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Save The ACA or Stay Away? (with Andy Slavitt)

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Andy Slavitt, President Biden’s White House Senior Advisor for the Covid response and President Obama’s head of Medicare and Medicaid, joins Sam to breakdown the current world of healthcare and discuss the life-changing decision to call the White House and offer to help fix the ACA website. They talk about why powerful people are so compelling and how it makes making decisions even harder and how to even know who in the room should be making the decision, and being willing to listen to good ideas from the other side. Plus they talk about why it’s important to be nice to Siri, the difference between being entitled or honored to have a big job, and Sam gives an overdue apology for making fun of the ACA roll out while at The Daily Show.

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Transcript

SPEAKERS

Andy Slavitt, Samantha Bee

Samantha Bee  00:31

Happy 2025, everyone. It is so great to be back in your warm ear holes today. It feels cozy and safe, and few places give me that feeling anymore, who we are weeks away from Donald Trump retaking office, and the vibes are frigid. Well, anyway, it’s January, also known as the beginning of the calendar year, when Christmas trees pile up on the sidewalks and get covered in dog pests and health care deductibles roll back to zero and reset. Like everyone, I have been thinking a lot about health care and insurance these days, which is why I have some serious choice words for people who, for decades, have tried to make health care so political. It is personal. It finds you often in your most desperate and vulnerable place, where you feel like nothing can save you or your loved ones. And then, to add insult to injury, you sit on hold listening to music for seven hours until your call accidentally gets cut off. We have all been there.

 

Samantha Bee  02:53

This is Choice Words. I’m Samantha Bee. My guest today is Andy Slavitt. Andy served as President Biden’s White House senior adviser for the COVID response, and as President Obama’s head of Medicare and Medicaid, he knows so much about what it takes to make a government department run, and said something, I can’t stop thinking about health care. It’s the last thing that should be political, because it’s so personal, and yet here we are, so take a listen and make good choices.

 

Samantha Bee  03:34

What a great day. We’re talking on January 6. Just a gorgeous day with nothing, you know, nothing on the calendar, nothing, nothing much to commemorate.

 

Andy Slavitt  03:44

Let’s certify a president.

 

Samantha Bee  03:46

Let’s certify a president. Let’s just do it. Let’s do something really exciting with the day. Are you a new year person? Are you like, a new year, new you type of person? Or are you just like, wow, we’re facing something so wild?

 

Andy Slavitt  04:01

I would recognize me from December.

 

Samantha Bee  04:04

You’ve molted?

 

Andy Slavitt  04:06

Yeah, list of 500 things I’m gonna do better this year, not gonna fail at any one of them.

 

Samantha Bee  04:13

No, me, neither. I’ve already killed it on such a level that probably people will study me in the future. That’s my guess. Yeah, how is that? How is that possible? All right, well, the show’s all about choice and choices that we’ve made, and that just has, like, a different meaning for almost everyone that I talk to. And we all make decisions in different ways. How do you feel like? What are you like when you have a big decision that you have to make. How does that sit with you’re good at that.

 

Andy Slavitt  04:44

I panic.

 

Samantha Bee  04:45

You do you panic?

 

Andy Slavitt  04:46

Great. And then I and then I asked my wife, and then I think about it a long, long time, then eventually decided that she was right.

 

Samantha Bee  04:55

She was right. It just takes, like, you give yourself 48 hours to come back to the. Part where your wife was just right?

 

Andy Slavitt  05:02

I just it’s more that, like, I can’t believe how quickly she knows the answer that makes it more difficult for me to, like, agree right away, because she’s like, for her, it’s like, oh, this is obvious. And then it’s like, well, it’s not so obvious because it’s obviously killing me.

 

Samantha Bee  05:19

It’s not that obvious because my guts are churning. And she’s like, it’s right in front of you.

 

Andy Slavitt  05:23

I guess it’s mood dependent, though, like, okay, if I’m in a if I’m in a flow state, you know, things are happening, right? You know, then, like, you see the you see the playing field a little bit more clearly, and the choices in front of you, big or small, seem very manageable and correctable if you get them wrong. And then there’s other times when, and this is the panic when we’re like, right? This thing’s so high stakes, and I have no idea what to do, and someone’s gonna be mad at me either way, and I’m gonna lose either way. And there’s so you can paint yourself a no win and a no lose easily, depending on how you’re feeling about it.

 

Samantha Bee  05:59

Well, you’ve made big decisions for people. You’ve worked in the federal government, you’ve made choices that you definitely I have to say that people you must have been like, well, half of people love this, and half of people will hate this. So I think I just have to do what’s in my heart, what is objectively correct, what does that feel like?

 

Andy Slavitt  06:22

Exactly right. I mean, if you can ask yourself, like, I found it helpful, I should say to ask myself, like, what is the principle that I’m trying to solve? And when I was in the White House helping to lead the pandemic response, it was very simple, save the next person’s life, right? What’s the decision that’s going to save the most set of people’s lives, because there’s like, however many people died on Monday, I can make that number go away and Tuesday as best as possible, then I’m doing my job and so and then I can withstand almost any criticism and feedback. So long as I feel like I am trying to do that. It’s when you get into a situation where you’re not sure exactly what you’re trying to solve for. Am I trying to make the president happy? Am I trying to make the press happy? Am I trying to make some scientists happy? Am I trying to make Twitter happy? Well, if you’re if you’re getting like, lost in all of that, it’s probably really hard to make a decision. So I try to go into these situations knowing, asking myself the question, what is my principle? In that case, my principle is, save the next life. And once I know that, it does become easier, because you’re going to get the criticism, as you said, but you’re willing to stomach criticism, because you know the benefit you’re aiming for.

 

Samantha Bee  07:41

Right, and is it, it’s not easy to stay on that. Like, I mean, does your wife help you stay on that type of decision? Like, it is easy to waver a little bit. It’s easy to be pulled in, like, a million different directions. Who is the how do you find your way back to the core?

 

Andy Slavitt  07:59

Well, people are compelling, right? And powerful people are really compelling. So like, let’s say I don’t know. The president says we, you know, we have, we have 1000 vaccines. We can either give them to people in nursing homes who are about to die, or we can give them to 1000 teachers who could open up schools and teach kids, right? And a powerful person says, I think that politically, it’s be really great for us to have more kids going to school. And you say to yourself, that’s pretty compelling, but if I gave those 1000 shots to someone in a nursing home, the chances are that they would live and look, you’re talking presumably, here only about tough decisions, because, like, easy decisions we don’t get to make, like our kids make them for us, like they get made. They just happen. So in every one of these situations, you know, you’re probably making a close call in a situation like that, where you say, well, my principal was x, but I just was presented a really compelling reason why we might do something different. Then I feel like the right thing to do is to get into a dialog and say, well, look, here’s how I look at it. I don’t know everything about this issue, but this is the lens I bring. Tell me about the lens you bring. And in the White House. And in any kind of good decision making organization, you usually have a policy making process. You usually have a process where people can very professionally and politely, kind of argue it out and reason out the points and try to come to a consensus, and you know, at the end of it, you might even say, look, it’s not the call I would make, but I totally get the call, and I am totally supportive of the call, right? And you get into feeling okay about it.

 

Samantha Bee  09:50

Are you a consensus builder, and is that much too much, like in general, too much, though, right? Because I do want to talk about your. Role in government. Do want to talk about all that? Was there ever a time where you were like, No, everybody back off. I am making the correct decision here, even though everyone disagrees with me, and then you were like, Oh, you were all right. That was terrible. Or alternatively, that you were like, I was right, and all of you were not correct.

 

Andy Slavitt  10:20

You know, part of the trick is to know when you’re the person in the room who should be the one making the decision, yes, because you’re the most information or the most perspective. And a lot of times, like very rarely, at the White House, that I ended up feeling like I am so sure of myself, know so much more than everybody else in the room, right? Because there’s so many smart people, and they have so many different perspectives, and the process of consensus was really good, but like in what I do in other settings, I’m 58 so I’m going to say this in a way this and sound pejorative to people in their 30s, but there’s someone in someone who’s 30 will say such as, I mean.

 

Samantha Bee  11:00

I’m fresh out of college, and you know that you look fresh.

 

Andy Slavitt  11:04

You know we’ll say, like, I think we should do X, and you’ll know that. You’ll know like, Oh, tell me why you think. You’ll know that she’s wrong or he’s wrong. So tell me why you think that. And you want to get them and get them there and get them to their own conclusion. And so like, if I’m going to steer someone to to my answer, I’m going to try to steer them delicately and gently. If there’s the time, there’s occasions where you have to be like, super clear and be like, You know what? I don’t even know what you’re talking about.

 

Samantha Bee  11:35

Is there a choice that you can point to that really changed your whole life, or changed your perspective, maybe in an unexpected way, or maybe in a very expected way?

 

Andy Slavitt  11:44

Yeah, boy, like, it’s such a fantastic question Sam, because you don’t know at the time, but you can look back and trace sometimes a decision you’ve made and say things would have turned out very differently, no better or worse, but very differently. And for me, it was probably the hardest decision that I really did have to make, which which was Obamacare launched in 2013 20, and then it crashed. And like I had been, this person who cared a lot about President Obama, cared a lot about the uninsured, cared a lot about health care, and like I, made a decision to literally call the White House and say, Do you need help fixing it? Now you think about that decision, it’s insane. I mean, it’s an insane thing to do, and I’m quite certain that the only reason that I ended up being the person to fix it was because no one else was dumb enough in the country, everyone you’re like, your problem, and I, for whatever reason, I’ve, like, made the call, and then once I made that call, everything else that happened from there sort of flew naturally, right? Wait, because I made that, that very hard call, and it changed my life in that I became and I went into the government. This is my first experience into the government, did this major project that hopefully saved this, a very important program, and got a lot of people insurance, and then the President later asked me to serve in the administration. And then, you know, later on, President Biden asked me to serve an image so like, if you if I think about like, that phone call, if I hadn’t made that phone call, be pretty certain, none of those things would have happened.

 

Samantha Bee  13:41

What does that phone call look like? Because I’m pretty sure if I was like, I’m gonna call the White House, I’m gonna tell them I have some solutions. I can fix it. Like, well, how does that work? Were you like, Okay, I know all these people. Or did you actually, physically you were like, beep-blop […]

 

Andy Slavitt  14:00

Yeah, called the switchboard, get me the president.

 

Samantha Bee  14:06

I need the red line.

 

Andy Slavitt  14:08

Yeah, it was more the former, or maybe that. It may have been like, technically, like an email or put word out, that hey, would you like to talk? I think I, what I said was, effectively, look, what do you have happening now? Feels like the most unimaginable problem, right? But it’s actually probably in the light of day, just a very visible problem. It’s probably an incredibly common problem. Technology projects get into trouble all the time, and it takes some combination of time, money and management to fix it? They get fixed. And there probably isn’t a big technology project that’s ever happened that hasn’t had something go wrong.

 

Samantha Bee  14:48

Of course.

 

Andy Slavitt  14:49

A little bit better. And then the other thing I said was, it’s probably not a technology problem. It’s probably a management problem. And they said, Well, what do you mean by that? And I said, the technology probably can do what you needed to do. Somebody just failed to do the things that need to get the technology need to so, because I’m not a technologist, I had no business being on point to solve a big technology problem for the country, other than the fact that I know how to solve problems and know how to manage things. And so I said, I suspect that if we manage it differently, we can solve it that, plus a whole lot of very smart technologists to be fair, right? And we did.

 

Samantha Bee  15:33

I remember that rollout, and I do believe, and you know, apologies for this, but I did work at The Daily Show at the time that the rollout happened.

 

Andy Slavitt  15:42

We it was probably amazing fodder for you.

 

Samantha Bee  15:45

Was amazing fodder, but a very serious and critical issue, and I.

 

Andy Slavitt  15:53

We were laughing stock. I mean, they were laughing stock. They felt like, and yeah, and kind of funny. That sort of full circle when, when the President went and did between my two ferns, right? Which is sort of a sign we were winning. We were starting to win our own sense of sanity and humor back. But I got inside until what I learned is just very much to make you feel bad about what you just told me, yeah, because I think that’s what you want.

 

Samantha Bee  16:17

You said you want. That’s what I want.

 

Andy Slavitt  16:19

I mean, like, no, there’s no feeling like, feeling like you failed the president, like and everybody, and when to hear the President talk about this was such disappointment, and to see the President laughed at because I, like, inherited the entire team.

 

Samantha Bee  16:36

Oh, my God, morale must have been.

 

Andy Slavitt  16:40

Horrible, I mean basement people crying and so disappointed in themselves. And yeah, you know what I said? Just shut off the news, probably including the Daily Show sorry but.

 

Samantha Bee  16:53

That was the right move.

 

Andy Slavitt  16:55

Did I say nice, happy things about you until well, after this thing is in the rear view mirror, and they may never happen, but.

 

Samantha Bee  17:04

It’s true. Like, it’s very hard to work in a feedback loop.

 

Andy Slavitt  17:07

It’s like being born with thumbs, like, years from now, like generations that people are going to be born with that trait, right? Like, because, like, literally, it’ll be a survival skill, right? Right? Yep, knows how, knows how to hide and tall grass and can’t, doesn’t read social media.

 

Samantha Bee  17:22

Yeah it will be like, um, it’ll be like, we’ll form, like, a gill or something in our brain that will just, like, do its own thing. It will just evolve.

 

Andy Slavitt  17:32

It’s literally the worst, it’s worst.

 

Samantha Bee  17:35

It is the worst you can sequel. It’ll sequester. It’ll like, organically, sequester.

 

Andy Slavitt  17:42

Joe. 9976257, know that I’m a fucking asshole.

 

Samantha Bee  17:50

And you know, it doesn’t matter how many nice things people say, you’ll always remember Joe.

 

Andy Slavitt  17:54

Right, even though it’s an anonymous person and.

 

Samantha Bee  17:57

Or a bot.

 

Andy Slavitt  17:58

Or a bot well, I actually do care what bots think about me.

 

Samantha Bee  18:03

I want to please the bots. That’s what I’m here for.

 

Andy Slavitt  18:06

That’s the long game.

 

Samantha Bee  18:09

If the bots love me, then I’ll have an army of bots on my anyways.

 

Andy Slavitt  18:14

Well, God, my wife and I are super nice to Siri, that’s super Smarties in charge and you were mean to Siri Sam, and she’s gonna see me and my wife, and she’s gonna be like you were nice to us when no one was.

 

Samantha Bee  18:30

I’ll, don’t think I didn’t also read that article years ago about how we need to be nice to our robotic overlords, because they are gonna scour our histories and see if we had mean things to say about the bots and the AI, whom I think is the most beautiful and elegant expresser of the human condition.

 

Andy Slavitt  18:52

That, by the way, yeah, you’re totally right. But that reminds me of, didn’t isn’t that what SNL did when Trump, when Trump won for President?

 

Samantha Bee  18:58

Oh, that’s right, they did. We’ll be right back after this.

 

Samantha Bee  21:05

Well, you know, one of the things that in the light of so we’ll talk about hard things now. We talk about the specter of health care and events of the past month and the murder of Brian Thompson, which was so shocking and ignited a maelstrom of controversy in the world. For me, as a person who came up in comedy, and comedy is my whole world. I just didn’t find anything funny about it at all. It was really like murder in the streets. It’s not like comedic fodder for me. It’s was terrible. But I did think that the conversation about health care and health insurance was interesting and needs to be had. And my view, just take away from all of that, was we actually have to talk about health insurance. We have to talk about health care companies all the time now, and if we’re not doing that, then we’re really not answering the call. Do you think that there is a productive way to harness the anger that has just erupted and come into the public space, like, how do we do that? How do we make change?

 

Andy Slavitt  23:47

So, first of all, I knew Brian, probably he was about 30 years old or something, and I didn’t know as much recently, but it was a kind of farm boy became accountant, you know, and doesn’t deserve to be a symbol for, like, all this stuff. So I know, I know that was implied in what you said, but wanted to make sure that I said it as well in the interest, yes, because the anger was there before, obviously, right? And so it can be done in a way where Brian isn’t the symbol for all of this. Do a lot of surveying around what people think about health and health care. And what’s interesting, and I think so misleading, is there’s a surprisingly number of people who feel pretty good about their own situations. Call it, 70% of people feel like they have pretty good healthcare experiences. And you can lead that to complacently think that people are satisfied with the healthcare system. Well, the reality is, people were most satisfied with the healthcare system. People are healthy and don’t have to interact with them very often. Or maybe they go and they’re interacting. Are mostly like low voltage allergist. And I got my prescription. I went to the pharmacy and my prescription was there, and only to wait four minutes so my then you get, like, debilitating back pain or cancer of one of your organs, or, you know, something, and then you’re like, thrown into the mess of the system. And, you know, we, rather than set up a system to work as a whole collectively, for us in general, what we’ve done is we’ve set up a system to create a set of opposing forces so that no one else cheats the other person in the process. And so we have a system built on suspicion, like, do you really need that test? Well, my doctor said I needed it. Well, we’re going to make sure you need that test, because the doctor is going to get paid a lot of money if you get that test. And so then you get caught up in this web, as opposed to a world, and there are some positive examples of this, including in the US, like Kaiser Permanente, where it’s all one thing, and the doctor says, you need something, and you get it. What frustrates us is that the doctor will tell us we need something, or a nurse will tell us we need something, and then someone else will tell us, well, I’m not so sure. And not only will they say, I’m not so sure, they’ll say no, but they won’t say no. Like, we have kids. I think you have kids, right? Yeah, if your kid says, like, can I have this ice cream? We’re like, no, but you can have this fruit, okay? Like, you know you don’t just, like, say no, you say, there’s this other thing you can have. Or if you do this, if you eat your dinner, you can have your dessert. Well, insurance company is like, what they end up doing is they because they’re so millions of things flying at them that they just basically come back and say, No, can’t have, instead of saying, what might be more helpful is, look, you have back, this back issue, you’re looking for this type of surgery, we find the surgery works only about 30% of the time, unless people have done physical therapy first. We recommend you go to this physical therapist and get these types of things done. If the pain persists after, you know, eight weeks of physical therapy, then you should probably, probably our candidate for surgery and come back etc, and then coordinate that with the physician. How hard would that be to do? Not very hard, but, but I think we live in a healthcare system where we all feel powerless. And what I think, is being expressed, as much as anything, any one particular issue, is that people feel like they have no agency, that there’s nothing they can do, that they’re going to be a victim of this process that’s larger than them. They don’t know who to call they don’t know who to help them. And by the way, it’s only their life or their wife’s life, or their husband’s life, that’s on the line, right? It’s not like, it’s not like, you know, someone’s out of chewing gum. It’s like you just said, I can’t have the surgery for my wife that the doctor said she needed. Yes, make me a little mad.

 

Samantha Bee  28:10

And you’re also like, in the most weakened state, like you were at a point, you can be at a point of total crisis, and have to like the way that things largely are now you’re also doing a full time job. Your full time job is your full time job, and your second full time job is waiting on the phone, right? Because you’re not really in conversation with anybody, and it can feel like you’re coming up, you’re just like, talking kind of to a wall.

 

Andy Slavitt  28:43

But right? You’re talking to this person who you don’t know what part of the world they’re in, and they get, they get to make a decision about whether you get this, like, $8,000 drug or you don’t, which is supposed to solve your pain and maybe make your cancer go away. You literally, this person has more power over you than anybody in your entire life ever has. They’re like, Oh, you know what? It’s my lunch break, right? And you’re like, okay.

 

Samantha Bee  29:10

So call back. And then it’s a Byzantine like, it is really easy to understand people’s frustrated.

 

Andy Slavitt  29:16

Yeah like, I mean, I talked to plenty of people who know Brian and knows there’s not one person who doesn’t understand the frustration. Yeah, they again I don’t think they would say people should be frustrated with Brian and that crazy, misplaced, but there’s not one person I’ve talked to who’s like, yeah, I don’t understand because if you, if you don’t understand it, you haven’t had a tough health care experience, and that just means, yet.

 

Samantha Bee  29:45

I think that that’s a very interesting point that I actually haven’t heard anybody say, which is, really it’s the number. It’s not that people are happy or unhappy. It’s like it’s more likely to be a source of critical frustration for. You, if you are, you know, constantly interacting with the health care system. If there’s a reason in your life where you’re in constant it’s a touch point.

 

Andy Slavitt  30:08

This is the pattern of our every day. We think about health care as little as possible, until it literally becomes the only thing we can think about, right? That is our life pattern. We stay and so as soon as someone crosses over and be from person A to person B, they get it. They get it. They’re like, Oh, my goodness.

 

Samantha Bee  30:30

Oh, my God, yes.

 

Andy Slavitt  30:31

Everything that mattered before yesterday, doesn’t matter any longer, because just learned that my son has brain cancer or whatever, and now everything that I thought was important doesn’t matter, and everything that’s related to this is 1000 times more important. So someone saying like, yep, I can’t call you till Monday when it’s Thursday is like a criminal offense. Yes, like that person should be marched to the Gulag, because I’m waiting three days to find out information about the only thing that matters in the entire world, and probably the people in the healthcare system at a very local level, like doctors and nurses and people in hospitals and stuff who are very sensitized to community, like they that feeling is probably there to a greater extent than when we’re at a kind of large, disconnected, big national system with call centers and people over the world like, we’ve depersonalized the process of the thing that’s the most personal thing of all.

 

Samantha Bee  31:41

So I guess with all of this, with all of the everything we’re talking about is so real, do you see this as a catalyzing event? Do you perceive Do you imagine that big insurers are going to look at their processes differently? Is everybody going to retreat to their Heidi halls now and like, hide from the public, or do you see more engagement? Do you see any possibility for improvement?

 

Andy Slavitt  32:07

I see both. So the first thing is, every insurance executive has secure, has full time securities, yep. But I’m actually more optimistic than that well. So first of all, I will tell you my own theory of healthcare, which is, there’s no such thing as a silver bullet, like there’s not one thing that’s going to fix everything. So I don’t think we’re, I don’t think this is I think we have a galvanizing moment where it’s like, man, look back at that and look how much everything changed. I think there are only a series of incremental, modest and often regional changes. And if you look at the history, and I’ve kind of, I’ve tracked from 1965 to the advent of Medicare to today, like the major shifts and transformations that have occurred. Interestingly enough, Sam, you might be surprised to hear me say this, AI kick can actually be a part of a solution, solution, right? I mean having some technology which allows things to be explained better, right? Having some technology which allows things to be understood better. Now, again, it can be used evilly as well, right? It can be used to deny things, but, but, but I think that, like, there’s a case to be made to say that if people generally want to get these decisions right and they want to be more humane about them, then we at least now have a tool to do that. Now that’s a big if there might be people out here listening saying, I don’t believe anybody at any insurance company has any good intent or won’t do anything unless they’re forced to do that, and that’s a very reasonable place to have a point of view, right, right? That’s a bit of a well earned point of view. But to the extent that you believe that this makes change more possible and more positive, I think that is right. I’ll tell you what I didn’t see. I didn’t see the insurance industry react in a way that was self justifying. I think they wrecked it away with horrifying to see what that was said about Brian and about this psychopathic murderer. But if you put that aside, I didn’t hear anybody say, yeah, no, these are perfect, right?

 

Samantha Bee  34:16

We’re doing a great job, flawless.

 

Andy Slavitt  34:19

This is taking me by surprise.

 

Samantha Bee  34:21

Right, I mean, we definitely do have to be like as human beings, as company. We have to be forced, often, to do the right thing. I mean, I think often about seat belts and how resistant people were to doing the right thing. It had to be like legislation to make us protect ourselves in automobiles. I don’t perceive and I could be totally wrong about this, but it does seem that our next president is assembling a team of people who are definitely not going to do the right thing or force companies hands. Yes, in a way that would be inconvenient. I mean, please tell me, I’m wrong. But once again, Republicans saying they want to abolish Obamacare, they’ve got concepts of a plan to do. So Are things going to be different this time? I don’t know.

 

Andy Slavitt  35:17

Look, I think we’re still in like, phase one reaction mode to this election, and, you know, I think there are a lot of people, Democrats, myself included, who would have said two, three months ago that, you know, Trump was someone who became president as a was voted out for by the minority of the country, and it was a very narrow slice of people, and it wasn’t a particularly diverse group of people. I think it is more she can’t say that any longer, and I think Democrats also really can’t have the conversation without saying where did we go wrong in terms of how we communicated our priorities to people that like they didn’t believe them anymore. I mean, this was a classic change election, you know, sure, the classic econ economy change election, and a lot of the things that the people will sort of put the whole package of Trump together and said, yeah, I think he’s the right choice. A lot more people did that in a lot more states than people thought. So I guess I’d say I’m reserving a little of my Okay, round one of Trump reaction right now.

 

Samantha Bee  36:34

Or saving your energy.

 

Andy Slavitt  36:36

Well, trying to get a sense for on the healthcare side, what are some of the things that they’re trying to do? And if you listen to some of the things they’re saying, they want to reduce chronic illness in this country. They want to reduce the influence of pharma lobby in this country. So they’re saying things that I think a lot of people would agree with. They’re saying that we have too much added sugar and highly processed foods and so forth and and so what I’m trying not to do is have that knee jerk reaction of the other team is saying this, therefore there must be something inherently wrong with it. And instead right saying, you know, there are some things where maybe there can be some common ground. I happen to hold the view that healthcare is the last thing that should be political. I happen to hold the view for the very reason you and I talked about that it’s the most personal thing. And when you’re sitting in the waiting room waiting for your spouse to get operated on to figure out what happened, you don’t have to look at a Republican. You’re praying to pretty much every god that heard of I’m someone who has always argued that we should be trying to take the politics out of health care as much as we can. And look and you’re talking to person who fought the battle to save the ACA. You’re talking to people. So it’s not like I don’t know how to put up a fight when it’s time for a fight, but I also think I don’t believe that President Trump is going to come in and try to get rid of the ACA. I don’t think that went well for him last time. I don’t think he’s going to try to do that. And so to the extent that they do pursue things that I agree with, then I think that would be great they pursue things and obviously policies such as limited reproductive rights and others that we disagree with, then we’ve got to fight on those issues.

 

Samantha Bee  40:47

Right.

 

Samantha Bee  40:49

Hold that thought more choice words after one more break.

 

Samantha Bee  41:18

Maybe I’m looking to feel better. So can you outline, I guess? Can you tell me what Which part do you think is bluster and what is real? Because when I look at like, RFK.Jr And like, there’s a difference between the things that he does that are like, gross and funny, like exercise and sweat profusely in jeans, like pull ups in jeans, and the things that are very dangerous, like getting rid of the polio vaccine, like, what part of that is possible, and what part of that is just a person in genes working out and just talking like, what are the guardrails that will continue to be in place?

 

Andy Slavitt  41:59

So I don’t know. RFK. Jr, or never met RFK Jr. And so this is less a comment on him and more a comment on you said you wanted to feel a little bit better.

 

Samantha Bee  42:08

Yeah like, what are there guardrails that are going to stay intact?

 

Andy Slavitt  42:12

There’s some but, like, here’s the other thing. Like, it’s very easy to be a critic when you’re on the outside and you don’t have accountability. So it’s one thing to say, you know, polio vaccine, or whatever you said about the polio vaccine, what interesting to hear is, okay, now you’re the person that’s responsible, literally, for children living and dying. What do you think? And wouldn’t be this most shocking thing to ever happen to have that view come out a little different and be a little bit like, I think that people who produce folio vaccine should have liability when something goes wrong. That’s all I’ve ever said, you know, or whatever, right? And and so, like, I don’t think, I generally think when people find themselves like, Oh my God, I’ve caught the bus. I you know the dog who caught the bus right? And you’re in the position of actually having to make the decisions. It’ll be interesting to see what decisions they make. Now Pollyannaish, because there’s, there’s a certain track record of things that have been said.

 

Samantha Bee  43:14

There is a bit of a track record of sawing the head off a whale and strapping it to the top of your COVID.

 

Andy Slavitt  43:20

And that’s a precedent. You can’t.

 

Samantha Bee  43:23

Not everybody is capable of that.

 

Andy Slavitt  43:25

And that’s the President. And look, he’s going to be, he might be called on to do that. And if a cabinet, if a cabinet secretary, is called upon to soft the head of an animal, we’ve never had anybody with the experience before. Have you thought of that?

 

Samantha Bee  43:40

Who among us hasn’t taken the corpse of a bear and arranged it in Central Park?

 

Andy Slavitt  43:47

With my on top of it? To be fair, in my case, it was a tiger.

 

Samantha Bee  43:51

A tiger oh.

 

Andy Slavitt  43:54

Same exact thing happened to me. I went to, was going to the same restaurant.

 

Samantha Bee  43:58

And then I forgot that I had an international flight that evening slipped my mind.

 

Andy Slavitt  44:02

That slipped your mind, very typical night for me, though.

 

Samantha Bee  44:07

It was just a full just a blackout night.

 

Andy Slavitt  44:11

You know, younger people don’t really this is the this is what the 80s and 90s are like. I mean, that is true. I mean, it wasn’t, if it wasn’t a wild animal, a club, a bar scene, a hit Park car, like in an evening. It was an evening they make.

 

Samantha Bee  44:26

Scorsese will make a movie of this evening. This is a 24 hour period like no other. Okay, from you were the head of the Centers for Medicare and Medicaid Services to entities that are a rot with emotion, and people need them. They’re so needed, essential. Trump has tapped Dr Oz to run them all. Jokes aside about him following in your footsteps. What can you tell me a little bit about what you actually did in that role? Because it is. Really something that people hear about we don’t really know.

 

Andy Slavitt  45:05

Well, so you’re responsible for about a quarter of the federal budget, about a trillion dollars, which is essentially the 130 240 million Americans that are on Medicare, Medicaid, the ACA Children’s Health Insurance Program. And if you think about who these people are, they’re the people in our country. It’s about half the country, but it’s the people that live either on a fixed income or a low income, right? They’re either aging on a fixed income and they’re getting sicker, or they’re poor and they need the health care system and everything we talked about earlier relation to, like, how much people are frustrated with healthcare system. Imagine that with, like, completely empty pockets, yeah, like, imagine that, and you’ve got no resources, right? That’s those are the people that you’re accountable for when you run CMS and making sure that they get the best care that they need to get, and secondarily, that the people that are not yet 65 that the programs available for them and for us, coming around the corner, looking around the corner, when it tells me that you obviously.

 

Samantha Bee  46:17

Yeah, no, obviously, I have, like, what 30-35, years? I mean, we’re just like, wait in the future for me.

 

Andy Slavitt  46:22

You can’t relate. And it’s really interesting. One of the things I learned, you learned, is that when people turn 65 and get them and get their Medicare card, people describe it universally, as one of the happiest days of their life, the relief they get when they get that Medicare card in the mail and it there’s an 85% satisfaction level with the Medicare program for seniors. And it’s amazing. Like, I don’t know anything that people think 85% people think is good, right? I mean, sex, maybe that’s it. Sex and Medicare.

 

Samantha Bee  46:58

Just 85% the other 15% are like, it doesn’t work for me, not into it.

 

Andy Slavitt  47:04

Probably true yeah.

 

Samantha Bee  47:06

Fair.

 

Andy Slavitt  47:06

That’s but 85 is pretty darn good. I mean, you can’t get, you can’t get 85% Americans agree on anything, and 85% of Americans go, yeah, that is the best thing that just that just happened, that happened to my mom when she turned 65 it’s really kind of an honor to oversee that program. And it is, in many ways, I describe it as the best job in healthcare and the worst job in Washington. It’s the best job in healthcare because you can help so many people in tribes and people in nursing homes.

 

Samantha Bee  47:35

And why is it the worst job in Washington?

 

Andy Slavitt  47:37

Because you got a huge target on your back. It says $1 trillion and everybody wants that money spent their way, right? And so, you know, you you get called to the hill because people want you to spend your money on this, and want the money on that. And so just a lot of politics, right? And if you focus on the political part of the job, it’s interesting, but can be distracting. It should the people part of that job, the 100 and 30 million Americans, million Americans, you running the biggest insurance program in the world.

 

Samantha Bee  48:06

I mean, I want that money because I want to open up my line of children’s tanning salons, and I just think, like, more tan children just gonna bring happiness.

 

Andy Slavitt  48:18

That’s a good idea. But here’s the good news. I don’t think it’s going to be that expensive.

 

Samantha Bee  48:23

Listen, I have a prospectus. I’ll send it your way. You’ve been thinking about that in a while. I’ve been thinking about it for a really long time. It’s my big idea. Well, so we don’t know. We’re waiting to see there are some good ideas in them, in the mix potentially. We don’t know if they’re going to be any good people left standing. Do you have friends over at HHS right now who are just like, well, okay, let’s do this.

 

Andy Slavitt  48:54

Well, look, I think it’s, I think it’s really hard if you’re at CDC or NIH, maybe even at FDA, because some of the things that have been said, been said, Look, I hesitated whether to say there’s some, but I know Dr Oz, he’s actually incredibly smart person and very serious person. So look, I don’t have, I don’t have reservations about him and what he’ll do in this job in particular. Yes, I’ve got concerns and disagreements with this administration broadly, and who will be, you know, he’ll be part of that, and I’m sure he’ll be involved in decisions that I don’t like. But, I mean, I’ll tell you this, you might find this interesting. He called me the day after. I’d never met him. He called me the day after he got named.

 

Samantha Bee  49:45

Really? Did he ask Owen? Tell me what you can about what you talked about?

 

Andy Slavitt  49:51

Yeah, I mean, he basically said I asked around about who did this job well, and your name came up and. And so what does it take to do the job? Like, what’s important? Like, what is it, what’s the nature of the job, what’s most important about it? Tell me what the hardest things are. Tell me what the most important things are. And you know, I was listening for kind of, Is this someone who is feels entitled to be here, or is this someone who feels honored to be here, right? And I definitely heard honored to be here, which was a big relief for me, and I think he had a lot of humility and asked a lot of questions, and I think he’s a good communicator. And so when we left the end of the Obama administration, President Obama said to us that the best transition ever performed in government was between the George W Bucha administration and his administration. He said it was amazing transition. It’ll go down in history. It’s the best ever. And he said, I would just ask of you, no matter what you feel you agree or disagree with on the policy side, from the people that come after you, that you honor, that you honor what the bush team did for us with the people that come after you and and so, you know, you said part of your job is to help them be successful, even if you don’t agree with all their policies. And part of the reason why I think that’s right is because you know, the Flashpoint issues on policy and health care, you can you named a couple of them, ACA and a couple things, but, 98% of stuff is stuff that people aren’t isn’t really usually political stuff, just stuff we’ve got to get done. Get done well and and so the stuff that makes the news and the stuff that’s in the White House and the stuff that’s political, there’d be plenty of forum for that to be disagreed upon and fought over. But the day to day of doing the job well really benefits the American public at least as at least as I believe it relates to the job at CMS. It’s not true necessarily at every job. I’m not going to make the same claim Justice Department, or in Sure, or in IRS or or environment, but I would say that has true. I say that is pretty true in health care.

 

Samantha Bee  52:10

You know what that? That was the relief that I sought, actually, like, Just hearing that he’s sort of open to, like, conversations about how to do the job well, and I do implore you to become best friends with dr oz now, that’ll be your next mission so you can seed, see, please seed great ideas.

 

Andy Slavitt  52:34

Well, we’ve talked several times a week since then. And, you know, I think, and you know, he just said to me, he today, in fact, he said the words to me. I don’t think he might be saying this that he hopes he knows at some point he’ll do this for a Democrat that comes after him.

 

Samantha Bee  52:56

Ah, okay, you know what? That was great. Actually, that is that was great. This was such an interesting conversation. This was a conversation I’ve been craving for a really long time. This was really, I know you thought it was just going to be all laughs, something that funny, and you’re that funny, but actually, this was both funny but also very good.

 

Andy Slavitt  53:20

I thought you had the wrong person. Like, I didn’t know what you’re like. Like, she wants to talk to me, to me about.

 

Samantha Bee  53:26

Guess what? I want to talk to you again six months from now, and you can tell me how you think it’s going, oh boy.

 

Andy Slavitt  53:34

I’m sure there’ll be disappointing things, that I’m sure there’ll be, hopefully, surprises. But if someone, well, here’s what I’ve learned, if someone’s willing to have a dialog with you, even if they’re on the other side of the table, yeah, and they have the same you think they’re basically of good faith. You get it’s worth getting in the room with people you disagree.

 

Samantha Bee  53:55

Oh, I agree with you so hard on that. I agree with you 150% even though that’s mathematically impossible.

 

CREDITS  54:08

That was Andy Slavitt, and I had no choice but to look up one thing. He literally called the White House to offer to help fix the Affordable Care Act website when it failed. How do we even do that? Does the White House have a phone number? Well, I found it. It’s 202-456-1111 okay, I gotta wrap this up so I can go try to call it Oh God, I hope Elon doesn’t pick up. Thanks for joining us. I’m Samantha Bee and see you next week for some more Choice Words. Thank you for listening to Choice Words, which was created by and is hosted by me. The show is produced by […], with editing and additional producing by Josh Richmond. We are distributed by Lemonada Media, and you can find me @realsambee on Instagram and X, follow Choice Words wherever you get your podcasts or listen ad free on Amazon music with your Prime membership.

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