On with Kara Swisher - RFK Jr., Vaccines, Bird Flu & Health Under Trump 2.0

Episode Date: December 19, 2024

RFK Jr. was on the Hill, on Monday, working to persuade senators he’s capable of running the  Department of Health and Human Services and its almost $2 trillion budget. Ever since the news his lawyer has petitioned the federal government to revoke the approval of a polio vaccine broke, that job has gotten a little harder — but it doesn’t mean he won’t get confirmed. And so could a number of other highly unorthodox candidates that Trump plans to nominate for key positions in the HHS. Kara talks to an expert panel to make sense of it all and find these nominations could means for America’s public health policy.  Her guests are: Dr. Zeke Emanuel, Dr. Celine Gounder, and Donald McNeil Jr.  Dr. Emanuel has written and edited 15 books and over 300 scientific articles. He was Chief of the Department of Bioethics at the National Institutes of Health, one of the architects of the Affordable Care Act and he teaches at the University of Pennsylvania. Dr. Celine Gounder is an internist, infectious disease specialist, and epidemiologist, a CBS News Medical Contributor and Editor-at-Large for Public Health at KFF Health News, and she teaches at New York University. Donald McNeil wrote for the New York Times from 1976 to 2021, where he was a health and science reporter and the lead reporter the COVID beat. He won the prestigious John Chancellor Award in 2020 and was on the New York Times team that won the Pulitzer Prize for Public Service in 2021. You can find his latest work on Medium. Questions? Comments? Email us at [e-mail] or find us on Instagram and TikTok @onwithkaraswisher Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi everyone from New York Magazine and the Vox Media Podcast Network. This is On with Kara Swisher and I'm Kara Swisher. Today I'm talking about the incoming administration's approach to healthcare, especially RFK Jr., President-elect Donald Trump's pick for Secretary of the Department of Health and Human Services, and a man who has some extremely unorthodox ideas about public health. HHS isn't the sexiest agency in the federal government, but it is one of the most consequential.

I wanna focus on it because I think it's critically important to think about public health right now, and it's really critical that think about public health right now. And it's really critical that we don't have people with questionable theories in charge of it, especially when people's lives are at risk. My guests for this conversation are critically important too. They're Dr. Zeke Emanuel, Dr. Celine Gounder, and Donald McNeil Jr. Dr. Emanuel has written and edited 15 books and over 300 scientific articles.

He has way too much experience to list here, but Emanuel was the chief of the Department of Bioethics at the National Institutes of Health, one of the architects of the Affordable Care Act, and he teaches at the University of Pennsylvania. Dr. Celine Gounder is an internist, infectious disease specialist and epidemiologist, a CBS News medical contributor and editor at large for public health at KFF Health News, and she teaches at New York University. Donald McNeil wrote for the New York Times from 1976 to 2021, where he was a health and science reporter and the lead reporter on the COVID beat.

I have huge respect for him. He won the prestigious John Chancellor Award in 2020 and was on the COVID beat. I have huge respect for him. He won the prestigious John Chancellor Award in 2020 and was on the New York Times team that won the Pulitzer Prize for public service in 2021. This is a powerhouse group of experts. They're not just smart and experienced. They're very opinionated and they have plenty of disagreements. And they're not part of what a lot of anti-science people think is the deep state. They are smart and interesting people. We should listen to them, so stick around. ["Dance of the Sugar Plum Fairy"]

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They believe that doing good is good for business and you can see how in ELF's 2024 Impact Report. Visit elfbeauty.com slash impact to learn more. Zeke, Celine, Donald, thank you for being on On. Nice to be here. My pleasure. Thank you for inviting us. So as our listeners know, President-elect Donald Trump says he'll nominate RFK Jr. to be the Secretary

of Department of Health and Human Services, or HHS. What listeners may not know is that RFK believes autism comes from vaccines, has suggested that COVID-19 might have been ethnically targeted to spare Ashkenazi Jews and Chinese people, and maybe HIV doesn't result in AIDS. Let's start by getting everyone's take on this selection. So let's start with Zeke, then Celine, then Donald.

I think there's a hodgepodge of positions. Some of them have a lot of sense, right? Ultra-processed foods and the obesity epidemic, chronic disease, the need for our health system to emphasize primary care and primary care physicians, all of them make a lot of sense and I think would actually lead to a better, healthier country. Then there's another set of beliefs, vaccines, one of them is absolutism on fluoridation, and some of the other positions like GLP-1s are, you know, should not be used, that I don't know where they come from, I don't know why he holds them, I can't see how they fit with the first set,

and they're largely incorrect or wrong, some of them are clearly wrong, like the link between vaccines and autism. Some of them are, I think, misguided, like the GLP-1 position. Yeah, he seemed to have flip-flopped on that a little bit, too. Well, I think Dr. Oz is pro-GLP-1s, which is probably the right answer. Right. Okay. Salih? I think what's concerning, not only with respect to Kennedy's nomination to head HHS, but also the other nominees,

is COVID denialism or minimizing as part of their track record, and then also skepticism of science and the scientific process. And I think that's really concerning because regardless of what your values are, your partisanship, we should at least be starting with a common set of facts based on science and then using that information

to guide policy making. And I think whether it's vaccines or fluoride or any number of the issues we'll be talking about, the fact that we're not starting with science in these discussions is alarming. It introduces uncertainty for many parties, including, for example, the pharmaceutical industry and how they plan what products they're going to develop. It introduces uncertainty for scientists who are trying to figure out what research they're

going to do, for trainees to figure out what they're going to study, what fields they're going to go into. So this really does create a very uncertain environment for all of us. Donald? I am so glad that we have a polio survivor in a senior position in the US Senate in the person of Mitch McConnell. And that McConnell is tough enough to actually issue a threat before the hearings have even started because he's willing to say, you better not come in here and play your anti-polio vaccine politics with me because I know what I'm talking about. I had

polio as a child. You know, thank God we've got somebody who's that old in the Senate, however, one may think about its other politics because he's able to stand in the way of really, really dangerous nonsense that is coming out. I mean, the idea that this guy, Aaron Ciri, who has gathered his connect to Kennedy, wants to stop the use of polio vaccine or ask for a new placebo-controlled trial of it, to me, it's like asking for a new trial of polio vaccine

is like saying, you know what, let's prove that cars are safe by using actual children as crash test dummies rather than building dummies. You don't stick kids in a trial of a vaccine trial when you know that the vaccine works. This is really dangerous stuff. And we're likely to start building a giant clinical trial in the United

States itself if enough people fall for vaccine denialism. It's going to be their kids with a placebo arm at the trial, and they're the ones who are going to end up hospitalized or dead if, you know, in order to prove the vaccines work again. That's not the way I want to do it. So HHS has 13 operating divisions, including the Food and Drug Administration, the Center for Disease Control and Prevention, the National Institute of Health. So Celine, explain the role of HHS Secretary, given how much influence they have over America's health, and to what extent would RFK Jr. be constrained by existing personnel and bureaucracy, or is it very easy to take over and make changes?

Well, some of this depends on respect for prior institutional norms. So normally, the HHS secretary would be getting scientific technical advice from others across the different agencies. These are traditionally civil servants who have been serving under both Democratic and Republican administrations, who are really technical issue experts.

What we saw under the prior first Trump administration was an executive order establishing that they could be hired and fired more easily. And the danger there is that that layer of technical expert scientists who advise people of both administrations, if that layer is eliminated and replaced by partisan people, one, it means that the HHS secretary is not necessarily going to be informed by the science in making decisions and that

those roles could very well be politicized. But again, you know, in addition to that, some of this depends on the degree to which the new HHS secretary does follow the scientific advice of people within the agency. He doesn't have to listen, right? At all. There are, I think, two or three broad things to understand about the Secretary. The first is the HHS Department is the largest by far in the United States. It's got about $1.85 trillion budget. Compare that to the Defense Department, which is $850 billion.

That means it's two and a quarter times larger than defense. So there's just an enormous amount of money flowing through. The second thing is the secretary has to sign off on almost everything. Now, a lot of that just pro forma unless you don't want it to be pro forma, in which case appointments to committees like the ACIP, the Immunization Practices Committee goes through. And if the secretary takes an interest and wants to change that, he or she has the power and authority to be able to do that. And I think that's very important. And the last thing is, much really depends upon the tone set by the secretary. Is it an open administration where they're open to new ideas

and new suggestions or is it closed where people are, you know, you won't get your hearing there or you'll get persecuted there if you raise the issue and so self-censorship pulls in. Even if people don't leave, they understand that there's no advantage in raising a point. I can tell you the sort of self-censorship and hesitation has already begun to set in. Right. So, Kennedy says he isn't an anti-vaxxer and he won't take away anyone's vaccine, but he's also spent decades fighting vaccines and has said things like there's no vaccine that is, you know, safe and effective.

Donald, help us understand the cultural context of this anti-vax movement. Before COVID, it seemed like anti-vax attitudes were mostly confined to religious groups like some sects, Orthodox Judaism, as well as crunchy well-off parents at Waldorf schools. But now it's mainstream with lots of vaccine skeptics. I mean, it's always, it's actually always been fringe. And, you know, a minority of people in this country are anti-vaxxers or even vaccine hesitant. It's just that it's taken up a completely different fringe. It used to be mostly a sort of left-wing, what you called crunchy granola type things, and now it's switched over to the Texans for vaccine choice and the things like that. I mean, what people grab onto a combination of true problems and false problems that are

blown out of proportion. You know, there's no questions that vaccines are, you know, have side effects and in some cases have bad results, but you always weigh the enormous And in some cases have bad results, but you always weigh the enormous benefit of getting rid of a disease or cutting a disease down by 99% against the occasional thing like something terrible like the cutter incident where, you know, a bad batch of vaccine actually did give a lot of kids polio. Or we've had a scary moment just in the last week where it looks like an RSV vaccine that's being tested in Panama is showing what's called a safety signal. It suggests that kids who got the vaccine

might actually have a chance of having a worse outcome if they get the disease than they would had they not had the vaccine. And that happened before in the 1960s when RSV vaccine was first tested out and it killed the whole field of RSV vaccine. And it looks like Moderna is now dropping their vaccine.

I am absolutely sure the anti-vaxxers will jump all over that and say, see, see, see, vaccines are dangerous. And the truth is when a vaccine is dangerous, the first thing they do is stop developing that vaccine and go looking for one another way. My biggest fear in all of this is that Kennedy and the skeptics in Congress are somehow going to try to take away the protection that vaccine companies have against liability suits. It's controversial. We have special protection for them that they can't be sued for damage that their vaccines

have. Much like the tech companies, but go ahead. Yeah. I mean, they're not completely immune. Obviously, if they're involved, if they engage in gross negligence and stuff like that, then they're still liable. But in the course of correctly trying to make the vaccine, in the very rare cases where somebody is hurt by a vaccine,

it goes before a special master who then can award them out of a fund that's created for exactly these situations. If that disappears, and they're liable to be sued for a million dollars or 10 million dollars by every kid who has even no problem, even imagined problems, they will get out of the field. They will just stop making vaccines, which is what they threatened to do in the 1980s when they faced this the last time. And that's why this whole special vaccine injury program was created. If they stop making those vaccines drop out of the field, we will have vaccine shortages very quickly.

Very quickly, because they won't be making it. And that is going to create a situation where you not only have vaccine hesitation among some people, but even people who want vaccine can't get the vaccine. That's when you get an epidemic. Celine, talk about the mainstream aspect. Aaron Rodgers, Kyrie Irving, Nicki Minaj, Eric Clapton, Joe Rogan, Tucker Carlson, Candace Owens are vaccine skeptics. Talk about the infiltration and what's the process of becoming an actual anti-vaxxer?

How does someone go from listening to Joe Rogan's whatever rant he happens to have on to preventing their children from getting vaccinated? I think you have a few things at play. I think part of this is identity. And unfortunately, over the course of the pandemic, well, it became a huge political issue for the first Trump administration. And so some of this was politicization of COVID

and by extension, the vaccines, because if you acknowledge that you need to be vaccinated, it means you acknowledge that COVID was a big deal. So I think that's part of it. I think another piece is that people are drowning in information, some of it good, some of it bad. A lot of people don't understand the scientific method, which is to say you formulate a hypothesis,

you try to disprove that hypothesis, you continue to evolve, tweak your experiments and repeat experiments, and you incrementally build science over time. That's not an intuitive way of thinking for most people. Most people start with, here's my conclusion, here's the stuff I can use to back it up. And so what that results in are things like cherry picking of information without looking at the whole body of evidence, logical fallacies. Some people may oversimplify, may misrepresent.

They might make arguments about slippery slope. You know, there's a whole bunch of these different cognitive issues where people are misinterpreting the information. It's really about mental shortcuts, which makes sense most of the time. It's really about mental shortcuts, which makes sense most of the time. But when you're talking about really nuanced

technical science, it's not necessarily the best way of evaluating that information. Right, so. And don't forget. Go ahead. There's also the profit motive. An enormous number of the people who are behind the anti-vax movement. I mean, you have, on the one side, you have mothers who are not anti-vaxists, they're mostly

hesitant. I mean, you're looking at your child, Dwight, does he really have to have 18 shots? Look how miserable he is after the shot. I don't know anybody who's had this disease. But on the other hand, the people who are saying to them, sitting on their shoulders and saying, stay away from it, it's dangerous, they're selling vitamins. Vitamins. They're selling chelation therapy, they're selling hyperbaric chambers. There's a whole industry of treating quote vaccine damaged children. And there are other people who are in it, I presume simply for the notoriety that

Robert F. Kennedy, you know, his children's defense takes in enormous amounts of money and donations for people. So people make a living out of being anti-vaxxers, and you cannot forget about that motive in corrupting their designs on gullible people. So Zeke, is there any kernel of truth though? Yeah, well, I like to say that there's no medical intervention that doesn't have side effects. Even a simple blood draw can have serious side effects. And so we have

to acknowledge there are going to be some side effects from vaccines. They're not zero problems. And I think Donald mentioned a few of things that go wrong. And all of us have seen some patients who've had serious, serious problems. I know my book editor has had a child who had serious problems from the COVID vaccine. When I was taking care of patients, I knew people who had Guillain-Barre and were immobile because of it. Those are tragedies. They're terrible. And yes, we have to acknowledge that they happen. And that's why we have, as Donald pointed out, the compensation scheme so that we compensate people fairly for a social benefit. Remember, getting vaccinated is good for you, but it's also good for everyone around you. And so it's got a social component. And, you know, parents who don't want to vaccinate their kids

often are riding on the fact other people will get vaccinated and my kid will get that benefit but won't have to take the risk of any potential. Take the very small risk, the non-zero chance. Yeah. So I think we have to acknowledge that and we're not honest if we don't acknowledge it. But the risk benefit, as we have said, the risk benefit is overwhelming, overwhelming to the positive. A small number of unfortunate and tragic cases for a whole society that no longer has to

think about TB, no longer think about smallpox. And before recently, no longer had to think about really whooping cough. Whooping cough and polio. So let me get to the polio thing. His combination still wasn't attracting the controversy that Matt Gaetz or Pete Hegseth have. The New York Times reported last week that his lawyer, Aaron Ciri, had filed petitions to revoke government approval of 14 vaccines, including the polio vaccines. It seemed to have changed it. Mitch McConnell spoke up. He's a polio survivor. He said you should steer clear of any even the appearance of association with such efforts. RFK Jr.'s on the Hill right now talking, we're recording this on Monday, talking over two

dozen senators, including Lisa Murkowski. I want to ask all three of you, do you think he'll get confirmed by the Senate? Let's start with you, Celine, then Donald, then Zeke. Yeah, I'm hearing that there are some 10 to 12 Republican senators who are lining up to oppose his nomination. That, you know, those are still rumors, and how this will play out remains to be seen. But I think there's a lot of reasons to think that Republicans may not support him.

Many of his policies would be pro-regulation, I think that Republicans may not support him. Many of his policies would be pro-regulation, would be questioned by industry, and typically Republicans have been anti-regulation and very much supportive of industry interests. And so, I am cautiously optimistic that perhaps he will not be confirmed by the Senate. Okay. Donald?

I'm not following. I always make an idiot of myself when I try to predict the future, and especially where politics are clear. I've been okay. I got lucky a few times on infectious diseases because I understand viruses better than they do politicians I like viruses better than I like politicians. I'm gonna stay away from this one. I don't know if he's gonna be Accepted okay, see you did talk to Trump a lot during his first turn about trying to persuade him to keep the Affordable Care Act Having talked to Trump. Do you think he is less radical or that he will be able to rein him in?

my view on that is President Trump has his own skepticism about vaccines. If we're narrowing it only to vaccines, that's true. I don't think he agrees with some of his other positions like ultra-processed foods necessarily. No, he loves those. He loves those. The last thing I would say is I think HHS and this stuff is probably not front and center of this incoming administration.

There are, you know, if you say there are three or four things at the top, I think there are three or four other things that are more important to them than these kinds of issues. These kinds of things. Well, and more important in terms of not even within HHS, I would say it's cutting, you know, budgets is the number one priority, not questions about vaccines or ultra processed food. Sure. And that also attracts a lot of attention.

But one of the things he said was he wouldn't give one penny to any schools with vaccine mandates. In an interview with Meet the Press, he opened the door to eliminating some childhood vaccines. Every school has vaccine. Every state has vaccine mandate. That's correct. That means you've got to withdraw money from literally every public school in the country. And do you see that happening, Celine or Zeke? No.

No. It's a state issue. It's a state issue. Yeah, this is, I mean, this is the point is public health powers reside at the state. So agencies like the CDC can collect data, can evaluate the science, can make recommendations, provide guidance, but then it's at the state and local level, whether they decide to mandate vaccination, for which vaccines.

Yeah, and also what exemptions are available to kids. So some states have only medical exemptions, some have non-medical exemptions, but that is not a decision of the federal government. But here's the complexity. That is true, those decisions are made there. On the other hand, whether the ACIP makes a recommendation has a big impact on the money supporting the vaccination

and whether that's gonna be reimbursed. And we should be very clear, most facts, certainly most childhood vaccines, I'm going to say most, I think it probably is all, are very low margin products. They're not the place the drug companies are making a billion dollars a year in profits, like some cancer, many cancer drugs. And so you need very little fear or very little switching to make it unprofitable for the drug companies to pursue this, both in terms of continuing to manufacture and most importantly, continuing to innovate in the vaccine space. And that,

I think, is also where, you know, even if the ACIP slows things or reverses some decision, you could have big, big reverberations. Because they won't be available. Or they won't be paid for. And then a lot of people, we know that if you, if vaccines aren't free, a lot of people won't get them. Yeah. So the insurance reimbursement is based on does ACIP recommend? So absent that recommendation, if they pull that recommendation, insurance companies may not cover anymore. Right, and it's usually

couched in language personal freedom and parental rights in a lot of these states. Donald, you've written the hell with it. The anti-vaxxers have won and when American children do start dying of measles, I hope there are pictures, I hope the full weight of the tasteless, abusive, headline hunting addiction of the American media is brought to bear." That's a sentence. Yes, it sounds like me. That's why I called you. I was like, type, type, type Donald. Yeah.

Sounds different when it comes out of somebody else's mouth. It sounds sort of radical and sensationalistic and all that. No, no, it's fine. It's fine. Yes, I wrote that. So, explain what you mean and what that would look like. What were you, the point you're trying to make? The anti-vaxxers have won. So, I just find that for years I have been covering efforts by well-meaning doctors, like those on the podcast right now, to try to say to other doctors, look, we have to reach people, we have to become better messengers, we have to be, we have to not speak down to parents, we have to not, you know, act like the expert,

we've got to find ways to, you know, to meet them where they are and talk to them. And my feeling now is that sensible point of view has lost. The anti-vaxxers are about to take office in this country. The people who push vitamins, people who push ivermectin are coming into their own and my fear now is the fallback position is that we're going to have a giant de facto clinical trial in this country showing whether or not vaccines work and the placebo arm of that trial is going to be the

children of the anti-vaxxers. They are the ones who are not going to be vaccinated. And eventually we're going to have new data when those children begin to get hospitalized and die. And it's not the way I want to win this debate, but I'm fairly confident that science and Darwinism will win when people actually see their children sickening and dying and realizing that more of the unvaccinated children, you know, sicken and die than the vaccinated children, they'll begin to be convinced again. They'll learn the same lessons we learned

from the 1930s and 1940s and 1950s. They'll go through the same terror we did. You know, I remember as a kid what, you know, the fear of polio was like, and my parents worried, but they made me stand in those long lines to get a shot and then a sugar cube at the end of it. And, you know, sadly, there's also going to be a lot of completely innocent victims who were turned to the roadkill by this because very young children can't be vaccinated because their immune systems aren't mature enough to be

able to handle those vaccines. And we normally protect them by vaccinating all their big brothers and sisters and cousins and people like that so that they're in effect ring-fenced by the people around them who don't have the disease. But pretty soon, if you've got a whole lot of kids coming to school, possibly with measles, possibly with whooping cough, possibly with, you know, God knows we might see a return of diphtheria. Celine, what do you think? Do you think this is, as Don said, a de facto clinical trial?

And do you need a high profile death to receive a lot of media coverage? Well, if you think about what happened with COVID and COVID vaccination, we saw actually a disproportionate number of COVID hospitalizations and deaths in red states because of lower vaccination rates. That, you know, will that data convince people change their minds if they start to see something similar

manifest among kids for these childhood vaccine preventable diseases? I don't know. It didn't work last time. Yeah. Did it shift public opinion in red states where there were higher levels of hospitalizations and deaths? I don't think we have any evidence of that. And people have ways of reconciling sort of that cognitive dissonance that may override these kinds of incidents happening. We'll be back in a minute. Support for this show is brought to you by Nissan Kicks. It's never too late to try new things, and it's never too late to reinvent yourself.

The all-new re-imagined Nissan Kicks is the city-sized crossover vehicle that's been completely revamped for urban adventure. From the design and styling to the performance, all the way to features like the Bose Personal Plus Sound System, you can get closer to everything you love about city life in the all-new reimagined Nissan Kicks. Learn more at www.nisonusa.com slash 2025 dash Kicks. Available feature, Bose is a registered trademark of the Bose Corporation. Support for On with Kara Swisher comes from SelectQuote. Life insurance is one of those things you don't actively think about getting, but you know it's important to have. And when you don't have it, it can feel like an unchecked to-do box sitting in the back of your brain. Well, you don't need to put it off anymore.

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So get the right life insurance for you for less at selectquote.com slash Swisher. Go to selectquote.com slash Swisher today to get started. That's selectquote.com slash Swisher. Support for On with Kara Swisher comes from Elf Beauty. In the corporate world, Elf Beauty is a bit of a unicorn. I've mentioned it before, but it bears repeating they're the only U.S. publicly traded company with 78% women and 44% diversity on their board. Trust me, they're a unicorn.

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about how Elf is double-cert certified by Leaping Bunny and PETA as cruelty-free. ELF believes that doing good is good for business, and that can be pretty rare again. It is absolutely rare. Visit elfbeauty.com slash impact to view their 2024 impact report. So let's talk a little bit about some other policy positions of RFK. He's called for the prosecution of Dr. Anthony Fauci, as has Elon Musk, who tweeted, my pronouns are prosecute Fauci in 2022. And again, last month when he posted on X, my pronouns are still prosecute Fauci. Donald, you've called for Biden to issue a preemptive pardon to Fauci.

Talk us through your reasoning. I wrote that six hours after Joe Biden pardon to Fauci. Uh, talk us through your reasoning. I wrote that six hours after, after Joe Biden, uh, pardoned Hunter Biden. I just thought if he's going to give his son a pardon, let him give everybody else who's in, in the, in the sites of the, of the prosecutors of the, of the vengeful justice department. Talk about Fauci specifically. A lot of them don't want them. Some of them don't want, don't, don't think they should get them themselves.

There's, I have heard, I haven't talked to them about it, I have heard that Tony Fauci does not want a pardon because accepting a pardon has a way of suggesting that you're admitting that you've done something wrong. But in this case, I don't think that's necessarily true. If you know that you've got a Justice Department that now is simply out to get people, whether they've done anything wrong or not, whether they've really committed a crime, you can practically always gin up some sort of crime that you can accuse somebody of, starting with jaywalking and going up to anything else. If you know that people are going to come after you, I don't see that there's any, you know, that accepting a pardon is actually an admission of guilt. I think that simply it's an admission that you need protection.

And Tony Fauci has already had Secret Service protection because of the number of threats on his life. Yes. And I'm very glad he accepted that protection. If I'd had threats on my life, I would be happy if the Secret Service was watching out for me. You know, I think there are many people who are in the sites of what is likely to be the Justice Department or Cash Patel who goes around wearing the Punisher logo on his scarf. The symbol of vigilantism in Marvel comics.

People need protection from that. Do you think he should get it, Fauci, Zeke, and then Selene? No. I think that is, I was very upset that President Biden pardoned Hunter. I think that's copying the exact thing Republicans do and it gives them a precedent that they can pardon all sorts of people on. It is a terrible, terrible miscarriage of justice in my opinion, when we are a country that's supposed to be governed by the rule of law.

Yes, law can go awry. I agree and I certainly can imagine it will go awry in some cases, but I don't think preemptive pardons are the way to solve that problem. And I think that's why we have, hopefully, good justices and good prosecutors who take principled stands. And, you know, the other unfortunate thing is even a preemptive pardon will not protect someone like Tony Fauci from Rand Paul and Senate hearings that also have no basis. We have to remember Tony Fauci has been a model public servant. You may not agree with everything he says. There are very few people I agree with everything they've said or every policy recommendation they've made. But he is a man who has selflessly

committed himself to the country when he had lots of other opportunities and always put the interests of the country number one in his consideration. Does that mean you get it right every single time? Absolutely not. But who? Trump, Elon Musk, RFK Jr., Dr. Oth, who among us has gotten every single judgment call or prediction right? Some more than others. Some more than others. Celine, what do you, should you present to Barden or not? No, I think it sets a terrible precedent, but I also have other concerns for Fauci, number one being that the Secret Service detail he's assigned is assigned by the Biden White

House. And I think there's a very good chance he will lose that under the next administration and his life will very legitimately be at risk. To me, that's a whole other threat. That's an excellent point to make. So I'd like to make a point about preemptive pardons, if I may. I mean, I don't think there's anything particularly religious, you know, sacred about the pardon power. I think it has been abused by almost every president that's ever had it. I mean, preemptive pardon was what was given by Gerald Ford to Richard Nixon. He was forgiven for anything he did or might have done while he was in office. Jimmy Carter pardoned 150,000 draft

auditors without even having to name them all, if I remember correctly. Bill Clinton pardoned his brother and pardoned Mark Rich, you know, possibly in return for some sort of consideration towards Hillary's, you know, I see the pardon power being abused. Um, you know, the, the, the sacred part of power. Well, no, no, it's more like I much more fear the kind of thing that I used to see when I was, you know, reporter in Africa where the minute somebody was out of office, the first thing they did was prosecute the previous president and everybody around them. I would rather see the pardon power overused, over generously, than I would see it becoming normalized for a president to take office and immediately jail everybody who had been

in office before them because they disagreed with him. That I think would be really an abuse of power. All right. So another off-k. We're not choosing between the two, Donald, I hope. I fear. I don't want to become one of those countries where, yes, you don't want to leave office because you're worried

you'll be prosecuted and thrown in jail unjustifiably. I think Trump had a word for those countries. Yeah. You know, and I was almost jailed in Zambia for simply going over and trying to talk to the former president while he was on trial. That's a real fear. And I would not like to see us become another one of those. Yeah, 100%. Another RFK junior, a hobby horse, is fluoridation. After the election, he said

that Trump will recommend removing fluoride from our public drinking water. Dr. Lena Wen, who's a CNN medical analyst and former Baltimore Health Commissioner responded with an op-ed that pointed out not only do many European countries not fluoridate their water, there's research that shows we might get enough fluoride from our toothpaste and fluoride can be harmful for our fetuses. Is there any point here, Celine, why don't you start? Just so you know, I didn't have fluoride in my water, I have the worst teeth in America at this point. But go ahead, Celine. Yeah, I think this is another one where you have to look at

what is under the federal government's control versus local jurisdictions. Versus states and cities and municipalities, right? Right, so the CDC recommends that communities adjust their fluoride levels up to a certain level if it does not naturally occur at that level. The CDC and the EPA also recommend levels that fluoride should not exceed.

And then the EPA further has legally binding maximum safe level of fluoride. But what you see is where these higher levels of fluoride exist, which may be of greater concern, whether it's with respect to some of the IQ effects or thyroid, those are generally places where it's naturally occurring at those higher levels. But big picture, the point of public health measures

is to really level the playing field for people who may not have access. We have a lot of families who are unable to get dental care, about 70 million Americans lack dental insurance. Dental care is the most common form of health care that adults put off because of high costs. And not everybody can afford, you know, to go to the dentist or brush their teeth regularly. So this really does make it accessible to everybody. So Kennedy isn't the only unorthodox choice.

For example, he wants Dr. J. Bhattacharya to be in charge of the National Institute of Health. Bhattacharya is one of the authors of the Great Barrington Declaration, which called for letting COVID spread among young healthy people in order to achieve herd immunity. And he had a number of controversial ideas for NIH, including a plan that would tie the university's likelihood of receiving research grants to some to-be-determined score of academic freedom. In other words, it's a way to punish supposedly woke universities. Let me start with you, Donald.

I've never interviewed Dr. Bhattacharya. I know some colleagues of his at Stanford who are unhappy about him as a choice. I think the Great Barrington Declaration was a short-sighted mistake, and I'm bothered by the number of people that I know, including some journalists I otherwise respect, who are still defending the idea. I mean, the idea that there was some way to make sure that the disease stayed only within the young, healthy population and that those people could somehow avoid their grandmothers, could avoid their obese relatives, could avoid people with immune conditions,

avoid people who are undergoing cancer treatment, things like that. It was always absurd. That's the way we used to reach immunity the old way by letting people, most people survive and other people die off and, you know, we had a better way of handling it. And I'm, you know, I thought it was a very bad thing that they put that idea and that people with MD behind their name signed it. So let's go through another really quickly and anyone can jump in very quickly, which we can.

Mehmet Oz to run the Center for Medicare and Medicaid Services. Who wants to take that one? It's a super wonky area, and that's really not something he has researched, written on. If you do read Project 2025 and use that as any guide, you know, it's sort of interesting some of the language there.

They spell out that since 1967, when Medicare and Medicaid got started, the combined cost of both programs was $17.8 trillion, and that the U.S. government national deficit is $17.9 billion, or excuse me, trillion dollars in that period, and conclude that Medicare and Medicaid are the principal drivers of the national debt. It's very clear that the incoming administration

would like to find ways to cut what we're spending on Medicare and Medicaid. Some of this may be through privatization of Medicare with Medicare Advantage. I think Medicaid is going to be a lot easier to scale back on, whether that is through state block grants, through work requirements. If you reduce the national national federal funding for Medicaid, some states that have expanded Medicaid may decide that they don't want to.

So I think there are, even if Oz has not come out with those policies, there is reason to think- This is the administration, right. Well, can I take issue with the Medicaid issue? Sure. You know, the Republicans have been for block granting Medicaid, but the

idea that you're going to cut Medicaid now in Republic with the Republicans to support, I think that is a non-starter. And I'll tell you why. Because every state that has had Medicaid on the ballot, red states, whether it's Idaho or Utah or Oklahoma or Missouri, the population has voted for it. They think they want it. And I think it would be the kind of thing if people suddenly realized I'm not going to get it or it's not going to cover me, they would be very angry about it. So I'm actually more skeptical now than I've ever been that now that they have all three parts of government, etc., that they're actually going to put the block granting of Medicaid on the ballot. Maybe we'll get Medicare for all. Who knows? No.

So let's go through a few more. Let's do this one, Donald. Dr. Marty McCary to run the FDA, Dr. Dave Weldon to run the CDC. Pick any one, Donald. I'm much more worried about Dave Weldon to run the CDC. Pick any one, Donald. I'm much more worried about Dave Weldon than about the others. Tell us why. Well, he's apparently, from what I've read, continues to be a vaccine denier, continues to believe that vaccines cause autism, continues to believe that some vaccines don't work.

And you know, Mem and Oz in charge of Medicare and Medicaid, why would he want that job? It's like a thankless, gigantic bureaucracy where everyone's gonna be fighting about money. On the other hand, running the CDC is a very important job as far as guidance on infectious disease, on all aspects of health is concerned. And you really have your hands on all the policy.

I don't want somebody who practically doesn't believe the germs cause disease from the sound of this, that kind of skepticism on this part, running an agency like that. So that's the one that worries me the most. Okay, anybody else? Yeah, on the FDA, I haven't seen a terrible, that much in terms of what Macri's positions are

in some of these issues per se, but if you look at RFK Jr. and what he has said, it's pretty clear that the way in which he would like to see vaccines studied is frankly not possible. This idea of having placebo controlled randomized trials is simply not ethical at this point in time because of what you would be exposing kids to. So that bar for evidence is really not a reasonable or ethical one.

There's also a real lack of understanding about who does research on what. So NIH does, funds the basic science research. Pharmaceutical companies then take that science and translate into that into products. And they do the trials, submit that data to the FDA for approval. It's not that the FDA is trying to prevent certain things from coming to market, for example, generics having expanded approvals or that sort of thing. It's that somebody has to have the for-profit motive

to do that research. And that's something that, you know, RFK Jr. seems to misunderstand. Also, he's criticized the fact that some of the FDA's work is funded by fees on pharmaceutical companies. Well, that is a decision we have made. We could have more taxpayer money go into this. If we don't allocate more taxpayer money

to manage that shortfall, then it means other work won't happen. It means a slowdown of approvals. It's like merger fees are paid by the companies. And there's now conversations about food dyes, for example. Why have we not studied food dyes more? Well, again, there's a limited budget. You're going to have to prioritize what is most concerning to the public's health, what

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Dine in only until 11 a.m. DNW's Classic Breakfast on now, Dining Only until 11 a.m. It's important to look back and assess what the Biden administration got wrong to and represent the mask mandates and the COVID vaccine mandates might have done more harm than good, some people think. Maybe CDC's guidance around school closings led to schools staying closed longer than necessary.

I would like each of you very briefly to say your assessment is something you wish had been done differently or something you've got wrong yourself Let's start with you Zeke and then Donald and Celine Well, I think this school issue actually turns out to be something we the country in general got wrong And I remember arguing that we ought to prioritize teachers for vaccines very early on so that we could reopen schools early in 2021. If you had teachers vaccinated and you had ventilation systems in place, we could have

opened schools much earlier. I think having schools closed for longer than a year was a real mistake. There are many other mistakes. And by the way, the CDC got masking all wrong for a very, very long time. And that's another thing. You know, I was one of, I'm proud to say, one of the first people when I was doing my MSNBC show

arguing that we should actually have masking. And so I think, I would think that actually one of the biggest problems in our COVID response was the school closure issue and we made a lot of mistakes there. It was something we could have solved. And it created a political virus. Yeah, that's part of the mistake. Yeah, Donald? The initial worst mistake I think we made was that we failed to produce a test

for more than two months in this country. So we had no idea where the virus was. If we had simply adopted the German test, the one that the WHO adopted within days after it was made, and we had started doing large-scale testing, we would have been able to figure out where the virus was. So you could shut down New York City because we were having a serious outbreak here,

but you wouldn't have to shut down Houston. You wouldn't a serious outbreak here, but you wouldn't have to shut down Houston, you wouldn't have to shut down Minneapolis, you wouldn't have to shut down places where the virus wasn't, because you would have had enough testing to know where it wasn't. And all of that created this, you know, a giant national shutdown at a time

when we probably needed some localized shutdowns was absolutely the wrong way to go about it. You know, it was clear that masks work. If everyone wears masks, the countries where everyone wore masks with no problems, places like Japan, places like South Korea had tiny fractions of our epidemics because people accepted masks. And, and you had masks on just as much, not people to protect themselves, but a mask on

the person who was actually the super spreader, a mask on the person who was actually the super spreader, a mask on the person who was coughing out the virus at the time. That's what's crucial that people don't understand. So had we had, you know, better tracing of where the virus actually was and aggressive protection measures,

we might've saved a lot of lives. And I absolutely think the Biden administration should have gone after mandates much earlier and much more aggressively. And they should have produced something like an immune passport that said, hey, I've had my vaccine and I can now lead a more or less normal life. I think the idea that children don't need to be, children have to be kept out of school forever, even though children are not likely to suffer

bad consequences of the disease, is forgetting about the fact that schools aren't made up, aren't run by children, children aren't taught by children, children aren't driven to school by children, children don't drop off their kids until, you know, schools are actually gathering places for adults and it was largely the teachers unions that were saying, hey, you know, we don't want the schools to open because our teachers are going to be in danger. If those teachers had all been vaccinated, you know, we might not have had that problem. Right. And so to me, yeah, I mean, look, vaccine mandates worked for an awful lot of corporations, including Fox News, for God's sake.

They had one, they had 90, whatever percent of their employees vaccinated. That should have been national policy. If it's good enough for Fox News, why isn't it not good enough for all Americans? Fair, that's what I always say. Celine, very quickly. Yeah, so I agree with Zeke on schools and I agree with Donald on testing. In fact, I think we're seeing a similar issue

for different reasons with testing for H5N1. We're not, until just recently, the USDA finally mandated testing of bulk milk across the country, but that only just happened, and it's been almost a year now that the virus has been circulating. So that's not because we don't have the tests,

it's because we can't get people to use the tests. But when you have a gap in your knowledge and your visibility into the problem, it's very hard to come up with good policies to control an infectious disease. I think another major issue was in the summer of 2021, we started to see breakthrough infections despite vaccination.

And that was a point where we should have corrected the messaging to get people to understand these vaccines are great for preventing severe disease, hospitalization and death. They do not prevent infection. They may curb to some degree transmission. And the problem is people have taken that to mean, oh, we'll see vaccination is useless

because I still got COVID. The point is not that you still got COVID, you didn't end up in the hospital. Die of COVID, that's a really good point. Same issue every year with flu vaccine. Yeah. Okay, let's end by taking a 30,000 foot view on the American healthcare system, as horrifying as it was.

The murder of UnitedHealthcare CEO, Brian Thompson has prompted a lot of reflection about our healthcare system, some of it quite ugly. Talk a little bit about where we are, each of you. Let's start with you, Zeke, and then Donald and Celine. Well, I think what we've seen from this is the level of ire. If you follow the polling just before, unfortunately, this terrible assassination happened, Gallup got the most dissatisfaction and the most sense that we have major problems or a serious crisis in our health

care system than it's ever happened and the least amount of satisfaction with the health care system. The public, despite lots of gains from the Affordable Care Act, tens of billions of people with health insurance, actually a flattening of the cost curve for more than 15 years, the public has found it increasingly frustrating to find a doctor, get services approved, get through the red tape of the deductibles and other things, and they are pissed off. And that's what you're seeing here. It's terrible that someone was murdered. Just terrible. I mean, there's no justification for this.

And anyone who thinks somehow the just deserts is just morally obtuse. But the system we have is broken. And let me say, I'm a guy who worked on the Affordable Care Act. I think it's done a lot of good. What it has revealed more than anything is we have a structural problem.

The way we've organized our system is broken. What it has revealed more than anything is we have a structural problem. The way we've organized our system is broken and we can do a lot of changes, which will get more people coverage, but not get to universal coverage, which will control costs but not bring our costs down to more reasonable levels. We have uneven quality. We have a structural problem, actually three structural problems, and until we address those, we're not going to have a system that people are happy with.

And the frustration level, I fear, is just going to go up and up and up. So Donald, talk about the presses rolling. I have nothing to add to that. I lived in France for three years and I missed the health care I had there. Right, but there's a public perception that single single payer health care to a lot of Americans, those ideas bring images of socialism, long wait lines, death panels, if you recall. How would you describe the news media's coverage of it in terms of getting the perception that it's not going to necessarily be that?

Because that's really sticks, whenever I mention it, that's what I get back. Well, if we had to be in Britain, it would this, or if we had to be here. The problem is it's like the coverage of history. It's so huge. No one article can take it in, and people are so bored and overwhelmed that they try to read a book about it that they just go, ah, it's too big to understand. So I don't have a simple answer for that,

but I agreed with everything that Zeke said about this is being broken. Well, and by the way, Medicare is socialized medicine. And people don't want to hear that. And how well- Keep your government hands off my Medicare and my social security check. Exactly. That is government.

That is socialized medicine. And if you look at how well does the Canadian system function or the NHS in the UK, that's also dependent on how well you want to fund a program. So if you underfund it, yeah, you're gonna end up with wait lists and care that people take issue with. If you look at just one tiny part of the outrage that people are having, expressing about the healthcare system in this country, why are health insurance premiums rising?

There's a whole number of reasons for this. So post-pandemic, we've seen a big surge in demand for health services, especially among older people. We've seen a lot more specialty medications, including the GLP-1 weight loss drugs. Those drive up healthcare expenses. So even if a small percentage of members are on those medications,

that accounts for a huge proportion of our total healthcare spending. Then you have mergers and acquisitions among hospitals and healthcare systems. So that reduces competition. We're dealing with staffing shortages, which drives up higher wages. So there's a whole number of issues.

And again, this goes back to what Donald was saying is, dries up higher wages. So there's a whole number of issues. And again, this goes back to what Donald was saying is, yeah, it's overwhelming. It's so many different things. It's super wonky. It seems boring. I think what has been most upsetting to me coming out of that murder of the UnitedHealthcare CEO

is it shows that people are at a point of frustration where they do not believe the government can fix these issues, that voting does not matter, that speaking to their elected officials does not matter, that they believe that political violence is the solution. And this is even for somebody who was clearly highly educated from a privileged background, that this is the only way to effect change.

And I think that's a super scary place to be. Were you surprised? I was surprised. I was surprised that it was a murder. But I think Selina's right. I've talked to a lot of congressmen and senators. I've talked to a lot of health care policy experts. I don't think people have a clear answer or clear understanding

of what it would require to switch our system into something that's working better, what the fundamental defects are, and therefore what the fundamental fixes are to the system. We can all point to how it's bad, but the solutions are not clearly articulated and have been vetted. And I think, you know, we have too many insurance companies offering too many thousands of things, and therefore the public makes bad choices, no standardization in all sorts of areas. And so we have a lot of fragmentation and a lot of complications and complexity to the system,

and that's what's killing people, literally frustrating and killing people. And we don't have a focus on the most high-value interventions, like reducing and killing people, and we don't have a focus on the most high-value interventions like reducing high blood pressure, reducing diabetes. But getting that through Congress, it's hard for Congress to understand because as both Celine and Donald have said, it's really wonky. It's for people like me who like this turgid stuff. And that makes it very difficult and very frustrating. One last question for all of you.

Give us your best case scenario for American health system 10 years from now if you could do anything to reform the system. Let's start Celine and then Zeke and we'll end with Donald. Oof. I would say a greater focus on preventive care and public health. And if you look at how much of health is predicted by health care or health care influences our health outcomes, it's only about 10 to 20 percent. So what is actually taking a bite out of life expectancy in this country? It's things like opioid overdose, gun violence, obesity. You're not going to solve the obesity issue with GLP-1 weight loss drugs.

They're just too expensive, not accessible. So we're going to have to think about other solutions. And those are solutions that are not in the clinic, not in the hospital. They're largely policy solutions. And so that's what it... Yeah. Well, and I don't say gun control for a very specific reason, because it's not always about controlling access to guns, you know, but there are many things that can help reduce

the risk of gun violence. And there's a whole menu of things we should be doing on all these different issues that we are not investing in right now. All right, Zeke. So if you're going to talk about improving the American health, I think that there are probably three really important things to focus on. One is hypertension. It's the most common chronic disease. 120 million Americans have it. If you actually control it, which is relatively simple and we have a lot of generic drugs on it, you get the

biggest bang in terms of life saved. The second thing is the obesity epidemic. That 70% of the population of adults are either overweight or obese is causing a lot of the problems, including our huge problem of diabetes. And the last thing is a mental health crisis, which is driven by loneliness, by cell phones, by lots of things. And we need to get our arms around that. That's how you improve the American health and bring more people from dying prematurely to living a full life. The healthcare system is way more complicated to control, but what you really need to do is we need to rationalize how people select healthcare. You can have multiple insurers competing, as long as you have standardization on what they can offer, the costs and other things. And that's the, Germany has that, Netherlands has that,

Switzerland has that. And we could get, we could get to a situation of, you know, you, multiple insurance companies, but a standardized set of products and a standardized set of low costs that people have to pay. And that would be a way better healthcare system than we have today. All right.

Donald, let's finish up. Well, policy is not my area at all. But what Zeke is pointing out is something I'd like to see introduced a little more into the mercantilism, which is sort of traditional American capitalism. It ought to be possible for the government as the biggest buyer of drugs to be allowed to negotiate. And I see that that's actually begun to happen. Now there is some control over the price of insulin, which have been completely out of control.

I think it's a good thing when the government is allowed to negotiate with the drug companies or to allow more competition among drug companies to produce the same drugs. You've got the patent system is constantly being abused by the drug companies or to allow more competition among drug companies to produce the same drugs. You've got the patent system is constantly being abused by the drug companies. And I think it's a good thing when insurance companies can compete with each other in order to produce, as long as they're overseen enough so that they can produce, as Zeke said, standard products up to the right standards.

The problem is we've got a system in which every aspect of the system has been captured either by the corporate lobbyists for the pharmaceutical companies or for the pharmacy benefit managers or for the insurance companies. And they've created a giant unworkable system that produces an enormous amount of profits, an enormous amount of money wasted on things like lawsuits, an enormous amount of money wasted protecting doctors against lawsuits for simply trying to do their job, and lousy medical care as a result.

And unfortunately, a very unhealthy population for a hell of a lot of money. All right. I do have one quick question. Scariest thing out there medically, would you say? Right now? Just for people to make them feel bad at the end. H5N1.

H5N1? Yeah, because we're mishandling it. And we're increasing the risk of it spreading into humans and becoming adapted for human-to-human transmission. I'm scared by it, but people keep asking me, the one question they want to know is, grab your arm and say, are we all going to die? And the answer is, yeah, we are all going to die. Is it going to be H5N1? I don't know. I thought so back in 2004 when it killed half the people who got it. And now, here it is, not, I mean, suddenly every cow in America has got it or has had it or is at risk of getting it. And, you know, fortunately, pasteurization kills it, but when it gets into humans, so far, not

a lot of dead humans. And that's a huge relief to me. All right, so not agreeing to Salim. All right, go ahead, Zeke, finish up. What's going to terrify you? Go ahead. H5N1 is a low probability but very high severity event. If you look at a more high probability and severe event, it's really the obesity epidemic for which we don't have a policy

approach in the country at the moment that is going to work. And so that's the way I would see it. Okay. And antibiotic resistant, you know, microbials or other. All right, we're going next, next, next. There's a lot of things we can worry about. Aliens, aliens, that's my issue, bringing alien diseases, I'm teasing.

Thank you so much, this was so substantive and I really appreciate each of you, Celine, Zeke and Donald. Thank you. Thank you, Kara, this has been great. My pleasure. This has been great. On with Kara Swisher is produced by Christian Castro Roussel, Kateri Yocum, Jolie Meyers, Megan Burney and Kaylin Lynch.

Nishat Kurwa is Vox Media's executive producer of audio. Special thanks to Kate Gallagher. Our engineers are Rick Kwan and Fernando Arr, and our theme music is by Trackademics. If you're already following the show, Avian Flu will not kill you. If not, shut up, Elon, are my pronouns. Go wherever you listen to podcasts, search for On with Kara Swisher and hit follow. Thanks for listening to On with Kara Swisher from New York Magazine, the Vox Media Podcast Network and us will be back on Monday with more.

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