Preet Bharara:              From CAFE, welcome to Stay Tuned. I’m Preet Bharara.

Andy Slavitt:                 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 us are going to look back on this time, but not all of us, and we’re all going to lose people we know.

Preet Bharara:              That’s Andy Slavitt. He served as the Acting Administrator of the Centers for Medicare & 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. Slavitt 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 ACA and created a related fund, Town Hall Ventures, to invest in promising healthcare startups. He also launched a nonprofit, United States of Care, which AIDS policy efforts to expand healthcare coverage to marginalized groups. Since the outbreak of the coronavirus, Slavitt has been a force on Twitter and on television, live tweeting meetings with policymakers, offering daily updates and pleading with Americans to #stayhome. 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.

Preet Bharara:              Hey, Stay Tuned listeners, I hope you and your loved ones are 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, we’re making this week’s episode of the CAFE Insider Podcast available for free to everyone. Anne Milgram and I spoke to our friend Juliette Kayyem. 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 H1N1 pandemic and the BP oil spill. She’s currently a professor at Harvard and a National Security Analyst for CNN, and she’s been doing a great service in recent weeks providing incisive analysis of the coronavirus crisis. Normally we sample portions of our conversation, but this week we’re making the full episode free. Just head to cafe.com/preet to sign up to receive the full episode. That’s cafe.com/preet. And if you already received cafe emails, check your inbox, you should have received a link. Stay healthy and stay safe.

Preet Bharara:              My guest this week is Andy Slavitt, the outspoken former Acting Administrator for the Centers for Medicare & Medicaid Services. Since the outbreak of the coronavirus pandemic, he has been a valuable voice in tracking the crisis, offering daily updates on Twitter and appearing on cable news and podcasts to help make sense of what is happening, and how best we can collectively respond. Slavitt, who jumped into government from the private healthcare sector to help salvage Obamacare, knows firsthand the difficulties of managing a federal health bureaucracy. We talk about his impressions of the Trump administration’s response to coronavirus, the challenges ahead and what we can all do to support frontline medical workers as they selflessly care for those suffering from COVID-19. 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.

Preet Bharara:              Andy Slavitt, thank you so much for being on the show and making the time.

Andy Slavitt:                 Great to be here Preet.

Preet Bharara:              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 25th. There’s breaking news from the Senate. There appears to be agreement on a package. We’ll talk about whether or not that actually gets through, whether the president will sign it. The president has been talking about “reopening the country by Easter”. We’ve got to 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 caring about and being involved in the world of healthcare?

Andy Slavitt:                 I grew up in Chicago, went to college. My best friend from college at Penn was a premed, and at 29, he called me one day, he had twin one-year-old kids and had a brain tumor. And six months later he was dead. And we had just gotten married and we were living in California. And so we had his widow, Lynn, and their two one-year-olds move across the country and come and live with us in California. So my first year of marriage, I 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.

Andy Slavitt:                 And on the heels of that, I started a company really basically trying to help the un and underinsured get lower costs of care. This was back in the ’90s when it was the internet day, and one thing led to another. I ended up running quite a big company in healthcare overseeing kind of the largest data and analytics businesses in healthcare. I got to know a lot about healthcare and was just basically a corporate guy for a decade, until one day in 2013 and healthcare.gov was launched and crashed. I think most of your listeners probably remember that.

Preet Bharara:              Yeah, that didn’t go very well. And I think the president made an allusion to it recently at one of his briefings.

Andy Slavitt:                 Right. It wasn’t the best moment at the white house. So what did I do? I picked up the phone and called white house and said, “Hey, do you need help?” And when you make the call like that, what do you think is going to happen? You think it’s going to go unreturned. Three days later, they announced that I was going to be the lead firefighter turning around healthcare.gov, which of course demonstrates one thing, which is that I was the only person in the country that had the stupidity to call. And at the end of their press conference, they announced that it would be fixed within five weeks. And they hadn’t mentioned that to me. So that led to five weeks of me living in a hotel in Washington and creating a command structure and overseeing both the government workforce, the outside contractors, and I brought a couple of hundred of my own people and we did it.

Andy Slavitt:                 I mean, by and large, it got fixed, and millions of people got health insurance. And at the end of it all they asked if I wanted to stay and serve out the term in the Obama administration. This was middle of 2014. And I ended up running Centers for Medicare & Medicaid Services, which oversees not just the ACA, but like its name implies Medicare and Medicaid.

Preet Bharara:              Also known as CMS.

Andy Slavitt:                 Also known as CMS. Right. Thank you for the permission to use an acronym.

Preet Bharara:              Yeah. We don’t have time to keep saying that whole phrase over and over again.

Andy Slavitt:                 Yeah, right.

Preet Bharara:              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 coronavirus.

Andy Slavitt:                 The CMS oversees about a quarter of the US budget, over $1 trillion, 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, CMS is responsible almost like an insurance company for everybody on Medicare and Medicaid, making sure that they get their benefits. And as a result of that, CMS is also the regulator of a number of things. They’re the regulator in the case of COVID-19, very relevantly the rules around insurance and safety in many categories, oversee clinical labs, which are a critical part right now of what’s going on with COVID-19, oversee the safety of nursing homes. But then also just oversee the rules of participation, how healthcare is paid for, and many, many other things.

Andy Slavitt:                 So if there are levers that the administration has in healthcare to affect the healthcare system and they can affect everything, a lot of those levers are in CMS. CMS is inside the Department of Health and Human Services, along with the CDC, along with NIH and along with FDA. And they’re all run very, very separately. So don’t think of them as a happy family, just think of them as sort of a category of things that report right now up to secretary [inaudible]

Preet Bharara:              Are they a warring family?

Andy Slavitt:                 It depends on the administration for sure. Their missions are so different that they’re not sort of by definition a warring family, but the FDA is filled with scientists. CMS is filled with policy, payment people. CDC is filled with public health people. So it’s just very different types of people. When I was there, Francis Collins, the head of NIH, Rob Califf, the head of the FDA, Tom Frieden, who was the head of CDC, and I were great friends, and we tried to do our best to communicate and bring our worlds together when had crises like we did in Flint, Michigan or in Puerto Rico.

Preet Bharara:              Then there’s also FEMA, which is separate. Who should be the lead agency or should there not be any lead?

Andy Slavitt:                 My answer is somebody should damn well be in charge.

Preet Bharara:              So is it Dr. Fauci? Is it Vice President Pence?

Andy Slavitt:                 It probably should be somebody like General Mattis, somebody who’s got strong logistical control. The way it works is disaster response or disaster recovery entirely sits within FEMA, except for pandemics, which officially sit within HHS. And there’s a war room, et cetera, within HHS. And what typically happens if the crisis gets bad enough, as happened with Zika, is the white house sets up its own 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 decisions got made quickly and the people in charge knew what they were talking about and everyone took their orders and ran.

Andy Slavitt:                 And in these crises, speed is your friend, perfection is your enemy. And what we have now is something less than that. We have a number of different agencies and a mercurial president. I mean he’s mercurial 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 any economic faction led by Larry Kudlow who was arguing strenuously that the damage of saving lives is not worth it to the economy.

Larry Kudlow:               Well, I’m not the health expert. We’re going to look at a lot of things. I mean I think what the president is expressing, and I’ve 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, in economic terms, perhaps even in health terms, and again I’m not the health expert.

Andy Slavitt:                 You’ve got health people like Dr. Fauci who are trustworthy and straight shooters and will calmly tell him what 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 HHS which has some resources. And what needs to happen is somebody needs to come together and say this whole command and control structure, we’re going to bring all of these resources and assets to their best use. Not all that differently than what I did turning around healthcare.gov although on a bigger scale. And use that to communicate to all the people on the ground and get resources and allocate resources quickly to the people on the ground in states and in hospitals and so forth.

Andy Slavitt:                 And I’ve 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 lot of time focused on Trump’s bad decisions, but the truth is you have to navigate from where you are than where you wish you were, and so I’m trying to help the team on the ground figure all that stuff out.

Preet Bharara:              So you said a lot there, I’m going to focus on some of those things. But first I want to give you the opportunity to respond to something that the president keeps saying, and I’ve heard him say a number of times to have some version of…

President Trump:          We inherited a very obsolete system. This was a system 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.

Preet Bharara:              Do you care to respond to that?

Andy Slavitt:                 I care too, but I probably won’t 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 someone should write a big report and 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 is, and we can talk through what that means. But basically think of it as the numbers 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, then it’s really, really, really important to be ahead of it. It’s kind of like if you borrow $1,000 from a loan shark, and 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 owe him $1,000 anymore, you owe $50,000 because the interest rate’s bloody 30%. That’s what it means to be behind in a crisis like this.

Andy Slavitt:                 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 last time, those two weeks are going to be two weeks we will never be able to catch up and I think they’re going to have a big impact on the body count. It’s the past right now, but it’s really the thing that I think is going to keep people up at night.

Preet Bharara:              I appreciate you took and are taking the high road cause we’re still in the middle of a crisis. When you say that you talked to folks at the white house, that might come as a surprise to some people because I know the president has said when asked the question, “Have you thought about calling some of your predecessors?” He basically dismisses that notion and 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. Can you say who you’re talking to with the kinds of people you’re talking to and what exactly the mood is over there?

Andy Slavitt:                 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 could think about the people on the task force and you could think about some of his closest, closest advisors and you can use your imagination as to… There aren’t that many of them. As to as to who that might be. But I hope by the time we get to the fall, we’re able to go back to politics as usual and be at each other’s throats and be on cable TV, obsessing over the political landscape. That’s not where we are right now. We’re not in a Democrat versus Republican. We’re in a species kind of thing. This isn’t us versus China.

Preet Bharara:              A little bit of it is fact versus fiction, right?

Andy Slavitt:                 Yup. Yeah. Well that’s true too. But I think the point is, and I’d say this, not just me, but I say this and I know this is true about you, and I say this about anybody listening. This is a point in time when I think people will regret if they haven’t been doing every single thing they can. The vast majority of us are going to look back on this time, but not all of us. And we’re all going to lose people we know. We’re going to have the largest body count in our history, rivaling the 1918 flu. We’re going to have horrific scenes on television, in hospitals that we’re only used to seeing in foreign countries, far, far away from us.

Preet Bharara:              But you’re saying that’s going to be true just to get a 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?

Andy Slavitt:                 I think that is our best hope right now. It’s a really interesting question you ask Preet, 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 and San Francisco and that area put in place very strict stay-at-home #stayathome rules and messaging. And Miami Dade was, to be kind, a little more lax, a little more late to it. And we looked at the data and the data we looked at was real time loading of temperature data from people’s thermometers that load to the cloud. And we compared it to average temperatures you’d expect during flu season.

Andy Slavitt:                 And we graphed the decisions that were made politically such as closing bars and restaurants, closing schools, having people stay at 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 R0 and I’m happy to go back and explain that because I hate throwing lingo at people, if people don’t know what that means. But this is all about this thing called the R0, and reducing the R0. And if you can do that, you can actually see dramatically improved results.

Preet Bharara:              As I understand it, the R0 is a reference to the average number of people that any infected person will then pass the disease onto. Is that right?

Andy Slavitt:                 That’s exactly right. And to finish 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 and they got religion early in Gavin Newsom’s done a great job. But as a result of that, you have people in San Francisco saying, “Well, 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’d say, “Ah.” And if they keep watching TV, they’re going to get it.

Preet Bharara:              It’s the ultimate paradox. And I’ve heard other people mention this as well. If everyone hunkers 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 did we have to do that?” But that’s the very reason why you’re seeing a better landscape, right?

Andy Slavitt:                 We’ve got a country of doubters, people who really value our independence. We are suspect of government, we’re not compliant. And under the fact, the point you made earlier, that we had to know what’s truth from fiction, add on 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 like it’s the flu and I don’t know who carriers are. And then a point that scientists made to me late last night that I suspected was true, but when he said it, I felt smart because I had been claiming it on cable TV, that our brains don’t work exponentially. Our brains work linearly. So we are used to taking an action and making progress. We’re not used to taking an action and seeing it get away from us.

Andy Slavitt:                 It’s like swimming after a speedboat. You can be 15 feet away and you can swim 15 feet. You’re no longer 15 feet away when you get there, you’re much, much further. And our brains have a hard time understanding that. So all this cognitive dissonance, let alone the economic dislocation and the social dislocation has people spun around.

Preet Bharara:              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 “reopening the country”. By that I guess he means this cessation of social distancing to the same scale, the opening up of businesses, et cetera. And he has now set, I don’t know if it’s aspirational 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 me to ask this question and for you to answer it, when you talk to folks who are around the president, are they of the same view? Because I hear reports that they are not, that that Easter seems too soon.

Andy Slavitt:                 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 of the moment or whether or not he ran that by anybody. But scientists are referring to this as the Easter Massacre. He said he’d like hundreds of people or thousands of people to sit next to each other in church and it’ll be beautiful. And here’s my message to people. There’s going to be many, many Easters in your life. There’s going to be many, many happy occasions in your life. This is a time of some sacrifice. And I understand that and we understand that. And the president doesn’t… I believe he’s starting 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. None of that’s the point. He’s not the person who I think you should stake your family and your communities [inaudible]

Preet Bharara:              Trust me, I don’t and I won’t, but a lot of people will. Is it important for public policy that people get the president to back off from that Easter 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 of the United States is saying.

Andy Slavitt:                 In the evenings I have this group of people that I talk to that are scientists and risk managers and Homeland Security people, and some of it’s direct voice, some of it is a lot of texting and email. One of the people on there who I would say he’s about as dark a cloud on this topic and maybe as dark a cloud as I’ve ever met in my life.

Preet Bharara:              We won’t have him on the show.

Andy Slavitt:                 Yeah. Don’t even talk to him. He says not to worry, Andy. By the time he sees the body bags, 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 if that’s true because I think we’re going… And this is happening in different cities at different times. It’s happening in New York right now and he may just sort of like write off New York, as he’s going to be saying nobody can leave New York. But the problem is it’s going to begin to happen everywhere. And I should explain something. There’s a lot of data thrown around. There’s a lot of… I think most people know a lot of these things. It’s a novel virus, we don’t have immunity, how contagious it is, the RNR, which you perfectly explained.

Andy Slavitt:                 And this 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 preexisting conditions. The third one is the one that’s going to 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, long, long life and if they were to get COVID-19 during a period of time when it was sort of coming and going fairly reasonably underneath the capacity of our medical system would be fine. They might have a case of a bad viral flu or pneumonia, but they may need to be hospitalized, ventilated, but many, many people would survive.

Andy Slavitt:                 But case fatality rate as they call it, CFR, if you want another acronym, is going to be much, much higher because when there’s a mad rush of people into the hospitals, we will have a shortage of doctors and nurses for reasons that people well understand at this point, a shortage of ventilators and a shortage of rooms to take care of them in these cities. So I think the point is the stay at home isn’t about avoiding the disease, it’s not about beating the disease. It’s about two things. It’s about giving our healthcare system a break and these workers a break so that they can handle what comes at them. And it’s about giving our scientists some time, because our scientists will do a lot of great things, but we need to give them some time. And Trump should not rush them.

Preet Bharara:              So let’s just 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 and in LA and in other places around the country, what would the next two weeks look like? How would it overwhelm the healthcare system in this country if we just went back to normal in three weeks?

Andy Slavitt:                 I’ve tried to take this a couple of ways. I’m going to try to do this as tenderly as possible because these are scary numbers, but I’ll tell you that Governor Cuomo as 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’s said, he’s now recited data which I can talk about because I got it send to me about 10 days before from the mayor’s office, and the same data that he’s been referring to. Which is that they have about 3000 hospital beds, ICU beds in New York. And the projection is that in April they could have as many as the need for 35,000 or more beds with vents.

Andy Slavitt:                 And that means that they will have to make decisions if things go at its current pace on who lives and who dies. Now because there’s a two week lag and because people are asymptomatic 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? And four weeks from now, will it be better or worse? And if it’s better then we got a shot, if it’s worse then it’s going to be exponentially worse. Because R0 in a place like New York, which is densely populated, can be over six without any of these measures. We need R0 to start to get to one and below for us to have the ability to beat this thing without it beating us. And getting R0 down to one, in Wuhan, they got it down to 1.3 after they took very strict measures.

Andy Slavitt:                 I think we’re somewhere still over two. The difference between over two and just over one and one, is dramatic, and we control that. The kind of exciting thing is kind of Rosie-the-Riveter style, we control the war effort here because we will infect people that we don’t know we infected. 80% of people that are infected don’t know where they were infected because this disease carries very asymptomatically in much of the population.

Preet Bharara:              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 or possibly given it to.

Andy Slavitt:                 I didn’t hear that. Does he have it?

Preet Bharara:              Yes. I saw that this morning. I also saw the Mitt Romney tested negative, to which the president tweeted something sarcastically, unpresidentially, shockingly. But is it possible… So let’s do 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 where 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?

Andy Slavitt:                 I actually have a lot of sympathy and 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 a pure public health standpoint, but because epidemiologists say that you can tell somebody something awful is about to happen and ask them to make preparations for about two weeks. And if it doesn’t happen, they really start to lose faith. And then they let down their guard and then when it comes to them, they don’t listen and it’s tragic. And remember Northern Italy, which is a horror show, and 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 a state that’s I think being a little bit misguided here.

Andy Slavitt:                 But the idea that we should have different strategies for different parts of the country is 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 and should want to do is tell people what the path out is as best he knows using actual facts from scientists. Because I think people not understanding how long this is going to go on, makes them restless, makes them want to jump out, makes the stock market restless. And 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 things. And I’m not saying he’s necessarily being that thoughtful about it. He may be worried more about his golf courses, I don’t know.

Andy Slavitt:                 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 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, it’s not a holiday. It’s when our great American companies start to produce enough of X. And when we have enough surveillance, because we have enough tests to do Y. And I’m going to challenge American industry and I’m going to 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 of world war II. This is going to be something that come next year, depending on where you live, we’ll be able to move out of this. But we’re going to do it intelligently and I ask you to stick with me. That’s the right message.

Preet Bharara:              It’s interesting speaking to someone like you who is both the healthcare policy expert and you’re also, to use a technical phrase, you’re a finance guy, so you know something about the economy. Just 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 are those two things inextricably intertwined?

Andy Slavitt:                 Well, in the short term GDP or growth or anything that allows us to feel personally financially healthy, can come from a few different places. It can come from business, it can come from consumer spending or it can come from government spending. So in the short term, we need massive amounts of government spending. The $2 trillion bill that got to agreement on last night and hopefully will go and get signed, will not be the last one. But these are things that will stimulate the economy. And pumping 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 not the economy we’re going to have long-term, but we need to be able to do that in the short-term.

Andy Slavitt:                 And then 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 going to say it’s not the most important thing. But the stock market, what do we think will have a greater impact on the stock market? Telling people that they can go back to work, that’s option A. Or option B, a dramatic reduction in case counts and death tolls. It’s option B in my view. When the stock market believes that there’s an end in sight and that we’re beating this and that people are staying home and that we’ve pulled together and that we can get through this, that’ll be better news for everybody, and it’ll give everybody hope.

Preet Bharara:              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 $2 trillion 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 help us get to the other side before the economy craters?

Andy Slavitt:                 I’m not in the business of making predictions. I’m here really trying to chart the best course and looking at a bunch of other people’s predictions. But I’d say there’s short term pain, right? If you’re out of 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 not a great situation for you. But figuring out how to get through it for, let’s call it at the outside up to 18 months, with some spurts of activity in the meantime. And by the way, Preet, I don’t think it’s just the economy. I mean when people’s favorite sports teams aren’t on and they can’t have a beer with a friend, if that’s their thing, and their favorite TV shows and movies aren’t on, the kinds of things that distract us from the hard things in life are also not happening, it’s hard.

Andy Slavitt:                 And so this impatience that he feels, it’s felt by a lot of people of all parties.Everybody wants this 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 just need our scientists time to catch up so we can… 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, but 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 50% of the capacity you used to have at first. And if anybody has a fever, they need to voluntarily go to a fever tent that we’ve set up.” Now in China they wouldn’t say voluntarily and I think they’d be much more effective because you’d have a lot more compliance. But in this country maybe that’s not possible.

Andy Slavitt:                 And in a fever tent you kind of wait it out and figure out whether you have it and you have enough testing. And then, not for nothing, we’re also going to have lots and lots of people who have some immunity because they have gotten this before, and those people can be out in the public square.

Preet Bharara:              That should 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, will they then be able to resist COVID-19 going forward?

Andy Slavitt:                 Right. So the reason that you haven’t been able to get a straight answer is because this is a novel virus and nobody can be absolutely 100% certain. Having said that, I have not talked to a scientist who doesn’t believe that people will have immunity, at least from this strain, 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’ve got that immunity. But people are pretty certain or people are feeling pretty optimistic that there will be immunity and that reports, what we hear of people saying, “Oh, someone got it twice.” They think are more likely to be testing errors than they are to be the truth. So if that’s the case, 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 a lot more options.

Preet Bharara:              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.

Andy Slavitt:                 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 has heard from an actual expert instead of someone like me who just talks to experts a lot. But my sense from talking to people is it’s not very complex to do. Doing it at mass amount of scale takes some time. Doing it in a way where you ensure that it’s safe, doing it in a way where 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 sense is that it will be coming shortly. But I wish I could tell you what [inaudible] was. I just can’t.

Preet Bharara:              You’re not going to say Easter?

Andy Slavitt:                 Yeah.

Preet Bharara:              I was giving you the option.

Andy Slavitt:                 If we were having this in the afternoon after a couple of cups of coffee, I would [inaudible]

Preet Bharara:              What about an evening after a couple of beers? Then you might’ve said Easter.

Andy Slavitt:                 Red wine has been my thing. And then lately I’ve been just staring at it and I’ve never even had a chance to open it because I’ve just been on so many calls.

Preet Bharara:              Well, that’s the mistake. This is maybe a little bit far afield for you, but you mentioned it so I don’t know if people who are not in New York appreciate that all non-essential business has 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 of that?

Andy Slavitt:                 That only is less amusing than… Did you see the thing put out by the New York City Health Department on whether it’s safe to have sex?

Preet Bharara:              No, I didn’t.

Andy Slavitt:                 The first line is, “Generally you are your safest sex partner.”

Preet Bharara:              Okay, let’s move on from there.

Andy Slavitt:                 Look, I think the point you just made is exactly the answer I would give to the question, which is we shouldn’t stop living. I mean, we shouldn’t turn into alcoholics, but if there’s things that give you pleasure in life, by all means laugh, have a glass of wine, give someone joy, do something nice for somebody. Whatever it is that makes you feel good, that’s safe, I think the memories and the stories coming out of this period of time when it’s over, there’s no reason for there not to be great memories. And I hope everyone is able to look back and say they did everything they could. We’re very likely to all know people who we lose to this illness, and it’s going to be a lot of sadness. But nobody should be feeling guilty for finding those pleasures in life.

Andy Slavitt:                 My wife and I are home right now with our two sons and it gives me immense pleasure that they’re stuck with me. It doesn’t give them immense pleasure, but I love the fact that 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, that’s a win.

Preet Bharara:              I saw someone tweet recently that the coronavirus and the compelled quarantining, it will shortly reveal which of us are gourmet cooks and which of us are alcoholics.

Andy Slavitt:                 Right. Or as my wife said, there’ll be both a baby boom and a divorce boom.

Preet Bharara:              I agree with those sediments about living life and taking moments of joy when you can find them. I want to 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 and biggest companies to make ventilators, which are the things that will save a lot of lives?

Andy Slavitt:                 So this is a place where I’m going to call the president to account. As I said, I’m trying to take somewhat of a moratorium. I’m just taking shots at the stuff he does to hurt people. But this is something that he should be held accountable for. I was 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 because we did the same thing with N95 masks and we got a lot of masks to 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 and New York needs 30,000, as Governor Cuomo said, ventilators. To just basically say, “Sorry guys, we’re going to take these and we’ll give them back.”

Andy Slavitt:                 And he’s like, “Well, we might do that, but maybe you can have this voluntary thing going.” And this is, I think ideology to be frank that is getting in the way. CEOs are, I think, whispering in Trump’s ear that that would be a bad move, that they don’t want to be compelled to do this stuff. And 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 a Twitter thread yesterday, the 24th, around why we are running into natural limits on the amount of tests that we can produce. And the reason is when you get behind all of it, and first of all we need to be able at some point test everybody in the country multiple times, not just people with symptoms. And right now we can only test frontline workers.

Andy Slavitt:                 And the reason we can’t, it turns out is there are these things called 8800 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 can make [inaudible] more of them. And that’s the thing that’s getting in the way of us having enough tests. And if this were a decisive war-time president, we would be on day 10 of that happening. As it is right now, I talked to people who say, “I can make these things, but someone has to tell me they’re going to buy them because I don’t know who’s going to have money.” The hospitals don’t have money. Is the government going to guarantee them? And if I were the president, I would do something very simple. I would say, “I am placing a purchase order for 500,000 ventilators and 2 billion N95 masks. Here’s the price. Go.”

Andy Slavitt:                 And I would then call all of my CEO friends who have these factories and I would give them the capital to convert their factories. I would get them going, and I would go to do photo ops and all these factories as they’re producing these things. And I would get the logistics and the FEMA team out getting these folks to the hospitals they need to get to.

Preet Bharara:              Yeah, it seems like it’s a win-win. I guess-

Andy Slavitt:                 It’s a win-win.

Preet Bharara:              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 something missing.

Andy Slavitt:                 It’s ideology 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 Zika, we told all the labs we would pay $52 per test at a minimum. And guess what? We had enough tests. We tested millions of people, and that turned out to be very wise. The Democrats proposed the same thing. By the way, Medicare and the Medicare administration said, “We’re going to pay $52 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 was say that, “Not just for people on Medicare, but for anybody, any test, anybody in the country, we’re going to pay $52.” The Democrats said, “Great, I’m on board.” The Republicans in the 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 “market price” paid.” Which essentially will mean that there’s much, much less production.

Andy Slavitt:                 And so I said to the white house, who’s talking to the Republican negotiators, “Can you remind them that the way people pay for it now is as 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 a public health crisis, there are people, whether it’s in the white house or staffers or anywhere, and I’m not saying it 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 who say, “You know what? We could have more tests, but if it’s a step towards Medicare for all, we’ll be sorry later so let’s not do it.”

Preet Bharara:              I want to go back to the ventilators in New York issue. And the governor has said, very plaintively, “Incredibly, we need at least 30,000.” But you said something a minute ago that made me wonder something. And that is, do we have an overall shortage of ventilators in the country as an absolute matter?

Andy Slavitt:                 Yes.

Preet Bharara:              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?

Andy Slavitt:                 So depending on how people do the #stayhome, if they don’t do it at all, we probably have one ventilator for every eight people who need one. And I’m going to tell you that, and I tried to say this gently, but there are papers going around the DOD and HHS right now on what are the ethics of making the decisions to deny people access to a ventilator. So the numbers are that we are short. We maybe have 65,000 working ventilators in hospitals, and we could have the need for five or 600,000. 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 went every factory doing it. But that doesn’t mean that you give up because every ventilator New York gets is a life saved.

Andy Slavitt:                 So it makes all the sense in the world to say, “Hey, if you’ve got an excess amount of ventilators in your community now, we will ask you to send those to New York.” And then you’ve got to ask manufacturers to build the capacity in the meantime. So I’ve just been asked to go make that play to a bunch of hospitals, and of course, they’re going to rightly say, “But it’s going to 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, and move personnel around quickly, and we’re going to lose a lot more lives.

Preet Bharara:              You prefaced that by saying you’ll kind of try to say it gently. To my mind there’s no gentle way to say it. You have a combination of clear 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 to take place. And then you also have, which in a different universe you might not have had, is a clear mechanism for causing those things to be made and guaranteeing a market. So for the life of me, I don’t understand why we’re not in a better spot.

Preet Bharara:              I did want to talk about the congressional package that seems to have been agreed to. Have you had a chance to look at the major provisions? Do you have a reaction to it overall?

Andy Slavitt:                 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, absolutely worth the two days it took to get this package done and out. It’s going to provide a lot more help to people who need it. But I think the message from Congress needs to be, “You’re not done. You’re not going to be done.”

Preet Bharara:              Two trillion is not enough?

Andy Slavitt:                 It’s not enough money and the situation on the ground is going to change. If you’re interested Preet, I put out through a group that I founded a five-point plan for Congress through the organization called United States of Care. It’s at usofcare.org. A five-point plan how Congress really needs to step in and and to help people. And so that has a lot of things need to be done, particularly for frontline healthcare workers. If we don’t address, we haven’t talked about that on the show, but even perhaps greater than vents, figuring out how to address the needs of basically our frontline warriors, in effect our military in this, we’re going to lose them. Not so much in the sense of death, but lose them from the workforce as they get sicker and sicker.

Preet Bharara:              Right, and I don’t know if there’s a term for this. I’m assuming that there is some R0 type of figure that will be associated with every health care worker that you lose. There’s a ripple effect on how many patients can be served and made well, right?

Andy Slavitt:                 Absolutely. I called for a $5,000 a month payment to every frontline healthcare worker and first responder in the country because of the massive need that we have to have them have segregated childcare, for them to get through what is going to be a time where they’re going to be operating without the kind of equipment we need. And I just go back to the point you made about the president. He’s trying on the label of wartime president. He likes that label. I’d love for him to be a wartime president, but that means he needs to arm his troops with all the equipment they need. He needs to read the battle maps, he needs to be decisive and he needs to get everybody moving. And he needs to be much more skeptical when people tell him that there’s hope. He needs to say, “That’s great. But I’ve got a plan for what I see in front of me.”

Preet Bharara:              Well, 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 Stavridis on the show some weeks ago and he was observing that what draws the president to this idea of war and generals is that he thinks they’re macho in their strength and their bellicose. And what he fails to understand that the best generals and top military leaders in history are actually very intellectual and very thoughtful and very deliberate, and care about data and science. And those are not things that the present seems to do much care about. He likes the title of general and he likes the title of wartime president, but not much else about that. What do you think the onset of the coronavirus and the response to it in America says about the healthcare system, and what are the lessons for a healthcare system?

Andy Slavitt:                 Obviously the infrastructure that we need just hasn’t been built and we haven’t been prepared. And go back if you haven’t watched the Ted Talk from Bill Gates in 2015 which I think many people have seen. And there’s other folks, Mike Osterholm who is a famous epidemiologist at the 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 I’m sure many more will say that they did. But we were so completely unprepared and we build stockpiles of oil for crises. We have stockpiles and more military planes I imagine than we need. Although someone can contradict me who knows more about military aviation. But our stockpile of both logistical support, people and the kind of equipment we need was just not there. And then we throw that on a healthcare system, which even on a good day doesn’t work incredibly well.

Andy Slavitt:                 So out of this, I have hope, but not necessarily confidence that people will take some lessons. I think the other big picture thing, Preet 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 give people facts as well as some hope and some enjoyment. And in some ways I have this overly romanticized view of us being in Churchill’s bunker together and getting through this. I’m 53. I’ve never been asked to sacrifice a damn thing in my life, and I think most of us haven’t.

Andy Slavitt:                 Our older generation has. I’m not willing to give up on my mom living to a hundred. I’m just not. I don’t care what Dan Patrick says. So if I have to spend 18 months with her in another city and me not being able to see her, I’m going to choose to view that 18 month 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 she spent way more time than that, telling me that my awful drawings from school looked nice. So we all are going to go through these days where we want to cower under the bed, but we’ve got to have each other’s backs. And so if I do that on Monday you say, “Come on Andy, I’ll help you get through this.” And then Tuesday’s your day Preet, and I call you on Tuesday and say, “All right I got you Preet.” Then you got to get out, because you’ve got to help other people and it’s going to be that kind of time.

Preet Bharara:              Do you think that this experience that America is going through and will continue to go through for a while will cause the country to be more receptive to things like Medicare for all?

Andy Slavitt:                 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 healthcare needs. And if there’s a lesson that’s driven home in a public health epidemic, when something’s highly contagious, maybe that lesson ought to be that just because you’re healthy, if your kids go to school with someone or you go 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 better care for all or whether it’s some other form of 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 doing something like that.

Andy Slavitt:                 And right now we have people voting to spend trillions and trillions of dollars in emergency situations, which I think would be better spent next time around just making sure that people didn’t have to worry about the payment side of this.

Preet Bharara:              Yeah. So here’s my next question then, which you’ve segued to beautifully. Suppose hypothetically, we have an election 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 spent all our money on this?

Andy Slavitt:                 No, I think that the Bernie Sanders’ plan is very, very, very expensive. I don’t think there are the votes in the Senate, even if Bernie Sanders were to become president for that to be enacted. And I actually think on some level, Bernie knows that, I’m not suggesting he doesn’t believe in it, but I think he believes he’s got to 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 not terribly expensive in the scheme of the kind of money we throw around 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.

Preet Bharara:              Are we going to get out of this okay and be the same country?

Andy Slavitt:                 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 or any mayor. So a lot of that powers is at our hands. Are we going to be the same country? No, I don’t think we’ll be the same country. Will we be better in some degree and worse in some degree? I think that’s probably the right way to look at it. Will we’d be the same people? I can’t imagine that any of us will be the same people. We’ll think about things differently. Things that you care deeply about on new year’s Eve and were really stressed about going into 2020, 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.

Andy Slavitt:                 But for most of the things we worried about in our day-to-day lives, those got knocked down around and helped us reprioritize. And that’s not a good thing or a bad thing, it means that we’re taking some things off of our list that maybe we shouldn’t need to worry about. And it means that perhaps we’re getting some perspective on life that is welcome and that 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.

Preet Bharara:              Andy Slavitt you had been very informative, very generous with your time. So I’m going to let you go so you can get on the phone with the white house and tell them to get some more god-damn ventilators to New York.

Andy Slavitt:                 I’ll get on that.

Preet Bharara:              Thank you sir. Thanks for your time.

Andy Slavitt:                 Thank you Preet.

Preet Bharara:              The conversation continues for members of the CAFE Insider community. To hear the Stay Tuned bonus with Andy Slavitt, and get the exclusive weekly CAFE Insider podcast and other exclusive content head to cafe.com/insider. Right now, you can try a CAFE Insider membership free for two weeks at cafe.com/insider. Well that’s it for this episode of Stay Tuned. Thanks again to my guest, Andy Slavitt.

Preet Bharara:              If you like what we do, rate and review the show on Apple podcasts or wherever you listen, every positive review helps new listeners find the show. Send me your questions about news, politics, and justice. Tweet them to me @PreetBharara with the hashtag #askpreet. Or you can call and leave me a message at (669)247-7338, that’s (669)24PREET. Or you can send an email to staytuned@cafe.com. Stay Tuned is presented by CAFE. The Executive Producer is Tamara Sepper. The senior audio producer is David Tatasciore, and the CAFE team is Julia Doyle, Matthew Billy David Kurlander, Calvin Lord, Sam Ozer-Staton and Jeff Eisenman. Our music is by Andrew Dost. I’m Preet Bharara, stay tuned.