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Abdul El-Sayed: “We Need to Remember This Is About People, Not Numbers or a Curve”

Abdul El-Sayed

In an interview with Jacobin, Medicare for All advocate and former Michigan governor hopeful Abdul El-Sayed explains why the COVID-19 pandemic was avoidable — and why the cruelties of the US's for-profit health and economic system are making everything worse.

Abdul El-Sayed speaks with the news media after campaigning with Alexandria Ocasio-Cortez at a rally on the campus of Wayne State University on July 28, 2018 in Detroit, Michigan. (Bill Pugliano / Getty Images)

Interview by
Natalie Shure

Abdul El-Sayed, best known for his insurgent progressive campaign for Michigan governor in 2018, has built a career at the intersection of politics and public health, serving both as a professor of epidemiology at Columbia University and as Detroit’s public health commissioner.

Since his underdog run, El-Sayed has emerged as one of the most prominent advocates of Medicare for All, endorsing and campaigning for Bernie Sanders in the 2020 primary. His new book, Healing Politics: A Doctor’s Journey Into the Heart of Our Political Epidemic, delves into topics made ever more urgent by the ongoing coronavirus pandemic.

In an interview with Jacobin contributor Natalie Shure, El-Sayed offers his thoughts on the political response to the COVID-19 crisis, the depredations of the US’s profit-driven health system, and the causes for hope in this fraught moment.


I interviewed you for a different piece a few weeks ago, but I feel like it was back in another world. You’ve mentioned feeling confused since. Can you unpack that for me? What are you feeling confused about?


Yes, pre-pandemic felt like a different world! I don’t know if you’ve ever been hit by something you weren’t expecting. But no matter when it happens, your body goes into response mode. It’s sort of checking all systems asking, “Am I okay? What needs to be done right now?” And then, after it happens, you realize that you got hit. And then you start dealing with the emotional and long-term consequences, of how you adjust your worldview because it happened.

For me, I’ve been so busy trying to respond that I am only just now coming to grips with the longer-term complexities and my own emotional reaction to it. And I think I’m doing that in the context of many other people coming to the same set of thoughts and questions — which is the most comforting and also terribly devastating thing about a complex collective trauma, which is what this is.


Yeah. So, along those lines, how have you spent the last few weeks? What kind of role have you fallen into?


Well, I’ll tell you, there’s not a day that goes by that I don’t wish I were back in my role at the health department. I feel kind of like a general who’s missing the war. Which is hard, because I trained to do a thing which I think I’m decently good at that’s really, really important right now. And I feel like I’m not doing that thing. I know that the people who are doing it are doing their best job, but it’s hard to know that maybe you could do a good job and that people could be healthier for it — that’s why we do this work.

But I have been trying to make sure that I’m a part of clarifying what’s happening for people, and translating it and explaining it to the best of my abilities. So that’s been in the form of a podcast, commentating, and a lot of interviews about what this means and how we should respond, but also about why it’s happened. There are the technical aspects of why, but there’s also the “big picture why.” And that’s harder to contend with, because it says a lot of things about what was preventable. There’s something to lament about the fact that we are even here.


A lot of your book is about these root causes and why things happen, beyond the proximate or direct cause of a given event. What are the most important underlying factors in how COVID-19 has played out in the United States?


Number one, our health system is uniquely poorly suited to dealing with something like this. When you’re talking about an infectious disease pandemic, it’s never good that 10 percent of your population has learned not to see a doctor when they have nonspecific symptoms that are the same as what this disease produces. There’s a whole part of the population that’s learned to ignore a fever and a dry cough, because that might mean a bill on the back end.

You look at how our system is financed, which relies on a profit margin. When all of a sudden, hospitals have to cancel all of their most lucrative cases of elective procedures to make room for the onslaught of COVID patients on the way, they’re now not only just fighting COVID, but also fighting bankruptcy. That’s where most of our hospitals are right now.

You think about the incentives of supply chains in for-profit systems that are taught to supply “just in time” — but “just in time” isn’t great when you’re in the middle of a pandemic. We’re just not set up for this.

Beyond that, the way our country is dealing with this is through social distancing, which is forcing the poorest and most marginalized people to choose between staying home to save their own lives, or those of others, versus protecting their livelihoods and going out and working. You’ve got people who are in impossible situations, because of the inequity and precarity of our economy for so many people. You think about the rising cost of housing, the cost of student debt, the cost of basic utilities, and these folks are getting hit by bills that keep coming.

All of it comes out of this system where we’ve traded off basic public services and public goods so that a few people can make a lot of money off them. We have a large proportion of our population that’s living paycheck to paycheck, who are not only dealing with the risk of losing their lives or the lives of loved ones in the middle of a terrible pandemic, but also their livelihoods and the economic consequences they’ll bear for a long time. And now that we’re in the process of trying to solve it, corporations have a lot more capacity to lobby for themselves than everyday people do.

So all of it goes back to this sort of miasma that I talk about in my book, that causes an epidemic of insecurity. This moment found us extremely vulnerable because of it, and has in some ways replicated the same pattern we’ve seen of money and power moving to the very few.


That’s a great rundown. Can you expand on your thoughts about the recent stimulus bill and the political response to the COVID-19 fallout so far?


One of the crazy things to me is that we know our hospitals are bearing the brunt of this right now. There are not enough ventilators, there’s not enough PPE [personal protective equipment]. But only about 5 percent of the overall bill was hospital relief, which was somewhat astounding to me, to be honest.

Number two, a whole quarter of the bill was corporate bailout money, and without any of the conditions a lot of us would have liked to see so those corporations couldn’t leverage this moment to consolidate their own power. Elizabeth Warren had a list of really great conditions that would have prevented that from happening, whether it was making sure that they didn’t violate collective bargaining agreements, or fire people, or buy back stock, or pay their CEOs bonuses in the middle of this. But those didn’t pass. And that’s frustrating!

I do think that the unemployment on steroids is a great start, as well as sending checks to people and their families. At the same time, though, you’ve got to ask: is it enough? This is an unprecedented moment in American economic history. People are feeling the brunt of that right now. And the best we could do is give them enhanced unemployment and a one-time check?


What can people be doing right now to counteract the impact of the coronavirus and the insufficient political response to it, and stand in solidarity with those most affected?


Number one, we’ve got to beat this virus, which means that public health has to be front and center. People need to stay home and protect themselves and their families. Number two, support small businesses in your community if you can, like local bookstores or restaurants. If you are somebody who’s lucky enough to be gainfully employed and working in this moment, it’s really critical that you’re doing what you can to continue to pay folks you would ordinarily, like day-care providers. And we’ve got to hold our policymakers accountable and make sure they understand that this should not have gone this way.

But the future is still ours for the making. After the pandemic, we cannot forget just how vulnerable we were to this, what should have been done to protect people, and how we failed over the course of decades to do just that.

Something like this could still happen in the future — it’s not like we’ve had our shock and that’s it. Climate change is still bearing down on us. It’s not enough to just make sure we’re solving challenges in the day-to-day, it’s also critical for us to step up and take on the biggest existential threats we face.


You’re understandably frustrated with the legislative response so far. How are you feeling about media coverage of the pandemic? What narratives should be pushed back against?


One is that the pandemic is like a hurricane, like it is an “unpreventable act of God.” But this was preventable — we could have fully prevented it. That narrative just allows Donald Trump to get away with, “Well, I’m doing my best in hard circumstances.” No! Had you not disinvested in public health, we would not be here right now.

Number two, there’s far too much coverage of inaction. We give Trump uninterrupted airtime across every major channel for multiple hours every day, to watch him blather about what he’s not doing. Or to beat up on journalists who are trying to cover him appropriately. I understand the argument that he’s the president of the United States, so how do you not cover what he’s doing? But he’s using discord and division to farm out these mini-narratives that are covered like soap operas rather than focus on the technical and political failures of our society, like who made decisions about who gets to have basic things and who doesn’t.

The third thing is that there needs to be more focus on individuals who are suffering, and really drilling down into what it feels like to be harmed by this. We need to remember this is about people, not numbers or a curve.


Shifting gears, the Democratic presidential primary is technically still continuing. Joe Biden is the presumptive nominee, and you were a surrogate for Bernie Sanders. How has this pandemic drawn out the differences between the candidates?


I really admire that Bernie has taken his campaign and used it to identify both what’s happening and what can be done about it. That shows a lot of leadership, and it’s such a contrast to what we’ve seen out of Donald Trump, who is focused on his ratings for his quite useless public spectacles.


What’s your assessment of Biden’s leadership and style since this started?


Well, he is really focused on “getting us back to normal.” I understand why that might be the instinct right now. At the same time, I just feel like our understanding of what’s normal is going to have completely changed after this experience, and it’s critical to be articulating what the post-pandemic America has to look like to win the future. That’s really, really important right now.


In a nutshell, what does it have to look like?


Number one, we’ve got to sew up our social safety net in some really clear ways. I don’t even like the idea of a “social safety net” — it should be a trampoline. We need to create opportunity for folks. Number two, we cannot continue to disinvest in public goods and public services and expect that somehow we will be okay. And number three, we’ve got to move to Medicare for All. We just have to do it.

My hope is that coming out of this, we decide as a society that we’re no longer okay with the mini-tragedies that used to befall people all the time, but just didn’t happen simultaneously the way they’re happening with this pandemic. We’re suffering a complex, collective trauma, but individual traumas happen all the time. Ten percent of people are uninsured, the majority have health care behind a paywall, 42 percent of people who get cancer go broke because of it — these are tragedies, they’re just not experienced all at once. And so my hope is, by going through this collective moment, we come to appreciate that we’re all in this thing together and that we are going to build the means of providing for all of us.

People are their best sometimes in crisis. You’re watching the kind of generosity and big spiritedness that we’ve taken out of our governing ethos, and it’s time to put that back in. Our government is the greatest and most obvious manifestation of our collective will, especially in a democratic society. So, I hope we can institutionalize that, and take it forward.