Title: Pitching Pete Buttigieg My New Healthcare Plan
Channel: Doctor Mike
Run: 2026-05-05T12:40:20-07:00

SPEAKER_00: Today, enough people will die in car crashes to fill a 737. And that happened yesterday, and that'll happen tomorrow.

SPEAKER_01: Today's guest is Pete Buttigieg, former presidential candidate and secretary of transportation. Why do you think folks in the Democratic Party, higher-ups, have been so skeptical or nervous about coming into these new formats, Jubilee, podcasts,

SPEAKER_00: Generally, in my party, for some reason, there's a real allergy to taking risk.

SPEAKER_01: Of course, we talked about politics, issues like airline safety, autonomous vehicles, and various things he was responsible for a few years ago. But we also opened things up and spoke about his personal relationship with healthcare. Specifically, the life and death case of RSV his son battled with as a newborn.

SPEAKER_00: The image I can't get out of my mind is how tiny he was. all this gear coming out of his throat. There's only one question we really care about, of course, which is like, is he getting better? How will we know when he's getting better? And basically what they told us was, you'll know he's getting better when he stops getting worse.

SPEAKER_01: Please help me in welcoming Pete Buttigieg to the Checkup Podcast. Mayor Pete, Secretary Pete, what's... Let's just go with Pete. Pete. Oh, Pete. Okay, I like it. I'm excited for you to be here because you're a person that is in politics but out of politics. You're a person that thrives in a debate format. In fact, one of the most exciting things that I saw you do that I think not enough politicians do is step inside the social media world known as Jubilee surrounded. You sat surrounded by undecided voters and you took on tough questions. You were very empathetic in your approach, but at the same time, no nonsense. And I did something quite similar to that with individuals who are anti-vaccine. And then a second time for those who support the Maha movement or Secretary Kennedy. What are your thoughts or reflections on doing that? And what did you think going into that? Because most politicians shy away from that format.

SPEAKER_00: Yeah, I mean, to me, the beating heart of politics is persuasion. It's the idea that you care about something, you have values, you have ideas, you have policies that you believe in, and you want to convince people that that's the right way to go. So by definition, you need to be talking to people who don't already believe that. And I'm a little struck by how little of that goes on right now. Yeah, why is that? Well, look, I think a lot of it is the kind of the work of the algorithm, right? Social media tends, when it comes to politics, it tends to feed us one of a couple of things. One is, here's this person I already agree with doing something I already agree with, or it's, you know, here's this person I already don't like doing something that reminds me why I don't like them, right? Right, yeah. And part of what I appreciate about the Jubilee the Surrounded format is kind of by its nature, it's people with different viewpoints encountering each other. And it's interesting, it can be riveting, but it's also just important because it's that actual work of trying to convince somebody of something, or at the very least, hold your own for what you believe, talking to somebody who believes the opposite.

SPEAKER_01: Yeah, but you're also going to a platform where they have control over the edit, It's basically an as live format with people asking all sorts of questions. Any fear going into that? Because I know for myself, I was very worried that I felt like I was representing the entire medical community in those moments. Did you feel any of that?

SPEAKER_00: Yeah, I mean, I think anytime you go into an interview that's unfamiliar, there's a level of trust there. I mean, I've never interviewed with you before, right? But to me, again, part of how you, especially if you're a political figure, but any kind of public figure, hopefully you relish taking what you have to say to different places and different formats. And I'll be honest, I didn't know about that format until it was pitched for me to do it. But then in order to get ready, I watched some of the others who had done it, mainly people I disagreed with. I watched Charlie Kirk on Surrounded and Ben Shapiro. And in addition to thinking about what I would say in that format, it just helped me think about what I believe. And I wish we had more forums and formats where you see the two sides kind of encountering each other or however many sides there are to an issue. And it helps you figure out what you think. Sometimes the other side persuades you. Just as often, hearing the other side actually makes you understand what you believe better than before. But the point is you think about it. And I think that's just so core to what communications media public life should be about, but there's less and less of it right now. Yeah.

SPEAKER_01: Did you get negativity or any negative criticism for just involving yourself with that platform?

SPEAKER_00: I think it was a little bit of skepticism. Definitely some folks said, look, like you're, in fact, at the time, I was appearing as a campaign surrogate, like as a volunteer. But I also had the day job of being the secretary of transportation. So it was this question of should a cabinet official be doing this, even in a private capacity? But I think if you think anything's beneath you, especially when you're talking about ways of reaching millions of people in an electoral season, you're kind of missing what's going on in our current moment of politics. where, look, not everybody's looking to established credentialed institutional media to get their news. And I say that as somebody who actually believes that their role is very important because they have to follow journalistic standards that not everybody does. But that's clearly just not where so many people look to first. And it's less important that I agree with a presenter or an interviewer than it is that there's an audience that trusts them. And if there's an audience that trusts them, I should trust that audience to care what I have to say.

SPEAKER_01: Yeah, that's such a good point because a lot of times I'll get criticism for doing something like the Jubilee episode where some of the statements they'll say, why are you platforming, essentially platforming those who have anti-vaccine beliefs? You're giving them more credibility. Science like this that's well-established shouldn't be debated. And they say the same when I would make appearances on Fox News. They would say, why are you going on there? They're spreading misinformation and those are their beliefs. But I would say, if I'm not gonna go on there, then who is gonna go on there? And the problem will just persist. And perhaps there's something to be learned. Like I learned a lot from the participants who had vaccine hesitancy or even anti-vaccine notions, maybe not so much from a scientific perspective, but from a human standpoint of what their concerns were, how did they end up there? Because to me, the harsh reality is we, if guided a little bit differently in our lives, had we been in a different situation, could have ended up in that seat. And people neglect that for some reason, especially in politics.

SPEAKER_00: Yes. And that's one of the core realities of politics is, of course, if I had a different life experience and was raised with different values and had different surroundings, I might have different political values. And that's true for all of us have to admit that, you know, none of us got our, you know, many of us may have broken away from how we were raised politically or think I'm not negating that people think for themselves. I'm just saying that none of our political values are sort of linked to unambiguous cosmic truth that came down on tablets from the heavens.

SPEAKER_01: It's not clearly a genetic, it's nature and nurture.

SPEAKER_00: We figured out what we believe and other people have too. And we're all right about something and wrong about something. And I say that as somebody who's passionately full of conviction about the things that I believe in, that I care about, which is why I go out and defend them. But yeah, one thing you and I have in common, I think, is going on Fox News. And my view is like yours. How can I blame somebody for not agreeing with me if they've literally never even heard what I have to say? Of course they don't share my opinion.

SPEAKER_01: Or have heard it through a medium of someone else interpreting what you're saying, as opposed to exactly what you would want to say. Exactly. I saw you the other day on CNBC, I believe it was. You had a pretty heated discussion and you seemed very passionate. Maybe some would say riled up. Do you feel emotional in those moments? How do you control yourself? What's your strategy?

SPEAKER_00: i'm very passionate about what i believe in i don't think i'm like i don't gesticulate i'm not like as like you know uh um fiery or emotional you know kind of in how i how i express that usually uh but like i get fired up in the moment sometimes especially when somebody's saying something i think is not true or if i care about persuading them i mean i think there's again if if i didn't think it was worth challenging somebody if I didn't respect them enough to challenge them, there'd be no energy there, right? I actually like going in there and sparring with people I disagree with. I care about what they think, or at least I care about challenging what they have to say.

SPEAKER_01: And that challenge probably works in both directions, right? That by them challenging you, it sharpens your ideas or your understanding of your own ideas. Like I think about this perhaps in a heavy scientific notion where The first person that said there's bacteria in our hands and we should wash our hands was viewed as someone hallucinating microbes or these weird organisms on our fingers. So on one hand, we need to be careful with wild imaginary ideas and not treat them as if they're established before they are, but also we need to be able to test novel and breakthrough wild ideas in order to make the moonshot, the cancer moonshot a possibility or something like it.

SPEAKER_00: yeah i guess i guess i never thought about how this is something that policy makers and and maybe doctors have to have in common which is on one hand it's really important to have a sense of conviction and confidence in what you're doing and what you what you believe but you have to balance that conviction with some amount of humility like you could be wrong about anything all of us could be wrong about something right i think part of what's gone haywire in in the the maha stuff and the vaccine skepticism is kind of capitalizing on this thing that's very valid which is we're never a thousand percent sure about everything and using that to invalidate really sound proven effective ways of helping make people healthier or stopping them from from getting sick and dying yeah it's it's the big notion that i struggle with quite often where as someone who communicates on social media talking about medicine

SPEAKER_01: i have to hedge every conversation whether it's with an individual patient or on a public health scale to some degree because we don't have 100% certainty in healthcare. It is an art and a science.

SPEAKER_00: And because you have integrity, you will admit that as a scientist or as a clinician, you admit that, and a lot of the political figures or the conspiracy folks don't admit that there's any uncertainty about what they have to say.

SPEAKER_01: Correct, and that has their message sometimes land more effectively. So it's like they almost have this tool that we are not using because it's ethical to do so.

SPEAKER_00: But we have an equal and opposite tool, I think, which is that watching people be honest, contend with uncertainty, even revise their thinking over time based on evidence, I think is part of how you earn trust. That doesn't happen overnight. But I still believe that doing that in the long run wins out.

SPEAKER_01: I agree. I think that's really true. Why do you think folks in the Democratic Party, higher ups, have been so skeptical or nervous about coming into these new formats, Jubilee, podcasts? uh i know uh vice president kamala harris actually came on our show three days before the election that was a big deal somehow we ended up in her book i didn't expect that both fortunate unfortunate uh because she said her staff didn't prepare her well for the conversation we had um but why is that why is there such a fear of this format i think

SPEAKER_00: generally in my party, for some reason, there's a real allergy to taking risk. And I mean, everyone in politics has some relationship with risk, maybe some aversion to risk. You don't want to do something that will undermine your ability to win or your ability to govern. But I think we've gone way too far to an extreme on that, where because we're afraid of saying something wrong or saying something that's going to get twisted and used against us, We just don't say very much, or many in my party won't say very much outside of very predictable, comfortable formats. But it's increasingly the case that people are getting most of their information from alternative or independent media. And you can love it or hate it, but it's just true. Right after I came out of the cabinet, I did a stint at the University of Chicago, spent a lot of time with undergraduates. And I would always do a bit of a show of hands, try to see like, how many of you get your news by watching television on a television? And the answer was basically zero, right? And the other thing I would say is, especially these really long form podcasts that go an hour, two, three, The thing that might be terrifying to a conventional politician is that it is physically impossible to be on talking points for that long. Just as a matter of stamina, it's not possible. So you're gonna come off your talking points. And if you're not comfortable with who you are in those moments in between the things that you and your staff agreed or the things you're gonna say and the way you're gonna say it, then of course I would be terrified. So do you think the Democratic Party is not comfortable with who they are? I think many in the Democratic Party have that habit, but I don't want to say that's true of everybody in the party. I think many of the most effective voices in the party are more likely to do that. And of course, there's a generational piece here too, right? There's whole generations of public figures who came up understanding that the way you connected with people was through speeches that you wrote out and then delivered or short TV appearances that you knew the three questions you were gonna get asked and the seven sentences you had to say. And it's just different now. So I think a newer generation is more inclined to take those risks and more comfortable in those formats.

SPEAKER_01: Yeah. Did you experience any of that from being mayor, smaller town, then going into national politics where you had to expose yourself on that level to have success? Oh, totally.

SPEAKER_00: Yeah. So even what you'd call the traditional media had way more access to me as mayor. So in South Bend, we had four TV stations where South Bend was the largest community in that media market. and a newspaper uh and an npr station so i knew that somebody was going to if if there was any public question to be asked somebody either from the media or just a neighbor was going to get my face to ask it right sometimes you see these scenes of like a senator kind of walking down the hallway trying to avoid you know the reporters or like ducking into the elevator before anybody could talk to them or they actually get cornered and they don't know what to do That doesn't happen to mayors because- You're always ready for them. That's just your life. That's your daily life. That's your life. You go to the grocery store, you're pumping gas. Somebody's going to come up to you and ask you to explain why you made this decision to change how the trash pickup works or whatever. So I think you do build a different habit of mind when you're used to being as kind of ridiculously accessible as a lot of local leaders are. And I would love for there to be more of that in our national politics instead of the other way around.

SPEAKER_01: So more local in our national.

SPEAKER_00: Absolutely. I think that's important for so many reasons. I think local government, it's not perfect, but it's less partisan. It's less predictable. The factions kind of shift instead of you knowing exactly how some council member is going to vote based on what party they're in. And it's just more intimate, more immediate. And there's a clear relationship to results. I would actually say from a misinformation perspective, obviously there's rumors and falsehoods at the local level too, but it's much harder for that to carry the day locally because if there's a bunch of potholes, you can't just say, there's no potholes, right? Of course there are. You can't just declare that a problem doesn't exist. You're accountable for some very real hard facts.

SPEAKER_01: What are your feelings on TMZ being now in Capitol Hill and running around Washington, D.C.?

SPEAKER_00: Ambivalent, it's interesting. I think there's already maybe too much of a weird celebrity culture about how Washington treats politicians, but it's weird to see actual celebrity culture in Canada. It's usually just within that little circle that people care about.

SPEAKER_01: I've seen them now run up and ask ridiculous questions.

SPEAKER_00: i i feel bad because of that generational divide you talk about where they're asking them questions about some pop culture britney spears news of the day and i'm like oh my god what are they going to even say and they're definitely going to say something wrong yeah but that's where it's fine i think it's really important to just be who you are right because if you get some pop culture question and you know the honest answer as often happens to me with pop culture is like i have no idea like just say it and it's fine I think where you get into trouble is when you think you have to have a take on everything or you have to know this or that thing or whatever. Or when you're in one mindset and then you wind up getting pulled into the other. One time I did get, I think it was a TMZ camera, it was a TMZ style camera anyway. And I was getting ready to go on a Sunday show, like the ultimate kind of policy television format. I think it was CBS. I'm getting out of the car. I'm going on CBS Sunday morning. I'm thinking about what I'm gonna say about the president's infrastructure plan and talking points and defend the administration. And then they catch me and they wanted to ask a question about how Marcus Freeman was doing at Notre Dame as the coach. And somehow my brain was still in the mode of like, I know if I went back and looked at that game tape, so to speak, it would be me talking as if I was talking about the administration. When actually all I needed to say was like, I thought he was doing a great job, but you know, it's that kind of thing.

SPEAKER_01: Yeah. I could see how your mind would have to shift very abruptly in between a very important, serious topic mode to something sillier. It could be difficult.

SPEAKER_00: Well, especially like, it's easy for me to say like, you should just say what's on your mind. And that's generally what I try to do. But look, if you know that if you say a couple of things wrong, like that could move markets, which is true for a cabinet member, or if you mischaracterize something, even just in the way you phrase it, that could mess up a legislative negotiation or even cause a legal problem. Of course you learn to think carefully about what you say. It's just that there's a time and a place for that. If you're, I don't know, issuing safety guidance, you gotta be hyper careful about the exact words.

SPEAKER_01: versus if you're just trying to introduce yourself as a political figure to a new audience and kind of reveal a little about who you are so that people know who you are enough to appreciate what you have to say it's interesting that there's such a dichotomy between being careful in this way yeah and then on the flip side the flippant version of it where it seems like the secretary of health and human services says anything yeah even when it's just so obviously statistically false I don't know what the middle ground is. How do we bring people together here where outright lies are called lies and the truths are called truths? Are we losing sight of what that middle ground looks like?

SPEAKER_00: Well, I think the middle ground looks like acknowledging when you don't know something, right? So one thing that you ought to do when you're just shooting the shit on a podcast and somebody asks you about it, I don't know, in my case, it'd probably be some like music or sports thing I don't know anything about. Or if you're an official in front of Congress and you're getting needled on something, If you don't know, just say you don't know. That's definitely the most honest and probably appropriate thing to do in both of those modes.

SPEAKER_01: Well, let me ask you something you definitely know about. What's it like to be Secretary of Transportation? And for those of us who are not familiar with that cabinet position, what does that mean? What are you responsible for?

SPEAKER_00: Well, the things you would naturally think of as kind of planes, trains, and automobiles, right? And then there's a lot of things that people don't know as much about as part of transportation, like pipeline regulation and safety or running the Merchant Marine Academy. But I guess I would maybe explain it a different way, which is that the biggest thing you're in charge of is safety. That's the most important thing. And whether it's making sure a pipeline doesn't blow up or whether it is the aviation system and the air traffic system, you're responsible for making it as safe as it can possibly be. Then there's a whole set of things around infrastructure. So obviously the big project of the Department of Transportation when I was secretary during the years of the Biden administration was getting this huge infrastructure package delivered that would invest in our railroads and our bridges and our roads and our airports. And we did about half a trillion dollars that we got passed through. on everything from these little projects to fix a street corner somewhere to things like the Hudson River Tunnel was one of the biggest public works projects in modern American history. It would put $16 billion into fixing those tunnels. So there's that set of things. And then the third set of things is consumer protection and regulation, which frankly, under some of my predecessors, the department wasn't doing very much, but I thought we could be doing more. So the biggest example that people know about probably is the airlines or might've heard about. We found that airlines were not treating passengers well. We realized that we had a lot of authority over that. And we pushed the airlines, sometimes with enforcement, sometimes with legislation. We pushed the airlines to treat people better. We got people more than a billion dollars of refunds back into their pockets. We changed what airlines will do if you get stuck in terms of getting you a hotel or ground transportation or food or something if you're stuck and it's their fault. We made it easier for a refund to come to you without even having to ask. We pushed them on on-time performance and just having fewer delays and cancellations. So all of those are part of what a secretary of transportation gets up in the morning and worries about. First and foremost, it's safety. But it's all those pieces, keeping the system safe, building the system so it's better for tomorrow, and then making sure all the players in that system, from a trucking company to an airline, are behaving responsibly.

SPEAKER_01: Was there, coming into that position, was there something that you imagined would be an easy, very effective solution that you wanted to implement, but turned out to be way harder, way more difficult to actually have it come to reality?

SPEAKER_00: Yeah, a lot of the infrastructure projects were like that. You're just thinking, all right, there needs to be a new bridge here. Let's get rid of the old bridge, put in a new bridge. Not that I thought it was simple, but it was astonishing to see just how many things things, red tape, supply chain issues. Sometimes it had to do with workforce too. How many things stand in the way of that getting done quickly and affordably? Took a lot longer than I thought to get the infrastructure package through. It took most of the first year, even though it was very popular and both sides said they wanted it. It happened, but it took a lot of push.

SPEAKER_01: What leads to that delay? Just self-interest?

SPEAKER_00: Yeah, it's a lot of the kind of sausage-making of various senators or House members holding out because they want to see this, but it's the opposite of what one of your other holdouts wants to see. So you can do more of this, but less of that. And then you get this vote, and you lose that vote. I mean, it's really kind of the legislative sausage-making. So is it like process or persuasion or a hybrid? It's a lot of that. And it's resources. Even in a big department, the DOT has 55,000 people. But that's not all. I think there's this... idea that federal workers are these kind of faceless bureaucrats pushing paper. I mean, the reality is the single biggest organization within our department was the air traffic organization. Think of the air traffic controllers, the people who were doing that work. The other thing that was ferociously hard was modernizing the air traffic control system. It's something my predecessors had worked on. It's something I worked on. It's something my successor was working on. And when you have a system that is 24 by seven by 365, where there is zero tolerance for failure, built up over decades, billions and billions of dollars going into it, the complexity of getting it to change without any balls being dropped is just enormous. I knew it would be tough, but it was, you couple that with some of the dysfunction in Congress. Like we proposed a multi-billion dollar upgrade for the technology of the FAA. And Congress didn't pass a budget at all that last year. So of course we didn't get the funding for that. So you hit those kind of, that was the most frustrating thing when you have a political cause for what seemed like a technical problem. You're trying to solve a technical problem. Like how do we get enough air traffic controllers on station? Or how do we upgrade this piece of technology? Or how do we dig this tunnel? and the technology exists and the knowledge exists, and sometimes even the money exists, but you still can't get the politics sorted out. That was the really frustrating part.

SPEAKER_01: I mean, that's frustrating, I'm sure, to you being in the driver's seat of that equation. For people that are watching, that are so frustrated with the bureaucracy of everything, from getting a bathroom built in a city park here, the difficulty, the time, the money, high-speed railroad system in the United States. That's been talked about for ages now. It seems like ever since I was in school, that was a potential agenda item for people. How do we fix that moving forward? Are there steps that could be taken here or is this just the reality of living in a democracy?

SPEAKER_00: No, this is one of many examples where I think we as a country have tolerated the intolerable. And one thing that's intolerable is how complicated and expensive it is to build projects. So we did a lot to change that when I was there, putting a shot clock on some of the bureaucratic processes, saying, look, this has to be done in a year, or if it's incredibly complicated and the law requires it, you still have to try to get it done in two years or less. trying to cut through just some of the layers of paperwork that went into things, even making the paperwork not paper anymore. It sounds like super simple stuff, but it hadn't always happened in the federal government.

SPEAKER_01: Believe me, we still have pagers in the hospital. That's true. Yeah, I've always wondered. In fact, maybe you could explain

SPEAKER_00: faxes are still a thing with doctors?

SPEAKER_01: It's because insurance companies probably don't want to upgrade because then they have to pay out more claims quicker.

SPEAKER_00: How can you, I don't know, I just find that astonishing.

SPEAKER_01: The pager thing, I agree there's a reason for it. If your cell phone loses reception on a floor of the hospital and they can't access you, that's a patient could die. That makes sense. So that's like, okay, fine.

SPEAKER_00: But can anybody defend why you keep being asked to fax things when... That's terrible. So there is a fix. But as you know, there's institutional barriers. But yeah, there's not a simple silver bullet. But there are many things that can be done, some of which we got done, others of which, if I were king for a day, we would be able to do, that would lower the cost of these things. And a lot of it is to do with the red tape and all the kind of politics that get in the way of just getting things. I mean, think about this. This is not just affecting transportation. It's part of it. Congress hasn't actually passed a full budget on time since the 1990s. So just the most simple thing that any organization, not simple, but one of the most basic things that any organization has to do is to pass a budget. And in a normal organization, a company, you pass the budget for the year, for example, you lock in that budget before the year starts. We do it after the fiscal year. In some parts of government, we still haven't done for this fiscal year that we're like halfway through. So we're just used to that like it's normal. And it's one of many examples. Think of it this way. If I say the system is broken as a political figure, that would be a totally uninteresting thing for me to say, right? Like the phrase the system is broken is a cliche. People say it so much. Think about what that means. Like the system is what all of us depend on. If it's broken, why do we go around acting like it's not broken? And I see that in the way our, you know, the way money and elections works right now. I see it in how unrepresentative our Congress is right now. I see it in our economy right now. And I think all of those things need to be treated like they're the broken, broken thing that they are. Too often there's this kind of, this kind of inertia to just treat them like, well, yeah, we don't like the way it is, but there's no other way. Of course there is. People living in other countries have FAT trains, more affordably built infrastructure, more representative government, all the way down to just stuff like, one that really gets me is ID. So the fact that to prove you are who you say you are in this country, sometimes you need to find like a birth certificate sitting in a folder in a file drawer of a county health department somewhere. That they got faxed to them and it's blurry. You know, your social security card, like this one string of digits. It's like the most important string of digits in your life. It's on this flimsy... Most people in most developed countries have some kind of digital ID system. We don't. And we're just used to that, I guess. We have some serious catching up to do in the U.S.

SPEAKER_01: Who fixes the system? Is it legislative branch, executive? Does Supreme Court play a role here?

SPEAKER_00: All of them need change. So when I was running for president almost eight years ago, I proposed structural change to the Supreme Court because I think it has lost legitimacy. It's viewed as a partisan institution, and that is incredibly dangerous because we need our Supreme Court to be something that everybody, love or hate the decision, believes to be legitimate. And there were reforms you could make so that you didn't have this kind of grotesque scenario of people hanging on way longer and older than they should be there to time their departure from the bench so that when the same party is in power, we don't have to have that. Congress definitely needs to change. We've got 435 seats in the House. Roughly 40 of them are considered competitive. So one out of 10 House elections is one where you actually don't know who's gonna win before election day in a 50-50 country. That is nuts. Of course, it's not representing us if that's how it's set up.

SPEAKER_01: Is that because people separate into groups that agree with one another or it's a bigger issue?

SPEAKER_00: No, it's because they are separated from each other on these crazy maps. I mean, yes, in some cases, sure. If you got a one-seat election in a place like Vermont compared to a place like Alaska, the politics are different, sure. But the gerrymandering is out of control. And now it's this arms race where one side does it so the other side feels they have to do it to compensate for it. So until we have less of that, and that's just one of the problems. Money in politics, huge problem. Everybody hates it. The problem, of course, with all of these things about our system is you have to use the system You know, the only legal way to deal with it is to go into the system to change the system. But we've done that before as a country many, many, many times. I mean, people sometimes forget that many of the ways we set up our election, they're not in the Constitution. They're in law. Those laws could change and be better. And some of the things that are in the Constitution we changed. We didn't used to get to vote for senators. They were picked out by a legislature. Then we were like, no, we should get to vote on who our senators are. They changed the Constitution. So this idea that you couldn't possibly do anything that required a reform like a constitutional amendment is something we've kind of sleepwalked into when the reality is, you know, we have amended the Constitution almost 30 times. Sometimes we've changed our mind about an amendment. Prohibition, right? We changed the entire Constitution so that you couldn't get a drink. And then we changed our mind and we changed it back. Don't tell me we can't change the constitution to clarify on money and politics, for example, that a corporation is not the same thing as a person and that manipulating an election with money is not the same thing as ordinary speech. We just need to take bigger swings when it comes to reform.

SPEAKER_01: You mentioned earlier that if you were king for a day, you would make certain changes in the DOT. President Trump has used executive actions to make all sorts of rules, essentially, as some would say, a king might. Do you feel like that is a valuable use of power, perhaps not for the decisions he's made, but do you like the way the executive branch is going about that? Is that something you'd like to see more of or less of in the future?

SPEAKER_00: Well, I don't like it because I think it's mostly illegal. But there is an important point that I think my political party could learn from, which is they're doing lots of big things at the same time. And they're looking through all of the tools in the toolkits and picking up every tool they can to get their agenda done. Again, I wouldn't emulate the agenda, obviously, and I wouldn't emulate the illegal behavior, because a lot of the things they've done, then they get beaten back in court. But we did take a bit of an approach like this, again, when it came to things where we'd just been banging our heads against the wall, like getting results out of the airlines. So at one point, the kind of department lawyers came to me on this case where an airline was holding out on hundreds of millions of dollars of refunds. And they said, you know, we're going to get them to finally pay it back because they're legally required to, and there's going to be a fine of a couple of million dollars. I said, well, I don't think that fine really had much of an effect. So what if you add a zero? And it turns out we had the authority to just add a zero. And if they disagreed, to make it 10 times the fine. If they disagreed, they could take us to court. And we started doing much more aggressive enforcement actions. And what happened was the airlines did not take us to court. They settled with us because they knew we were on solid ground. other times we didn't actually have to use these big kind of big guns of federal policy we use transparency so we set up a website that just you can still find it it's called flightrights.gov i don't my successor is a was an airline lobbyist so he's obviously less interested in enforcing customer service regulations on airlines but i don't think he took this down if you go to flightrights.gov you can see this list little green check marks, little red Xs, kind of issue by issue on which airlines have which protections. If you get stuck, do they get you dinner? Do they get you ground transportation? Do they pay for your hotel? Will they book you on another airline? And what we did was we decided to put that information out. But first we told all the airlines that we were gonna put that information out. We said, why don't you look into your customer service plans and see if there's anything you wanna change before we make it really easy to find. And a lot of them did. A lot of them actually changed their policies because they knew we were gonna make it easier for a passenger to check their policies. So here you have an example Didn't take an act of Congress. It wasn't an enforcement action. We didn't have to take anybody to court. You were thinking like an influencer, a disruptor. I suppose, yeah, yeah. We're just putting good information out there. But the point is you've got to do both, or you've got to do all of the above. You've got to use all the tools that you have legally to get big changes through. And when you do that, you get results. And I think we should learn to be more creative legally, sound, ethical, but creative about how to take all these tools that are in the law and in the different levels of government and use them to get results for people. Because the whole point of government is to make your everyday life better, whether it's as an airline passenger or as a worker or as a consumer or as a parent, like the job of the federal government is to use whatever tools it has to tear down the barriers that stand between you and a better life.

SPEAKER_01: You mentioned airlines and my heart had multiple palpitations because of the state that our airline system is currently in. Delays, deaths, dangerous near misses. Why do you think this is happening?

SPEAKER_00: Well, a lot of reasons have gone into that, and I can't speak to everything that's going on under my successor because I've been out of that office for a while. But I am concerned about a lot of areas in transportation, especially actually in rail and surface transportation, where some rules are being softened that have to do with safety. On air travel, you could tell two different stories that are both true. One, I'm very concerned about the near misses and obviously the tragedies that have happened recently. And again, being on the outside, I don't know as much about some of the details that investigators know or that the department knows. Do you talk with Secretary Duffy? I reached out to him when he got the job. We had one conversation, a couple of conversations during the transition. We haven't really kept in touch since. But I'll also say this. Aviation is the, commercial aviation, like just being on an airliner, like I was today on my way up here, the safest way to get somewhere in this country by far. It's not even close. During the time I was secretary, we had 4 billion employments, 4 billion times a passenger got on a plane. And out of those, the number of crash fatalities from commercial airliners was zero. Zero out of four billion. There are very few other things you can do in your life four billion times, including walking across the street or even eating a meal without a fatality. And that didn't just happen. That happened because of rules, technology, people. And it takes a lot to keep it that way. But what's really strange about the human mind is while we all notice anytime there's any deviation from that safety record on aviation, we're weirdly tolerant of a terrible safety record on driving. So today, enough people will die in car crashes to fill a 737. And that happened yesterday, and that'll happen tomorrow. And a top priority for me was to reverse the rise in roadway deaths that we had experienced as a country. And we did, we brought it down. How do you do that? A lot of things. Part of it's the way that the roads are designed. It actually really matters whether the way, even just the shape of the lane.

SPEAKER_01: Like those little barriers on the sides or the sound.

SPEAKER_00: Bump-outs on a busy street kind of make the car slow down and look around a little bit more. Two-way streets, sometimes, not everywhere, but often can be safer than a one-way pattern, at least for pedestrians. Roundabouts, actually, people are sometimes annoyed by them if they get installed in a place where you're not used to them, but you often see a dramatic reduction in serious injury. Yeah, because at a roundabout, it's almost impossible to have a head-on collision or get T-boned. So you may have fender benders, but it's less likely to be fatal. Again, all of this depends on the place and the situation, but we put a lot of dollars, a lot of federal dollars out of that infrastructure package into projects that communities wanted to do, had wanted to do for a long time. And I knew as a mayor, I knew what it was like to have had 12 different places around the city where I wanted to make road improvements. We just didn't have the money. We got the money to the communities to make those kinds of improvements. So there's road design, there's technology. Technology is kind of cut both ways. On one hand, cars are a lot safer and we took steps to require things like automatic emergency braking, right? That just wasn't there a few years ago. On the other hand, distracted driving is a huge issue. And there are a lot of things that take people's eye or their mind off of the road right now, which is often fatal. There's behavior. There's what people actually do. So you have to have safer people. You can make the vehicles themselves safer. All of these things kind of interact with each other to affect roadway safety. Probably the most important safety development, we have to make sure it develops the right way, is automated vehicles, which look, there are a lot of situations where apples to apples, it's already the case that a self-driving car is safer than you or I would be behind the wheel. That's hard to admit, because the average driver believes that they are safer than the average driver, but it's increasingly true. at least under the conditions where they're being tested. And what I know is that we cannot keep accepting the idea that we lose almost 40,000 people a year. It's the same as gun violence in terms of the body count. and act like there's nothing we can do about it, while this other form of transportation, flying, where you were propelled through the air in a tube at nearly the speed of light, miles above the surface of the ground, propelled, I might add, by flammable liquids, right, can go a year or two or three or 10 with zero airliner crash fatalities.

SPEAKER_01: So what is Secretary Duffy doing now that's creating or allowing the situation to devolve as it is now? Because right now it's really bad in terms of delays and-

SPEAKER_00: Yeah, so I don't know as much about kind of the inner workings of the department as I used to. What I will say is that when we had a lot of delays, we really pushed the airlines and let them know that we were going to hold them accountable for what, especially if it was something we thought they could control. And they hated it. I mean, I remember in particular a very direct, pretty blunt conversation with the CEO of Delta Airlines after they had a meltdown that left a lot of their passengers stranded. He was upset with me because I was holding them accountable as an airline. And he said, my customer service people are getting really hot treatment right now because of this. And I said, no, it's not because we're holding you accountable. It's because you let your customers down. They're not mad because of something I did. They're mad because of what you guys did or didn't do. And Southwest had this big meltdown. We held them accountable with a major enforcement action. Now, Secretary Duffy has actually reversed some of the enforcement, some of the things that they were required to do under our settlement. So I do worry that if you take your foot off the gas on that kind of enforcement, that does make the airlines think, okay, maybe we don't have to work quite as hard to take care of our systems and our passengers. the other thing that i think is a real problem is that the industry has just gotten less and less competitive when they deregulated the airlines and created the system we have now this was decades ago they thought there would be dozens of airlines And right now it's possible that just between when you and I are sitting here and when this podcast drops, there could be another consolidation where we have even fewer airlines than we used to have. And as with any industry, the less competition you have, the fewer airlines or the fewer companies you have competing against each other, the more you have trouble with actually getting good outcomes.

SPEAKER_01: So when JetBlue and Spirit were trying to come together, what were your feelings on that?

SPEAKER_00: Well, our feelings about it were that it probably violated the law and would make customers worse off. And again, you had some of these airlines trying to say, well, unless we have yet another merger, there's just no way that we can survive. And you have to really ask, what is that saying about your industry and about your airline? That the only way you could possibly stay in business is if you combine with another airline. Now, that doesn't mean we never allowed mergers. There was one between Alaska and Hawaii, for example, where we held them to a very strict standard that said, look, we need to see these things that show us that you're going to make passengers and customers better off. If you can do that, then you'll meet kind of our legal criteria. And they did, and we signed off. But with JetBlue and Spirit, it just didn't add up.

SPEAKER_01: talking about these types of consolidations that are trying to happen in the airline industry, I see it happening in the healthcare industry. And it's absolutely destructive in so many ways. And I want to talk to you about healthcare, because obviously, Healthcare Checkup podcast. But I'm curious about your relationship to healthcare, perhaps as former cabinet member, as a mayor, maybe even more importantly, a father. What is your relationship with healthcare? How do you gauge the United States is doing on that front?

SPEAKER_00: Well, I guess like most people, I mean, my relationship, my most important relationship with healthcare is as a human being, and have really been plunged into some pretty intense experiences, especially as a parent. So, the encounter with healthcare that was the most dramatic in my life was when our twins who were just infants, became ill with RSV. As you know, RSV is this respiratory virus. If you and I get it, it's a bad cold. If an infant gets it, it's life-threatening.

SPEAKER_01: Yeah, much smaller airways, an immune system that has never seen the virus, so it doesn't have a memory of all the cells that can come to its aid. Historically, any time a child gets their first case of RSV, pretty much any virus, but specifically RSV, it's always the worst case. The next one is always a little bit easier. partially because the airways are larger, but also because of that immune memory component. So I can only imagine how scary it must have been. What was that scenario like? What happened? How did you find out that they were that ill?

SPEAKER_00: Well, at first we just noticed, I mean, they were just a few weeks old, and both of them seemed like they were sick in some way. But especially with our son, Gus, it wasn't just that he was coughing. It was this You could see his belly was like going in and out. Yeah, that's the word the doctors used. And they talked about these retractions. I think they called it the work of breathing. Like the work of breathing was too much.

SPEAKER_01: Yeah, we look for the ribs to be doing the accessory breathing, using accessory muscles to breathe, but also the neck. So if a child's like really struggling to get air in and their typical diaphragmatic muscles are fatiguing, they start using this accessory muscle and that's where we start getting concerned. And what's unique about children, even more so for infants, is that they have a propensity to decompensate very quickly because they have low reserve. As adults, we have a higher reserve in terms of immune system performance, blood flow, immune cell support. They don't. At the same time, what's interesting about them, they also bounce back quite quickly. So that's what my difficulty is in being a family medicine doctor is when I see a child, I need to make the distinction of in which direction are they going? Because what I see now can be totally different tomorrow. It could be much worse or much better. And that's what makes it very difficult to know what to do in those scenarios. So I'm curious how it played out.

SPEAKER_00: Yeah, that's exactly what happened with us. So both of them were ill enough they had to go to the hospital. They put them on oxygen. And you're a parent. These are your infant children. We were new parents. We didn't know what was normal. We were still just figuring out how to be parents. My husband and I were.

SPEAKER_01: Where were you in terms of job at that time?

SPEAKER_00: I was secretary. And I had taken a parental leave. I was encouraging our employees to do that. Federal employees have leave, so I wanted to do the same thing, lead by example. Obviously, I was available for emergencies, but I thought it was important both to my family and as kind of the leader of the department to set the right example. as a father and take the leave that I think every parent should be able to do and that every federal worker thankfully has the right to do. But I thought it would be feeding them and getting through the sleep. And it was, all those things you're just figuring out with bottles and diapers. And suddenly we're dealing with this and they're both in the hospital. And they both had these little like cannulas around their little faces, you know, on oxygen. And then kind of like you were saying, our daughter started getting better. She just kind of popped back and he started to seem to get better too. I thought we were out of the woods, but then he starts getting worse. And to me, it was scary enough to be in the hospital. But then I remember all of these kind of doctors and staff kind of coming in and out of the room. And it felt like they were just, every time there was like more of them. And I mean, I can't describe how tiny he was. I mean, I don't think he was 10 pounds yet and just feeling totally powerless, like just not knowing what was going to happen next. And what happened next was he started getting worse and they did more oxygen, you know, two liters, four liters, however high it goes. I don't know, but, but they're putting more and more oxygen into him and he's not getting better. And you're trying to understand what, you know, what these numbers and these things they're, I'm an educated guy, but I don't know about this stuff. And you're trying to make sense of it. And emotional and sleep deprived and all those factors. Yeah, and you haven't slept. And then at a certain point, they said, we have to intubate him. We're going to have to put him on a respirator so he can breathe. And I remember the doctor saying, you might want to step out of the room for this because it's not a nice procedure. And we did. And I remember Chastin and me just hugging each other in the hallway, wondering what's going to happen next. And we live in a smaller town, Traverse City, Michigan, and they wanted to get him to a bigger hospital. So they said, he's gotta go to Grand Rapids, where there's a big, great children's hospital. they wanted to use a helicopter, the weather was too bad, so they put him in an ambulance. So Chasten is in this ambulance for a couple of hours with Gus, like racing down to Grand Rapids while I went home to relieve my mother-in-law, who's keeping an eye on our daughter and realized I gotta get her down to Grand Rapids so we can all be in one place as a family. And then by the time I got there, I walk into the room in the ICU and our little guy's all this equipment and there's all this beeping. It's like a TV show of a hospital. And the really tough thing was I did know my way around an ICU a little bit because my father had been intubated in an ICU, dying of lung cancer. And so, and our son actually has the same name as my father. So I go through this hospital door and it says Joseph A. Vodich, which is the name of our son and the name of my father. And on some level, the same thing's going on. I mean, they're both fighting for their lives with a, you know, they can't breathe and they're intubated. And of course, with my father, that was the end of the road. And Chasten was really, my husband was really good about reminding me that like, that's not what's happening here. It doesn't have to be. And he had been a CNA too, so he kind of knew his way around the hospital too, which helped. didn't help as much as his emotional intelligence helped, but you know, all of that. And it's weird too, cause you know, he's sedated, right? Cause you do that, you know, when a patient is intubated, but he's still kind of like there. I mean, I remember if I held his hand, you know, his tiny little fingers would like wrap around my pinky finger and just the utter powerlessness of not knowing what was gonna happen next. Because you want your doctor to be able to say like, okay, this is what's going on, and this is what'll happen the next few days, and you can expect this, and that'll happen. And instead, we're asked, there's only one question we really care about, of course, which is like, is he getting better? How will we know when he's getting better? And basically what they told us was, you'll know he's getting better when he stops getting worse. And just to see how tiny he was, like fighting for his life. And you're just waiting, you're just watching these numbers, the O2 number and the pulse, and you're just waiting for days. And going back and forth to the cafeteria, Like I said, I was on leave, but that was when there was that supply chain crisis. And there were ships backed up in the ports of LA and Long Beach. And there were certain things that I just, you know, even then, obviously I had to take care of or be on the phone to deal with. I remember one time I had to get on a Zoom so quickly that there wasn't time to leave the hospital room he was in. So I went into the bathroom and shut the door behind me of the little ICU room so I could put on a virtual background so that people weren't distracted by it. seeing that I was in a hospital. And then there were these weird kind of ugly politics of like attacking the idea that we were in on even taking parental leave in the first place. And then just, I don't know, just the image I can't get out of my mind is how tiny he was in this bed, which is for a kid. I mean, this is a pediatric ICU, but he still looks so tiny. And then all this gear like coming out, coming out of his throat and

SPEAKER_01: Did you appreciate how transparent and forward and honest the doctors were in telling you that they don't know and that we'll only know once he stops getting worse?

SPEAKER_00: Yeah, I guess. I mean, of course, the thing you want the doctor to tell you is the answer. You want the doctor to tell you what's going to happen. But if they can't, then they shouldn't. And we did have really great doctors and nurses. Does anyone stand out in your mind during that journey? I remember a doctor had just the right kind of bedside manner of being really honest to the point of being blunt, but obviously acknowledging our feelings. And we were saying, I think we were asking some question. I don't know exactly what we were asking, but I think he knew the real question was how bad is this? And just saying, you're in a critical care unit. So that's how serious this is. And then walking us through kind of what we were up against and what might happen. And nurses, I mean, they were all great. Really gave me even deeper appreciation for nurses than I already have. Yeah, the biggest thing was just telling us the truth, doing what they could. I think also being pretty tolerant, it must be difficult to do your job as a doctor when every, especially a pediatric doctor in an ICU where every room you go, there's like parents hanging on your every word, right? Probably hovering around you on rounds. I know we were just trying to figure out like, what does this mean? But we got through it. One day he was better than the day before. And I remember just after those nights every day thinking like, I'm just getting used to the idea of even being a parent. And could it really be that just a few weeks in, like that's all the time we're gonna have with him? Like, how could that be? But then one day he was a little bit better and the next day he was a little bit stronger. And one day the tube comes out and, I have this picture of him just looking up at me when after we got, they got the tube out and he's even off the oxygen. I think he's just looking up at me and just being a baby again.

SPEAKER_01: to just be a dad again.

SPEAKER_00: And.

SPEAKER_01: Do you ever enter that mental space again, where you start feeling those emotions that you felt that day in the ICU, where you're worried about perhaps something you don't need to be worried about, but because you were in that position not so long ago, that it still stirs up those emotions.

SPEAKER_00: Yeah, maybe. I mean, I don't want to self-psychoanalyze, but I think because I had a very intense job kind of waiting for me, when I wasn't dealing with that, there was something else that was equally demanding that I could kind of put my mind toward for better and for worse in terms of my own health. But yeah, I think on some level that's still, but I want to describe it as like a, It's also, I think, an amazing thing to just know, you know, with him and his sister, because I know what they were up against at one point in their lives. Like this morning, before I went to the airport, it was probably 4.30 in the morning, and he's a morning person somehow. he's four years old now, just like detects, you know, I'm like tiptoeing out, trying not to wake the dog, trying not to wake Chasten, like gingerly trying to like carry my suitcase downstairs. And of course he like activates, finds me, runs up, like jumps up in his little pajamas. And like, he's like 45 pounds. And of course in the back of my head, as I'm having these normal interactions with my like healthy, big kids, you know, just realizing how close he came when he was, you know, a few pounds. Our daughter too, she had some feeding issues when she was first born. And so we had to fight. The doctors would come in, during the first few days, we had to stay in the hospital after they'd been born. We got to, I don't want to take you through our entire story, but it was what they call a surprise adoption. So we got a call. And the next day we're at the hospital. And- Life moves quickly. Yeah, very quickly. Especially like, oh, by the way, it's twins. Like we'd been on a list for a long time hoping to adopt, but they said, no, it's twins. Here's the situation. Can you come? And then we were there. But then we couldn't leave the hospital for several days because they were born early and they wanted to make sure they were okay. And with her, she just had trouble feeding early on, so they put a little tube. What is it? Yeah, yeah, NG, they called it. And then we got her on the bottle, and they're telling you, like, you have to do like 25 milliliters or whatever. It was like down to the milliliter. And we'd be like fighting for it. We'd be like.

SPEAKER_01: Yeah, I guess, yeah. That's why we discourage giving water to newborns, because there's no room, and you gotta give them nutrition, so.

SPEAKER_00: And I did not grow up around infants, so I'm figuring out the whole bottle feeding thing to begin with. And we're writing it on this whiteboard. When it's 23 versus 25, like two milliliters difference, we would notice, right? And I'm thinking about that now when she's just demolishing chicken nuggets or whatever. You know what it took to get you- Yeah, to enjoy these chicken nuggets. I don't even know how I got onto that, sorry.

SPEAKER_01: That's a great story. I didn't mean it in terms of a pathological statement that you're experiencing PTSD, but it's natural, not pathological, to remember those emotions. And humans reprocess traumas and griefs and scary moments like that as part of our natural cycle in order to help deal with them better. So in fact, that would be a healthy non-pathological thing to experience. You had a lot of things going in your favor during this moment that a lot of my patients, I work in a community health center, in our CHCs that we see for our patients, that they have barriers to access. So parental leave, great that you had that. A compassionate partner, an advocate, someone to be there with you is such an invaluable tool to have. Insurance that actually covers, that doesn't create barriers. But so many Americans don't have that. Why is our healthcare system so broken? Was this talked about at cabinet meetings? How do you feel about it in general today?

SPEAKER_00: Yeah, I mean, when I ran for president, which was before any of this, before your parents, before we knew our way around a children's hospital, I believed then and I believe now that we need to overhaul the system, especially in terms of insurance, that everybody should have access to that level of insurance and that we can do that through a plan that anybody can get it on a public plan. If you want a private plan, fine, but we provide a quality public plan like Medicare, better than Medicare, but in that same way. And everybody should have that because, yeah, I mean, we had so much going for us, including just the good health insurance that came with my job. And if we didn't have that, or if I didn't have Chasten and extended family around, like you said, paid leave. I mean, just being able to actually take the time to be there for them. I don't know who else would have. I mean, when one of us was with him, the other one had to be with our daughter. I remember being in, we got a hotel kind of across the road and being in the room with my daughter, making phone calls to members of Congress late in the night, trying to sell the infrastructure bill, because we were in the middle of that process too, knowing that Gus and Chasten were down at the ICU and she's perking up every couple hours wanting to be fed. And how are you supposed to deal with any of that if you can't get time off work? if you don't have the gas money to get back and forth to where you need to be, if you don't have the kind of family network that we relied on, in-laws, friends, and a lot of that is addressable. I mean, obviously you can't expect the government to be responsible for what your family looks like, but of course, everybody in this country should have access to that insurance, should have that insurance automatically.

SPEAKER_01: Do you think your healthcare vision when you ran for president would be different had you have been a father beforehand?

SPEAKER_00: Well, definitely be even more passionate about it. I think in terms of things I've learned along the way, more appreciation for the role of nurses as well as doctors, more appreciation for the things that surround the healthcare experience, like transportation, stuff that's not in the doctor's office or in the hospital. People don't associate with healthcare. Right, yeah. But of course, like just getting back and forth to the hospital, you know, that kind of thing. And then through a different set of experiences, realizing, more than I appreciated several years ago, when the conversation was all about Medicare, Medicare for all, my plan was called Medicare for all who want it, but like get everybody to something like Medicare. I have more appreciations for the issues and problems around Medicare now too, because of what my mom's going through. So while we've got little ones and we're taking care of them, my mom broke her hip last year in a fall. During the course of that, we learned some things while she was in the hospital on the cognitive side that she's facing. And at one point I was trying to get her medication sorted out and realized that she didn't have insurance anymore because Basically, I'm simplifying, but not that much, basically because she didn't answer an email and some mail that went to an old address that she didn't even have anymore. And she got dropped for a while on her prescription insurance. And how was the system expecting somebody who's on Medicare But somebody who has dementia is expected to deal with this bureaucratic stuff that I find confounding.

SPEAKER_01: As a doctor, I found it confusing. I had the administrator for CMS, Chiquita Brooks-LaSure, she was struggling doing this for her parents. and she ran the whole system. And she's in charge of the whole thing, yeah.

SPEAKER_00: So I do think this is really important because there are all these policy fights over how to get everybody something like Medicare, which I believe in and I care about. But sometimes we talk only about that. It makes it sound like, well, Medicare is just fine. Everything there is working just fine. And the reality is this, and these layers of the Medicare Advantage plans, figuring out what she was covered for when she needed intensive inpatient rehab. Right, the different alphabet of it all. Yes. Yeah, like I remember news stories right here, or even my own policy plans talking about Part D versus Part B or whatever, but I don't really know how many letters up it went until I was trying to navigate her stuff. Yeah, there's a lot of letters, yeah. Anyway, so that's something else that I think I learned about through experience that's kind of feeding back into how I think about healthcare.

SPEAKER_01: Yeah, for me, the big issues surround horizontal and now vertical consolidation that I see happening in a way that I feel like in any other industry would be hyper-regulated, but in healthcare it's not. And not only is that not good because healthcare is important, it's probably the industry where it's least acceptable to have a monopoly. Like if a toy company has a monopoly, who cares? A luggage company has a monopoly. But when it's a healthcare company, like this Uberization of healthcare, where you're deciding people's health over profits or under profits is really problematic. And I don't know why it's not a topic. It feels like it should be a bipartisan topic that everyone is discussing. where I don't hear of any great solutions being proposed. Have you heard of anything that makes sense? Because I have some ideas. I'd love to hear more about them. So as an example, for me, what frustrates me so often is being a primary care doctor, I want to get ahead of problems. It's much more cost effective and health effective to prevent a heart attack than it is to treat one when it's happening. We obviously need to create cures and treatments when people are already sick, but it's great to get ahead. We don't invest in that. And a big reason why insurance companies don't support that is because a lot of our insurers are driven by employment. And that employment changes quite often. It's not like how it used to be 50 years ago, where people stayed with the same industry or the same employer for ages. So they have no incentive to keep that person as healthy as possible. They want to spend as small amount as possible. So finding some sort of way where if a person begins with an insurer, they now stay with that insurer for a period of time, even if they switch employers would be valuable because now the incentive changes to keep that person healthy because that incentive is also tied to your profit. Second, a big issue comes for me with prior authorizations and insurers deciding care for our patients, as opposed to doctors deciding care for patients. And I see where there are true issues with this because the insurance companies have a fiduciary responsibility to their shareholders, not to patients. That sounds terrible, but that's the reality. Doctors have a responsibility to patients, but inherently as individuals, they also have some economic responsibility to themselves. So the insurers are put in this position where they have to mitigate how much spend is happening, whether it's appropriate, whether these treatments make sense, are they standard of care, they need to curtail spending when there's waste or fraud. Whenever either party makes a decision, there is the possibility for bias to occur. Why isn't there a middle objective group, a court, a referee, if you will, to help make that decision as opposed to creating arguments from two parties that vehemently disagree and partly driven by their own biases, whether it's for their own wallets, for their patients, for their companies or shareholders. So I think that would be great. I haven't heard that discussed. And the obvious one that I think is discussed is the transparency aspect of it. Where if you look at an industry in healthcare, like cosmetic surgery, for example, where you can call an office, find out how much a nose job costs, you can decide as a consumer where you want to go. But when it comes to a patient coming to see me and I tell them that, hey, they need an MRI or they need a surgery, For them to find out how much that costs, boy, is that a process.

SPEAKER_00: Yeah, and it costs something else depending who you're insuring. It feels like it costs something different depending what day of the week it is. It's very hard to understand.

SPEAKER_01: It's honestly, sadly true because it's in-network today, out-of-network tomorrow. This doctor is now dropped by this insurer, and it expired, and the disastrous implications of that mean people go bankrupt in our country as a result of... actually at times doing the right things. I did a live tour. It was kind of a comedy show to get people excited about healthcare. And we ended the show by telling a story of a teacher who was insured, great shape, exercised regularly, ran marathons, I believe, right? and had a heart attack, unplanned incident, right? Can't prepare for a heart attack, unlucky situation. Was taken to a hospital that was the closest because it was an emergency. Turns out that that hospital or the provider was out of network, got hit with a surprise quarter million dollar bill or some huge money. where it has nothing to do with him. He's doing all the right things. It's an emergent situation, how that happens. And the only reason that that situation was solved was because he went to media and the pressure for media on this institution solved this issue. So in this day and age, the fact that that's still happening in addition to the hybrid complex administrative heavy system that we function in, I'm confused. So I'm curious what your thoughts are.

SPEAKER_00: I mean, one ingredient in each one of those stories that I think doesn't get talked about enough is power. So the insurance company has a certain amount of power. and sometimes maybe more power than the doctor trying to get something done. The patient in the situation you're describing, obviously you have no power if you're just literally being rushed to the hospital with a heart attack. And then once you're being seen, do you have any power as a patient to guide the outcomes that make sense for you? Or is it all kind of sitting with these for-profit entities that are sometimes dealing among themselves, right? Sometimes, as you know, the hospital and the insurer who are supposed to be in that adversarial process are actually part of the same company. That's the integration, which is nuts. And yeah, you think about if you're not lucky enough to Have your story covered? I mean, how many people have been in that same boat and just gone bankrupt because of it, right? Or gotten worse patient care because of it.

SPEAKER_01: And you can't expect- Or spent their hard-earned savings on it. Because while we talk about instances where people can't afford it and go bankrupt, some people lose their entire life savings over it. And that's not a bankruptcy issue. Now you're just sitting at zero and have to work into an age where it's not sustainable.

SPEAKER_00: But this, again, is why I think we really need to have a public plan that everybody can get on. And then if a private plan wants to stay in business, they have to show that they're even better. And there is a race to the top instead of a race to the bottom. I think that what we've seen right now, I mean, look at the fact that Medicare is not even allowed except in limited cases. We tried to change this in the last administration, but only in limited cases can they even negotiate drug prices, right? Even though the overwhelming majority of Americans think we ought to do this. This shows that there's also a level of power, not just the power equations that happen kind of in a patient care situation, but obviously in Washington, right? To stop that from happening more when people expect it and demand it. So you have to have something that's accountable to the public. And right now, from the top on down in Washington, I think there's a culture of very little accountability that seeps its way down into how decisions are made and those entities that are part of the public sector. Then not being willing to use I mean again, I know it's a very different sector But to take the example I would share from the airlines where we realized we had a certain amount of power because the law placed it in our hands To look over the shoulders of these corporations and make sure that they were treating people fairly That's true in the airline sector. It's also true in the health sector that if the right people are using the tools that are already there, and we should give them more tools, then a patient knows somebody's fighting for them when they're fighting an insurance company or when they're fighting to get their bills lowered. Because when you're in that situation, of course, the last thing you should be thinking about is insurance or money at all. And just the fact that when you go in to get treated, right, as a patient in America, the first question you get asked as you're conscious is about your insurance, shows you how out of whack our priorities have been as a country.

SPEAKER_01: What drives me up a wall in this scenario is politicians struggle with this themselves with their own family members. When they break a hip, when they have a hospitalization for an unrelated issue, If they're experiencing it, why don't they take steps to counteract this? And right now, I mean, our current Secretary of Health and Human Services doesn't seem like he cares about making a change in this. I mean, I love the slogan, Make America Healthy, I don't know where the again comes from. Again, what era are we going to where people live shorter lives, where bacteria and stubbing your toe was a death sentence? I don't know.

SPEAKER_00: Yeah, I mean, that's the thing. There's this imagined golden age when they seem to... But I think the broader point is the Secretary of Health and Human Services doesn't have to worry about this. It's not a problem. He can hire somebody to worry about it for him. And he works for somebody who's even richer than he is. And you have this circle of folks making these decisions who, look, the president literally owns a club that you have to pay a million dollars just to get into. These are not folks who have navigated the system in a way that they have to worry about any of this. Every human being has health issues and is humbled at some level by that when you're encountering a doctor. But even the hassles that somebody who has a good job and an upper middle-class income, let alone what you're up against if you're living in poverty or if you're a single mom of a medically fragile child or any of the scenarios that so many Americans are going through, It's just not their problem.

SPEAKER_01: Given that they're so unrelatable, as you describe, these million-dollar entry fees to clubs, why are they so popular?

SPEAKER_00: Well, they're not, importantly, right? I mean, they're very good at creating the impression that they're popular. Interesting. Tell me more about that. Well, I mean, the big majority of the country disapproves of the way the president's doing business. Big majority of the country. Well, that's now. Yeah. But to get elected. Yeah. But even then, like, squeaked it out. And, you know, if you ask, like, what share of the American people really identify as MAGA, it's less than a third. Now, this brings me back to what I was saying earlier about our kind of whole system, right, that in our country, a movement that's a minority like that, as long as they take over one of the two parties, and as long as you always have to choose between one of the two parties, and it's 51-49, then all you really need is to get slightly more than half of slightly more than half, right? A party is half the country, you get half the party. And you can run the table. But I worry that there's this impression, because these people got elected, and unlike them, I do not deny that they got elected. They got elected, they won an election. But because they did that, for all kinds of overlapping and complicated reasons, that all this stuff they're doing is popular. And it's not. A strong majority of Americans believe that the government needs to be doing more, not less, to get people insured, including a public plan, whether you call it, you know, again, the version I called was Medicare for all who want it, because I think you should have a choice, but it was that or Medicare for all. Strong majority of Americans believe in that. Even stronger majority of Americans believe Medicare should at least be negotiating drug prices. Strong majority of Americans think there needs to be more transparency in the way that medical services are priced. Huge majority of Americans get that you should listen to your doctor on something like getting immunization for your child or for yourself. that you should have that conversation and that there's a huge body of evidence around this. One of the reasons why compared to a generation or two or three ago, people aren't dying of the same preventable communicable diseases at the same rates, right? So don't get me wrong. Like this is obviously a movement that was powerful enough to take over the government. But I worry they create this illusion of invincibility and this illusion of inevitability that we really need to, I'm not just saying this in a partisan way, I'm just saying anybody who disagrees with some of what they're doing or all of what they're doing needs to recognize you're more powerful than you think, precisely because people believe this. I went into the district of one of these right-wing members of Congress who refuses to hold a town hall. It was in Western Wisconsin. And I just thought, you know, you won't have a town hall with your constituents. I'll do it for you. A thousand people come out. And I don't know if his challenger will defeat him or not. I think she might. But regardless of the campaign side of things, What I know is that he noticed that was happening, and a few days before that town hall, miraculously, was one of the few Republicans to vote with the Democrats on extending the tax credits that help you pay your health premium under the ACA. And this is not a moderate guy. This is not somebody who normally votes with Democrats. I'm mentioning this to say that even outside of the context of an election, which is when you have the most power as a citizen, There are things we can do to mobilize around certain issues that get the attention of the politicians we already have, flawed though they might be, that make it clear in a way they can't ignore. The same way that despite it being a core commitment of the Republican Party, even when they've been in charge of all three branches of government, they've never actually kept their promise to get rid of the Affordable Care Act. Why is that? Because they know that enough Americans believe that's wrong. And so they won't do it. I think we need to remember that in a moment like this, when people feel so disempowered as citizens.

SPEAKER_01: Yeah, you know, I think about social media as a tool, as a way to mobilize and get people's attention. Given the fact that there's this new modern Democratic Party that's evolving on social media, what do you think that movement represents? Are there ideals in this party that perhaps in 2020,

SPEAKER_00: the coastal cities around elite circles are landing well for people but then for the average american household it feels a bit disconnected do you are there any issues like that i think the most important thing is to stay rooted in everyday life so that's what somebody whether they're in brooklyn or in northern michigan where i live or in south bend indiana where i grew up or anywhere else has in common And that can be linked to some really serious, you might say partisan commitments that we have, things we believe in, you know, that the wealthy ought to pay more in taxes and that the Affordable Care Act ought to be expanded and not abolished, you know, specific controversial political things that we believe that most people agree with us on. But what I'm saying is they matter because they cash out in your everyday life, right? I do think sometimes politics gets treated as this kind of like game in itself. It happens more when you're in the run-up to a big election. But I've got to think that what most people are looking for, certainly my experience in office, running for office, and right now where I'm neither, you know, most people are just saying, what does this mean for me? Is my life going to be different, better or worse? Because you're in charge instead of you. And if my party can make it, keep it about that, then I think we'll win. And if it doesn't sound or feel like we're about that, then I think it's gonna be really hard to win. So you think the power of positivity is stronger than the power of anger? I think it's relating the two. So yeah, I think, look, being angry, I'm angry about a lot of things, but on its own, it's not a governing vision. And if it's all you have, then when you actually wind up in charge, you're not gonna have a lot of answers. If all you have to say is get rid of these guys, they suck. And by the way, they do, and we should get rid of them by voting them out. But that doesn't mean, that's only part of the proposition.

SPEAKER_01: Yeah, running on a referendum is not a complete package.

SPEAKER_00: Look, it might be enough for 2026. I mean, enough people might just be mad about the terrible decisions being made by the Trump administration and the terrible things being enabled by the Republicans in Congress that the Republicans will lose and the Democrats will win. But it would be so much more powerful if it was backed by a vision that said, okay, it doesn't have to be this way. And here's how your everyday life is different. If we make sure the wealthy pay their fair share in taxes, then there are more dollars available to expand Medicaid so that fewer people are sick and more people can pay for their coverage. If you're on the Affordable Care Act, we can restore those tax credits that help you pay your premiums so you didn't have to choose between a mortgage payment and a healthcare payment, which is a choice a lot of people faced and wound up dropping their health insurance. We can connect these things up to how your life is going and say, here's what we would be doing differently and why. That is so much more powerful. I guess whenever... I'm pointing out the things this administration is doing wrong. I want to do it in the name of what we could have that is better, not just that they're wrong, but that we could have something different and better. When they're doing something corrupt, I want to show what it would be like if we had more integrity. When they're cutting taxes for the richest people in the country, I want to remind folks of what we could be doing together with those dollars if the tax code were more fair. So it's the negative and the positive go together, but you can't just do the negative for its own sake.

SPEAKER_01: Yeah. Do you think the fact that in 24, we had an election where the Democrats didn't have a primary, do you think in general primaries hurt or help a candidate? Because in some ways, how we began this conversation, we talked about discourse sharpening your skills and your ideas, but in some ways it can create openings for opponents to come in. So I'm curious where you land on that.

SPEAKER_00: Ultimately, I think it's better when you have more of that competition. I mean, I think back to the 2020 race where again, obviously I didn't win, but. Yeah, what's that like? What is it like running for president? I know we'll come back to that. Yeah, I mean, first of all, when I ran, there were 20 people at first running. Not all of them made it to the final stages, the Iowa caucuses, where I won Iowa and then came in second in New Hampshire, and then I dropped out after Nevada and South Carolina. But the first debate, I remember they had to break it up into two heats, because there were 20 of us. They did 10 at a time. And I think if I remember right, I think we did 10 debates that I was part of. The field shrank as we went. And I don't know how to put into words, even now, years later, reflecting back on it, what that experience was like. But I will say, of course it makes you sharper to have to defend your ideas, to think about in a field of competitors, like where you agree and where you disagree, where you have the same idea but a different style, where you have the same style but a different policy, where you have the same policy but a different way to get it done. And I think that process, especially when the party doesn't have a leader, a single leader, so like now, is extremely important for making clear kind of what a party cares about, what it focuses on, the style as well as the substance. And yeah, I think we would have been, we're always well served when there's more of a contest. Yeah.

SPEAKER_01: Do you think in the future elections that identity politics will play a large role? I'm curious actually, in fact, being a gay man yourself, did that play a role in your time running for president?

SPEAKER_00: Everybody has an identity. And your identity is part of your life and part of how society treats you. And, and, and you may lean into it or you may not, but like, it's a thing it's there. I think it's a mistake to imagine that that's the number one thing or the only thing that shapes how a voter decides who they want to be their leaders. After all, for most of us, it doesn't dominate how you go about your everyday life. Again, it matters, uh, in, in countless, huge overlapping ways for everybody. But I think that one common mistake of the political kind of consultant class is because those categories exist, you make that the number one way that you engage with voters. You group them into these identity groups. And so I'm gonna talk to black voters about black voter stuff, and I'm gonna talk to voters 18 to 24 about 18 to 24 year old stuff. And I'm gonna talk to gay voters about gay stuff. And like all of that might, you know, obviously every group has particular things that affect them as a group, but like, if I'm talking about how to get a job or how to keep your job or how to make sure when you have a job that one job is enough to live on, that matters to every black voter, every gay voter, every 18 to 24 year old voter, every voter, right? And so I think we recognize that identity plays a role in people's lives, but we lead with whatever's the most important thing in your life that's affecting whether your life goes well or poorly, at least which of those things government could make a difference on. Where is government helping? Where is government hurting?

SPEAKER_01: And what would a better government, Yeah, because those who are struggling financially, at the end of the day, that's what unites you. In our country, at least the way that it exists today with lobbyists and businesses running everything, or at least seemingly everything. So that's the uniting principle that can rally a base because the base doesn't have to be uniform. In fact, we're so heterogeneous that we need to celebrate that and figure out how to make it work for us. What does the next 10 years look like for Pete?

SPEAKER_00: I don't know. I'm not making any decisions this spring about running for office. Obviously, that's something I got to think about going forward. I know what I'm gonna do in terms of what my life is about, which is advancing values that I care about and believe in. Right now, I'm spending a lot of time supporting candidates and causes connected to those values. And that's things like going on podcasts or going on TV or traveling. We just did a big town hall in Tulsa. And I mentioned the one in Wisconsin. We do big events like that. We do smaller events, community round tables.

SPEAKER_01: I have an organization- Does it feel better doing it now without a specific-

SPEAKER_00: Agenda? Yeah, I mean, I have an agenda in terms of, you know, wanting to make sure we surface important issues. But yeah, I'm not like there as the transportation secretary. And I'm not there, you know, asking people for their vote. At least not for me. I'm asking people for votes sometimes for candidates I believe in. We set up an organization called Win the Era, which kind of houses a lot of this work. I'm doing a lot of writing. I'm writing a book about what I think we could have if we weren't just constantly trapped in the status quo. Please don't put us in it negatively.

UNKNOWN: Yeah.

SPEAKER_00: I can guarantee you, unless something really strange happens in the next few minutes, I can guarantee you that much. So all through my life, I've realized that You can have more clarity about the difference you're trying to make than the job you're about to have. Never would have thought I was going to run for mayor until relatively soon before I actually did. Didn't think I would be running for president until a relatively short amount of time before I was. Made a lot of decisions to not run for certain offices because that wasn't the best way to make the difference I was hoping to make. And I guess the other thing I'd say is like, it's not just professional for me anymore, right? I mean, we've talked about my kids who like, you know, Chas and I are raising these incredible twins who just like every day are so hilarious and fun and also challenging. Like it's definitely the hardest thing we've done as well as the best. And so all of those things add up into life, right? The life you have at home and then the public life where you think you can make a difference. And I'm not trying to be cagey. I just literally have not made a decision about what to do next. But I'm sure whatever I do, whether it's running for office, whether it's writing more, whether it's more advocacy, will basically be about this. How do we live a better everyday life through ways of doing things in this country, especially our government, that are better than what we inherited. So that we know that our generation, just like generations before, will be better off than our parents and grandparents. That's no longer certain in this country. but it should be. And if we made different choices, it will be. And I'm going to work on that one way or another.

SPEAKER_01: So April, 2026, one to 10, what is your level of optimism that the world your children will grow up in will be a better world than today?

SPEAKER_00: I don't know that I can put that as a prediction, more as like, it's our assignment. Like, we've got to make sure that it is. I can't give it anything less than like, I'm going to make it a 10 with every fiver of my being, right? Because they're my kids. And like, they're going to ask, like when they're old enough to ask. I'm already getting a lot of questions. Right now there are questions I can handle. is Taylor Swift real? That's one I got when I was driving the kids to school the other day. It's like, yeah, she's real.

SPEAKER_01: Like they were worried she was an AI. She was that talented at singing.

SPEAKER_00: I think she's in the same category as Disney princesses to them. Ah, okay, fair. Which interestingly, they insist are also real because they saw Minnie Mouse at Disneyland once. Disney makes sense. So anyway. How do we get onto this? Where were we? Yeah, yeah, yeah, yeah. So, so, so. The future, the optimism level. So, like, now it's like, you know, it's Taylor Swift.

SPEAKER_01: So, your effort level for your optimism is a 10, but what is your actual optimistic level? I mean, we're at war. You were in the military.

SPEAKER_00: What? Oh, it's bad. It's bad. But my point is I'm going to put in the effort to justify an optimism level of 10. Got it. Because they're going to ask, like, what were you doing back in the 2020s? And I'm gonna have to say like, yeah, back in the 2020s, like it was crazy. People were going bankrupt because they didn't have healthcare. We were like, all this crazy stuff was going on. That sounds barbaric, you know, sitting here in the 2040s, looking back. But I want to be able to say I did everything I could to shape things, you know, with fellow citizens to make things better, which is why you two live in a world where you're confident that you're gonna be better off than our generation was and where nobody's losing their house or their shirt because of healthcare and where you have a shorter work week and more money in your pocket than before, because we took technologies like AI and saw to it that they didn't just lead to an explosion in inequality, but actually benefited people, which took hard work and tough calls and important policies. And the reason you feel like you live in a healthy democracy, as Americans often have, but sometimes haven't, like we didn't back in the 2020s, is we fixed it. So you get to fix the next round of problems that's coming along. We have to believe People did that for us. We've got to do it for them. I would not be optimistic at all if I thought we were confined to the status quo that we inherited, if I thought that things were just going to keep going the way that they're going. But the whole point of America is that they don't have to be. The whole point of America is if something's going wrong, it's because we let it, because we the people are in charge. Living, breathing document, right?

SPEAKER_01: It's kind of cliche, but dare I say, because it's a living, breathing document, we can be the life support that helps it continue breathing.

SPEAKER_00: Okay, yeah.

SPEAKER_01: I mean, hopefully more than life support, but yeah. I mean, I guess it depends on your level of pessimism in the current moment. I guess.

SPEAKER_00: No, we're doing better than that. Or at least we will be. But yeah, I'm not here to pretend things are better than they are. I'm here to say that precisely because we're in so much trouble as a country and precisely because so many things are being broken right now, we can come out of this building something that isn't just better than now, but it's better than before. If we do that, as ugly as the 2020s are in a lot of ways, especially politically, we could actually wind up being proud of this era if we use it the right way.

SPEAKER_01: I'll tell you this, you raised my optimism meter by at least a point, which is hard to do for someone who sees the dark depths of our healthcare system. So I thank you for that. And I thank you for this conversation, making the time to talk to a very engaged community who is passionate about making the world a better place, much like you are. So thank you for all your work in that regard. Likewise, thanks for what you do. Appreciate it. Speaking of the Department of Transportation, click here to see some of the most unhealthy things people do on airplanes. And as always, stay happy and healthy.