The Bulwark Podcast - S2 Ep1016: Jonathan Cohn and Mark Lilla: Lobotomizing America

Episode Date: April 8, 2025

When it comes to biomedical research, America is already great. We are the world's leader in the field. But the Trump administration is gutting research and innovation on things like cancer, Alzheimer's, and arthritis—and the amputation of our scientific expertise under RFK, Jr. has been about as thoughtful as the tariffs rollout. Meanwhile, when it comes to the developing budget bill, Medicaid is getting some surprising red state support from people like Josh Hawley. Plus, when people willfully choose ignorance as a way to cope with an uncertain world. Professor Mark Lilla and The Bulwark's Jonathan Cohn join Tim Miller.  show notes Mark Lilla's new book, "Ignorance and Bliss: On Wanting Not to Know" Mark's website Jonathan on Trump's cuts at child-care programs like Head Start

Hello and welcome to the Bulldog Podcast. I'm your host, Tim Miller. We've got a two-parter today, but first I wanted to mention yesterday, many of you emailed me, I appreciate that, about the fact that I guess I said that the Dave Chappelle clip I played was from last week when it was from 2017. So, whoopsie. I will say though, the fact that Dave Chappelle was making this very poignant critique of Donald Trump's tariff policy eight years ago, does kind of undermine the arguments from some of the Trump fluffers on Wall Street who were so blindsided by this, the Bill Ackmans of the world. Bill Ackman's out there tweeting about how could this possibly be?

It must be a conspiracy. It must be Howard Nutlick who's long on bonds trying to hurt the economy. Now, Trump's been warning you that he was going to do this for a long time now. You just didn't believe him. So anyway, kudos to Dave Chappelle for his 2017 prescience. One other news item I just wanted to get to before we get to our guests, because I don't think we're going to cover it in either of those conversations. There's some Supreme Court rulings last night with regards to the kidnappings, deportations,

whatever you want to call them, to Sikot in El Salvador. The first one was with regards to Kilmer Abrego Garcia. He's this father in Maryland who the government admitted was wrongly sent to El Salvador since the Justice Department lawyer that was making that argument was put on leave by Pam Bondi for I guess not being sufficiently supportive of the administration's lawless deportation regime. So anyway, this went to the Supreme Court and John Roberts put a stay on the circuit court judge's order that Abrego Garcia be returned.

Essentially, I think what court watchers are saying, and we'll have more on that later this week, is that Roberts put the stay on there because there's going to be a truncated timeline, which means that the Supreme Court is likely to act quickly in this case. So in the meantime, Arrego Garcia is stuck in a torture dungeon in El Salvador. So hopefully SCOTUS can act with alacrity on that. There's another SCOTUS ruling with regards to the Alien Enemies Act deportations, not the one where the Justice Department admitted they screwed up, for all these other folks who, many of them, it seems like they're very likely they screwed up, but the government hasn't admitted it yet.

And in this case, the ruling is mixed. It's bad news. I mean, horrifyingly bad news for the 260, 300 some odd men who've already been sent to El Salvador because the options for relief for them seem to be a stretch, to be honest. Not totally hopeless, but essentially, the court rules that prospectively in the future, the administration needs to give people that are going to be removed based on the Alien Enemies Act notice and an opportunity for habeas corpus.

I was watching one of the ACLU lawyers who's been really at the point on this and says like at some level, this is good at least that the Supreme Court unanimously said that people deserve due process. It's not Stalin's Russia quite yet. The bad news is like the way that they wrote it is that a lot of these folks are going to have to try to seek relief in the Texas Fifth Circuit, which is the most hostile to asylum cases. So at some level, it is good that the court did not just give total carte blanche to the

president and Stephen Miller and Tom Homan to send anybody they want to a dungeon in El Salvador. On the other hand, what are the opportunities for relief, for recourse for the people who have already been sent? There was no indication that the Supreme Court had any interest in forcing the government to return the people that are already in El Salvador. So we will keep monitoring that and we'll keep you posted on what can be done. It's something that I'm certainly going to be asking politicians about when they come

onto this podcast. In the meantime, as I mentioned, we have a two-parted today. And the second segment, it's Mark Lilla. It's a political philosophy and humanities professor at Columbia, who's kind of big think writings about how we got where we are have been, I think, super compelling and I've wanted to have him on the pod for a while, but up first he's the new senior national correspondent here at the Bulwark.

He writes a bi-weekly newsletter, The Breakdown, about what is happening in our government. He's the author of The Ten Year War, Obamacare and the Unfinished Crusade for Universal Coverage. It's Jonathan Cohn. Welcome to the pod, man. Hey, it's good to be here. Very excited to have you on board.

I know what we're planning for you here, but why don't you tell the listeners kind of what role you're gonna fill? Because I think it's really important. After Trump won, I was saying to Sam and Sarah and JVL and everybody that like, I don't know, I'm coming on here and popping off on a lot of stuff

that I'm like learning about in real time. And then during campaign season, this is my area of expertise. I can pop off on it. But the changes are so dramatic in the actual functioning of our government. We needed somebody to come on and help me work through all that. And so I'm hoping you can play that role. But give listeners a little bit about you and what you're planning on doing.

Yeah. Yeah. So I mean, my background is as somebody who writes about policy which my whole life I always felt sort of had to apologize for in the world of political journals. I'm like, it's a little boring It's a little wonky, you know, but turns out that you know policy is another word for what the government does that affects people and You know affects their lives, you know, are they going to get health care, you know, are they going to get deported? You know Run down the list. The newsletter, the idea is to be twice a week. The way I think of it is it's why

policy matters, how policy matters. There will be a mix of explaining when these debates are going on. You hear that they're cutting funds at the National Institutes of Health or that there's a tariff coming, or that they're talking about new, rolling back environmental regulations. Well, I hope if I do my job right, number one, I'll be able to tell you what's actually happening, what that means and why.

But then I'll also be able to tell you what that means for you, the viewers, for everyday Americans, how this is actually going to play out in the country. And so a kind of mix of those two, a mix of kind of behind the scenes in Washington, but also what's happening out in the rest of the country. And they'll take advantage of the fact that I don't live in Washington. Actually, I'm in the Midwest.

And so I kind of use that as my journalistic backyard and write about what's happening here, fly to other parts of the country and give you kind of a picture so you can understand what this all means. All right. Real America. We're out here. We out here. That's right.

So your newsletter coming out a little later tonight is going to focus on the impact of tariffs. So here in Michigan, I was talking to Mallory McMorrow, I guess last week, and I know you've been interviewing her as well about her run for Senate. And Michigan, in a lot of ways, is ground zero for this. And people are going to be affected by tariffs everywhere, but just because of the cross-border exchange with Canada and because of the manufacturing that's happening in the state. So talk about your reporting and what's coming out in the newsletter and what you're seeing

in Michigan on the tariff impact. Yeah. Yeah. Yeah. So, I mean, obviously, you know, this is Michigan, home of the auto industry. And you know, if anyone who's lived here for a while knows, I mean, it's really, even now, I mean, the auto industry is not as big as it used to be, but it is just so integrated into the economy here. And it's not just the big three, right?

It's not just GM and Ford and Stellantis, which we used to call Chrysler before it was bought by this foreign conglomerate. I mean, those are the big plans. You drive around Michigan any length of time on the highway, at some point you're going to pass the GM plant and you're going to see all the trucks lined up outside. And that's obviously a big part of it. But then there's this whole ecosystem, this whole economy around it, these suppliers, medium size, small, and it just reaches into every community. Of course, they have a broader impact in terms of people working in the factory, they got to eat, so they go to the diner, although we call them Coney Islands, not diners.

But you go to the Coney Islands. You do? We do. I know. It's a whole thing. You say that like a sentence? We go to the Coney Island? No, no, no, no, no. I'm, that's what they call them, the Coney Island.

So you see, we are getting into like some sort of revelations about me, which is although I've lived here for 20 years, I actually am from the East Coast and I still have those traces, you know. All right. But so you have this ecosystem of all these parts suppliers and it just ripples through these communities. And when it comes to the tariffs, there isn't like, we talk about Detroit, but the Detroit auto industry is really more like the Detroit Windsor auto industry.

You may have heard this before, but it's not uncommon for a part that goes into an F-150. If you sort of trace it, it will actually cross the border multiple times. And there's just this constant back and forth traffic. And so the more you're putting tariffs on, you know, the more you're raising the price of these cars and these trucks, even if they're assembled here in the U.S., you're still paying for all the sort of parts that are coming into them. Now, there are overlapping agreements in the Trump administration. Sometimes it says, well, we might exempt this

or we might not, but it's just all this instability. And you already are seeing the impacts. There are announcements of plants idling, canceling plans to build new factories. You're already seeing this ripple through here. So that's what's going on here in Michigan. In terms of my newsletter, I actually, it was a story that kind of came to me from

somewhat randomly from someone I had interviewed for a story like two years ago on a totally different subject He called me up and he actually he works for a um, when he's boutique, you know game companies That makes like strategy role-playing games. I don't actually I You know, I like to drink and go to football games. Yes people so I don't really know a lot about board games Yeah, so I will say meaning there's an onion. So I don't really know a lot about board games. Yeah. So I will say, meaning there's a non-insel. I was not. I'm sorry, board game fans out there. Sure, there are very sexually active board game fans out there.

So anyway, please explain to me, is what I'm saying. I know nothing about this culture. I mean, honestly, I know a little bit more, maybe. But I was not a Dungeons and Dragons kind of kid or whatever, you know, I was checkers or, you know, go outside, you know, football, whatever. Again, no insult intended. Anyway, this guy called me who I know, and he's like, you know, you know, it's like, I think you might be interested in our company is like, we are like facing an existential crisis. Because of course, you know, you think about

what's in the game, it's board, you know, the board and those sort of cards, and then the pieces. Well, that's, that's all manufactured in China, or Vietnam, depending on the on the company. And this is, you know, they're talking about raising their costs 50 100% now that they can't do that. And this particular company, like a lot of companies in this space, the joy of being a reporter is the things you learn about that you never knew before. So I didn't realize this. But for these, you know,

very sophisticated games, I mean, they're expensive, right? We're not talking like, you know, $20 for the Monopoly set, right? This is like a hundred, $150 game. What they do is they sort of put out a call early that we are thinking of making this game, and it's got some kind of whatever fantasy narrative to it. And people kick in money for a Kickstarter,

and they raise the money that way. And it's about a two-year cycle from sort of conception of the idea up through when you sell the game and you know they price it out and people pay in and then when the game is ready they get it. Well they've now sold a bunch of games based on their cost projections from two years ago and you know this is a successful company. So he was explaining to me the process of how they price. And he's like, look, we try to take into account the unthinkable, you know, what if postage goes way up?

What if there's like a natural disaster that interrupts the shipping lanes between, you know, here and Asia? And they build that all into their pricing model. They did not three years ago build into the possibility that Donald Trump would not only get elected, not only impose tariffs, but be calling for a 54% or maybe 104% tariff.

104. 104. On China now. Yeah, yeah. And he's like, what do we do with this? I mean, they've sold the product, they now owe it to people. It's gonna come over, it's gonna cost them twice as much.

I mean, they're gonna lose money on these. I mean, they are going to lose money on every single unit if this tariff stays in place. So I thought that was a kind of interesting way to kind of get at a kind of inside, you know, what is it, how do tariffs actually work at that sort of business firm level? And you know, and this is like a small business, you know,

it's eight employees and, you know, it's not talking to them, this is not, you know to them, this is not making an impersonal making of widgets. They think of their buyers as like a community. This is, again, not my world, not your world, but- Well, and you plan all this stuff ahead. I think the interesting thing is that it's like, oh, these tariffs are going to come on by April 2. It's Liberation Day.

That's not like how businesses work, that they can just flip the on like such a huge change in their cost and only a month. I got a text from a non-political friend of mine. This is like a little bit maybe the other side of the market from the board game market. But he had a friend who texted him that was importing kind of high-end house interior stuff, like the kind of marble or, you know, whatever from that you that you you know Only can get from certain countries around the world They're like we ask your political friend like is this gonna be around for a while Like is this is this you know gonna go away? Is this a bluff?

Like what is happening right like for people who did not like engage that closely in the political campaign who were running businesses I do think it's just been a shock to these types of smaller, you know boutique businesses across different sectors that I don't have lobbyists like weren't Contemplating the idea that the marble they import from wherever it could go up by whatever random Percentage that country got on the big billboard that Donald Trump made with the bad math. Yeah, yeah, I mean they had no idea and they still can't plan right because he's all over the place. I mean even within the span of a day you're getting ten different messages from ten

different members of the administration. I mean it's a it's a bad idea executed badly right. They can't plan and I actually did talk to the trade group for the toy companies and the small gamers. That's what they said. I said, look, isn't the whole idea here to bring this production back to the US? Can you do this? He's like, we can't plan on that. He's like, we have no idea what this is going to look like in a month or five years. Not just screwing small screws into phones.

They're also going to be hand making individual pieces of the Dungeon and Dragons board game here in Michigan. That could be a new job coming to Michigan from the fired government workers. Who knows? Displacement is happening. On the fired government workers, your healthcare is like really your go-to area of expertise. So you've already written a newsletter about kind of the dramatic changes we're seeing at HHS. What from your reporting,

has struck you the most as far as potential ramifications from changes at HHS? Yeah. Yeah. I mean, there's so many. I'll just mention two that come to mind that we've talked about. One is this stunning gutting of future research and innovation and science and it's at all levels. I mean, there's the immediate freeze and canceling of so many ongoing studies and grants into, you know, things like Alzheimer's and cancer, things people really care about and should care about.

Again, as with the tariffs, in the most clumsy way possible, right? I mean, it's not just that they're canceling, they're sort of taking away the funding through the National Institutes of Health of all these medical studies. This is very random, when they hit Columbia University with all these funds, I mean,

the list of ongoing projects that just lost their money, I mean, it was everything from people studying ways to combat osteoarthritis, right? To, I guess, a cancer or Alzheimer's. This was in the name of, in theory, punishing Colombia for not cracking down on anti-Semitism. And whether you take that seriously or not, I mean, whatever. But even if that was the goal, what does that have to do with a cancer study? Why would you defund seriously or not? I was just like, what? I mean, whatever. But even if that was the goal, what does that have to do with a cancer study? Why would you defund a cancer study?

That makes no sense at all. So you have that sort of immediate effect. But then I just think it's just the sort of longer term effect, which is there. And there are so many scientists, young scientists, who are now not going to go into the field. They're not going to get started. And, you know, this is a classic case of a sort of, you know, the impact is we won't feel this tomorrow, right? We will feel the impact in 20 years when we don't

have a cure for something we might have because that scientist, you know, is going to go into some other field, you know, that skill set. And one thing I just I keep coming back to is I think about this. I mean if you sort of listen to Mosker, you'll listen to like Russ Vaught, or any of these people who are sort of on this crusade. And there's just this implicit denigration, right, of these like researchers. And as if these were like people,

kind of exploiting the public till for their own good. Middle managers in the HR department who aren't doing any work, you know, who or whatever like working eight working bankers hours like, yeah, sure. That's just not, that's not the fucking scientists at HHS. It's not, it's not the scientists at HHS or the university. I mean, almost by definition, if you have the skill set of that scientific level, and you're at a university, or you're at HHS, you know, employee pages, you can make a lot more money than private sector. Oh, yeah, you're not there to get rich. You're there because you care about this

as an intellectual project as something good for humanity. And look, I mean, every, I know, large people are certainly well paid, they're not suffering. Sure. I live in a university town, I'm married to a professor. So I mean, I know a lot of people are certainly well paid. They're not suffering. I live in a university town. I'm married to a professor. So, I mean, just to be, you know, I know this world. These are not people in poverty or anything. But like, you could be making a lot more money out there. The fact that you've decided to be in a research, you know, or in the government says that you

actually care about this. And this denigration of these people is something that just, we saw this also, I think, you know, I was thinking about, I've written about this too, we've talked about, you've talked about this, I know, with the people working at USAID, people working on PEPFAR. If you have the skillset, medical or administrative,

that you can make a lot of money in the private sector. And instead, what are you doing? You're working on getting drugs, life-saving drugs to people with malaria or HIV. These are the people we're denigrating? I mean, what are we doing here? I mean, what kind of value system is that? Putting aside the kind of all the firings and all the fallout from that, because you're

going to be back on this pod talking about that a lot, I think, over the next few months. Just also just like the straight health changes that we're seeing already from HHS, maybe not from HHS, but the impact of the rhetoric coming out of RFK maybe is having an impact. So we've seen now two measles deaths of children in Texas, and I guess RFK is, I gave kind of a tepid endorsement of the MMR vaccine, you know, in reaction to that. But what else are you seeing in that part of the health space?

Yeah. I mean, you know, it's kind of amazing. You know, it was tepid. It was a clear sentence, but it was like sentence 22 of a very long statement. And it was just like it was a perfunctory, you know, the MMR vaccine is an effective way to resolve this or something like that. It was like just a very perfunctory statement, which is better than nothing, you know, better than saying, hey, you know, one thing to consider would be beef tallow as a solution to this, but like, you know, it's not great. Right, right. Well, and I don't want to sound paranoid, but have you noticed that we haven't actually heard him say that? It's a great point. These are statements. I mean, Bobby, it's Bobby. I think we should take the MMR vaccine.

Yeah, we haven't heard him rasp that out yet. I don't think it's on video. I'll be curious about the backstory here. It turns out how those came to be and what he actually wanted it to say, whatever. I'm sure that will come out at some point or maybe I'll find out. He is promoting this as this great health agenda, right?

I mean, that's something make America healthy again. And the gist of the agency is to emphasize his idea of what makes people healthy, you know, which is no vaccines and, and, and, you know, there's some parts of it that I think lots of people think, oh, that's, you know, let's get rid of artificial food dyes. Let's encourage healthier eating. Sure. I mean, that's, you know, that sounds great. But, you know, HHS does a lot of stuff to make people healthier, to keep people healthy. And all those departments are getting gutted. We see that at the CDC.

He keeps talking about we wanna do things for chronic health. We had all kinds of people working on HHS, whether through government insurance programs or direct provision of services that are trying to work on chronic disease and make people better. They're all losing their jobs. This idea that he's this sort of crusader for health, I think even if you put aside

what he thinks and some of the scientifically nonsensical views he has. I mean, even if you accept that that's a sort of reasonable, you know, kind of agenda, which, you know, I think most scientists would, you know, he's actually, he's just dramatically diminishing the staff of people whose job it is is to make people healthier. So how is that gonna make people healthier? I just don't, I don't, I don't see it.

It's nonsensical. And, you know, my sense is, you know, that I can't tell how engaged, I mean, I've talked to people, it's hard to know how engaged he really is on an admin. This is not like a master administrator we're talking here. Somebody really knows how to manipulate the sort of bureaucracy. So it's hard. It feels like, I mean, at least partially, maybe it's kind of a Trump 1.0 version of

him is like, he's getting some of his people in there, like Dr. Casey Means and Cali Means. There are some cranks and random weirdos he's got in HHS, and you've got to presume those people are doing something. Yeah. Yeah. He's getting his people in and getting the people he doesn't like out. The amount of expertise they've sent out the door is just stunning. The sort of best known at this point, I think, is Peter Marx, who was the top vaccine safety official, who tried to be, according to Marx, really tried to be accommodating. Marx said, look, if you want to really look into this autism vaccine link that we've debunked repeatedly, sure, I'll help you do that. And I think Marx probably thought, OK, we'll debunk it

again. And according to Marx, that wasn't good enough. Reading between the lines, I think he thought Kennedy wanted to stack the inquiry against vaccines. And Marx was like, no. But you're losing all this institutional expertise. And that gets back to what we were talking about earlier,

which is institutional expertise in something like this is so important. Someone told me that it's going to seem like a sort of random and silly thing, but there was an official at NIH whose job it was, was like the sort of most knowledgeable person, like more or less on the planet, on how to run a clinical trial, just the mechanics of how to do it,

how to do it safely, and what protocols, and all that. And that person's gone now. And you know, that's not like super sexy, right? It's not the person who's, you know, doing the cutting edge, you know, cancer therapy. Seems pretty important though. Right, right. And you know, that person's gone. And like, you know, at every level now, it's going to be harder. People, you know, at any dealing with NIH is we that much slower, that much harder, that much more prone to failure. And these are the kinds of things that set us behind. And I think I just, this is the part of this that just blows my mind.

Maybe I'm naive, but even if you don't agree, you know, whatever, you know, sort of the sort of, you know, MAGA view of the world, you know, it is supposed to be about making America great. And if you thought about like, what is America actually great at right now? Biomedical research, like we are the world leader. Why? I mean, there's nothing ideological about biomedical research. Like, why would you want to undercut that? I mean, it doesn't even make, I don't even understand it from the MAGA point of view.

I mean, I do, I understand where it's coming from, but it just seems so obviously self-destructive. That's the craziest part. Like, it's hard to even see what the political advantage is. Like, it just seems totally, to get to our next guest, like, reactionary and crazy and just like living in a cave. I understand, like, the rationale for we're going to reform the way we do Medicaid and Medicare, and there've got to be certain cuts to those programs. And so, you know, we got to be certain cuts to those programs and some, you know, we got to means test it. Some people are getting that they don't deserve and maybe there's some fraud and maybe we shouldn't give that, whatever. Like there are at least

are like rational arguments for all that. Like we can't afford all the services that we're doing like because the scale of that spend is so relevant towards like the debt we've accrued. I'll have a rational debate with people over that and what the right amount of reform is on all that. Cutting the NIH scientists might cost money, probably. In the long term, it will probably cost us money because of whatever fucking disease we don't solve. Then we have to send those people into the Medicaid and Medicare system. Anyway, send those people into the Medicaid and Medicare system. Anyway, we will do a deep dive because this is going to be one of basically two crux points of the big tax and budget bill that's going to come this year is what these guys do with regards to Medicaid cuts and Obamacare extensions, etc.

Why don't you just give people the biggest picture outline of what you think is coming What like the big you know fights are over and then we'll do a deeper dive on that in a couple months when when the Rubbers meet in the road Yeah, yeah, so I mean, you know look they're writing this tax bill. They need to find money to offset The amount of money that you lose in the taxes, we think they do, who knows? Maybe they will, they won't, whatever. But they're looking for savings. And of course, they don't like government.

Our concern is who have very principle, they don't think government should be in the business of health. They want to minimize government's role in healthcare. And of course, we have this program, Medicaid, gives coverage to more than 70 million, mostly low income people. Mostly it's sort of working age people and children, by sort of in terms of numbers of people in the program, although most of the money in the program

is actually a very big chunk goes to people who are either elderly or people with disabilities. Medicaid is the single biggest finisher of nursing home care in this country. So they need to find the money. There's a couple of different ways to do it. The biggest gun they could fire at Medicaid would be to really make a radical change in its financing.

The federal government provides the majority of the money. States make up the rest. You could cut back on what the federal government is contributing in any number of ways in a very significant way that would leave states on the hook for much more and most states would not be able to afford it, so they'd have to cut back. This is the kind of change they've talked about. They've talked about this for decades

when they were trying to repeal Obamacare. It was part of the Obamacare repeal legislation. It's the toughest to do politically because it puts states on the hooks, including a lot of red states. And it's gotten some attention in this round, although we've heard a lot. It doesn't seem to be the number one item on anyone's list,

because it looks like a benefit cut. It looks like you're cutting Medicaid. And politically, that is dangerous at this point, especially including many red states. So that is one possibility, very real, but at this point doesn't look like the most likely. There's sort of a second category, which I do think is much more likely, which is they will, you know, looking at work requirements, work requirements, ideas that you have to demonstrate that you're employed or have a good reason why you're not in order to get Medicaid

benefits. It polls well in general, if you take a poll, and it's an easy way to get lots of money. Pete Slauson Is it though? I mean, like in the grand scheme of things for how much that they're gonna be cutting in taxes, is that a big enough ticket item to get to the trillion that they're trying to cut? Well, it depends on how they do it with any of these things. You can sort of dial it up or dial it down.

But the general rule is if you're getting a lot of money out of it, that's pretty good tell that you're not just getting people who you know, the general rule is if you're getting a lot of money out of it, that's pretty good tell that you're not just, you know, getting people who, you know, this isn't just about getting lazy people or encouraging people to work. I mean, we've done versions of this before. And what ends up, you know, most people on Medicaid are working. And if they're not, you know, it's because they're a caregiver, they have a disability, they're in school.

So you're dealing with a small number of people who don't qualify for the program if you have a kind of work requirement. But what happens in practice is it's quite difficult always to sort of verify your work status. There's all this paperwork that gets done. You're dealing with a population, low income, maybe doesn't have great education, hard to navigate the system.

And every time this has been tried, the same thing happens. You end up tons of people who qualify for Medicaid have satisfied the work requirements and need it, don't get it. They get kicked off the rolls. They get caught in this bureaucratic hell. You spend so much money on the administration that that eats into the savings. Mad Fientist Then people end up in the emergency room and they're getting treatment anyway because we're not leaving people to die.

Yeah. Maybe not the most efficient. Yeah, yeah. Doge, though, Doge is focused on efficiency. It's right there in the name. Right. I saw that. I read that somewhere.

It's efficiency. There is a third category of what they call waste and abuse, which is a broad category, which there are some financing games. States play all kinds of financing games with the system as they all do. There's certainly a case for clamping down on those. Although- That's not going to be where the big fight is. The big fight is going to be on how to actually significant substantive cuts to try to get

the ticket price for these tax cut extensions down. That's really what it comes down to, right? It does, it does. And, you know, the politics of this are very interesting because, you know, historically, you know, here in the world of healthcare, you know, the assumption was Medicaid was weak politically. It wasn't like Medicare.

Everyone pays into Medicare, everyone gets Medicare. We've seen in the last 10 years, that's actually not true because Medicaid is so woven into our system at this point. So, you know, nursing home care, which I was mentioning before, but also the hospital system is sort of, you know, the economy of a hospital's markets depend on it. It's really important, especially in rural areas. And then that gets to this politics of this is cutting Medicaid hurts a lot of red states,

a lot of red districts. It's been, literally all of us who've been watching this have noticed one of the, on the Republican side, as this is sort of starting to get some conversation, I mean, you've heard skepticism from the usual suspects. Lisa Murkowski, famously a defender of Medicaid, in part because in Alaska, the native Alaskan population has been the main beneficiary of expansions of Medicaid.

This is a big reason she voted against Obama repeal back in 2017. Well, another Senator who's been quite outspoken of all is Josh Hawley, and not exactly a flaming liberal, but Hawley, Missouri is one of those states where they had a voter referendum. Voters overwhelmingly approved an expansion of Medicaid so that it now covers everybody with incomes up to or just above the poverty line.

And the way my understanding is, this is a little fuzzy, but my understanding is the way it's worded in Missouri is that that amendment is that if the federal government somehow pulls back on that money, that amendment is still enforced. They still have to provide that Medicaid cover. So Missouri is gonna have to find the money for it. It's a big ticket item, you know, they're gonna have to raise taxes, cut education. They don't want to do that. So Hawley has been quite vocal. He doesn't want to cut Medicaid benefits. He said work requirements may be interesting. So I think that's something to watch. And you know, in the House, I mean, there's a lot of, you know, you can look down the

list, I mean, of the vulnerable Republicans, there's at least 20 in districts where they've expanded Medicaid. And you know, for most House members, the single biggest employer in their district typically is the hospital system at this point. Hospitals. So, they're going to hear about it. Jonathan Cohn, so good. We'll go way deeper on this in the future.

I appreciate you very much. Welcome to the Bulwark. It's good to have a policy nerd, not a Dungeons and Dragons nerd, but a policy nerd on the staff and we'll be chatting with you soon. Thanks for having me. All right, everybody.

Up next, Mark Lilla. All right, we are back. He's a professor of humanities at Columbia University, author of the Once and Future Liberal. His latest book is Ignorance and Bliss on Wanting Not to Know. I'm relating to that right now. It's Mark Lilla. Hey, Mark. Thanks for coming on the pod. Glad to be here.

For folks who aren't as familiar with your work, I thought maybe it'd be a good place to start just by giving us a little kind of penny tour through your backstory and your political journey. Well, I guess relevant to this podcast, I got involved in intellectual politics when I became an editor of The Public Interest back in 1980 and worked for Irving Kristol and ended up going back to Harvard to get my PhD and worked very closely with Daniel Bell and Nat Glaser and New Pap Moynihan. And so I was part of that whole world and then found myself drifting away from it in the 1990s as the neocon world changed, became more populist. And since then I've been, you know, I feel like

I'm the last Mohican of the Moynihan tradition among my peers, I guess me and Leon Weasel's here. Well, maybe Bill's kind of returned back to you. Well, he has. Maybe lost a lost sheep in the, you know, and then has kind of come on back into the flock. Prodigal son is back, right? Yeah. I was a big car and tail fins. Yeah, yeah. So, you know, I got my PhD. I'm now a professor at Columbia. I've been at Chicago, been at NYU. And my main place to write has been the New York Review of Books, though now I'm also

writing regularly for Liberty's quite happily. If your listeners don't know what Liberty's is, it's an extraordinary quarterly edited by Leon Waseltier that is as close to you can come to the partisan review for our time. And so I find myself in this position of being the kind of centrist realist who annoys progressives. And I still have relations with people on the conservative side, and I write about what's going on in the right, mainly with a broken heart.

My books, I have been, I've mainly been, I guess you might say, studying the dark side of the street. My interests have been in the counter enlightenment, in the radical right, and have a couple of collections with the New York Review called the shipwreck mine, the reckless mine. A few years ago, I blew up the internet with an article in the New York Times called the end of identity Liberalism, which turned into a book that did not blow up my bank account, but still it's out there. Well, so this is where I first came to be aware of you was, I wish I could say it was

my, you know, reading liberties quarterly, but it was from the Sam Harris podcast when you were speaking about this a while back. And so I want to get into your new book and your coverage of the reactionary politics. If we could just spend a moment on the kind of democratic side of the aisle. You wrote then in that once and future liberal, you write as a frustrated American liberal.

You had written that liberals bring many things to electoral contests, values, commitment, policy proposals, but they have not brought an image of what our shared way of life might be. Then obviously then you wrote into kind of identity politics and how that fragments. I just would wonder if you'd spend a moment kind of trying to encapsulate your arguments there because they're very relevant right now as those are the types of things a lot of Democrats are reflecting on today. Yeah, it's sort of become common wisdom now.

It was not when, you know, I first wrote in 2016. My argument is not so much that the Democratic Party is not middle of the road. It's rather that ever since 1972 or so, those on the liberal left in 1972 or so, those on the liberal left have thought of themselves as belonging to a number of different movements connected to various causes. At first it was particular causes like Vietnam, the environment, feminism, and so on. And progressively it became divided up by identity groups. But what Democrats lack that Republicans have is an idea that while there are causes, there's also the cause. And that without securing electoral power, we can't do anything about the other little causes

that we're interested in, but we're not adapted to talking to each other even about what our larger purposes are, what kind of society we see, what kind of vision of America inspires us that in fact is inclusive, inclusive in the best sense. So I talk about the potential glue being a heightened sense of citizenship and giving

that a kind of content, a kind of social citizenship as well for understanding our commitments with the welfare state. That's not to disline from kind of something that Westmore, the governor of Maryland was talking about when I interviewed him a while back and trying to kind of encapsulate how, I think he called it like a liberal patriotism, which is in some ways has a relationship with citizenship. I'm just wondering, is there anything out there that you've seen that has encouraged you or that has animated you coming from, you know, folks on the left who are trying

to work through all this in the fallout of the election? Well, not yet. What I didn't say about the book is that I especially focused on the atomizing effect of identity politics on the liberal left side. And so in terms of developing a comprehensive view that people of every class could relate to of what a good America would look like, we're still stuck being hated, you know, in nine-tenths of the country. I've not seen anything as I relate in somewhere I wrote that after I wrote my New York Times article, I met with some people by setting up summer schools that would be like the ones that exist on the right. So hair tog and AEI and all those things that create a whole cadre of people who are trained to think about the cause

in terms of both serious books, but also in terms of policy and meeting political actors. We've never had anything like that on our side. And so I circulated a kind of mission plan to various people, talked to Senator Bennett and so on, and various foundations, and no one really nibbled. And finally, one of the funders took me out for a drink. He said, look, I love this thing. If I had the money, I'd do it myself. Let me tell you why it's not going to happen.

He said, people in my class, the donor class, don't understand what you're saying. Why? Because they think their idea of engaging in politics is to do three things in this order. To focus on an issue, to focus on a candidate, and to focus on the next election. Whereas when I was at the public interest in the 1980s and these summer schools were starting, and I'm working for Irving Kristol and the student newspapers

are starting, there was a sense that you had to grab a whole generation and educate them and get them to know each other. And now of course as you know better than I do, people in these quite large circles now, they date each other, they marry each other, they divorce each other, their kids are now becoming journalists and working in government. It's a whole sub world. But we on the democratic side are just all divided by our little issues. So I'm hoping this summer to devote some time to doing something either in Harpers or the Atlantic, laying forward this idea and seeing if anyone who has money in institutions is interested in pursuing it.

And the Turning Point USA side of this, you know, I go to their year-end thing every year just to kind of stay in touch with what's happening on the MAGA youth. And you know, I usually write kind of a funny article making fun of them at the end of the thing. But this year at the beginning of it, I was like, I had to include kind of a preamble, which is yes, there's some ridiculousness and some things that are noxious and horrific about it. But, and but, it's like hard to imagine a democratic version of it. And like, that's a problem. Right? Okay. One last thing on the democratic side. Is there any, do you sense in the people that you're talking to, obviously, since you're kind of a point person on a critique of identity

politics, I'm sure you hear from people, do you sense that things are really changing or that there's kind of a papering over? Do you think that it's sunk in the pernicious elements of it? Obviously, there were some good parts too. And people are know, pivot back, or do you think that that's more lip service at this point? My answer before January would have been that on the one hand, it's being institutionalized and in a way that it becomes anodyne, you know, despite the huge bureaucracies, but bureaucracies have trouble persecuting people.

When you have a small office, you can do it, but not when you have a whole bureaucracy. But then Trump comes along with his anti DEI campaign, throwing the baby out with the bath water, striking the fear of God and everyone. And, you know, I'm in one of those positions that people who follow politics are often in where we don't like the way something is done, but are glad that something pernicious is gone or is leaving. to rethink affirmative action, because I'm still for affirmative action. The problem is that it got generalized so that it applied to all these different groups,

where essentially the original concern was it still ought to be Black America. But it's hard legally to do that, to focus, right? So I'm hoping a reset will allow universities and businesses to do this in a more informal way, since obviously people in these institutions are committed to it, without the mandates coming from above and without the bureaucracies in our institutions. Before we get to the book, one other of your kind of past focuses

I just wanted to talk about a little bit was reactionary politics. I was watching an interview you did with Andrew Sullivan where he asked you to explain the difference between kind of conservative impulse and the reactionary one. Well, I think the interview was like eight years ago, but it feels extremely timely of a question now

So I wanted to re-up it with you. Yeah. Yeah, it is I think Well in my view We have two Ideological pairs of adversaries in our political thinking and also in our political engagements. The older one, it's older in a sense in the American sense, but the older one is the tension between liberals and conservatives. And that difference, to my view,

rests on serious difference in the understanding of human nature and of the nature of society, that is how human beings interact and therefore how institutions should be shaped. And conservatives have a more organic view of society, of individuals relation to society, contrary to the advertising. In fact, genuine conservatives ought to be in favor of constant change because you're changing according to new conditions but it's done slowly and organically. Liberals on the other hand stress, so that's

oak shot right, liberals on the other hand stress individual initiative, our freedom from organic society even while being part of it, and feeling that the conservatives underestimate individuals and underestimate what we can do collectively. Okay, that's one pair. Then the other pair, which grows out of the French Revolution, are two ideologies that are not about human nature, but about history, about the nature of history. And both of them share a kind of apocalyptic, messianic view of history. So one is the left revolutionary tradition

from the French Revolution through the Russian Revolution, Chinese Revolution. And that's the idea that the fundamental struggle is over the course of history. Who's going to control the future? And the understanding that something is built up in history that then has to be grasped and then pushed in a certain direction. And so on the left side the idea was that you would bring to a boiling point the contradictions of capitalism

and out of that you would get a new society. Reactionaries on the other hand, had this mindset that there's been a rip in history, that there was a time in which we lived pretty well, organic society, communities and all the rest. And then one day there was a kind of natba. And something changed in the West or in the United States where after which everything that was valuable and organically in our society came under attack. Individuals became less virtuous, less happy. We became a country of radical individualists, whether it comes to our social behavior or it comes to our economic activity.

We end up with an atomized society and we end up just being soulless cogs in a big machine. And so there, the reactionary though has two impulses. One, possible impulses, one is to let's go back to the past. And certainly one sees that on the right today. And it's been there for a while. The other one, and this is closer to Trumpianism, the other reactionary view is that what we want to do is move into the future, but inspired by the past so that we get a new muscular future that's inspired by the way America

used to be. But it's going to be not bucolic, but rather it's going to be muscular and strong and authoritative and all the rest. In both of those positions, the nostalgia for the past and the idea of leaping to the future are deeply anti-liberal and deeply anti-conservative. It's funny listening to you talk about the, talking about this with Andrew, like the concert that concerted impulses you describe it, right, the communitarian, you know,

like the society matters, community matters, it should, you know, make change slowly, be skeptical of change. And that impulse is just like completely non-existent. Like just listening to you describe it was very clarifying in that, you know, was very clarifying in that we are very much in a reactionary moment and there are different strains of it, right? You've written about kind of the radical Christian nationalist side of the reactionary movement

that we're seeing on the right, and then there's more of the tech version of that. But do you think that is right? And that kind of reordering feels like a semi-per... Nothing's permanent, right? But that reordering feels like it's here to stay for a little while to me. I don't know. What about you? Yeah. Somehow an aquarium has been turned into fish soup and we have to figure out how to turn

it back into an aquarium, right? Well, it's been interesting. I mean, if we talk about personalities, what happened to Rod Dreher or what happened to Patrick Deneen, they began speaking like the genuine conservatives. Rod more in a kind of Blakeian romantic view of the past where with Patrick, it was more old small town America. It was very attractive. His first book was really good. I mean, his first political book. And then something happens and Trump coming on the scene and Orban coming on the scene.

Somehow flipped a switch in the minds of certain people. somehow flipped a switch in the minds of certain people. Now there's still some people on the right of the old style, I think of Yuval Levin, and I'm sure there are other people at AEI that you can come up with. But this toxin has entered the bloodstream. I mean, anybody that you name, and with love to Yuval, is not really part of, meaningfully part of the party right now, you know, in any meaningful sense, for as far as power

is concerned or influence. As far as comes to power, that's right. That voice just gets killed. So I spent a week, I was invited to teach in the summer school at the University of Austin in Texas two summers ago. And it was weirdly schizophrenic. So they have these courses that are called like forbidden courses. Just for people who don't know, yeah, the University of Austin is kind of the Barry

Weiss and some other folks did kind of a spin off. Quasi-University, it's not, I don't think it's an accredited university at this point. Yeah, I think it is. Yeah, it's more for like challenging, you know, the status quo, challenging the way the universities are teaching our kids. So anyway, just to give people that mostly from the right perspective, just to give people that backstory. However, the president of it, Pano, I forget his last name, a Greek name, he was the

former president of St. John's. And so when he came on, the vibe that was given off of it is that actually we're going to be kind of St. John's University with students who may have these right wing politics, but they simply want to get away from a liberal environment, but we'll do what St. John's did. And so I gave a course precisely on this subject, the difference between conservatives and reactionaries, great kids from nine in the morning until two in the afternoon. And then there was an afternoon program where it was, you know, it was just flag waving, owned the libs, all these odd tech types who came in from Silicon Valley, futurist types, some of them talking about René Girard and all the rest. And it was

just, and the kids themselves and it was just, and the kids themselves noticed it. They said, you know, we're getting whiplash here, going from reading Roger Scruton and Michael Oakeshott in the morning and talking about DEI in the afternoon as if they're connected. It's one thing if, you know, you go to your study and study the great Brooks and then you go out for the fight.

But there's this impression that these things have to connect. And it was a big disappointment. I had some hope that maybe it would work out, but it's not. Okay. Let's get to your book, Ignorance and Bliss, because there is, I think, a through line here and a connection there, which is one of the lines you have is that reactionary politics are flourishing in our liquid world should surprise no one.

So make this connection for us to why, to the book, and to like why you think this might be happening now in a deeper kind of level. Well, just to give a super quick pracy of the book, it's something I began working on 25 years ago when I gave a lecture at Chicago on this theme and was picking up on picking at over the years, the book is really about the human desire not to know and what the psychology of that is and what the implications are for our beliefs about

the soul and God and spirit, how we think about children and innocence, how we think about coping with the present and imagining a more perfect past. But the core of the book, the beginning of it, is kind of a, not so much an argument, as an unveiling of the complicated psychology or the psychological forces that were beset by to know and not to know. And so Aristotle says everyone wants to know, which is true, but the will not to know is really not explored much in the philosophical

tradition, but it shows up in literature, it shows up in myth. So I begin with the myth of Oedipus, who wants to know and doesn't want to know what his relation is with his mother-wife. And then St. Augustine, we move to the present. So it's a kind of, I call it a ramble through some of these issues that on a theme that no one seems to pay attention to. The theme being kind of like, why do we want to block out the unpleasant information essentially? Why is there this desire for ignorance?

Yeah, well, part of it is we couldn't get through the day if we didn't. An example I use in the book is imagine if everyone had an LED screen across the forehead that where you just had a tape of what they were thinking at every moment. And if you engage with them, they're thinking about you and you're reading about yourself and they're reading about your reaction to them. Works out on this podcast. Everybody's just hearing what I'm thinking at every moment, but maybe at society level

that might not work. Yeah, right. But you couldn't even develop as a self that you could know if yourself is nothing but the result of all this information coming in. So, there are all sorts of things we block. We don't want our movies to be spoiled. We wrap presents. Don't want to go to the doctor if you feel like you have a,

for some people, yeah. For some people, I don't know, the sex of your kid. So there are all sorts of ways in which we, certainly at my age, walking past a shop window is a very charged thing. I've got to suck my stomach in and hold my head in a certain way that it looks like I have more hair than I do. So we do it in life. But what happens is that at the much deeper level, we find it hard to cope with just the

human condition. And we find it hard to cope with death. We find it hard to cope with death, we find it hard to cope with uncertainty in particular. And so we don't quite know how to regulate our own curiosity or make sense of this desire. Some people are just naturally curious, we all know them, right? They're always looking stuff up online and looking at documentaries, and then there are people who generally think they don't need to know more than they do. And then there are people, and they're the interesting ones, who are really resistant to new information, right?

They have their views about things. This is my view about vaccines, and it's not going to change. And so I think about how people get into that sort of position. When it comes to politics, you can see how this would work itself out ideologically. But I also think we live in a special period, and that's what you mention. I've learned a lot from the books of a Polish sociologist now Dan named Zygmunt Bauman, B-A-U-M-A-N, that your listeners may or may not know. And he wrote a number of books with the word liquid in the title, the first one, The Liquid

Society. And he was former Marxist and he had this deep idea, which is that Marx's and Engels's idea of everything solid melting into air was for them a tragedy. They believed in solidity. And what they thought was that the sort of atomization of life under capitalism was unhealthy and we needed to move to a more stable, just society, which would be after the revolution. But we find ourselves living in societies not where, as in archaic societies, that the institutions we're born into exist where we die, or in a situation with maybe one or two things change.

But we've created a world for ourselves where everything is changing all the time. And with the internet, we're aware potentially of everything going on everywhere at all moments. We're not built to cope with this. We're not built to live this way. We were sort of built to live on land instead. We're all on suddenly on surfboards and The waves keep coming and we're just trying to stay afloat

And in that sort of situation this will the ignorance comes out as a kind of healthy one, too that people can't make sense of all this change and so they shut down. They have certain views about sex and gender, case closed. They have certain views about old America, case closed. Certain views about tariffs. Forget the evidence, right? That's the situation we're in now. Yeah, and in that sense, it kind of ties to this,

like why, because you could have imagined going the other way. I mean, like the tech utopians, like, made the opposite argument, right? Like, was that we are going to come to this moment where we had all this information at our fingertips, people are going to know more than ever. Like, it's not crazy to have thought that at this moment

we would have reached a time of peak curiosity and interest in what was happening. It feels like it's had the opposite result. There's been this retrenchment. To me, and to reading the book, and a lot of it goes away, you're back at Aristotle and Oedipus for a lot of the book, but it's like, to me, a lot of this most recent developments is really phone related. It's like at some level, this internal desire that we have to not want to know things that are unpleasant has been hypercharged by the fact that there's so much unpleasant stuff being delivered to us at once. Yeah, and the more information we get, the more we feel we don't control our environment.

And that's frightening. And the tech futurists, they have this idea that we're going to know so much. But a lot of what we have to know is what other people are like. But other people are changing all the time. And they're changing because things out in material life are changing. And so it's not that you, oh, we have this information that comes out from a stable world, and then we navigate it. It's not that.

It's that we're surfing and causing the waves at the same time. And so our ability to master anything is or when things go wrong, we don't have, you know, someone once pointed out to me that if you look at all the history of utopian schemes, none of them have prisons. They're ideal cities. You know, there's no sense that anything could go wrong, right? And the tech futurists are like that. They don't seem to want to recognize the limits of what we can take in and our need.

You know, we can't wake up every morning asking ourselves whether today is going to be a day when our parents love us or it's one of those days when they're not. We need to have a kind of continuity in our beliefs just to get through the day. If we changed our beliefs every second that we got new information, we'd be frozen in time. So we need to kind of commit to an opinion for a while. I want to close. I'm just wondering if you have any practical thoughts for the types

of folks that are probably listening to this. We have small, all-liberal listeners mostly, for the most part, and people that are more curious on that scale that you kind of laid out. But even with our listeners, I can just see it because we now know all the numbers, right? If I put up something that's like, this is going to be very bad news for Donald Trump, more people are likely to look at that than less, right? When I put up something that, you know, that folks that listen to this are going to find unpleasant either about what's happening in the news or what I think that the Democrats are doing

or whatever, fewer people are. Some people are going to be like, no, screw you. Why are you telling me this? That's not everybody, but that strain is in all of us. I don't listen to my favorite sports team's recap podcast after they lose. I only listen after they win. There are little examples of this.

Do you have any practical kind of thought, kind of thought, you know, having thought deeply about this, any practical ways for, for individually, for people to kind of navigate the ignorance and bliss? Well, with regard to politics, I guess the first thing is to notice what is happening. I mean, the, to, to notice this will to ignorance and how it pops up and it can pop up on every side. I mean, if you just look at the reaction of the White House under Biden and the press in his last years, the you know, strong refusal to believe their lying eyes was extraordinary, right? Yeah.

But the other thing in the moment is that, as you said, conservatism is dead. These people are not conservatives. And that you're up against reactionary forces that are all about will and not about understanding. And they have to be met by other sorts of needs. But we can give up, you know, our own quest for understanding precisely these things. So checking your priors and also just trying

to get used to uncertainty. When things change so much all the time, it's very hard to just sail forward and at least to be aware of that and what you're doing with regard to that. It just means more self-awareness. Mark Lilla, I really appreciate you. The book is Ignorance and Bliss. Thank you for coming on to the Bulwark Podcast and we'll be looking out for your writings

in the future. Stay in touch. I appreciate it. Thanks a lot. All right. Everybody else, we'll see you back here tomorrow for another edition of the Bulwark Podcast. Peace. Been drinking whiskey, I don't know what I'm saying But goddamn, I feel free

And I, feel like I'm out of my mind I'm high, don't pay attention to downsides As these days go by Go by While we pray, there's no laugh There's no laugh We never would've thought life would end up like this To sign a close, seeing things that naked I might miss The mind, it wonders

I find that it's harder to realize What the fuck it is we're doing this hour? This is a curse Excuse me miss, again I guess I'm in a fall Girl I'm pretty wise, I'm just a river I heard that every race is so that's what it is He's killed me, missed a kill, I guess I can hold And put up pretty white eyes, just to make it up

I heard it every time, so that's what it is The Bullork Podcast is produced by Katy Cooper with audio engineering and editing by Jason Brown.