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Tracking & Tackling COVID-19 (with Andy Slavitt)


From cafe welcome to stay tuned. I'm preet Berrara. This is a point in time when I think people will regret if they haven't been doing every single thing they can vast majority of my surgeon look back on this time but not all of us and we're all GONNA lose people we know. That's Andy Slavic. He served as the acting administrator of the Centers for Medicare and Medicaid services during the final two years of the Obama Administration in that role he helped to salvage the affordable care act amid technical difficulties with its website and fierce resistance from Congressional Republicans Slavic has stayed in the healthcare fight during the trump administration. He has hosted town halls across the country during the unsuccessful. Gop attempts to repeal and replace the and created a related fund townhall dentures to invest in promising healthcare startups. He also launched a nonprofit United States. Have Care which AIDS policy efforts to expand health care coverage to marginalized groups since the outbreak of the Corona Virus Slab. It has been a force on twitter and on television live tweeting. Meetings with policymakers offering daily updates and pleading with Americans to Hashtag stay home. We talk about all of this plus the wrenching trade off between protecting the economy and saving lives the good and the bad and the congressional stimulus bill and the lessons. He has learned from his time responding to health crises on Capitol Hill. That's coming up. Stay Tuned Hey. Stay tuned listeners. I hope you and your loved ones or staying safe in this difficult time. There's a lot of uncertainty right now. And we're doing our best to try and make sense of the headlines with experts. Who can help cut through the noise to help? Bring some clarity for making this week's episode of the Cafe Insider podcast available for free to everyone and milk and I spoke to our friend. Juliet Cam she served. As President Obama's assistant secretary for Intergovernmental Affairs at the Department of Homeland Security in that role. She oversaw the response to the H One n one pandemic and the oil spill. She's currently a professor at Harvard and the National Security analyst for CNN. And she's been doing a great service in recent weeks providing incisive analysis of the corona virus crisis. Normally we sampled portions of our conversation. But this week. We're making the full episode free just head to CAFE DOT COM slash preet to sign up to receive the full episode. That's cafe dot com slash prepaid. And if you already received cafe emails check your in box. You should have received a link. Stay healthy and stay safe. My guest this week is Andy Slab. It the outspoken former acting administrator for the Centers for Medicare and Medicaid services since the outbreak of the corona virus pandemic. He has been a valuable voice in tracking the crisis offering daily updates on twitter appearing on Cable News and podcasts. To help make sense of what is happening. And how best we can collectively respond slanted who jumped into government from private healthcare sector to help salvage obamacare knows first-hand the difficulties of managing a Federal Health Eurocracy. We talk about his impressions of the trump administration's response to corona virus. The challenges ahead and what we all do to support frontline medical workers as they selflessly care for those suffering from cove in nineteen. We also talk about issues particularly pressing in New York and the importance of Federal State collaboration to flatten the curve. That's coming up. Stay tuned Andy Slab at thank you so much for being on the show and making the time. Great to be here. I'm sure you've been busy. We have a ton of stuff to talk about. I should note for listeners that we are recording this on the morning of Wednesday March twenty fifth. There's breaking news from the Senate. There appears to be agreement on a package will talk about whether or not that actually gets through whether the president will sign it. The president has been talking about quote unquote reopening the country by Easter. We've gotTA talk about that too but before we do any of that. I thought I'd ask you to talk about some of your background. How is it that you ended up carrying about and being involved in the world of healthcare? I grew up in Chicago. Went to college. I best friend from college. At Penn was a premed and at twenty nine. He called me one day with the twin one year. Old Kids and had a brain tumor and six months later. He dead and we had just gotten married and we were living in. California and so we had his widow Lynn in their two one year olds move across the country and come live with us in California so my my first year of marriage had two wives and three kids which is very overrated. If you've never done that And really helped her get back on her feet and in the process learned a lot about what. It's like to have a lot of medical bills that you can't afford to pay and tried to help her through that and on the heels of that I started a company really basically trying to help the underinsured get lower cost of care. This was back in the nineties when it was the Internet Day and one thing led to another. I ended up running a quite a bit company in Healthcare Overseeing kind of the largest data and analytics is this isn't healthcare at a lot about healthcare and it was just basically a corporate guy for a decade until one day and twenty thirteen and healthcare dot Gov was launched and crashed at the most of your listeners. Probably remember that and it didn't go very well and I think the president made made an allusion to it recently at one of his briefings right. It wasn't wasn't the best moment of White House. So what would I do? I picked up the phone and called White House. And Said Hey Jeannie help and when you make a call like that or do you think's going to happen you think it's GonNa go on returned three days later. They announced that I was going to be the lead firefighter turning around healthcare dot Gov which of course demonstrates one thing which is I was the only person in the country that had that Stupidity Cau- and at the end of their press conference. They announced that it would be fixed within five weeks and they had mentioned that to me so that led to five weeks of me living in a hotel in Washington and overseeing the ingredient command command structure overseeing both the government workforce outside contractors and I brought a couple hundred of my own people and we did I mean by and large the fixed and millions of people got health insurance it at the end of it all. They asked if I wanted to stay. Serve out the term in the Obama Administration this was middle of twenty fourteen and I ended up running centers for Medicare and Medicaid Services which oversees digest the ACA. But like its name implies Medicare Medicaid also known as cms also noticed cms right. Thank you for the permission to use an acronym We don't have time to keep saying that whole phrase over and over again so we hear about cms all the time. Explain to folks what that agency does specifically and how it fits into the overall government response to the corona virus. Cms overseas about a quarter of a US budget over a trillion dollars. Which is the entitlement programs in Medicare and Medicaid Children's Health Insurance Program and the ACA? So really if you think about it quite literally see a message. Responsible almost like an insurance company for everybody on Medicare and Medicaid making sure that they get benefits and as a result of that. Cms also the regulator of a number of things. They're the regulator In the case of covert nineteen very relevantly the rules around insurance and safety and many categories oversee clinical labs which are critical part. Right now of what's going on with cove in nineteen oversee the safety of nursing homes but then also just oversee the rules of participation. How healthcare's paid for and many many other things so if there are levers that the administration has in healthcare to affect the healthcare system and they can't affect everything. A lot of those levers are in. Cms CMS is inside the Department of Health and Human Services along with the CDC alone with an Hmo with FDA and they're all run very very separately so don't don't think of them as a happy family just think of them as as sort of a category of things that report right now. Up to secretary out Cesar are they warring family? You know it depends on the on the administration for sure. The Russians are so different that they're not sorted by definition a warring family but you know the FDA is filled with scientists cms is filled with policy payment people. Cdc is filled with the public health people. So it's just it's just very different types of people when I was there Francis Collins headed by h Rob Calif the head of FDA. Tom Friedman it was ahead of a CBC. And I were great friends. We tried to do our best to communicate in and bring our worlds together only at crises. Like we didn't Flint Michigan or in Puerto Rico. Then there's also fee which is separate who should be the lead agency or should there not be any lead. My answer is somebody should in charge so is a detrick Ouchi. Is it vice president pence? You know it probably should be somebody like General Mattis. Somebody who's got strong logistical control. The way it works is disaster. Response Disaster Recovery entirely sits within FEMA except for pandemics which officially sit within. Aj and there's a there's a war room cetera with an AJ jess and typically happens if the crisis gets bad enough as as happened with Zico is the White House sets up its own kind of command structure and that actually works well because you need a really quick chain of command and control and the White House did a phenomenal job. At least when I was there under Obama responding to that crisis because decision guy made quickly and the people in charge knew what they were talking about in everyone sort of took the orders and ran in these crises speed is your friend perfected your enemy and what we have now is Something less than that. We have a number of different agencies in a material President Muniz material in the sense that he will not necessarily stay with the same idea or message depending on who he talks to last. You've got an economic faction led by Larry Cudlow who was arguing strenuously that the damage of saving lives is not worth it to the economy. Well I got the health expert. We're going to look at a lot of things I mean I think but the president is expressing. And I I heard this from a lot of very smart people. Active in the economy and the markets. At some point. You have to ask yourself whether the shutdown isn't doing more harm than good and economic terms perhaps even in health terms and again. I'm not the health expert you've got health. People like Dr Franchi who are trustworthy. In in in straight shooters and will calmly. Tell him what he thinks. They think he needs to hear but he may or may not be listening in any particular day and then you have fema who is used to responding to local disasters but can be quite helpful. Here you've got. Hsl has some resources and what needs to happen? The somebody needs to come together and say this whole command and control structure. We're GONNA bring all of these resources and assets to their best use. Not all that differently than what did turn around. Healthcare DOT GOV although on a bigger scale and use that to communicate to all the people in the ground and get resources and allocate resources quickly to the people on the ground and states and in hospitals and so forth and I have been talking with the White House every day multiple times a day including the team working on this and I have a lot of empathy for what they're going through because it's a crisis that they weren't prepared for the Obama Administration left in place and infrastructure trump. Took that away. And they're now starting from scratch. I would love to spend a Lotta time focused on trump's bad decisions but the truth is you have to navigate from where you are where you wish you were and so. I'm trying to help the team on the ground. Figure all about you so you said a lot there. I'M GONNA I'm gonNA focus on some of those things but I I wanna give you the opportunity to respond to something that the President keeps saying and I've heard him say a number of times. Some version of we inherited a very obsolete system. This was assisting that was out of date obsolete or it was a system that was never meant to take care of the kind of quantity the number of people that we're talking about millions and millions of people do carry respond to that. I care too but I probably will because it's the wrong time for this argument and near as I can tell. This spreads pretty much evenly between Republican and Democrat and Democrat and Republican. I think so much right a big report in commission this. When this is all said and done I will. Just tell you that when you're chasing a linear pandemic it's one thing when you're chasing something that's growing exponentially like this as we can talk through what that means but basically think of it as a number you're seeing on TV. Every day are doubling about every two and a half to three to four days and that means body counts that means case counts than it's really really really important to be ahead of it. It's kind of like you know if you borrow a thousand dollars from a loan shark in the difference between paying him off on time or waiting a number of periods to pay him off and finding out that you don't own a thousand dollars anymore. Yohan fifty thousand dollars because the interest rates bloody thirty percent. That's what it means to be behind crisis like this. And so the several weeks to months where the rest of the world was looking at what was happening in. China was really a great time to start building. Supplies MASKS VENTILATORS GETTING HOSPITALS. Ready getting contract tracing ready getting tests ready and that lost time those two weeks Are going to be two weeks. We will never be able to catch up and I think they are going to have a big impact on the on the body count if the past right now. But it's it's really the most It's really the thing that I think is GonNa keep you up at night. I appreciate you took an are taking the high road. Because we're still in the middle of a crisis when you say that you talk to folks at the White House. That might come assist apprised as some people. Because I I know the president has said when asked the question? Have you thought about calling some of your predecessors? He basically dismissed. That notion says No. I don't need to do that and so it's interesting at least to me that there are people in the White House talking to a former Obama official. Who can you say who you're talking to the kinds of people you're talking to what exactly the mood is over there? Yeah so I would say and I don't want to reveal any of the conversations because I don't think they were had with me under the auspices of them being public. But I think you can think about the people on the task force and you think about some of his closest closest advisers. And you can. You can use your magic nation as to burnt that many of them as to as to who who that might be but I think I hope by the time we get to the fall. We're able to go back to politics as usual and beyond each other's throats and beyond cable TV obsessing over the political landscape or or. That's not where we are right now. We're not in a Democrat versus Republican. Were in a in a species kind of thing is versus China. A little bit of factories is fiction. Right yeah yeah well. That's true too but I think the point is. I'd say it's not just be but I'd say this about an. I know this is true about you and I say despite anyway listening this point time when I think people will regret if they haven't been doing every single thing they can vast majority of a searchable of back on this time but not all of us and we're all GONNA lose people we know we're going to have the largest body count in our history rivaling. The nineteen eighteen flu. We're going to have horrific scenes on television. It hospitals that were only used to seeing in foreign countries far far away from us. But you're saying that that's going to be true sense of the scale you're talking about. You think that will be true even if we do everything we can right now. With respect to distancing measures and everything else I think that is our best hope right now. It's a really interesting question you ask because if we do it right. It is incredibly unfulfilling. In one regard. We're used to doing things that are reinforcing. We do them. We see the benefits of those actions but we just did some real time data. We took a look at two locations. Santa Clara California and Miami Dade Florida. The reason we looked at those two cities is because Santa Clara Attempt Cisco in that area put in place very strict stay at home hashtag stay home rules and messaging and Miami. Dade was to be kind little more lax little late to it and we looked at the data in the data we looked at was real time loading of temperature. Data from people's thermometers that load to the cloud and we compared to average temperatures. You'd expect during flu season and we graft decisions that were made politically such as close in bars. Restaurants closing schools having people stay home and you saw sharp drops in the number of cases with this disease in Santa Clara compared to Florida. So scientists talk about something called an R. Naught and. I'm happy to go back and explain that because I hate throwing Ligo people if people don't know what that means but this is all about this thing called the are not in reducing the Arnott. And if you can do that you can actually see dramatic improve results as I understand it. The are not is is a reference to the average number of people that any infected person will then pass the disease onto that right. If in fact right it's a finished my earlier point. The people in San Francisco are not seeing a horror show at the hospitals in Santa Clara. I should say they did have the first death in the country In the religion early in Gabonese. Who's done a great job? But as a result of that you have people's Cisco saying while we're in lockdown what's the point and the point is the point. They are the reason that we are seeing. And we are likely to see. Better results In San Francisco because of what? They're doing the problem is when they look out the window. They don't see that if they could be teleported to Seattle or New York right now. They said And if they keep watching. Tv THEY'RE GONNA get it. It's the ultimate paradox. I've heard other people mentioned this as well if everyone hunker down and do what you're supposed to do. You won't see as much tragedy as you might have otherwise at the end of which you'll say. Well why do we have to do that? But that's the very reason why you're seeing. You know a better landscape right. We've got a country. Doubters people who really value our independence. We are suspect of government. Were not compliant. Add onto the fact that the point you made earlier that we hard to know what's truth from fiction and I'm to the fact that We don't have a context for this because this is an invisible enemy and particularly for younger people. This feels it like. It's the flu. And I don't know who carriers are and then appoint the scientists made to me late last night that I suspected was true but when he said I felt smart because I had been claiming it on cable. Tv that our brains don't work exponentially our brains were linearly so we are used to taking an action and making progress. We're not used to taking action and seeing it get away from us. It's like swimming after a speedboat. You can be fifteen feet away. You can swim fifteen feet. You're no longer fifteen feet away when the when you get there you're much further and our brains are have a hard time understanding that so all of this kind of distance let alone the economic dislocation in the social dislocation has people spun around so the President keeps talking about the worry. He has about the cure being worse than the problem. And at the time of this taping he's been talking about quote unquote reopening the country. But I guess he means you know the cessation of social distancing to the same scale the opening up of businesses etc and is now set a sort of aspirin aspiration or not. He speaks about it. Pretty flatly Easter. Because he thinks there's some symbolic virtue to Easter. That's three weeks away a little less than three weeks away When you talk to folks if it's okay for this question for you to answer it you talk to folks who around the president are they at the same view because I hear reports that they are not that did Easter seems too soon yeah? I don't think I've met anybody who thinks that is based on science and I'm not sure whether he said that kind of spur the moment or whether or not he ran that by anybody by scientists are referring to this as the Easter massacre. He said he'd like hundreds of people thousands of people to sit next to each other in church in. It'll be beautiful and you know. Here's here's my message to people there's going to be many many. Easter's in your life. There's going to be many many happy occasions in your life. This is the time of some sacrifice and I understand that and we understand that in the president. Doesn't you know I believe he's trying to do his best. This is a lousy situation. But he doesn't make decisions for us. You're best off listening to your local health commissioner in this particular situation than you are the president and whether you're a trump voter or not whether you like him or don't like him none of that matters so that's the point. He's the person who I think you should stay. Your family and your communities fit a neighbor. Trust me I I don't and I won't but a lot of people will miss an important for public policy that people get the president to back off from that Easter. And and if so how do you go about persuading the president who thinks a particular way about things and has a particular focus so that lots and lots of people won't defy what their governors or mayors are saying and follow what the President Nited? States is saying so in the evenings. I have this group of people that I talked to that are scientists and risk managers homeland security people and some of its direct voice. Some of it is a lot of texting an email. One of the people on there who I would call I would say. He's about his dark cloud on this topic. Immediate Darker cloud as I've ever met in my life We won't have him on the show. Do you don't even talk to him. he says not to worry. Andy he will by the time he sees the bodybags. There's no way he's going to be able to go through with it and He's talking about a period of time. Where and I don't know that's true because I think we're going to this happening in different cities at different times. It's happening in New York right now and he may just sort of like right off New York. You know as he's going to be saying you know nobody can leave New York but the problem is is going to begin to happen everywhere and I should. I should explain something pre. There's a lot of data thrown around. There's a lot of happy to go. I think most people know a lot of these things. It's novel virus. We don't have immunity. How contagious it is the ARNAV which you perfectly explain. And the disease is lethal to three types of people people who are older people who are not necessarily older but have compromised immune systems or chronic conditions or pre existing conditions. The third one is the one that's GONNA kill the most people in my opinion. That's the risk factor of being in a community that doesn't have any more intensive care unit beds or ventilators so people who could live a long life and if they were to get cove in nineteen during a period of time when it was just sort of coming and going fairly reasonably underneath the capacity of her medical system would be fine. They might have a case of a bad viral flu or pneumonia. But they may need hospitalize ventilated. But they many many people would survive but case Retali- rate as they call it see if our view on another acronym is going to be much much higher because by the When there's a mad rush people into the hospitals we will have a shortage of doctors and nurses for reasons that people will understand that this point a shortage of ventilators and the shortage of rooms to take care of them in the in the cities. So I think the point is the. St Home isn't about avoiding diseases about beating the disease. It's about two things is about giving our healthcare system. A break in these workers break so that they can handle what comes at them. Let's about giving our scientists some time because our scientists will do a lot of great things we need to give them some time and trump. You're not rush them. So let's let's talk about the Easter scenario for a moment so people really understand how dangerous it is what the president is saying. Hypothetically if on Easter we stopped doing all these things that we're doing in New York in L. A. And in other places around the country. What would the next two weeks look like how? How would it overwhelm the healthcare system in this country? If we just went back to normal in three weeks I'll take a couple of days. I'm going to try to do this tenderly as possible because these are scary numbers. And I'll tell you that governor Cuomo has I think many people are seeing is doing about as good a job as you can imagine leveling with people telling them the actual situation Being very insistent but also doing it in a way which respects their psyche and he has said he's he's now recited data which I can talk about because I got sent to me about ten days before from the mayor's office and the same data that he's been referring to which is they have about three thousand hospital beds beds in New York and the projection is an April Dearborn. Have they can have as many as thirty. The need for thirty five thousand or more beds with with vents. And that means that they will have to make decisions if things go its current pace who lives who dies now because there's a two week lag and because people are asymmetric for a while we are going to be dealing with some of that but the question is two weeks from now will it be better or worse in four weeks from now will it be better or worse and if it's better than we got shot if it's worse than it's GonNa start going to be exponentially worse because are not in in a place like New York which is densely populated can be over six. Without any of these measures we need are not to start to get to one in below for us to have the ability to beat this thing without it beating us and getting down to down to one in Wuhan. They got a down to one point. Three activated very strict measures. I think we're somewhere still over to the difference between over two and over just over one and one is dramatic and we control that. That's the kind of exciting thing is Kinda Rosie. The riveter style. We control the war effort here because we will infect people that we don't know we infected eighty percent of people that are infected are don't know where they were infected. Because this is this disease-carrying very dramatically and much of the population like Prince. Charles has no idea the royal family put out. They don't know where he got it and they don't know who he's given it to possibly giving it to. I didn't hear that at the half the yes. I saw that this morning. I also saw the Mitt Romney tested negative to which the president tweeted. Something sarcastically on presidentially shockingly. But is it possible? So let's a second thought experiment not a total back to normal on Easter. But you hear some people saying and it sounds reasonable to a lay person. Not someone of your experience to say look. There's some places where it's going to be bad and where it is bad like New York but there are other places. I don't know Utah. Idaho Montana I'm trying to pick less densely populated states. Were they can go about business in a more normal fashion and you isolate spots and you do a sort of balance. Is that a possible strategy or does that not work either actually have a lot of sympathy respect? For that argument it would have to have a couple of other attachment points to it but the reason I do is not necessarily from pure public health standpoint but because epidemiologists say that you can tell somebody something awful about to happen and ask them to make preparations for about two weeks. And if it doesn't happen they really start to lose fade and then they let down their guard and then when it comes to them they don't listen in. It's tragic in remember northern Italy which is a horror show in southern. Italy are very different right now. And we live in a very big geographic country. So what I said earlier about respecting your local health commissioner. I would say that's true unless you live in Texas or state that's I think being a little bit misguided here but the idea that we should have different strategies for different parts of the country. It's something that I think makes a certain amount of sense and then secondly the president while I don't think he's obviously saying wise things what I think the president should do you want to do is tell people what the path out is best. He knows using actual fax from scientists. Because I think people under not understanding how long this is going to go on makes them restless makes them want to jump out makes the stock market restless in? He's right of course that a bad economy People out of work can also have negative effects and there can be mental health issues and suicides and all those. I'm not saying he says surly being thoughtful about it. It may be worried more about his golf courses. I don't I don't know but I can say that if I were on the task force inside the Obama Administration right now we would also be having conversations about what are the smart ways to begin and what are the. What are the characteristics? We would need to see to open up the economy. And I've been working on something. Which is if the president said it would allow him to say you know when things will open up. It's not a date. It's not Easter holiday. It's when our great American companies start to produce enough of acts and when we have enough surveillance because we have enough test to do. Why and I'm GonNa Challenge American Industry and I'M GONNA use the Defense Production Act to get us there as quickly as possible but stay tuned folks. This isn't going to be six years. World War Two. This is going to be something that come next year. Some you know depending on where you live. We'll be able to move out of this but we're GonNa do it intelligently and I ask you to stick with me. That's the right message. It's interesting speaking to someone like you. Who is both the healthcare policy expert? And you're also to use technical phrase. You're a finance guy so you know something about the economy discussed further to what you said right now. What can we expect in terms of the smartest balancing act between averting outright depression but also keeping everyone safe or those two things in inextricably intertwined will in the short term GDP growth or anything that allows us to feel personally financially? Healthy can come from a few different places. It can come for business. It can come from consumer spending or could come from government spending so in the short term. We need massive amounts of government spending the two trillion dollar bill that dot agreement on last night and hopefully will go and get signed will not be the last one. But these are things will stimulate the economy and humping money into people's pockets. Who need them not necessarily businesses but small businesses individuals? Making them feel secure. That will work for a time. It's not the economy we want long-term. It's unbecoming we're going to have long term but we need to be able to do that. In the short term and to some extent the economy is driven not just by actual facts but by perceptions and expectations so demonstrating that. We have this thing under control. I guarantee you the stock market which trump watches. And I'm not going to say it's unimportant but I'm just GonNa say it's the most important thing but the stock market what we think. We'll have a greater impact on the Stock. Merc telling people that they can go back to work as absolutely or option. Being a dramatic reduction in case counts and death tolls. It's option B my view when the stock market believes that. There's an end in sight. And they were beating this and that people are staying home and that we've pulled together and then we can get through this. That'll be better news for everybody and it'll give everybody hope. Do you think that the government has the ability to do the kinds of things it can do giving people cash and giving people loans and all those things that we're talking about in this two trillion dollar bill and then in future bills? Do they have enough time to do that? In the short term so that we get to the point where we have option B. and the case counts. Come down dramatically. Do they have the ability to to help us? Get to the other side before the economy. Craters I'm not in the business of making predictions here really trying to to chart the best course in looking at a bunch of other people's predictions but I'd say They're short term pain right. I mean if you're at work right now or you're worried about your job or your savings are evaporating. It's not even right to say. Will it get bad? That's a that's A. That's not a great situation for you but figuring out how to get through it for let's call it at the outside up to eighteen months with some spurts of activity in the meantime and by the way I don't think it's just the economy mean when when people's favorite sports teams are on and they can't have a beer with the friend if that's their thing and their favorite TV shows and movies aren't on you. The kinds of things that distract us from the hard things in life are also not happening in A. It's it's hard and so this impatience. He feels myths felt by a lot of people of all parties. Will everybody wants us to be over with but the truth is it'll get over with faster if we do some of the things that have been done in. South Korea and other places and we need to we just need our scientists time to catch up so we can I mean. Let me put it to you this way. If he said you have a small business you want to open it up. You can open it up. And here's what you have to do. You have to take everybody's temperature as they walk in the door and you can only have say fifty of the capacity used to have it I and if anybody has a fever They need to voluntarily go to a fever tent that we set up now in China. They wouldn't say voluntarily. I think they'd be much more effective. Because you'd have a lot more compliance but in this country. Maybe that's possible and in the fever tend to wait it out and figure out whether you have it and you have enough testing and then not for nothing. Where else can have lots and lots of people who are have some immunity because they have gotten this before and those people can be out in the Public Square Mesh end up being a lot of people right if this is spreading as much as the scientists and doctors say but I guess all of this is premised on something you said a second ago and I've never understood with great clarity if this is true or not. Is it the case in your understanding that if someone has had the virus and resolved either having symptoms or not would then be able to resist Kobe? Nineteen going forward right so the reason that you're able to get a straight answer is because this is a novel virus and nobody can be absolutely one hundred percent certain having said that. I have not talked to his scientists. Two dozen. Believe that you'll people will have a unity at least from this stream and of course you'll need to test have a test again and then have an antibody tests which will test whether or not you got that immunity but people are pretty certain. Feel pretty optimistic that there will be immunity in the reports. We hear of people say up. Someone got twice. They think are more likely to be testing ears than they are to be the truth. So if that's the case and and we don't know for sure but if that's the case that's very good news because that gives us a lot more flexibility and and a lot more options. So how far are we from you? Think from the time when we can have a system through which we can figure out who has immunity so those people can at least be comfortable and confident and go back to work. I'm not sure I know people are working on it now. This is an understanding that I'm happy to have contradicted by anybody who is heard from a an actual expert instead of someone like me who just talks experts a lot but my sense from talking to people. It's not very complex to do doing it at maximum scale takes some time doing it in a way. Will you ensure that it's safe doing the way we were? You ensure that people are using it all of those things. Add to the time but from everything I hear the. Fda is doing a very good job approving these kinds of things and working cooperatively to get these kinds of things done so my my sense is that it will be coming shortly but I wish I could tell you. What shortly was I just. I just can't you're not going to say Easter always giving you the option. If we were having this in the afternoon after a couple of cups of coffee I would fly memory wack. What about what about an evening after a couple of beers then you might have said Easter. You know Red Wine has been my thing and then I've been lately. I've been just staring staring at it and I've never even had a chance to open it because I've been in so many calls by Achmed. Maybe a little bit far afield for you but you just you mentioned it. So if people who are not in New York appreciate that all non-essential businesses been shut down one of the businesses that remains open throughout the state of New York are liquor and wine stores that have been deemed essential. What do you make? That only is a less amusing than the did you see the the thing put out by the New York City Health Department on whether it's safe to have sex I didn't the first line is generally you are your safest sex partner okay. Let's move on from him. I think I think that is the point. You just made us exactly. I would give to the question. Which is we shouldn't stop living. I mean we shouldn't turn it out the Hollick's but if there are things that give you pleasure in life by all means laugh had a glass of Wine Gibson Joy. Do Something Nice for somebody. Whatever it is that makes you feel good that safe. I think the memories and the stories coming out of this period. Time when it's over. There's the reason they're not to be great memories and I think I hope everyone is able to look back and say they did everything they could. Were very likely to all know people who we lose to this to this illness and that is going to be a lot of sadness but nobody should be feeling guilty for finding those pleasures in life. I look I'm home. My wife home right now with our two sons and it gives me midst pleasure that they're stuck with me it doesn't give them immense pleasure but I I bumped fact that like they can't go out and see their friends and they have to hang out with their dad and they have to listen to my stupid jokes so for me like that's a win. I saw someone tweet recently. That the corona virus and the compelled quarantining. It will shortly reveal which of us are. Gourmet cooks in which of us are alcoholics. Right right or is my wife. Said it'll be both the baby boom in a divorce. Boom I agree with those sentiments about living life in taking moments of joy when you can find them I wanna go back to some of the other concrete things that need to be done to avoid the worst case scenario so you mentioned the Defense Production Act and we've been talking about it for the last couple of weeks are people pulling their hair out over. The president's seeming unwillingness to use the defense production act to get our best biggest companies to make ventilators which are the things that will save a lot of lives. So this is a place where I'm going to call the president to account you know as I said I'm taking trying to take somewhat of a moratorium on just taking shots at the stuff. He does to hurt people but this is something that he should be held accountable for those on the phone with the White House this morning and they said hey andy. Can you build a website that compels people to donate ventilators? Who have extra ventilators and I because we did the same thing with ninety five mask? We've got a lot of masks a lot of people and I said sure I'm happy to do it. But is this a half step towards saying if you're in a location or you're a veterinarian? You have a lesser. Need in New York needs thirty thousand as governor Cuomo said ventilators to just basically say sorry guys. We're GONNA take these and we'll give back and he's like well. We might do that but maybe you can have this voluntary thing going and so and this is I think Eddie Alaji to be frank that that is getting in the way you'll see IOS. Are I think whispering in trump's ear that that'd be a bad move that they they don't want to be compelled to do this stuff and it had to be honest? I don't think there's any greater honor than being asked to be part of the solution and we can only produce. I had put a thread yesterday. the twenty fourth around why we are running into natural limits on the amount of tests that we can produce in. The reason is when you get behind all of it and first of all. We need to be able to at some point test. Everybody in the country multiple times not just people with symptoms and right now we can only test frontline workers in the reason we can't it. Turns OUT IS THERE? Are these things called eight hundred liquid transport robots that there's only a certain number of and we only have a small number of in the United States and we can make more of them? We could make Baltimore of them. And that's the thing that's getting the way of US having enough tests and you know if this were a decisive wartime president we would be on day. Ten of that happening as it is right now. I talked to people who say I can make these things but someone told me they're going to buy them because I don't know who's going to have money to hospitals don't have money a government going to guarantee them. If I were the president I would do something very similar. I would say I am placing purchase order for five hundred thousand ventilators in two billion in ninety five masks. Here's the price go and I would then call all by CEO friends who have these factories. And I would give them the capital to convert their factories. I'll get the go and I go to do photo ops and all these factories producing these things in that would get the logistics and the FIMA team out getting these folks hospitals and need to get to. It seems like it's a win win. I don't I mean I guess if the win win. I don't know that the president has a very strong ideology business or otherwise so I feel like that theory misses the mark a little bit that. There's there's something missing. It's eighty allergy in the sense that It doesn't feel or sound very pro business. I'll give you another ideological thing so last night I was working on this and I actually don't know the outcome but when we had Zeka we told the all the labs we pay fifty two dollars per test at a minimum and guess what we had enough tests Tested millions of people that turned out to be very wise. The Democrats proposed the same thing. So by the way Medicare and the Medicare administration said. We're GONNA pay fifty dollars for everybody on Medicare which was great. They did it last week. And it was brilliant and I applaud them for that. What I propose that they do with say that. Not just for people on Medicare but for anybody to any test anybody in the country. We're GONNA pay fifty two dollars. The Democrats said Great. I'm on board. The Republicans in Congress said that feels like a step to medicare for all. And so we don't want to do it so we're going to have quote unquote a market price. Paid which essentially will mean that. There's much much less production and so I said to the White House who's talking to the Republican the gophers. Can you remind them that? The way people pay for it now is a percentage of Medicare so we are not actually adding Medicare to the equation. But it was baffling to me that even in the midst of public health crisis. There are people whether it's in the White House or staffers or anyone. I'm saying doesn't exist on the democratic side. Either so I'm not making a judgment but in the midst of all this there's still people say up. You know what we could have more tests. But if it's a step towards Medicare for all will be sorry later so let's not do it. I WANNA go back to the to the ventilators in New York issue and the governor has said very plaintively incredibly we need at least thirty thousand be said something a minute ago. The made me wonder something and that is do. We have an overall shortage of ventilators in the country. Absolute matter and or is it that we have a misallocation of ventilators and there are thousands. That are sitting somewhere where they're not going to be needed immediately and they can be brought to New York to fill the need so depending on how people do the Hashtag stay home. If they don't do it at all we're short probably we probably have one ventilator for every eight people who need one and I'm GonNa tell you that. Try to gently but there are papers going around the DOD in. Hhs Right now on. What are the ethics of of making the decisions to deny people access to evacuate her? So the numbers are that we are short. We we may be have Sixty five thousand working ventilators in hospitals in we could have the need for five or six hundred thousand so there is an absolute shortage. No question about it in the US and in other parts of the world and massive amounts of demand. They just couldn't make them fast enough. Which is why you every factory doing it. But that doesn't mean that you give up because every ventilator New York gets is a life saved so you'll it makes all of us in the world to say hey if you've got excess amount of ventilators in your community now we will ask you to send those to New York and then you gotta ask factual to build the capacity in the meantime so I just been asked to go make that play a bunch of hospitals and of course they're going to rightly say but it's GonNa come here what's going to happen and the government doesn't have the trust to demonstrate that they can move these things around quickly Move personnel around quickly. I WANNA lose a lot more. Lives you preface it by saying Gently there's there's no way to say it. You have a combination of nuclear math and predictability. No we don't want to be in the business of predicting lots of different things but some things I think. Every expert can predict and that is a shortfall in terms of ventilators followed by the prediction. That if you don't have enough ventilators a lot of people are going to die and strange and disturbing and upsetting triage has take place and then you also have which in a different university might not have had is a clear mechanism for causing those things to be made and guaranteeing a market. So I you know for the life of me. I don't understand why we're not in a better spot. I did want to talk about the congressional package that seems to have been agreed to have. Have you had a chance to look at the major provisions? Do you have a reaction to it overall? I haven't seen the last version. I've been really fixated on a couple of elements but I would say based on everything I've seen. It was worth the two days of absolutely worth the two days. It took to get this package out. It's going to provide a lot more help to people who needed but I think the message from Congress Institute. You're not done you're not going to be done. It's two trillion is not enough. It's not enough money in there. Just the situation on the ground is GonNa Change. If you're interested pre I put out do a group that I founded a five point plan for Congress. The organisation called United States care it said U. S. OF CARE DOT org a five point plan. How Congress really needs to stat been and and to help people and so that has a lot of things that need to be done particularly for frontline healthcare workers if we don't address we haven't talked about the end of the show but even perhaps greater than vents figuring out how to address the needs of our basically our frontline warriors their their military. In this we are going to lose them that so much in the sense of death but lose them from the workforce as they get sicker and sicker and is. I don't know if there's a term for this. I'm assuming that there is some type of figure that would be associated with every healthcare worker. You lose there's a ripple effect on how many patients can be served and made while right absolutely I called for five thousand dollar a month payment to every help frontline health care worker and first responder in the country because of the massive need we have to have them have segregated childcare For them to get through what is going to be a time. Where aberration without the kind of equipment we need and you know. I just go back to the point you made about the president. He wants to he. He's trying on the label of wartime president. He likes that label. I'd love to be wartime president. But that means he needs to arm his troops with all the equipment they need needs to read the battle maps needs. It'd be decisive in. He needs to get everybody moving. Needs to be much more skeptical when people tell them that. There's hope he needs to say that's great. But I got a plan for what I see in front of me. Well you know. The president doesn't understand a lot about war and in particular he doesn't understand a lot about generals and admirals. We had Admiral James to reduce on the show some weeks ago and he was observing. What draws the president to this idea of of war and general's is at. He thinks they're macho in their strength in their bellicose and what he fails to understand that the best generals and top military leaders in history are actually very intellectual in very thoughtful and very deliberate and care about data and science and those are not things that the presence seems too much care about. He likes the title of generally likes the title of time President. But not much else about that. What do you think the onset of the Krona virus and the response to it in America says about the healthcare system and what are the lessons for healthcare system obviously the infrastructure that we need just hasn't been built and we haven't been prepared in go back if you haven't watched the Tedtalk from Bill Gates in Twenty fifteen which I think many people have seen it other probes Mike Ostra home? Who's a famous epidemiologist? At University of Minnesota. There's other folks of course. In retrospect everything looks predictable. Right a month ago. There were five people predicting this or many more will say that they did By we were so completely unprepared. And we build stockpiles of oil for crises we build we have stockpiles morph military planes. I imagined than we need although someone contradict me knows or military aviation by our stockpile of oath logistical support people in the kind of equipment we need was not there and then we throw that on a health care system which which it even on a good day doesn't work incredibly well so we have an out of this. I have hope but not necessarily confidence that people will take some lessons. I think big picture thing pre is I really worry about the anxiety and mental health effects of this time we know. Ptsd is a real thing We know that families are going through a lot of uncertainty both health financial and otherwise. I hope you don't mind me saying that. We're actually going to start a podcast called in the bubble really for families that are going through this period of time of uncertainty trying to fast as well as some hope and some enjoyment ed in some ways I have this romanticize overly romanticized you of in a big in Churchill's bunker together and getting through this. I'm fifty three. I've never been asked to sacrifice damn thing in my life and I think most of us haven't our older generation has A. I'm not willing to give up on my mom living to one hundred. I'm just I don't care what Dan Patrick says so if I have to spend eighteen months with her in another city in me not being able to see her. I'm going to choose to view that eighteen months as a great time to talk to her on the phone every day and do video chats and play online word games and it's a very very short period of time because Magilla. She spent way more time than that. Telling me. That my My awful drawings from school look Nice so if you know we all go through these days where where. We WanNA cower under the bed but we got to help each other's backs and so if I do that on Monday you say you. Don't come on Andy through this. Then Tuesday's Your Day pre I call you on Tuesday and say all right. I got Then you gotta get out. 'cause you gotTA help other people and it's going to be that kind of time. Do you think that this experience that America is going through and will continue to go through for awhile will cause the country to be more receptive to things like Medicare for all? I think a combination of this experience and the younger generation are going to be a really interesting combination for our future. I would hope that people see the wisdom of making sure that every single person in this country doesn't have to worry about their health care needs and if there's a lesson that's driven home in public health epidemic. When something's highly contagious maybe a lesson ought to be just because you're healthy. If your kids go to school with someone or you got to work with someone who can't afford to take care of themselves. Maybe that's not going to be good for you either. And so if that lesson gets through to people I don't know whether it's Medicare for all or whether it's some other former universal coverage there's five ways to do it. None of them perfect all of them better than what we have today and I think we talk about the cost of this thing and of of doing something like that and you know right now. We have people voting to spend trillions and trillions of dollars in emergency situations which. I think we'd be better spent next time around just making sure that people didn't have to worry about the payment side of this. Yeah so so. Here's my question my next question then which you've segue to beautifully. Suppose hypothetically we haven't election on on the same date as it's been specified for and Joe Biden wins the election and he wants to enact some more sweeping healthcare. Is he not going to be able to do it? Because we spend all our money on this no I think I think that the Bernie Sanders plan is to. That plan is very very very expensive. I don't think they're the votes in the Senate. Even Bernie Sanders were to become president. for that to to be enacted in. I I actually think on some level Barney knows that. I'm not suggesting he doesn't believe in it but I think he believes he's gotTa pull the country in that direction for us to get to somewhere else doing what I think. Joe Biden would like to do which is to say. Hey if you want Medicare you can have it. If you want to keep your employer coverage you can have it and those sorts of things That's a terribly expensive. In the scheme of the kind of money we throw around in in Congress and look we're going to still need to stimulate the economy. It's probably likely that healthcare is going to be one of the things that we can do to stimulate the economy. Are we going to get out of this? Okay and be the same country. We're going to get out of this. The question is how many lives are. We going to lose along the way and we have more to say about that than the president or any governor any mayor so a lot of that powers that our hands. Are we going to be the same country? No I don't think it'll be the same country. Will we be better in some degree and worse than some degree? I think that's probably the the right way to look at it. Yeah we'll we'll be the same people. I can't imagine that any of us will be the same people will think about things differently. Things that you cared deeply about a New Year's eve and we're really stressed about going into twenty twenty. Those are less important now. Perhaps with the exception of WHO's President. That may be just as important to people now as it was before but but for most of the things we worried about day to day lives. Those got knocked down around and helped us reprioritised. And that's not a good thing or a bad thing. It means that we're taking things off of our list that maybe we didn't need to worry about and it means the Pratt forgetting perspective on life. That is welcome in an and is helpful. It also means that it's a bit scary because things were much more precarious than we ever knew. And so we had a false sense of security Living in this country particularly Andy Slab at you have been very informative very generous with your time. So I'll let you go so you can get on the phone with the White House and tell them to get some more goddamn ventilators to New York again. I'm at thank you sir. Thanks time thank you bring. The conversation continues for members of the Kathy insider community to hear the stay tuned bonus with Andy Slab it and get the exclusive weekly cafe insider podcast and other exclusive content head to cafe dot com slash. Inside Right. Now you can try a kathy inside or membership free for two weeks a cafe dot com slash insider. Well that's it for this episode of stay tuned. Thanks again to my guest. Andy slanted if you like what we do. Rate and review the show at Apple podcasts. Or WHEREVER YOU LISTEN. Every positive review helps listeners. Find the show. Send me your questions about news. Politics Injustice tweet them to me at Pre Perot with the Hashtag ask creep or you can call in. Leave me a message at six. Six nine two four seven seven three three eight. That's six six nine two four preet or you can send an email to stay tuned. A CAFE DOT COM. Stay tuned is presented by cafe. The executive producer is tomorrow supper. The senior audio producer. Is Dave attach? Your and the cafe team is Julia. Doyle Matthew Billy David Kerr Lander Calvin Lord Sam Oser Stayton and Jeff Eisenman. Our music is by Andrew Dust. I'm pre- BERRARA stay tuned.

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