The 2026 U.S. midterm elections are just weeks away. Among the highest-profile races is the contest for Michigan’s open Senate seat. With Senator Gary Peters not seeking reelection, the Democratic candidate is Abdul El-Sayed, who holds degrees in both medicine and public health and previously served as the head of Detroit’s public health department.
We asked El-Sayed how his scientific background affects his policy decisions, what the “Make America Healthy Again” (MAHA) movement has gotten right and wrong and what his vision for Medicare for All is.
[An edited transcript of the interview follows.]
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How has your background in science influenced your thinking on policy in general?
I’m a systems scientist. That’s how I trained. I wrote my doctoral thesis on systems in epidemiologic research. Every good scientific inquiry starts with a great question, and I think so much of what’s wrong with public policy starts with a great question: Why don’t we have health care when we need it? Why is there such massive inequity? What is the best way to allocate our scarce resources? How do we take on the challenges of a world in which there’s too much violence and too little peace?
The thing about science is that you construct a hypothesis of the world and you test it. I think that that level of rigor—to ask, “What is the nature of this problem? How do I integrate data about the problem? How do I answer this? And then how do I work this in terms of the political process and the policymaking process?”—all of that creates living labs where we try to build the world that we all want to live in, a place that’s more peaceful, where more people have the things that they need and deserve, where we can live together in harmony. Once you train in the sciences, you don’t leave that scientific approach to thinking and that rigor of thinking. And I try to bring that to policy problems.
A lot of what science does is descriptive rather than prescriptive, so it can be a little bit of a jump from one to the other. So can you elaborate on how you take that kind of “rigor of thinking,” as you said, and then apply it to solutions that the data suggest will work?
Well, you know, it’s true [science] is descriptive. But every question that we ask in science is to design an intervention, right? We don’t just ask these questions because they’re fun to ask…. They are fun to ask and answer, but we ask them because we do want to make things better. Why do we want to understand the way that the body breaks down glucose? Why do we want to understand what the appendix measure doesn’t do? Because we want to do something about it, right? We want to design anything that addresses the problem. We want to understand what the implications of removing an appendix might be.
I think it’s important to remember that, in science, it’s not that we’re just descriptive; it’s that we are descriptive so that we might be prescriptive in an evidence-driven and thoughtful fashion. I think it’s the same approach in public policy, where you want to understand the system, but you want to understand the system so as to intervene, and then it’s iterative; it’s recursive. You will engage your current understanding of the problem, you’ll pose an intervention, and then you’ll study the outcome of the intervention to see if it works.
As we’re building and designing interventions, it is about being willing to say, “Okay, this worked really well. Here’s the next thing we can do to make it even better.” And it’s that ability to continue after the problem until we’ve gotten solutions that really are purpose fit. Understanding that the world also evolves and changes, that the nature of the problem today might change as a function of what you did but also of other forces that are shaping the problem.
Your expertise is largely in public health. You’ve spoken a lot about the structural and social determinants of health, but it can take a long time for systemic change to occur. The effects may only be felt years down the line. How does pushing for those changes help people right now?
That’s the thing: you have to make sure it does help people in the place and the time in which the pain is being felt the hardest. I think that’s the thing about it…, that, too often, people can’t wait for the system to change. You have to think in the system, but you also have to be thinking about the issue. And I think the best analogy here is in medicine.
It’s one thing to say we’re going to cure your cancer, but we also have to heal your pain right now because that pain is the most acute symptom of what the long term might be doing to you. It’s thinking in time and place, both about addressing the system and also addressing the most acute manifestations of a broken system, and you’ve got to do both at the same time.
Can you elaborate on what systems, outside of direct health care, need to change to let Americans have healthier lives?
Think about our energy systems. We could be providing high-quality, renewable energy that does not force us to breathe from the ends of a smokestack, that is both more affordable and more accessible. But we don’t do that because of the power of a few corporations to dominate that system and to continue to sell us stuff that is less efficient and less effective.
Think about the system of inequality in this country. How do you make sure that a few corporations can’t just rig the system to continue to put it in overdrive so that they make more and extract more from us? You think about the impact of tech, in the way that we build tech policy. Amazing science goes into building really great tech. But at the same time, what is driving that? What are the incentives driving that? Are we building artificial intelligence (AI) to take away our jobs and win a race that might end up destroying us all, or are we building AI as a tool that empowers us in our lives? And how do you get the incentives of that right?
Across the board, there is a structural process that you have to think through but also key consequences that you have to adjust around, even in the short term.
There’s some overlap there between health policies you’re proposing and those put forward by the MAHA movement. What do you make of MAHA?
I think it is a consequence of a few people exploiting the distrust of a system that has earned that distrust. The reason that people distrust science isn’t because they don’t trust science. We use science every day. It’s because they don’t trust the corporations that hold that science. You’re paying more and more for insulin that’s existed for 100 years. It’s not a far leap to go from “I don’t trust these corporations because I can’t afford the things that they are making” to “I don’t even trust the things that they’re making,” and I think MAHA has been a response to that.
I think what people really want is: they want to be healthy. And I think science has always been the best arbiter about how to make people healthy. The problem is: we’ve got to make sure that the scientific discoveries that we put forward are also affordable to people so they can actually have them.
How do you draw the line between skepticism, which is part of the scientific process, and rejecting evidence, which is something we’ve seen MAHA spokespeople and figures do?
It’s faulty and dangerous to reject evidence, and you’ve got to push back on that. How do we build the kind of health policy that takes on the evidence-based ways that corporations are making us sicker, whether it’s pollutants in our environment or additives that should not be added to our foods, or to the ultraprocessed food environment?
Meanwhile vaccines have done some really, really great things, and there’s no evidence to suggest that, on net, they’re causing more harm than good. And so I think you’ve just got to hear the scientific process. The problem, though, is that, too often, we don’t act on a lot of the problems that we do have evidence for, and it creates a level of skepticism. I’m trying to just lead us where the evidence goes.
One thing your health policy agenda doesn’t touch on is glyphosate, which is a major issue for many MAHA followers. Where do you stand on that?
I’ll be honest: I didn’t take a very direct position on that because I need to understand the science a little bit better. I want to be led by science, and I also understand the deep concerns that folks have.
I think we need to err on the side of caution. But we also need to make sure that science drives our positions. And we need to be able to demonstrate the potential impacts over time.
But part of the problem is just the way that we set scientific data standards. In the U.S., too many of our standards are “innocent until proven guilty,” and I think that when it comes to broad health concerns, you really need to demonstrate that something is safe before you start putting it in all of our foodstuffs. I think that is part of the challenge that the broader MAHA movement has been concerned about. I know there’s a lot of controversy around these particular sets of chemicals, but I want to be able to really review the science, understand where we sit and then apply that principle. We need to be able to demonstrate that this is definitely safe rather than assuming it’s safe until we’re proven wrong, like all these PFAS chemicals [perfluoroalkyl and polyfluoroalkyl substances, or “forever chemicals”] that only later science has demonstrated are so dangerous.
A lot of your positions require well-staffed enforcement agencies, which have gone through large-scale cuts. What can be done to beef them up, given that it’s clear that’s not where the administration’s priorities lie?
We’re going to need to reinvest in these agencies—and not just reinvest but modernize and make sure that we’re not just building back. We need to build forward the agencies that we need for the 21st century. They’ve taken a gigantic scalpel—no, forget a scalpel—[they’ve] taken a chainsaw to these agencies, and we’re going to need to be invested appropriately so that we can we can start to enforce where we need to. Whether it’s the [Food and Drug Administration or the Environmental Protection Agency], reinvesting in [the Centers for Disease Control and Prevention or the National Institutes of Health], we are going to have to do that.
We’re going to need people who both understand and have been to these agencies before they ever got elected and also can be sitting with experts to say, “If we could build what we need, not just what we’ve had, what would that look like?”
What can be accomplished may hinge on the outcome of the presidential election in 2028. If you’re elected in the midterms, is there anything that you plan to do from your position in the Senate over the next two years?
I think it’s worth reviewing a lot of the way that [the U.S. DOGE Service] happened and asking how much of that was actually legal and understanding what that is.
I wish I could tell you [that], from the U.S. Senate, I could I could snap my fingers and take it back to where it was. That’s just not where we are. We have to leverage the political process to build what we need. From the U.S. Senate, there’s a lot of lawmaking we can do that I hope would pass both houses. Now, if Donald Trump wants to veto, he can. But all that’ll do is demonstrate the pressure that needs to be put on him and demonstrate exactly how frankly mendacious he has been when it comes to the proper function of government.
We’ve heard from people who are not in the scientific community who believe that getting government out of research isn’t necessarily a bad thing, that we should get private industry funding basic research. If you’re elected to the Senate, what will your position be?
We need to restore funding, but it also needs to be built to what it should be. It’s not enough to go back. You talk to anybody in science, they’ll tell you that NIH money is really important, but too often the way that the NIH works is an anachronism to how science actually works right now. Another point I’ll make is that these cuts may seem harmless until you’ve got 8,000 people who are infected with Cyclospora, and people are trying to dodge lettuce in the United States of America. I think it’s important for us to put a name on the consequences and start to address them.
You are a vocal proponent for Medicare for All. Depending on where one gets their numbers, between 800,000 to up to three million people are employed either in health insurance or in fields adjacent to health insurance. How would you approach implementing Medicare for All while limiting mass layoffs in these industries, especially as AI puts pressure on workers?
You’re already seeing a lot of these corporations start using AI to try to eliminate these jobs. While [those job numbers] may be true today, within the next two years, they are coming for those jobs. You’re still going to need people who can process all of the churn that happens, although it’s going to be substantially less. You’re still going to need people in the industry who are doing those jobs.
The other thing I’ll just tell you is that Medicare for All is going to be a net positive for health care jobs. People right now are working for an industry that makes its money denying people health care. Think about the number of people who exited the current health care system that are going to be repatriated back in when we finally guarantee every single person health care.
Would that mean importing jobs that are currently in the private sector into the public sector?
No, not necessarily. You’re creating a lot of health care jobs, which will be private. [The idea is to have] public insurance but private health care. Ten percent of the population right now can’t regularly get the health care that they need. Medicare for All would enable them to get that health care, and so you’re going to see massive growth in the private sector to provide health care as paid for by public health insurance.
Similarly, to your point around the health insurance jobs, you’re going to be able to leverage health insurance. Even Medicare, as it operates right now, there is some subcontracting to private companies that manage some of the paperwork even if the health insurance is still publicly guaranteed. That said, you are going to be able to create a lot of public sector jobs doing a lot of this work. And so the transition will create many more jobs than are lost, mainly via health care, which is going to stay private under Medicare for All.
