Update on Trump’s Health…and Ours, with Dr. Bob Wachter and Senator Chris Murphy

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Andy starts with an update on President Trump’s health and the impact of what’s happening at 1600 Superspreader Avenue with Dr. Bob Wachter. Then, Connecticut senator and ACA advocate Chris Murphy discusses the future of the ACA, what the COVID-19 outbreak among Republican senators means for the Amy Coney Barrett hearings, the looming election, and what you can do to work for a positive outcome for all of those.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Dr. Bob Wachter on Twitter @Bob_Wachter. Follow Senator Chris Murphy on Twitter and Instagram @ChrisMurphyCT. 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://lemonadamedia.com/inthebubble/ 

Check out these resources from today’s episode: 


Chris Murphy: [00:01:00] So the president started by putting Neil Gorsuch on the court, continued with Brett Kavanaugh. And now one vote away from being able to overturn the Affordable Care Act, he now has a chance with the nomination of Amy Coney Barrett to finally get what he couldn’t get done in the elected branch of American government: the full repeal and elimination of the Affordable Care Act with nothing to replace it.

Andy Slavitt: [00:01:35] Welcome to In the Bubble. This is Andy Slavitt. What you just heard was Chris Murphy, the senator from Connecticut, talking about this upcoming hearing and what’s at stake with the Affordable Care Act. So the president is sick and getting other people sick and we can’t find out what the heck’s going on. What else is new? Country sick, president sick, not getting the facts. So here’s what we’re going to do. We are going to begin the episode by finding out about the president’s medical condition by talking to Dr. Bob Wachter.

Andy Slavitt: [00:02:08] Many of you note by Wachter from Twitter. Some of you might know him personally. He is a physician and professor. Most importantly, he’s the chair of the Department of Medicine at University of California, San Francisco. And he has been tweeting his rounds over the course of time, meaning as he runs into the patients and sees their symptoms. And so he is excellent at knowing what treatments mean, what symptoms mean, what we’ve been hearing, what we haven’t been hearing. I think we may in the future hear a very interesting upcoming episode that Bob and I are planning to do together. But right now, we’re going to have Bob on to talk about what’s going on with the president. And then we’re going to talk to Chris Murphy because we have a lot going on in the next few weeks. And I want to make sure people are up to speed on what’s going on with the Affordable Care Act, with the justice, with the election and how all those things are tied together. So we’re going to get a lot done in this episode. I think you’ll be able to get CMU credits or something. Let’s get Bob on the phone.

Andy Slavitt: [00:03:13] Good afternoon, Bob.

Dr. Bob Wachter: [00:03:17] Andy, long time no see.

Andy Slavitt: [00:03:26] How impressed are you that the president can walk off a set of stairs?

Dr. Bob Wachter: [00:03:31] Well, he couldn’t, because if you watched him at the end, he was really huffing and puffing, was trying his best not to not to show it. I mean, he’s got mild to moderate hypoxia. Hypoxia is low oxygen, so your oxygen saturation, if we put the little thingy on your finger, would be 98 or 99 percent. We don’t get super worried in terms of it being a threat to you until it’s below about 90. But anything below about 95 is real. There’s something going on that’s getting in the way of you exchanging the oxygen you breathe in and getting into your bloodstream. And so it, you know, 95 is worse than 98, 85 is worse than 95. If it goes down a mild amount from normal 98 down to 93, you’re probably to feel a tiny bit short of breath, but at rest you’re going to probably feel OK. And if you’re on steroids, which make people feel euphoric and that they’re going to take over the world, you probably feel great. And so one of the things we’d like to do in patients who have any kind of lung disease is before they leave the hospital, we walk them around and check their oxygen saturation after exercise. So I think what that stunt demonstrated was that his hypoxia, the level of his oxygen is probably fine when he’s at rest. But when he pushes himself, it goes down. And that was him struggling for air, trying to put on the game face for it. But he was he was clearly struggling. So my guess is he’s got he’s got hypoxia when he exerts himself. 

Andy Slavitt: [00:05:05] He says his oxygen level is 110 percent, which I think is a record. Did he go up those stairs slower or faster than Rocky Balboa on the steps of Philadelphia?

Dr. Bob Wachter: [00:05:19] Yeah, it would’ve been great if he put his arms up in the air and turned around and faced the crowd. That would’ve been really cool. I would’ve been inspired, for one, I don’t know about you.

Andy Slavitt: [00:05:27] Right. Well, so what he’s trying to tell us is that he’s strong and that he’s healthy and I think he said that he might be even immune from COVID-19.

Dr. Bob Wachter: [00:05:38] He’s probably right. That’s one of the few things he said that’s probably correct. I mean, you know, once you have it, you are likely to be immune from getting it again. So if you are a narcissist, you know, getting it and surviving it particular, if you don’t get long COVID and you feel fine is a pretty good thing.

Andy Slavitt: [00:05:57] But I think he meant it as in he was so strong that he was immune already, which is why he conquered it. I think that’s how he intended it. What do we know about his condition and what has likely happened? And you know, we can start with what his physician said, but I think unfortunately, because I think you’ll probably tell us that we didn’t learn everything we need to know from those two press briefings, that you’re going to have to intuit some things. And so maybe you can tell us what we’re confident in and maybe just some of the things that you you believe are true.

Dr. Bob Wachter: [00:06:38] Yeah, there’s a version of medical Kremlinology that has to go on here to figure out what he said, what he didn’t say, and sort of connect the dots. And that takes takes advanced medical knowledge to do that, as it turns out. So here is what he said. My sense is we he told us every bit of good news and every bit of bad news he evaded through either a mechanism of I’m not going to go back in the past, even though he told us many things that went back in the past, or I thought that very creative invocation of HIPAA was pretty cool after he told us as vital signs what medicines he was on and a few other things. But here’s we know we know is oxygen saturation was low. That’s really crucial because if you get COVID, as you know, 30 or 40 percent of people will be completely asymptomatic. He’s clearly not in that camp. He had a fever and fatigue and lethargy and muscle aches and other things and a cough. And then the next category is, has it gone down in your lungs? And is it is it harming your ability to breathe? And the best test of that as your oxygen level, the oxygen saturation. So after a few tries, he told us that it had gone down as low as 93 percent, which is modest but real. That doesn’t happen randomly and it’s not a blip. And then he said, but it but it never went down to the low 80s.

Dr. Bob Wachter: [00:07:56] That’s a bizarre thing to say unless it did go down to the mid-80s. So I’m taking away that it went down to the mid-80s. And the reason I’m taking that away is partly because of that bizarre framing, but because they started two medicines, the remdesivir and the dexamethasone, that really are only indicated in patients that have significant hypoxia and you wouldn’t call a little blip down to 93 significant hypoxia. Now the remdesivir, a lot of us would have started it if the option level was was down at all. Not a big deal. The dexamethasone is a quintessential sort of mixed bag because there actually is harm. The study that demonstrated that it was beneficial in the lowered mortality rate also demonstrated that if you have a patient who didn’t need oxygen, they were on average harmed by using it.

Andy Slavitt: [00:08:45] Because it suppresses the immune system, is that right?

Dr. Bob Wachter: [00:08:47] Yeah. That’s the idea, the assumption. The assumption is early on, what you want to do is not suppress the immune system. You want to bolster it. Later on, if the patient is getting an overwhelming infection and you think they’re now at the stage where their immune system is part of what’s causing harm, you do want to suppress it. So the combo of him saying it didn’t go to the low 80s and that his doctors — he’s got good doctors — decided to start the dexamethasone, tell me he probably went down to the mid-80s. I guess he didn’t stay there because, you know, they said that his his oxygen saturation was normal when they discharged him. I have no reason to believe that that wasn’t true.

Andy Slavitt: [00:09:24] And so they gave him a third medication, which many people may not be aware of that maybe you can talk about. He got it on compassionate use and it’s — well, I’ll let you explain it. Maybe you can tell us the significance of that and what we know about that and the impact of it.

Dr. Bob Wachter: [00:09:41] Sure. The third medicine, so we got the antiviral medicine, remdesivir, which has been demonstrated to be beneficial mostly by shortening the length of the illness, didn’t reach significance in terms of in terms of mortality, but reasonable thing to do for a sick person in the hospital. That dexamethasone, as I said, was a close call. I am sure they had Talmudic debates about whether to give it, because it actually could have caused harm if they gave it sort of too early or before he was too sick. The third thing he got, which was monoclonal antibodies, and there are several of them being tested. They’re quite promising. He got one that’s called a cocktail, meaning there are two different monoclonal antibodies that got put together in a stew. And they gave it to him made by a company name Regeneron. The early studies — and they have been so far published in press releases given out to investors. So not in any medical journal, not peer reviewed, but the early studies seem to indicate some level of benefit in surrogate endpoints. In this one, the only endpoint that I believe it showed was that the level of the virus went down significantly. Now does that correlate with better outcomes? Probably, but not proven yet. Its current status is it’s not even available under emergency use authorization, certainly not approved for general use. So they got it by his physician contacting the company and the FDA and asking for compassionate use. That is very highly unusual. Generally, compassionate use happens when you have a patient who you’ve tried everything and nothing’s working and you’re down to your — it’s a Hail Mary pass. It’s the last thing that might work. So it’s a little bit unusual to get it.

Andy Slavitt: [00:11:26] If you were his physician, would you have would you have done the same?

Dr. Bob Wachter: [00:11:29] No. No. 

Andy Slavitt: [00:11:31] You wouldn’t have called for it? 

Dr. Bob Wachter: [00:11:32] No, because his risk was not so high that I’d be looking to give him something that has not been proven to be useful. And as he gets sicker, I know I’ve got two things in my bag. If he ends up in the hospital, the remdesivir and the dexamethasone that have been proven to be beneficial. So I don’t criticize the doctors for asking for it. I probably wouldn’t have asked for because it would’ve been a bizarre question because they would’ve said what the hell? We’re not going to give you that on compassionate use. But of course, the CEO of the company is a member of his golf club. So there was a little bit of inside track.

Andy Slavitt: [00:12:06] Yeah. And we’ve talked about monoclonal antibodies here on the show with David Agus not so long ago and we talked about is something is very promising, but it’s also having trouble attracting enough patients for their clinical trials. And, you know, part of this feeding frenzy of every biotech company in the world starting a clinical trial for COVID means that certain ones aren’t getting done. But it does seem to communicate that someone at least believes, if you want to say, OK, what’s the most promising thing out there? If I were to guess, I’d say, well, why don’t we start with what they gave the damn president? Because they guy’s been talking about hydroxy left and right. I didn’t see them asking for it. I didn’t see his doctors asking for it. Once he was in there, I think it was OK, let’s give him the most promising stuff we got. And so that’s potentially an odd story, but promising for maybe the rest of folks on the horizon.

Dr. Bob Wachter: [00:13:01] Yeah. I mean, hydroxy, you know, in the four months since he began touting it has been subject to a number of rigorous studies, all of which have demonstrated that it doesn’t work and it causes net harm. So I’m glad they didn’t give it to him, it would have been incorrect from an evidence-based standpoint. I think the trick with the monoclonal antibodies is partly trying to figure out its use case. So here you have a very expensive drug, the value of it is that you can give it before someone gets super sick. And that’s exactly when he got it. He got it before he went to the hospital, I believe. The only things available up to that point are ones that you only give people that are pretty sick who are in the hospital with low oxygen. So you say, OK, there’s a good niche. Well, how is that going to work out? Are you going to give it to every older person with COVID with maybe a projected mortality rate of greater than one in 10? Depending on how beneficial it turns out to be, you’re going to be treating an awful lot of people that would have done fine without it. In a setting where we do have other medicines that we can now give them that we know work. And also in a setting where eventually there will be a vaccine that comes out. There’s going to be a relatively short window of time where a company might do well on these drugs and trying to figure out who actually will benefit from it. What the use case is. I think it’s pretty tricky.

Andy Slavitt: [00:14:27] I’ve got the solution, though, Bob, because we know that drug companies like to lower their prices dramatically. So I think, you know, if it works, they’ll make it free. You could see that coming, right?

Dr. Bob Wachter: [00:14:38] I mean, you’ve been in that position of power. You know how that works, so I have no reason to to contradict that.

Andy Slavitt: [00:14:46] I’m kidding. Looking at where he is today as a patient and what lies ahead, is he out of the woods?

Dr. Bob Wachter: [00:14:54] No, he’s in the woods. Just taking data that now is publicly available, if you took all 74 year olds who are overweight and male. that group has about a 20 percent chance of dying of COVID from the get-go. Once he’s now sick enough to be in the hospital and require oxygen, that number has got to be a little bit higher. The trajectory in COVID sometimes is they come into the hospital, they get really sick on day one. But just as often they come in the hospital or maybe not even the hospital, they’re home. They’re doing fine. And it’s somewhere between day three and about eight where things go off the rails. So he’s still in that window where there is a reasonable chance, probably not 50/50, probably still more like 20, 25 percent that he will get sicker. They’ll call the helicopter back to take him back to the hospital. You know, he’s not out of the woods for that to happen to him. And that’s why I had some quibbles at least about the discharge decision. Now, every day he goes on, you know, it’s a curve. So every day, if tomorrow he doesn’t crash, then his probability of a bad outcome goes down. In a couple days from now — so it’s a little better judgment call when you say he needs to go, because you might say, well, should he stay in the hospital for 10 days? The answer is no. I think if he had had three or four days of rock stability, oxygen level is good, including when he walks around, fever’s gone, he feels good. Then I think it’s reasonable to send him home. But he’s certainly not out of the woods.

Andy Slavitt: [00:16:30] If you think about what he has to do lying ahead, he’s got campaigning he needs to do. He has golf he needs to play, you know. Which of these activities, if you’re his physician, would you strongly advise him to not do? And what would you tell him, you know, it’s probably OK if you do it in proper doses.

Dr. Bob Wachter: [00:16:51] Well, I’m a golfers, so I can’t ever argue against that as an essential activity. But in general, you have to dissect out what is the risk of his being infectious and the infection control risk, which is very real. And that doesn’t go down to anywhere near zero until about 10 days after the onset of symptoms. So that’s sort of one piece. Should he be isolated from everyone for the next 10 days? The answer is yes. He’s putting other people at risk if he doesn’t do that. So that would influence campaigning and sort of everything else outside of his room. In terms of his ability to do other things, that really is up to how he’s feeling. I mean, there’s nothing magical about that. Some people a week out feel fine, they’ve gotten their strength back. Maybe they’re a little weak. Maybe they’re a tiny bit lethargic. They would pull back on their activities. Once he’s passed that acute danger period, there’s nothing really that would say, you know, if you feel up to playing golf, playing tennis or going to a rally where it’s otherwise safe, there’s nothing about the illness that would make that a particularly dangerous thing to do. Totally depends on how he’s feeling.

Andy Slavitt: [00:18:01] Well, I really appreciate you coming on the show. I’ve been meaning to have you for a while. And Bob is terrific if you don’t follow him already on Twitter and his nightly recaps. He’s amazing. He’s also a wonderful, wonderful guy. So I really appreciate you giving us this update.

Dr. Bob Wachter: [00:18:16] Yeah. Thanks so much for having me. I really appreciate it.

Andy Slavitt: [00:22:30] Thanks, Bob. I probably should have called him Dr. Wachter. But I call everybody by their first names here. And our next guest, I’m going to welcome Chris Murphy, who I’m also probably not going to end up calling Senator Murphy, because, as you’ll see, he’s a really terrific personal guy, a huge advocate for healthcare issues. And he is a member of the HELP Committee and the Foreign Relations Committee. HELP Committee has jurisdiction over many of the important topics in health care. And he was a Connecticut congressman, I believe, from 2007 to 2013 before he became a senator. I think you’re gonna enjoy this.

Andy Slavitt: [00:23:17] There’s Chris. You’re one of the people who I think of who has fought hardest for the Affordable Care Act. And also, I think, just been most lucid about pointing out all of the contradictions of the president trying to make a claim that he can run on healthcare while this lawsuit is going on. So I don’t know, maybe we should start there and just kind of lay out how you see it and how you see the next couple of weeks with the potential confirmation hearing unfolding. And of course, we got a bang, bang, bang. We have a confirmation hearing, an election and the Affordable Care Act case on the 10th of November.

Chris Murphy: [00:24:06] Yeah, I mean, before anybody had ever heard the word COVID, healthcare was the number one issue in America. It was the number one issue for swing voters, it was going to be the defining issue of the 2020 race, whether or not we ever were met with a pandemic. But now that we are over 200,000 people dead, the idea that this administration still thinks it’s a good idea to take away health care for 23 million and let preexisting conditions once again become something that could cause you to lose health insurance is just unconscionable. And, you know, they had the chance in the middle of this epidemic to pull back the lawsuit or the administration, the very least, could have pulled their support for it. They could have signaled that things have changed and thus maybe now isn’t the right time to continue to press forward with this effort through the courts to do what they couldn’t do legislatively, which is to obliterate the protections in the Affordable Care Act. And, you know, I guess it’s unsurprising given how much time they’ve spent on trying to get rid of the ACA since 2010 that they not only decided to keep going in the middle of COVID-19, but they decided to double down with the opportunity to steal a court seat from Obama.

[00:25:22] They are now going to try to get this all done and wrapped up for the election so that right after the election, this case, which is pending, can move forward with Amy Coney Barrett on the court. And, you know, I just sort of look forward to, you know, the beginning of next year. We’re still going to be in the middle of this, even if Joe Biden is elected. Nothing is going to really change until Trump is gone. We’re going to have 220,000, 230,000 people dead and we’re going to start having millions of people lose their insurance because this case asks not for the Affordable Care Act to be repealed over time or in parts, it asks for the Affordable Care Act to be invalidated all at once. And so just imagine beginning of next year with cases on the rise and all of a sudden millions of your neighbors losing healthcare out of nowhere, just a humanitarian catastrophe.

Andy Slavitt: [00:26:10] Right. Let’s step through that in a second. I would ask you a question, I just want your best guess. We have hearings supposed to start next week on Justice Barrett. How many Republican senators would you say don’t have COVID, if you had to guess?

Chris Murphy: [00:26:27] I mean, I think they are all getting tested right now. I mean, I just came back from getting tested as we started this. So, you know, there’s probably a few more that have it. But I would guess we’re getting to the end of the disclosure.

Andy Slavitt: [00:26:39] Can you get enough in a room to do a hearing?

Chris Murphy: [00:26:41] I mean, you know, Ron Johnson said today that he will he’s going to vote no matter what, whether he has it or not. He says, I will be in the Senate chamber voting and he’s telling the truth. These guys are not going to let a deadly virus get in the way of stacking the Supreme Court. I mean, this is what they live for. So they’re frankly willing to die for it as well. 

Andy Slavitt: [00:27:04] And let you die for it. 

Chris Murphy: [00:27:06] And let me die for it. So, yeah, this idea that, you know, we’re gonna be able to stop this because of this outbreak misunderstands, you know, how serious these guys are about ripping everybody’s healthcare away. Ron Johnson, Mike Lee will show up for the vote with positive cases of COVID if that’s what’s necessary to get her on the court.

Andy Slavitt: [00:27:26] Yeah, there’s some discussion at the hearing that they may try to do this on Zoom. And I just wondered what you think, whould the Judiciary Committee hearing a case for the highest court of the land, is that acceptable to do on Zoom, or should it be demanded that it be in person?

Chris Murphy: [00:27:43] It’s 100 percent not acceptable to do on Zoom. I mean, we’ve all had very functional Zoom calls, but we’ve all had more in which it doesn’t work for a variety of reasons. I’ve done these remote hearings and they’re hard to follow, right? It’s hard to be in a conversation with somebody remotely. People are getting kicked on and off. I mean, this is a life-changing appointment to the Supreme Court. It was not just the Affordable Care Act. If Amy Coney Barrett gets onto the court, states will be allowed to criminalize abortion. Background checks laws will likely be invalidated. Your life is going to be fundamentally different if this nomination is rammed through. And so the idea that they’re going to do this by video call is just preposterous. No. This hearing has to happen in person. And I think they’re going to look absolutely foolish if they try to push this forward via Zoom, right?

Andy Slavitt: [00:28:39] Yeah, I can imagine some of the older Republican senators like being on mute half the time. [00:28:42][3.2]

Chris Murphy: [00:28:44] It already happens. It happens all the time in these and these calls. I mean, there’s certain senators who shall remain nameless, who have yet to appear on some of these committee meetings that are done virtually. I think it’s largely because they can’t figure out how to do it. I mean, it would be an embarrassment to the Senate beyond all the embarrassments we’ve been through if they tried to go forward with this.

Andy Slavitt: [00:29:07] All right. Well, if I were a controversial nominee and if you were a controversial nominee, I’d love to be heard on Zoom. I’d love to be able to just kind of tune out and, you know, be in the comfort and privacy of my own place than have to face people directly. It’s easier to dodge, it’s easier to filibuster. I mean, if I kept talking now, Chris, you wouldn’t be able to get a word in. And having been a witness to about 15, at least 15 hearings, you know — I wan’t even appointed for life. I was being prosecuted over someone having a pizza party. It’s really important.

Chris Murphy: [00:29:43] Yeah. And I think, you know, the taxes you talk about are real. I mean, what these nominees try to do now is to just talk and talk and talk and not stop because each member only has maybe five, seven, 10 minutes. And you are right. One of the hardest things I have found is in these video forums, it is really hard to stop somebody when they are filibustering. And they can easily just talk over you. So, yeah, this plays to the advantage of a nominee who’s trying to hide things.

Andy Slavitt: [00:30:12] Yeah. So for people who are listening and who’ve never been through this or seen the process, there’s a whole industry in hearing prep and there are lawyers that get paid, you know, $1,200 per hour to prep witnesses and techniques. We’ve all seen the results of that, but it doesn’t come because people are gifted at it becomes because people teach you how to be mindful of the clock and all of these other things and how to avoid answering questions. Very hard to imagine some of those moments in the cabinet hearing between Senator Klobuchar, Senator Harris and Justice Kavanaugh happening when they weren’t there. Before we get to go back to healthcare, there’s another troubling aspect of this appointment that is confusing, which is the notion of appointing a justice that has a potential, at least if Trump has his way, to decide the election, putting forward somebody while at the same time saying as plainly as he said it, that he believes the Supreme Court is going to decide this because he has hundreds and hundreds of volunteer lawyers at every state that are going to contests a lot of these ballots. I want to go back and make sure we remind people that voting will be safe and the votes will be counted and votes will be heard. And I don’t want anybody to get confused by the fact that Trump has hired lots of lawyers to discourage people from voting. Actually, the reason you should vote is because it will make it impossible for these lawyers. But putting someone on the court at that moment feels especially problematic in the context of our republic.

Chris Murphy: [00:31:41] Yeah, you sort of imagine that there are two reasons why this nomination is being rammed through before the election. So remember, in many ways, it’s politically easier for McConnell to do this in the lame duck. He could have the hearings right now and just put off the vote until November or December. And then that vote occurs after the elections, where there’s really very little downside risk to people like Susan Collins or Martha McSally. And he is less likely to be accused of rushing it through. But they seem right now to be intent on having the vote before the election for two reasons. One, as we mentioned, there’s this healthcare case that has a hearing a week after the election. And if you’re not there as a Supreme Court justice for the hearing, it’s a little harder to actually sit in on a decision, not impossible. But as you mentioned, the other reason is that Donald Trump wants Amy Coney Barrett on the court to hear any contests to the election. And one of the key areas of questioning during the hearing is going to be, you know, what kind of cases does she think is appropriate to be heard at the Supreme Court? Let’s say, for instance, there are two sets of electors sent from a state who judges that contest. Is that the Senate or the House? And there’s clauses to suggest the Constitution allows us to determine who should be seated or does the Supreme Court step in. So I think those are some of the most important questions. And I hope she has answers. I mean, to the extent that she is just going to punt on every single question of Supreme Court jurisdiction over election questions that would make me even more nervous that the fix is in.

Andy Slavitt: [00:33:22] It’s another reason why you can’t have this on Zoom. Because those kinds of questions, you really need people to account for what they’re going to do, what they’re going to say. Would it be up to her to recuse herself from a case like that or is there some way she could be automatically recused? I just don’t know how it works.

Chris Murphy: [00:33:41] There is no mechanism for recusal. One of the strange facets of the Supreme Court is that there is a code of conduct that applies to all federal judges that sets the standards for recusal except for the nine Supreme Court judges. So every appellate court, every district court judge is subject to a recusal standard, but not the Supreme Court. They hold themselves above the law. I actually have legislation that would subject the Supreme Court to that same standard. It is yet to pass. But even that code would likely not force her to recuse herself from a case about the election simply because the president who appointed her is a contestant. There’s no way that she or Gorsuch or Kavanaugh are going to recuse themselves from an election case. And I just don’t think that’s going to happen.

Andy Slavitt: [00:34:31] Are you confident that in the end with this election, that justice will be served, that the republic will hold? And there our checks and balances, one of them, whether it’s the Senate, the House, the courts will allow the power of whatever the people decide to prevail.

Chris Murphy: [00:34:47] Well, if you’re asking me if I’m 100 percent confident, then no. Listen, I think there is no doubt that this president is going to attempt to steal this election. It made no sense that he was attacking mail-in ballots because we all know that Republicans cast more ballots by mail than Democrats. So the only reason he’s been sort of waging this war on that vote by mail or absentee balloting is to try to just create a false controversy so that he can steal the election. The Russians are more active this time around than they were in 2016. They’re smarter about their intervention. And there’s no doubt they have the desire to try to screw with voter lists, to shut down voting in particular states. So I think there are all sorts of possibilities for this to go south. That being said, we have the biggest voter protection legal effort that has ever been mounted by a political party in the history of this country. As you mentioned, if we just go out and win, and win by pretty solid margins in a lot of these contested states, then it’s a lot harder for the president to mess with the count.

Chris Murphy: [00:35:54] And I think people are going to take voting more seriously this year, which means either deciding to vote on Election Day on the machines or making a plan to vote and voting as early as you can and paying very close attention to all those rules about how you seal the ballot, how you sign the ballot if you’re going to choose to vote that way. So, you know, I think people are up to the task. My hope is that this latest debacle with the president’s diagnosis will be the final proof to people he doesn’t deserve reelection, and we won’t be, you know, on the edge of our seat on election night.

[00:36:26] But Chris, he just said that he’s learned about coronavirus.

[00:36:48] Like a good student. He refused all the briefings. He didn’t read any of the scientific evidence. He waited until he had the virus to do that non-book learning. And we’ve seen how much he has learned over the past 24 hours, having subjected to Secret Service detail to exposure inside a hermetically sealed car.

Andy Slavitt: [00:38:52] So let’s return to healthcare for a second, and there are elements of the ACA that most people are familiar with. There are elements of the ACA that sometimes people forget are part of the Affordable Care Act. And I want to start with one of them, which is the impact on seniors. Seniors have about $1,000 savings by the closure of the donut hole that would go away if the ACA goes away. And the reason I want to start with this one is because I want people to understand the mechanics, not only with seniors costs going up $1,000 dollars, but pharma companies would receive $3.5 billion dollars of tax cuts at the same time. And President Trump has already diminished the life of the Medicare trust fund by two years. In other words, it now expires or becomes insolvent during his presidency. He is clearly diminished the value of the life of seniors by saying nobody gets this, only old people. And so I want to start there, because this notion, and I think it’s very pertinent fully to the election, of this confluence of events and how we treat our elders. And what this court case says about that.

Chris Murphy: [00:40:02] Yeah, I mean, there are millions upon millions of seniors in this country who don’t have an extra $1,000 lying around, who are living paycheck to paycheck, who are already making some pretty awful decisions about, you know, how long they keep their heat on every day, how many pills they buy, what their cupboard looks like on a week to week basis. And if the Affordable Care Act is repealed, $1,000 at least of those drug savings disappear. And you’re gonna have millions of seniors who are going to now be on the hook for drugs that the Affordable Care Act used to pick up. And I think that there’s other point you’re making is really important, which is that that money doesn’t just disappear. It’s not like that goes back into the Treasury. It goes into the pockets of the pharmaceutical companies. Because you know what? We never did a good enough job of explaining to people that, you know, the Affordable Care Act reduced the deficit. It didn’t increase the deficit because we paid for every single dime in that bill, not by raising taxes on regular middle-class folks. We did it by increasing payments by drug companies and insurance companies and the very, very rich into the federal government to help pay for that. And so what is going to happen when the Affordable Care Act goes away is not just the 23 million people lose their insurance and seniors have their prescription drug costs go up, but profits will increase for insurance companies and for drug companies and the very, very rich will get a giant tax cut because all the money that they were putting in to help pay for seniors drug costs to go down will be returned to them. That’s what’s going to happen. And, you know, that’s why I still maintain hope that between now and this vote, we can convince enough people to mobilize to stop Amy Coney Barrett.

Andy Slavitt: [00:41:53] You pointed out the very wealthy. It’s an interesting statistic, the top zero point one percent would receive a $200,000 annual tax cut if the ACA goes away. So if people are out there kind of wondering, well, why would Trump be so insistent on getting rid of something which clearly is massively popular? And he’s pretending to support its features. Why would he do that? And one answer is that the super wealthy essentially would by shrinking the care that goes to people who are wary of expanded Medicaid coverage and subsidies to the Affordable Care Act, take all that money away, all the money that goes to the seniors, and it goes basically in the pockets of extremely wealthy people.

Chris Murphy: [00:42:48] Yeah. I mean, it’s because he’s mean and he doesn’t care about your healthcare. It’s because he wants to destroy anything with Obama’s name on it. He doesn’t look past the cover. If Obama had anything to do with it, it must be by definition bad. And then it is also because it does end up lining the pockets of his friends. And from the beginning, this administration has been a con. He is using his tenure in the White House to line his own pockets. Now that we know more about his tax returns, I think we’re more confident that the reason he sought the White House may have been to increase his brand and to earn chits around the world so that he could make enough money post-presidency to pay back the loans. But, you know, he and many others were also gain a pretty substantial tax benefit if the Affordable Care Act goes away.

Andy Slavitt: [00:43:41] And that is the underside of this. There’s two things that people can do if they don’t want to see that outcome. Let’s make sure you and I hit on both of them. One of them is to prevent this rushed Zoom hearing and confirmation of Judge Barrett. And the second is, failing that, a clean sweep of the Senate, House and White House for the Democrats. Now, mind you, that second solution only solves one problem. It only solves the ACA problem. It doesn’t, in fact, solve the voting rights issues and the corporatization of politics and all of the other things that the court can do. So it’s not the grand solution. But for the ACA, with a Democratic Senate majority maintaining the House and Joe Biden as president, that becomes actionable. Does it not?

Chris Murphy: [00:44:40] It probably does. So, you know, there is probably a way to reconstruct at least the majority of the Affordable Care Act through different legislation in 2021 if this case is successful because, you know, every case is fought on fairly narrow legal grounds. And if this case is successful, there probably is a few switches we could pull only if we have control of the White House, the Senate and the House of Representatives to get insurance back on for 23 million Americans. But that may only be temporary. My belief is that, especially these last three nominees, Gorsuch Kavanaugh and Coney Barrett, they see themselves as politicians. They have beliefs, and one of them is that the Affordable Care Act should not exist, period, stop. And my worry is that they will sort of take as many cases as are possible up to the Supreme Court in order to strike down as many different iterations as we pass. So we may be able to fix this, but there is no guarantee in the long run. Which is why, you know, the immediate task at hand is sort of not counting on the election to fix what may happen if Amy Barrett gets onto the court. We have to reconstruct that tempest of political opposition that existed in 2017 when the Affordable Care Act was up for repeal. We’ve got to rebuild that over the next 30 days to try to convince four Republicans to vote no, or at least to vote to push this off until after the election, to try to live to fight another day.

Andy Slavitt: [00:46:15] Yes. I mean, living with this sword over our heads on our health care, that it could be taken away at any moment, there’s a set of people trying, and that vulnerability is really not what Americans deserve. They deserve to know that our elected representatives are trying to improve the things that don’t work and not playing cynical games. All right. So this podcast drops Wednesday, the 7th. So that makes 27 days before the election, November 3rd. You’re one of the people who I think is really great at cutting through the b.s. and communicating with people and having them focus on the right important things. So for the next 27 days, where would you have people focus, people who care about, among other things, their health, but also this country? What’s their formula for the next twenty seven days?

Chris Murphy: [00:47:10] I learned a new term today. I was scrolling through my Twitter feed and I read an article about what to do other than doom-scrolling, doom-scrolling this idea that you can just scroll through your Facebook feed or your Twitter feed and just be forlorned every second of the day about the health of our democracy and that that can become an obsession in and of itself. So the most important thing is to not doom-scroll, right. Not to spend the next 27 days focused on all of the things that could go wrong between now and Election Day. You need to do something every single day to go out there and help a candidate, either Joe Biden, or in my case, one of the candidates that’s going to help us gain a Senate majority.

[00:47:53] That article, which was making the case that people need to do something, said the most important thing you can do is make a small donation, or raise small amounts of money for Senate candidates. And on their short list was Alaska, Kansas, Georgia, Texas, Iowa. The second thing you could do is sign up to make sure this election is fair. There are a couple of good sites that are recruiting election protection volunteers, people who will go out to the polls and just, you know, make sure that there isn’t any funny business, that there aren’t people showing up with AR-15s to try to intimidate voters. So you can be an election protection volunteer. And then we’re still doing the old-fashioned campaigning. We’re not doing it the same way. But you can be on the phone calling voters every single night for the next 27 days. Go pick a candidate. Find the method which they’re contacting voters. What our data tells us is that there is no better way to change your mind or to turn out to vote than a volunteer on the phone or at a door. And while you can’t knock doors, we can still get on the phone. So pick an activity and do one every single day. There’s only 20 something days left. You’re not too busy to do half an hour or the work or $20 worth of contributions every day or so.

Andy Slavitt: [00:49:10] Yeah, no, that time is it’s a really well-made point. And by the way, I just talked to the Biden campaign and released some actual safety rules around canvasing. So doorknocking is possible to do in a safe way. It’s on my Twitter feed. I had a group of epidemiologists develop this. It’s actually commonsense stuff. You need to make people feel safe and you’re not going to have a conversation that people don’t feel safe. But if you knock on the door and retreat down the driveway, or if you’re in apartment building and there’s room — if there’s not, of course, you don’t knock on the door, and you can even leave literature. You wear a mask, you make sure you’re clean and you ask people if they’re comfortable having a conversation. It’s entirely possible to do that safely. Likewise, voting, particularly voting early, is very safe. Lana and I went to vote.

Andy Slavitt: [00:49:56] They kept us six feet apart. They only let four or five people into the actual room where people voted at the same time. They were very conscious, they had Plexiglas everywhere. We were in and out in a matter of minutes. And so, you know, obviously people who require additional protection because they are immunocompromised or elderly, etc., make sure to do that. Of course, voting by mail is an option. But voting in person, if that’s what you like to do, there’s plenty of time in most states — I think every state but one you can vote as of even right now in a couple of states, actually until the 15th of October. And if you go then, it’s not very crowded. So, you know, it is possible to protect yourself and exercise your democratic rights if you do it right.

Chris Murphy: [00:50:40] Yeah, my wife and I voted in person for the primary in Connecticut. And, you know, as a function of how many people are voting early, Election Day, at least in Connecticut for the primary, it was a little bit of a ghost town, even though overall turnout was strong. So, you know, if you’re used to voting on Election Day — and in Connecticut, we actually don’t have early voting. So in Connecticut, you either have to cast an absentee ballot or vote on Election Day. You know, people are taking your safety seriously and there won’t be the kind of lines that you might be used to, at least I still think, because somebody’s going to do it ahead of time. So voting, again, don’t do it if you’re immunocompromised or you have any other sort of adverse health recommendations, but voting in person on Election Day is still an option.

Andy Slavitt: [00:51:29] All right. So let’s bring it out on some positive stuff, Chris. The country has a lot of challenges. We’re a country that has dealt with challenges, we’re a country with lots of capabilities as well and lots of strengths. Help us think through what you hope for the next year in American life, what you think are some of the most important things for us to do as a nation, to get back to achieve this kind of country that we all know we have here.

Chris Murphy: [00:52:02] Well, this is the greatest crisis this country has faced since World War II. And in the aftermath of World War II, we didn’t just recover. We reinvented ourselves. We created American modern society in the wake of a world war that took hundreds of thousands of our citizens lives coming off of the most massive economic depression in the nation’s history. And maybe our reinvention isn’t as revolutionary in 2021 as it was in 1946, ’47, ’48, but there’s the opportunity. We have some some manifest inequalities and weaknesses in this country that have been exposed during this crisis. And we have the opportunity to build this country back. Better to come together in 2021 and say to ourselves it’s not OK that we’re continuing to fight over the idea that everybody in this nation should have access to healthcare. This has proven that we just have to have a rock solid guarantee. There are too many people in this country who lost everything within weeks when they lost their job because nobody has any savings, because the economic floor in this nation is far too low. We need to rebuild that floor, which includes making new commitments to people about how we’re gonna help you retool yourself to get sort of the jobs that are gonna be showing back up again in 2021.

Chris Murphy: [00:53:28] That means better educational benefits. So whether it’s a higher minimum wage, a more guaranteed system of universal access to health care, additional guaranteed educational benefits in the middle of a crisis. This country has often decided to reinvent itself, and we can do that for the better. And who better do that with than Joe Biden? Joe Biden is somebody who has shown an ability to reach out across the aisle, who has those sort of rare healing powers in large part because of what he’s been through. And I just have faith that if we sort of come out in the right numbers in November, we’re gonna have an opportunity not just to get rid of COVID, but to rework the rules of this nation so that everybody has a shot to survive something like this if it happens again in another five, 10, 20 years. I remain very, very optimistic about our chances to get there.

Andy Slavitt: [00:54:24] That’s great. I think we should never lose sight of the fact that we still are who we are. We still have that in us and leadership will help bring that out of us. But we have to be a part of doing that. Well, you’re going to keep fighting. It’s always great to know that people like you are there fighting and are going to tell it like it is that you’re going to not quit. So thank you for that. You’ve always been that that just for Connecticut, but for the important things that are so important to many, many Americans.

Chris Murphy: [00:54:54] Well, thanks for having me. Thanks for everything that you do. You are relied upon by so many of us. Very few people that are as smart as you are on both policy and the politics of healthcare, many other topics and so appreciate you always being on the other end of the line for lots of us.

Andy Slavitt: [00:55:21] All right. That was an action packed show. Thank you to Chris Murphy, senator from Connecticut. Thank you also to Bob Wachter for the excellent clinical analysis. Let me just tell you what’s coming up. You’re not even going to believe our shows next week. I don’t know if you’re going to be able to sleep. Monday, we have Senate Minority Leader Chuck Schumer. As the trial of Judge Barrett begins, we will have the leader of the Senate talking about the strategy, approach and issues. We are thrilled that Chuck is joining us. On Wednesday, another opinionated East coaster, Zeke Emanuel. Zeke is one of the most prolific and opinionated people when it comes to health and medical science. He has been one of the most visible scientific experts on TV. He’s a friend of mine from the Obama administration and before. I think you’ll really get a kick out of this conversation. And then the following Monday, as we’re getting deeper into October, there’s an episode that I’ve been meaning to do for some time. And it’s a really special episode about the topic of mental health, addiction and suicide. But the content is obviously a little bit deeper. And I’m going to have to guess Gary Mendell, who has started the most phenomenal organization after he lost his son after a long battle with drug addiction. And then Stephanie Wittels Wachs, who is someone else who’s lost an immediate family member to addiction. And I think it’s an important episode in light of the fact that there are many other costs to COVID-19 than simply the illness. And they deserve to be explored in an honest and open way. And so I hope you’ll listen in and enjoy that episode. I really appreciate you listening to this podcast.

Andy Slavitt: [00:57:35] Thanks for listening to In the Bubble. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen, produce the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer. Improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produce the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media @LemonadaMedia. And you can find me @ASlavitt on Twitter or @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen. But still tell them at a distance or with a mask. And please stay safe. Share some joy and we will get through this together. #StayHome.

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