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What's on Tim Ryan's mind?

The Senate hopeful chats with "Morning Joe."
Image: Senate Democratic candidate Rep.Tim Ryan during Ohio's U.S. Senate Democratic Primary Debate.
Senate Democratic candidate Rep.Tim Ryan, D-Ohio during Ohio's U.S. Senate Democratic Primary Debate in Wilberforce, Ohio on March 28, 2022.Joshua A. Bickel / The Columbus Dispatch via AP file

The race for the United States Senate seat in Ohio, between Democrat Rep. Tim Ryan and Republican author J.D. Vance, is neck and neck. The "Morning Joe" field team recently had the opportunity to catch up with Rep. Ryan in Ohio. He graciously allowed me to speak with him during stops across the state. During one of the longer stops in Toledo, I asked Rep. Ryan the difference between Vance and himself.

“I am an Ohio guy,” Rep. Ryan told me. “I have been here my whole life. I never left. I never gave up on Ohio. And J.D. has.”

“We are here to fight,” Rep. Ryan added. “That is why I ran for office in the first place, representing working-class communities. You just do not give up. And now the tide’s starting to shift. We are landing high-tech companies. We are building electric vehicles, batteries, and solar panels here in Toledo. It is an exciting time to be part of it. I just want to make it that everyone gets in on it. The question is, do you want somebody in the Senate who will cut and run and give up on you, someone who is going to go in with the crowd? Or do you want someone who is going to stand up and fight? It is a clear distinction in this race.”

Ohio is a GOP stronghold, and Rep. Ryan’s campaign is offering his party a potential model for appealing to working class voters, forcing Republicans to expend resources to try and beat him. If Rep. Ryan is successful, he could provide a blueprint for how Democrats can win back voters in this important region of the country.

Rep. Ryan is a local, an Ohioan who places the health, safety, education, and prosperity of young Americans to heart.

“I think these races are about the future,” Rep. Ryan said. “That is the beautiful part about being an American voter. Every couple of years you get a chance to pull the lever one way or the other. It is a vote on how you feel in the present moment, but what you want the future to look like.” Building resiliency, grit and determination in our youth is key, he added.

“How do we get them the skills that they need in high school?” Rep. Ryan asked. He believes, at the end of the day, that enabling young people to thrive and have an enjoyable life is a worthy goal for all Americans. He does not believe that fancy titles are what make young people fulfilled in life. He looks to the example set by his hardworking grandparents. They had good jobs that brought joy to their lives.

Rep. Ryan’s wife recently retired after teaching fourth grade for 20 years. “The one thing Andrea taught me more than anything is as a teacher, and I think as a leader, is you have to love the kids,” Rep. Ryan said. “That must be the foundation. It is back to the brain science.” He said that if kids are in fight-or-flight mode and do not feel secure, they cannot focus and learn. Once they feel safe, secure, loved, and cared about, their minds open-up and they can function better.

Rep. Ryan has broken with his party at times. He was opposed to President Biden’s student-debt forgiveness plan and believes Democrats were wrong pushing for Americans to get college degrees. He agreed with former President Donald Trump’s tough stance on China trade policies. He criticized President Biden for considering rolling back those tariffs. The lawmaker also clashed with House Speaker Nancy Pelosi over the $1.9 trillion pandemic relief package, which he voted against. Rep. Ryan said the bill was too costly and not targeted enough to help people hurt by the pandemic.

While his views on some issues align more with Republicans than Democrats, he was critical of GOP leadership. In 2016, he called then-Republican nominee Trump’s proposal to ban Muslim immigrants “anti-American”.

“I look at my grandparents,” Rep. Ryan said. “They had good jobs and gardens. They went dancing. They had a few cocktails. They watched sports. They went to church. They had joy. Now it is a grind for the ‘exhausted majority’. It is 12-hour days.” Rep. Ryan feels the exhausted majority of people in the United States are asking themselves kitchen table issues, with a growing sense of desperation. They are asking themselves if they will be able to pay for their health care bills. Rep. Ryan does not want that for his kids. He does not think anyone else does, either.

Ryan was significantly influenced by his grandfather’s work ethic, civic-mindedness and commitment to family. “It was everything,” Rep. Ryan said. “My grandfather was an usher and would be painting the church rectory while I was out on the playground. If I had a game, he was always in the stands. If our family needed something, he was there.”

Now that he has children of his own, Rep. Ryan realizes that he did not fully appreciate his grandfather’s dedication, sacrifice, and community engagement. He is now filling his grandfather’s shoes. He jokes that he has the same job as his grandfather, except he has a title.

Meanwhile, Ohio is struggling with the drug crisis. Rep. Ryan takes this public health and public safety crisis seriously. Provisional data from the CDC reveals that more than 107,000 drug-overdose deaths occurred in the United States last year, most of them involved synthetic opioids, such as fentanyl. That drug, often made from chemical components sent from China and illicitly manufactured by Mexican drug cartels, is far more potent than morphine or heroin. More than one million deaths from drug overdose have occurred since 1999.

“It needs to be a whole of government approach,” Rep. Ryan said. “You need a strong border. You need to know who is coming in and out of your country. You have to be tough on China, where the fentanyl arises, and then comes through Mexico, where it is processed. You must have that security piece.”

Rep. Ryan is deeply troubled by the explosion of fentanyl-related death across the United States and in Ohio. According to Harm Reduction Ohio, his home state saw 5,174 overdose deaths in 2021. Fentanyl, or one of its super-potent analogs, were involved in 80 percent. The CDC reported that barriers prevent many people with opioid use disorder from obtaining treatment. Experts believe these barriers are stigma, structural challenges, and lack of addiction-treatment infrastructure. These factors impede access to medications used to treat opioid use disorder.

Rep. Ryan chimed in about recent reports of multi-colored fentanyl smuggled into the United States. “This rainbow fentanyl that we are now hearing so much about is frightening,” he said. “We have tried to let our kids know as much as we could. It is not 1970 or 1980. It is a whole different ballgame from the recreational drugs that permeated our culture for a long time. You try one of these things now and your life could end.”

For example, two young people died of overdose at Ohio State a few months ago. They stayed up late studying and decided to take Adderall to keep them awake. The stimulant was laced with fentanyl.

The field of behavioral health includes mental health and substance use disorders, and I believe Rep. Ryan understands how these problems exacerbate each other. He said he believes mental health and trauma-informed care are essential to keep American youth healthy.

“We have learned so much about the impact of adverse childhood experiences, through all the research performed over the last 20 to 30 years,” Rep. Ryan said. He advocates for programs like Centering Pregnancy. That program, championed by midwives and nurse practitioners, supports pregnant women. Ryan places emphasis on programs that keep stress levels down during pregnancy.

“We are doing the same old, same old, for the most part,” Rep. Ryan said. “How do we have a smart government, a nimble government, that takes this data and all this research, and immediately injects it into the way we are organizing our education system. I think that is the most comprehensive way.” He also advocates for the importance of food in physical and mental health.

“And you cannot ignore food and the connection between diet and mental health, diet and depression, gut bacteria and all of those things that we are learning about the microbiome,” Rep. Ryan said. He worries about some schools that may still feed kids high-sugar, low nutritional value foods. “It is no wonder our kids are bouncing off the walls and not learning. I mean, we have to be smart about this stuff.”

Ryan weighed in on the Mental Health Matters Act, H.R. 7780, which passed the House in the last week of September 2022. The bill requires certain federal actions to increase access to mental and behavioral health care. Among other provisions, the bill creates various grants to increase the number of school-based mental health services providers and establishes requirements for institutions of higher education concerning students with disabilities.

“First of all,” Rep. Ryan said. “I think one of the biggest things is identifying what is in the bill.” He also knows that finding the resources to fund legislation is critical. “Even in the gun reform bill, there was money that we put in for mental health. You can have the ideas, but if you do not have the resources, it is not going to work. The Mental Health Matters Act is putting a flag in the ground. So how do you front load some of that stuff? We must make the argument as a society. People are tired of paying taxes that are too high. It is the same with our health care system.”

Ryan describes the American health care system as a disease care system. He is dismayed that prevention is not a high enough priority. “We wait until you get sick and then dump all kinds of money into the system,” he said. “That is why health care is so expensive in the United States as opposed to other industrialized countries.” He is continually working to make improvements with Medicare, including capping drug costs. However, he does not believe there will be a comprehensive approach to health care until the culture in the United States shifts and is ready for major change.

“There is an old business saying that ‘culture eats strategy for breakfast’,” Rep. Ryan said. “Culture eats policy for breakfast as well. It does not matter what your ten-point policy plan is, if the culture is not conducive to cooperation, to compromise, then you are not going to get a policy that is going to last. As a spine surgeon for over thirty years, I have lived through the challenges faced by Americans in having access to safe, quality, and compassionate health care, and being able to afford it. How the upcoming election in November changes the healthcare system for Americans will remain to be seen. Rep. Ryan waxed philosophical on the upcoming midterms.

“The exhausted majority of Democrats, Republicans and Independents,” Rep. Ryan said. We must “isolate the bullies and extremists and say ‘no, no thank you’. If the extremists win, we are going to have at least another two to four years of them being empowered, emboldened and potentially in control of Congress. That is a very scary situation when you listen to the rhetoric from some of them.”

And when it comes to the issues, Ryan says his focus is on rebuilding “the great American middle class,” which is a tall order. In 1990, manufacturing accounted for about 22 percent of all employment in Ohio. By 2019, that number had dropped to just 13 percent. When Trump entered office, Ohio had about 684,000 manufacturing jobs and by the end of his term, that was down to about 660,000. In other words, the state lost more than 24,000 manufacturing jobs while Trump was in the White House.

That is not a great track record for a president who promised to bring back American jobs. And it is not just Ohio. Across the country, manufacturing employment has declined from 17 million in 1980 to around 12 million in 2020. Ryan will have his work cut out for him to rebuild the American middle class if he becomes a United States Senator this November.

Talking about difficult situations, perhaps no other topic has gotten more national attention than the recent changes to Roe vs. Wade, the landmark 1973 law that made abortions legal in the United States. The recent decision to give legislative power to the states, has pumped new enthusiasm into the Democratic base.

Ryan, an ardent pro-choice supporter, recently took to Twitter to attack the Republican party and his challenger J.D. Vance’s position on the issue. “It’s been three months since the Supreme Court overturned Roe v. Wade. Now, Senate Republicans want a national ban on abortion—we can’t let J.D. Vance get anywhere near the Senate.” Ryan went on to appeal to Democratic voters, reminding them that the future of safe, legal abortions in the United States rests in their hands, by expanding the Senate majority.

When looking at all his achievement and taking all his challenges into account, David Axelrod, the Democratic strategist central to Barack Obama’s presidential campaigns, said he thinks Ryan is doing well because he is connecting on economic issue and being relatable. “Headwinds are tremendous, but if Ryan wins—and even if he doesn’t—other Democrats should pay attention.” Axelrod noted that Ryan has been able to effectively communicate his message to voters despite the tough economic climate. He also praised Ryan as someone who comes across as a regular guy rather than a political figure.

Concern for his constituents and for the future of young people in Ohio, is on the top of Ryan’s mind.

David R. Campbell M.D. is a medical contributor to MSNBC and NBC. He is also chief medical correspondent for "Morning Joe."