COVID-19’s Deadly Grip: Former CMS Administrator Andy Slavitt on America’s Next Right Steps

Andy Slavitt

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Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation , health policy , care delivery and the great minds
who are shaping the health care of the future. This week Mark and
Margaret speak with Andy Slavitt, former Acting Administrator of the
Center for Medicare and Medicaid Services under President Obama,
f ounder of several entities since Town Hall Ventures and United
States of Care. Andy Slavitt is building a bipartisan coalition to
advance health coverage for all Americans, especially as the country is
grappling with a failing response to containing the COVID - 19
pandemic.

Lori Robertson also checks in , the Managing Editor of FactCheck.org
she look s at misstatements spoken about health policy in the public
domain , separating the fake from the facts . W e end with a bright idea
that’s improving health and well - being in everyday lives. If you have
comments e - mail us at [email protected] or find us on Facebook ,
Twitter , or wherever you listen to p odcast . Yo u can also hear us by
asking Alexa to play the program Conversations on Health Care . Now
stay tuned for our interview with Andy Slavitt here on Conversations
on H ealth Care.

Mark Masselli : We're speaking today with Andy Slavitt, former Acting Administrator
for the Centers for Medicare and Medicaid Services under President
Obama . He is the founder of the United States of Care and Town Hall
Ventures, both entities ai med at advancing health reform and health
coverage for Americans. Recently, he's been writing extensively on
COVID - 19. He also launched new p odcast I n the B ubble addressing
pandemic issues from his home studio , Bubble.

Margaret Flinter: Mr. Slavitt led the team that fixed Healthcare.gov that was the online
insurance portal created under the Affordable Care Act. He also
served on the Obama A dministration's Heroin Task Force, as well as
Vice President Joe Bide n's Cancer Moonshot. Since 2017, he has
dedicated his efforts to fighting the repeal of the ACA through the
creation of bipartisan coalitions . Andy, we welcome you back to
Conversations on Health Care today.

Andy Slavitt: Thanks for having me.

Mark Masselli : Yeah, you know, and Andy you joined us back in November 2019 ,
a ncient history.

Andy Slavitt: Yeah.

| Mark Masselli : B ut I have a hypothetical question for you. If you were invited into the
White House right now to help them solve this crisis that we're facing,
what would you do right now? I asked you th is, you were brought on

Andy Slavitt

to the national stage when the Affordable Care Act online insurance
portal Healthcare.gov was put on life support, and you were part of
what Time Magazine referred to as Obama's trauma team. O bviously,
right now, I think our country is in trauma . W hat advice and what
pathway would you advise the administration to head?

Andy Slavitt: Well, I think it depends if you could persuade the P resident that it's in
his best interest to provide overall leadership and to take
accountability for the results in the country . I mean, right now, I think
his belief seems to be that if he doesn't take accountability , doesn't
collect the data, analyze it , discuss it honestly , doesn't deal with the
hard facts and the hard truths that he'll be able to blam e someone
else, when things don't go well w hether it's governors, or China, or
the WHO or someone else. If I couldn't persuade him of that , it
wouldn't be all that fruitful . B ut I think the things that he should be
doing when he can start doing right now a re , one , presenting a very
clear honest case to the public , t hat's fact based , tha t's not based
upon what he wants to believe or doesn't want to believe.

I think he underestimates the public's ability and willingness to listen
to hard truths. I think the p ublic has been very receptive to hard
truths , if they feel like they're getting told them in a straight way. I
think, you build a competent and connected team of people around
you that are have penchant for taking on issues and acting, showing
compassio n t o the public, helping people understand that we're going
through a very difficult time and it's likely to be extended and felt
differently everywhere . Those are the first critical steps along with
listening to your scientist and let the scientist help you find your way
out of this. There's no choice to reject the public health crisis in favor
of the economy. The economy will not respond to that.

Margaret Flinter: Well, Andy, as we watch the virus accelerate across the country and
the d aily n ews a s everybody hits new targets, broke new records. It's
hard to listen to the P resident excoriating his own CDC as well as Dr.
Anthony Fauci, arguably one of the most esteemed immunologist in
the world and somebody that seems to have great respect among the
American pu blic. It doesn't seem like a winning strategy. I guess the
question is beyond just what would the White House and the
P resident do different . How does the sort of collective we build
consensus for public health interventions that the American people
can tr ust and find reliable and reasonable like wearing universal mask
wearing in public , social distancing, avoiding the large crowds . These
are things that feel s like takes beyond just the White House to try and
get us to consensus . W hat are your thoughts on t his idea of
threatening school districts with loss of funds if they don't fully open
schools in a few weeks ? We're just hearing such fear confusion among
educators and families around the country.

Andy Slavitt

Andy Slavitt: You're absolutely right. The blame for where we are doesn't fall on
any one person or any one place. It actually falls on the virus itself. It’s
a deathly blow . We have to do our best to respond to it. I would say
that there are two things we've got to get better at. One of them is a
failure to adapt to learn. It's a novel virus, so we don't know anything
going into it. If our experts or our scientists say something in February
or March that they then revised in April and May, that's good, that's
how it's supposed to happen. We have to adapt . It’s sca ry being in the
middle of the scientific process, right, because we want people to tell
us the answers . B ut the truth is we're going to take two steps
forward, one step back, sometimes two steps back one step forward ,
and t hat's the way it's supposed to be . B ut if we don't adapt, if
scientists learn that there is an intervention, like a mask , that works
better . Even though we might have been told a month or two before
that the mask isn't what we need , w e have to adapt.

When New York goes through a crisis, a nd Detroit goes through a
crisis, and the governor says, I've lost three people in my family, be
careful. S he says that to Florida and Arizona, they should learn that
lesson from her , not have to learn it themselves. I think that's the
second failure I poi nt to , to g ot to get better at i s i t's almost a failure
of imagination. It's like, if it hasn't happened to us, then we don't
believe it. That failure of imagination turns into a failure of empathy.
All of us can be carriers, even if it's not dangerous to us . We don't
know who i t’ s going to be dangerous to or not , but a ll of us can be
carriers, so all of us can infect lots of people. We have to show that
level of empathy , and for no one else for essential workers, for people
working in the grocery store , fo r people delivering food , for
everybody who h as to work, we can't fail them.

Mark Masselli: I wonder if there isn't a sort of the third obstacle, which is it seems to
me that we've lost our way in terms of finding bipartisanship . You
recently advised Jared Kushner in the Trump White House in COVID -
19 , and you've teamed up with the President's former FDA
Commissioner Scott Gottlieb to promote effective public health
interventions to address the pandemic . Wonder if you could talk a
little more about the bipar tisan effort. It seems we're operating in a
red and blue state world when we’ve got to figure out how to come
together. As we used to, I think on foreign policy, we have to find that
this is sort of the waterfront of where we need to come together. But
tal k a little bit about your thoughts about how we build a bipartisan ’s
coalition of building consensus on these tough health policies that t he
country faces.

Andy Slavitt: I think it's very discouraging for people to see their elected officials
fight over so mething that for them is an existential threat. I think it
would be more encouraging than seeing people come together and
put aside their differences and say, we are on the same team , w e're in

Andy Slavitt

this together. It's why I give Scott Gottlieb great credit and other folks
who have joined us in these efforts because we know that if we cosign
something people will listen more , than if either he put something out
on his own or I put something out in my own . It feels more trusted
because it takes more effort. It tak es more compromise, but neither
of us are running for office , so it's easier for us to do. The politics in
this country have gotten so bad that it's hard er for other people to do
that.

I think if there was a different Republican in the White House, Mitt
Ro mney saying, or even George W. Bush, we would have a bipartisan
response here. It doesn't mean there wouldn't be arguments over
how much money to spend, doesn't mean there wouldn't be some
election year politics. But any other, quite honestly, Republican
p resident in our lifetime understands the nature of a pandemic .
George W. Bush was very worried about pandemics. I think that the
politics are here right now because of President Trump has shaped
the Republican p arty, including many of the members of Congre ss, it's
in his image, and people don't get out of line. I think it's very difficult
for Republicans to compromise on what they believe is compromised
on some of the things that I believe are good for the public right n ow,
given the way the party is being run.

Margaret Flinter: Well, I personally want to thank you and congratulate you on your
efforts to uphold the ACA ’s health reform changes against some
pretty mighty headwinds. I think it was Congressman Joe Kennedy III
who lauded your efforts is almost si ngle handedly saving the ACA with
your town hall strategy. Here we are in the midst of a pandemic,
every single person potentially a step away from being unable to work
because either their job disappeared or they're ill. We saw a report
this week that mor e than five million Americans have lost their health
coverage due to COVID related job losses. But maybe you could talk a
bit about the ACA protections that you fought so hard to protect,
which have such great meaning now for Americans as they enter this
v ery vulnerable time.

Andy Slavitt: L ook, I was just one of millions who were [ inaudible 00:10:48] the
time , and little did anybody know at the time that we'd be facing
these circumstances. There is never a good time to take away
people ’s health care covera ge . You don’t need a pandemic to
demonstrate what a bad idea is . B ut what a pandemic brings out is a
couple things. One, as you said is all the people who are losing
coverage because the connection between employment and
insurance is there in society. Wher eas you're no less of a human being
because you've been laid off or furloughed, you have no less right to
be able to care for your fa mily. That's should be obvious.

But secondly, this whole notion of pre - existing conditions . Pre - existing

Andy Slavitt

conditions were de signed for a simple reason , t hey were designed
because the insurance system was designed to make sure that
insurance companies could make money. It was designed by
insurance companies, it wasn't regulated to prevent that , and so
that's designed that way. I would share what I know if you were sick
because I need to make money and if you're sick and I didn't know
that then I need to charge you a lot more money or not after you r
insurance. The ACA just flipped it arou nd and said insurance
companies be designed for individuals that insu rance companies need
to adjust.

I magine a world where tens of millions of people have had COVID - 19,
then let's say, a year from now, two years from now you get asthma,
or you get a blood clot in your leg , or you get PTSD, your ins urance
company will be able to tell you, that's all based upon this pre - existing
condition of COVID - 19. By the way, if you were one of the millions of
people who had COVID - 19 and didn't know it , they will be able to
actually just take away your coverage be cause according to the way
that the rules were before the ACA, if you didn't disclose an illness,
then your coverage could be eliminated. It's a scary world that in the
first place, in this context it would be obscene.

Mark Masselli: We're speaking today w ith Andy Slavitt, f ormer Acting Administrator
for the Centers for Medicare and Medicaid Services under President
Obama. Andy, since the advent of the pandemic, you've been writing
extensively, but you also launched a podcast I n the B ubble, addressing
the p andemic from your home studio, which you're in now the
B ubble, featuring some really quite remarkable people I know either
you had or just about to have Dr. Larry Brilliant on known as an
epidemiologist who eradicated smallpox globally. I wonder if you
cou ld share their perspecti ve about these global pandemics. But we
need to learn from people who've seen this around the globe and
how they've dealt with it there , but what have you extracted and
learn ed from the exper iences they've shared with you?

Andy Slav itt: F irst of all the podcast called In the Bubble, my 18 year old son came
to me and said, d ad let's do a podcast together. When your 18 year
old son comes to you and says let’s do ---

Margaret Flinter: Let’s do anything.

Mark Masselli: I have an 18 year old, I know this. There’s like no question.

Andy Slavitt: He stuck i n home with me. It’s a fun -- it was a fun project. I describe d
it as 50% Winston Churchill, 50%, Fred Rogers, reliable voice, a
unifying voice instead of messages, and then helpful, so th e whole
family can listen to it because we're going to be dealing with this for a
while. There ’s lots of elements and lots of aspects to it and so we
have political people on, we have entertainers on , we have people

Andy Slavitt

talking about various aspects of what we 're dealing with. Larry
Brilliant is going to be on . We have actually Senator Bernie Sanders
coming on. Then the following week we've got Ambassador Rice . But,
Larry Brilliant was very interesting because he of course gave a TED
Talk in 2005, which predict ed almost exactly where we’d be and of
course he was the technical director of movie Contagion, which was
very close to where we are. I said, are we better or worse than you
thought we'd be handling it ? He said , in effect, he feels worse today
than he did the day the pandemic started.

I went through piece by piece and he said I feel the scientist get an A
minus. He said certain members of the public get an A plus b ecause
they've been out the front line saving lives. He said the public as a
whole there are a lot of people who disappointed in . He said our
political leaders, his grad e was I believe his phrase was special place in
hell, because he said, we would have -- we would not have beaten it
in terms of eradicating it, but we would have contained it by now w ith
proper leadership . He said, e verything we've seen from this virus
hard, challenging, but all within our scope to manage, as has Vietnam,
as has th e Czech Republic, as has Greece, as has New Zealand, as has
the whole set of diverse countries. He said, when we did all of our
planning the one thing we didn't plan on was essentially a national
response of denial and indifference.

Margaret Flinter: Well, Andy, as a society, we are not accustomed to the kind of
constraints that we've had. We want schools op en , we want to
celebrate with our families at gatherings, we want to cheer our
favorite sports teams in person . But you write so eloquently that if we
can't see our past then we don't know where we're going. We know
we need great data. We need testing capa city . We need the data from
the testing. O ur frontline workers, their burnout isn't going away. Still
concerns about adequate P PE and you warn that further shortages
are looming. You're promoting a campaign to open safely. What does
that mean to you? How d o we protect our health care workforce and
the population at large as we brace ourselves for what we have to
assume will be additional waves of the pandemic?

Andy Slavitt: These are tough times, people are going through a lot of anxiety, a lot
of challenge s, not just health, not just financial, but the ir social
structure isn't there. I mean in World War II people ha te each other.
We haven't had that in -- unless you're a Bears’ fan it’s a tough time. I
mean, there are certain sports teams, I'm a Chicago spo rts fan, for me
they're not losing right now and so on . The question is not, do we
close down or do we open up ? The questi on is, how do we open up
safely, because Americans want to get back to normal l ife but they
don't want to do it at the expense of thei r neighbor ’ s lives.

We have 20% of our population that is forced to work and essentially

Andy Slavitt

they're doing services for the rest of the population. But we're really
taking advantage as a society. Things are not safe for them , and if
they're not safe for others they're not going to do things that drive
the economy, spend money, buy cars, travel, sign new leases, hire
employees, the things that make an economy come back. Sure ,
people who are well off will spend money and people will get haircuts
and other things , that’s not going to drive an economy. D o you have
to choose between an economy or solving the public health crisis ? I
think as the rest of the world have shown , if you can solve the public
health crisis, by making people feel safe, by making people feel l ike
yes there will be cases but they will be contained , you will be able to
have lots of testing so you'll know at all times your status . The
economy can actually go on .

I f you don't do that and you can't get access to a test or a test result
for weeks , an d y ou don't have enough personal protective
equipment, then all you know is that you've got thousands and
thousands of people walking around spreading the virus . Many of
them don't have any symptoms and you're in complete out of control
until such time as someone shows up at the hospital. By that time the
train has left the station , so it's not complicated. People know what to
do. The White House plan put forward by Dr. Birx did pretty much
that. The President just chose to ignore it. He just chose the day after
he put it out to send out a tweet saying l iberate Michigan and l iberate
Minnesota. One day ’s attention span is not going to get us there.

Mark Masselli: Let me get your thoughts on the health care system as a whole. It
seems like we're at this inflec tion point as we think about maybe not
today but in the near future about how we might redesign and
reframe the health care infrastructure here in this country. We've
seen this rapid adoption of telehealth. There's much more though
associated with the oppo rtunities that are in front of us. I know at our
organization we're trying to sort of look at that path forward, if you
will . I ’ m wondering what your vision is of how the ongoing
transformation might be foundational to a new American health care
system.

An dy Slavitt: T here's three things I think that become crystal clear to anybody
paying attention about our health care system. I wrote about them in
rd
a piece in JAMA that came out July 3 . But beyond the basics three
things that really stood out as things ne eding change. The first is we
have to disconnect employment and insurance, and we have to
substitute that with existence. I exist I get insurance, not I'm
employed I get insurance, because it's too tenuous like not just during
a pandemic but younger genera tions of people are employed very
differently and they will be employed very differ ently.

The second , we need to put the center of the relationship with our

Andy Slavitt

physicians , not with insurance companies . W e should be setting up
relationships and paying directly care providers with some sort of
capitated value - based payment. T he reason I say that is because in
the middle of this crisis, peopl e pay their insurance premiums, an d
where did that insurance premium s it? It sat with insurance
companies in doctors ’ offic es who could have been the ones investing
in people's health with that money, we're struggling. W e can't have a
system that works for a middleman only. T he system the way it's
designed exacerbated problems, it didn't protect -- there was no built -
in resili ence . T he role that insurance companies play, many of those
functions are valuable, but they shoul d sit behind the care provider t o
help them take risk, managed care, coordinate care, etc. a nd they
c ould be paid for out of what's paid to a health care orga nization.

Th en the third thing is we need a health care system that's built on
equity, that doesn't think about or talk about equity and disparities as
an afterthought , doesn't mean the same. It means we get a health
care system that are designed for peopl e ’s c ircumstances . M any
people live in communities where they don't have broadband. They
live in communities where they don't have access to maternal health ,
parts of the country where people are older and they're sicker or
don't speak English, and we expe ct them to come to us. O ur system is
hard enough to navigate for people who are pretty good at navigating
it . Y ou're taking two buses to a dialysis appointment. We're not going
to get people healthier that way. W e need a system that is designed
with those needs in mind . W e need to stop reporting average piece of
data , w e're growing this by 5% , quality is here . W e have to start
talking about how that affects different subgroups.

When I was running CMS, and I said go talk to a hospital CEO and he
would say, w e're doing great at the A AA because we've increased
quality scores by 5%. My first question would be , what's happened to
quality s cores for your bottom quintile? Bottom 20% , h ow far away
are they from the average? Well, we don't know. H ow about rural
healt h community? Don't know. How about black c ommunity ? D on't
kn ow, the average doesn't matter. W hen w e talk about the average
we're talking about suburban, middle class white people, and guess
what , they're doing fine. The problem is we don't put any attentio n on
the people that the health care system is failing fo r which numbers
about 1 30 million people when you hea d out .

Margaret Flinter: We ’ve been speaking today with Andy Slavitt, former Acting
Administrator of the Centers for Medicare and Medicaid Service s
under President Obama and the F ounder of United States of Care and
T own H all V entures. You can follow his podcasts I n the B ubble and his
writings on medium by going to United States of care.org and
townhallventures.com or follow him on t witter @ A S lavit t . Andy,
thank you so much for your ongoing passion for improving American

Andy Slavitt

h ealth care for your commitment to finding bipartisan solutions and
for sharing your story on Conversations on Health Care.

Andy Slavitt: Thanks for having me.

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consu mer advocate
for voters that aim to reduce the level of deception in US p olitics. Lori,
what have you got for us this week?

Lori Robertson: The Centers for Disease Control and Prevention reported that through
th
May 30 14%, of confirmed coronavirus cases le ad to hospitalizations,
including 2% in intensive care units . But President Donald Trump
f alsely claimed 99% of cases are “ totally harmless ” . The President,
according to his press secretary was referring to the case fatality rate ,
a nd he claimed the amount of testing the US has conducted showed
this. The testing actually showed a case fatality rate of 4.5% when the
th
President made his comment over the July 4 weekend, but not
everyone who has contracted COVID - 19 the disease caused by the
virus has been test ed. Some estimates say the fatality rate among
those infected is likely around 1%.

Columbia University epidemiologist Stephen Mo r s e told us quote,
some estimates do place the mortality at about 1%. But he said that
didn't mean 99% of cases were totally har mless. In addition to those
who die, many are hospitalized. In June the CDC published data on the
nd th
1.3 million reported cases in the US from January 22 to May 30 ,
finding that 14% of patients were hospitalized , 2% were in the ICU ,
and 5% died. The World Health Organization also says that 13.8% of
confirmed coronavirus patients have severe disease and 6.1% hav e
critical cases.

Dr. Ashish Jha , Faculty Director of the Harvard Global Health Institute
said that the broad consensus is that the infection fatali ty rate is
between 0.6% and 1%, but that varies based on whether a population
is older or younger. But if someone spent weeks in a hospital and
survived , Jha said, “ T hat was not inconsequential . ” “E ven if the
infection fatality rate is about 1% that's a lo t of people .” S aid Dr. Lee
Riley, Professor and Chair of the Division of infectious D isease and
V accinology a t the University of California Berkeley School of Public
Health. There are also the financial ramifications of treatment, the
impact on hospitals o f the pandemic and the burden to the US health
system. Riley told us, not much is known about how frequently
COVID - 19 patients suffer long term effects. But there are signs that
the disease does not always completely resolve itself as rapidly as

Andy Slavitt

expected. T hat's my fact check for this week. I'm Lori Robertson,
Managing Editor of F act C heck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at www.chcradio.com . W e'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

M ark Masselli : Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Anxiety
disorders are on the rise among the nation's youth and experts in the
field of child psychology f eel the conditi on starts much earlier in
childhood, and it's far more common than previously thought . W ith
an estimated one in five children being affected, but too often these
so called internalizing disorders go undiagnosed. Unlike children with
more expressive conditi ons such as ADHD or Autism Spectrum
Disorder, young kids struggling wit h anxiety or depression o ften
internalize their symptoms, and may just seem like an introvert to the
casual observer.

University of Vermont Child Psychologist Ellen McGinnis says the
pr ocess of diagnosis for younger children is often painstaking and can
take months to confirm. Dr. Mc Ginnis says the traditional method of
diagnosis involves creating scenarios that induce anxiety, followed by
behavioral observation by clinicians, and the re sults can be inexact.
She teamed up with her husband and fellow researcher, biomedical
engineer Ryan McGinnis to create a wearable sensor that can pick up
on physical cues that suggest the presence of anxiety, using
accelerometers and simple algorithms to compare normal stress
responses.

Dr. Ellen McGinnis: A device is called an Inertial Measurement Unit and it's about the size
of a business card. W e strap that two belts on each child and when
they did the mood i nduction task, it has an accelerometer in it a nd so
we're able to pick up angular velocity speed, how much the child is
bending forward and backward and turning side to side . I t actually
picks up 100 samples per second, so much more than the eye can see.
W e were able to see if kids with anxiety and d epression move
differently in response to a potential threatening information , a nd
they do . K ids with disorder turn further away from the potential
threa t than kids without a disorder.

Mark Masselli: The research paper shows the device was nearly 85% accur ate in
making a correct diagnosis. S he says early diagnosis is the key to
avoiding more damaging manifestations of anxiety disorder later on .

Andy Slavitt

A simple wearable tool that can assist parents and clinicians in
determining if a child is suffering from anxiety disorder, leading to less
guesswork and more r apid diagnosis and treatment. Now that's a
bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli : Peace and Health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcast. If you have comments, please e - mail us at
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