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‘This is about fighting a war’: former Medicare administrator Andy Slavitt on what to expect in the months to come

Slavitt, the former Acting Administrator of the Centers for Medicare and Medicaid Services, was part of the team that fixed Healthcare.gov after its botched rollout.

Andy Slavitt
Andy Slavitt: "This is an existential crisis and we are going to lose lots and lots of our loved ones and friends and neighbors and it takes a bunch of more serious top down directive response to save every life possible."
REUTERS/Jason Reed

Every week for almost three years, Andy Slavitt flew from Minneapolis to Washington to work. But today, and for the foreseeable future, Slavitt is at home. And he wants you to know that. 

Slavitt, the former Acting Administrator of the Centers for Medicare and Medicaid Services, was part of the team that fixed Healthcare.gov after its botched rollout. Today, among other things, he is the board chair for United States of Care, a nonpartisan nonprofit that says they want to ensure health care for everyone.

Slavitt talked to MinnPost about the Federal government’s response to the coronavirus and how he expects the situation in the U.S. to evolve. The conversation is edited for clarity.

***

MinnPost: Are you on the ground right now in Minnesota? Are you in Edina? 

Andy Slavitt: I am at home. As my #StayHome campaign would suggest.

MP: So what are you seeing on the ground there in terms of: are folks staying home? Are you seeing folks outside walking by? 

AS: They’re staying home, they think they’re keeping good social distances. There’s certainly a need for the government to be clearer about what the guidelines are. I think the more strict the orders, the better.

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You know, in the 1918 flu, Minnesota had the lowest mortality rate in the country because the population stayed inside, followed strict social distancing guidelines and maintained them. We probably started a little later than we should have and we are probably not calling them as strictly as we should. And the federal government at every level needs to get on top of that.

MP: When you’re talking to policy makers at the state and local level, what have their interactions been like with the Trump administration? Because obviously there’s been some very public ones like [Michigan Gov.] Gretchen Whitmer, but I’m sort of curious what other folks are saying as they try to reach out and get what they need. 

AS: You know, any governor, and just like Dr. Birx and Dr. Fauci, needs to reconcile themselves with the fact that the president has a very fragile ego and he responds well to flattery. And if we want a [Department of Defense] ship to come down on the Great Lakes and park itself at Lake Superior, you know, you have to get on his good side. Shouldn’t have to be that way, but that’s how this administration is. And I think [Gov. Tim] Walz is smart enough and a straight shooter enough that he’s going to not have a bad relationship with the president of the time like this.

MP: What do you make of Vice President Mike Pence in the background being designated as someone to lead during this period? 

AS: I think the shape of this crisis is that it needs to be led by military operations people. Because we have to. This is about fighting a war. We’ve got to move logistical resources from place to place. Because we don’t have enough equipment where we need to do much better coordination. And what we have is sort of a loose affiliation of people without a clear command and control structure. You know, this is not about Mike Pence personally. It’s about the fact that he’s not the right type of person to manage a crisis at this kind of scale. And he has other duties as well. You know, this is an existential crisis and we are going to lose lots and lots of our loved ones and friends and neighbors and it takes a bunch of more serious top down directive response to save every life possible.

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MP: What do you foresee this looks like in August?

AS: I mean, the biggest problem and challenge in August is going to be, people are going to be cooped up for a lot of the time. They’re going to be running out of money, they’re going to be socially isolated. And we will be seeing improvements in case counts and we’ll be seeing improvements in death rates. And it will be entering election season.

And the president will want life to return to normal. He’ll want the NFL to play. And that’s a giant trap, because as we know, we won’t have enough herd immunity, at that point in time. And we will… unless we have amazing therapeutics that are out on the market — and I’m not ruling that out — then, we’ll get that second bump that people talk about in the Imperial College report and that we saw in many places in the 1918 flu. So my fear is that this has to be sustained for the right amount of time.

MP: What should people be looking at to understand how things will go forward?

AS: I’m a subscriber to the plan put out by AEI yesterday, on the triggers that they identify for moving to the next stage. And it’s probably today the most comprehensive piece on the path forward. Is not date driven. That’s really important. It’s event driven. It talks about the things that need to be in place before we can move to the next level.

It has four key stages that we’re going to have to go through and what we’re going to need to do to get there. And so if we get to those things in time then we can be moving much more rapidly. But we have to give our scientists time to catch up to this and we have to give our frontline healthcare workforce enough opportunity to manage this, so we don’t have people dying in hallways of hospitals.

MP: Are there any other hurdles that you think people should be aware of? 

AS: There’s going to be all kinds of pressures for us to move life back to normal. Look, we all want to move back to normal. And for a lot of people it’s going to be a significant sacrifice. But you know, the country — not [my] generation (I’m 53), the generation immediately before me, and certainly the younger generation — they’ve never been asked to sacrifice before. We’re used to having a country where we get what we want, when we want it. We have a healthy distrust of government. We like our independence and our freedom. Those are kind of our kind of our culture and our principle.

And you know, it’s hard to have three things going on at once: economic distress, losing loved ones, and then not being able to have the sociological connection points help you through tough times. It’s very difficult. So not going to deny that it’s difficult, but we’ll have to help each other resist the temptation to do things which will prolong the agony, because that will not only promote health agony, it will also help people with economic agony.