really the level at
762
00:45:11.429 --> 00:45:14.550
which I would encourage people. The powers are there. These
763
00:45:14.610 --> 00:45:20.429
are really kitchen table concerns people have. Like it's what's happening,
764
00:45:20.869 --> 00:45:23.250
I don't know, with pollution near the school where your
765
00:45:23.269 --> 00:45:27.239
kids goes to school. It's what's happening with gun violence
766
00:45:27.280 --> 00:45:30.380
in your neighborhood. It's the opioid overdoses. You know, your neighbors,
767
00:45:30.539 --> 00:45:33.539
you're talking about so-and-so lost their son. These are things
768
00:45:33.559 --> 00:45:37.159
that are very tangible to people where you can get involved.
769
00:45:37.539 --> 00:45:39.599
And it doesn't have to be a partisan thing.
770
00:45:40.260 --> 00:45:43.030
Dr. Celine Gounder, thank you so much for joining us
771
00:45:43.090 --> 00:45:51.639
here and informing us here at Assembly Required. At Assembly Required,
772
00:45:51.880 --> 00:45:55.820
we encourage the audience to be curious, solve problems, and
773
00:45:55.840 --> 00:45:59.699
do good through a segment we call Our Toolkit. Now,
774
00:46:00.219 --> 00:46:03.119
we're going to fight the allergy to science and information
775
00:46:03.400 --> 00:46:07.039
by being curious. During my time in the Georgia State Legislature,
776
00:46:07.659 --> 00:46:11.539
I relied heavily on KFF News, and it's still my go-to.
777
00:46:12.340 --> 00:46:15.579
KFF News is an independent source with news and health
778
00:46:15.599 --> 00:46:19.360
policy research, so sign up for their newsletters at KFF.org.
779
00:46:21.889 --> 00:46:24.269
For regular listeners, you're going to notice that today I'm
780
00:46:24.309 --> 00:46:27.849
doing things a little differently. You see, we've gotten quite
781
00:46:27.909 --> 00:46:31.550
a few listener questions that have a running theme. First,
782
00:46:32.380 --> 00:46:35.000
Ed Bogue wrote an email titled How to Be an
783
00:46:35.159 --> 00:46:39.980
Activist with Social Anxiety. He writes, Since the election, I
784
00:46:40.280 --> 00:46:43.619
have felt energized to help defend human rights, but severe
785
00:46:43.679 --> 00:46:47.289
social anxiety has been a major barrier for me. Even
786
00:46:47.309 --> 00:46:50.309
when it's just low-stakes small talk, My throat gets so
787
00:46:50.369 --> 00:46:53.449
dry that I can barely speak, and years of customer
788
00:46:53.469 --> 00:46:56.739
service work hasn't helped me overcome this. How do I
789
00:46:56.780 --> 00:46:59.400
get involved and make a difference when so much of
790
00:46:59.420 --> 00:47:05.219
the work is about connecting people? Number two, Muyan Chen
791
00:47:05.659 --> 00:47:09.219
wrote about wanting to be politically engaged even though she
792
00:47:09.260 --> 00:47:12.340
just has a green card. I came to the U.S.
793
00:47:12.360 --> 00:47:15.190
from China more than 10 years ago and now work
794
00:47:15.250 --> 00:47:18.929
as a researcher in a national lab. Being a foreign national,
795
00:47:19.389 --> 00:47:22.269
with a green card now. It's been quite stressful to
796
00:47:22.349 --> 00:47:25.349
watch the events unfolding, but it seems difficult to do
797
00:47:25.489 --> 00:47:28.889
anything about it legally. I'm wondering if there are anything
798
00:47:29.289 --> 00:47:33.590
such as volunteer opportunities that I can contribute to. And
799
00:47:33.630 --> 00:47:36.800
number three, a caller whose name I didn't quite catch
800
00:47:37.570 --> 00:47:40.599
called in and left a voicemail responding to the Heather
801
00:47:40.619 --> 00:47:44.920
Cox Richardson episode. She writes, I've been getting myself and
802
00:47:45.119 --> 00:47:48.659
my small online community to call our representative every day
803
00:47:48.780 --> 00:47:51.320
and leave messages with them, as well as an email.
804
00:47:52.280 --> 00:47:54.679
Just kind of letting them know, you know, what we
805
00:47:54.739 --> 00:47:57.000
think and what we need from them. And so I'm
806
00:47:57.019 --> 00:48:00.039
just wondering, are there specific folks we could be calling
807
00:48:00.059 --> 00:48:02.460
and writing? I like the idea of a bunch of
808
00:48:02.519 --> 00:48:06.199
us doing this kind of small thing together. We've been
809
00:48:06.239 --> 00:48:09.300
calling individual members that we can, also writing and calling
810
00:48:09.340 --> 00:48:12.860
our senators about Trump's nominations to his cabinet, but just
811
00:48:12.880 --> 00:48:17.050
looking for any other ideas for folks to call. Now, normally,
812
00:48:17.090 --> 00:48:19.090
this is where I'd either answer your questions or give
813
00:48:19.139 --> 00:48:22.039
you resources on what to do about what we just discussed,
814
00:48:22.219 --> 00:48:25.199
like public health. But today, we're going to begin a
815
00:48:25.440 --> 00:48:30.420
capsule course. In grassroots organizing, Ed's social anxiety means we
816
00:48:30.460 --> 00:48:32.519
just find a different way for him to contribute to
817
00:48:32.539 --> 00:48:38.010
the cause, like setting up agendas or coordinating resources. For Muyan,
818
00:48:38.469 --> 00:48:42.309
her expertise can be a major asset in finding information
819
00:48:42.670 --> 00:48:46.860
and developing communication systems. And for our phone warrior... you're
820
00:48:46.889 --> 00:48:50.219
in the midst of convening advocates to push our agenda
821
00:48:50.380 --> 00:48:54.420
for good. Because here at Assembly Required, we know we
822
00:48:54.440 --> 00:48:59.000
can start solving problems by showing up and taking action.
823
00:48:59.980 --> 00:49:02.400
Over the next several episodes, we're going to use this
824
00:49:02.460 --> 00:49:05.860
segment to talk about concrete steps that we can take
825
00:49:05.940 --> 00:49:11.139
towards insisting that political leaders do their jobs. Federal action
826
00:49:11.530 --> 00:49:15.760
will obviously matter, and absolutely it's important. But what I
827
00:49:15.820 --> 00:49:18.829
hope you've heard over these many episodes is that we're
828
00:49:18.889 --> 00:49:23.349
here to win. However, winning won't be fast, and it
829
00:49:23.389 --> 00:49:26.469
will require many of us across the country to take
830
00:49:26.570 --> 00:49:30.139
on different parts of the problem and combine our successes.
831
00:49:31.159 --> 00:49:34.079
And that means often working at the local level so
832
00:49:34.099 --> 00:49:37.000
we can one day have federal impact. This is not
833
00:49:37.059 --> 00:49:40.400
in lieu of federal action. It's in addition to. Let's
834
00:49:40.420 --> 00:49:44.340
get started. Our first step is identifying the issue that
835
00:49:44.420 --> 00:49:47.860
matters to you most. Is it your state's refusal to
836
00:49:47.900 --> 00:49:51.739
expand Medicaid, book bans in your local school district, a
837
00:49:51.840 --> 00:49:55.059
food desert that seems to be growing? Do you need
838
00:49:55.099 --> 00:49:59.260
to launch a tenant's union? Pick one as your tester pancake,
839
00:49:59.820 --> 00:50:02.670
the issue that you want to start with. So over
840
00:50:02.690 --> 00:50:06.150
the holidays, your task is to decide on the issue
841
00:50:06.329 --> 00:50:10.710
you want to tackle. Be as specific as possible about
842
00:50:10.730 --> 00:50:14.469
the problem. And also, be as local as you can
843
00:50:14.610 --> 00:50:17.670
with the solution. If the city council can solve it,
844
00:50:18.280 --> 00:50:22.739
start there. If it's the county commission, know it. Does
845
00:50:22.820 --> 00:50:27.500
the state have jurisdiction? If so, that's your target. Take
846
00:50:27.559 --> 00:50:30.420
the time to know who's in charge and who can
847
00:50:30.440 --> 00:50:33.570
make the change you want to see. This is called
848
00:50:33.730 --> 00:50:36.730
power mapping. So find out as much as you can
849
00:50:36.789 --> 00:50:41.099
about the issue... who's responsible, and who else is already
850
00:50:41.139 --> 00:50:44.679
working on it. Check social media and Google to see
851
00:50:44.719 --> 00:50:47.309
if anyone else is talking about this issue. Write it
852
00:50:47.429 --> 00:50:49.929
all down, and let's get ready to go to work.
853
00:50:51.849 --> 00:50:54.710
As we close, I want to share one last listener comment,
854
00:50:55.130 --> 00:50:58.250
and this is from Emily Drake. She writes, I wanted
855
00:50:58.289 --> 00:51:01.079
to thank you, first of all, for answering my question
856
00:51:01.119 --> 00:51:04.659
a few weeks ago. After hearing your answer and listening
857
00:51:04.699 --> 00:51:08.199
to this week's episode about the education system, I have
858
00:51:08.239 --> 00:51:11.400
decided to go back to teaching public school and to
859
00:51:11.480 --> 00:51:14.829
get involved as much as possible. I taught public school
860
00:51:14.869 --> 00:51:17.269
for seven years and I've had a few years off
861
00:51:17.630 --> 00:51:19.670
staying home with my kids. But I think it's a
862
00:51:19.730 --> 00:51:22.650
good time to go back and use my skills for good.
863
00:51:23.150 --> 00:51:26.889
So thank you. I appreciate all you do. Well, thank you, Emily,
864
00:51:26.949 --> 00:51:29.829
for sharing and for telling me how you're getting to work.
865
00:51:30.550 --> 00:51:31.989
And if any of you want to tell us what
866
00:51:32.050 --> 00:51:35.110
you've learned, how you've solved a problem, or how you've
867
00:51:35.190 --> 00:51:39.699
rejoined the fight, send us an email at assemblyrequired at crooked.com
868
00:51:40.099 --> 00:51:43.280
or leave us a voicemail. Your questions and comments might
869
00:51:43.320 --> 00:51:51.440
be featured on the pod. Our number is 213-293-9509. I
870
00:51:51.480 --> 00:51:54.900
wanted to say thank you. Thank you for listening. Thank
871
00:51:54.920 --> 00:51:57.559
you for engaging. Thank you for letting us know that
872
00:51:57.599 --> 00:52:00.750
we're coming together and we're getting to work. That wraps
873
00:52:00.809 --> 00:52:03.730
up this episode of Assembly Required with Stacey Abrams. I'll
874
00:52:03.750 --> 00:52:11.199
meet you here next week. Assembly Required with Stacey Abrams
875
00:52:11.500 --> 00:52:14.820
is a Crooked Media production. Our lead show producer is
876
00:52:14.860 --> 00:52:19.000
Alona Minkowski, and our associate producer is Paulina Velasco. Kirill
877
00:52:19.039 --> 00:52:22.920
Poloviev is our video producer. This episode was recorded and
878
00:52:22.960 --> 00:52:26.840
mixed by Evan Sutton. Our theme song is by Vasilis Fotopoulos.
879
00:52:27.119 --> 00:52:31.170
Thank you to Matt DeGroat, Kyle Seglin, Tyler Boozer, and
880
00:52:31.269 --> 00:52:35.849
Samantha Schlossberg for production support. Our executive producers are Katie Long,
881
00:52:36.289 --> 00:52:38.610
Madeline Herringer, and me, Stacey Abrams.