COVID-19 Webinar Series Session 3 – Leading through Crisis: Perspectives from Gov. Michael O. Leavitt

12:00 p.m. – 12:05 p.m.     Welcome and Introductions

Sarah J. Dash, MPH

President and CEO, Alliance for Health Policy, @allhealthpolicy

12:05 p.m. – 12:30 p.m.    Moderated Discussion

Michael O. Leavitt

Former Governor, Utah; Former Secretary, United States Department of Health and Human Services

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

Good afternoon. I ain’t there – president and CEO of the Alliance for Health policy and welcome to the third event in our kuva 19 webinar miniseries. You can follow today’s conversation on Twitter using the hashtag all help lives or follow us at all Health policy. The alliance gratefully acknowledges the National Institute for Healthcare Management foundation for supporting. Today’s webinar before we begin I’m going to briefly Orient you all to the go to webinar platform and review brief technical notes first to ensure the best.

0:39

Audio-visual performance. Please. Make sure you are dialed in using your phone and close all other windows that maybe open you should see an interface light that looks like this and you can ask questions using the question chat box. You can send in those questions at any time and will address those during the broadcast finally all of the materials that accompany this webinar including a recording will be available at all Health policy dot-org.

1:06

Today I am thrilled to be joined by Governor Mike Leavitt Governor. Levitt is a distinguished public servant. He served as the governor of Utah for nearly a decade as well as the secretary of the Department of Health and Human Services during the George W Bush Administration Governor Levitt. Welcome.

1:24

Thank you, sir, and good day.

1:29

Let me ask you you have an incredibly unique Vantage Point as both a governor. And as a former HHS secretary and you have in fact LED through pandemic yourself. Can you explain to us the different roles of the federal state and local governments and responding to this outbreak?

1:48

Yes, may I say I think we have to start just just an acknowledgement that we have all now begun to make and that is that pandemics are a unique emergency. We have become accustomed to government playing a role in an emergency when there’s a large hurricane or a tornado or an earthquake or a terrorist event. We’re able to deploy as a federal government to the scene with many different resources most of which.

2:19

Come from States as we look at what the state where the federal government has to deploy in terms of people feet on the ground.

2:28

If you will most of those tend to be people from States who are not engrossed in the emergency itself with a pandemic everything is happening at the same time everywhere and that makes this a uniquely uniquely local emergency That being said it’s important to acknowledge that there’s a role for everyone especially the federal government but are the roles of the federal government first vaccine and we have great hopes of being able to develop vaccines and medicines that in fact diminish the symptoms or in some ways bring about healing the federal government.

3:17

Has that role there are of course Is the capacity for the federal government to collect and spread risk through tax dollars. We’re saying now work on the third supplemental appropriation to respond. Only the Congress only the federal government can do that. There’s the collection of data and the providing of information that has to come through the aggregation of data that’s collected at the local level.

3:46

No one would have that capacity other than the federal government to be able to Create those kinds of data standards and aggregate the information. The federal government has supplemental assets that can be deployed in times of hardship. They have the military and other kinds of things which could be if required deployed. So there is a very distinct Federal role but anyone who believes that the federal government can come to their rescue by its deployment.

4:21

Ointment would be somewhat disappointed I think because that has to be done for the most part by state local governments who have resources on the ground and the job primarily of the federal government that my view is to meet its unique roles in being able to support what’s happening on the ground. For example, let’s take school closures as an example. The thing about a pandemic is that it unfolds differently.

4:51

Different regions of the country at the same time and so we do see different responses being taken by Governors and by local Mayors and County commissions who have a view through their Public Health officials. What should be done in those areas. There may be schools that do a soft clothes and maybe schools were closed for a long period then maybe schools who have a limited schedule. It depends on the nature of what’s happening. And of course, my advocacy is always for them to be met.

5:21

Making decisions based on local public health advice. So Sarah, I think that gives at least a range of the government’s role, but could I say this isn’t just a government response. Obviously, there’s a role for everyone you’ll hear me say over and over of that families need a pandemic plan and that’s certainly true as we begin to see now a lot of Sheltering in place going on or where we see people going through voluntary isolation.

5:50

There’s a role for Every business is now having to Think Through how they will accommodate this new and quite unusual situation churches schools universities institutions at every level need to be thinking about their plan. So again, there’s a role for everyone in pandemic plan.

6:15

Thank you so much Governor. Well, let’s go to that because in the past just in the past week to maybe 10 days there have been really unprecedented steps taken at the state and local levels to encourage this idea of social distancing to slow the spread of this particular covet 19 pandemic and to flatten the curve from your Vantage Point. How do you think those efforts are going? Do you think there’s more that remains to be done? Do you have any concerns at this?

6:47

Well, I think we all have concerns. I think there’s always more to do but I do think we ought to acknowledge that what is happening among the American people is nothing short of historic. People are responding. This is hard.

7:04

It’s not something people would choose there are lots of reasons not to do it and there are some who aren’t doing it as well as we could I think expected they Should do. However we’re seeing such a profound response with businesses working from home with entire professional sport leagues and entertainment venues closing with families making preparations.

7:36

This is a profound response and it will save lives and so I think we can we can also acknowledge and I think should There’s so few times in our country’s history where people pull together in a way that provides a sense of community. I think it’s inspiring for example that we have government now working together in a way that we have longed for for a period of time three, four months ago. You can say congress will be working together in a bipartisan way to produce a common product.

8:14

That would have been unlikely. But in this moment of Crisis Americans are stepping forward and I think it’s demonstrating that that spirit is very much alive.

8:27

Thank you Governor. Will you talked about folks working together and and coordination and maybe you could shed some light on from your former perspective at HHS about how how do federal agencies have to coordinate?

8:41

We obviously have so many of them involved in different aspects of the response what what needs to happen what gets activated in a pandemic such as this This is the reason that the president chose to place at the top of the other as chairman of the task force, the multi-agency task force the vice president. That was an important symbol to say that the entire executive branch. We’re going to work together and a full government response. There’s not an area of the federal government that is not required if you’re in labor, you got it.

9:23

If you’re in Commerce your own full on the balls of your feet, if you’re an HHS, you’re working day and night. If you’re the Department of Education you have problems that you’ve got to deal with. If you are State you’re working with other governments. If you’re a treasury, you’ve got all kinds of new regulations and demands to put forth that to put forward if your energy or worried about the energy Supply.

9:48

Every Department of the national government has a role here and so with Without that kind of coordination it would become very difficult to function. Now I would argue with are you at least make the point that one of the criticisms that can properly be made of the way we organize and particularly the way we appropriate it’s often difficult to collaborate across.

10:24

Line items even within a budget and so I would to those who are listening who have some influence on the way legislation is written for appropriation. Keep that in mind. There’s a need for federal agencies to work together. But that means that they also need at points at points in time to contribute jointly to projects that can be for the common good.

10:55

Thank you such an important point and it does indeed seem like there is such an unprecedented amount of interconnectivity between obviously what we’re seeing with the public health with the epidemiology with the health system preparedness with the economy of schools and businesses have to close for the time being so so it seems like there’s there’s just this unprecedented amount of coordination.

11:23

You are also We now in the private sector and we’ve heard, you know private entities also stepping forward. What is the infrastructure in place to ensure that the public and private sectors can coordinate to execute a more comprehensive response that we need. I think people are innovating right now because that is not an area that I would say is particularly strong. I have been on a number of different large video.

11:54

So conferences where people are struggling to come up with information that allows them to model what their new future looks like all of us are coming to the conclusion. We’re going to have to operate in an environment. We have not been accustomed to what does that look like what and so I think that’s an area that will undoubtedly see more focus on in the future because people are struggling to even know what to do.

12:22

I was just Talking with a friend of mine who runs a small shop in at a golf course and he was saying I don’t know what to order. I don’t know if I should order anything.

12:40

I don’t know how that see customers in April or May or June or July and it has a big impact on giving people assumptions giving people the degree of certainty possible is an important role that I think public policy makers and those who serve the public should keep in mind.

13:04

Thank you. Governor. Do you think there will ever be a going back to the way things were before do you think there will be some lessons that we learn going forward some innovations that maybe take hold or is it too early to tell yet?

13:17

Well, I will say generally and then I’ll answer your question specifically when you study pandemics as I have you begin to realize that pandemics are reshaping events the economics of a nation of the world become.

13:40

Reshaped the politics are affected sociology is affected business practices are affected by this morning. I live in the west and so it is still mid-morning and I’ve done three video conference meetings and it’s working out. Okay, we’re learning to use that tool in a way that we hadn’t before that.

14:10

He existed but I have a feeling we’re going to see a lot more of that kind of communication that will begin to shift the world economically in a way that it wasn’t before. We’re learning new skills. I think that we’re going to see I think we’re likely to go through some rough Economic Times in the next couple of months and as we do we’re going to be reminded of getting back to basics.

14:40

And during times of prosperity. Sometimes we begin to feel a little too entitled. I think our attitudes are going to be adjusted in this process as well. Well cover that that dovetails perfectly with a question. We’ve actually gotten in from the audience which is whether you have two or three suggestions on what individuals can do from home to support our government and help out the community during these times.

15:11

I think the best thing we can do is be as prepared as possible to take care of ourselves. This is a place where self-reliance pays off not just for individuals who are not dependent upon government, but it also takes the burden off of the government so they can pay better attention to the details that they are that they uniquely can accomplish. What does that mean?

15:37

Well, I think it means that we Follow the guidance that were being given number one that we actually do practice social distance in the best way. We possibly can all of us know what the parameters of that have become the degree that we have prepared. We have ample supplies in our home in order to feed us and Medicaid us when we’re required when we’re in the ways that we’ve been prescribed. That’s a very good thing means there are fewer.

16:09

Four of us that are shopping at any given moment. So I think that’s one thing we can do. I think the second thing is that we acknowledge that this is a very trying time but it is going to end and that we need to remain as optimistic as possible and deal with what’s in front of us and and move forward. This is not a time for panic.

16:32

It’s a time to prepare it’s a time for us to do to innovate and find ways to Make to make things work. I would say lastly. I think it is if we follow the rules of hand-washing get simple kinds of things. I’d almost seems Elementary to keep talking about that. But when we follow those rules, we’re doing something good for ourselves, but we’re also doing something very good for society.

17:05

Thank you. Well, let’s talk about another population that’s really going to be affected by our individual choices. And that is health professionals who are at the front lines right now preparing for you know a surgeon and more serious cases were at the Frontline treating people. Can you talk a little bit about health professionals?

17:26

And what help do you think health professionals can expect from the federal government and from state and local officials and you know as we know, of course on Wednesday, President Trump invoke the defense protection act giving the federal government broad powers to address supply shortages, which we know has been a challenge. Can you talk a little bit about how how our country needs to help help professionals at this time?

17:53

One of the most challenging aspects of planning for a pandemic condition and exercising to prepare was the allocation of scarce resources and we will see that unfold over the course of time. Let’s just take something that is not as not yet occurred, but at some point will and that is the development of Acts of the vaccine vaccine.

18:23

We hope Will appear we hope that it will be available widespread. Universally. However, it’s not likely that it will all come at once and there will have to be decisions made if you have a limited number of Dos dos has where do they go first? And then the so the policymakers will need to develop a list of priorities and typically that will be those who are caregivers in.

18:53

Petals and in physician offices and other places where sick people turn for help. They need to be the first place. The second would be at risk populations and so forth, but we have to acknowledge that those who are putting literally their own safety at risk to help us need to be the most protected.

19:18

I think we’ll also I think we should also be tailoring some That supplemental appropriation help that we get to be focused on those individuals. They are giving not just of their own time that they are putting themselves at risk. And without it. We could not be in a we would not be in a position to constrain the destructive potential of this pandemic disease.

19:48

Thank you and certainly in a related way. Could you talk a little bit about the role of HHS as well as the governors and the military to help with procuring the supplies and equipment that we need what kinds of things do they need to happen going forward beyond the the supplemental appropriation as you mentioned?

20:09

Well again, I think it’s important to keep in mind the contract of the way things operate in public health. The federal government has taken a significant role over the course of the last decade and a half or two decades.

20:26

Mostly because the states have seen Medicaid expenditures going up so dramatically that one of the areas that they have begun to Cut back on is public health and therefore the federal government has tried to supplement that that under investment is in some ways the the effect of that we’re now seeing but public health is both constitutionally, but more importantly functionally is very much a local function.

21:01

There are City and County Public Health departments, which have a delegated Authority from the state the state is then turns to the federal government for guidance and assistance, but public health is at its root a state function.

21:23

So the role of the Federal Government will be for example, like CDC CDC has been given some policy role but for the most part it’s to offer guidance to the states and to coordinate the action across the country. They possess assets that the state themselves could not be able to provide. So the the role between Governors and and HHS in particular is very important in essence while it’s a kind of shared responsibility.

22:02

There are times in the federal government is acting as primary and there are times when the federal It is acting as secondary and in those cases as when it’s secondary, the federal government is there to be an assistance when they are primary their role is is to provide clear guidance some of those areas where they would be primary would be CDs that would be the the development of standards for data. That’s a primary area. Another one would be the approval of medicines vaccines in the coordination.

22:37

That would be an area where the federal government is primary. So we have a relation that relationship has to be both pliable and it has to be efficient because there’s not just it’s not a single relationship it goes both ways. There’s primary relationships for both in their secondary relationships for both. Thanks Governor. So we’re getting close to the end of our time here.

23:06

So I To kind of round it out with a couple of additional of additional questions and you talk about the role of states and their Medicaid programs. We know some states are making changes to their Medicaid programs or calling for some additional Federal matching funds. So to address the crisis, how do you think the state should be thinking about their Medicaid programs right now as we think about this pandemic?

23:35

So let’s just begin start with a knowledge meant that Medicaid is a state federal partnership. It’s not only funded in Partnership. But the capacity of the states is in because of that partnership is in large measure dependent upon the federal government guidelines. So the one of the areas will be what what is the capacity of a Medicaid State Medicaid?

24:05

On co-payments what type of what about testing will that be covered? Those are just two very simple expressions of this will be a need for the federal government HHS or CMS to provide the license if you will for the states to amend their their benefit plans and that’s beginning to help.

24:30

So there’s an area where both the federal government needs to act and then the states need to act just because the federal government acts doesn’t mean that the states have to but it when this federal government says look, we think that every test ought to be paid for it’s likely to require the federal government to the state governments to amend their plan to do so, so there’s a both illegal and an interpersonal working relationship that that has to exist. We will we’ve seen this recently and Medicare a Medicare is a little different because that’s clearly a federal program, but there’s a need for telemedicine.

25:04

Some for example and this literally yesterday the president and CMS and HHS announced that they’re going to clear a whole series of regulatory questions that have been in place about payment for telemedicine. That’s a very important development and I might add you asked earlier about changes that will occur during this pandemic that we won’t go back on. This is one of them.

25:33

There’s been a need Need for us to clear the pathway or Physicians to operate across state boundaries that’s been a hindrance to to telemedicine that’s been cleared out. Now. That’s the kind of thing now that I don’t think will ever go back on will begin to see telemedicine become a much greater part of the functioning of the American Health System as a result of things that we’re learning and doing during this pandemic condition.

26:05

Aw, thank you Governor. I want to ask you sort of to look looking forward just to the next week so much has happened in just one week with with the flattening of the curve the efforts to social distance, obviously. Unfortunately, the number of cases continues to rise as as we look forward and things are moving at lightning speed Congress has already passed two bills. They’re looking at a third, you know, the CDC the NIH.

26:35

CMS FDA and as you mentioned all of the other agencies that are not specifically Health are are all firing on all cylinders. What do you think are the most important things for us to look for as we as we look to the news in the next week?

26:53

Well first Congress is obviously working feverishly to do the job that they believe needs to be done which is to arm those dealing with this with with the tools. They need Congress as an institution. I mean, I know they want to get this done but one of the reasons they need to get it done as because they need to get out of town and get home and start doing the same thing the rest of us.

27:22

They’re doing for their own safety a number of members of Congress and their staff. I think have tested positively now that’s to be expected. It’s just a biologic fact that if you have as many people gathered together trying to do good work, even though they’re being careful. It’s going to begin to spread and that could be in the long term a debilitating problem. If if suddenly the institutions of the legislative branch have a hard time functioning, so there’s a very good reason nationally.

27:52

In a very good reason for them personally and to get this job done and to be able to then return to their home districts. And so I believe will see that happen. I think the second thing we have to be we have to just be ready for is we’re going to see a sharp increase in the number of cases and I we don’t know how long this will last. We don’t know how high it will go, but we do know there’s going to be a sharp increase and we ought to be prepared for that.

28:22

And we’re doing everything I think in local communities to ready for that to be ready for that. And how long will it be before we know if our social distancing efforts have have worked. I think that public health professionals have made clear. We probably won’t know with certainty or seven or eight weeks and why is that or six or seven weeks? It’s because historically when you model these out there’s a when they get the big uptick on the hockey stick if you will.

28:53

Those generally will go through six or seven weeks to get to their Peak the speed at which it goes is dependent upon the success and social distancing. So if we begin to see those Peaks be just a little lower than they might have been in there a little longer than they might have been we will know that we have succeeded and we’re going to have to be prepared to sustained as and I would suggest that anyone who has the hope that this will end.

29:22

The next two to three weeks I fear will be disappointed. I think we’re in for a longer ride than that. And that’s not just my opinion. I think that’s what we’re hearing from public health officials as well. So we need to settle in and be ready but to recognize this is going to end and I would also Sarah like to toward our conclusion. I’d like I’d like to just say I see through all of this hardship.

29:51

Very powerful sociology taking place here. This is this is humbling our country in a way that could can be unified thing. I’m talking to friends of hearing about their calls and Outreach to relatives and people haven’t spoken to grow while I’m hearing people talk about the way they’re playing reading talking interacting with family members that has not been possible in the past.

30:22

I’m hearing people reach out to help their neighbors. There is a sense of humanity that we’re all sharing in this process and I think it can can in the in the final analysis. There will be positive things that come out of this hardship in the course of that. We obviously have to face the hardship, but let’s also take full advantage of the opportunity to change our lives in a positive way.

30:51

Well, Thank you Governor. That is a wonderful note to end on we thank you so much for your insights and the benefit of your experience as we all grapple with this with this and hopefully go into the weekend thinking about that shared sense of humanity as we all deal with this so Governor Levitt. Thank you for joining us to our audience. Thank you for joining us. Please do stay tuned for announcements about additional programming on the coronavirus crisis, which will take place next week.

31:21

Weak and to all please. Be safe and stay healthy. Thank you Governor. Thank you.