Prescription Drug Costs Are About to Drop (with Sec. Xavier Becerra)

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Prescription drugs are about to become more affordable for millions of Americans, despite the efforts of the pharmaceutical lobby. HHS Secretary Xavier Becerra joins Andy to talk about the fight to control drug costs, how it relates to containing inflation and what it means for your wallet. They also dig in on the Administration’s efforts to keep abortion accessable following the Dobbs decision and more in this wide ranging discussion.

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Follow Sec. Xavier Becerra on Twitter @SecBecerra.

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Andy Slavitt, Xavier Becerra

Andy Slavitt  00:16

This is IN THE BUBBLE with Andy Slavitt. If you heard Monday’s episode with Katelyn Jetelina, it should be fairly clear that there are some warning signs that we’re going to see a winter wave of COVID-19. The questions are, how bad, what’s the severity? Which variants? How well will the boosters do? Will people get boosted? Many of these are answers we don’t have yet. But we have given our best shot on Monday with one of the best people around who looks at all of the data. And we’re going to amp that up a bit further today. With a conversation with Xavier Becerra, the Secretary of Health and Human Services. Secretary Becerra was a congress person from Los Angeles for a long time. One of the most senior people in the Hispanic Caucus, I believe, if not the head of the Hispanic Caucus. Then he was attorney general California where he played a notable role in defending the Affordable Care Act at the Supreme Court. And today he runs all of HHS, which is we’ll get into includes the CDC includes the FDA includes Medicare and Medicaid and the ECA, all of which I used to work on in the Obama administration, and a number of other important areas, the NIH. So it’s basically all the people you hear every day Tony Fauci, Rochelle Walensky. He’s their boss. And so I wanted to take the opportunity with Secretary Becerra to not so much drill into the pandemic conversation because I believe people a little bit perhaps closer to the day to day, like Katelyn Jetelina, like other guests we’ve had like Tony Fauci and Ashish Jha who are frequently will give you their better perspective, I wanted to take the opportunity because you spend every day we get to get it Cabinet Secretary on this or any show to explore some of the bigger issues and bigger questions on people’s minds. And you’re gonna see I start in a very funny place with him, actually started with how his job can help impact inflation, and then talk about things in the minds of many Americans around their health like prescription drug costs, like the inequitable access resources, like untrustworthy communication coming out of the CDC. And I do think it’s important to drill in on this victory against prescription drug companies who really were able to charge exorbitant prices for prescription drugs and how that’s about to change pretty dramatically. So interesting conversation should cover many of the things we care about under health that we get to hear. And so without delay, let me bring on the secretary Xavier Becerra.

Andy Slavitt  04:28

Great to be with you, Secretary Becerra, how’s my favorite department doing?

Xavier Becerra  04:31

Hey, we’re hanging in there, we’re keeping busy?

Andy Slavitt  04:34

For those who don’t know, the Department of Health and Human Services contains the CDC, which we all know the FDA, NIH, Medicare and Medicaid, the Affordable Care Act, and I think that’s probably only about half of your agencies, right?

Xavier Becerra  04:48

Yeah, we take care of all those migrant children who come across the border unaccompanied. We deal with it, believe it or not infant formula, but when there was a shortage. As you know, if Ebola is a threat, we have to get ready for that. Monkey pox, you name it, we do it.

Andy Slavitt  05:08

Are hard to say that there’s a more central agency department in the lives of Americans, you’re touching almost everybody with these programs, and certainly over the last few years a central role. So maybe we could just dig into some of the things that are really affecting the American people today. And I’m actually not going to start with health, I’m going to start with money, people’s pocketbooks, because inflation is a topic that a lot of people’s minds, healthcare is now being attributed as a significant cause of inflation. It’s hitting people in their pocketbooks. So maybe you could start with how you see that, what the administration and the department are doing to try to combat healthcare, inflation and put more money in people’s pockets.

Xavier Becerra  05:54

Yeah, we all, you know, have to balance those checkbooks. And we’re seeing that prices have gone up. And I know the President is working real hard to bring prices down, especially with gasoline. And when it comes to health care, the last thing you need to do is drive to the doctor’s office or the hospital find out you got a big medical bill as well. And so we’re going to tackle that. And the President worked hard to make sure Congress gave us the authority to actually for the first time that you and I can ever recall in the history of our lives, be able to actually negotiate for a better drug price for American consumers, and certainly for those in Medicare. And that’s a big one, because I know, when you were here at HHS, Andy, that was a big issue. We never got to tackle it. Pharmaceutical industry is very powerful. But the inflation Reduction Act now gives us gives me for the first time, the authority to actually try to negotiate for 65 million people, better drug prices. And when you know that we’re paying two to three times more in America, in price for the same drug that someone else in another country is getting for a far better price. And that drug may have been manufactured here in the US. It’s not right, right. So we have to do everything we can help to stabilize prices.

Andy Slavitt  07:08

So my mom spends, she’s on Medicare, she spends 1000s of dollars a year under prescription drugs alone. How is what you’re talking about going to impact her, we also have friends with diabetes, who’ve been paying an awful lot of money for insulin, you know, when you have a condition like that it just overwhelms every element of your life. And so is this something that’s going to be able to be tackled.

Xavier Becerra  07:32

So those who you know, who need insulin, maybe they have diabetes, some people pay hundreds of dollars a month to get their insulin, starting next year $35 cap, you will not have to pay more than $35 a month for your insulin services if you’re on Medicare, and you need that insulin, and in a year or so later after that, as a result of the inflation Reduction Act, those out of pocket expenses that your mom pays, I don’t know how much it is. But if it’s more than 2000, she won’t have to worry, because that’s the most you’ll have to put out of pocket. And I was in New Mexico, and I heard a story of a woman who’s on Medicare, who had a bill of $90,000 in the year. And so she just can’t wait till we get that $2,000 cap in place.

Andy Slavitt  08:21

So you mentioned the pharmaceutical industry, which from what I recall, along with maybe the gun lobby, and maybe oil and gas is about as powerful in industry special interest group is you’re going to find in Washington. And I think that’s still the case. You know, they’re making the claim or they’re trying to make the claim that you can’t have both affordability and innovation. You got to choose one that you can either afford your medicine, or you could have new drugs. What’s wrong with that argument? Are they right or is that wrong?

Xavier Becerra  08:54

I’d have them read anything. Henry Ford wrote way back in the early 1900s, when he made it possible for more Americans to be able to own a vehicle than ever before. People thought that would be out of the price range, and we’d have to have horse and buggy for the next century. We can do this. Absolutely, we can. I think the question I would ask back to the pharmaceutical industry is why do Americans have to pay 2, 3, 4 times more for the same drug that they’re selling to other people in other countries for far less?

Andy Slavitt  09:23

So the other thing, driving inflation is labor costs. Right? And it maybe it gives me an opportunity to ask you just about the men and women and other individuals who work in the healthcare system in the US doctors, nurses technicians, who’ve had a really, you know, we’ve called them heroes. But sometimes those words have meaning sometimes it’s been hollow because they’ve worked so many hours, and a lot of them are burned out until there’s this sense that there’s hundreds of 1000s of people who are a big part of the healthcare workforce. And they’ve been thinking about leaving the workforce or already leaving the workforce that’s causing a lot of strain. And it’s part of the price issue, you’re in any thoughts about, like how to speak to those folks and kind of how we think about reinvigorating this kind of this workforce and avoiding some of the shortages?

Xavier Becerra  10:16

You know, we always talk about earning a living, it’s hard to say that we’re rewarding work when you’re coming home, dead tired, and you may not be able to afford everything you need for your family. And so we have to really rethink our priorities. And we’re trying to help, we’ve made investments of hundreds of millions of dollars, to help with providers who really stuck with us during the COVID pandemic, to try to help them through this very difficult period. But we definitely have to make sure we’re focusing on the workforce, because we need more of them, not fewer of them. And in some areas of the profession, you can make more money flipping burgers at McDonald’s. And that just doesn’t seem right.

Andy Slavitt  11:01

Sure. I’m wondering how this notion of virtual care enters into this labor pictures, Mr. Secretary, a lot of Americans got used to during the pandemic, healthcare beginning to work like other things in their life where you know, you don’t have to go to the store and buy something you can get on your phone or your computer to talk to whether it’s a behavioral health specialist or your primary care doc or something like that. And they seem to like it, and clinicians seem to like it. And it’s just more how the world seemed to work. And it also allows labor to go further. So it takes some of the inflationary pressure off, and maybe not for nothing. He gives clinicians more options in terms of how they want to work and stay in the workforce. But when the pandemic is officially declared, the public emergency is over. A lot of that virtual care won’t be paid for any longer. The mental health care will be for Medicare, but physical health would be scheduled to I think it needs congressional support. Do you guys have a view and the administration and the department about that situation? And is it indeed something that you’d like to try to find ways to keep going?

Xavier Becerra  12:06

Without a doubt, I think there’s almost consensus today that we need to keep telehealth going. We saw how important it was for rural America to be able to access their provider without having to travel be in person. We know that with technology just as we’re doing this interview, you can easily communicate with a doctor or a health professional. And there’s no reason to turn back. Congress, I think, understands that. We’re working with them to try to make sure we adapt and adopt some of those changes. But we need them soon. Because the last thing we need is to go back to the days when too many people missed their health care appointments.

Andy Slavitt  12:44

Let’s take a quick break. I want to come back with Xavier Becerra to talk about the question on so many people’s minds, which are what can administration do about the Dobbs case and about women’s loss of access to reproductive rights in many parts of the country. Let’s turn to another topic that’s on American’s mind and that’s reproductive rights. Abortion. So look, we both know what happened over the last number of months adaptive decision came down Yeah. For so many it was worse than a body blow. Whether they might have expected it or seen it coming or not, in fact, it was the government telling, you know, half the population, you know, your rights don’t matter, your body’s not your own. And what we’ve seen since then is it turns out that it’s not just abortion that’s being made illegal in a number of states. But it’s actually other elements of being pregnant and being fertile. If you, for example, we’ve heard from women who they’re pregnant, and then they get cancer. And the state gets to decide oftentimes, what the woman can do to treat her cancer because it affects the fetus, which is something that state now claims that they have the rights to represent. So it’s a really, it’s a tough issue, people, it’s messy. And so I’m wondering how you think about what opportunities there are to protect these rights for people? How some of this stuff is it’s getting is that happened in states and some of the worst abuses and the no excuses and all of these things that are resulting in sadness and death, not just for women, but for girls.

Xavier Becerra  16:01

Yeah, yeah, well, and first, let’s make sure we’re clear, I think we always as Americans understand that our health is precious. And we want to be able to do everything we can to maintain our health and make it better. And we believe as American citizens that we have that right to that personal decision, that freedom to make a decision about what’s best for our healthcare, not have somebody far away in political office make those decisions for you. And it just seems that autonomy that we used to respect and crave is going away, at least for a segment of our population for women. And it’s unfortunate, because there are consequences, as you just mentioned. So President Biden has made it very clear his administration, our folks at HHS, we’re going to do everything we can to protect a woman’s reproductive health. That means giving her access to the health care she needs, not what someone else says she needs, but what she believes she needs after consulting with her doctor, or whoever she respects. And that means making sure that, for example, something as simple as protecting her privacy rights when she goes and sees a provider, and protecting the provider who may need to have information about the services protected, it means making sure that a woman not only has access to reproductive health care services like abortion she might need, but also birth control services, and medication abortion services that are early upfront services during the time that there might be a detected pregnancy. All of that, on top of the fact that it just doesn’t seem right that in order for you to be able to exercise your rights to your own personal decisions on health care, you may have to travel hundreds, if not 1000s of miles. And so we’re going to do everything we can to protect every American’s right to make their own choices, and their own have the freedom to make their decisions on what’s best for their health.

Andy Slavitt  18:00

There’s a couple of things you mentioned that I’ve heard people talk about. I’m curious if you could comment, one is medication assisted abortion, should that be available? And is in when would it be legal to get access to those prescriptions in any state in the country? And then the second question is, you know, there is federal land in every state. There’s military bases, there’s VA hospitals with train staff. And is it conceivable that women who are in states where abortion has been made illegal, could have access to federal lands, for access to abortion?

Xavier Becerra  18:39

So on the first question about medication, abortion, you can’t go in to get any kind of treatment in any provider health care provider, unless it’s gone through the process to make sure it is safe. It’s an effective service or treatment. And so we have regulations and we have oversight to make sure that the whatever might be called medical services, is actually gone through the tests. So we are letting Americans get what they need. We know that medication abortion, the FDA has certified that it is safe, it is effective, and therefore it is authorized, it is legal. And so we’ll do everything we can to protect an American’s right to have that type of medication that’s been proven to be safe and effective for over 20 years, and will continue to do that. On the question of where a woman could go to exercise her reproductive health care rights. We will do everything we can to make sure that she’s able to reach the services she needs. Hopefully it’s close by but if it’s not, we’re going to work to make sure that something is available accessible, that’s real quality that will give her decent services, because the last thing you want is to leave people without the peace of mind And when they are really desperate to make sure they get the right health care.

Andy Slavitt  20:04

You know, sadly, we find ourselves yet again talking about people politicizing other people’s health. And, you know, we’re obviously we’re a couple of weeks away from a midterm election. So it’s hard not to even think about how politics plays into things. And, you know, I reminds me of you and I first met and started spending time together when you were in the Congress, and we were talking about it, make sure every American could get access to the benefits and the rights protecting the Affordable Care Act. So are we facing another election where again, people have to really think about the outcome of their health?

Xavier Becerra  20:37

Well and I’ll let the politics play its way out. We’re talking about health care, and I’m speaking to you as the secretary. So I want to respect my lane here, where I can go and can’t go I’m not I’m no longer a member of Congress, who has the freedom to just talk on any subject. But what I can tell you is this. I don’t, I don’t think it matters what type of government official you are, you should be in the business of trying to expand access to care, to include more not to exclude people, and not to ban care. And I don’t believe health care ever should be about exclusion, and leaving people behind. And so we’ll keep working. But we’ve made some great progress. There are more Americans today, as you know, Andy, who have health coverage, health insurance than ever in the history of the United States, more than 300 million Americans have access to care. And that peace of mind that comes with it, we have the lowest rate of uninsurance healthcare uninsurance that you and I have ever seen in the history of the country, the lowest rates were down about 8% is still too high. But it used to be about 16% or higher, no more than 10-20 years ago. And so we’re making great progress, because we’re being more inclusive. We’re trying to expand people’s rights, not shrink their rights and exclude people.

Xavier Becerra  20:49

Let the record also note that we have an administration or at least a Cabinet Secretary that cares about the Hatch Act, which is unusual compared to the last administration. And we’ll put a link to what the Hatch Act is in our show notes. People want to know what that’s all about. Let’s turn to the COVID-19. And kind of where we stand with the pandemic. Certainly, you have a number of people from your department and from the administration, who’ve done a lot of work to make sure we have high quality boosters that have been updated in drugstores everywhere around the country. This obviously was something that I was working on back in the day, it seems like 50 years ago, but at this point in time, we’re having a real challenge getting people to listen, and to get boosted. And I think it’s beyond, like people who are getting anti-vaccine and all that, but seems to be that that a number of Americans are just sort of not taking advantage of kind of what is a very good protective health measure. And furthermore, when you get into certain parts of the country, great drugs like Pax COVID, which the FDA worked hard with manufacturers to get to people sales aren’t being prescribed very much. How do you guys think about what more can you say about how to meet this challenge?

Xavier Becerra  23:28

Yeah, and let me make sure we present the full picture there are today, more than 90% of Americans have gotten at least one vaccine shot. That’s pretty darn good. We have put more than 627 million vaccine shots in the arms of Americans. Some for the first time, some the got the second shot, some have gotten the booster and the second booster, and several million now have gotten the updated vaccine, which we hope in the future will become the once a year vaccine you get on COVID The way you get a vaccine once a year for flu. At the same time. We still have more than 300 Americans dying every day from COVID. We still have several 1000 Americans who are going to the hospital every day from COVID. And so the most important thing we can do is tell Americans the facts. There’s so much disinformation out there. Andy, what I can tell you is this, our updated vaccine this by Vaillant vaccine as it’s called because it attacks not just the original version of COVID but also the Omicron version of COVID which is hitting hardest here. It is going to make the holidays go well for those who get that shot. So I would really encourage folks to know the facts. Know the numbers follow along with so many other millions of Americans and get yourself vaccinated so you can really enjoy the holidays and hug your loved ones and really enjoy that dinner around the table without having to wear a mask, it is so important that we just realize that what’s been safe and effective continues to be so.

Andy Slavitt  25:08

Yeah. Look, I really appreciate the very straight clear communication around a topic that people can be confused about. And it’s funny I spent the last three days with Governor Newsom, who says hello, by the way. And, you know, one of the things we were talking about was the kind of erosion of trust in government and government messengers as it relates to health. But as you know, it relates to almost every topic under the sun. So you step back and think about kind of lessons from the pandemic and how we work on issues like trust. What comes to mind for you?

Xavier Becerra  25:46

So a great question. And I first I’d say, if you if you lay the facts, next to the hype, and the myth, the facts really speak for themselves, they easily take out the myth, the hype, the misinformation and disinformation. I just wish that people knew how to distinguish the misinformation from the real information, the facts on how effective these vaccines have been. But the other thing I’ll say is this, if we could take out the distortion of politics, in our conversation about the vaccine, about COVID, in this pandemic, we get a lot more Americans who, who would be getting that update up to date booster, because they realize that they’re doing not just themselves a service, but their family members. Because today, the reality is, the Americans who we see dying, are Americans who have a lower immunity threshold, or Americans who are in their older age, and who wants to be the American, the family member who infects grandma, during the holidays. You know, it’s it just doesn’t make sense at the end of the day. And we have to do everything we can to make sure people have the facts. And then they can make the decision because we have made vaccines available for free, within five miles of where you live. And so there’s no reason why you can’t get it. And, and oftentimes, because some people, some communities, you got folks who work two or three jobs, they got to go home right away to take care of family. For them, it is a really difficult thing, they don’t get time off from work, they don’t get, you know, paid lunchtime to go out and get the vaccine, we’re gonna go to them, we’re not going to wait for them to come to us, we’re going to go to them.

Andy Slavitt  27:29

You know, one of the things that pandemic shines a light on is a topic that you’ve cared about deeply for a long, long time. And that’s the sort of inequitable access of resources to people in this country. And you know, whether you’re because of the color of your skin, or because you live in a rural town, or because you don’t speak English as a first language, we’ve got really massive inequities that were and they were all on display, during the pandemic, in terms of who was dying more frequently, and who was getting sick more frequently. So can you discuss how the department is thinking about this whole notion of health equity, and how to use a pandemic to just change the way things work?

Xavier Becerra  28:12

How well I sort of refer to it because what we’re finding, and by the way, there are more Americans of Latino descent who have access to health care today because of insurance than ever before. There are more African Americans today who have access to health care, because they’re insured as well. As I said, we have the largest number of Americans who are insured. So that has brought so many.

Andy Slavitt  28:34

You used to call me every week, when I was in administration, you were in Congress to say, Andy, how are we doing on making sure that Black and Brown people, people who speak English as a first language, others are getting through the application process with ease, so a lot of people have insurance because you decided to make sure you’re kicking my butt.

Xavier Becerra  28:54

Well, and you decided to do your work. And you really made sure that we launched in a way that helped get those populations into the mix. And that’s, that’s a precious thing. But what we’re finding is that, if you just reach them, they want to do the right thing. They just have to make sure they understand what the right thing is, and that they know it’s readily available. When I go to sub communities. And I say to them, the vaccine is free. They don’t think it applies to them. And I had I heard a story of a farm worker who had failed, had not come in and get a vaccine and two more until recently. And the reason he explained that at this clinic health clinic that he attended, he gets out of work very late, and he has other responsibility, he has to rent too. And he’s afraid that because he’s always very sweaty and dirty after working in the field, that he was embarrassed to come in to the clinics that hospital settings, dirty and sweaty. And so he waited until he felt like he could shower but he kept waiting and never got it. So he came in dirty. And he said I apologize that I’m coming into Ready and dirty, but otherwise I can’t get the shot. That’s the kind of the story you’re hearing. And look, we can reach these folks. And uh, you and I know it. And we’re doing it. We when I started my position as secretary, a year and five or so months ago, we were already seeing the disparities, white adult Americans were by at that point in the spring of 2021, were about two thirds, vaccinated, two thirds of them had gotten vaccinations, barely about 50% of Black adults and Latino adults had gotten shot. And so we were seeing the disparities already. And we said, No, we just can’t do this. And I’m proud to say that a year or so later, we erase that disparity so that white Americans, Asian Americans, Black Americans, Latino Americans, Native Americans, we at all at that, by that point earlier this year reached that 90% threshold.

Andy Slavitt  30:52

It’s an amazing story, because it had never been done before in healthcare, where inequity gap was closed like that with one exception, which actually, you should also be proud of which is expanded Medicaid and states that expanded Medicaid disparity gaps have closed. Let’s take a break here. We’ll come right back and talk about all these efforts coming together. And kind of how it’s being sort of undone by the mental health crisis and the fact that we’re actually losing life expectancy in this country over the last few years for the first time ever, so we’ll be right back with Xavier Becerra. I want to take disparities out of the context of COVID-19 just into the general context of Medicare and Medicaid. Yeah, which is overseen by my favorite department, lots of friends, both of ours that are doing great work there, and talk about how they use the Medicare and Medicaid program to take some of the lessons maybe that success that you just referred to, and stamp out the inequities that exist every day for Black and Brown Americans, rural Americans and others.

Xavier Becerra  33:09

Well, and I’m going to throw a term out there that I’ll try not to use again, because I don’t want to, you know, folks sick accused policymakers and vote folks in government from using all these terms that don’t make sense. But social determinants of health you and I know this term, when I was in Congress, very few people ever use it or knew what it meant. And what it simply what it means is, there are a whole bunch of things going into your health and making you healthy. And one of those is has may not have anything to do with a hospital, a doctor, or what you consider health care. It has to do with your environment. It has to do with your work conditions, who are whether or not you have access to good housing, or good nutritious food, and all those things within our society, those social determinants drive what happens to our health. And so should not surprise people that in parts of the country where you don’t have access to good, fresh fruits and vegetables and so forth, that oftentimes you see high rates of diabetes. And so because far more people understand what we mean by social determinants of health, because we’re doing so much more to tackle those, we’re making some real progress. So there are states like my state of California, that has moved in, in the Medicaid setting. So that today when we talk about improving health care for those who are lower income, and that’s what Medicaid is for, for lower income. We don’t have to worry only about what you do in the hospital or at the doctor’s office. But we’re allowing states to experiment to make sure that your overall day and life we try to make sure it’s healthy. So are you accessing nutritious food? Do you have a safe way to get to work? Are your kids having access to basic health care, preventative healthcare services, maybe through the school through a school nurse? We’re going to do everything we can to make sure Medicaid goes into those areas that affect your Health, but more traditionally, over the years had never really been willing to help cover some of those costs. And because of that, we think we’re going to make not only a more well-rounded American, but we’re also going to help our economy.

Andy Slavitt  35:14

Yeah. And for those who are interested, I’ll put a link to […], which has the name of the program, you just refer to in our show notes. And, indeed, I think four states now, where you can get services paid for that help you stay healthy, rather than just paying for expensive health care when you get sick. And of course, one of those social determinants, you know, is becoming very real is climate, and what’s happening to people who are impacted by climate change, right?

Xavier Becerra  35:40

Absolutely. If you can’t have safe drinking water while you’re in trouble. But if you have no water, you’re in deep doo doo. As they say, there are communities I know even in my, you know, very wealthy state of California, where you try to turn on the tap, and nothing comes out because your wells have run dry. And so talk about how you live when you don’t have access to basic water through your faucet, you have to depend on bottled water all the time, that could really impact things. I used to represent a district in Los Angeles when I was in Congress, in East Los Angeles in downtown Los Angeles, where we had so many of the major freeway intersections within the district. Well, those freeway interchanges, as you know, sometimes get clogged with cars, all spewing exhaust, and there are communities homes right below those freeway exchanges. Those are kids playing playgrounds, in backyards, breathing, all that stuff, all that impacts health, and we know it very well. And that’s why it’s so important to tackle climate change, as you talk about health care.

Andy Slavitt  36:44

Yeah. So some up with a couple a couple of things. And I think, you know, I think about all the initiatives you talked about, and indeed, all the research at an age, all of the public health work at CDC, the cures that FDA approves some of the social determinants of health and health equity work in Medicare and Medicaid. And I can’t help it like when I when I bottom line at all, be struck by the fact that we’re losing years life expectancy in this country, this goes back before the pandemic is, you know, but well before your time in office, but it’s sort of been a real significant problem. There’s a lot of issues obviously caught up in that, including mental health, addiction, diseases of despair suicide. So that’s certainly one of the one of the major factors, I guess, you know, at the end of the day, you know, it’s the thing that ultimately, policymakers have a big role to play in and, and have some accountability for what can be done. I mean, what’s the what are the some of the dramatic big picture shifts needed. So we could turn around that that sad story of declining life expectancy?

Xavier Becerra  37:54

Andy, it’s actually pretty simple, you just have to be willing to do it and put a little bit of money behind it because you save so much money at the end of the day. And quick example, we are now inviting states under Medicaid to offer to pregnant women who are going to have a baby, instead of only providing them with the traditional under Medicaid 60 days of coverage after they deliver the baby, the postpartum care, 60 days offer them 365 days of health care coverage, because what we’re seeing in the numbers is that oftentimes death or bad outcomes for baby and for mom occur in those first 365 days. So if we stop giving that woman who’s a new mother, and her baby access to the kind of care that helps her nurture her baby along for more than two months, you see problems. And so more than half of the states now have taken up our challenge, and are now offering women in America access to 365 days of postpartum care, which I think is going to be a game changer, especially in the Black and Native American communities where we see really, really disparate results compared to other Americans. That’s one clear case of how we’re going to make a difference. And I think if we do little things like that, we’re going to see a big change. But the biggest problem we have Andy and you know this, is we have a very porous, public health care system. We don’t have a nationwide system of health care. It is a system that’s based on each state because the Constitution left health in the hands of the states. So you can go from one state that offers really good care to another that may not. And so those gaps are essentially one of the reasons why the wealthiest nation in the world had some of the worst health outcomes when it came to COVID. And why we weren’t able to stop it and so many Americans have died. We have a poorest health care system. And if we could plug those holes so that people wouldn’t fall through those cracks and die, we’d be far better off. And so we’re trying to do everything we can to shore up the system, we’re helping a lot of the community health centers, I know that you were a big supporter of the federally qualified community health care centers, we’re doing everything we can to help on the behavioral health side, and I just got to put in a plug for 988. That’s the new three digit number, the lifeline number for those who are contemplating suicide, or having real mental stress. If you’re not sure what to do, and  you’re about to take the wrong fork in the road, please call 988. And we’ll be there to help. We’ve launched on July 16th, with this three digit number, it used to be 10 digits, and used to be a different 10 digit number, depending on what state you were in today is just three digits. So it’s like 911, but 988 that we saw from August of 2021, last year to August of this year, when we had just had a month of data coming in, 45% increase in the number of people calling in. So there are ways that we can do this. It’s not rocket science.

Andy Slavitt  41:04

Yeah, we did. We did a great episode on it. In fact, we’ve launched the entire show about 988. A parallel show, because it’s so important. And it just it really brings home. What is becoming an almost overwhelming crisis among kids among adults in depression, and anxiety in more severe mental illnesses in addiction. You know, obviously, we have problems like fentanyl, which we’ve done a show on, which is a whole another topic. But we all are think are starting to recognize a problem. And the good news is I think there’s a lot less stigma. But we still lack the number of mental health resources and counselors. How important is this as a priority for the administration?

Xavier Becerra  41:46

Well, remember, during the State of the Union Address, the President made a historic announcement, and a historic investment in his budget for behavioral health, mental health services, drug addiction services, and we’re hoping that Congress will follow through and match the President’s commitment by giving us real money for the budget, because we’ve never seen a president really dedicate that type of attention. And resources, they, as I say, your budget speaks to your values. And so we hope that we’re able to really go heavy on addressing the needs and mental health care, especially with our youth, the rates of suicide ideation, is growing among teenagers. Just under 988, we have a text and chat function. So it’s not just a phone call. It’s amazing. I don’t quite get it. Because I’m, you know, I’m old school, but young people prefer to text. And the text feature has just, we just blown it out of the water with the type of response rate we’re getting from folks who are using the text and chat features to communicate. And it’s great that we’re doing it. Because without it, we might not have captured someone who’s prefers not to use a phone call. And it’s those little things that can make a big difference. We again, we know what we can do, and we just got to get out there. And for a small investment man, we can make a big difference.

Andy Slavitt  43:09

As to close it up, you know, you made me think of something interesting, which was you talked about vaccines being available to Americans, and one of the words you use was free, which is not a word we hear every day the American healthcare system. And by the way, it’s like one of our favorite words. It sort of reminds me, I wrote a piece in The Atlantic where I said, this is Americans went first experience of single payer, and they loved it, they were experiencing what they could still make, they may or may not want to get a vaccine, obviously most did. They may or may not like other elements of the healthcare system, but they never for a second had to worry about walking in and them saying, Hey, you owe us $10, and then having to slink out because they didn’t have it. And so I think, you know, to the extent that we make more and more progress towards universal coverage system, one where everyone has the right to protected to get health care, people may look back on the pandemic and say, that was one of the trigger experiences that people had, you’ve been a proponent of universal coverage. And, and I believe single payer at various times. Any reflections on kind of the when you step up 50,000 feet and look big picture at the system? Are those the kinds of transformational changes that you think could be in the future?

Xavier Becerra  44:25

Well, you know, you hit on something very important, Andy, and that is that the President made a commitment to make sure anyone in this country any American could get vaccinated and not worry about having to pay, not worry about having to travel a long distance to get there. And I will tell you that having lost a million Americans to date something over a million Americans to COVID It would be a lot higher number of our lost loved ones if there hadn’t been 267 million or so Americans who got the vaccine. And it is critical that we give people respect and meet them where they are. So they can be part of this process of staying well. And I will say this, we prove that Americans are not widgets, you should not treat an American as a commodity. When it comes to health care, we all need it, and it shouldn’t go to the highest bidder, or those who have enough money to pay first. Something like a vaccine should be there for all Americans. Because at the end of the day, you can be very wealthy, but you’re not safe if your neighbors not safe. And so I think the closer we get to having universal coverage, the better off we’ll be. And by the way, it’s not just universal coverage in America, as we’re finding now with Ebola, and with monkey pox. And certainly, of course, with COVID. They may not originate here, but they eventually could get here and we’re not safe until everyone is safe. That’s why at the end of the day, we should recognize that we’re a family regardless of how close you are to them. You may be around halfway around the world, but you’re still part of the family.

Andy Slavitt  46:06

Secretary Xavier Becerra, thanks for coming in the bubble. And spending all this time and doing a lengthy interview and really talking about the kind of whole array of health issues and some economic ones facing Americans.

Xavier Becerra  46:20

I hope this gets out to everybody all over the place.

Andy Slavitt  46:23

You got it. We’ll do our best. Let me tell you what’s coming up. Next. thanks to Secretary Becerra. Of course, Friday conversation around where the January 6 two hearings have landed. What they all mean? And then Monday, we go right into a conversation with this very senior person at the State Department, Derek Chollet. And we’re gonna go into some of the meaty issues that are on our minds, namely, Saudi Arabia’s oil cut what’s happening truly underground in Russia? Is NATO holding together. What about China’s threats around Taiwan? Really, really happy to have him on the show. Then Cody Keenan, from the Obama administration. His chief speechwriter is here on Wednesday. Friday, a conversation about Roe being on the ballot. And then a great set of shows the following week leading up to the election. Don’t forget to vote, everybody. Thanks for listening in.

CREDITS  47:40

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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