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

Andy Slavitt
REUTERS/Jason Reed
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."

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.

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.

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.

Comments (20)

  1. Submitted by Betsy Larey on 04/04/2020 - 08:35 am.

    Am I understanding this correctly? The author is implying that people will have to stay at home for 12-18 months? People need to work. There is not enough money you can print to take care of 330 million people for 12-18 months. I am all for social distancing, but we have to let people work. And if you think closing pools, beaches, golf courses is a good idea my opinion is it is not. People have to be able to enjoy outside to have some semblance of normalcy. We are playing golf in FL and practicing safe distancing. Target is only allowing so many in the store at one.time. We can do this without shutting down everything. Articles like this present a doomsday scenario for 18 months, which I think is overkill. Kind of like when you have cancer and the chemo kills you. There has to be a balance, and he’s not presenting a balanced option. You can do better. If this is the way its going to go in MN, I’ll stay in FL for the summer.

    • Submitted by Robert Gauthier on 04/04/2020 - 10:13 am.

      You are hearing him right, 12-18 months till it burns out. If you are in FL playing golf, you will likely get it and may or not survive, given FL hospitals. This is not an inconvenience, it is literally life and death. Hospitals in the SE are calling nationwide for anyone who is medical to come, I get 5-6 calls a day. Stay in FL if you want, we do not need another infected person up here.

      What might cut it short is emergence of a vaccine, but that is aways off. Testing would help, but the Orange one has completely botched that. We are all now seeing how PR was treated, we are all just pawns in a re-election campaign.

    • Submitted by BK Anderson on 04/04/2020 - 10:23 am.

      No, you are not, especially since Slavitt specifically says that a proper response plan “is not date driven…it’s event driven”.

      The (absurdly lengthy) AEI roadmap linked to indicates that a transition to “Stage II (reopening)” depends on whether a state has experienced a sustained reduction in new cases for 14 days and has ramped-up hospital preparedness. There’s no reason to think this can’t occur in most states (that are taking the crisis seriously) well before 12-18 months, so you are kind of being the doomsday alarmist here.

      Enjoy your time golfing and beach-combing in FL, but be aware it is being “led” by an extreme Trumpite stooge, the woefully unqualified “conservative” ideologue Ron DeSantis. Are you wiping down every flag-stick, ball washer and golf cart? Avoiding the 19th hole? I hope so!

    • Submitted by Tom Wilson on 04/04/2020 - 10:36 am.

      If I were you I’d head back to Minnesota. The Fla. governor fiddled around so long, Fla. may be the next covid hot spot! ps you might want to drive back, flying is a bad option!

    • Submitted by Sandra Nelson on 04/04/2020 - 11:25 am.

      Contrary to your assertion, Mr. Slavitt does not imply that people will have to “stay home for 12-18 months.” In fact, he does not mention a time frame at all. Rather, he refers to a plan that “Is not date driven. That’s really important. It’s event driven.”

      By the way, there is plenty to enjoy outside in the absence of “pools, beaches and golf courses.” I commend you for practicing safe distancing on your golf course, but please be aware that it is not the norm in Florida and several other states.

    • Submitted by Elsa Mack on 04/04/2020 - 02:15 pm.

      I can’t find anywhere in this article that Andy Slavitt says people will have to stay home for 12-18 months. If you look at the AEI plan that is linked to, they mention specific benchmarks for when we’ll be ready to start opening things up again: widespread testing capabilities, hospitals able to keep up with demand, number of cases diminishing for two weeks, etc. It doesn’t make sense to project a date until we start reaching those goals.

      Based on the Florida Department of Health’s Covid-19 dashboard, Florida currently has over 11,000 cases, with almost 1400 people in the hospital, and 191 deaths. Minnesota’s numbers are much, much lower. So evidence suggests that Florida overall is not actually handling the situation particularly well.

    • Submitted by Robert Ahles on 04/04/2020 - 02:34 pm.

      In what paragraph do you find that the “author is implying that people will have to stay at home for 12-18 months”? I just hope you stay in Florida and don’t come back to Minnesota to help spread this virus. You are the type of person that can’t listen and react to the experts.

  2. Submitted by BK Anderson on 04/04/2020 - 09:37 am.

    All very sensible stuff from Mr Slavitt. But it all presupposes the nation had a competent leader of the executive branch, a mature and informed person capable of wisdom, who had experienced non-sycophants advising him. And we don’t have that and can’t get that.

    The very idea that Trump (with his many severe personality disorders) could even understand personal sacrifice–let alone be willing to endure it–is dark comedy. He will do whatever he thinks will aid his “re-election” chances, nothing will have a higher priority than that. He is an anti-leader, the perfect antithesis of leadership.

    So the corona pandemic is certain to be absolutely as bad and lengthy as it can possibly be.

  3. Submitted by Connie Sullivan on 04/04/2020 - 12:06 pm.

    The only response to people like Betsy, who flee to warmer climates during Minnesota winters, is to suggest that they stay where they are and not return yet to Minnesota. Here we are working together as a large community to slow the spread of CoVid19 in the state, and our Governor Walz has been following all the best scientific ad medical rules for how to get Minnesotans to do this sheltering in place. Unlike too many snowbirds, we’ve been taking this pandemic seriously and our current routines would not be to Betsy’s liking.

    The link that this article provides will inform Betsy about how scientists and governments identify each stage of the response to the virus and how we eventually will be able to ease up–or not. I advise Betsy to read it.

    In the meantime, those who are willfully ignorant enough to still be gathering to play golf in Florida had best know that, up here, you’re not going to be able to play golf. Or do much of anything social until Minnesota gets a handle on the virus. Stay there, Betsy and if you can, stay healthy!

  4. Submitted by Barry Peterson on 04/04/2020 - 12:09 pm.

    I am happy to stay indoors and not worry about summer fun at the beaches and aquatic parks. I believe Mr. Slavitt has the right idea. I have been reading about the Spanish flu of 1918. Minnesota Daily, University of Minnesota’s student newspaper, did a really great story on that episode in our state’s history earlier this week, and it hit home the need to be aware of science.

    Other journals that I’ve been reading in both the United States and from Singapore, Japan, and other nations (which have a digital presence), are telling the story of the importance of early distancing intervention. Stories from friends who live in east and southern China, who have been asked to limit their exposure to others, have also affected my understanding of the need to control this virus’ spread.

    I am content to watch movies on Netflix and Youtube. There is a lot of other entertainment, in terms of music that is being played in online concerts, and television programs. Children’s magazines are putting out recommendations for activities for children to learn science from their homes, as well as other activities.

    I am not happy that barber shops are not open, as I get my shampoo from Sports Clips, which is the best unscented shampoo that I have ever used. That in mind, I called the governor’s office this morning, Saturday, April 4, and politely suggested that hair salons be opened and that operators should use the same kind of face masks that I had to put on when visiting University of Minnesota Physicians (UMP) Mill City Clinic a few weeks ago. If liquor stores can be open, so too do I believe barber shops and hair salons should be open.

    However, I am interested in doing whatever is necessary to contain COVID-19 in our state. So, I refuse to lambaste politicians for taking action intended to slow and stop the spread of this virus. It is not a joke, and I hope that people who are adverse to a momentary slowdown in their liberties will understand that it is necessary to save lives — if not our own, than others whose immune systems are weak and who may be adversely or mortally affected by our presence if we are carriers of this disease.

    • Submitted by Barry Peterson on 04/04/2020 - 12:48 pm.

      One of the children’s magazines that I found online, http://www.boyslife.com, is a magazine from my youth when I was a Cub Scout and later a Boy Scout. The ideas work exceptionally well for girls and young women, as well.

      Form information on activities for children, please google: children’s magazines activities for children online.

  5. Submitted by Richard O'Neil on 04/04/2020 - 01:58 pm.

    This commentary is not in any way positive. In other words there is no hope.

    • Submitted by Barry Peterson on 04/04/2020 - 04:03 pm.

      Richard,

      There is hope. Please contact your state representative and/or senator to share your concerns.

      Please do as I have been doing, which is relaxing and just letting life happen around me as I secure aid from the state and federal government for time that has been lost to this virus.

      I have lost customers and am awaiting remedial pay from the government for my business.

      Please learn about the CARES Act of 2020.

      You may also contact your U.S. representative or U.S. senator’s office for help in understanding options available to you for gaining income during downtime in your business or job.

      Please google: U.S. Senate and Representative’s office for Minnesota, and the same for your state representative and senator for your city.

      Best wishes!

      • Submitted by Barry Peterson on 04/04/2020 - 06:11 pm.

        To Richard O’Neil and Others,

        While I generally agree with the stay at home order and the shut down of many business for a while in an effort to mitigate the spread of this deadly form of coronavirus, I have also shared my concerns with the office of our Minnesota governor.

        To reach the governor’s voicemail service, which they listen to and consider (I have been aware of it for years and have actually received a positive response from a couple of the office staff), please call them at 651-201-3400. You may reach a member of the staff, or you may reach an answering line with a recorded message. They are busy answering many calls, so please leave a message if you do not get a live operator.

        651-201-3400.

  6. Submitted by Elizabeth Lund on 04/04/2020 - 05:26 pm.

    Not everyone will need to socially isolate once we have immunity testing. Many people get sick and get better without a test that confirms that they have had covid 19 so even though they now have antibodies, they must continue to self isolate. The number of people who need to isolate will at some point be limited to those who have not yet developed an immunity once we are able to test everyone for antibodies. Social isolation may go on for 18 or so months but for fewer and fewer people. Economy will gradually recover, mental health will gradually recover, virus will be held at bay until a vaccine arrives. I like phase 4 of the report, build a system that is ready for the next pandemic, whenever that may be.

  7. Submitted by Monte Gumba on 04/07/2020 - 08:19 am.

    Sorry Slavitt is a hyper-politicized voice in all of this. He predicted that most U.S. hospitals would be overrun by the second week of March.

    https://www.theguardian.com/world/2020/mar/14/coronavirus-us-hopsitals-healthcare-andy-slavitt

    We are still under the hospitalizations and death rates that our bad flu season led to, just two years ago (2017-18)

    https://gis.cdc.gov/GRASP/Fluview/FluHospRates.html

    While of course COVID-19 is a serious issue, that should indeed require a serous response – but the media-induced socioeconomic disaster has already eclipsed the medical-health one caused by the virus.

    I am in no way a fan of Trump and his general constituency but how can we trust sources like this when you attempt to frame someone like Slavitt as anything but a hyper-partisan political actor….?

    • Submitted by Monte Gumba on 04/07/2020 - 08:30 am.

      Also, I am very wary of politicians and other public figures using the “this is a war” analogy – while I understand the sentiment of a call to arms, I fear that is not what many of them are actually getting at…

      If we are at war with this virus, what does it mean about people who are infected? Are they traitors, should we treat each other as possible infected agents? This may sound hyperbolic but I think this framing has already led to in a major increase in the already popular practice of public shaming…but its also already led to degrading civil liberties.

      Slavitt himself says here clearly, if he were in charge he would have the military leading the fight….this means troops on the streets, enforced curfews….sounds like a nightmare…

  8. Submitted by Barry Peterson on 04/04/2020 - 07:02 pm.

    Florida has a population of people over the age of 65 at 20.5%. They are in the range of people who die at higher numbers than younger and healthy people. In Governor DeSantis’ state, that brings well over four million people nito the range of those who are easiest made ill and who die in number about about 4% of the affected population.

  9. Submitted by BK Anderson on 04/05/2020 - 08:30 am.

    All of which means DeSantis’s blase, virtually denialist attitude to this dangerous pandemic verges on the criminal.

    But since a (small) majority of Floridians were braindead enough to elect this spiteful Trumpite stooge (assuming one trusts the Repub election machinery down there), I suppose the old adage “one reaps what one sows” applies.

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