---
author: The Ezra Klein Show
date: '2026-09-25'
guest: ''
layout: post.njk
source: https://www.youtube.com/watch?v=f7MVyjL-rbk
speaker: The Ezra Klein Show
tags:
- political-strategy
- healthcare-reform
- national-identity
- left-wing-populism
- geopolitics
title: 密歇根州参议员选举：铁锈地带的进步派纲领、医疗改革与美国身份认同的深度探讨
summary: 文章深入分析了密歇根州参议员选举的政治背景，探讨了左翼民粹主义在“铁锈地带”的含义，并聚焦于全民医保改革（Medicare for All）的时机。同时，文章通过候选人个人经历和移民身份认同的视角，探讨了美国作为多元化理想集合的本质，以及在国际冲突中的美国角色与公民社会的凝聚力。
insight: ''
draft: true
series: ''
category: politics-society
area: society-thinking
project: []
people: []
companies_orgs: []
products_models: []
media_books: []
status: evergreen
---
### 密歇根州参议员选战：铁锈地带的进步派纲领与美国身份认同
**主持人**：密歇根州的联邦参议员选举，很可能成为民主党内部路线交锋最前沿的主战场之一。左翼民粹主义在被称为“铁锈地带”的州份究竟意味着什么？民主党人下一步应该如何推进全民医保安全网改革？现在是彻底重构奥巴马医改（ACA）的时机吗？实施全民医保（Medicare for All）乃至不断扩大医保覆盖面的时机是否已经成熟？此外，民主党在以色列和巴勒斯坦问题上的立场将走向何方？美国在这场旷日持久的冲突中应当扮演怎样的角色？
阿卜杜勒·埃尔-赛义德（Abdul El-Sayed）是密歇根州联邦参议员的民主党候选人。他的竞选对手是共和党人迈克·罗杰斯（Mike Rogers），在近期大部分民调中，埃尔-赛义德都处于领先地位。在这个选举周期中，候选人接受长篇深度访谈的机会少之又少，网络上充斥着碎片化的信息。因此，我想当面与他深入交流，不仅为了了解他的经历与从政初心，也为了探究他一旦进入美国联邦参议院，究竟能为选民带来怎样的改变。
今天，他来到了我们的演播室现场。欢迎你，阿卜杜勒·埃尔-赛义德！
Original English
**Host**: The Senate election in Michigan could be the foremost battleground platform for one of the major ideological fights within the Democratic Party. What does left-wing populism look like in the heart of the "Rust Belt"? Where should the Democrats' perspective on healthcare safety-net reform go next? Is it time for a fundamental restructuring of Obamacare? Has the moment finally arrived for Medicare for All, expanding Medicare's reach and coverage further and further? And furthermore, what will the Democratic Party's relationship with Israel and Palestine look like? What role should the United States play in this conflict?
Abdul El-Sayed is the Democratic nominee for the U.S. Senate from Michigan, running against Republican Mike Rogers, and leading in multiple surveys and polls across different demographics. Candidates in this cycle rarely give long-form, comprehensive interviews of this depth on the internet. But I wanted to speak directly with him in person—to understand who he really is, what drives him, and what exact difference he would make in the United States Senate. Joining us right now is Dr. Abdul El-Sayed. Great to see you.
**阿卜杜勒·埃尔-赛义德**：非常感谢你的邀请，很高兴来到这里。
Original English
**Abdul El-Sayed**: Thank you for having me. Great to be here.
**主持人**：我想请你先聊一聊你的家庭背景与个人成长故事。你的父母来自埃及，而你的继母一家竟然是阿比盖尔·亚当斯（Abigail Adams）的远亲后裔。能跟我们讲讲你的家庭和成长经历吗？
Original English
**Host**: So, I want to start by asking you to tell us a bit about your family story. Your parents are Egyptian immigrants, while your stepmother's family traces its ancestry back as distant relatives of Abigail Adams. Tell us about that background.
**阿卜杜勒·埃尔-赛义德**：是的，我的亲生父母后来分开了。回溯过去，我的母亲一直是我这辈子见过的最聪明、最智慧的人，尽管她当年甚至没有机会接受正规的学校教育。她总共抚养了八个孩子，可以说是用尽毕生心血在操持家庭。我的父亲则年纪稍大一些，他是一位真正的知识分子。在那个年代的埃及，如果不是长子，家庭资源往往很难倾斜到你身上。但他非常渴望求学，于是他竭尽全力去争取受教育的机会。在当时的埃及，如果你想成为一名学者或大学教师，你必须在全国性统考中名列前茅，才能进入工程学院或医学院深造。
Original English
**Abdul El-Sayed**: So, my parents divorced when I was young. Looking back, my mother remains the smartest, wisest person I've ever encountered in my life, yet she never had the opportunity to go to school. She raised eight children, essentially dedicating her entire existence to nurturing her family. My father was older, truly an intellectual. In Egypt at that time, unless you were the eldest son, opportunities were severely limited. But he was determined to pursue higher education. He studied relentlessly, because in the Egyptian system back then, you took standardized national exams where top scores determined whether you could study engineering or medicine.
**主持人**：在那种体制下，如果考砸了或者没有背景，人生轨迹就会被彻底固定。
Original English
**Host**: Under that system, if you didn't place at the top, your path was basically set for you.
**阿卜杜勒·埃尔-赛义德**：完全正确。在当时的埃及，如果成绩垫底，等待你的就只有被强制征入军队服役。那时候的国家处于军人独裁统治之下，整个国家都笼罩在威权高压的阴影中。对于像我父亲这样的年轻学者来说，国内连真正的研究生和博士深造通道都极其匮乏。大学体系僵化，学术环境处处受制。当他偶然获得了一个前往海外留学深造的机会时，他没有半点犹豫，毅然说道：“我一定要去，我必须抓住这个机会。”
对他而言，心里始终憋着一股不服输的劲头：“为什么别人能做到，而我不能去追求心中的理想？”直到今天，他依然保持着这种性格，我也正是因此深深敬佩着他。
来到美国后，对他来说，这里就是一块真正拥有自由的土地。我父亲不是那种只空谈口号的人，但在他看来，能够拥有各项公民权利、享有投票权、成为民主制度运转的一部分——这些绝非理所当然的琐碎事物。我经常思考，他是否曾经想过，自己的儿子有朝一日会决定竞选公职，去角逐代表人民的立法席位。
Original English
**Abdul El-Sayed**: Exactly. At the bottom of the list, people were simply drafted into the army under an authoritarian military dictatorship. That was the regime governing the country. And for someone like my father, there wasn't even a true equivalent of a graduate or postgraduate program. The university system was rigid, and students were kept under strict control. So when the opportunity arose for him to go abroad to study, he said, "I'm going. I have to take this chance." For him, it came down to a fundamental belief: "Why can't I pursue what I believe in?" He still lives with that same spirit today, and I love him deeply for it.
America, to him, was a place defined by real, tangible freedom. My father wasn't someone who made grand rhetorical speeches, but having rights, participating in voting, and being an active part of a functioning democracy were things he never took lightly. I often wonder whether he ever imagined that his own son would choose to run for political office.
---
### 美国理想的真谛：从移民经历看公民社会的凝聚力
**主持人**：移民来到这个国家的人，往往对“美国梦”有着最深刻的体会。无论你来自哪里，无论你的肤色如何、口音怎样，你都能在这个国家成为真正意义上的美国人。
Original English
**Host**: You know, that realization that no matter where you come from, what color your skin is, or what accent you speak with, you can become an American—that is profoundly powerful.
**阿卜杜勒·埃尔-赛义德**：是的，我一直极其郑重、无比严肃地看待这份身份认同。我至今清清楚楚地记得，当我父亲正式宣誓入籍成为美国公民的那一天。那时我还很年幼。我记得我的继母——她是个地道而淳朴的美国人——开玩笑地指着我说：“照这么说，布巴（Bubba）明天要是走到这里，是不是也能变成一个金发碧眼、操着正统美国本土口音的公民？”而当时只有几岁的我心里困惑地想：“这怎么可能呢？他明明还有着浓重的老家口音啊！”然而那一纸入籍证书下来，他就是法律意义上完整且平等的美国人了。
这让我从小就明白了一个道理：美国从来都不是由某种单一的长相、族裔或口音来定义的。美国是一整套神圣不可动摇的理想与信念的集合。它建立在一套共同的价值基石之上，只要你全身心投入其中，你就是这个国家不可分割的一分子。这也是我长久以来不断反思的核心问题。
Original English
**Abdul El-Sayed**: Yes, and I've taken that responsibility with the utmost seriousness throughout my life. I still distinctly remember when my father became naturalized as an American citizen. I was very young at the time. I remember my stepmother playfully saying, "So does this mean Bubba is going to walk in here tomorrow with blonde hair, blue eyes, and no accent at all?" And as a kid, I thought, "How can that be? He still has his thick accent!" But just like that, he was naturalized. He was fully American.
That taught me early on that being an American isn't defined by what you look like or whether you speak with an accent. America is a set of ideals. It is a shared civic faith. That principle is something I have reflected on for many years. When you are fully committed to those ideals, you are entirely part of this community.
**主持人**：这一点非常关键。我自己的父亲来自巴西，我也亲眼见证了他宣誓入籍的全过程。那种情感冲击力是无与伦比的：从法律和公民权利的角度看，你就是一个百分之百的美国人，与其他任何人没有任何高低之分。
这正是“何谓美国人”的精髓所在。世界上很多国家依然依靠单一民族、特定种族或特定宗教来划定国族界限。比如在英国，即使几代人生活在那里，来自巴基斯坦等背景的家庭仍常被主流社会区分对待，人们会问：“你究竟是英国本土人，还是英籍巴基斯坦人？”但在美国最震撼人心的地方在于，我们不仅拥有宪法保障的公民身份，更有包容多元的宪政文化。
当然，现在依然有一部分人试图收紧对“美国人”的定义，试图把特定少数群体排斥在外，筑起一道排他的高墙。但我们必须坚信，美国之所以伟大，就在于我们能够把来自不同背景、拥有不同分歧的人群团结在一起，共同守护民主协商的过程，从而创造出一个远远大于各个组成部分总和的强大国家。
Original English
**Host**: And that hits home deeply. My own father was an immigrant from Brazil, and I vividly remember when he was naturalized. It moves you to your core: in every civic sense, you are an American, with no asterisk attached.
This speaks directly to what being an American means. In many countries around the world, national identity is still anchored in ethnic uniformity, tribal belonging, or religious homogeneity. Take Great Britain, for instance—people whose families emigrated from Pakistan might say they reside in the UK, but society often categorizes them separately from "indigenous" British citizens. What makes America truly exceptional is that our identity is not merely about having citizenship papers; it is fundamentally about our shared constitutional culture.
Yes, there are factions today who wish to shrink the definition of what it means to be an American, seeking to exclude various outside groups and enforce rigid cultural conformity. But our greatest strength has always been our grand democratic conversation: bringing disparate people together across differences, trusting the collective process, and building a union that is vastly greater than the sum of its individual parts.
**阿卜杜勒·埃尔-赛义德**：你说得太对了。这确实很有意思——几十年过去了，我父亲至今仍然带着一口浓郁的埃及口音，但我看着他的眼睛，我看到的是一个对这个国家充满感激与信念的美国人。
我们年轻的时候常会开善意的玩笑。在节日聚会上，大家聚在一起，我父亲会笑着讲述当年在埃及生活的种种艰难，而我总在心里默默感叹：在埃及，你或许怀揣无数宏伟的构想与才华，却因为没有特权和出身而寸步难行；而在这片土地上，只要你付出汗水与智识，无论你的起点多么卑微，你都有机会去践行抱负、去追求公平。对我而言，这就是美国最神圣、最珍贵的核心价值。
Original English
**Abdul El-Sayed**: This is so true. It's funny, all these years later, my father still carries that distinctive accent. But you look at him, you look into his eyes on patriotic holidays, and you realize how deeply he cherishes this country.
We used to laugh together as a family about the contrast. He would tell stories about growing up in Egypt, and I would think: back there, you could have all the brilliant ideas and talent in the world, yet find yourself completely shut out by rigid social barriers; but here in America, you are given the space to turn ideas into reality, to build a life based on your merits. To me, that promise is the very soul of what America represents.
---
### 穿梭于两个世界：童年视角下的阶层反差与公共卫生初心
**主持人**：当你还是个孩子的时候，你是否敏锐地察觉到了自己生活的世界与你在埃及的表亲、亲属们的生活环境之间的悬殊差距？那种巨大的现实反差对你的三观产生了怎样的冲击？
Original English
**Host**: When you were growing up, did you clearly see the stark contrasts between your everyday life in the United States and the lived experiences of your relatives and cousins back in Egypt? How did navigating those two worlds shape you?
**阿卜杜勒·埃尔-赛义德**：是的，那段经历对我的人生产生了决定性的影响。我的父母当时非常希望我能够牢牢掌握阿拉伯语，深刻了解家族的文化根脉，因此在他们能够负担得起的时候，他们会让我回去探亲。我清晰地记得，在开罗的机场里，当我走出舱门时，迎接我的是一大群堂表亲和祖母。
我当时穿着典型的美式夏装，行李箱里塞满了带给亲戚们的各种礼物。在埃及的街头巷尾，我坐在亲戚颠簸的面包车里，看着窗外街道上为了生计奔波苦熬的人们。
Original English
**Abdul El-Sayed**: It was profound. My parents were determined to make sure I learned their native language and understood where my family came from. So whenever they could manage, they arranged for me to visit relatives overseas. I distinctly remember arriving at the Cairo airport, being greeted by a massive crowd of aunts, uncles, cousins, and my grandmother.
I was there in typical American summer clothes, bringing over suitcases loaded with gifts and clothing for everyone. And as we drove through the bustling, dusty streets in crowded vehicles, looking at families struggling through daily hardship, the sheer contrast hit me immediately.
**主持人**：你当时大概多大年纪？
Original English
**Host**: Around how old were you when you first experienced that contrast?
**阿卜杜勒·埃尔-赛义德**：我那时大概十三岁。十三岁，正好是一个少年开始审视世界、构建自我价值体系的关键时期。所有这一切都让我感受到了强烈的心理震撼。
在美国密歇根的学校里，作为一个少数族裔，你必须时刻向同学和老师解释自己的名字怎么发音、自己的肤色为何不同、家庭饮食为何不一样——你总是处于需要为自己的存在向外界解释的状态中。可是，当我踏上埃及的土地，身处与我流着相同血液的亲族之间时，我却看到了完全另一维度的现实：这里的物质匮乏、医疗短缺和生活艰辛是如此真切。人们常问：“你怎么能把不同世界的生活摆在天平两端去衡量？”
我在美国长大，享受着健全的现代公共设施、充足的教育资源与优渥的发展机会；而我那些同样聪明、同样勤奋的亲人们，却困在医疗匮乏和生存压力的泥潭里。每当我带去那些在美国随处可见的日常物品和药品时，亲人们眼中流露出的渴望与感激，甚至让我感到内疚与心碎。
这让我从小就真切体会到了生命的随机性与社会制度对普通人命运的深刻塑造。这并不是个人是否努力的问题，而是底层的制度安排、公共卫生资源与公平保障决定了成千上万人的生死与尊严。正是在面对这种强烈的对比时，我坚定了自己后来投身公共卫生、投身医学、并最终走上为弱势群体争取制度性公平与医疗权利的政治道路。
Original English
**Abdul El-Sayed**: I was around thirteen years old. At thirteen, you're at that formative age where you begin processing how the world functions, and the contrast was stunning.
In Michigan, as a kid with an unfamiliar name and background, you spend so much energy navigating differences—explaining how to pronounce your name, fielding questions about your skin color, constantly feeling like you have to justify your identity. But then you arrive in Egypt, among family members who look like you and share your heritage, and suddenly you witness deep systemic hardship and material deprivation. How do you reconcile those realities?
Back home in the United States, I had access to stable infrastructure, top-tier schools, and boundless institutional support. Meanwhile, my cousins—who were every bit as smart and capable—were trapped under economic stagnation and a complete lack of basic social protections. When I would arrive with suitcases of ordinary household goods, playing the role of Santa Claus, and see how much those simple resources meant to them, it fundamentally altered my perspective.
It made me realize how much of human destiny comes down to the luck of where you happen to be born. It showed me that individual effort alone cannot compensate for broken, unfair systems. That realization is what drove me directly into medicine, into epidemiology and public health, and ultimately into the fight to reform our healthcare policies and political institutions so that every human being is afforded basic dignity and protection.
### 埃及祖母的对话与对“优绩主义”的反思
**Abdul El-Sayed**: 最后，我和祖母之间有了这样一段对话。我对她说：“好了，泰塔（Teta，阿拉伯语‘祖母’），我到底拥有什么？这里又有什么呢？”她看着我说：“你所拥有的，全都是最好的。”我当时说：“得了吧，怎么可能。”那是炎热的夏天，我的其余亲人全部都在这里。这让我久久不能平静。你知道，回头去审视她所度过的一生，即便抛开那些沉重的历史大环境不谈，仅仅是出生在这里这件事——正是这一点深深触动了我。
Original English
**Abdul El-Sayed**: And at the end, I had this moment where I was like: "Okay, Teta, what do I have? What is there?" And she says: "Everything you have is the best." I said, "Come on." It was summer, and the rest of your family is right here. And it really got to me. You know, you look back and see the life she lived, even putting aside the historical circumstances, just to be born here. That really got me thinking.
**Abdul El-Sayed**: 这到底意味着什么？我不断回想起那段经历。你知道，面对周围所有其他的人，同时也通过对自己更深层的理解，去反思：在那里度过的那四个月，究竟带给了我什么？而最重要的是，让每个人都能真正理解这种处境。我竭尽全力去理解这一点。不管怎样，置身于截然不同的境遇之中，你是否对他人抱有那样的敬意？
Original English
**Abdul El-Sayed**: What does that really mean? I remember how it happened, you know, toward everyone else, but also through self-understanding, asking myself: what did I experience after being there for those four months? And most of all, everyone understands. I tried so hard to understand that. In whatever different circumstances, do you have that respect for people?
**Abdul El-Sayed**: 随着岁月的流逝，当你深知世上有那么多人都在拼尽全力地工作，甚至比你更加专注、更加勤勉，去完成他们命中注定或被召唤去承担的责任，去往他们必须去的地方。那么紧接着第二个问题来了：你究竟为什么要做你现在所做的一切？你做这些只是因为别人夸赞你吗？因为你知道，很多上了年纪的人常说：“噢，你真聪明，你工作真努力。”
Original English
**Abdul El-Sayed**: As time passes, when you know how many people are out there working, working even harder, striving with everything they have to fulfill what they are called to do and go where they need to go. And then second, why do you do what you do? Do you do it because, you know, older folks look at you and say, "Oh, you are smart, you are working hard"?
**Abdul El-Sayed**: 当时我给出的回答是：“我的祖母不仅极其聪明，而且一辈子都在辛勤操劳，付出了无比艰辛的劳动，但她却从未得到过我如今所拥有的任何一样东西。”那么，所谓的“能力本位”或优绩主义到底算什么？这种感觉究竟意味着什么？
Original English
**Abdul El-Sayed**: And I responded: "My grandmother was smart, and she worked hard, grueling, back-breaking work every single day." And she never got any of these things that I have. So then, what is that feeling? What does that say about this concept of merit?
### 公共服务、制度责任与道德评判
**Abdul El-Sayed**: 我认为，当我投身于政府公共服务领域时，我常思考我们所肩负的责任。那不仅是说：“你看，承担责任意味着在任何资源的调配使用上，在谈判桌前，你必须始终保持清醒与笃定，为那些本身一无所有的人去据理力争。”在我看来，每个结果都在为某些人塑造着实质性的影响，不是吗？
Original English
**Abdul El-Sayed**: And I think that when I came into government service, I thought about your responsibilities, about saying: "Look, being responsible means that at the table, whenever resources are being used, you have to be confident and ensure access for the people who have none." In my view, results create something real for someone, right?
**Ezra Klein**: 确实如此。现实中往往存在着一种张力：你所创造的成就是完全归功于你个人吗？那些身处底层、未曾拥有机会的人，他们是否同样具备巨大的潜能？抑或我们努力去理解的，其实是人类在幸运、境遇与成功之间的深刻关联，以及在面对失败和挣扎时的本质？
Original English
**Ezra Klein**: Right. There is always the question: is what you created entirely of your own doing? Do other people also have that same potential? Or are we trying to see that the most fundamental thing about human beings is how luck, circumstances, and achievement intertwine, and how that plays out in failure and struggle?
**Abdul El-Sayed**: 确实如此。但我想，为什么有那么多人能在生活中找到真正有价值、有尊严的东西？这绝非偶然。正如在生活中，我所经历的无数人与事，比如在出租车上，或者在日常相遇中，他们都具备同等的能力。当我目睹那个出租车司机的整个人生轨迹时，问题便显而易见：这一切仅仅是因为有人愿意辛勤劳作就能得到的吗？
Original English
**Abdul El-Sayed**: That's right. And the struggle. But I think, where do so many people find what is truly worthy and meaningful? It wasn't an accident. I saw people who are equally capable in my life. Inside a cab, right after a break, I saw his life. And so it's easy to ask: is it just about who is ready to work hard?
**Abdul El-Sayed**: 我很想直接否认这种简单的假设。有时我回想，我的外祖母也拥有完全相同的品质，但她拥有我今天所拥有的这些机会吗？她做到了吗？如果我拥有了所有的平台与资源，这就能证明一切理所应当吗？这个核心问题，难道不值得我们深思吗？
Original English
**Abdul El-Sayed**: And I want to say no. And I sometimes think: my grandmother had all those qualities too. Did she have the opportunities I have? Did she do it? If I have everything, does that make it right? That is the real question, isn't it?
**Abdul El-Sayed**: 令人深思的是，我们如何运作我们的各种制度与机构。制度本身是否在深层道德追求与现实欲望之间保持了统一？在生活的各个层面，体制往往展现出强大的力量与专制色彩，让人身不由己。我的祖母在她的时代从未进入过体制的核心，甚至随时可能被机构边缘化，而我们往往未能给予他们应有的敬重。
Original English
**Abdul El-Sayed**: What's remarkable is, you know, how we run institutions. Institutions carry moral weight underneath, beneath all the desires. Certain aspects of life and work in institutions can impose a kind of rigid control that people struggle against. My grandmother was never part of an institution in that way; she could be discarded by them, and we didn't give that the honor it deserved.
**Abdul El-Sayed**: 当你真正进入学校，进入体制内部，成为其中的一份子时，机构有其自身的内在动机和激励机制。它会试图去激发你的兴趣，引导你按照它的规则去追求所谓的正确道路。但你一旦出现偏差，或者置身于不同的评价标准下，问题就会接踵而至。我们通常期盼机构领导者能够坚守正义，整合规范，维护道德底线。在基础教育阶段，这种矛盾还不算剧烈，但当你放眼大学或更高阶的机构时，情况就不同了。
Original English
**Abdul El-Sayed**: When you come into schools and become part of the institution, it has its own set of internal incentives. It tries to steer your interests toward what is deemed right according to its framework. If you step outside of that, you know, you run into real problems. We expect institutional leaders to uphold the right behavioral norms, and in early schooling that might not seem so fraught, but then you look at universities.
**Ezra Klein**: 确实如此。在这些核心场所，它们理应充当全社会的道德裁判者，但当你目睹它们在层层外部压力下节节败退、失去操守时，人们不禁会想：这到底是怎么回事？一个机构的潜能与担当到底在哪里？它真正应该坚守的底线究竟是什么？很多时候，机构的内在激励往往与我们所期望的社会道德完全背道而驰。
Original English
**Ezra Klein**: Right. These places are supposed to be moral arbiters, yet you watch them collapse in the face of all this pressure. It makes you wonder: what is this? What is the maximum responsibility of an institution? What should it be doing? Because so often, institutional incentives end up operating as the complete opposite of what we expect of them.
### “9·11”事件与穆斯林身份的骤变
**Ezra Klein**: “9·11”恐怖袭击事件发生后，它彻底改变了世界。关于那场悲剧如何重塑了你的政治观与身份认同，你曾写过许多文字。能跟我详细谈谈那段经历吗？
Original English
**Ezra Klein**: September 11 happened. You've written extensively about how that moment transformed your politics and your perspective. Tell me about that.
**Abdul El-Sayed**: 你知道，我的家庭来自埃及。在穆斯林传统中，给孩子取名通常有三个备选方向：最受尊崇的当然是先知名讳“穆罕默德”；其次是“阿卜杜拉”（Abdullah）或“阿卜杜勒·拉赫曼”（Abdul Rahman）。因此，父母最终给我取名为阿卜杜勒·拉赫曼。在阿拉伯语里，那是一个极其优美且寓意深远的名字。
Original English
**Abdul El-Sayed**: You know, my roots are in Egypt. And in Muslim tradition, there are three classic names that are most cherished. One, for obvious reasons, is Muhammad, after the Prophet. The others are Abdullah and Abdul Rahman. So my name became Abdul Rahman. It's a beautiful, beloved name.
**Abdul El-Sayed**: 后来我们举家迁居到了美国。“阿卜杜勒·拉赫曼”（Abdul Rahman）这个名字对美国人来说实在太拗口、太难念了，你能理解那种尴尬吗？我对此记得非常清楚。那是我该上幼儿园的时候，大家都知道，小孩子在学校里很容易被起各种绰号，但当时老师和学校需要知道究竟该怎么称呼我。
Original English
**Abdul El-Sayed**: Then, you know, we moved, and my life unfolded in the United States. "Abdul Rahman" is a mouthful of a name, you know? I remember this so vividly. I was about to go to kindergarten, and in schools kids often get nicknames, but people needed to know what to call me in kindergarten.
**Abdul El-Sayed**: 我记得我母亲当时感到非常焦虑和困扰，她特意和我父亲商量。她说：“亲爱的，我们到底该怎么叫这个名字才好？”于是他们在表格上工工整整地拼写出了“A-B-D-U-L-R-A-H-M-A-N”。而恰巧在那段时期，流行歌星宝拉·阿卜杜勒（Paula Abdul）红极一时，那是她的黄金时代。
Original English
**Abdul El-Sayed**: I remember my mom being very anxious about it, talking to my dad. She said something like: "Dear, what name are we going to tell them to call him?" And so they wrote it down: A-B-D-U-L R-A-H-M-A-N. And right around that time, Paula Abdul was huge...
**Abdul El-Sayed**: 顺便提一下，我和我的妻子杰基（Jackie）从小就认识，我的母亲从杰基三岁起就看着她长大。而在那个夏天，宝拉·阿卜杜勒的单曲高居流行音乐排行榜首位，与此同时，NBA传奇巨星卡里姆·阿卜杜勒-贾巴尔（Kareem Abdul-Jabbar）也刚刚退役。于是很自然地，大家就直接叫我“阿卜杜勒”（Abdul）了。
Original English
**Abdul El-Sayed**: This was Jackie, by the way—my mom raised Jackie from when she was three years old. And that summer, Paula Abdul was topping the music charts, literally straight to number one, and Kareem Abdul-Jabbar had just retired from basketball. And so I simply became "Abdul", right?
**Abdul El-Sayed**: 经过这件事后，我的父母非常明智地总结出了一条经验，他们决定：“对于下一个出生的孩子，我们一定要起一个简单好念的名字。”于是，他们给我的弟弟取名为“萨姆”（Sam）。
Original English
**Abdul El-Sayed**: Exactly. And my parents very wisely said: "For the next kid, we need a name that is easy to pronounce." And so they planned to call him Sam.
**Abdul El-Sayed**: 然而，多年以后，沙特阿拉伯出生的奥萨马·本·拉登策划了一切，两架飞机撞向大楼，彻底摧毁了一切平静。我清楚记得那场灾难发生时的每一幕细节，那消息在墙与墙之间、在房间的每个角落回荡，我们在家里激烈地讨论着。我永远无法忘记那一天。
Original English
**Abdul El-Sayed**: But then Osama went and ruined everything, you know, with the planes. It was horrific, and I remember every bit of that day, talking about it wall-to-wall in our house. I remember that day so clearly.
**Abdul El-Sayed**: 袭击造成了极其可怕的惨剧。当时我正在读大学三年级。在事件发生前，我一直天真地坚信一切都会好起来，周围的氛围向来平静祥和。但就在那一瞬间，所有的社会气场彻底变了。我内心震惊地想：“这到底是怎么回事？难道是我的族人干的？难道真的是他们干的吗？”
Original English
**Abdul El-Sayed**: It was terrible. And you ask why. I was a junior in college at the time. Up until then, I had felt confident that everything was fine. But immediately, the entire energy shifted. I remember thinking, "What are you... did my people really do this?" It shook my entire world.
**Abdul El-Sayed**: 这种残暴的行径竟然可能发生——有人劫持了日常用来将人们运往心之所向的民航客机，将其变作屠杀无辜民众的致命武器。那种心理冲击难以言表：数千英里外发生的暴行，瞬间直接击中了你个人的日常生活。在那种时刻，你突然背负起了一种沉重的集体连带责任。
Original English
**Abdul El-Sayed**: To think that this could happen—using an airplane, something designed to safely carry people to where they want to go, as a devastating weapon. The feeling that something happening thousands of miles away could instantly reverberate through your personal life. Suddenly there was this inescapable sense of collective responsibility thrust upon you.
**Abdul El-Sayed**: 无论是非曲直，周围的社会环境瞬间传递出一种严苛的审视：“只要发生了一件恶性事件，你就必须为你的整个群体做代表，向所有人证明你自己。”你被要求去代表每一个长相与你相似的人、每一个敬拜同一位上帝的人。在很多层面上，这种无形的审视成了家常便饭。
Original English
**Abdul El-Sayed**: For better or worse, there was always this pervasive pressure: "If something happens, you have to prove yourself and represent everyone." You are expected to answer for everyone who shares your appearance, everyone who prays like you. In so many aspects, that burden became a common occurrence.
**Abdul El-Sayed**: 当时我非常为我的弟弟感到担忧。我清晰地记得周围的人纷纷劝他：“你知道吗，你最好把名字改成萨姆（Sam），那样一切都会好起来，能免去很多麻烦。”但他毫不犹豫地拒绝了，他说：“不，我的名字叫奥萨马（Osama）。我没有做错任何事，我也没伤害过任何人。我为我自己的名字感到自豪。”要知道，当时他还在上小学。
Original English
**Abdul El-Sayed**: I was so worried about my younger brother. I remember people telling him: "You know, maybe you should just change your name to Sam. Everything will be much easier for you." But he said: "No, my name is Osama. I haven't done anything wrong. I'm proud of my name." And remember, he was only in elementary school at the time.
### 从边缘到核心：局内人的精英体系体验
**Ezra Klein**: 听你讲述这些童年与成长时期的回忆，展现出了一种非常独特的生命体验：你既深切体会过作为外部边缘群体的异化感，同时又以极其优异的表现一路穿行于美国最核心的精英机构内部。从幼儿园到高中，你不仅是个出色的运动员，后来还考入了密歇根大学，不仅担任校队队长，更当选为密歇根大学学生会主席。
Original English
**Ezra Klein**: Listening to your memories, it highlights an extraordinary trajectory: experiencing American institutions from the outside as a marginalized identity, while simultaneously excelling on the inside. You started navigating this in kindergarten, then in high school you were an athlete, at the University of Michigan you were an athlete, team captain, and president of the student body.
**Ezra Klein**: 你完全有资格在这个精英体系里占据一席之地。随后，你更荣获了罗德学者（Rhodes Scholar）的桂冠，前往英国牛津大学深造。可以说，你同时拥有这两种极端的视角：一方面作为边缘少数族裔承受着外部投射的偏见，另一方面又作为顶级精英机构的宠儿置身于体系的最中央。
Original English
**Ezra Klein**: You earned your place at the very highest levels. You went on to become a Rhodes Scholar and found yourself in Great Britain at Oxford. So you experienced both worlds: being subject to bias from the outside, while simultaneously occupying the very core of these elite institutions as a captain and scholar.
**Abdul El-Sayed**: 确实如此。回顾这两种截然不同的人生体验，作为能够同时涉足这两个世界的人，恰恰站在了精英圈层与真实社会碰撞的交界处。一方面是光鲜的荣誉，作为罗德学者在典礼上致辞，或者在绿茵场上叱咤风云；我从小到大都极其热爱体育竞技，无论童年还是学生时代，体育都是我生命的核心。
Original English
**Abdul El-Sayed**: That's right. Having that dual experience—standing right at the intersection of those institutional boundaries, you see it from both sides. On one hand, being the captain, giving speeches as a Rhodes Scholar, competing on the soccer field—I loved sports deeply throughout my childhood and school years.
**Abdul El-Sayed**: 但正是在这种经历中，我逐渐看清了现代优绩主义体制的本质。就像教练严厉告诫的那样：“不要在低位偷懒玩火，去做好你的本职防守！”在这个自诩唯才是举的现代优绩社会中，那些少数赢得竞争特权的位置，究竟是如何被塑造和分配的，它的虚妄与残酷让人感触颇深。
Original English
**Abdul El-Sayed**: But that journey taught me so much about the reality of it. It's like a coach yelling: "Don't play careless underneath, do your job!" You realize how narrow those privileged spaces really are, and what modern meritocracy truly represents behind the scenes.
### 竞技体育与“优绩主义”的现实边界
**嘉宾**：对我来说，体育始终是一个让我能够清晰感受到规则明确存在的地方。
Original English
**Guest**: ...there were always a place for me where I could, where the where the rules felt clear.
**访谈者**：你以前练过摔跤，对吧？
Original English
**Interviewer**: You're a wrestler, right?
**嘉宾**：我以前确实练过摔跤。时至今日，我仍然觉得摔跤是我做过的最纯粹的一件事。
Original English
**Guest**: I was a wrestler. I to this day I think I've never done a purer thing.
**访谈者**：没错，确实是这样。擂台上只有你和对手两个人，你们拥有的装备完全一样——因为你们根本没有任何外在装备，对吧？
Original English
**Interviewer**: Yeah, exactly. It's you and the other individual and you you you got the same equipment which is nothing, right?
**嘉宾**：而且你要知道，你们在体重级别上也是被严格限制、处在同一范围内的。所以问题很简单：你能不能在对方把你压制之前，先将对方制服？正因如此，我认为我后来面对整个人生的大部分方式，最初都始于这段参与体育竞技的经历。
然后到了大学阶段，我渐渐意识到，其实自己非常喜欢思考，而且思考本身是件很有趣的事情。相比于奔跑，我在思考方面的能力要强得多。于是，我开始将很多在体育训练中形成的相同习惯、同样的自律以及同样全心投入的精神，运用到了学业之中。
而这里面非常耐人寻味的一点在于：我拥有过令人难以置信的优越机会。关于这一点，我想做个客观的校准说明——我能够就读极其出色的公立学校，而很多孩子终其一生都从未获得过这些机遇。我随后考入了密歇根大学，并开始在这个全新的环境里施展这些能力。渐渐地，你开始受到各方的邀请，去往不同的场合，参与各种不同的事情，成为精英圈子的一份子。
但也正是在这个时候，你开始真切地领会到“优绩主义”（Meritocracy）究竟在何处戛然而止。你开始对那些决定谁能入场、谁被排斥在外的机制变得极其敏感。你逐渐学会了如何按照体制认可的衡量标准去取得成就，或者至少是按照这个体制自我划分的方式去取得成功。但随后你会慢慢看清，很多时候究竟谁能成功、谁会失败，其背后的决定性因素往往与个人是否勤奋努力、是否具备纯粹的能力没有太大关系。人们获得机会所依据的规则，从来都不像竞技场上那样写得清清楚楚。它绝不像在体育场上比拼那样分明，也绝不像与某个人进行一场纯粹的摔跤较量那样纯粹公正。
然而，正是这些隐性规则，对谁能分得一杯羹、谁一无所有起到了至关重要的决定作用。此外，这一切背后还有一种“皇帝的新衣”的荒诞成分——现实中存在着大量能力极其出众的人，他们却永远无法跨进这个门槛；与此同时，我们仅仅因为某些人坐进了这个特定的房间，就将某种特定水准的才华、天赋、勤奋等美德统统归功于他们，但我并不认为这种归因是完全公平或者真实的。而在这些空间内部的人，却常常心安理得地利用手中的权力去对付房间外的大多数人，这种权力的行使程度早已远远超出了应有的公平底线。
Original English
**Guest**: And and you know you're you're bounded by weights. So can you pin that other person before they pin you? And so a lot of the way I engaged all the rest of my life I think started with this this experience playing sports. And then I think in in college I kind of realized actually I like to think and thinking is fun. And um I'm I'm I'm much better at thinking than I am at at running. Uh and so um and so I I started to apply a lot of the same practices, the same discipline, the same sort of commitment um to to school.
And what's interesting about it is that I had this incredible, you know, and I want to adjust for this. Like I got to go to amazing public schools. I a lot of kids never never have those opportunities. get to go to the University of Michigan and then I get to start applying these skills in this place and you start getting invited to places and to do different things and be a part of it and then you also start to appreciate exactly the bounds at which meritocracy ends right the ways that decisions get made about who's part of it and who's not that you start to get really sensitive to and you know you learn how to achieve on the merits of the institution or at least the way the institution divides itself.
And then you start to appreciate that a lot of a lot of times who succeeds and who doesn't that gets predicted in ways that have less to do with hard work, sheer capacity, etc. And the rules by which people access aren't always clearly written. It's not like an athletic field. It's not like the pure experience of wrestling somebody. And that matters a lot for who gets and who doesn't get.
And also there is this emperor has no clothes aspect to all of this which is just like hey there are a whole lot of super capable people who will never get in here. And meanwhile we ascribe a certain level of talent, ability, hard work, etc. to having been in this particular room when I don't know that that is entirely fair or true. And the amount of power that people willingly wield from inside of these spaces against often a lot of these other folks is is so far beyond what should be fair.
### 从临床诊疗到审视结构性制度
**访谈者**：我一直对人们天生的思考层面很感兴趣。在与你交流时我注意到的一点是，你的思维会非常自然、极其迅速地转向结构、制度和客观境遇。我想这与你人生轨迹中的一次重要抉择密切相关：你进入了医学院，但很快就从临床医学转向了公共卫生领域。作为曾经长期报道医疗健康行业的人，我会把你的转变形容为从传统的医疗诊治转向了健康的社会决定因素（Social Determinants of Health）。不过，请具体跟我聊聊那个决定——因为立志成为一名执业医生需要付出巨大的努力与投入，究竟是你在临床中看到了什么，让你觉得必须走向体制与结构的层面，而不是继续从事人对人的个体诊疗服务？
Original English
**Interviewer**: I'm always interested at the level at which people think naturally. And one thing I notice with you is your mind goes very naturally and quickly to structures and institutions and circumstances. And I I guess that connects to to a move you make which is that you go to medical school and you pretty quickly move from that to public health. And the way you describe it as somebody who covered healthcare, you know, a lot back in the day is you sort of move from medicine to the social determinance of health. But but tell me about that decision because trending to be a doctor is a lot. But what is it that you saw that made you think I have to move towards the structure of this not the persontoperson service?
**嘉宾**：其实我打心底里非常热爱临床护理和看诊的那一部分工作，真的发自内心热爱。我热爱接触形形色色的人，热爱倾听他们的故事。在临床接诊的过程中，患者其实是在给予你一份极其珍贵的馈赠：他们在生命中最糟糕的一天，带着他们最棘手、最沉重的问题来到你面前，并且怀着你能为他们提供帮助的信任，毫无保留地向你敞开自己的脆弱。
然而，在那些临床诊疗中，你却会一次又一次地撞见一个残酷的现实：你根本没有被赋予能够彻底治愈或充分帮助眼前这位患者的工具。医疗机构把这些资源和手段分发给了一部分人，却剥夺了另一部分人获取它们的权利。如果你始终挂念着“并非所有人都能享有健康长寿的生命”这一现实，并开始不断追问其中的根源；如果你花费了大半生的心血去学习如何成为解决这个难题的一部分力量，但最终却猛然发现自己身处的这个医疗机构虽然赋予了你专业救治技能，体制本身的种种枷锁却死死捆住了你的双手，让你根本无法去做真正需要做的事情——在那个时刻，你内心会产生无与伦比的巨大挫败感。
我永远都不会忘记我在一家小型附属卫星医院轮转时遇到的那位患者。当年我在纽约市读医学院，轮转到了位于曼哈顿最北端的一家小型卫星医院。因此，那里的绝大多数患者都来自布朗克斯区和上曼哈顿地区。
当时有这么一位女患者，她在地铁的楼梯上摔倒磕破了头。她根本不想呆在医院里，而医院里的医护人员也压根不希望收治她。我当时正在做代理住院医师实习（Sub-internship），也就是即将正式开始内科住院医规培前的一段轮转实习期。我的职责是在急诊室和医院住院病房之间充当沟通协调的联络员。
当时这位女士摔伤了头部送过来，额头上很明显已经鼓起了一个血肿大包，她情绪极度失控，冲着现场的每一个人大喊大叫。她处于重度醉酒状态，而且当时还是大清早——正如你所知，清晨酗酒在临床上几乎是物质滥用和严重酒精依赖的特异性病征（Pathognomonic）。
于是我走上前去询问负责接诊的急诊科住院医：“她的头部CT扫描结果显示什么？”要明白，如果你在公共场所摔倒磕破了脑袋被送到急诊室，做头部CT检查是标准的常规操作，这是为了排除颅内出血最重要的第一道防线。
结果那名住院医漫不经心地回答：“哦，我们根本没给她做CT。”我惊讶地问：“为什么不做？”他看着我，眼神里甚至流露出一种近乎可怜我少不更事的眼神，说道：“哎呀，收治她就等于是一次‘社会性收治’（Social Admit）。”
在那一瞬间，我的内心彻底爆发了：“见鬼，这怎么可能！”她的头上明明顶着一个巨大的血肿包！我才不管她的社会背景和生活境遇有多么复杂不堪，如果她颅内正在出血，她今天就会死在这里！
Original English
**Guest**: I really loved the clinical care part of things. I really did. I I I love people. I love hearing their stories or something a gift that people give you when you talk to them in a clinical encounter where they bring you their worst problem on their worst day and they're willing to share that vulnerability with the belief that you can help them. And so often you'd be in those clinical encounters and realize that I actually am not being given the tools to help you fully.
And this institution gives those tools to some people and not others. And if you're concerned with the idea that not everybody gets to live a long healthy life and you start wondering why and you spend a whole lot of your life learning how to be a a solution to that in part and then realize that you're in this institution. you've got these skills, but the institution itself hamstrings you from actually doing the thing that needs to be done, you start to get really frustrated.
And I'm never going to forget a patient while I was at a um small satellite hospital. So, I went to med school in the city uh in New York and small satellite hospital, the tip, northern tip of of Manhattan. So, a lot of the the patients are um are from the Bronx and upper Manhattan. And there was this patient who would fall and hit her head on the subway stairs. She didn't want to be there. They didn't want her there. I'm in a sub internship, a rotation where, you know, I'm getting ready to do my internship in medicine. And my job is to be a liazison between the emergency room and uh the hospital wards.
And this woman had fallen, hit her head, clearly had a wel forming, yelling at everybody there. She's inebriated uh and it's early in the morning, which you know, pathommonic for uh for having substance use. uh an alcohol dependency. And I go to talk to the resident who was in the emergency room. I was like, "What did the CT show?" And that's you're going to get a head CT if you fall and you hit your head and you wind up in an emergency room. It's like the the number one thing you do to rule out a brain bleed. And he's like, "Oh, we didn't do one." I was like, "Why not?" He's like, "Well," he looks at me and he he almost has this like pitiful look in his eyes like she'd be a social admit.
And at this point, I'm like, "Oh, hell no, man." Like clearly has a wel on her head. I don't care whatever her social circumstances are. If she has a brain bleed, she is going to die.
### 急诊室里的“社会性收治”与两周救治
**访谈者**：你想知道什么是“社会性收治”吗？说白了，这就是医疗界传统上所说的“钱包活检”（Wallet Biopsy）——先查查病人有没有钱。
Original English
**Interviewer**: You want to see what a social admit is? This is the old wallet biopsy.
**嘉宾**：一点没错。急诊室潜意识里的潜台词其实是：一旦我们把她收治住院，后续就会引爆无穷无尽的社会救助难题，以至于折腾到最后我们根本不可能真正帮到她什么。我们在医疗层面上无能为力，而医院却要为此持续亏损赔钱。更现实的问题是，像这样一个身无分文又没有健全家庭支持的病人，后续该怎么办理出院手续？
于是我直接打电话给我的带教上级主管医师（Attending Physician），直截了当地汇报：“请看一看，他们急诊科连常规头部CT都没有给她做，这太荒唐了。没有规范的完整病史询问和体格检查（H&P），甚至连基本的身体检查都没有完成，这简直令人无法理喻。”我的上级医师听后表态说：“好吧，既然你认为必须收治她，那我们就收治她住院。”
经过全面检查，事实证明她患有晚期完全发病的艾滋病（Full-blown AIDS），体内有活动性出血，盆腔存在肿块，血糖指标更是彻底失控紊乱。在那次诊治中我学到的医学常识之一，就是HIV病毒会侵袭人体调控血压的重要器官——肾上腺。因此，尽管这位女患者一辈子都患有严重高血压，如今她的血压却极度偏低，因为负责调控她血压的整个内分泌激素系统已经被彻底击溃破坏了。
好在，我们随即将她收治入院，对她进行了长达整整两周的精心照护。在救治期间，我与医院的社会工作者团队紧密配合，为她排查了所有资源，终于为她联系到了全地区唯一一家愿意接纳HIV阳性感染者的戒断康复机构；随后，我们又利用她的HIV感染者身份，帮她成功申请对接了专门面向艾滋病群体的“莱恩·怀特”（Ryan White）保障性住房救助项目。当时我由衷地感到欣慰，心想：“太棒了，所有善后安置全部有着落了！”我们一遍又一遍、反反复复地与她核对并确认了后续的生活康复计划。
到了住院的最后一天，我来到病房对她说：“好了，今天就是你正式动身前往康复中心开启新生活的日子了，接着你就可以去……”
结果她冷冷地打断我：“我才不去那鬼地方。”
我愣住了：“不好意思，你说什么？”
她坚决地重复道：“我绝不去康复中心。”
我急切地问她：“为什么不去呢？”
她回答说：“因为我要跟我女儿一起回家住。”
我诧异地说：“我之前根本不知道你还有一个女儿。”
她反唇相讥：“那是因为你从来没问过我。”
我据理力争道：“我绝对详细询问过你的家庭情况，但是……好吧。”
她接着说道：“反正我和我女儿重新取得了联系，她今天就会开车过来接我回家。”
我努力克制情绪对她说：“如果真是这样，那太好了。你能够和你的女儿重归于好、修复关系，这确实是一件天大的好事。但是上一次你们之间究竟发生了什么？看起来你们之前已经有相当长一段日子没有任何联络了。”
她坦白道：“哦，那是因为我又开始酗酒了。”
我问她：“那你怎么能确信这次回家之后自己不会再次复饮呢？”
她理直气壮地说：“我已经整整两周滴酒未沾了！”
我向她解释：“可那是因为你在住院期间，我们一直在医学上用苯二氮䓬类药物（Benzodiazepine taper）给你做药物减量替代戒断治疗啊！所以，听我的建议，先去康复机构完成系统的康复疗程，把你的住房保障落实妥当，这样你才能真正稳固地重建与女儿的亲情关系。显而易见，你们母女之间是有深厚感情的。”
然而，她突然暴怒地冲我吼道：“别对我指手画脚！你少摆出一副高高在上的架势，你并不比我高尚，你一点都不比我强！”
我看着她，平静下来说：“你说得对，我绝没有觉得自己比你高尚，我也绝不比你强。如果你真的坚持要这么选择，作为你的医生，我只是有责任坦诚地告诉你我的专业判断……”
但她毫不退让地摔下一句话：“不用说了，我就是要跟我女儿回家。”
Original English
**Guest**: Exactly. Meaning, we're going to if we admit her, we're going to run into so many social issues with her that at the end of the day, we're not going to be able to help her. There's really nothing we can do for her and the hospital's going to lose money. And you know, where do we how do you even discharge a patient like this?
So, I call up my attending and I'm like, "Look, like, didn't even do a head CT. This is ridiculous. Like, no real HMP, no physical. Like, I this this is absurd." And my attending is like, "Okay, like if you think we should admit her, we should admit her."
Turns out she has full-blown AIDS, actively bleeding, pelvic mass, her blood sugars are all over the place. One of the things I learned is that HIV can infest the adrenal glands, which manage your blood pressure. So despite having been hypertensive her whole life, she's now got low blood pressure because basically the hormone system that managed her blood pressure shot.
Okay. Took care of her for 2 weeks, worked with the social work team. We we found her the only rehab facility that took HIV positive patients. Then got her hooked into her Ryan White housing, which she had access to because of her HIV status. And I was like, "All right, great." Right. And we've reviewed the plan over and over and over again.
Last day, I'm like, "All right, today is the day you're headed off to rehab and then you're" And she's like, "I'm not doing that." I was like, "I'm sorry, what?" She's like, "I'm not doing that." I was like, "Why not?" She's like, "Well, I'm going home with my daughter." I was like, "I didn't know you had a daughter." She's like, "You didn't ask." I was like, "I definitely asked, but um" She's like, "Yeah, well, you know, I I reconnected with my daughter and my daughter wants to pick me up."
I said, "That's great. It's great that you're you had this relationship with your daughter. It's fantastic. What happened last time? Like, it seems like you hadn't talked to her for a while." She's like, "Oh, I started drinking." I was like, "Well, you know what makes you think you're not going to start drinking again?" She's like, "I haven't had a drink in two weeks." I was like, "Well, we've had you chemically, you know, on a on a benzoazipene taper, right?" So, uh, and you know, maybe you go to rehab, get your housing in order, you can rebuild that relationship. It's clear that you you got a relationship there.
And she's like, "Don't tell me what to do. You're not better than me." I was like, "You're you're right. I'm not better than you. And if this is what you want to do, you know, I just got to tell you, I think it would be." And she's like, she's like, "No, I'm I'm going home with my daughter."
### 地铁车厢里的重逢与制度性幻灭
**嘉宾**：事情过去大约几周之后，我刚刚提交完自己的住院医师规培申请。那一天，我坐上了开往曼哈顿下城哥伦布圆环（Columbus Circle）方向的A线地铁列车，准备去一家土耳其餐厅与一位挚友聚餐。那一幕我毕生都无法忘怀：当我跨进地铁车厢的那一瞬间，我赫然看到我那位女患者正整个人瘫倒在地铁的长条座椅上。那幅场景犹如一记重拳，狠狠地砸在了我的心口上。我立刻走上前去查看她的状况，确保她人还平安无事。
Original English
**Guest**: I had just finished putting in my residency application like a couple weeks later and I'm I'm getting on the A train going downtown Columbus Circle area to have a meal at a Turkish restaurant with a friend I'm never going to forget. I get on the subway and my patient is laid out on the subway seats and it was like a gut punch. So I go and check up on her to make sure she's like okay.
**访谈者**：就是你刚刚救治过的同一个人？一模一样的那位患者……
Original English
**Interviewer**: The same person you just ran. exact patient...
**嘉宾**：……毫无知觉地瘫倒在地铁车厢里。
Original English
**Guest**: ...flat on the subway.
**访谈者**：横躺在地铁的座椅上。
Original English
**Interviewer**: Flat on the subway seats...
**嘉宾**：整个人瘫在地铁座椅上。我走过去轻轻摇了摇她。她根本不记得我，完全不知道我是谁。她还活着，呼吸也还在，一切生命体征尚存，但她只是再次喝得烂醉，彻底昏迷了过去。
那天我照常去吃了晚饭。但回到家后，我毅然决然地撤回了我的住院医师规培申请。因为归根结底，这个女人的遭遇成了对我整个临床行医职业生涯的一记全民公投式的拷问。她原本就是我当初立志行医最渴望去救治的那类底层患者。而整段经历中最令我感到痛苦、最令我痛恨的一点在于：急诊室的那位住院医当初残酷的预判竟然是对的。
我们现存的这套医疗体系，根本就不是为了救助这类饱受折磨的底层患者而建立的！如果这是一个真正公正的医疗体系，它理应成为他们的后盾。而她所表现出来的抵触与抗拒，几乎就像是在……
Original English
**Guest**: Flat on the subway seats and I, you know, shake her a little bit. She didn't remember me. Didn't know who I was. She was alive and breathing and everything. She just um passed out.
So, I go have my dinner. I come home and I pull my residency application cuz at the end of the day, she became a referendum on my entire clinical career. Like, she was the kind of patient I wanted to take care of. And the thing that I hate most about that experience is that that resident was right. And our system is not built to take care of those kinds of patients. And if it was a just system, it would be. And it's almost like she...
**访谈者**：请把你的意思彻底说透。因为如果回到我们片刻前探讨的关于客观境遇与运气的议题，换一个人看到这个故事，很可能会得出截然不同的结论，他们会说：“是啊，你本来就不可能拯救所有人，对吧？这在某种程度上归咎于她个人的选择。是她自己在酗酒，是她自己主动拒绝去康复中心。政府体制通过你个人的竭尽全力，已经为她做到了体制所能做到的一切，难道不是吗？那家医院在过去整整两周时间里在她身上花费了巨额的医疗费用，全是由纳税人的钱买单的，可她在那个节点依然拒绝接受帮助。”
Original English
**Interviewer**: say what you mean to that because to go back to what we were saying a little bit ago about circumstance and luck, somebody else might look at the story and say, "Yeah, you can't help everybody, right? This is on some level on her. She's drinking. She chose not to go into rehab. The state did the state through the person of you did everything it possibly could for her, right? That hospital spent a lot of money over those two weeks. taxpayers paid for that and she still didn't want the help in that moment."
**嘉宾**：这种陈词滥调确实合乎常规逻辑。但请你想一想，在她一生的坎坷经历中，她与这个所谓的医疗健康体系打过多少次交道，最终得到的却只是完全相同的敷衍剧本？她遭遇过多少次某些地方官僚机构的冷血抛弃与背叛，以至于当我信誓旦旦地告诉她“一切后续救助都已经为你安排妥当”时，她根本不敢对此抱有丝毫信任？
这是一个在初中八年级就不得不辍学的女人；在她幼小童年时期，她就饱受母亲男友的残酷虐待；她早早跌入了严重的酒精依赖深渊。你说的没错，没有任何单一个体能够凭借一己之力拯救世界上的所有人。
但在我们身处的世界里，在这个全人类有史以来最富庶、最强大的超级大国中，我们难道不应该期盼拥有健全的社会结构与制度，能够做到两点：第一，在源头上预防发生在像她这样的人身上的种种最悲惨厄运；第二，当他们不慎跌落社会裂痕时，有坚实的社会安全网能够托住他们！
从理论上讲，医院本来就应当扮演这样的角色。如果你去翻阅医院这一社会机构的发展历史，它诞生之初正承担着这样的托底救济职能。然而，我们却亲手终结了医院的历史使命，不再允许它成为那样的避难所——因为如今我们建立起来的，不过是一台台极其擅长开账单、收医疗费的冷酷“计费机器”（Billing Machines）。
最讽刺的一点在于，顺着那家破旧的卫星医院往下走不远，就是赫赫有名的纽约长老会医院主院区（NewYork-Presbyterian Hospital）。只要你走进顶层的高级豪华病房大楼，那里铺满了奢华的地毯，而你……
Original English
**Guest**: Correct. But think how many times do you think she's interacted with the healthare system only to learn the same script? How often has she been let down by some bureaucrat somewhere so that she doesn't really trust when I tell her that this is all lined up for her?
This is a woman who dropped out of schooling in the eighth grade. She was abused by her mother's boyfriend when she was a kid. She fell into alcohol dependence. And you're right, no one individual can help everybody.
But we want to live in a world in the richest most powerful country in the world where you have structures and institutions that a prevent the worst things that happen to her and B can catch you when you fall into those cracks. And arguably a hospital is supposed to be that. Like you look at the history of the institution of the hospital, it was that place. it was we have stopped it from being coming that or being that place anymore because what we have are billing machines that are very very good at billing. The irony of it is just down from that hospital you have the main New York Presbyterian hospital. You go up to the top pavilion and you've got carpeted rooms, which is...
### 医疗体系的本质异化与职业困境
**访客**：这确实是一种观点。但世界上存在着许多技艺极其精湛的钢琴家，他们代表着行业顶尖的才华与卓越。而在我们的医疗体系中，情况却完全不同。医疗的初衷本应是减轻患者的痛苦，但现实中它却异化成了一门极其庞大且以盈利为驱动的暴利产业。它靠向普通大众兜售医疗服务来攫取巨额财富，这也正是导致医疗成本畸高、体系深陷荒诞与扭曲的根源所在。
Original English
**Guest**: That is one view. But there are pianists who are the most talented in the world, embodying excellence. Our healthcare system, however, is no longer about easing people's pain. It has turned into another massive moneymaking industry, extracting huge sums of money from people. That is why costs are excessive, profoundly broken, and fundamentally distorted.
**访客**：置身于这样的医疗体验中，无论你是前来求医的病患，还是在前线提供照护的医护人员，内心的感受都绝非愉悦。我也曾作为一名患者经历过这一切，而这种痛苦的遭遇成为了一个强烈的象征符号。
Original English
**Guest**: Inside this clinical experience, whether you are a patient or a healthcare provider, it does not bring joy. Having been a patient myself, this became a profound symbol of the dysfunction.
**埃兹拉·克莱恩**：在你真正深入整个医疗卫生系统之前，这个象征符号对你而言到底意味着什么？它是否促使你彻底改变了个人职业的发展方向？你当时心里是否在想，凭借一己之力究竟能为改变这个系统做些什么？因为正如你刚才谈到医院现状时所言，那些描述完全属实，但我很想探寻的是，你当时究竟意识到了什么？
Original English
**Ezra Klein**: Before you transitioned into the broader healthcare system, what did that symbol mean to you, and did it drive you to pivot your own career? Did you feel there was something specific you could do about it? Because what you said about hospitals is entirely accurate, but I want to understand what clicked for you at that moment.
**埃兹拉·克莱恩**：当那位患者出现在医院里时，我记得当时有人试图在这个极其棘手的案例中伸出援手。你们当时竭尽全力去提供协助，试图为其构建一整套完善的康复与支持计划。手头可调动的资源虽然十分匮乏，但大家依然倾注心力想要促成改变。但在那个时期，类似的困境实在发生得太频繁了。
Original English
**Ezra Klein**: When that patient showed up in the hospital, as I understand it, someone really tried to intervene and help in that situation. You genuinely attempted to assist, organizing a coordinated rehabilitation plan. The resources at hand were scarce, yet you desperately wanted this to work. But back then, during that period, such breakdowns were happening constantly.
### 系统性改革与基层支持的边界
**访客**：是的。那么面对这种局面，人们心中究竟会作何感想？你是选择抽身离开去寻求外部的变革，还是选择留下来成为推动内部改良的一份子？平心而论，这往往取决于不同世代所秉持的理念，难道不是吗？
Original English
**Guest**: Yes. So what do you think? Could you step outside to demand change, or can you remain inside and be part of the change? Honestly, that depends heavily on generational perspectives, doesn't it?
**访客**：我想表达的核心在于，在美国，特别是一位身处底层的非裔女性所面临的现实。回看那个历史时期，人们不禁会深思：我们究竟能为他们做些什么？是在社区中投入大量建设，让当地学校拥有最优质的软硬件，配备充足的助教和专业辅助人员来围绕教师提供支持？还是对有特殊需求的学生和学业受挫的孩子倾注专项扶持资源？
Original English
**Guest**: Exactly. What I want to emphasize is the experience of someone like a Black woman in America. If you look back at that era, you ask: what could we have built? Building up infrastructure so that schools have the best resources, surrounding teachers with paraprofessionals, and investing heavily in students with special needs or academic struggles?
**访客**：我们是否应当为青年学生开辟出升学之外的其他多元成长路径，而不是让他们在两到四年的大学体制中面对挫败与迷茫？比如提供扎实的学徒制、职业技能培训，以及在弱势社区中创造小微企业就业机会？为了帮助她的母亲，改变这个家庭成长与生活的社区环境，这些努力难道不正是当下最迫切需要的吗？
Original English
**Guest**: Or creating alternative pathways for students so they don't simply get lost in a two-to-four-year college track or face failure, offering real apprenticeships and vocational training, and generating opportunities in local small businesses within marginalized communities? All these things are essential to help her mother and transform the community where that family grew up.
**访客**：正因如此，我迫切希望解决这些根本痛点，修补我们千疮百孔的社会保障体系，让身处其中的人们能够真正做成他们想做的事。同时，我依然渴望坚守临床一线的人性连接。当一个人陷入孤立无援的绝境、向你倾诉苦痛时，你渴望成为那个真正能够帮上忙的人，这种由衷的冲动极其珍贵。
Original English
**Guest**: That is why I wanted to address these core issues, repairing our safety-net systems so people can do the work they aspire to do. And I also wanted that direct clinical connection. There is something profoundly valuable about being the person who can genuinely help someone when they are confiding their struggles in you.
### 八分钟诊疗与保险审查的荒诞闹剧
**访客**：然而整个临床系统所面临的残酷现实是什么？所有身处一线的临床医生几乎都会无奈地告诉你：“我只有整整8分钟的看诊时间。” 面对眼前饱受摧残的病患，当对方正掏心掏肺倾诉人生中遭遇的重大创伤时，医生心里却在被迫倒数：“好的，这番话已经占去了1分钟，我只剩下7分钟了。”
Original English
**Guest**: But what is the systemic problem facing clinicians? They tell you: "I only have eight minutes. Eight minutes." A patient pours out their heart in that moment, and the clinician is thinking: "Okay, that took one minute. Now I have seven minutes left."
**访客**：医生面对的是堆积如山的繁杂病症，一个患者身上往往纠缠着六七种复杂的健康困境。而此时的患者往往极度沮丧和绝望，他们会忍不住控诉：“大夫，我刚刚向你倾诉了我整个人生中遭遇的最沉重打击与苦痛，你却根本没有办法真正拯救我。”
Original English
**Guest**: You are dealing with multiple complicated clinical issues, often six or seven overlapping problems. Meanwhile, the patient feels deeply defeated because they say: "I just shared the biggest crisis and pain of my life, and you cannot truly fix it or help me."
**访客**：更令人窒息的是后续流程。诊疗结束后，医生必须坐在电脑前，为了微薄的服务报销向商业保险公司提交详尽记录。而保险公司往往会冷酷地驳回：“等一下，你的病历记录格式不规范。重新修改这个字眼，否则我们不会为你与患者沟通的那几分钟支付一分钱。” 这种繁琐冷血的官僚拉扯，彻底击碎了医疗应有的人文关怀。
Original English
**Guest**: And on top of that, you are forced to submit detailed notes for terrible reimbursement rates and fight with the insurance companies. They say: "Wait a second, your note wasn't coded correctly. Change this specific phrasing in your note so you get reimbursed for the minutes spent with this patient." The entire arrangement is profoundly broken.
### 媒体反思与单一人保模式的现实拷问
**访客**：然而，这一整套畸形运转的机制，却构成了某些既得利益集团源源不断的提款机。这一切不仅在控制着公众，甚至像《纽约时报》这样的主流舆论阵地，也一直在连篇累牍地对这类事件进行报道。无论是在过往的各轮选战还是当下的公共议程中，大众都迫切渴望了解这背后的深层真相。
Original English
**Guest**: Yet this whole machine generates massive revenues for a handful of players who run the system. Even in outlets like The New York Times, we have repeatedly seen stories tracking this reality during election cycles and public debates, because people are desperate to understand what really happened.
**访客**：作为长年深耕医疗报道、对这一系统有着深刻洞察的专业人士，你深知这套医疗体制在过去数十年间积累的顽疾究竟是如何一步步暴露出来的。而在涉及“全民医保”（Medicare for All）的宏大讨论中，政客们往往夸夸其谈，拿出一套看似自洽的政策说辞，试图说服大众：“只要先做这个，再推行那个，就能迎刃而解。” 他们把普通人全盘当成了购买服务的个体客户。
Original English
**Guest**: As someone with a fundamental understanding of healthcare through years of coverage, you've seen how this was laid bare. But when politicians debate Medicare for All, they present polished arguments claiming that if you do this and then that, everything falls into place, treating you entirely as an individual consumer.
**埃兹拉·克莱恩**：但请仔细想一想，在当前的美国体制下，医疗体系中所有的资金流转与账单交易究竟是因何而生的？医疗机构、大型医院之所以能攫取巨额收益，恰恰是因为它们提供了具体的医疗服务并为此发起庞大的资金结算；医疗器械制造商、跨国制药企业之所以大发横财，也是因为它们在临床诊治中开出药品并使用高精尖耗材。
Original English
**Ezra Klein**: But think about it: today, all financial transactions in healthcare exist because services are delivered. Hospitals and medical centers make money precisely because they bill for provided care; medical device suppliers and pharmaceutical corporations reap fortunes when drugs and devices are prescribed in clinical contexts.
**埃兹拉·克莱恩**：正因如此，在这个庞大的利益博弈局中，根本没有任何一个商业实体会发自内心地去关照病患全生命周期的健康福祉。人类追求身心健康的理想无可厚非，但如果你所处的整个体系在制度设计上就注定要从病患身上榨取利润，那么患者注定会成为层层盘剥中最痛苦的牺牲品。
Original English
**Ezra Klein**: Therefore, none of these corporate players have a real, structural incentive to safeguard your long-term wellness. A human desire for health is natural, but if you construct a system designed around maximizing financial extractions at every level, the patient inevitably absorbs the deepest suffering.
### 雇主医保的隐性负担与分摊机制
**埃兹拉·克莱恩**：让我们把视角拉回到极为具体切身的日常经历上来。以个人购买或雇主代缴的医疗保险为例：在现实中，员工通常每两周或每月从工资单中扣除一笔费用。作为纽约时报等机构的受雇员工，你的每张薪资单上，首先被联邦政府扣除的是 FICA（联邦保险贡献法税），山姆大叔总是在第一时间收走属于他的税款。
Original English
**Ezra Klein**: Let's ground this in our concrete personal experience with health insurance. You pay a premium every two or four weeks. If you are an employee at a company like The New York Times, the first chunk taken out of your paycheck is FICA taxes by the federal government—Uncle Sam gets his take first.
**埃兹拉·克莱恩**：随后便是医保扣款。为了你和家人的医疗覆盖，纽约时报承担了一部分保费，你个人也要在工资中分摊一部分。除此之外，你还必须面对高额的免赔额（Deductible）。你可以把免赔额理解为你享受医疗服务前必须自掏腰包的巨额硬性支出。不仅如此，后续还有就诊自付额（Copay）和定点医疗网络（In-Network）的严苛限制。
Original English
**Ezra Klein**: Next is the insurance contribution for you and your family. The New York Times pays a share, and you pay a share. Then comes the deductible—which is money you must pay out of pocket before coverage kicks in. After that, you still face copays and must navigate whether care is inside the approved provider network.
**埃兹拉·克莱恩**：商业保险公司为了控制支出、避免承担高额赔付，会设置极其繁琐的理赔门槛；而另一端的医疗提供者为了摊薄成本，不得不压缩每次面诊的时间，导致留给患者的诊疗时长越来越短。面对这种僵局，许多人寄希望于“全民医保”，认为只要由联邦政府作为单一买单人（Single Payer），消灭商业保险公司的利润动机，就能彻底解决这套在65岁以上老人群体中行之有效的模式在全年龄段推行时的财政与政治难题。
Original English
**Ezra Klein**: Insurers have an incentive to limit care to minimize payouts, while healthcare providers are squeezed on time, leaving you with shorter visits. Some argue that moving to Medicare for All—creating a single federal payer like the system for those 65 and older—would eliminate profit-driven transaction overhead and solve the fiscal-political dilemma.
### 市场竞争的失灵与道德选择的悖论
**埃兹拉·克莱恩**：在这里，我愿意扮演一下“恶魔代言人”（Devil's Advocate）。有人常常指责美国医疗保障体系的根本弊端在于市场利益驱动，指责逐利资本是万恶之源。但请仔细想想：在食品工业、餐饮零售等诸多其他行业中，企业同样以盈利为核心动机，市场竞争却能够有效提供丰富多样的产品与相对低廉的价格，并没有演变成全面崩溃的灾难。
Original English
**Ezra Klein**: Well, let me play devil's advocate here. Many argue that the fundamental flaw in the American healthcare system is profit—that players care only about profit, not you. But in many other sectors like food and retail, businesses pursue profit, yet market incentives generate affordable, high-quality goods. Why doesn't that happen here?
**埃兹拉·克莱恩**：美国拥有极其庞大的医疗消费产业和繁复的监管体系，保险公司的监管力度看似无孔不入。按照常规市场规律，竞争本该促使服务价格持续下降，然而现实中医疗价格不仅没有下降，反而一路失控狂飙。大家都在探寻背后的成因，究竟是什么导致了市场机制在医疗领域的全面失灵？
Original English
**Ezra Klein**: We have an incredible oversight and insurance infrastructure in America. One would expect market dynamics to drive prices down, but that never happened. Why did market incentives fail so completely in this space?
**访客**：这种反差正是我想向大众彻底讲透的核心所在。当我去购买一台电脑或一件衣服时，我有充分的自主选择权，买与不买全凭自愿。但当我的孩子突发重病、命悬一线时，我们面临的是争分夺秒的急诊抢救，那一刻我根本无法转身离开，更不可能在不同医院之间货比三家去进行所谓的“比价消费”。
Original English
**Guest**: That is the crucial distinction I want people to understand. When I want to buy a computer or a jacket, I can decide whether to spend the money. But when my child is sick and we are in urgent need of immediate clinical care, I cannot simply walk away or shop around for a cheaper price.
**访客**：在那种生死攸关的绝境中，患者和家属没有任何讨价还价的筹码，医院开出多高昂的账单你都只能被动接受。在生活中的其他商业领域，逐利动机或许能在某种程度上驱动效率提升并满足公众的正常消费需求，但在救死扶伤的医疗领域，强行套用市场机制只会催生毫无道德底线的巧取豪夺。
Original English
**Guest**: You are forced to pay whatever price is demanded, because profit in healthcare operates on entirely different dynamics than standard goods. In other areas of life, profit motives may align with consumer preferences. But in healthcare, exploiting desperation for profit is a fundamental structural failure.
**访客**：没有人会在身心健康时主动渴望接受医疗手术，大家真正渴望的是拥有健康的体魄。一旦灾难降临，患者必须倾尽所有去获取救治资源。正因如此，我们才更加依赖强有力的公共规则去约束市场的贪婪，防止医疗机构在人们最脆弱无助的关头肆意敲诈、漫天要价。
Original English
**Guest**: Nobody wants medical treatments for fun; what people want is health. When catastrophe strikes, patients will do whatever it takes to secure care. That is why we must rely on public guardrails to impose market discipline and prevent catastrophic price gouging when people are in desperate need.
**访客**：医疗保险的底层逻辑本应与房屋火灾保险类似：在日常生活中，你按期缴纳保费，防范的是小概率的毁灭性灾难；一旦房屋不幸遭遇大火，保险应当提供坚不可摧的安全底线，而不是在火光冲天的危难时刻，任由营利机构对灾民进行无休止的敲骨吸髓。
Original English
**Guest**: Insurance in its true sense is like home insurance against fire: you pay premiums knowing that if your house catches fire, you are protected from ruin. It should never be an exploitative financial trap sprung on people in their darkest hour of crisis.
### 医疗保险的本质与市场困境
**Speaker A**：归根结底，绝不能单靠市场化的医疗保险。因为事实就是如此残酷，不是吗？无论如何，我们所有人在人生的某个阶段都需要医生的帮助与治疗。有些人的健康状况甚至面临更严峻的考验。根本难点在于必须从顶层统筹资金，随之而来的关键问题是：究竟需要筹集多少资金，以及如何筹集？这正是症结所在。
Original English
**Speaker A**: Never rely purely on market insurance, because, yes, it is what it is, isn't it? At the end of the day, all of us need medical care and help from doctors. Some face far more severe health challenges. The problem is that money must be collected and raised from above, which raises the essential questions: how much and how? And right there lies the fundamental problem.
**Speaker A**：所谓完全依赖私营医疗保险的设想根本行不通。因为众所周知，人总是会生病，然后康复，但这种高免赔额和自付额并不是真正为你着想的保障，反倒成了掏空你钱包的枷锁。这就是当下的医疗保健体系。我绝不为此辩护。他们不断收钱、搜刮资金，把沉重的开销转嫁到我们头上。
Original English
**Speaker A**: The idea of purely private health insurance is useless. Because you know you get sick, and then you recover, but these high deductibles are not meant for you; they just empty your pocket, and that is our health care. I will never defend it. They take money, take more money, and shift the cost burden back onto us.
**Speaker B**：但在自由市场上，难道你不需要更多的选择吗？销售和市场机制正是我所擅长并理解的领域。
Original English
**Speaker B**: But on the market, don't you want options? Do you want more choices? That kind of marketing and selling is what I understand.
**Speaker A**：但私营健康保险行业实际上根本没有达成改善健康的目标。它们什么实质性的医疗都没提供，只是在充当收费通道和报销中介。而我们作为投保人却一直在为它们买单，饱受经济负担的折磨。因此，当我谈及“全民联邦医疗保险”（Medicare for All）时，我所主张的是一场彻底的医疗服务供给体系改革，而不仅仅是支付手段的修补。
Original English
**Speaker A**: But the health insurance industry truly serves no real purpose in delivering care. They produce nothing. They just handle claims and billing. And we pay them as our obligation, enduring endless financial suffering. That is why, when I talk about Medicare for All, what I mean is a genuine reform of the healthcare delivery system and services, not merely insurance reform.
---
### 价格约束、行政简化与创新成本
**Speaker B**：但这种看法并不准确。请听我说，市场能够对服务提供方施加纪律约束。按你的意思，难道只要推行全民医保，我们就能解决一切？
Original English
**Speaker B**: But that is not true. Listen to me. Disciplining providers and other players matters. In your view, is that what you are saying? You want to say that, but what I intended to address is whether you care about the fact that under Medicare, we can achieve substantial cost control.
**Speaker A**：全面推行全民医保的核心，在于它能带来前所未有的行政精简与大幅降价（price reduction）。更重要的是，它能对医疗服务和诊疗流程确立统一的标准规范。然而，很多供应商却竭力抗拒这种改变。例如在药品供应上，像礼来（Eli Lilly）等药企在其他国家的定价都远低于美国，因为那些国家的政府通过集中谈判达成了价格妥协，而药企却总拿“这会扼杀创新”来当借口。
Original English
**Speaker A**: What it does most significantly, beyond administrative streamlining, is massive price reduction. In addition, it establishes standard practices across all medical services. But as I explain, this changes how providers operate. For instance, whether under Medicare for All or externally, what a hospital or pharmaceutical company like Eli Lilly can charge is much lower in other countries. Those governments negotiate compromises on drug prices, while companies claim this damages innovation.
**Speaker B**：医药企业经常宣扬所谓“全世界都在免费搭便车享受美国研发成果”的理论，声称正因为美国人为昂贵药物买了单，新药研发才得以维持。但真正的关键在于上游供应链和研发源头。
Original English
**Speaker B**: There is this theory that the rest of the world free-rides on American innovation, claiming that because Americans pay full price for drugs, new treatments get developed. But looking closely at the real suppliers and the whole setup: whenever we need healthcare, we want certainty and guaranteed care. Yet the current system fails to give people transparent pricing or minimum cost guarantees.
**Speaker A**：现实是，最关键的基础研发和风险攻关，从一开始就是由政府通过美国国立卫生研究院（NIH）等公共财政资助的！每一个医生开出的关键药品，其底层科学研究都少不了 NIH 的经费支持。这是不容置疑的事实。随后，跨国制药企业接手过去，利用公开资助的成果牟取暴利。它们甚至辩称风险都在自己身上，以此正当化高昂的专利定价。
Original English
**Speaker A**: The reality of the system is that, first and foremost, the highest-risk basic research is subsidized by the government through institutions like the NIH. We both know this. The entire early-stage research process was funded by the NIH. Therefore, this is number one: the critical molecular entities in drugs prescribed by doctors trace back to public science. Then private corporations take over for massive profitability, arguing that because some trials fail, they must reap huge profits from the public.
---
### 公共保障的底线与“Costco 模式”隐喻
**Speaker B**：这就带来两个核心层面的思考：一方面你完全可以坚定支持全民医保；但另一方面，我们对制药业的公共政策底线究竟应该设在哪里？有人在讨论全民医保时把它比作一家向所有人开放的 Costco：“全民享受 Costco，但不再允许有 Trader Joe's、Walmart 或 Target。”
Original English
**Speaker B**: That leads to two thoughts. In my view, you can be an ardent champion of Medicare for All, but the question arises: what should the policy be toward the pharmaceutical industry? In some versions of the Medicare for All debate, as mentioned earlier, it's described like: everyone gets Costco, but it's Costco for everyone. No Trader Joe's, no Walmart, no Target, right? You can only have what Costco carries.
**Speaker A**：在加拿大等很多国家，在全民公共保障之上同样存在补充体系。问题在于，你认为全民医保应该设定的是一个不允许逾越的“上限”（upper limit），还是一个确保人人平等的“底线”（lower limit）？这就像公立学校系统一样：无论你身处何地，只要纳税，公共教育就为你提供坚实保障。全民医保应当是一项全民托底的权利保证。
Original English
**Speaker A**: Look at countries like Canada, where there are additions to the public system. The question is: do you think of it as an upper limit, or do you view it as a solid lower limit, a foundational floor? It's just like public schools. Wherever you live, public education is guaranteed for you. Medicare for All is a guarantee of basic coverage for everyone.
**Speaker B**：现行系统的最大弊端在于扭曲了医疗机构的定价与报销。比如妇产科医生的报销，商业保险给予的支付往往高得多，而政府医疗补助（Medicaid）的报销费率却只有商业保险的一半甚至更低。这导致大量诊所拒收 Medicaid 患者，加剧了医疗资源挤兑和不平等。
Original English
**Speaker B**: But another crucial aspect of the Medicare debate is healthcare delivery itself. People in our current system face severe distortions in medical practice. For example, for an OB-GYN, reimbursement from private insurance is far higher because commercial plans agree on higher rate packages, while Medicaid reimbursement is roughly half of private insurance. This creates huge problems for patients on Medicaid, limiting access and straining providers.
---
### 渐进路径与一蹴而就的现实考量
**Speaker A**：这正是症结所在。医疗不应沦为按支付能力划分等级的特权。当年的“罗姆尼医保”（Romneycare）虽然是一套包含个人强制投保和私营保险市场的妥协方案，但它至少推动了覆盖面的扩展。而现在很多人所期待的全民医保，究竟是一步到位实现大一统，还是分阶段推进？
Original English
**Speaker A**: Exactly, it shouldn't just be a single uniform Costco for everyone either. What I see here is the tension between different visions. Remember how Romneycare unfolded: it was an intricate blend of individual mandates, private insurance, and shared responsibilities. What I see debated around Medicare for All is whether people view it as a single immediate transformation or an incremental journey where this is just step one.
**Speaker B**：如果把最终实现全民健康保障比作攀登珠穆朗玛峰（Mount Everest），那么通往峰顶必须先建立大本营（Base Camp），途经多个不同海拔的营地。在你看来，这期间的关键台阶究竟是什么？我们从哪里起步？
Original English
**Speaker B**: You used that analogy, and I agree: the ultimate destination is Mount Everest. But to get there, you need to first reach base camp, tackling smaller peaks and intermediate ridges along the way. Which, in your opinion, are the necessary steps in between? Where does Medicare expansion begin?
**Speaker A**：如果从最务实的角度来看，登顶珠峰绝不可能一跃而就。我们不能幻想到了 2029 年元旦新任期开启时，白宫里会有一个神奇的开关，只要轻轻一按，全民医保就能在一夜之间完美运转。医疗体系的变革必须是全方位的整体工程（holistic），必须面对真实的制度阻力和执行复杂度。
Original English
**Speaker A**: Therefore, the fastest real path to reaching the summit of Everest cannot assume that on New Year's Day in 2029 we can simply flip a switch. There is no magic light switch in the White House that can instantly operationalize Medicare for All for everyone. You have to take a holistic approach, engaging with providers and system mechanics, because people will tell you: "Fine, there are real transition steps required."
### 联邦医疗保险优势计划（Medicare Advantage）的套路与机制
**阿卜杜勒 (Abdul)**：所有这些不同的部分，而且根本没有必要去逐一审视，这就是所谓的联邦医疗保险优势计划（Medicare Advantage）。所有这些计划，以及它们所宣称的意愿。但在我看来，事情正变得越来越麻烦。这就是“联邦医疗保险优势计划的策略”——他们说：“我们就是那个解决之道，我们会在第一线为你提供某些具体的服务和物资。”但严酷的现实是，我们看到他们口口声声承诺给你的所谓“福利”，实际上根本没有切实兑现。如果你想要全面的覆盖，你原本必须把所有组成部分（all parts）都纳入进来；你原本可以通过值得信赖的 Medicare Part D 来按需获取保障。在这里，它看似免费，实质上却是一种商业特许经营（franchise）式的营销运作。它做成了表面工夫，然而大家真正挤破头争取的那些核心优待，到头来只会把你的头脑彻底搞糊涂。这是头号核心问题。
Original English
**Abdul**: абарҭ еиуеиԥшым ахәҭақәа зегьы, насгьы уи абара аҵанакуам, Медикер Адвантаж апланқәа. Абарҭқәа зегьы апланқәа, насгьы урҭ агәаԥхара. Сара исымоуп ахашҭра уадаҩхоит. Медикер Адвантаж агамбит Ҳара уи ауп Ҳара ԥыҭк шәаҳҭоит ажәыларатә цәаҳәақәа рҿы иҟоу амаҭәахәқәа. Иҵәцароуп, ҳара уара {цитата} аԥыжәарақәа, иуҭаӡом Ус анакәха, уара иуҭахын, Уара иуӡахуан all parts. Уара иҟауҵон игәрагоу Ахәҭа Д. Аҟны Ари хәыда-ԥсадоуп, franchise. Иҟаҵоуп. Аханы Зегьы злаццакуа Аԥыжәара, ахы еиланарҩашьоит ухы. This is the number акы.
**主持人 (Host)**：然后你就开始面对形形色色的普通民众。在我的观察中，孩子们的情况其实一目了然，不是吗？谢天谢地，孩子们（Children, thank God）——如果他们的身体状况不佳，那他们往往就处于极度严重的重病状态。正因如此，从儿童期一直到四五十岁的成年阶段，这就是整个医疗体系在现实中必须承载的人群。
Original English
**Host**: Нас уара Уалагоит ауаа. Сара сгәанала Ахәыҷқәа еилкаауп, ус акәӡами Ааи? Children, thank God, Насгьы урҭ ргәабзиара ҽеимзар, усҟан урҭ ӷәӷәала ичмазаҩуп. Убри азы рҟынӡа, нас 50-40 рҟынӡа ашықәсқәа. This is what it has ауаа.
**阿卜杜勒 (Abdul)**：我所主张的原则是：如果我们有能力做到，就必须做到彻底而完备。如果做不到完全覆盖，那就必须追求真正的简捷明了。现在很多人都在说：“噢，太好了，你如果支持全民医保（Medicare for All），不管具体细节怎样，它至少清晰简单明了。”医疗服务本该提供更广泛的保障；如果能够满足这几项核心诉求，我就完全支持这项事业。我马上要谈到这个问题的深层实质，难道不是这样吗？
Original English
**Abdul**: Сара сзакәу Иҳалшозар инаӡаны. Мап анакәха, нас амариа. Ауаа урҭ ирҳәоит, "О, ибзиоуп, уара Медикер зегьы рзы, изакәызаалакгьы амариа. She provides еиҳа. If this matches Абарҭ ах-ҭахрақәак, сара абри азы. I am going Азныказы уи аҵаулара азҵаара, ус акәӡами?
### 医保法案的演进与两党政策渊源
**阿卜杜勒 (Abdul)**：我们所面对的政治对抗，本质上与这种深层变革的政策博弈紧密相连。追溯这项立法与政策倡议的源头，传统基金会（The Heritage Foundation）在1989年就提出了这个构想，你很清楚这一点。这最初完全是共和党人的主意（It was an idea. Republicans.）。同样地，个人医保强制令（individual mandate）在马萨诸塞州率先实施，随后反对阵营便竭尽全力阻挠后续的演进。事实就是如此，这是真实的现实。这种制度性推诿简直令人发疯，以至于我们在真正解决问题上一无所获。那么，我们究竟该如何找到最大的推动力，朝着正确的方向前行？其中的困难在于，我自己也经常面对这种体制的惰性。
Original English
**Abdul**: Ҳара Аҿагылара еидҳәалахоит аҽыԥсахра аҩаӡара аманы аполитика. Law on Адгалара Аҭынха Афонд 1989 азы Уара иудыруеит. It was an idea. Republicans. ИАРА УБАС насшәа индивидуалтәу Массачусетс. Нас Ирылшо зегь ҟарҵоит Ус ауп. Ииашоуп. Ари хагароуп. Ус ҳара акагьы. Ус анакәха аиура Иреиҳаӡоу аимпульс Амҩа иашала ахырхарҭа? Ауадаҩрагьы, Сара лассы-лассы Сара
**主持人 (Host)**：首先，是战争与公共卫生的问题。战争与健康保障之间存在着直接的张力。既然谈到这里，第二点就是公共话语（discourse）。我们的理解是，你究竟做了什么？战争可不是由他们挑起的。不，我们需要明白，我们正在努力改变的是整个政治生态和理解方式。能够做出这种历史性表态的人，根本不属于原本僵化的政治体系（political system）。我个人更加倾向于克林顿（Clinton）当年的主张；他在竞选公职（ran for office）时就明确谈到了全民医疗保障，这也是他当年来到这里时的坚定表态。
Original English
**Host**: рыла. First, war агәабзиара. Аибашьра агәабзиара. Уара уахьгьы алацәажәара. Аҩбатәи, discourse. Аилкаара, Иҟаҵәҟьоузеи уара? didn't start them. Мамоу Иаҭахуп уи Ҳара ҳҽазаҳшәоит аҟаҵара. Аполитикаҿы аилыркаарақәа. The one who would ари аҳәамҭа ҟаимҵеит, political system. Сара Сара еиҳа еиӷьасшьоит Clinton. Иара иҳәеит: агәабзиара. ran for office. Иара иҟан came here.
### 政府清单、选择权与中产阶级医疗困境
**阿卜杜勒 (Abdul)**：让我们审视一下安全与保障的实质。在这种现行政策下，公共展示往往变成了推卸责任。比如我认识的露易丝（Luisa），你赞成这种做法吗？是的，这就是他们所谓的“选择权”吗？你看清楚，实际上是政府或保险巨头直接从他们的官方名录中做出挑选（The government chooses from their list），这难道也能被称为自主选择？他们建立了所谓的“健康美国”组织机构，但在我看来，与其说是让民众自由选择医疗机构或医疗服务，倒不如说是无论这些选项是否存在，系统都已经预先限定了一切。他们所谓的全面系统，实际上充满裂痕。
Original English
**Abdul**: Шәааи Ашәарҭадара ҳахылаԥшып Абри аполитика, иҟалоит аӡыргара ашьҭра. Сара исымоуп Луиза. Иугәаԥхома Ааи. ИАРА УБАС? алхра. Уахәаԥш иара. The government chooses from their list. Иара алхра? Иқәдыргылеит аиҿкаара " Америка агәабзиара, Изакәызаалакгьы, сара Сгәанала, уи акәын аинститутқәа ралхра мамзаргьы амедицинатә амаҵзура, аасҭа Дыҟазаргьы дыҟамзаргьы Ааи? Ус ауп урҭ шыҟоу еибаганы иҟоуп.
**主持人 (Host)**：在这些城市议会以及地方基层内部，我们看到了当年支持奥巴马的群体，不是吗？大家必须意识到，核心的聚焦点就在他们身上。然后，换句话说，随着政治时刻的演变（political moment, changed），医疗收益的内部分配发生了剧烈变化。时至今日，局面早已面目全非。这正是问题的根源所在——我们的医疗体制究竟为广大中产阶级（middle class）带来了什么？
Original English
**Host**: АҨНЫҴҞА Абарҭ рахьтә аӡәырҩы Аамҭазтәи ақалақьтә советқәа Ҳара иаҳбаз Обамацәа, ииашам? Насгьы иҟашәҵароуп азҿлымҳаратә ҭыԥ, уи дара. And then, after- даҽакала иуҳәозар, аполитикатә moment, changed. АҨНЫҴҞА амедицинатә ахашәала. Иахьа уи ус акәӡам. Убри иазкуп. амедицинатә middle class?
**阿卜杜勒 (Abdul)**：整个医疗产业已经演变成我们今天必须直面的根基性障碍。我们来深入谈谈吧，除了策略层面，我们在第二轮的较量中必须尽早确立领先优势。因此，这正是我竭尽全力想要做成的改变。在一定程度上，尽管感到心力交瘁，但我依然深知自己的使命所在，深知如何付诸行动。我做出了自己的选择。关于这一部分，必须把它带入更广阔的公共舆论空间去讨论。几年前，在围绕密歇根州参议院选战展开的讨论中，我亲眼见证了这一切（I watched）。那个时期，所有人都被卷入其中。但真正耐人寻味的是华盛顿的动向：在最初的选战中，他们甚至拿所谓的伊斯兰教法（Sharia laws）来制造恐慌和议题。这引发了极其剧烈的政治风向转变，难道不是吗？
Original English
**Abdul**: Сара Аиндустриа ҟалеит Ҳара ҳзықәгылоу ашьаҭа Ҳаицәажәап, Уи адагьы, атактика, Ҳара ԥхьагылара ҳауеит Аҩбатәи-аҩбатәи аӡыргара уажәнатә зааӡа. And therefore, I Абри ауп сара исҭаху. аҟаҵара. But partly згәы шьҭыҵуа, Сара соума Издыруеит ишыҟасҵо. Сара салырхуеит. Ахәҭа абри иазкны, насгьы абри еиҭагатәуп аицәажәара акосмос аҟны, аҟны Шықәсқәак раԥхьа, Мичигантәи Асенаҭ ахь Иалацәажәап around him? Абра Ааи. I watched. аамҭа. Иара ыҟоуп Исыԥхьоит зегьы рзы. Аха аинтерес зҵоузеи, Вашингтон Аԥхьатәи алхрақәа рҿы урҭ урҭ рҟынтә. And since you Sharia laws. Аригьы ӷәӷәала аԥсахра ҟалеит. Ииашоуп?
### 媒体政治、身份认同与基层现实
**主持人 (Host)**：作为实实在在的当事人，你对这一切到底怎么看？你对此感到认同吗？你当时真的采取行动了吗？
Original English
**Host**: Дара Уара узусҭоу, уаҩҵәҟьак иаҳасабала абри. Шәгәы ишԥаанаго абри? Уара иҟауҵама?
**阿卜杜勒 (Abdul)**：我当时做出了长达数千英里的全州基层走访。说实话，我把所有的筹码都压在了这一追求上（I'm betting on it）。我很清楚，在那些日子里，对方的阵营——比如罗杰斯（Rogers）的名字整天、每天都在媒体上铺天盖地。我也清楚共和党那一套话术的核心是什么：他们一边喊着“住口，别再讨论了，停止争论！”一边却在解决现实问题上无所作为。因为我绝不接受这种粉饰太平。看看像 Newsmax 或者福克斯新闻（Fox News）这类媒体上的言论吧，他们所宣扬的一切，不过是在迎合特定受众的偏见罢了。然而广大民众是清醒善良的。你知道，我完全拥护服务于每一个普通人。最关键的问题在于：你究竟代表谁？你到底是谁？
Original English
**Abdul**: Сара ари азыԥхьагәаҭара ҟасҵеит миль. Аиашаз, сара I'm betting on it. Сара идыруан иара иҽны Аҿаҿынтә сыхьӡ Роџьерс амш зегьы, есыҽнытәи. Уигьы здыруеит Изакәызеи ареспубликатә Уаҟәыҵ ацәажәара. Уаҟәыҵ." Аха акгьы рылшом аҟаҵара. Избанзар сара Сара исцәымӷуп ари. Урҭ реиԥш ацәажәара Ниусмакс ма даҽакы, аа- аа, иара убас Фокс Ниус, изҳәо урҭ, зегьы дара ишрыцу аилкаара. Ауаа ибзиоуп. You know, I'm all изакәызаалак. Насгьы еиҳарак Уара узусҭада, насгьы узусҭада?
**主持人 (Host)**：你真的在为他们切身奔走工作吗？这是一个极具现实价值的课题。我从未见过与你如此相似的人。我真的很想与你深入探讨：你为什么非要做这件事？你站在这里究竟是为了实现什么？你的核心追求到底是什么？你所做的工作真的落到实处了吗？大家都很好，至于其他所有人（So, everyone else）——我经常会反问：“我真的理解这背后的意义吗？”换成别人，可能根本不敢涉足；第二点，他们心存畏惧；第三点，他在公众面前到底在宣扬什么？在谈论什么？
Original English
**Host**: Аус ууама? Ари аинтерес аҵоуп. . Сара ахаангьы similar to you. Сара Сцәажәар сҭахуп. Изакузеи Уара уи ҟауҵарц уҭахума? Изакузеи Уара ара иҟауҵозеи? Уара узакәызеи Аус ууама? Ииашоуп? Ауаа ибзиоуп. So, everyone else Сара уи зегьы шԥасҭо "Иӡбахә еилыскаауама?" Уи даҽаӡәуп, убри ауп ииашам. And in- аҩбатәи, дшәом. Ахԥатәи, зыӡбахә иҳәозеи? дцәажәоит?
**阿卜杜勒 (Abdul)**：看看“全民医保”（Medicare for All）这项主张吧，我发自内心地支持它，我全心支持。人们会问：“他到底是什么人？他又做成了什么？”噢，他是一名医生（Oh, he's a doctor），他去提供真实的援助，为贫困的孩子们配上近视眼镜，投身于对抗医疗暴利和企业债务的斗争中。现实根本不像政客描绘的那样轻松，我们当下目睹的是日益严峻的生存压力。为什么他们总是墨守成规？正因如此，我始终坚持去实践真正行之有效的方法（works）。现实摆在那里，我们绝大多数人所切身经历的，正如你谈到的日常经济重担。嘿，你能够轻松为你自己的车加得起汽油吗？能随心所欲负担日常消费品吗？能够顺利拿到购房按揭贷款（Get a mortgage）吗？或者说，你能做到生病去医院看医生时毫无经济顾虑、完全不感到害怕吗？因为说到底，这才是普通人生活中最核心的问题。
Original English
**Abdul**: Аԥшра, Medicare for all? Исгәаԥхоит. Исгәаԥхоит. And what is he? иҟасҵеит? Oh, he's a doctor, ацхыраара, Ахәыҷқәа абласаркьақәа рышәҵа, ақәԥара иалагеит Акорпоративтә ауалқәа. Уи иакәӡам ус акәушәа збоит уажәнатә ацәгьа. Why are they Убри азоуп еснагь исымаз works. Убри ауп Иҟоу уи ауп . And most of us Ҳазлацәажәо иазкны you talked. Еи, уара уоума gasoline for yourself? Мамзаргьы yourself products? Мамзаргьы Get a mortgage? Мамзаргьы Аҳақьым иахь дымшәаӡакәа насшәа? Избан акәзар, уи ауп зыӡбахә ҳәоу.
### “大替代”阴谋论、MAGA 政治与政治角力
**主持人 (Host)**：概括来说，我的名字从来不会平白无故推高汽油价格（on gasoline）。而在唐纳德·特朗普的语境下，回顾“9·11”事件发生的那段时期，事情哪有那么简单？那仿佛是某种来自深渊的剧烈震荡，整个世界都目睹了当时的惨状。在举国陷入创伤与悲痛的关头，某位国会议员却向美国社会散布极端言论，声称某些群体无法融入西方文明。在我看来，那完全就是一种歇斯底里的疯狂（madness）。“9·11”袭击事件随后被利用并引向了一场更加激进的战争（a more aggressive war）。事实上，他当时在 NewsNation 和福克斯新闻的节目中言之凿凿。但我认为核心问题依然摆在眼前：就像在“9·11”事件中，他们展现的是赤裸裸的冷酷无情。然而现在，这套理论又进一步与臭名昭著的“大替代”（big replacement）阴谋论杂糅在一起。他居然在公开兜售这种观点，你认为这合理吗？这根本行不通。
Original English
**Host**: еизыркәкәаны. Сара стәы Ахьӡ ахәқәа шьҭнахуам on gasoline. Дональд Ҳара уажәы Уи аамҭазы, сара Сентиабр 11. Иабамариоу? ҵаҟантәи даалҵызшәа аду. Иаабеит ишыҟалаз Агәыдибаҳәҳәалара аҽы. Congressman Америкатәи ауаажәларра, Иақәымшәо Мраҭашәаратәи ацивилизациа. Иара иҟан , сара сгәанала, madness. Иара Сентиабр 11 азы ажәылара ҟалеит a more aggressive war. Иара Аиашаҵәҟьа, аиашаҵәҟьа дцәажәеит НиусНейшн, Фокс Ахҭысқәа. Сгәанала, иҟоуп азҵаара: Ааи? Like September 11, you агәымбылџьбарара. Аха ари атеориа аидеиақәа дрылакьысуеит big replacement. Иара Угәы ишԥаанаго, ари иашоума? Ус аус ауӡом.
**阿卜杜勒 (Abdul)**：很好，我想明确指出的是：通过这种手段，你固然能在短时间内谋取某种政治算计的局部结果，但就最终的实质结果本身而言（the result itself），你到底在折腾什么？难道这就是整个所谓“让美国再次伟大”（MAGA）政治架构的最后一口气吗？这种势力正在不可逆转地走向衰落。现在很多人都在问：他们到底在干什么？他们逐渐意识到，依靠制造恐惧和政治迫害的把戏已经难以为继了。正因为大势已去，他们现在的手段才变得变本加厉、愈发可怖（more terrible）。说实在的，由于民众开始普遍觉醒并认清真相，他们的市场正在不断萎缩，而他们的行径也因此变得极其丑陋（really ugly）。
Original English
**Abdul**: ибзиоуп. Исҳәарц исҭаху, Уара иуоуеит иалкаау алҵшәа. Нас уаанхарц, нас уара the result itself. Насшәа Узҿуи? Уара Ари аҵыхәтәантәи аԥсеивгара шакәу МАГА аиҿкаара зегьы. Насгьы ԥсыҽхоит. Ирацәаны Уажәы урҭ Иаҿуп аҟаҵара? Ус анакәха, урҭ еилыркааит урҭ ус ишыҟам ашьҭашәарыцара. Дара Убри азоуп уажәгьы аус зуа more terrible. Насгьы ииашаҵәҟьаны Имаҷхоит, избанзар ауаа really ugly.
**阿卜杜勒 (Abdul)**：同样地，社会上也存在着一些新的尝试与相似的反响：“你为什么要去投身政治？”在整个国家的很多角落，我经常被问到：“我打从你还小的时候就认识你，看着你一路长大，我之所以支持你、赞赏你……是因为你始终坚定如一。”但我总是回答：“不，我就是来自那个社区、那个幼儿园起步的阿卜杜勒。”你知道，问题从来不在于外在的标签；真正的关键在于——你是否敢于真正站在竞技场中央（in the arena）？真正的问题是：你到底是谁？你是否真的在竞技场内为民众奋力拼搏？
Original English
**Abdul**: "Иара убас ҽазышәарақәак ыҟоуп, аиԥшра, Уара аполитика уалалоит. еиҳараӡак атәылаҿы. Сара ишәысҵоит шықәса анихыҵуаз инаркны аҟәаҟәа. Ус ҟасҵоит Уара Сара исгәаԥхоит... Уи акы ауп ... иара". Мап, сара Абдул соуп ахәыҷбаҳча аҟынтә абаҳча. You know, and . But the question is not Ус анакәха, аренаҿы уҟоума? Азҵаара, уара узусҭада? Уара аренаҿы аус
### 美国国内政治与以色列政策的分歧
**提问者 / 对话者**：你真的相信这些说法吗？在我们的政党内部，就存在着这样一种派系。关键的难题在于：我们究竟该从哪里发起抗争？这就像是一场测试，也是一种道德风险。
Original English
**Interviewer / Speaker**: Do you truly believe that? Inside our party, we have a faction like that. The real difficulty and question is: where do we take the fight? This is like a test, a moral hazard.
**应答者（嘉宾）**：做某件事情时，我想知道你究竟是谁，你是否有决心把这件事付诸行动？这就是我们面对很多失败时的症结所在。你嘴上那么说，但你是否真的有决心？无论发生什么，都要坚持下去。
Original English
**Respondent**: When it comes to taking action, I want to understand who you are. Do you really have the heart and determination to do this? This is why we bear these failures. You say that, but do you have what it takes? Are you determined to follow through no matter what happens?
**提问者 / 对话者**：认清你无法做到什么，并接受这一点。这听起来非常荒谬。
Original English
**Interviewer / Speaker**: Understand what you cannot do and accept this. It sounds ridiculous.
**应答者（嘉宾）**：我希望这能成为一种教训。我所持的观点正是如此。比如像 J.D. Vance（J.D. 万斯）——你知道，所有这些人……这简直荒谬透顶。很多时候事情并非出于个人的自愿选择。
Original English
**Respondent**: I hope this serves as a lesson. Here is what I hold. Take someone like J.D. Vance—you know, all of these things... How ridiculous is this? It's often not even by voluntary personal choice.
### 对外政策、援助与游说集团的博弈
**提问者 / 对话者**：不管是我、你，还是他，大家都心知肚明，很多人根本不相信那一套。最终我们必须独立做出决定，并为后果负责。关于美国对以色列的立场，到底应该是什么样的？
Original English
**Interviewer / Speaker**: Whether it's me, or you, or him, it's clear they don't believe it. In the end, things must be decided independently. When it comes to America's position on Israel, what should it actually be?
**应答者（嘉宾）**：这就是涉及以色列与加沙的核心问题。本届政府面对以色列，那个时代已经过去了。你可能会问，另一个问题是：如果去巴勒斯坦看看，难道现实不是这样吗？但在政治层面，从哲学和长远视角来看，我坚信平等。
Original English
**Respondent**: That is the question regarding Israel and Gaza. With the administration and Israel, this time has passed. Another question arises: when you look at Palestine, can you imagine otherwise? In politics and philosophy, looking at the situation, I believe in equality for all, including Jewish Israelis.
**提问者 / 对话者**：关键在于如何在两者之间斡旋，这关乎整个过程，而不仅仅是一个现成的结果。现在的问题是，巴勒斯坦国并不存在，许多人被囚禁在露天监狱中。来自密歇根等地的数百万选民认为，巨额资金的去向不仅没有解决民众的困难，反而让局势恶化。
Original English
**Interviewer / Speaker**: It is about how to maneuver between the two; it is about the process, not just about the result. In my view, that is the problem. Right now there is no Palestinian state, and people are held in what amounts to open confinement. Millions of people, like those in Michigan, see that money is spent while ordinary people's struggles worsen.
**应答者（嘉宾）**：但要做到这一点，如果不直面这些争端是很困难的。关于 AIPAC（美以公共事务委员会），我认为 AIPAC 代表的是另一个时代的声音和完全不同的以色列。很多人更关心医疗保健等国内基本民生。
Original English
**Respondent**: But to do this, it is hard not to address these challenges head-on. As for AIPAC, I think AIPAC represents another era and a very different Israel, while many people are struggling and just care about basic issues like health care.
### 国际司法、权力失衡与历史创伤
**提问者 / 对话者**：我同意你的看法，巴勒斯坦问题是一个长期存在的现实因素。人们越来越希望看到国际社会能够不带偏见、依法依规地审理这些纷争。但国际刑事法院（ICC）并没有军队来强制执行判决。
Original English
**Interviewer / Speaker**: I agree with what you said; the long-term Palestinian factor is real. More and more, there is interest in having the world resolve these matters judicially and deliberately. But international courts like the ICC are not enforced by military forces.
**应答者（嘉宾）**：犹太人认为这是他们唯一的庇护所和国家，但现实中存在着巨大的权力失衡（imbalance of power）。这场冲突没有给任何人带来好处。不仅是内塔尼亚胡政府的问题，当前的政局与军援政策让我们深陷其中。
Original English
**Respondent**: On the other side, Jewish people feel this is the only state they have, yet there is a severe imbalance of power. This conflict brings no good. It is not just about Netanyahu, but about the policies that subsidize and perpetuate the violence. It must be said.
**提问者 / 对话者**：Ezra，你说得对。无论是在党内初选还是更深层的政治博弈中，大家都清楚局势可能会变得更糟。在涉及这个国家的政策上，我们不能再掩盖战争与种族灭绝带来的严重指控。
Original English
**Interviewer / Speaker**: Ezra, you're right. You think deeply about this question. In primaries and at a deeper level, people know that things could get worse. When it comes to our policy toward this country, we cannot hide these issues of war and genocide in the courts.
**应答者（嘉宾）**：我完全理解双方所承载的历史创伤。犹太群体承受着大屠杀（Holocaust）留下的深重创伤与寻求避难的记忆；而巴勒斯坦人民同样承受着“灾难日”（Nakba）带来的流离失所与巨大创伤。如果无法直面并弥合这些创伤，和平就无从谈起。
Original English
**Respondent**: I understand. I truly understand that there is a lot of trauma. There is the profound trauma of the Holocaust and the search for refuge; equally, there is immense trauma from the Palestinian Nakba. Both realities must be acknowledged.
### 结语与推荐书单
**主持人**：几天后就要回去了，我们不再……我们必须面对当前的处境与原则。但我有一个答案。这应该成为一项原则。就此，我们将结束本期节目。我们能给观众们做一些推荐吗？那么，我想了想，也许……
Original English
**Host**: мышқәак рышьҭахь аҩныҟа Уаҳа Ҳара ҳаҟазароуп Аҭагылазаашьақәа апринципқәа. Аха азы Аҭак сара исымоуп. be a principle. Лара иҟазар ауп. Абри аҟны Ҳара ҳалгап. Ҳара ҳтәы арекомендациа азура ахәаԥшцәа? Ус анакәха, сара дазхәыцит, иҟалап
**嘉宾**：嗯，第一本是大卫·哈伯斯塔姆（David Halberstam）的著作。我认为那是一部无与伦比的作品，它写尽了那些“最出类拔萃的人”（The Best and the Brightest）所需要的一切。嗯，第二本关乎“娱乐至死”。我知道你……尼尔·波兹曼（Neil Postman）。每当我想起他，内心都深受触动。如果波兹曼活在当下，他会怎么看待TikTok？他写下那本书时正值电视时代，那是信息传播的媒介，但也必然存在彼此冲突的现实。TikTok不仅是一辆狂奔的信息载体，对吧？你知道的，人们看着滑稽的动作、热爱跳舞，但另一方面，难道不是这样吗？
Original English
**Guest**: Ум, актәи, аа, " David Halberstam. Сара зеиԥш ыҟам Зегь змаз ауаа иаҭаху иҟасҵеит. Uh, second one аԥсра. Сара издыруеит уара САРА… Neil Postman. Сара дҵысуеит уи даназхәыцлак Аԥошьҭаныҟәгаҩ иҟаиҵон ТикТок. He wrote this in Ателевизор аамҭа, ари –ари адырраҭара ауп, насгьы, хымԥада Еиҿагылоу абзамыҟә. TikTok is Ааи? It's just a car, Иудыруама, илеиуашәа збо, акәашара абзиабара, даҽа ганкахьалагьы isn't that right?
**主持人**：嗯，与此同时也吸引了极大的关注。你知道，所以你应该让人们去思考一些事情。比如说，在这一年里，信息充斥着生活，你知道，到处都是信息。你想要表达某些观点，像这样不断添加各种观点。
Original English
**Host**: Ум, насгьы Убри аамҭазгьы даара азҿлымҳара. Уара иудыруеит, . So, you should ауаа акы иазхәыцларц . Иаҳҳәап, ашықәс азы Аинформациа, иудыруеит, насгьы аинформациа. Уара Акы аҳәара Убас еиԥш аҳәара ацҵара .
### 公共品困境与政治反思
**嘉宾**：第三本是希瑟·麦吉（Heather McGhee）的《我们所有人的总和》（The Sum of Us）。啊，我与你感同身受。呃，公共品（public goods）。思考这个问题，在政治层面，它帮助我们将那些亟需解答的复杂问题逐一梳理并予以回应。是的，海莉（Helie）。嗯，我选择这个角度，是因为我们之间经常展开的讨论，其探讨的本质正是：真相究竟能达到怎样的程度？告诉政府吧，现在有必要审视这种视角。嗯，但这其中存在着某种痛苦。依我看，我们面对政府时，事实其实相当复杂。我作为一个人说这番话，政治与我们多次面临的诸多困境紧密交织在一起。
Original English
**Guest**: Ахԥатәи "Ҳара ҳаихшьаала" ауп. , Heather McGee. Аа, сара уара ушоу. Уф, public goods. Уф, азҵаара дазхәыцуа, Аполитикатә ҩаӡараҿы, ари Иҳацхраауеит Аҭак аҟаҵара зҭаху азҵаарақәа Иҟаҵатәхоит аҭак аҟаҵара. Уф, ааи Ҳели. Um, and I chose ари вариантуп, избан акәзар Лассы-лассы иҳамоу аицәажәара Ҳазлацәажәо аԥсабара ауп Шаҟа аиаша ыҟазар алшозеи? Аиҳабыра ираҳә, иаԥсоуп view now. Ем , аха иҟоуп акы ахьаа. Насгьы сгәанала ҳара Аиҳабыра рахь, аха ишыҟаҵәҟьоу Сара уи уаҩык иаҳасабала исҳәоит, Аполитика уи иадҳәалоу рацәоуп урҭ ауадаҩрақәа рҟынтәи зныкымкәа, иҳамоу.
**主持人**：痛苦？面对政府以及……你说得不全对，但确实有需要考量的地方（to consider）。因为其背后有着错综复杂的原因。
Original English
**Host**: ахьаа? аиҳабыра рҿаԥхьа, насгьы Уара уиашам. Аха иҟоуп to consider. Избанзар, амзызқәа.
### 脆弱性、同理心与致谢
**嘉宾**：正因如此，我依然清晰地记得当时的场景。那是一种创伤，实实在在的创伤。医生所在的病房里，那些无法掩盖的伤口暴露无遗，从这个地方凸显出清晰的脆弱性（vulnerabilities）。这令人不得不“驻足深思”。后来她说，我完全理解，并且由衷敬佩。“很遗憾你在这里。”“你并不属于这里，你想留在这里吗？”“我们都不希望待在这个地方。”但如果不这样做，握住手，“我来照顾她，好吗？”换句话说，他明白她正躺在医院里。对于他来说，触碰到了别人的伤痛，本能的同理心油然而生。
Original English
**Guest**: Убри аҟнытә сара даара Ибзианы исгәалашәоит уи зеиԥшраз. ахәра. ИАРА УБАС ахәра. And the doctor аҟәша иузахмырԥо Абри аҭыԥ аҟынтәи илабҿабоу vulnerabilities. Аригьы "Аанкылара." Нас лара Сара еилыскаауеит, насгьы даараӡа пату ақәысҵоит. It's a pity you're here. Уара уакәӡам Do you want to be here? Ҳара ҳакәӡам абра. Аха ус ҟаумҵар Унапы аанкыланы I'll take her, okay? Шьҭахьҟа даҽакала иуҳәозар, иара еиликаауеит Ахәышәтәырҭаҿы дышьҭоуп. Иара изы Аӡәы ахәра дакьысит, Иԥсабаратәу цәырҵроуп .
**主持人**：我认为这确实非常令人赞叹。如果能做到这一点，我将无比感激。衷心感谢！谢谢大家！
Original English
**Host**: And I think that this Даараӡа иџьашьахәуп I would be grateful. Гәыкала Иҭабуп. Иҭабуп.