Keen On America

“We should all be able to look at the numbers and agree that this is not sustainable and that whatever we’ve been doing is not working. Democrats have had their chance, and Republicans have had their chance, and it’s only gotten worse.” — Halle Tecco
Warren Buffett called America’s healthcare costs “a hungry tapeworm on the American economy.” That tapeworm now devours nearly a fifth of the nation’s GDP—and the patient, as always, is on the table. We dedicate today’s show to this most perennial of all America’s problems, with two guests and two new books that approach the tragi-comedy from different angles.
Self-styled innovation wonk Halle Tecco—founder of Rock Health, investor in over fifty digital health companies, professor at Columbia Business School—argues in Massively Better Healthcare that the system is both excessively public and excessively private, a Kafkaesque bureaucracy in which verticalized health plans now own the PBMs, the pharmacies, and increasingly the doctors. The result is monopoly medicine on a scale that would have appalled the original trust-busters.
This is ultimately an antitrust story. As we’ve discussed on the show with Tim Wu, Biden’s chief antitrust enforcer, the concentration of corporate power is the great unfinished business of American democracy. Tecco makes the case that Big Med is where the trust busters should go next after Big Tech. UnitedHealth is now one of the largest employers of doctors in the country. So it wasn’t exactly shocking when the UnitedHealth CEO was assassinated two years ago. The system isn’t broken, Tecco suggests. It’s working exactly as designed—just not for patients.
Surgeon Robin Blackstone, MD, author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0, joins us in the second half of the show to offer a view from the front lines. After 30 years as a surgeon, Blackstone confirms everything Tecco diagnoses—and adds a chilling detail of her own: the system is priced entirely for fixing illness, not preventing it. Her prescription is a “triangle of trust” between patient, physician, and AI—with the patient finally owning their own data.
Both agree on one thing: every dollar spent on public health saves $14.30 in medical and societal costs. We are all already paying for all the waste. We just need to fix Big Med. But who’s going to do it? Tecco says that America is ready for another round of Obamacare politics. But I’m not so sure.
 
Five Takeaways

•       Healthcare Is a Tale of Two Civilizations: If you’re wealthy, you go to UCSF and get the best care in the world. If you’re not, you’re one of the 100 million Americans without a regular primary care provider. Healthcare debt is the number one cause of bankruptcy. A person earning $30,000 in a rural county can expect to live a full decade less than someone earning $100,000 in an affluent suburb.
•       The Real Winners Are Monopoly Medicine: Verticalized health plans now own the PBMs, the pharmacies, and increasingly the providers. The ACA’s profit cap forced them to grow the pie instead of getting more efficient. United is now one of the largest employers of doctors in the country. Independent pharmacies are closing at the rate of one per day. Rite Aid is bankrupt—the only major chain not owned by a health plan.
•       Every $1 in Public Health Saves $14.30: We’re already paying for the crisis—in emergency room visits, lost productivity, and disability. We just need to move the safety net upstream. Public health is the only part of the system designed for prevention, yet its share of total health spending has dropped 25% in two decades. The economic case is overwhelming. The political will is not.
•       AI Could Break the Information Asymmetry: Patients are already using ChatGPT to diagnose themselves—and sometimes it’s saving their lives. One woman caught her own pneumonia because her doctor couldn’t see her for a week. But some doctors want to keep the paternalism: one AI tool built on medical journals is restricted to clinicians only because making it available to patients would “piss off the doctors.”
•       The System Is Priced for Rescue, Not Health: Everything is loaded to the moment your gallbladder goes bad or your heart gets a blockage. Prevention doesn’t get paid for. Both guests agree: we need a massive re-pricing that rewards keeping people healthy, not just treating them when they’re sick. That means paying doctors to prevent strokes, not just to fix them.
 
About the Guests

Halle Tecco is the founder of the venture fund Rock Health and an investor in more than fifty digital health companies. She is an adjunct professor at Columbia Business School and a course director at Harvard Medical School. Her new book is Massively Better Healthcare: The Innovator’s Guide to Tackling Healthcare’s Biggest Challenges (Columbia University Press).
Robin Blackstone, MD, is a physician, health systems architect, and founder of Blackstone Health. A surgeon by training with 30 years of clinical experience, she is the author of Doctor AI: Reimagining Health. Rebuilding Trust. Delivering Health 4.0.
References

Previous Keen On episodes and authors mentioned:

•       Robert Pearl on how AI will be monetized in the healthcare industry

•       Tim Wu on the extractive economics of platform capitalism

•       Zeke Emanuel on which country has the world’s best healthcare

•       Warren Buffett on healthcare costs as “a hungry tapeworm on the American economy”
About Keen On America

Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
Website

Substack

YouTube

Apple Podcasts

“If we let things continue in the direction that they are taking now, I think it is more likely than not that we will end up in some kind of Great Power war within the foreseeable future.” — Arne Westad

This conversation was recorded before the invasion of Iran, which makes what you are about to hear even more chilling. In his new book, The Coming Storm: Power, Conflict, and Warnings from History, Yale historian Arne Westad warns that the structural parallels between our multipolar 2020s and the world before the First World War are too striking to ignore—and he names the Middle East as one of the flashpoints that could spark a much broader conflagration.
Westad argues that the structural parallels between our multipolar 2020s and the world before the First World War are “striking.” A dominant power (USA) withdrawing from the international system it created. Rising inequality and globalization backlash. New technologies that speed up time and shrink the window for decision-making. A rising Great Power—China—that, like Wilhelmine Germany, simply cannot stop growing. And a declining empire—Russia—that, like Austria-Hungary, has quarrels on every border and an alliance with the rising power next door.
The cast of characters, Westad warns, is also uncomfortably familiar. Trump is Joseph Chamberlain—the British conservative who turned his party against the free trade system it had championed. Putin’s Russia is Austria-Hungary: an empire in long-term decline that acted in 1914 because it believed Germany would back it up. And nuclear weapons? Before 1914, people wrote long books about how new military technologies made war unthinkable. We are taking refuge in that same bad logic today.
The difference, Westad insists, is that we know how 1914 ended. We have international institutions built to prevent it. And we still have time—but not much, he warns—to forge the kind of Great Power compromise that could pull us back from the brink. Whether we will is another question entirely. Especially given our current historical amnesia. So might Archduke Ferdinand be Ayatollah Ali Khamenei this time around? Stay tuned. It’s squeaky bum time once again in world history.
 
Five Takeaways

•       We’re Living in a Pre-1914 Moment: A multipolar world. Rising inequality. Globalization backlash. New technologies that speed up time and reduce the window for decision-making. A dominant power withdrawing from the international system it created. The structural parallels between the early 20th century and the 2020s are, in Westad’s word, “striking.”
•       China Is the New Germany: A rapidly rising Great Power that can’t stop growing, generating dissonance in an established international system. As the British told the Germans: “If you could just stop growing, little Hans, all would be fine and dandy.” That’s exactly what China cannot do. And it takes two to tango on compromise.
•       Russia Is the New Austria-Hungary: An empire in long-term decline with quarrels on every border, allied to the most rapidly rising Great Power next to it. Austria acted in 1914 because they believed Germany would back them up. The parallel to the China-Russia relationship today is uncomfortably close.
•       Trump Is Joseph Chamberlain: The British conservative who turned his party against the free trade system it had championed. Chamberlain never made it to prime minister, but he came close and reshaped his party in ways no one foresaw—exactly what Trump has done to the Republicans.
•       Nuclear Weapons May Not Save Us: Before 1914, people wrote long books about how new military technologies—poison gas, battleships, aerial bombardment—made war unthinkable. We are taking refuge in the same logic today. Westad is not so sure the deterrent fully holds anymore.
 
About the Guest

Odd Arne Westad is the Elihu Professor of History and Global Affairs at Yale University. He is the author of The Coming Storm: Power, Conflict, and Warnings from History as well as The Cold War: A World History, The Global Cold War (winner of the Bancroft Prize), and Restless Empire (winner of the Asia Society Book Award).
References

Books and authors mentioned:

•       Christopher Clark, The Sleepwalkers, on how Europe stumbled into the First World War (previous Keen On guest)
•       Philipp Blom, The Vertigo Years: Europe 1900–1914, on technology and cultural disruption before the war
•       Paul Kennedy, on the rise of British-German antagonism and Great Power rivalry
•       Margaret Atwood, The Handmaid’s Tale (referenced in the Sutton episode the previous day)
About Keen On America

Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
Website

Substack

YouTube

Apple Podcasts

Spotify

 
Chapters:

“When you use humor to degrade people, you can get away with it—but you’re also doing something that’s completely devastating.” — Rhae Lynn Barnes

Donald Trump’s recent retweet of Barack and Michelle Obama depicted as apes was dismissed by his supporters as “just a joke”—another example, they claimed, of liberals lacking a sense of humor. But Princeton historian Rhae Lynn Barnes argues that this kind of “humor” is anything but innocent. It draws on a centuries-long white supremacist tradition of dehumanization—one that stretches back to the origins of American mass entertainment itself.
In her book, Darkology: Blackface and the American Way of Entertainment, Barnes traces how Blackface minstrelsy became the quintessential American cultural form—America’s first great entertainment export—shaping music, comedy, performance, and politics from the 19th century through the 20th. Barnes explains how P.T. Barnum helped popularize the grotesque “scientific” spectacle of Black people as the missing link in evolution, and how the Barnum model of hoax-driven mass media foreshadows Trump’s own relationship with controversy, “fake news,” and attention.
Barnes argues that Blackface wasn’t merely a fringe theatrical practice. It was normalized—then institutionalized—through schools, churches, civic clubs, and even the federal government. The result was an intergenerational system for teaching white supremacy through catchy songs, jokes, and seemingly harmless performance.
For Barnes, the most important chapter of the Darkology story is the Black resistance minstrelsy triggered—from Frederick Douglass’s campaign of dignified self-representation to NAACP organizers and Black veterans who fought to remove minstrel shows from schools and public life. Rather than anti-American, Barnes insists that confronting this censored cultural history is the patriotic duty of all Americans. That’s America’s defining story, she says. The pursuit of freedom—and the ongoing struggle to live up to it.
 
Five Takeaways
1. Racist Humor Has Deep Roots: What gets dismissed today as “just a joke” belongs to a centuries-old tradition of dehumanizing caricature that masked cruelty as entertainment.
1. Blackface Was America’s Cultural Foundation: Minstrelsy shaped American comedy, music, performance—and even political campaigning. It was the quintessential American entertainment form.
1. Barnum Invented the Spectacle Model: Hoax-driven media sensation fused with racial pseudo-science and spectacle long before modern political showmanship adopted the formula.
1. White Supremacy Was Taught as Fun: Catchy songs, simple dances, and comic routines created an intergenerational system of racial socialization embedded in schools, churches, and civic clubs.
1. Patriotism Requires Historical Honesty: Confronting this censored past strengthens democracy. America’s defining story is the pursuit of freedom—not the denial of injustice.
 
About the Guest
Rhae Lynn Barnes is a historian and professor at Princeton University. She is the author of Darkology: Blackface and the American Way of Entertainment.
 
References
Previous Keen On episodes mentioned:
1. None
 
About Keen On America
Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
Website
Substack
YouTube
Apple Podcasts
Spotify
 
Chapters:

(00:00) - Introduction

(00:25) - Trump, race, and “just a joke”

(01:31) - The long history behind the meme

(02:30) - P.T. Barnum and the “What Is It?”

(03:41) - Barnum, hoaxes, and Trump’s media instinct

(05:39) - Blackface as America’s signature entertainment

(07:34) - When “minstrelsy” goes mainstream

(09:50) - Black responses: Douglass to Ragtime

(12:28) - Veterans, schools, and the NAACP fightback

(17:54) - Presidents, power, and “Whiteology”

(19:50) - Humor as an intergenerational weapon

(21:20) - Immigration and learning “whiteness”

(22:30) - Is American history defined by white supremacy?

(24:00) - The pursuit of freedom—and confronting the past

(28:18) - Why this history still matters now

(31:11) - Gerald Ford and the politics of Blackface

(32:56) - Closing thoughts and goodbye

“If you disestablish Christianity, then Christian leaders need to make Christianity a consumer product. They need to give the American people something they want.” — Matthew Avery Sutton

Over the years, Keen On has done many shows on the relationship between the United States and organized religion. Daniel Williams argued that smart people still believe in God. Jim Wallis warned that a false white gospel is threatening America. But we’ve never quite done a show on Christianity as “the thing in itself”—the force that made America what it is, for better and for worse. That’s what this conversation is about.
Historian Matthew Avery Sutton’s new book, Chosen Land: How Christianity Made America and Americans Remade Christianity, is a sweeping argument that Christianity is not just part of the American story—it is the American story. The founders created a godless Constitution not out of principle but pragmatism: they couldn’t pick a winning denomination. The unintended consequence was to open the floodgates. Powerful Protestant groups seized even more power, building an unofficial establishment that shaped everything from westward expansion to the Civil War to the rise of the religious right.
Sutton’s most provocative insight is that disestablishment turned Christianity into a consumer product. Forced to compete for adherents against entertainment, sports, and media, American churches became entrepreneurial, technologically savvy, and relentlessly current—reinventing themselves every generation. That’s what sets American Christianity apart from the rest of the Western world. It also helps explain Trump: a president who uses Christianity in a “crass, overt, and hypocritical” way, but who is doing something that generations before him built the infrastructure to enable. Whether this is Christianity’s last gasp or the prelude to another great revival, Sutton says, nobody knows. But the air we breathe in America is Christian air, and this book explains how it got that way.
 
Five Takeaways

•       The Godless Constitution Backfired: The founders couldn’t pick a winning denomination, so they disestablished religion. It was pragmatic, not ideological. But this opened the floodgates. The Christians who already had the most power—Methodists, Baptists, Episcopalians, Presbyterians—seized even more, creating an unofficial Protestant establishment that determined who was in and who was out.
•       Christianity Became a Consumer Product: Disestablishment forced churches to compete for adherents. They had to be aggressive, entrepreneurial, current—competing with entertainment, sports, and media. They became masters of new technologies and communication, reinventing Christianity every generation. That’s what sets American Christianity apart from the rest of the world: an unintended consequence of the First Amendment.
•       The Civil War Was Christians Killing Christians: Presbyterians killing Presbyterians, Methodists killing Methodists. It exposed the fragility of the effort to build a Christian utopia when you can’t settle the question of slavery. The Confederates actually wrote God and Jesus Christ into their constitution—they believed the Union had gone off the rails because its Constitution was too godless.
•       The Liberationists Are the Heroes: Indigenous preachers who saw Jesus as liberator, Black Christians, gay rights activists in the 1960s and 1970s, Barack Obama. There have always been alternative visions of Christianity in America. Sutton’s heroes are those who see Jesus as a radical figure who wants to overturn hierarchies and bring equality.
•       This May Be Christianity’s Last Gasp—Or Not: Just under two-thirds of Americans now identify as Christian—a historic low. Trump’s hypocrisy is driving young people away. In anointing Trump as their savior, the religious right may have hammered the final nail into their coffin. But every time scholars predict secularization, America has a revival. Nobody knows what’s next.
 
About the Guest

Matthew Avery Sutton is the Claudius O. and Mary Johnson Distinguished Professor and chair of the Department of History at Washington State University. He is the author of Chosen Land: How Christianity Made America and Americans Remade Christianity as well as American Apocalypse and Double Crossed, and a recipient of a Guggenheim fellowship.
References

Previous Keen On episodes mentioned:

•       Daniel Williams on why smart people still believe in God
•       Jim Wallis on the false white gospel and faith and justice
•       Margaret Atwood on The Handmaid’s Tale
About Keen On America

Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
Website

Substack

YouTube

Apple Podcasts

Spotify

 
Chapters:

(00:00) - Introduction: Christianity as "the thing in itself"

(02:11) - Is this really a surprise?

(04:05) - Which Christianity? Questions of power

(06:36) - The founders and the godless Constitution

(08:55) - Was it a coup?

(11:15) - Jacksonian democracy and revivalism

(12:56) - Colonizing the West and Native Americans

(16:03) - What does evangelical actually mean?

(17:31) - The Civil War as a religious war

(21:05) - Max Weber and Christianity as consumer product

(28:02) - Margaret Atwood and The Handmaid’s Tale

(30:17) - Peter Thiel and the Antichrist

(36:31) - Is this Christianity’s last gasp?

“We keep telling you there’s an eviction crisis, so organize with us. Feel free to come into our meetings. Feel free to learn about the lives of people who have been here for a long time.” — Manissa Maharawal

Yesterday we spoke with anthropologist Ida Susser about France’s Yellow Vests—provincial truck drivers, nurses, and teachers who drove hours to Paris, furious about decades of disinvestment in their economy. So does America have its own Yellow Vests? You might find them in (of all places) the San Francisco Bay Area, the setting of a new book by a former student of Susser’s about what happens when the same disruptive economic forces hit an American city.
Anthropologist Manissa Maharawal’s new book, Anti-Eviction: The Fight Against Tech-Led Gentrification in San Francisco, chronicles the grassroots movement that rose up against big tech during the boom of the 2010s. Like the French Yellow Vests, these were ordinary people from the San Francisco Bay Area—teachers, bartenders, nurses, copy editors—who refused to accept their displacement as inevitable. Like the Yellow Vests, they grew out of no political party or even ideology. The anti-eviction movement emerged from Occupy, just as the gilets jaunes emerged from the roundabouts outside Paris.
Anti-tech activists in San Francisco’s Mission District watched Google buses roll through their neighborhoods and decided to blockade them. But where the Yellow Vests defied the left-right spectrum, Maharawal’s activists have a clear target: the neoliberal market logic that justifies gentrification as the result of “inevitable” market forces. She is sharply critical of the abundance argument advanced by Ezra Klein and Derek Thompson, arguing this supposedly free market has given the Bay Area a glut of luxury housing and almost no affordable units. The real crisis, she says, isn’t too few homes—it’s too little regulation on the homes we already have.
Fifteen million sit vacant in the United States, Maharawal reminds us. Private equity firms are buying up a quarter of the housing on the market. Even Trump has woken up to this. In a moment of political pessimism on both sides of the Atlantic, both Susser and Maharawal offer evidence that ordinary people can both organize and, at least, shape the political conversation.
 
Five Takeaways

•       Tech Gentrification Is Modern Colonization: Activists in San Francisco’s Mission District compared Google buses to conquistador transportation—rolling through their neighborhoods, stopping at their bus stops, letting in only young white tech workers while longtime residents stood by with their children. San Francisco had become a company town for the tech industry, with the city rolling out a red carpet—including massive tax breaks—while people in surrounding neighborhoods were evicted.
•       The Market Will Never Solve This—And That’s the Point: It’s never going to be profitable enough to build the deeply affordable low-income housing we actually need. That’s why all the housing built in the past fifteen years has been luxury housing. New York City has entire half-empty skyscrapers. San Francisco consistently meets its targets for luxury construction but fails on low-income housing. Market-based solutions alone are insufficient.
•       Rent Control Stabilizes Lives, Not Just Rents: Maharawal grew up in a rent-stabilized apartment in New York City—it’s the reason her family could stay. Rent stabilization gives people a chance to imagine a future somewhere. The real foil isn’t small landlords; it’s private equity firms making billions off rental housing. A statewide rent cap proposal in California didn’t even make it out of committee in a Democrat-led state.
•       The Housing Crisis Is About Regulation, Not Just Supply: Fifteen million homes sit vacant in the United States. Maharawal argues the crisis isn’t simply a lack of housing—it’s a lack of regulation on the housing we already have. The Abundance argument for deregulation misdiagnoses the problem. When you reframe it, solutions like rent control, community land trusts, and social housing become obvious.
•       Anti-Eviction Activism Offers a Model for This Moment: The movement grew out of Occupy, as activists found themselves moving evicted friends out of the city every weekend. A small group of dedicated people built community, combated the deep alienation that eviction creates, and fought to keep each other in their homes. Some of them are still there. In a time of political hopelessness, these are concrete examples of things that worked.
 
About the Guest

Manissa Maharawal is an assistant professor of anthropology at American University in Washington, D.C., and the author of Anti-Eviction: The Fight Against Tech-Led Gentrification in San Francisco. She is a co-founder of the Anti-Eviction Mapping Project and has previously written about the Occupy movement and housing justice in the San Francisco Bay Area.
References

Previous Keen On episodes mentioned:

•       Ida Susser on the Yellow Vests and the battle for democracy in France
•       Patrick Markee on homelessness in the New Gilded Age
•       Ezra Klein and Derek Thompson on Abundance and the housing crisis
About Keen On America

Nobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.
Website

Substack

YouTube

Apple Podcasts

Spotify

 
Chapters:

(00:00) - Introduction: The housing crisis in the Bay Area

(01:46) - Anti-Eviction and the colonization metaphor

(04:16) - "It's just the market" — is that a credible argument?

(06:12) - Things could be different: contesting gentrification

(07:34) - Has San Francisco’s government helped or hurt?

(10:07) - Rent control: the policy nobody will pass

(12:20) - The Abundance debate and the split on the left

(15:08) - Misdiagnosing the housing crisis: regulation, not just supply

(16:47) - Governo...