Vivek Ramaswamy, the Republican candidate for governor of Ohio, at a campaign event in Vandalia, Ohio, on October 3, 2026. | Jessica Phelps/Bloomberg via Getty Images
In early October, Vivek Ramaswamy, the Republican candidate for governor of Ohio, went for a classic “politician on the stump” move: He picked up a kid. Or at least he tried to. Ramaswamy fumbled the boy a bit, producing a clip that quickly went viral on social media.
The next day, Ramaswamy posted a picture of himself with his son in his arms on social media. It was a cute retort. But many of the responses were ugly — racist attacks against Ramaswamy that drew on anti-Indian stereotypes.
It was the latest example of a broader shift on the right, where Indian Americans and Indian immigrants have become a conspicuous target of online conservative anger.
“The people who had negative stereotypes about Indians in their mind said, ‘Hey, look, the guy can’t even pick up a kid…he can’t even act like a normal American family man,’” freelance journalist Zaid Jilani told Today, Explained co-host Noel King.
Jilani, who recently wrote about the surge in anti-Indian racism for Vox, joined the podcast for a conversation about how he sees the bigotry as rooted in status envy, how Indian Americans and Indian immigrants are responding, and his surprisingly hopeful outlook for the future.
Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
American racism is very interesting, always has been. And there is a type that says, immigrants are dirty, they come here, they’re uneducated, they leach off the government, they’re taking our resources.
The stereotype of Indian immigrants to America and Indian Americans is people who go to college, people who often have advanced degrees, people who often live in nice neighborhoods, make good money, are family-values people.
Why do you think these values that seem as if they mesh with what Republicans want are so triggering to people these days? Is it just yes, but they’re brown?
I think that is a component of it. I spoke to one Indian American advocate who told me that Indians and South Asians more broadly are visible minorities, right? If you think about other minorities who are highly successful, that’s not always the case.
For instance, I think that Jewish Americans have been known since the late 20th century as being a successful minority group, but they’re not necessarily highly visible. You can’t always identify someone. If [Texas Railroad Commissioner candidate] Bo French saw a bunch of white people in the stadium with the Longhorns, I’m not sure he would be picking out who’s Protestant, who’s Catholic, who’s Jewish. But with Indian Americans, they are highly visible.
That being said, I think you have to think about where Indian Americans are in society and the kind of feelings that can create among everyone else. If you look, for instance, at Silicon Valley, the major tech companies, Microsoft, Google — the head of [Microsoft’s] Xbox division is an Indian American woman now.
You have a group of people who I think are in many ways a very micro minority — we’re talking about 1 percent to 2 percent of the United States — visibly rising into so many positions that I think a lot of people have typically associated with white folks. White people generally run the Fortune 500, white folks run the universities, white folks are the most successful doctors and engineers. And that was true for the 20th century.
But when you start seeing a much larger influx of Asian immigrants, starting with liberalization of immigration laws in the ’60s, but also when there was a rapid growth of the technology sector in the early 2000s, you start to understand a little bit more where the resentment comes from because it’s more, I would say, analogically similar to antisemitism than it is to the racism that Mexican Americans face or the racism that Black Americans face.
“It’s a much larger anti-globalization backlash on the right, not only when it comes to things like immigration, but also trade and tariffs and restrictions like that.”
It’s not that Indian Americans are necessarily being stereotyped as antisocial, criminal, coming here illegally, so on and so forth. It’s more that they’re being seen as a status threat to a lot of particularly middle-class Americans, people who want their kids to rise to the top of their school, who want their kids to have the corner office. They want their kids to be able to get the most prestigious positions.
I think in the minds of a lot of these people, not only now does their kid have to compete with all the other normal white kids in their community, they have to compete against the entire world. It’s a much larger anti-globalization backlash on the right, not only when it comes to things like immigration, but also trade and tariffs and restrictions like that.
When you talked to Indian Americans for this piece, what did you hear from them that surprised you?
Probably the most surprising thing was how much pragmatism they responded to all of this with. Nine times out of 10, when you have stories about racism, the victims of racism are outraged — understandably and justifiably outraged. Nobody wants to be mistreated. Nobody wants to be denigrated. They certainly don’t want to see restrictions on the right to immigration, or other things to limit their numbers, which is the end point of a lot of this.
At the same time, I think a lot of the people I spoke to were very upfront. They’re like, “Hey, look, we have found a lot of success in America. We got the golden ticket to be able to come here, for our kids to study here, to be able to really seek these opportunities, but we understand what’s happening in the economy. We understand there’s a lot of people who are struggling and then they see us rising to the top of all these organizations. They see us with our kind of well-ensconced place in the economy. And I think it’s important for us not to flaunt our success that much.” At least a couple people said something to that respect. They almost empathize with the people who were hating on them.
It struck me as such a classic immigrant pragmatism that you see from the first or second wave of immigrants: people who realize that they are newcomers to a society or maybe their parents were newcomers to a society, and that there is a certain level of grappling they have to do with, “Hey, how can we continue to have success? How can we continue to grind and resist this racism, but also not rub it in people’s faces that we’re doing well because the more they do that, the tougher it can be?”
A number brought up Vivek Ramaswamy in the sense that Vivek happened to go on social media and talk about what he felt like were deficiencies in American culture when it comes to studying, when it comes to working hard.
I think that in bringing that up, they were saying that that wasn’t particularly helpful because whatever positive aspects there may be to Indian immigrant culture, we shouldn’t talk about them in ways that denigrate other people because that’s obviously going to rub people the wrong way.
You’re making the point that some of the surge in anti-Indian racism on the right is about status anxiety. I was listening to this podcast that Chris Rufo and Jonathan Keeperman did. These are two influential right-wing activists. They called it “The Indian Question” — a lot of people’s eyebrows shot up — and they seem to be making the argument that it is about status anxiety.
They also were making less coherent arguments about how it’s un-American to study for the spelling bee, which is what South Asian kids do, and that white kids are more American because they play football, then they go to a party and get drunk, and then they get 1,500 on the SAT.
I’m not saying any of this makes sense. I’m saying it was fascinating. I’m assuming you watched that exchange. What did you make of that?
There’s a certain level of coping mechanism being deployed there in the sense that they are trying to explain the success of Indian Americans as a deficiency: “Maybe they’re getting to the top schools, but that’s because they’re shut in all day studying.”
But it’s not really true that Indian Americans are necessarily cloistered into unhealthy habits. They’re actually finding success across society. For instance, I’ve tutored kids for five, six years. I just really enjoy working with kids. And something you’ll find with a lot of the Indian American kids, they are actually getting increasingly well-rounded.
Part of that is because you have to, to have success, to get college admissions and so on and so forth. They almost always play sports. They’re involved in extracurriculars. You’re seeing a lot more Indian Americans go into the arts, into cultural fields, into Hollywood. I think that’s actually a very normal path for immigrants.
I think the first or second wave of immigrants has to be very pragmatic. They have to keep their heads down. They have to grind, study, and their parents encourage them to do the same thing. Indian American parents are always like, “You got to be a doctor. You got to be an engineer. Don’t be foolish and try to be a journalist or go to Hollywood.”
But as they establish themselves, as they build nest eggs, they have a little more breathing room, and so they can do different things. I know that Christopher Rufo, for instance, is an Italian American, and I believe I read one time that he even speaks Italian at home because he really values that culture so much and he wants to raise his kids in that. The first wave of Italian immigrants were no different than that. They cloistered into a few sectors where they felt they could find success that was necessary for their integration into the economy and to get their footing. But now we don’t think of Italian Americans as stereotyped into just a few parts of the country or a few parts of society — we barely notice, unless maybe you notice from someone’s name that there even are Italian Americans.
What they’re describing about Indian Americans is very normal. It’s actually very normal for first waves of immigrants to cluster in a few areas and then they spread themselves out as they’re able to get that a little bit of breathing room and room to ground to stand on.
House Minority Leader Hakeem Jeffries speaks to the press on the steps of the US Capitol on September 30, 2026. | Finn Gomez/Getty Images
Barring a catastrophic midterm polling miss, Democrats are on track to win a majority in the House of Representatives next month. Come the new Congress in January, that will mean a new House speaker — and if all goes to plan, that will be current House Minority Leader Hakeem Jeffries.
If elected, Jeffries, from New York, will be the first Black speaker of the House. Though Jeffries has been in Congress for nearly 14 years now — and many of those years have been spent in Democratic leadership — he also remains something of an enigma.
The New Yorker’s Jason Zengerle profiled Jeffries back in May. He spoke with Today, Explained co-host Sean Rameswaram about who Jeffries really is, his path to what would be a historic speakership, and what he really stands for.
Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get your podcasts, including Apple Podcasts, Pandora, and Spotify.
In your profile of potential future Speaker of the House Hakeem Jeffries, you start with a story that people might find surprising. And I was wondering if you could tell us said story.
[Jeffries] was in Florida, raising money, which is one of his central responsibilities as a minority leader. And he was being driven to a Democratic donor’s house in Palm Beach. And while he was being driven there, he got an alert on his phone letting him know that Donald Trump had posted a message to Truth Social in which he rehashed a bunch of the 2020 election conspiracies. More significantly, [Trump] had included a depiction of Barack Obama and Michelle Obama as apes.
Jeffries has this reputation for being a very calm, deliberate, not angry person, oftentimes to his detriment. I think a lot of Democratic partisans wish he would be more angry. But the way he told me the story, he was legitimately pissed off. And he realized that he needed to respond in some way. And he didn’t think that a tweet would be sufficient.
He wanted to do an Instagram post, and he looked into his aide’s iPhone, and he said, “Fuck Donald Trump.” And as soon as he was done recording the video, I think he started to have second thoughts. And they sent the video up to Washington for a social media team to edit, and he told them, “Let’s bleep out the word fuck.” And for him, it was a smashing social media success.
I was in his office in the Capitol six days later, and he was telling me this story and basking in some of the reflected glory and talking about all the social media love and talking about the real-world love. But then he kind of paused, and he said something like, “You know, but I still haven’t heard from my mom, and I’m a little worried about that.” Which I thought captured him pretty well.
“I don’t think you’re going to see a new Hakeem Jeffries if he’s speaker. I think he’s going to, especially rhetorically, perform the same way he has before.”
Why did you want to start your profile of him with that story? What does it tell us about who this individual is?
I thought it captured the dilemma he faces in some ways, just in the sense that he is this very deliberate, calculated political figure, very conventional. And he is operating in a political space these days that doesn’t really reward or appreciate that approach.
Oftentimes that approach is not successful. I think he’s trying to adapt to the new rules of the road, and he’s kind of doing it in fits and starts, and sometimes he’s more successful than others. But I still think, even when he is successful, he has some qualms about it.
How long has Hakeem Jeffries wanted to be speaker of the House?
When he got to Congress, in 2012, he definitely wanted to become a player. He wanted to be in leadership, chair a committee, whatever. He was someone who had his eye on that.
But at the same time, the Congressional Black Caucus had started to think a little bit differently about what they could achieve in Congress. For a long time, they wanted their members to get chairmanships and things like that, or maybe be majority whip. But by the time Jeffries got there, they started to think that we could actually get a speaker. And his arrival kind of coincided with this realization on the part of the CBC. And I think a lot of CBC members viewed Jeffries as a potential future speaker, and they started to groom him for that.
Pretty soon after that, Nancy Pelosi started to think of him as someone who would be a good member of her leadership team. And I think by 2018, that’s when it really became apparent that he was going to be someone who could potentially be speaker.
What does he actually stand for as the most powerful Democrat in the House?
I think, quite intentionally, he doesn’t stand for anything. I think that in some ways has been key to his success. He has managed for the most part to avoid being kind of pigeonholed or put anywhere on the ideological spectrum. He is very critical of the far left of the party, especially the DSA. He views the DSA as college-educated young white people who are coming to Brooklyn and displacing older Black working-class people.
I was talking to this former Democratic congressional aide and basically asking this person the question you’re asking me: What does he stand for? And this person was trying to explain it and finally just was sort of exasperated, and he said he’s intentionally trying not to stand for anything. He’s sort of like hotel art. He just is, and it’s satisfactory.
We don’t have a lot of case studies for how he manages his caucus because they haven’t been in power. But I think maybe one of the most telling examples was the shutdown, because Democrats were, in a way, the power brokers there. Tell us how Hakeem Jeffries managed that.
That was probably his greatest success as minority leader. When Trump took office for the second time, especially for those first few months, I think all of the congressional Democrats, and Jeffries especially, were really on their heels. They could not figure out how to deal with this guy and what they were going to do to stop him. Jeffries was even complaining that he didn’t have any leverage. But then he eventually realized that a shutdown would be at least a little bit of leverage.
The real question was, what was the shutdown going to be about? And there were a lot of Democratic members of Congress who wanted it to be about authoritarianism or corruption. They wanted it to be at all these different issues. And Jeffries was really insistent that we need to make this about one issue, and we need to make it about healthcare.
The Democrats were the ones who caused the shutdown. And normally, the way shutdowns have worked in the past, it’s the party that causes the shutdown that gets the heat from the public. But this time around, I think because Democrats were so consistent in saying that this is about healthcare, and Republicans were so scattered in their own messaging and their own explanations of what was going on, Democrats’ polling numbers went up, Trump’s and Republicans’ went down, and that was a real victory for Jeffries.
Did that whole incident put Jeffries on the president’s radar in a way that he wasn’t?
It comes, and it goes. For a long time, he wouldn’t mention Jeffries at all.
I guess the way to tell if Trump is thinking about you is if he posts about you on Truth Social, and he started to post about Jeffries a lot — all the usual kind of insults he lobs, especially at Black politicians, that Jeffries was low IQ and a thug. But yeah, he does seem to be paying a little bit more to Jeffries now than he was before.
And do we think Jeffries is ready to go toe to toe with the president of the United States if that’s what voters decide he’s to do this November?
In his mind, he’s ready. And I think in his own stilted, rehearsed, steady fashion, he will go toe to toe with Donald Trump. He will talk about affordability, and he’ll talk about corruption, and he’ll talk about the “so-called president.”
I don’t think it will necessarily be satisfying for a lot of Democratic voters out there and Democratic partisans, but I don’t think you’re going to see a new Hakeem Jeffries if he’s speaker. I think he’s going to, especially rhetorically, perform the same way he has before. But I think it’s going to take him a little while to figure out how to do the job.
In theory, getting a donor liver in the United States when you need one should be an extremely equitable process: The sickest patients with the greatest chance to benefit from a donated organ should jump to the front of the line regardless of their gender, race, or other factors.
But in practice, things look quite different.
One study from 2020 showed that women were 8.6 percent more likely than men to die waiting for a liver transplant and 14.4 percent less likely to receive a deceased donor liver transplant compared to men. That gap may not seem enormous, but it still represents a significant disparity. As it turns out, it’s rooted in the very system that’s supposed to make the process fairer, a process that unintentionally ranks women lower on the waitlist for livers.
The system in question is known as the Model for End-Stage Liver Disease (MELD). The scoring model has been used since 2002 to rank candidates on the waiting list based on how likely they are to survive without a liver transplant in the short term. The higher your score, the reasoning goes, the sicker you are and the more urgently you need a liver transplant.
One of the values used to calculate the score is creatinine — a waste product made by muscles as they break down proteins or other compounds to release energy. In medicine, the creatinine levels in your blood are used to determine how well your kidneys are functioning because they process and remove creatinine.
And this is where the system designed for equity gets a little less than equitable for some patients.
Creatinine levels are affected by muscle mass, and women typically have lower muscle mass than men. A man and woman experiencing the same level of kidney dysfunction will therefore have different levels of creatinine in the body. The MELD model doesn’t take this difference into account — and so lower levels of creatinine in a woman’s blood can make her seem healthier than she is, bumping her farther down the liver waiting list.
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In 2023, Dr. Ray Kim, a transplant hepatologist at Mayo Clinic in Arizona who developed the original system, debuted a new model called MELD 3.0. The model not only seeks to address the sex disparity in liver access but also improve the accuracy of scores for all patients. Among other changes, it takes into account the sex of the transplant candidate and uses it to adjust the MELD score by 1.33 points for women. This is meant to address the difference in creatinine levels between men and women and provide a more accurate understanding of how sick a female patient really is.
Simple fix, right? Even though MELD 3.0 took the sex disparity in liver access seriously and developed changes to combat it, early research on its efficacy found that even this new and improved system hasn’t yet brought men and women to parity on the liver waitlist.
And the problem may lie less with what MELD 3.0 did than with what it did not do, prompting the question: Are we focusing on the wrong problem?
Sex matters…but so does size
Before the MELD score, liver transplants were largely conducted on a first-come, first-served basis. Those who were added to the waiting list first, received livers first. If a really sick candidate was added to the waiting list late, say because of delayed diagnosis, they would almost certainly die while waiting for a liver to become available.
The original MELD fixed that problem by creating a measure of urgency that was easy to calculate. The initial model used three main blood test values — bilirubin, creatinine, and a measure of blood clotting time — and later improvements also took into account the sodium level.
Key takeaways
Women are more likely than men to die waiting for a liver transplant in part because the system used to rank candidates on the liver waiting list underestimates how sick women are.
In 2023, the liver transplant system adopted a new version of that scoring model, which adds 1.33 points to women’s scores to correct for differences in muscle mass between the sexes. Early research shows that the new model increased transplant rates for women, but the gains were transient.
Experts say that the score is only part of the problem. A donated liver has to physically fit inside the body receiving it, so smaller candidates end up waiting longer for a liver they can accept.
The organ allocation system currently has no way to prioritize smaller livers toward smaller patients, who are more often women. Fixing this is likely the key to ensuring equitable liver access for men and women.
Traditionally, the MELD model assigns a score between 6 and 40 to liver transplant candidates. MELD 3.0 adds 1.33 points to women’s scores to account for the differences in creatinine levels between the sexes. The new model also measures albumin, an additional biomarker, and adjusts for interactions between the different variables.
Sommer Gentry, a professor at NYU Grossman School of Medicine and contributor to the paper on MELD 3.0, said that using sophisticated algorithms with more biomarkers not only helps to better predict risk for women, but using a more accurate model also benefits the whole population. The researchers estimate that this fine-tuned MELD 3.0 model will reduce at least 20 waiting list deaths per year. Last year, around 800 liver transplant candidates died while waiting for a liver.
But creatinine is only one of the two main problems that create a disparity in liver access for women. The second, Gentry says, is body size, an issue that’s not addressed by MELD 3.0. A transplanted liver has to physically fit inside the body of a recipient, and women are typically smaller than men, so a very large liver cannot be offered to a small woman. But the reverse is not necessarily true because receiving a liver that is small for the potential recipient doesn’t typically harm the candidate.
“The smaller you are, the less likely you are to be offered something that’s actually going to work for you,” Gentry said, adding that women end up waiting longer to receive a liver that will actually fit their body.
Part of the conversation on sex disparity in liver access is based around which of the two problems — creatinine or body-size interventions — to fix first, and whether it is possible to create equity by addressing just one of the two, Gentry said. MELD 3.0 was an attempt to remove the former barrier.
“I think that some other papers are coming out that suggest that perhaps the other aspect of size matching is still a concern and still possibly not addressed by the resulting liver transplant system,” Gentry said.
Why is the new model still falling short?
Gentry believes that MELD 3.0 has increased liver transplant rates for female candidates since its adoption in 2023. But early research, however, suggests that the new model falls short of fixing the problem.
Studies done on MELD 3.0’s impact on liver transplant rates for women indicate that the model increased the number of liver transplants for female candidates — but the gains were short-lived.
An analysis published in July of nearly 10 million daily records from over 60,000 candidates on the US liver transplant registry found that rates of completed liver transplants for women increased in the period immediately after MELD 3.0 was implemented, but the increase was temporary. Women’s estimated odds of receiving a transplant drifted back to pre-MELD 3.0 levels by the end of the study period, 15 months after the new model was implemented. Women on the waiting list and women who had received a transplant also had higher scores in the three months right after MELD 3.0 took effect, but their scores later fell back to levels comparable to those of men.
Both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare.
The authors think that the early surge in liver transplant rates for women was a onetime catchup. MELD 3.0 pushed a group of women who had been stuck on the list — sicker than their old scores suggested — over the priority threshold all at once, leading them to receive liver transplants.
Notably, the one effect that did persist was that under MELD 3.0, women received more “organ offers” than before. Every time a deceased donor liver becomes available, the system generates a ranked list of the patients suitable to receive that organ. Under MELD 3.0, the number of times an available liver was offered to a female candidate increased, probably because their (more accurate) MELD 3.0 scores better reflected how sick they were. But they’re not necessarily receiving those livers, presumably because of organ size issues.
These findings suggest that revising the MELD criteria alone may not be enough to eliminate the sex disparity, especially if the body-size disadvantage is part of the problem.
The authors say that a patient’s sex is merely a poor proxy for the real issue — we don’t have allocation systems in place to ensure that candidates with smaller body sizes also have the same robust access to livers.
Toward liver donation equity for all
If we could figure out how to better address questions of body size in organ donation, the benefits could be enormous. According to Gentry, body-size disparity affects the organ allocation system in general. Similar issues arise with heart and lung transplants too, where the size of the organ relative to body size has to be taken into consideration during organ allocation.
She says that a size-aware organ allocation system would therefore benefit patients on the waiting list across the board. Whether an available organ is the right fit for the potential recipient should be weighed heavily in allocation algorithms, rather than just a list of ranked waitlisted candidates.
“That should be a larger consideration in sorting the patients who will be offered a certain organ — to ask if this organ is especially suited to one kind of patient over another,” Gentry said.
Under such a system, she said, smaller livers could be offered first to the smallest candidates on a ranked list of those who are also sickest. The assumption is that a smaller candidate will have to wait longer for a viable liver that fits them, even if they have a very high MELD score.
For such a policy to be instituted, the Organ Procurement and Transplantation Network – a nonprofit that oversees the distribution of donor organs — would have to approve it. And before such a system could be presented to the regulatory organization, more research is required.
It is often the case in medicine that our definition of what counts as a healthy body is measured against the average white male. This too often lowers access and quality of care for both women and people of other races. For example, the standards for creatinine levels in blood reduced access to kidney transplants for Black transplant candidates for years until recent efforts were made to start correcting it.
In that sense, both the successes and shortfalls of MELD 3.0 demonstrate how rethinking existing policies and standards can help reduce inequities in organ access and healthcare. The conversations and critiques that followed its rollout have exposed a clear gap in organ allocation strategies, one that disadvantages a large group of patients. Closing that gap, not just in liver transplantation but across the board, could bring us a step closer to equity while also making more efficient use of the organs available to save lives.
“There’s no mechanism right now, if a small liver is available, for offering it preferentially to the small women who might not be able to accept lots of other organs that are becoming available,” Gentry said. While fixing the model to rank women more accurately on the liver waiting list is a start, including body-size considerations in the organ allocation system might be the real bottleneck to address.
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