The Disaster That Just Passed the Senate

President Trump’s “big, beautiful bill” is a bad piece of legislation. It includes trillions of dollars in tax cuts that are very much tilted toward the rich, along with savage cuts to Medicaid, nutrition assistance and green energy. And on Tuesday, July 1, the Senate passed it in a 51-50 vote, with Vice President JD Vance as the tiebreaker. But bad policy only matters if people know about it, and a lot of people don’t — partly because there are an overwhelming number of provisions, and partly because the Trump administration is already flooding the zone with so many other major policy fights. So I asked Matt Yglesias, the author of the Slow Boring newsletter, back on the show to go through what is in this bill and why it has been so hard to build momentum for pushback. We spoke on Thursday, June 26. Mentioned: “A List of Nearly Everything in the Senate G. O. P. Bill, and How Much It Would Cost or Save” by Alicia Parlapiano, Margot Sanger-Katz, Aatish Bhatia and Josh Katz The System by David S. Broder and Haynes Johnson The Ten Year War by Jonathan Cohn Book recommendations: Proto by Laura Spinney Wuthering Heights by Emily Bronte The Social Transformation of American Medicine by Paul Starr Thoughts? Guest suggestions? Email us at [email protected]. You can find the transcript and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs.html This episode of “The Ezra Klein Show” was produced by Jack McCordick and Rollin Hu. Fact-checking by Kelsey Kudak. Our senior engineer is Jeff Geld, with additional mixing by Aman Sahota. Our executive producer is Claire Gordon. The show’s production team also includes Marie Cascione, Annie Galvin, Michelle Harris, Elias Isquith, Marina King, Jan Kobal, and Kristin Lin. Original music by Pat McCusker. Audience strategy by Kristina Samulewski and Shannon Busta. The director of New York Times Opinion Audio is Annie-Rose Strasser.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:31Ezra Klein?

  So I'm taping this introduction on Tuesday, July 1st. The Senate passed Donald Trump's big, beautiful bill just moments ago. 50-50 vote, Vice President JD Vance, the tiebreaker. This bill, it is a bad piece of legislation. Trillions of dollars in tax cuts, very much tilted towards the rich. Savage cuts to Medicaid, to nutrition assistance, to green energy. And even with those cuts, we can expect more than $3 trillion to be added to the national debt over 10 years. And I think befitting policy like that, the bill is hugely unpopular. A poll from late June found nearly 2 to 1 opposition to the bill. Vulnerable Republicans do not seem excited to run on the wreckage it's going to create.

• 1:15Ezra Klein?

  Tom Tillis, the Republican senator from North Carolina, a state Trump has won over and over again, just announced he's stepping down at the end of this term, in part over the Medicaid cuts. But bad policy only matters if people know about it. And a lot of people don't. And hearing about this bill, even those of us covering it can't keep the whole package in mind. The Times has a great list of nearly all the provisions. I'll link it in the show description. A lot of them would be major policy fights on their own. But in part because of that, and because the Trump administration is flooding the zone with so many other major policy fights, it has been hard to focus attention on what is passing and what can actually be done about it. And so I asked Matt Iglesias back on the show to go through what is in this bill and

• 2:00Ezra Klein?

  why it has been so hard to generate the kind of political force on it that we saw in Trump's first term, when Obamacare appeal went down to defeat. Matt, of course, is the author of the So Boring newsletter. We spoke, I should say, on Thursday, June 26. As always, my email, [email protected].

• 2:27Ezra Klein?

  Matt Iglesias, welcome back to the show.

• 2:30Speaker 01

  Really glad to be here.

• 2:31Ezra Klein?

  The big, beautiful, Chuck Schumer calls it big ugly bill. What is your high level description of how this thing fits together?

• 2:41Speaker 01

  Well, you have two different versions. They both contain about $5 trillion worth of tax cuts, of which they're trying to sort of disguise the cost and say it's more like 4 trillion. But it's trillions, trillions of tax cuts, mostly tilted toward wealthier people, although some for middle class, working class people. And then it's offset by cuts to nutrition assistance, cuts to clean energy programs and cuts to Medicaid. And so there's a lot of disagreement between the House and the Senate about exactly how to do the Medicaid cuts. And that's sort of a lot of what the wrangling is about. But that kind of broad shape of the bill, that's been the sort of locked in framework for months.

• 3:22Ezra Klein?

  So has Donald Trump just always been Paul Ryan in orange makeup?

• 3:27Speaker 01

  I don't know that he's exactly Paul Ryan in orange makeup, but he has always been in favor of big tax cuts. And there is some pressure to offset the cost of those tax cuts with spending cuts. The big change is that Trump made Republicans be much more cautious about cutting Medicare and Social Security. And so that means that the Trump era Republican cut proposals fall much more heavily on poor people specifically, rather than on the elderly, which was sort of the Paul Ryan version of this. And I think it's a really underplayed aspect because Trump has actually gained a lot more support from low income voters than Republicans had in the past. He's changed really the image of the party

• 4:11Speaker 01

  with regard to how it relates to lower income people. But the policy is incredibly unfavorable to them.

• 4:17Ezra Klein?

  So this is a bill where some of the most brutal cuts fall on Medicaid users.

• 4:25Ezra Klein?

  How do they cut Medicaid?

• 4:27Speaker 01

  Well, this is part of what they're disagreeing about. But one of the big ways is that they're changing what's called Medicaid provider taxes. So states raise money for Medicaid, in part by taxing the hospitals and other providers who provide Medicaid services. And the House and the Senate have different ways of putting even stricter, tighter rules on the use of these provider cuts. Then the other thing they do is big work requirement rules. So you're going to have to certify that you are working or participating in some kind of work-related activity. And a lot of people are expected to fall through the cracks of that kind of system, really reduce spending.

• 5:10Speaker 01

  They're also putting higher enrollment barriers for Affordable Care Act subsidies and some different rules around immigration status. But the biggest ones are those provider cuts and the work requirements.

• 5:22Ezra Klein?

  And the way Republicans defend this out on the trail is, look, all we're saying is if you're on Medicaid, you should either be working, or if you're an able-bodied adult, you should be trying to find work.

• 5:37Ezra Klein?

  And you said people fall through the cracks of it. But when I talk to people who do Medicaid work, who know about how these work requirements work, they say, no, they're not going to fall through the cracks. That this is a very onerous paperwork and reporting requirement that people often just fail to be able to do. They check in with the government, but then forget to one month or don't realize they have to. And that it's a way of using administrative burden, like all of this paperwork, to kick people off of the program.

• 6:08Speaker 01

  I mean, I think you can see there's a mismatch between the way Mike Johnson characterizes us. He talks about, you know, we've got all these able-bodied young men who are sitting on the couch all day, playing video games, collecting Medicaid benefits. But you don't collect Medicaid benefits. Medicaid defrays the cost of your medical bills. Able-bodied young men are not racking up incredible medical bills, almost by definition.

• 6:35Speaker 01

  So for the bill to save money, it has to be cutting off care to people who are in fact sick and in need of medical care. That's how the savings work. And it's also, you know, it's easy to neglect how hard it is to fulfill certain kinds of requirements. But people, you know, who are poor, who are dealing with medical problems, who have a lot of stuff going on in their lives, aren't always able to get all this checkbox stuff done, which is why millions of people are going to lose coverage. And it's why it's going to save a meaningful amount of money. The only way to offset the cast of tax cuts is to deny medical care to people who need treatment.

• 7:12Ezra Klein?

  I really want to underscore this thing you just said, because I think you stated it very clearly.

• 7:18Ezra Klein?

  You could save money in social security by not having social security send people checks every month. But you cannot save money in Medicaid that way.

• 7:27Speaker 01

  Right.

• 7:28Ezra Klein?

  The way Medicaid has to save money is that somebody who would have gone and got in treatment for cancer, got in treatment for COPD, got in treatment for an aching back, whatever it might be, will now either not go get that treatment or somehow this person who was on Medicaid and was poor enough to qualify for Medicaid is going to pay for it some other way. We, the federal government, are implementing an onerous set of paperwork and reporting requirements, where if people who are already poor, sick, or otherwise disorganized cannot or do not abide by them, when they get sick, they will not be able to get chemotherapy

• 8:13Ezra Klein?

  or they will have to go into medical debt to get chemotherapy. Like, why? So I can get a tax cut?

• 8:21Speaker 01

  Yeah, I mean, there's a profound sort of ideological disagreement, right? I mean, you know, one of the things like Gallup asks people is, should it be the federal government's responsibility to make sure that everybody gets health care? And about 60% of the public says yes. You know, at the highest level of abstraction, the public has sort of progressive view about this. And Republicans don't. You know, they were not for the Affordable Care Act. The most conservative states don't accept Medicaid expansion funds. They have tried to impose work requirements in Arkansas, for example. So we ran the experiment. Does putting work requirements on Medicaid increase employment? And the answer was no.

• 9:06Speaker 01

  When they did it, employment didn't go up. People did lose coverage, but employment didn't go up. And Republicans didn't reverse course after that. They didn't say to themselves, oh, our goal here was to get more people working, but didn't succeed at that. They said, you know what? This cut the rolls. It cut spending. We're happy with that. And that's a free market view. I mean, if you want a television, you've got to pay for it yourself. If you want chemotherapy, you've got to pay for it yourself. And I think that's a morally questionable worldview. But, you know, I think it's something that Republicans believe in pretty sincerely, but they also don't want to articulate in those terms because it sounds terrible.

• 9:47Ezra Klein?

  In the 2012 election, Mitt Romney famously got caught on tape saying, look, there's 47% of this country that are just takers. They're not paying income taxes. They're just getting things from the federal government. And I'm paraphrasing him here, but he basically says, look, our job is going to be harder because that's always going to be a popular politics and those are not our voters. Donald Trump won voters making less than $50,000. It is very plausible that a majority of people on Medicaid now vote for Republicans. So I think the politics of this used to be, the way people understood them is that Republicans want to make these cuts for the ideological reasons that you're describing. But they were cuts to the Democratic Party's voters.

• 10:32Speaker 01

  Yeah.

• 10:33Ezra Klein?

  Now they are very substantially cuts to the Republican Party's voters. They are cuts to Republican states. They are cuts to Republican hospitals, rural hospitals in areas that vote for Republicans that are very dependent on the care that gets financed by Medicaid in order to stay open. This is Republicans' old ideology coming into conflict with their new coalition.

• 10:57Speaker 01

  Yeah, absolutely. And you know, if you look at the share of people who are on Medicaid by state, there's seven states where over a quarter of the population is on Medicaid. One of them is New York, one of them is California, but the other five are New Mexico, Louisiana, Arkansas, Kentucky, and West Virginia. And then you look at states like Mississippi and Alabama, if they would accept Medicaid expansion funding, there's a huge potentially eligible population share in those states. And it's a big conflict inside the heart of Republican politics. You know, Mitch McConnell's from Kentucky. It's one of those states. He's someone who, I guess his political swan song is really just saying what he thinks about everything. He said about this, you know, I know my colleagues are hearing from

• 11:42Speaker 01

  people who are worried about Medicaid, but like, we've got to get this done. And his literal words were, they'll get over it, which I think is not something a person running for reelection would say. But, but that's very emblematic of what you're talking about. There's just a conflict between what is the Republican Party electorate and their ideology, which has shifted in some ways, but really remains focused on low taxes on investment income, low corporate taxes, and wanting to cut spending on, on programs for the poor.

• 12:16Ezra Klein?

  Let's talk about the tax side of this bill.

• 12:18Speaker 01

  Mm hmm.

• 12:19Ezra Klein?

  You can cut taxes in a lot of different ways. It's not just like a giant individual income tax cut. What are the major things this bill does? And I don't just mean here as a tilt towards the rich or the poor. I also mean just, how does it change the incentives for people to do or not do things in the economy?

• 12:37Speaker 01

  The centerpiece of this bill is taking the 2017 Tax Cuts and Jobs Act, taking temporary provisions from that bill and making them permanent. So a lot of that is just small reductions in the income tax rate at every particular bracket. Some of that is an expansion of the child tax credit. And some of it, a lot of it, is corporate tax breaks, you know, different ways to sort of lower the taxes of businesses that have have large investments. Trump then also piled on on the campaign, these new ideas, right? No tax on tips, no tax on social security, no tax on overtime. Those weren't really like fleshed out in the campaign in a real way.

• 13:19Speaker 01

  But Congress has felt the need to put some version of them in here, which is part of why Republicans are having trouble with this. Because sort of making TCJA permanent is nonnegotiable for them. But delivering on Trump's promises is also nonnegotiable. And so that's turned this into this very, very, very expensive sort of thing.

• 13:39Ezra Klein?

  The no tax on social security didn't really make it in, though, right? Because of various budget rules.

• 13:44Speaker 01

  Bird, bird rules, yes.

• 13:45Ezra Klein?

  I'm just going to give a very quick budget explainer before I go on. In order to not have this be subject to the filibuster, in which case it would not pass, Republicans are using a legislative vehicle called budget reconciliation. This is now used for almost everything that's very big. The Build Back Better, the Inflation Reduction Act used it. And it has weird rules on it, according to something called the bird rule. And one of those rules is it can't really do all that much to social security. Other rules are that everything has to be explicitly budgetary in nature. And so then the parliamentarian goes through and and things get challenged. And the parliamentarian decides like, well, is doing this really a budget thing? Are you trying to sneak in another change and calling it a spending and tax change?

• 14:25Speaker 01

  So one thing about this bill that's a little strange, I guess, is if you talk to sort of conservative tax wonks, the thing that they are most excited about is the business provisions. 100% bonus depreciation for equipment, domestic R and E expensing. So these are sort of corporate tax breaks that conservatives believe will encourage more investment and sort of make make the economy more prosperous. That totals to about 700 to 800 billion dollars worth of cost, which is, you know, I don't want to say that's not a lot of money, but it's a relatively minor share of a $5 trillion. Tax bill. So the bulk of this sort of dollar

• 15:08Speaker 01

  cost of the bill is repealing the alternative minimum tax, expanding the standard deduction, and just rate cuts in individual income taxes. And this 1099 pass through deduction thing, which is basically if you own certain kinds of closely held businesses, you get to just claim a huge tax cut. So for example, if you are like a real estate developer, or you own golf clubs, you just arbitrarily pay a lower tax rate. You know, and then there's a $200 billion estate tax cut. So, you know, again, on the merits, the conservative view is that these kind of tax cuts encourage higher levels of savings and investment in the economy. Because the people

• 15:53Speaker 01

  who save and invest are disproportionately very rich, it has a very skewed distributional tilt. So they've also thrown in all kinds of other stuff that doesn't have that same kind of impact, right? So there's like a bonus standard deduction for senior citizens. So that's supposed to be something that you can like, go to a town hall and say to, you know, grandma, like, this is what I did for you. But the cost of that is $90 billion versus 212 billion for the estate tax.

• 16:21Ezra Klein?

  Amazing the way a bill this big begins to warp one's ability to talk about big numbers. Like, that's only $90 billion. That's pocket change. Usually, when we have these big fights over tax cuts, those of us for who are sins have to read a lot of congressional budget office reports, know this long running fight over whether or not when a bill like this has its cost estimated by the Joint Committee on Taxation, and sort of, but not exactly by the CBO, they'll use something called dynamic or static scoring. And the debate here is static scoring just sort of totals up how much things cost. And then dynamic scoring, in theory, also runs a model saying, well, will this help grow the economy or not? And if it does help grow the

• 17:05Ezra Klein?

  economy, then in theory, that should offset some of its costs, because a faster growing economy creates more tax revenues than can be put in. So the sort of Republican argument is always that these things are overestimated in their cost, because they're using static scoring, not dynamic scoring, we need to use dynamic scoring. So they got, in this case, dynamic scoring.

• 17:25Ezra Klein?

  What happened when they got the dynamic scoring, Matt?

• 17:28Speaker 01

  Yeah, so the dynamic score actually raised the cost of the bill by about $400 billion.

• 17:34Ezra Klein?

  Why did it do that?

• 17:35Speaker 01

  Well, because it expands the deficit by trillions of dollars, which they think in the current climate will raise interest rates. Importantly, I mean, this would raise interest rates throughout the economy, but it means that the federal government's interest rate costs will go up, and that swamps the growth impact that this bill is supposed to have. One reason for that also is that the dynamic modelers see a very muted growth impact because the big pro-growth measures are temporary. Bonus depreciation, interest rate limits, domestic research expensing, those are all extended through 2029. So if you're talking

• 18:16Speaker 01

  about changing like the long-term trajectory of business investment, a temporary extension doesn't necessarily move the needle that much. If you're adding trillions of dollars to the debt in what's already still a somewhat inflationary environment with some upward pressure on interest rates, you create bigger costs for the federal government. But I mean, also, I would say bigger costs for like, you know, if you want to get a mortgage, if you want to get a car loan, if you want to build a house, any kind of project like that. And that's a big difference from 2017. When Trump was president before, interest rates were super low. So the kind of like professional deficit hawks were saying, oh, this is bad. But the modeling was kind of like, it's probably fine. But like now it's

• 18:59Speaker 01

  not fine. The deficit is a serious issue, and this makes it much worse.

• 19:04Ezra Klein?

  I have genuinely not seen a big tax cut bill fail a dynamic score like this. I know this has like a sort of naive question begging quality to it.

• 19:17Ezra Klein?

  But there is some world in which you would have expected that to get Republicans who are running a policy process here to like, stop for a minute and wonder if this bill is well designed for the moment in which they are trying to drive it. Like, in theory, they care about the debt. In theory, they are trying to grow the economy. The fact that this gave them so little pause, aside from listening to Donald Trump and like paying off big donors, what they are even trying to achieve here becomes a little bit opaque. They're not going to get more people working. What is all this for?

• 19:52Speaker 01

  You know, Donald Trump, I think even his fans would acknowledge is not a super detail oriented policy wonk. He is a person with a certain kind of feel for the vibes in the electorate. Some of this stuff, right? Like, the idea of like, there should be no taxes on car loan interest rate payments. I think that's a terrible idea on the merits. But I also acknowledge that like, it probably sounds good to most people. And so he kind of hit on some of this stuff over the course of the campaign trail, and they're putting it in the bill. And it really raises the cost, even though it doesn't relate to sort

• 20:32Speaker 01

  of the core objectives of Republican Party tax policy designers. And, you know, one of the things I have often lamented about the Democratic Party in recent years is that it has lacked the kind of strong leadership that can sort of like make choices and put its stamp on things. Republicans have very strong leadership in the form of Donald Trump, and that means that nobody wants to tell him, you know what, this overtime thing, we can't do it. It's undermining our goals here. It's going to backfire, even though it sounds good to people. They don't really want to pick and choose between these provisions. So they've come up with something that's just too big to pull off unless you want

• 21:15Speaker 01

  to make the spending cuts even bigger and even harsher, which already, I mean, they're facing a lot of pushback and some dissension inside the caucus about what they are going to do. You know, if you took Trillions of dollars more out of spending, you could make this work. Once upon a time, Elon Musk was claiming that he was going to find $2 trillion worth of fraud in the federal government. That didn't happen. The difference between the state of the world, in which you can save hundreds of billions of dollars in fraudulent social security payments, and one in which you can't, should alter your policies, but we're not in that mode.

• 21:49Ezra Klein?

  This is a lot of money. I mean, this is really a lot of money to put on the credit card at a time of high interest rates. Because I feel like there is such a tendency for the out-of-power coalition to emphasize the deficit and the consequences of unpaid-for spending or tax cuts. I'm always, even as I think about it, like, trying to catch myself, am I just sort of doing motivated reasoning here? But the Biden administration really did pay for the Inflation Reduction Act. That really did have pay-fores in it. Barack Obama paid for the Affordable Care Act.

• 22:32Ezra Klein?

  How are you thinking about the debt and deficits right now? What is actually the problems and why is it actually different than maybe it was 10 years ago? And how much does this actually then matter layered on top of that?

• 22:48Speaker 01

  I mean, I remember four years ago, we were talking about the American Rescue Plan, which was not paid for, you know, deliberately. It was stimulus measure, and some people were saying, "This costs way too much money. It's too big." And my thought at the time was, interest rates have been super low, like, forever, for basically my whole career. So I, A, sort of just, like, don't believe that inflation and high interest rates can happen, and B, if it does happen, the politics is just going to shift. We're going to be back to where we were in 2011, when everybody was fanatically focused on deficit reduction, and that might be good. And I was just completely wrong about that. Inflation did go up.

• 23:32Speaker 01

  Interest rates went up to get inflation-contained. It became a serious Kind of concern. And then we got the IRA, which sure, I mean, it was paid for, but it wasn't like a deficit reduction bill. And then there was nothing. There was no big speech about how, you know, we got to get everybody around the table and talk about things. And Trump came back with just incredibly fiscally irresponsible proposals. And it's weird, right? I mean, everybody in politics, you ask anyone and they'll be like voters are really upset about the cost of living. And I get that it is a little bit complicated to explain to somebody

• 24:14Speaker 01

  why a giant deficit increasing tax bill will raise your cost of living. But like it will, factually.

• 24:23Ezra Klein?

  How?

• 24:23Speaker 01

  Because it's going to raise interest rates, right? I mean, it's going to raise the cost of money.

• 24:28Ezra Klein?

  Why will it raise interest rates? Explain to me like I'm five.

• 24:31Speaker 01

  All right, here we go. So when the budget deficit goes up, the federal government needs to sell more debt. And the federal government is the safest entity you could lend money to in the universe, certainly in the United States of America. So however much money is sort of loaned to the federal government drains the pool of potential savings that could be lent to everybody else. That's sort of one way to think about it. Money will become scarcer, loanable money will become scarcer, because the federal government's borrowing all of it. Another way is to look at it through the inflation mechanism, right? The gap between what the federal government spends and what it taxes is like extra money into the economy. That has an inflationary

• 25:13Speaker 01

  impact, which the Federal Reserve then has to offset by keeping interest rates higher. And so, you know, you have J D Vance and Trump and others who are like screaming like Powell's got to get the interest rates down. You know, and I think reasonable people can disagree, like, should there be a quarter point rate cut next meeting? Or should there be no rate cut? But if you borrow trillions of additional dollars, that's going to make it harder to make the case for those kind of rate cuts. It's also going to make it harder for these short term rates to pass through to the the longer term rates. So. You know, if you're talking about young people who want to buy a house, the sticker price of a house matters, but the price of a mortgage also matters. It's a huge influence on what you can afford to do in practice.

• 25:58Speaker 01

  Small business loans, car loans, you know, large equipment. I don't really think people should be financing consumer purchases with credit card debt, but a lot of people do. And so, you know, it's going to raise costs across the board for middle class people. Take away healthcare from lower income people, but big strain on rural hospital systems. We haven't talked about the energy provisions, which are going to make electricity probably more expensive in the face of rising demand.

• 26:25Ezra Klein?

  Let me come to the energy provisions in one second. The other thing I just want to emphasize that you said there. When we tend to talk about cost of living in a bill like this, we tend to be talking about about interest rates and inflation, just as you did. I do just want to state the obvious, which is that if you were poor and you had Medicaid and now you don't, like your cost of living just went up. Healthcare just became much, much, much more expensive for you if you do not have some other form of equivalently subsidized and comprehensive health insurance sitting in your back pocket. If you were on food stamps, on SNAP, and you get thrown off the program because of these proposed cuts, food just became much more expensive for you.

• 27:08Ezra Klein?

  Republicans sometimes try to pretend that government transfers are not real, that like the role they play in people's budgets is not real, but it is a real role. So the whole thing for a president who ran promising to bring down the cost of living, and also, by the way, promised to balance the budget. It's just the scale of the dishonesty.

• 27:37Ezra Klein?

  And the cruelty is so staggering.

• 27:40Speaker 01

  Yeah, so there's a sort of robust debate happening about the health impact of Medicaid cuts. The sort of lottery-style evidence tends to show a fairly muted health impact, but has a small sample size. If you look at different research designs that let you get more statistical power, but some more questions about causation, it tends to show that, like many lives, will be endangered by these Medicaid cuts. But what even the skeptical analysis shows is that the financial benefit of Medicaid is large. And I think it's important for affluent people to not lose sight of that. Like, my son has been to see the doctor a lot of times in the course of his life.

• 28:24Speaker 01

  He's never actually had a serious medical problem. If we had just been unable to get him medical treatment all these times, I think in the grand scheme of things, he would have been fine. But like, the anxiety to loving parents of not being able to take your kid to the doctor when he's sick is extreme. If you had any ability to pay for medical care for your sick child, like, you would do it. And so what we see is that Medicaid expansion states reduce medical debt by about $1,400 to $2,300 per person. Because like, people try to get health care when they feel that they need it.

• 29:01Ezra Klein?

  Per person on Medicaid or just per person in the state?

• 29:04Speaker 01

  Per person on Medicaid.

• 29:05Ezra Klein?

  Yeah.

• 29:06Speaker 01

  The other thing is that you get uncompensated care in hospitals, right? Because we don't actually have a system in the United States where we're gonna just like, leave you on the street corner if you're having a stroke, something like that. So, you know, you are shifting costs onto forgone care by poor people, medical debt by poor people, uncompensated care for hospitals, which is then paid for by the insured population. And there's this threat that hospitals will just go out of business. I'm in Maine right now, in a very rural area. You know, hospitals don't have a ton of customers here. If they lose 10%, 15% of their customer base and have higher uncompensated care burdens, some of the facilities will just close.

• 29:49Speaker 01

  Senate Republicans have been talking about creating some kind of hospital bailout fund to prevent this, but it seems crazy to me to address business model problems for hospitals by giving them direct payments to stay in business even though they're not treating people. Rather than to just let people get treatment.

• 30:36Ezra Klein?

  I do want to talk about the energy credits.

• 30:39Speaker 01

  Yeah.

• 30:40Ezra Klein?

  Tell me about that side of the bill.

• 30:41Speaker 01

  Sure. So the Inflation Reduction Act created a lot of tax credits for different kinds of zero carbon energy. So they took what were existing investment and production tax credits for wind and solar, somewhat different ones for geothermal, somewhat different ones for nuclear. They folded it all together into a technology neutral tax credit program that was made permanent. Republicans in the House have proposed basically just scrapping all of this. So that would leave us with like less financial support for clean energy than we had in the previous Trump administration. So the context for this is that electricity demand is going up a lot, primarily because of data center construction.

• 31:27Speaker 01

  The pipeline for building new natural gas turbines is sort of bottlenecked. The actual turbines are not available. Most of the new electricity that is coming onto the grid in the United States is utility scale solar or onshore wind. There's going to be less of that built. If the House person were to pass, you would also cut off sort of promising speculative research in sort of clean firm technology. But so, yeah, I mean, we're going to have less but dirtier electricity and higher bills.

• 32:01Ezra Klein?

  There's also a dimension of this where these were promising sources of investment. But I was reading a story the other day about how this is throwing battery investment into some turmoil. That was a pretty bright part of the US economy. We've done a lot to begin building the supply chains. We consider them important. We also consider the solar panel supply chains important. And one way that we were inducing those chains to grow in the US and to grow in sort of like friendly countries was using these tax credits. So there was always a little bit of a lot being done by this part of the IRA, right? It had these intense buy American provisions because we were trying to like onshore this technology, but also we were trying to install a lot of the technology.

• 32:41Ezra Klein?

  But if you rip this up, I mean, you have the increasing climate change risk and consequence. You have the increase in electricity volatility and possibly in electricity bills. Then you also have the seeding yet more to China, which is investing just massively in solar technology and battery technology. I mean, you look at charts of Chinese utility scale solar installation and it is astonishing. This just has this quality of destroying like a useful part of the economy just because they ideologically don't really like renewables and didn't like the IRA.

• 33:24Speaker 01

  The battery stuff especially, you know, because batteries have just gotten a lot better over the course of the past five, 10, 15, 20 years. Batteries are mostly made in China. They are mostly made through China dominated supply chains. This has been a sort of Republican critique of electric car promotion, that you're just going to make the United States more dependent on a Chinese supply chain. Democrats tried to address that concern by putting money into creating an American supply chain for batteries. Republicans are not assuaged by that and now just want to get rid of the supply chain. Leaving aside the electric cars, right? I mean, if you look at the war in Ukraine, if you look at the fighting between Israel

• 34:07Speaker 01

  and Iran, battery-powered drones are, I think, very clearly sort of the future of warfare. It is genuinely dangerous for the United States to cede battery technology entirely to the People's Republic of China. It is probably not viable to just try to have like a military-only batteries industry because like the batteries that are in military drones are not special. And so if you have a good civilian industry, you can have a good military industry. Also, the amount of money at stake, specifically there, is just not very big. You know, a lot of it seems sort of cultural identity politics. Trump claimed in his first campaign that he was going to bring back the American coal

• 34:52Speaker 01

  industry. That just like completely didn't happen during his first term, but he's like, he's making another run at it. They're going to classify coal as a critical mineral, and they are seemingly trying to like cut off all other potential forms of energy other than coal. And wind in particular is really big in red states. Iowa, Kansas, I mean, these are just like places with big, empty, open space that are good for building wind. So I don't even know. I don't know that there's any logic to it other than a just kind of effective disdain for batteries and for renewables.

• 35:29Ezra Klein?

  They also seemed, and you can tell me if this is still true in the current versions of the bill, but they seem to be causing havoc in nuclear loan guarantees and subsidies, things that might support things like advanced geothermal. I mean, there are a bunch of more, I don't know how to describe this. I feel like in environmental politics, there's this weird cut where there are a couple clean energy technologies that are on the other side of like the left-right culture divide and nuclear and advanced geothermal were both there. But they seem to be like slashing into that too. The sort of center right or right wing innovation types I know have seemed very,

• 36:11Ezra Klein?

  very, very unhappy about what this bill is doing to the kinds of energy that they support and get excited about.

• 36:17Speaker 01

  Yeah, the House bill in particular does. The Senate bill reflects more input from those kind of people via Lisa Murkowski and other kinds of things like that. But in the House bill, they were going to like basically get rid of the Energy Department's lone program office, which has been supporting most nuclear development and get rid of tax credits for geothermal, things like that. You know, those technologies, Republicans sort of like them more than renewables, at least in principle, but they're very speculative, right? So the provision of subsidy to keep investment flowing into those industries is very important

• 36:57Speaker 01

  because like you can't actually make money right now investing in advanced geothermal. There's the hope that in the future, as they sort of adapt drilling technologies to the case of hot rocks, that this will like unleash incredible amounts of clean energy in the long run. But like somebody needs to drill the money losing wells today. You know, what's interesting, I mean, there's a, we say that Republicans like nuclear and geothermal a lot more than they like renewables. And I think that's true of sort of deceive Republicans, Republican Party theoreticians. But you know, the Republican Party is very attuned to the fossil fuel industry as such.

• 37:41Speaker 01

  And the natural gas industry is, I would say, more fearful of nuclear and geothermal than they are of wind and solar because gas sort of complements renewables, right? Like when the sun doesn't shine, you just turn on the natural gas plants. The whole virtue of clean firm technology is that you don't need to turn it off when the sun isn't shining. And that's the stuff that could actually put fossil fuels out of business for that reason. And so on an interest group level, there's as much or more hostility to those kind of clean firm technologies, even though like theoretically Republicans are more open to it.

• 38:17Ezra Klein?

  Back up to inauguration. You've got all the tech CEOs arrayed and, you know, at the inauguration. If you're listening to J D Vance interviews he's given, he's very pro nuclear. You know, this influence for people like Peter Thiel and Elon Musk, who have been pro technology and they want a lot of innovation and Musk is known for rocket ships and electric cars and batteries are very important to him. And that sort of promise, like futuristic Trump administration, what I would have called like reactionary futurism, Marc Andreessen, Joe Lonsdale, right? Like, I think the, the sort of folk understanding of their, of where their ideology had gone is like, we need an authoritarian in order to drive us past like the weak, risk averse,

• 39:01Ezra Klein?

  interest group fractured mess of politics and into the techno futuristic technocracy that we've all been imagining. Like, that just has all seemed really weak, right? They didn't like, Elon Musk went around and like, cut into USAID, which is horrible, and like, the Consumer Financial Protection Bureau, but did not build a government capable of innovating in some different way or getting to space a lot faster. All this stuff where like, you could have imagined a sort of techno futuristic, right? You know, the dark abundance, right? It's just not happening. You're just not seeing it.

• 39:36Speaker 01

  Yeah, I mean, some of that is, I think, the slipshod nature of Doge, you know, which was put together by people who didn't really know very much about the federal government and didn't seem inclined to like, read any books or things like that. But, you know, I think that the hyper partisan nature of Trump's politics basically makes it impossible to do these kind of good government reforms or futurism, things like that. I mean, something either party finds, right, is that if you're trying to do things on a party line vote in an era of high polarization, you are working with very thin margins.

• 40:18Speaker 01

  And that means you can't alienate any of the people who are inside your coalition. And so you have to do everything as these kind of buy offs. And that just makes it really hard to like, advance, you know, a futuristic vision. Like, you can't drive.

• 40:38Speaker 01

  Being changed by saying.

• 40:40Ezra Klein?

  I want to push on this because that's true up until Donald Trump gives a damn himself. And then it's like RFK Junior, a Democrat until 45 minutes ago, can be head of HHS. Tulsi Gabbard can be head of National Intelligence. And if Donald Trump wanted there to be big subsidies for nuclear in this bill, they would be there. I do think this reflects a sort of mixture of, I think the dynamic you're saying is sort of true, but I think that dynamic reflects a kind of a drift, right? Those people are there, but in the end, they did not maintain power. You don't hear that much about Mark Andreessen at Mar-a-Lago anymore.

• 41:21Ezra Klein?

  Elon Musk, very famously, is now not on the inside of the Trump administration. And Trump himself was never actually ideologically bought in. And J.D. Vance, I guess, doesn't care or doesn't care enough to engage or doesn't want to like talk to Donald Trump about it or something. But the entire political economy of Trumpism is that you don't have a strong policy process. But if some random person can get Donald Trump to like something, Donald Trump can make the rest of the Republican Party do anything he wants, including support like crazy tariffs they would have never touched at other times. He's just not because he doesn't, he's not engaged on any of this or doesn't care or actually opposes it or something.

• 42:02Speaker 01

  Well, I mean, there has never been, I mean, you mentioned tariffs, right? I mean, tariffs is the economic policy topic on which Trump has persistently fought with sort of conventional Republican Party thinking over a course of like 10 years now. And that's just like antithetical to this idea of like a more dynamic American economy.

• 42:27Ezra Klein?

  Yes.

• 42:28Speaker 01

  And the fact that there was like a sect of futurists who were so annoyed with Joe Biden that they decided Trump was going to be their champion, it never really made sense in light of Trump's like profound commitment to trade protectionism. Not just because trade is important on its own terms, but because like the whole debate of trade. Protection is like pretty literally like, should we say that the costs of economic change are worth paying for the benefits of growth and dynamism? Or should we not? And like, Trump has been very clear that as long as the people paying the costs meet a certain Trumpy vision of like a kind of person who he likes.

• 43:13Speaker 01

  He doesn't want change, right? So like, he's supported the Longshoreman Union in opposing port automation because he's a longstanding personal relationship with the head of the East Coast dockworkers. And because, you know, it's like burly white guys, the kind of people he likes. He likes the coal mining industry, right? Like, it's very obsolete, but he doesn't want it to be put out of business by change, by dynamics. I think, you know, one should have known that on some level. But the other thing I would say is that everything with Trump ends up being closer to baseline Republican Party politics than it kind of seems at first glance, right? So like, Tulsi Gabbard is in his DNI, but we bombed Iran.

• 43:55Speaker 01

  RFK Junior is in his AGHS secretary, but like, we're not like regulating the fast food industry.

• 44:01Ezra Klein?

  No, we're cutting Medicaid.

• 44:03Speaker 01

  Right, like, there's aspects of like Maha that kind of remind me of like an Ezra Klein column from 15 years ago, but none of that is happening. There's no like actual taking on agribusiness concerns, driving transformation of the food system to make people healthier. There's no aspect of Trumpism that's like, I'm gonna take on the stakeholders in conservative politics in like a really meaningful way. There's kind of, you know, there's a lot of personalism. There's like, I can jam this no tax on tips thing onto the political agenda, but I'm not gonna say we're gonna do no tax on tips instead of. A business tax cut.

• 44:45Speaker 01

  We're not doing choice-making populism where the Chamber of Commerce is like, "No, Donald, like, you can't do that. We need our business tax cuts." It's just kind of yes and, hope it all works out for the best. You know, Trump feels that it all worked out in the first term. People liked that first Trump economy.

• 45:04Ezra Klein?

  Well, here's the thing about Donald Trump. I mean, everybody knows that he's got just an incredible intuition for public opinion and for what's popular and what's unpopular. So, like, granted, this bill has a lot of bad ideas, but at least it's really popular in polling, right? Like, a huge political winner for it? No?

• 45:20Speaker 01

  No, I mean, the polling is terrible. People really don't like Medicaid cuts. This is like, actually, a big transformation of politics, is that Medicaid has become dramatically more popular over the past 10 years. There's a lot of people who have had Medicaid in the past, or who like, have a friend or a family member who's on Medicaid, and they basically like it. This has become a popular program. As there's been class realignment, as rich people become Democrats, they sort of still feel sentimental about the poor, and as poor people become Republicans, they still like having health insurance. So, this has become, like, really toxically unpopular in a kind of striking way, but it hasn't been the subject of a lot of attention.

• 46:05Speaker 01

  I would not say that the dominant story of Trump's first six months in government has been the one big, beautiful bill act.

• 46:12Ezra Klein?

  Yeah, so, I really, it is extremely unpopular. And I am actually surprised how unpopular it is because of how little attention it's gotten.

• 46:50Ezra Klein?

  So you and I have talked a lot over the years about what gets called populism and sort of your argument that big problem for the Democrats is that they don't take enough popular positions or abandon enough unpopular positions and that like sort of one of the strengths of Donald Trump is that he has done a bunch of that moderating on Medicare, moderating on Social Security. But there's always been this other question, right? Which is even if you are taking a popular unpopular position, how much attention is that position getting? Like, what is politics about? Is it about your good issues or is it about your bad issues? And one of the sort of arguments you've been making about Democrats in the past, you know, month or so is that they are not doing enough or not succeeding in

• 47:31Ezra Klein?

  doing enough to make politics about this bill, which should not be a crazy thing for politics to be about, right? This is a $5 trillion, depending on how you count it, bill that is actually going to be the signature legislation of Donald Trump's term. So walk me through that critique. And is that a problem with the Democrats, a problem with the media, a problem with like the voters who aren't paying attention? Like, how do you understand the sort of failure of this bill to become the thing we are talking about?

• 47:59Speaker 01

  It's a mixed bag. I mean, I do think, obviously, on some level, it's just harder to get people engaged in discussion of like JCT dynamic scoring and like Medicaid eligibility rules than something like we're deploying Marines to the streets of Los Angeles. That being said, like eight years ago, Affordable Care Act repeal was a really, really big deal. And there were big protests about it. And a lot of that was that there was a healthcare advocacy infrastructure that Democrats had built up during the sort of ACA years and that continued to exist there. A lot of that advocacy infrastructure has withered over the past few years, both because Democrats are more focused on climate change, but also

• 48:42Speaker 01

  because the Medicare for All wars had become a sort of like an ugly pain point for people. You know, if you go stand up and say, like, I really want to talk about healthcare, you're going to get a bunch of people saying, like, we should do Medicare for All. And like, now you're fighting with people to your left instead of like making a point about Republicans. That said, like, party leaders like Chuck Schumer and Hakeem Jeffries are talking about this a lot. They are constantly talking about how they want to get more people talking about it. They are trying to get their colleagues in Congress to talk about it more. I think a big problem is that the Democratic Party is leaderless at the moment. The leadership that they have is held in low regard by their own voters. And there is a lot of interest

• 49:27Speaker 01

  in factional infighting. We can have debates about abundance. We can have debates about Zohran Moudani. There's a lot of stuff that, and like me too.

• 49:35Ezra Klein?

  Like, my Twitter feed is national. And there's a lot more debate about the NYC mayoral primary right now in it than about the actually national, big, beautiful bill.

• 49:46Speaker 01

  Right. And it's because, in a genuine way, Democrats are interested in stories that have implications for factional infighting. And I think one of the ironies of this bill is that, like, Democrats all agree about it. Jared Golden, Marie Glazian-Campares, Adam Gray, the most moderate members in the House are like, this is terrible. We're all voting no. The most liberal members also don't like it. So there's nothing to fight about. And conservative people are pretty disengaged from it, too. Like, they're not making a lot of noise about it, which I think is tactically savvy on their part. You can say it's a failure

• 50:27Speaker 01

  of the media. Like, I kind of wish that, you know, the mainstream media would, like, only run articles about things that I think are important. But also, like, we're doing business here. Like, my articles on this subject do not perform as well as my articles on other things that have more juice.

• 50:45Ezra Klein?

  Let me ask you about that. Because, like, we both covered, we were at Vox at this time, we both covered the Trump administration in its first term, their effort to repeal Obamacare.

• 50:55Speaker 01

  Yeah.

• 50:56Ezra Klein?

  And maybe I'm misremembering this, but I remember that as very dominant news for an extended period of time. And I'm not sure if that's because there was less that happened in the middle of it, like us bombing Iran. I don't know if it was because it was a clearer narrative. I have this view that these massive omnibus bills have become harder for people to talk about because there's just too much going on in them. I think this is actually a problem for Build Back Better, which Democrats had trouble messaging and trouble getting people to think about because it just did 80 different things. I think it was a little bit true with the Inflation Reduction Act. But there does really feel like there's a difference between how central the Obamacare

• 51:36Ezra Klein?

  repeal effort was and Trump won and the way attention feels like it slides off of this in Trump 2.

• 51:45Speaker 01

  Yeah, and you know, I mean, I think the analogy to the Biden era mega bills is a good one. And at the time, Democrats at least were claiming to believe that if people were paying a lot of attention to the contents of Build Back Better, like they would love it and there would be this outpouring of public enthusiasm for them. And they were struggling to get attention to a bill that was a very miscellaneous hodgepodge of things. I would say that's probably working in Trump's favor at the moment, right now, that people are having trouble sort of getting their minds around an initiative that's not very popular. There's always this idea like, is Trump trying to distract our attention from things?

• 52:25Speaker 01

  And like, probably they didn't have a war with Iran for the purposes of distracting our attention from this legislative fight. But that is what happens, right? Like, when you do big dramatic things on other issues and just kind of say, you know what? I'm going to trust that congressional leaders can get this done without me spending a lot of time driving attention to it. I think that may be a good strategy. Trump, during the ACA repeal fight, really pivoted his own messaging to like, talking a lot about the need to do this and like staging big splashy events with House Republicans, things like that, because he believed, as presidents tend to, I mean, you've written

• 53:07Speaker 01

  about this many times over the years, but there's like, a persistent belief that if the president talks a lot about something, that's going to cause people to want to do what the president is saying. And all the evidence is that that's not true. And I think Trump is pretty wisely just not talking about this and saying like, it's party politics. He can convey his opinions to senators without making it a dominant story in the news.

• 53:33Ezra Klein?

  At the same time, I've been thinking about how unbelievably uninspired the Democratic messaging is on this. You know, when I was prepping for this conversation and I'm watching Hakeem Jeffries on the House floor, like, holding up an Elmo puppet, or Chuck Schumer, whether the C-SPAN messaging is good or bad, there's just like not the kind of thing that breaks through. Democrats have a lot of money in their campaign accounts. You could imagine really, really slick videos where you're talking with, you know, you're doing the kind of man on the street thing with people who use Medicaid in very Trumpy districts, talking about like what Medicaid means to them, what it's done for them, and like how they would feel if it was slashed to the bone or at these rural hospitals. Like, I'm

• 54:17Ezra Klein?

  not saying everything would break through, but it doesn't seem impossible to me if you had millions of dollars to message things, that you could come up with some things that would dramatize what is happening here, right, in ways that might get some attention. Democrats and Republicans seem to have allowed this to become an inside game in Congress.

• 54:38Speaker 01

  Yeah.

• 54:39Ezra Klein?

  And inside games are not that attractive to people to cover. And that's not been true on, say, the immigration stuff, where Democrats are going, getting like arrested by ICE because they are trying to create mass mobilization events. I feel like the, the news media, we're always like, well, is the thing gonna pass? And if it seems like they have the votes, the coverage kind of turns down because we just sort of cover uncertainty and conflict. But there needs to be something, but it does not feel impossible to me to create interesting content about this, but everybody just feels like they're playing by real congressional rules in a way that, you know, then the attention goes to the things that do not work that way and have more compelling visuals and mass participation in them.

• 55:24Speaker 01

  I mean, I think that the...

• 55:29Speaker 01

  Younger, especially, members, the more media savvy members, but just a lot of the sort of safe district members are not serving their caucus goals very well. That they are putting a lot of time into thinking of ways to be creative about the immigration issue and be seen as like fighting Trump on the level of tyranny. We had these nationwide no kings protests that was like very successful. That was well organized. It got attention. You know, there were good visuals, things like that. Those could have been no Medicaid cuts protests, but they weren't.

• 56:10Speaker 01

  We know that the democracy message has like fallen flat in the Trump districts, right? Whereas the healthcare stuff is like shocking to Trump voters. It's new information. It directs some firsthand. And then if you ask the kind of frontline members, what are you most comfortable talking about? It is Medicaid. It's OB/ BPA. They're like eh, on this immigration stuff. You know, I think that there is blame to be leveled at Schumer and Jeffries for just a kind of lack of creativity on their own messaging, a lack of skill, things like that. But also, there are many dimensions of political efficacy. I don't think either of those are guys who were like ever known as like the viral video guys.

• 56:55Speaker 01

  And, you know, the members who are sort of gaining clout inside the coalition are finding that the way to gain clout is by doing advocacy on sort of more post-material things that I think are more engaging to Democratic donors. And I don't think it's serving the country well. I don't think it's serving the party all that well. When Cory Booker did his talking filibuster, that was primarily focused on these. I mean, obviously, he talked about a lot of things because he was going for 24 hours. But like, his key message. Twenty-five? Twenty-five. His key message point was about Medicaid and Medicare. So a lot of this, I think, does go back to this factional argument, right?

• 57:37Speaker 01

  It's like Democrats in 2017, I think, felt self-confident about the Democratic Party. And we're like, you know what? What brings us together is healthcare, and we're going to talk about that. And now there's like a lot of uncertainty, a lot of depression, a lot of infighting. And so it's like, you know what brings us together is healthcare? So like, that's boring. And like, we need to fight with each other.

• 58:02Ezra Klein?

  You can tell me this is something you're saying, but at least something I'm taking out of what you're saying, or feels true to me, which is that a lot of what is engaging Democrats and liberals, and certainly abundance has been part of this, is like a working backwards from 2028. I feel Democrats, their mind is not even in 2026 in the midterms, it's in 2028. They're sort of disassociating in many ways from like this moment, or Zohar Mamdani maybe being an exception to that. People are interested in Mamdani, not because they care so much about the New York City mayoralty, but it's like, maybe he means that in the future, we're going to have all the kinds of Democrats, if you're a democratic socialist, that we actually want, like, running the party, right? People are doing a lot of like, projecting forward.

• 58:42Speaker 01

  Right, like Mamdami holds forth the possibility that in the future, Democrats will break with the longstanding bipartisan pro-Israel consensus. That's interesting. You look at like, the New Jersey gubernatorial primary, it was just a bunch of Democrats running. Miki Sherwin, and like, good for her, I like her, she's against Medicaid cuts, but like, so is everybody, right? Like, it's just about New Jersey, and therefore people are appropriately not interested unless they happen to live in New Jersey. But what happens between now and 2028 is important for millions of people, and it would be good to get some more focus and some more attention on it, even though it

• 59:24Speaker 01

  doesn't connect to any of these blue sky, what is the future of Democrats? Because everyone just agrees that the future of Democrats is that they're going to support progressive taxation and a social safety net. But I actually think that's important, like, that's the actual foundation of the contemporary Democratic Party.

• 59:42Ezra Klein?

  Yeah, it's funny, one of the critiques I got over the past couple of months that I had not been expecting is people being like, abundance doesn't talk about things like Medicaid and universal healthcare, so that shows you don't, it's like, no, no, I just took that as settled. I just didn't think, I didn't need to edit my support for Medicaid or for universal healthcare.

• 59:57Speaker 01

  But I mean, it's a great example, if you had put... A chapter in the book where you were like Medicaid is good and we should have incremental expansions of healthcare access. People would have read it and be like, that's a boring chapter. Like, why is that in the book?

• 1:00:10Ezra Klein?

  Right.

• 1:00:11Speaker 01

  Right? It's not good content to just sort of reiterate Democratic Party conventional wisdom. But there's millions of people with healthcare on the line and it is important to find ways to talk about, find ways to get people engaged with it. But there is, as you say, like so much investment in what does it mean for 2028? What are the prospects for generational change in the Democratic Party? That's interesting to people. But again, it has like nothing to do with Medicaid.

• 1:00:37Ezra Klein?

  I've honestly heard more about the David Hogg infighting around the Democratic Party and primaring older Democrats. It's funny, it's just not a thing that has, I've been thinking a lot about the dynamics that sustain attention. You get attention on one thing. And so there have been plenty of like good tweets on this or a video or a floor speech. But the question of like, how do you sustain attention? It requires people arguing about a thing. And the other thing that I think is real here is that the dynamics of social media algorithms means that people are mainly talking to others within their coalition. And so arguments happen within the coalition are very salient. And then arguments happen

• 1:01:20Ezra Klein?

  between the coalitions are much less so. There's like less engagement between the two sides. And so the things that they debate become a really big deal during an election, say.

• 1:01:30Speaker 01

  Yeah.

• 1:01:31Ezra Klein?

  But in oftentimes, it actually creates a sort of weird dynamic where it's like, okay, yeah, like all the Democrats are against this. But you're an attentional merchant. What do you think would make this more salient? What do you think the actual hooks of it are?

• 1:01:45Speaker 01

  Yeah, I mean, I, you know, I do think obviously Medicaid cuts and hospital closures is good. I mean, I think trying to do stunts and events.

• 1:01:53Ezra Klein?

  Good for getting attention, not your super pro Medicaid cuts.

• 1:01:56Speaker 01

  Right, right, right. I mean, it's sort of the attention grabbing part. I also think conservatives writ large, I would say, have been pretty disciplined about not debating this kind of issue in a way that is a little bit challenging to deal with. So I do think that it would be helpful to have more of an affirmative agenda. On healthcare that people would be talking about, that they would be arguing with. You know, if you could get people together on like, here is how we want to make healthcare more affordable for the American people. They want to make it less affordable. Then you can have a somewhat more focused and structured argument that hopefully like

• 1:02:38Speaker 01

  gets some people on the right to like articulate their opinions about this because otherwise it's sort of too easy to sort of let things slide. I will say the other thing, I mean, you raised the point that political media is very interested in process and in sort of like wins and losses. The Republican Senate margin is just big enough that I don't think anybody thinks this is not going to pass. The question is, what will this be? But like, the House majority is thin, but like House moderates have never blocked a bill, as far as I can remember. I'm sure like in the 1870s it happened, but it's always been Senate moderates who have

• 1:03:23Speaker 01

  more independent stature or sort of known in their home states, but we're no longer in a mode where it's like Susan Collins and Lisa Murkowski and one other person can block this thing.

• 1:03:33Ezra Klein?

  Well, Josh Hawley wrote a piece in the New York Times.

• 1:03:37Speaker 01

  Yeah.

• 1:03:37Ezra Klein?

  Saying that the Medicaid cuts were bad.

• 1:03:39Speaker 01

  Yes.

• 1:03:40Ezra Klein?

  Right? Steve Bannon has a, there is something here. I mean, there is a weirder dynamic here and a more exploitable dynamic than just Democrats like Medicaid and Republicans don't because a bunch of the rising populist generation of Republicans think they shouldn't be doing this and have clearly just been cowed into submission.

• 1:03:58Speaker 01

  Yeah, I mean, I think that's right. You know, it should be a good opportunity for things. Maybe it will even happen. I mean, I saw for the first time we had Medicaid protesters at the Capitol, people in wheelchairs.

• 1:04:10Ezra Klein?

  Yeah, getting arrested.

• 1:04:11Speaker 01

  Arms had been zip tied to keep the Capitol safe, I guess, from these people who can't walk.

• 1:04:17Ezra Klein?

  Well, you know how seriously Donald Trump and the Republicans take the safety of the US Capitol?

• 1:04:21Speaker 01

  Yes, the integrity of the US Capitol has always been his top thing. So, you know, I mean, maybe it's just about to begin now, this mobilization. You know, I think a great thing for Zohran Mamdami to do would be to spend some time talking about like a big consensus issue because one thing I'm thinking about is in whose interest is it? To facilitate a lack of factional infighting. And it's like, the guy who just won the contentious primary, he already won. So like, now what he needs is to remind people, people who didn't vote for him of like, all the stuff they agree with him about.

• 1:04:55Ezra Klein?

  It's just an amazing, though, revealed insight into how weird the dynamics of political attention are. Because I'm not saying you're wrong, you're right. But that it's obvious to both of us, it would be more meaningful for the 33-year-old Assembly member who won a New York mayoral primary to really engage on this Medicaid bill than like, than like, all of the Democratic politicians who actually hold office and see, you know, might have a vote. There just is something, there's something about the way attention does not accrue to power that is really interesting. Hakeem Jeffries can't get people to pay attention, and he's the minority leader in the House. I agree with you, Zoran Mamdani could.

• 1:05:39Ezra Klein?

  AOC has been obviously messaging about this, but I think probably could focus on it more, right? Like, attention is such an unevenly distributed capacity?

• 1:05:49Speaker 01

  Yes. Well, and you know, some of this is the old saw about, you know, dog bites man and man bites dog, right? But so it's like, of course, the Democratic leaders are like, saying this is bad, right? You know, we had, like, I think Jimmy Kimmel played an important role in the ACA repeal.

• 1:06:06Ezra Klein?

  About my career appeal with the story about pre-existing conditions.

• 1:06:09Speaker 01

  Yeah, you know, in part because he's not a very political person. So when he decided to talk about something, it was like, oh, my God, you know, Jimmy Kimmel. And like, the actual point, I agreed with the point he was making, but it's not like nobody else had ever thought of that in the preceding 10 years of talking about this. It was just, you heard from somebody fresh and somebody famous, a like, really sort of banal point about the importance of those pre-existing conditions regulations. And if you could just find somebody new to talk about healthcare. Everybody likes to talk about who is and isn't going on Joe Rogan. And like, where's he at on Medicaid cuts? Like, I don't know, right? Like, that's interesting. I mean, obviously, I hope everybody watches the Ezra Klein Show and talks about this

• 1:06:54Speaker 01

  with their friends, because one of the things about attention in a social media era is like, We're not passive, helpless victims

• 1:07:01Ezra Klein?

  Yes.

• 1:07:02Speaker 01

  of the attention economy. I mean, we decide to an extent what to pay attention to, what to give hearts on, what to argue about, what to retweet, what to discuss with our friends, things like that. And like, part of the message here is like, the meta-message, right? Like, you, the listener, ought to try to increase your personal level of engagement with this topic and with content that relates to this topic, and not just be monomaniacally focused on factional positioning for the future. It's good to talk about abundance, I think is important. It's good to talk about the housing legislation that's pending in California. That's a big one. But, you know,

• 1:07:45Speaker 01

  we all do need to also talk about aspects of consensus.

• 1:07:49Ezra Klein?

  I think that is a good place to end. Also, final question. What are three books you'd recommend to the audience?

• 1:07:54Speaker 01

  Laura Spinney's book, Proto: How One Ancient Language Went Global, about the rise of the Proto-Indo-European language. That's a really good one. Wuthering Heights, which I just finished, a classic novel. That's what I've been trying to get on for my reading and things like that. But I also revisited Paul Starr's classic, Social Transformation of American Medicine, because I've been trying to get my attention back on the healthcare issue.

• 1:08:19Ezra Klein?

  Did you really? Are you just saying you did?

• 1:08:21Speaker 01

  No, like, I picked it up. I was reading through it, because I wanted to read about the origins of our path-dependent healthcare system. I will tell you, I did not do like, a cover-to-cover reread.

• 1:08:31Ezra Klein?

  That book is great. And just while we're doing old healthcare books, if anyone just wants to read a book about how differently healthcare and just policy processes work, something you and I talk about sometimes when we get together, is that it feels like there's no policy process anymore. But David Broder wrote a book about the 1994 healthcare fight, the Bill Clinton healthcare fight, called The System.

• 1:08:53Speaker 01

  Yeah.

• 1:08:54Ezra Klein?

  And you just read that book, and you read about just like, how much energy went into the crafting and debating and re-crafting and re-debating and committee members and everything of the Clinton healthcare bill. You think about the insanely slapdash way. Just a giant bill right now is being put together and barely debated, and like, things traded in and out, no serious analysis, just ignoring what is actually out there. And you just realize how...

• 1:09:21Ezra Klein?

  I don't want to say it's unserious because the consequences here are deadly serious, but there's been a real deterioration of the procedural scaffolding and deliberative structure of politics and how we make bills, particularly on the Republican side, although not only, I think, on the Republican side, but it

• 1:09:40Speaker 01

  Yeah.

• 1:09:40Ezra Klein?

  I think you'll be more shocked by it than than people realize.

• 1:09:43Speaker 01

  Yeah, because if you read Jonathan Cohn's book about the 10-year war, about Obamacare, right?

• 1:09:48Ezra Klein?

  Yep.

• 1:09:49Speaker 01

  That's a halfway house, right? It's not the same committee-driven process from Broder's book. Like, it's become more leadership-driven, but they are still very focused on the actual policy stakes. At critical points, like people in the White House are like, no, you have to do it this way, for like boring, wonk kind of reasons. And like lots of members of Congress really don't want to, and they're like pushing them on the policy merits really hard. And that seems completely out the window these days.

• 1:10:21Ezra Klein?

  Matt Iglesias, thank you very much.

• 1:10:24Speaker 01

  Thank you.

• 1:10:44Ezra Klein?

  This episode of The Ezra Klein Show is produced by Roland Hu and Jack McCordick. Fact checking by Michelle Harris with Kate Sinclair and Mary March Locker. Our senior engineer is Jeff Geld with additional mixing by Aman Sahota. Our executive producer is Claire Gordon. The show's production team also includes Marie Cassillon, Elias Isquith, Marina King, Annie Galvin, Jan Kobal, and Chris Tinlin. Weave original music by Pat McCusker. Audience strategy by Christina Semilouski and Shannon Busta. The director of New York Times Opinion Audio is Annie Rose Strasser.