Bulwark Takes - Inside Trump’s Bizarre Healthcare Call

Episode Date: July 24, 2025

Jonathan Cohn is joined by Dr. Zeke Emanuel to discuss the future of American healthcare. As Trump’s past and current efforts to dismantle Medicaid and the ACA continues to be a disaster, Dr. Emanuel has proposals for a more efficient, universal system. They also touch on medical research funding, the role of states, and the geopolitical risks of falling behind countries like China when it comes to healthcare.

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If you have questions or concerns about gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. Ben MGM operates pursuant to an operating agreement with iGaming Ontario. Hello, everyone. It's Jonathan Cohn at The Bullwork. We're going to talk about healthcare today, a whole range of topics. We're going to talk about Medicaid and Obamacare, what Trump's doing to them, what we should be doing instead. We're going to talk about medical research, higher education, what Trump's doing to them and what we should be doing instead. We're gonna talk about medical research, higher education, what Trump's doing to them

and what we should be doing instead. Our guest today is Zeke Emanuel, uniquely positioned to address all of these topics. He is an oncologist, he is a bioethicist, he has run a division at the National Institutes of Health, he has worked at the White House. He is currently a professor and vice provost at the University of Pennsylvania.

He is a prolific writer, author, and or editor of 15 different books, apparently, with two more coming down the pike, which we'll talk about in a minute. Zeke, I am so happy that you are here. I got to ask you, with all that list, do you ever sleep? Oh, plenty. Sleep is very important. Seven

to eight hours a day. I don't get up in the night worrying. Okay. Okay. Well, well, there you go. There you go. Well, I'm really glad you're here. We've known each other a really long time. One of the things I appreciate about you is, you know, your politics are not a secret. You know, you're a liberal, you're a Democrat, you work in the Obama administration, but you call them like you see them. You're not afraid to call bullshit on your own side. I think sometimes you like to call bullshit on your own side.

You'll also work with anybody. You don't, you know, it's someone who has a different set of views. It's a political adversary. You are all about getting shit done, finding solutions, which brings me to one of my favorite Zika manual stories, highly relevant to our discussion today. And just to set the scene, and I think, you know, you'll pick up quickly where I'm going

with this one. It's late 2016, it's early 2017, Donald Trump has just been elected. He, day one, he and congressional leaders are saying we're going to repeal the Affordable Care Act. There's all this talk about in the air. You get a phone call and just tell our listeners, who's the call from, where are you and what do you do? Well, I have to back up a little before that telephone call

to explain why I got a telephone call and put it in context. Some people may know that one of my brothers is an agent. And way back when he was an agent for Donald Trump, and he maintained communication with Trump. And when Trump got elected in 2016 the first time, he called Trump, or they were talking. I don't think he actually called.

And he said, you know, if you're going to do something on healthcare, you got to consult with my brother Zeke. He told me that he did this and I was like, yeah, I'm not getting a call. It's like no chance because as you point out, I am pretty well known for certain political views. Plus, I worked in the Obama White House and I had a role in the Affordable Care Act enactment.

But then I commute between Washington and Philadelphia and I was on a train and my phone rings and at the top it says unknown. And that usually means one of two things. It's a reporter or it's the White House. I don't know that I get unknown from any other group. And so I pick it up. I usually ride in the quiet car, even though I'm pretty loud,

just so I can concentrate. And the voice on the phone says, so I leave the car, the voice on the phone says, this is Donald Trump's office. The president-elect would like to speak with you. And I'm like, you've got to be kidding me. The only place if anyone's a regular rider of the Amtrak, the only place you can get a modicum of quiet to hold a very high level discussion with the president-elect is the toilet. So I go into the toilet, lock the door,

and proceed to have a conversation with the president-elect. I've been in those Amtrak toilets. I don't know how you did that. Very loud, not the easiest bit of a conversation. But you did, and you went to then went to Trump Tower to have a kind of conversation. He said, well, we started talking. And I said, well, there are a lot of things you could do on healthcare that would be quite positive. And I mentioned cutting drug costs because I knew

he was interested in that. And that would probably be a priority of his. And he said, well, when we get sworn in and we start the new administration, we'll have you down. And I said, well, Mr. President, I'm just a little worried the congressional Republicans will be sworn in about three weeks before you get sworn in and they vow to repeal Obamacare and they might hamstring and ham cuff you before you even take the oath of office, we should probably meet earlier. And he said, okay, I'll have my office call you and we'll arrange something. And in fact, he did arrange,

and I was down there in early to mid December, and the major purpose of that meeting, as far as I was concerned, were two. One was to get him to say there was going to be no repeal without a replacement plan and to forestall immediate repeal by the Republicans, and Paul Ryan without there being a replacement plan. Because they didn't have a replacement plan,

they still don't have a replacement plan, they still don't have a replacement plan. And so I suggested that that alone would slow the train. And for anyone who studied politics, slowing the train allows the opposition to coalesce. Lyndon Johnson always said, speed was the most important thing in getting legislation done. The second goal was to try to get him off this repeal

and replace agenda and again, emphasize that he should look at drug pricing because, and I put this to him in the meeting, he said, listen, President Obama couldn't get that. You would be better appealing to the ego. You would achieve something the Democrats and Obama couldn't achieve and that the American public desperately wants. And then the conversation veered into lots of other things. He brought Price, who was his designee for HHS on the line. We talked about vaccines and whether they cause autism and a few other. Wait, I didn't know that part. So was he on the vaccine autism thing? That's interesting. Oh, way back when he before RF well well before he had any relationship with RFK, he was on the vaccine and autism side. I know that literature pretty well. I know all the

details of the Lance famous Lancet article that caused a controversy. And I explained to him that that was not true. And I argued why the paper and the hypothesis is wrong. And he sort of ended that phase of the conversation with this, not quite dismissing, but say, well, you know, basically I'm not convinced. And I still think that there's a relationship here. So I didn't succeed in persuading him. I did not know that. I did not know that. Well, just to zip ahead, because I want to

get to where we are today. You know, you had that conversation. You tried to derail me. Didn't really you went back to the White House later, actually have a picture of that, which we'll put up for years. That's that's how meaning at the White House after they started doing repeal you're there Mike Pence the vice president is there you Paul Ryan actually president Trump back there. You were not able to get him off repeal He ends up trying we all know what happened. They try it fails John McCain does his big, you know thumbs down Here we are eight years later and they have passed a big healthcare, but this time they took the speed advice, or they learned that lesson for sure,

and they moved lightning quick. Now, I always, whenever we start talking about this, I try to point out to our listeners, to our readers, they did not repeal the Affordable Care Act, the architecture is still there, the basic formula of Medicaid is still there, but these are significant cuts. A trillion dollars almost out of Medicaid, more money out of Medicaid is still there, but these are significant cuts. A trillion dollars almost out of Medicaid, more money out of the Affordable Care Act.

Plus potentially we'll see what happens with these extra subsidies that are up for renewal. Those might very well go away. When you talk to the Republicans, when I talk to the Republicans who voted for this, who said they were going to do this, they said, it's okay. We're just getting rid of waste. We're just getting rid of waste. We're just getting rid of fraud and abuse. The only people who are gonna lose their coverage are people who shouldn't be eligible,

it'll be documented immigrants, people who were there for some kind of enrollment error, or people who should be working and are an able-bodied adults. And everyone's gonna be fine. You tell me, you've been in the middle of this. Do adults and everyone's gonna be fine. You tell me, you've been in the middle of this, do you think everyone's gonna be fine? Oh, there's no chance.

And we know that there's no chance because you already have people who voted for this with buyer's remorse and talking about, well, we're gonna prevent this from really going into effect because they realize it's going to devastate their states. So why is it a false narrative? First of all, there have been lots of research by independent organizations that there's

nowhere near $200 billion a year, $100 billion a year, what pick your number of fraud and abuse in the Medicaid system. Second of all, most of that well north of 80 to 90% of that quote fraud that there is actually in the system is performed by providers and insurers, not by the innocent enrollees. There may be some there, but most of that is a result of the complication of the system, complication of knowing whether you're eligible or not. I don't know if anyone listening or watching this has actually gone to a website for Medicaid and tried to fill or look at the forms and fill them out. The Texas one, I just recently looked at it,

is around 20 pages. It asks all sorts of totally crazy, ridiculous things. Like, do you have a trust? What kind of trust is it? Do you own land that has mineral rights on it? What kind of, and- Well, there's a lot of oil executives trying to get on Medicaid, right?

I mean, it's like, um, who are you trying to catch here exactly? And there's literally 20 pages of this where Texas knows full well what someone's income is And they can check with the IRS and they don't need any of this information from an individual This is all about dissuading them from getting and applying and going through with the process, creating hurdles for it. So that's the first thing. Second thing is, we know that if you're trying to fill this out, a lot of times what happens is you don't have the paperwork right. I don't know how many of your listeners have ever tried to fill out a complex form, send it in,

and then someone says, oh no, I just had that situation with the bank. And I got, you know, two advanced degrees, uh, from pretty prestigious places. It's a lot of complications to get all that paperwork. And by the way, the Medicaid, at least in Texas requires six months of pay stubs. Just imagine assembling that. Six months of pay stubs. Yeah. Six months of pay stubs.

So one of the problems is a lot of the people they catch, it's not fraud, it's paperwork nonsense. And that needs to be distinguished from fraud. Second, the able-bodied adults who aren't working, who are on Medicaid without the usual exemptions, recent pregnancy, disabilities, taking care of children, that turns out to be less than 5%. And you aren't getting 11, 12 million people who are going to lose coverage. That is well more than 5% of Medicaid throughout the country.

So you put all of this together, this is not fraud and abuse. This is going to, people are going to be dismissed from coverage who are eligible and otherwise eligible and you know this is a case of well the federal government's not doing that is true it will be the states that will in the end have to decide oh do we pick up the you know reduced payments that the federal government's making us and make the whole the System whole or do we end up having to cut because we don't have enough matching grants We don't have enough resources ourselves to cover tens of billions of dollars. And so yes people will lose coverage There is no doubt about it. So a couple weeks ago

You wrote for us a really interesting article. I mean, this idea that, you know, the I think Democrats, not just Democrats, a lot of people who aren't Democrats agree these Medicaid cuts are bad, they'd like to see them, they don't want to see them take place. What you wrote that I thought was so interesting was you said it's not enough, just to push back not enough just to undo the cuts, we should be thinking constructively about how to make this system better.

There's a political question about when is the right time to present that and how you present that, but let's put that aside. Kind of sketch out briefly your kind of vision for what you'd like to do instead. Well, I think, again, this goes back in history to Medicaid's founding. It was never an optimal program. I don't think any health policy expert, even when it was passed, thought it

was well designed. It was modeled on something that Wilbur Mills created in 1960 as a compromise. And it called elder care. It was where the federal government gave states that the Mills Care Act was that what I can remember. It was where the federal government gave state the mills care act was that what I can't remember. And it's blank. It's an elder care. So the basic, at that time, the Congress was considering a democratic version

of Medicare and a Republican version of covering the elderly with a voluntary purchase into insurance with subsidies from the government sound familiar. And they rejected both the democratic version of using social security and the Republican version of using these subsidies to buy insurance. And they wanted to do something, or Wilbur Mills, who was chairman

of the powerful Ways and Means Committee, wanted to do something. So he created this program of grants to states to cover, to create their own voluntary systems to cover elderly in some way with very few requirements. About three years later, it was evaluated, I think 1963 or early 1964, and it was deemed a total failure. Not very many elderly got covered. It was pretty much states didn't take it up and when they did it was pretty much a waste. But it became the model, this

sort of a state federal government partnership, money coming from the federal government matched by the states, cover people who were unemployed or couldn't, pregnant women. And it's a problem because it's run at the state. So in the US you have 56 different programs. They don't talk to each other. They have different eligibility rules. Just to give you one example, in that world, in Arkansas, you aren't covered if you're an able-bodied

adult making only 17% of the federal poverty line. On the other hand, in Minnesota, you're covered if you're making 15 times more than that, just incoherent policies. And so my view is, you know, we should not build back, you know, oppose the Medicare cuts and the Medicaid cuts and let's get Medicaid back. No As responsible government officials, I think our policymakers. I think we should think well, what's the kind of system we really want and let's begin to design that because four years of this

Medicaid arrangement under Trump it's's gonna destroy the system. And we are gonna have an opportunity to rethink the basic structure and we should use that opportunity. That doesn't mean we want the cuts to happen and people suffer and people literally die because of it. But I think that's gonna happen inevitably and what we can do is to reimagine.

So here's my reimagining. What right now, even with the best arrangement, all we've gotten in the United States is to 8% uninsured. That means 30 million people roughly are uninsured in the United States. That is not universal coverage. Every other high income country in the world gets universal coverage.

We have to create an arrangement for Medicaid that gets us to universal coverage. The second thing is we've got to end this sort of fragmentation, too many different ways of getting coverage. So my proposal is, let's put three groups together. People eligible for Medicaid, people going into the exchange, and all the people who are uninsured. That creates actually a pool of about 120 million Americans.

150 million roughly Americans get insurance through their employer, and then you've got roughly 60 million Americans getting Medicare. That single pool, very big, it allows you to do automatic enrollment. Since almost all Medicaid in the country is through Medicaid managed care organizations, let's have an exchange, one exchange across the country, obviously that's provided individually, and people get limited choice. There are six plans, you can choose from six plans.

This large number of choices, 44 different plans just makes it confusing and hard for people. And among those plans are some local plans. It can all be these big nationals like United or Humana or Centene. And then let people choose and they get subsidies in proportion to their income. And we reduce the administrative costs in two ways. One is we standardize things like benefits, we standardize copays and deductibles, we standardize the billing process, we standardize the quality metrics,

we standardize the eligibility. That creates a much more uniformity and the comparison is based upon network and quality. The last thing I say, and this is a really important point, little complicated, but we now, most of us who get coverage through our employer and people in Medicare and people even in Medicaid, get coverage, have to pick annual re-enrollment. Now, I don't know what's sacred about annual, but it creates lots of problems.

So my suggestion is we don't have annual re-enrollment. You enroll in a plan and it stretches for five years. Now, obviously, if you have a change of circumstance, you get married, you move, or you have a new child, you can change your plan. But for most of us, they're into that plan for five years. There's a huge advantage to that.

Because if you're an insurer, now I'm responsible for that person for five years. Suddenly I take seriously things like prevention. It's much better. In five years, there's a chance this person might have a disease that I could have treated better like hypertension or like diabetes, and I can treat them and forestall additional costs.

That will in the end be better for me. The incentive to invest in prevention or management of chronic illnesses well is reduced if every year someone's moving out of the system. Right now, 18% to 20% of people move in and out of Medicaid every year. Same thing in the exchanges. It's actually more in the exchange. I think it's like 26%. Same thing in private employer-sponsored insurance.

If you actually create five-year contracts, you reduce what's called the churn, people going in and out into different programs. And you change the financial incentives for insurers to actually take prevention seriously, to take managing chronic illnesses seriously. You have more of a healthcare system, less of a sick care system, which Americans want. So I think, you know, it's interesting. So just to, I mean, there's a lot there. So we could, I would love to, I would spend hours on this maybe someday we will, you know,

but just the idea, I think two pieces there that are so important, the idea of standardization that like people, you know, there's this idea that more choice is always better. I think that is not true. And in fact, the best versions of Obamacare I've seen are like in California where they've done a lot of that. Right? I mean, you don't, you know, the packages are all pretty similar. You can actually compare what you're getting with the insurance. There's not 10, you know, bazillion different options. And that, you know, cutting down the churn from a healthcare standpoint is so important, continuity, et cetera. So, okay, let's stipulate that. Let's take this from the standpoint

of someone who agrees with you, philosophically wants to get the universal coverage. So obviously there are people who don't agree with the universal coverage, they don't, you know, whatever, let's totally respectable of you, but we're not gonna talk about them for right now. Just the people who are on this side wanna get to universal coverage,

look at your plan and say, well, okay, that's an awful lot of surgery to do there. If we're going to do that much surgery, why are we stopping with, you know, having all these different plans and why not just put all these people into one giant public plan? Why are you doing all these insurance? I mean, you're already you're breaking some eggs here now. So why not break a few more and get us to something that's really, in their view, a better system?

Well, I don't know that there's evidence that sort of Medicare for all version is a better system? Well, I don't know that there's evidence that sort of Medicare for all version is a better system. And there's no, I'm going to make this controversial statement, I think it's 100% true, but I could be wrong. And maybe some smart person listening may come up with things that there's no system that covers something as complicated as healthcare, that is one system for 330 million people, which makes it very complicated to do. That's the first thing.

The second thing is if you have everyone in one Medicare system, just imagine how difficult it is gonna be to do things like change payment to physicians where all their money depends upon one system. You will see fighting like you've never seen. Third point, we know from lots of data, as much as Americans hate the health insurance system, they actually like their particular insurance. Just remember the Harry and Louise ads from 1993,

created by Chip Khan. Health Insurance Association of America. Right. Exactly. Americans hated their insurance company back then too, according to polls, and he made health insurance companies look lovable and made America fear the alternative. Didn't know that was possible.

Right. Right. I think we're not gonna get, and by the way, if you really did take on the insurance companies, you have to remember people like United and others are very, very big, powerful, and would spend a lot of money trying to defeat this. I think, and the last thing I would say is, I do think, you know, people read the Medicare

Advantage data differently. I read the data as saying, look, managing, when you have a capitated amount, you get a set amount for patients, you do manage ever so slightly better. And that makes a difference for importantly, things like chronic illness, because you have one group of point people. So I actually think there's, and I think there is an advantage to competition, limited competition, regulated, reducing the trickery, reducing the multiple prices, reducing the gaming. And by the way, this idea, as far fetch as it might sound, you know, it's more or less modeled on the Dutch system,

the German system and the system in Switzerland where they have all the money goes through a payer, but they have multiple completing, they call them sickness funds for enrollment and those sickness funds have to manage to a budget. Want to have like a long discussion about sort of virtues of different public and private discussions, although probably pretty close to where you are on this. But let me take it from the other side. And someone looking at this saying,

well, that plan of yours sounds really interesting and kind of, yeah, it would be more efficient, it'd be simpler, but wow, you're still changing a lot. And if we've learned one lesson over the years is that making major structural changes in healthcare is really hard. The ACA, the whole thing was designed to avoid those ads that killed the Clinton healthcare

plan back in the 90s. And that's why you built on this crazy system without disrupting too much. You're talking, I mean, I know we're leaving employer insurance alone here, you're leaving Medicare alone, but you're still disrupting a lot. And disruption is scary to people and it's easy to demagogue and why should Democrats, you know I mean, that's a lot of political vulnerability to take on When maybe you know, it's just easier just to kind of undo the cuts I mean why make this so complicated? I would say two or three things. The first is

For the first time ever if you look at Gallup polling you have a majority of Americans who say that the healthcare system has major problems or is in a state of crisis. I think the pressure is going to build over the next number of years for this major reform. It's not going to lessen. The reason I think that is you've got projected increase of costs. I mean, people are already talking about double digit increases of costs in the exchanges. Employers are looking, if not high single digits, if not double digit increases in costs. So costs are going to increase putting pressure on.

There's multiple other things that are going to put additional pressure and make the public as well as the providers dissatisfied. There's providers, hospitals and doctors are going to have to be more free care and uncompensated care because people are going to be uninsured and can't afford it. Deductibles are likely to go up in response to the increase in costs as employers basically are going to put more on people. And I think you also having a sort of fed up-ness with just the run around and the amount of time and mental energy it takes any time you have to use the healthcare system. So I think actually the pressure for bigger change is going to increase, not decrease. And the further Congress kicks this down the road, I think, tells me the more upset people are going to be, not the less upset with

how the system is operating. I mean, the crazy thing is now, 15 years after the Affordable Care Act has been passed, you have people who have health insurance, even pretty decent health insurance, worrying about can they afford the co-pays of deductibles and going to the doctor and putting it off. That is a, you don't have insurance anymore if that's what you, the situation you've got.

And to the extent that that that increases or I can't afford my drugs because the co-pays are too high, you're going to just have more pressure to make more major reform. I think one of the things you're getting at, Jonathan, is an important point which is going through the usual legislative process is probably not the way something like this is going to happen. Oh, interesting. Okay. So what is the way to do this? Well, I just don't see Congress getting the sort of feeling isn't there for thinking, working together,

and we're not going to likely have either party getting to 60 votes in the Senate. So I think we need to think about alternative approaches to getting this kind of level of reform. And by the way, I don't know. Do you just, I want to nail, I want to get, so do you mean like go through reconciliation? Do you mean like get rid of the filibuster? Or do you mean like go through reconciliation? Do you mean like ever to the filibuster? You do mean by? Actually, I think you know Simpson bowls is the kind of thing I have in mind with some Some other things now, I don't know how many of your listeners Even know who Simpson is. This is a commission a bipartisan commission that had a kind of buying. Yeah, right, to like, this was on deficit and fiscal policy. And it was to come up with a plan. And then

Congress would basically vote up or down the plan. And it was with Ellen Simpson was a former senator from Wyoming who people on both sides of the aisle trusted. Bowles was a Democrat from North Carolina. It was bipartisan. Yeah. Yeah. They came up, they were working out of the spotlight to come up with a program away from lobbying. I think there are a number of requirements you would have to have. Lock these people on a desert Air Force base,

take their cell phones away and a few other things not necessary to make it happen. You laugh, but just think about times when that kind of approach has actually been used in American history. And I would identify two times that- Okay, I want to hear these two times. What are these two times?

Jonathan, your American history needs constitutional convention. They were on a- True, true. Sweltering summer from May to September in Philadelphia. And they nailed the windows shut of Independence Hall to hash out the Constitution.

And there were no leaks to the press. The press kept on it. Now, that's the equivalent of taking cell phones away, right? Sorry, guys, you're going to work, and we're going to put you in the desert just so you get to feel what those founding fathers felt, right? That's not the only time. In the creation of the Federal Reserve,

Senator Aldrich from Rhode Island, who was head of the banking committee, took eight experts off to a much more luxurious Jezebel Island. They cleared out the whole island. I think it's an island off Georgia, if I'm not mistaken. Very highfalutin place to go hunting and other stuff. And he took them to work. And again, they were supposed to go there undercover. The press did get wind of it, but they were isolated because they were on this island,

no telephones, no nothing. And they were working without the pressure of various lobbyists and interest groups, et cetera. I think we need to think about something like that. And we've done similar things in other high stakes areas. And I think that's the kind of way we need to begin to think of big national projects where I think it's really just too much for Congress. And also the pressures of politics, interest groups, money, all that stuff, it doesn't do the national interest.

And I think it might be something Congress would actually like to say, yeah, we'll listen to this bipartisan commission of a gus, 25 people who really know about the system and can weigh what to do. Well, I think we've certainly seen evidence that Congress doesn't like to actually make decisions these days. So we got that going for us. I promised people we'd get to medical research.

So I don't want to, I don't want to disappoint you. You're steeped in the world of medical research. Give me a kind of lay of the land. How much damage, I mean, we've got these cuts to NIH, to NSF, I mean, as you go down the list, how much damage is being done and how much of it can be undone? Well, you have a interesting series of things happening where institutions are making a whole lot of cuts already. I know at Penn, we've reduced the number of graduate students in the basic biological sciences arrangement at the med school

from 150 a year to 100. We are recognizing we're going to have austerity looking for alternative sources of payment and financing for basic research. Let's be honest, the only thing that has those billions of dollars is really drug companies and drug companies with changes at the FDA. It's a problem for them because they rely on basic science to help them develop potential molecules and targets. Now to fund that basic science is, you know, there's all sorts of incentives against them doing it unless it's something very, very specific where they can own the intellectual

property that comes out of it. You see Duke changing its arrangement with faculty. If you don't have external grants, we're cutting your salary kind of arrangements, basically, untenuring tenured faculty, not so much taking the tenure away, but taking their salary and decreasing it. So you're seeing a lot of cutbacks, and you've seen whole sections of the NIH go. So it's a serious problem. And the craziness, this is the thing, there's no strategy,

well there is a strategy here, but there's no strategy that has the national interest at heart. This is biomedical research is the the area the United States is clearly recognized as the world's leading leader in. Now, can NIH funding be improved and fixed, and are there problems with it? Absolutely. I'm the first to say it. I worked at the NIH for 14 years.

I think I loved my time there. I worked outside the NIH at academic centers. I think there are many things we can do to improve the funding, one of which I would love to see is shifting more grants to younger people and giving them sustained seven-year funding to prove themselves, yay or or nay and get tenure or not tenure. I think that would be a really, really positive move, reducing the time of training so people don't have three, four, five postdocs so that they can have one postdoc and no more. So there are a number of positives.

I do like the idea that they have actually said that the number of grants anyone can submit in a year is limited to six. I might even go down from that. So there are some things here that are good, but in the end, this is going to be quite negative, especially when you're reducing the total budget. And the Chinese have ramped up since COVID tremendously on their research. We know this because we can see the number of biomedical, the number of drug companies that are going to

Chinese company and licensing their technology that they're really making great strides. To hobble ourselves to the moment the Chinese are rising seems like a very bad geopolitical approach to the development of biomedical technologies. Yeah, that's one of the nuttiest parts of this to me is you look at medical research, basic science, same thing also in alternative energy, electric vehicles, all of that. We are just cutting the legs out, our own legs out from, I'm mangling the analogy here, but we are killing our own innovation. We are killing, which is a source of jobs and what our great strength as a country. And we're handing all of this to the Chinese and other

countries, but especially Chinese who are doubling down on these investments. And the crazy part is, it's all being done in the name of Of a crusade to make America great again and beat the Chinese. I mean, it's like it's it's mind-boggling Just well, I don't know. I agree with you. There's no strategy from the geopolitical sense I think the only strategy certainly in the biomedical space appears to be is Tony Fauci somehow related to it cut is fresh How and somehow related to it cut Are these scientists all these left-wing wing scientists cut? I think that does

feel like the Rationals and that of course is a terrible rationale from a national perspective. And it does not work if you really want to regain American predominance or not regain because we have it, but retain American predominance in biomedical research. And I totally agree with you.

It, EVs, we lost that lead to the Chinese. I mean, almost everyone agrees that BYDs, but a car is better than anything we produce in the United States. And we have yet to upgrade our grid and alternative energy, solar and wind, and the investments and incentives to do that are going away.

This is a very, very bad long-term strategy. Now, this is another place, if I were, we have to think hard, What's our ideal strategy here? We're going to have a lot of destruction and decimation in this space. How would we ideally like to have this happen? What are the kinds of things if we get to reimagine it in the next administration we would like to build?

It can't be the old system for a lot of reasons. I mean, we, we haven't had hardly any improvement in the grid, for example. Uh, because of lots of being hamstrung in lots and lots of ways. And that has to be a, a, certainly a top priority. Zeke, Emmanuel, thank you so much for coming on the Bullwork. We'll be talking again soon, I hope. Yes.