Post by the Scribe on Mar 12, 2020 22:18:23 GMT
White House Knew Coronavirus Would Be A 'Major Threat' — But Response Fell Short
March 12, 20201:20 PM ET
Heard on Fresh Air
TERRY GROSS
Fresh Air
44-Minute Listen ondemand.npr.org/anon.npr-mp3/npr/fa/2020/03/20200312_fa_01.mp3?orgId=427869011&topicId=1031&d=2656&p=13&story=814881355&siteplayer=true&size=42404313&dl=1
Politico reporter Dan Diamond says infighting at the Department of Health and Human Services and the need to flatter Trump impeded the response to the coronavirus.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross.
We're going to talk about how President Trump and some members of his administration have mismanaged the coronavirus outbreak, helping fuel the crisis. My guest Dan Diamond is a reporter for Politico who investigates health care policy and politics, including the Trump administration's coronavirus response. He's written about dysfunction and infighting within the administration and how that's slowed the response to the spread of the virus and led to some counterproductive decisions. The virus has spread to the point where, yesterday, the World Health Organization declared it a pandemic, which is defined as the worldwide spread of a new disease.
Dan Diamond, welcome back to FRESH AIR. Tell us your main takeaways from the president's speech last night.
DAN DIAMOND: Well, Terry, I guess we can start with the good, such as it was. On Wednesday night, nearly two months after the first U.S. case of novel coronavirus was detected, President Trump finally treated this outbreak with the seriousness it deserves. He's given press conferences where he said the cases would effectively go away. He has posted tweets, even on Monday where he compared this to the flu. This is not the flu. The flu does not lead the National Basketball Association, the NBA, to suspend its season.
I think it's a positive that the president seems to finally realize the severity of the problem. Unfortunately, his short remarks contained a lot of mistakes and misinformation. The president said that travel from Europe would be suspended for 30 days. That wasn't completely correct. The White House had to immediately walk that back. U.S. citizens and their families and legal permanent residents can still come back. The president said that cargo would be banned from Europe. That would have been a huge blow to the economy, especially given that some crucial medical supplies come from the EU. But it turned out that Trump misspoke again; cargo will still be allowed.
The president said that health insurers had waived the cost of treatment for coronavirus. That's no small thing. Patients who are afflicted can end up in the hospital for weeks. That could have been a multibillion-dollar decision. But as my Politico colleague Sarah Owermohle first reported, insurers had only waived the cost of testing, and that had already been established in White House meetings.
And then the broader moves and the president's language confounded and concerned public health experts. The president repeatedly leaned into phrases like, this is a foreign virus, that Europe is now a source of America's problems. On one level, he's right; the virus came out of China, and that country's leadership has a lot to answer for in how they initially screwed up the response. I think the Trump administration did have good reason to shut down China travel in late January, given the uncertainty about the new outbreak.
But at this point, the virus is here. It's silently spreading. And locking down more borders may not help us very much and only alienate allies that we need to fight a global war on disease. As I was walking into the studio, Terry, I saw the European Union had put out a statement slamming the U.S. for taking this step without even informing them.
GROSS: What are some of the things you wish he had addressed in the speech that he didn't?
DIAMOND: Well, in his remarks, the president didn't address the biggest problem - that our domestic health infrastructure is not ready for this, partly because of his administration. We're still wildly behind on testing that was botched by the Centers for Disease Control. We don't have enough supplies, like respirators. Our hospitals and doctors are almost certainly going to face real challenges as demand spikes. And I think listeners should be clear-eyed that what's happening in Italy, in Spain, with their hospitals and ICUs totally slammed, that could happen here, too, in the next two weeks.
GROSS: We seem to be entering, like, a new phase of the epidemic. Yesterday, the World Health Organization declared the virus a pandemic. The NBA suspended the season. Tom Hanks and Rita Wilson have been diagnosed with the virus. So have we reached a new stage? And what does that mean?
DIAMOND: Well, in many ways, the World Health Organization was just confirming what public health experts have said now for days or even weeks. This virus is here. It is around the world. It is spreading. It is putting many people at risk.
But I do think, Terry, we will look back on Wednesday and, in the span of about an hour and a half, remember that moment as the moment when the United States really began to grapple with this virus - between the president's sober remarks; immediately followed by Tom Hanks, famous actor, announcing that he had this virus; the National Basketball Association suspending its season; here in D.C., a senator's office announcing that an aide had tested positive for coronavirus. A lot happened in a short amount of time to bring the virus home to many different people in many different parts of the United States.
At the same time, there's still a number of folks and perhaps even listeners who will hear this, who will have heard the president's remarks and still shrug it off, and part of that is because of the president himself playing it down and convincing some percentage of Americans, some of his followers, that this was not a big deal until he said so last night.
GROSS: Among the things the president didn't address last night is giving advice to states and cities about, you know, protocols for gatherings, advice to hospitals about how to handle protocol, like, what the protocol should be. Do you know if there are any federal protocols coming out of the administration to states and cities, to hospitals and health care workers, any set of standards that they're advising, you know, states, cities, hospitals, churches, synagogues, public places to follow? Or is it every city, every state is making these decisions on their own?
DIAMOND: At this point, there is guidance coming from the CDC, the Centers for Disease Control, to help hospitals, help health care workers figure out who to diagnose, who to treat, who should be tested. Those guidances (ph) have been a work in progress and consistently behind where they probably need to be - running behind.
Cities, states, localities in the United States do have a fair amount of control and sway over what they choose to do. And some in California have been extremely aggressive in moving to ban public gatherings, to lock down certain events. California Governor Gavin Newsom, late last night, said that all events in the state, he recommended, should be canceled for over 250 people. So if you're having a convention, if there's a sporting event, a concert, anything 250 people and up should be put off for the rest of the month because those can be vectors to lead to significant infections among a lot of people if one person is spreading the virus.
But at this point, we do not have, from the White House, any clear directive on what the country should do. And with his bully pulpit, with that national address, that could have been an opportunity for the president to deliver a stark but probably necessary message on what local leaders should do; he didn't do it.
GROSS: You know, you've written that the biggest mistake so far the Trump administration has made with the coronavirus is not having test kits and testing sooner. What went wrong?
DIAMOND: As one official has said, Terry, the question might not be what went wrong; it's what went right? The Trump administration and health officials knew back in January that this coronavirus was going to be a major threat. They knew that tests needed to be distributed across the country to understand where there might be outbreaks. But across the month of February, as my colleague David Lim at Politico first reported, the tests that they sent out to labs across the country simply did not work. They were coming back with errors.
The CDC, the Centers for Disease Control, recognized that and promised that new tests would be distributed soon. But one day turned into two days turned into three days turned into several weeks, and in the meantime, we know now coronavirus was silently spreading in different communities, like Seattle. By the time that the Trump administration made a decision to allow new tests to be developed by hospitals by clinical laboratories, it was a step that was seen as multiple weeks late. And now as we talk in March, there are concerns that maybe there aren't enough materials to keep producing tests down the line - so a series of planning failures and missed opportunities to really get ahead of a problem.
GROSS: And it might be hard for the labs that actually conduct the tests to keep up with the need.
DIAMOND: The Trump administration has argued that there's a surplus of tests, that anyone who wants a test can get one. And there is some truth to that. Now tests have been churned out. But the sheer number of people who can run these tests, the number of labs that can perform them, right now it's still fairly limited. And even if there is raw supply for now, there are only so many labs that can do the tests and deliver results.
GROSS: Why didn't the U.S. use the World Health Organization's test?
DIAMOND: If you or your listeners know the answer to that, I would love...
(LAUGHTER)
DIAMOND: ...To have someone tip me off because that is a question that I've been trying to solve and my colleagues have been looking to solve, too. The World Health Organization did have a working test. Someone somewhere made the decision that the U.S. was going to go its own way, and that started a chain reaction of not having a working test and then having these delays for weeks - so certainly a failure, not necessarily the worst failure but the one that started us down this path.
GROSS: It's almost embarrassing, nationally, that the United States is so far behind other countries in terms of its ability to conduct tests for the virus.
DIAMOND: I think at this point, Terry, South Korea, in the past 24 hours, has probably done more tests for coronavirus than the United States has done in the past two months. South Korea can do 10,000 tests per day. At last count, we have done somewhere between 5,000 and 8,000 tests.
GROSS: What do you think the impact is of the lost time?
DIAMOND: I think it's been a shame for public health writ large, and I think it's been horribly concerning for local leaders. We are flying blind, as the coronavirus threatens the United States. If there is an outbreak, if hundreds of people are infected in a certain city, it's been nearly impossible until recent days for officials to get a handle on that, and that means it's hard to make decisions about whether schools should be canceled or classes pushed off at a local college or conferences delayed.
Some of the measures being taken are smart, preventive efforts to keep people from catching this virus, but some are simply aggressive measures because, in the absence of not knowing, it's always safer to do more rather than less. And if we don't know how far coronavirus has spread, there are only so many public health staff who can deploy to fight this problem, and their efforts are being spread very thin because they don't know where to target.
GROSS: Well, let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back. This is FRESH AIR.
(SOUNDBITE OF JOAN JEANRENAUD'S "DERVISH")
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. So what is your assessment - since you cover the health agencies, what's your assessments of how much - that has gone wrong as a result of, like, bad political decisions, incompetence, just bad luck?
DIAMOND: I don't use this word lightly, Terry, but I'd say that this testing failure and the broader response to the coronavirus has been a catastrophe. The reasons it is a catastrophe, some are on the Trump administration itself; some are simply bureaucratic breakdowns. And if I'm apportioning blame - in the middle of a crisis, it's hard to tell at all times who made what decision when, but certainly, the Trump administration failed to plan for this moment. There were leadership failures, like failing to think through the implications of not having a testing strategy in place. There were leadership failures in allowing feuds to fester for months and months that - in the middle of a crisis, those cracks have widened and caused delays in making simple decisions.
At the same time, there are also low-level bureaucratic failures that are enough to make a person cry. There was a New York Times story this week about the team in Seattle of flu researchers who wanted to use their research to help uncover where coronavirus might be spreading, but because of complicated regulations, they were not technically supposed to use their data that had been collected for the flu to also search for coronavirus. And they tried for weeks to get permission from local leaders, from national leaders, especially, and just couldn't get it. They were being passed from bureaucrat to bureaucrat. Finally, they went ahead and helped uncover the Seattle coronavirus outbreak but then were told to knock it off.
And I look at these decisions and, in the moment, can somewhat understand why a mid-level official might say we have to follow policy and procedure. But in the middle of a crisis, turning to bureaucratic rulebooks is not the way to address this, and that has left the U.S. just a step behind at every step of the way.
GROSS: Trump has made it clear he wants low numbers. He didn't want people who tested positive from a cruise ship to be evacuated and then quarantined because the numbers would go up, and he didn't want those numbers to go up. It would look bad; it would make him look bad. So what do you think the most consequential decisions he's made so far are in terms of the virus, decisions for better or worse?
DIAMOND: When President Trump went on air and did a press conference talking about his concern over the, quote, "numbers" and didn't want a cruise ship with infected Americans to necessarily dock and have the passengers evacuated because he was worried about the numbers, it was a remarkable statement for a president to say. The president has been obsessed with the numbers, obsessed with the optics of how this looks, which is not what you want the U.S. president to be focused on. The president's decisions on coronavirus, Terry, are, I think, an outgrowth of how he has approached government the past three years. There were so many ticking time bombs that never actually exploded, crises that were averted because either the economy was sailing along, the president's tweets were papered over. But now we are in a crisis moment where these decisions matter.
And when I look back on what the president did or did not do, one major piece of behavior is his attack on what some might call the steady state, the career civil servants across the government who work for multiple presidents and bring expertise. The president has driven a lot of those people away. That has weakened the response across government. It has made it harder to coordinate some of these efforts. And in this current moment, there were teams that were either cut or turned away or minimized that could have been useful to fighting a pandemic.
GROSS: Are there cuts the Trump administration made to the public health infrastructure that have left us more undefended? For example, wasn't there a National Security Council health task force that was disbanded under Trump?
DIAMOND: That's right. The president famously axed a team in the White House about two years ago that was focused specifically on pandemic preparedness. He cut funding for a program that predicted when viruses could jump from animals to humans basically around the same time that this new coronavirus appears to have jumped from animals to humans in China. And there are big parts of the bureaucracy that he has either tried to cut or otherwise alienated and driven people away. I do think, Terry, it's possible that some of these moves have been overly emphasized. Several officials pointed out to me that the White House pandemic preparedness team was made up of just three or four people. And if that's the dividing line between a pandemic or not, the United States is perhaps more vulnerable than we realize. And we still have career scientists like Tony Fauci, who's clearly a star, working to fight this outbreak. But it does come back to the president bigger picture. He's chased off experts when we need them most, and he's claimed that he can get scientists back when he needs them, which is just not true.
GROSS: Something I found very interesting - and I'd love to hear your take on this - is that Tucker Carlson, who, of course, has a show weekday nights on Fox News - he has been one of Trump's strongest advocates. And Trump seems to listen, you know, to watch Tucker Carlson's show. So I don't know if he said this on the air, but I was on the Fox News website, and he had something in print on the website that was headlined, "The Coronavirus Will Get Worse. Our Leaders Need To Stop Lying About That." And that was Tuesday of this week. And by our leaders, I will assume he means people in the Trump administration and perhaps the president himself. What do you make of that?
DIAMOND: Well, I haven't seen Tucker Carlson's piece, but I will say that the president has made a number of false claims, spread misinformation and frankly has hindered the overall government response, whether that was the president claiming that the number of cases would go from 15 - which was a number that he fixated on based on the number of Americans who were initially detected in the early weeks to have come back from China or perhaps had a close relationship to someone who had returned from China where the infection had originally spread - the president maintaining that number of infected Americans would quickly go to near zero, which - every official I talked to said was not the case. Officials have been preparing for two months for this to sweep across the United States, and the president misled the American people by suggesting that this was under control when, by all accounts, it was never going to be.
The president also has taken multiple opportunities at press conferences to riff on things that frankly have no relevance to the coronavirus fight. The press conference he gave about a week ago at the Centers for Disease Control was so rambling and wide-ranging that Sen. Elizabeth Warren and Sen. Ed Markey are asking Mike Pence to explain what the president was even talking about when the president, at one point, appeared to compare CDC's response to the coronavirus outbreak to how the media and Democrats treated his impeachment, a comparison that doesn't make a lot of sense both in reflection and also in the moment. He has also created an environment where his aides have been afraid to tell him bad news, and that has skewed what the Trump administration ends up pursuing. If the president is only willing to look at the most optimistic scenario, it makes it very hard to do worst-case planning.
GROSS: My guest is Dan Diamond, a reporter for Politico who has been investigating the Trump administration's response to the coronavirus. After a break, we'll talk about the members of the administration who are in charge of managing the crisis and what their backgrounds are and what their track records have been. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF JOHN WOJCIECHOWSKI'S "TWIRL")
GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dan Diamond, a political reporter who has been investigating the Trump administration's response to the coronavirus. Diamond has been covering health care policy and politics for about 10 years. He's been writing about how President Trump and some members of his administration have mismanaged the coronavirus outbreak, helping fuel the crisis.
So how America responds to the coronavirus is in the hands of people most Americans don't know much about. So let's take a look at who are some of our health policy leaders right now, what their backgrounds are and what they're doing. Let's start with Alex Azar, who's the head of Health and Human Services. He took over after Tom Price was forced out, and he was forced out in large part because of an investigative article that you did showing that he'd used government funds for a private jet.
DIAMOND: The Tom Price exit at the health department really was the inciting incident for so many feuds that continue today. And, yes, Politico did a series of investigative stories that led to his ouster about 10 days after our first story. And I say our because I was teamed up with my wonderful colleague Rachana Pradhan. Alex Azar has been like the Forrest Gump of Republican politics, where, if you were making a clip reel of the past 25 years, Azar would pop up in so many notable moments. He clerked for conservative Justice Antonin Scalia on the Supreme Court. He worked on the Whitewater investigation of President Bill Clinton. And then he was a lawyer working on the Florida recount in 2000, Bush v. Gore. Because Bush won, Alex Azar was rewarded with senior jobs in the Bush administration, ending up as the No. 2 official at the health department before he then went and worked in the private sector at Eli Lilly, a major pharmaceutical company.
What's also interesting about Alex Azar isn't just the jobs he had. It's the people he met along the way. When President Trump chose Brett Kavanaugh to be on the Supreme Court a few years ago, Alex Azar was at the celebration for Kavanaugh. The two of them are very, very close. On the Whitewater investigation, both of them - Azar and Kavanaugh - worked with another man named Rod Rosenstein, who ended up helping lead investigations into President Trump in the past few years. And Azar are also became friends with young conservatives in the 1990s and 2000s, like Laura Ingraham, who is now the Fox News host who, when Alex Azar and the health department are criticized, has been a force pushing back and inviting the secretary on her show to help him get his side of the story out. Overall, Secretary Azar has brought order to a health department that was very dysfunctional when he arrived, but his management style has similarly alienated people like Seema Verma, the surgeon general and many others too.
GROSS: What is it about his management style that's so alienating?
DIAMOND: Well, it depends who you talk to because some would say he's the manager that the health department needs, that he has put difficult performers in line and managed out the biggest problems. But his critics would say that Alex Azar doesn't brook (ph) folks who might be ambitious and have ideas different from him and cuts them out entirely.
GROSS: My impression is that he is anti-abortion. He has described HHS as the department of life. He described the Trump administration as the most pro-life administration in the country's history. He said that in a very admiring way. How has that affected him as the leader of HHS? And was he appointed in part because of his anti-abortion position?
DIAMOND: Secretary Azar has had private views of being anti-abortion for years and years. I've talked to friends and colleagues who say what he has said recently in public is what he has thought in private for decades. What I think is notable, Terry, is that Alex Azar has leaned into his anti-abortion thoughts and bona fides at a moment when his job was most at risk. Secretary Azar has led the health department for two years. The most significant statements he's made about the health department being the department of life, giving very effusive interviews where he praises the president's crackdown on abortion funding, for instance, that's happened a lot in the past few months because his own job was so at risk, I've been told, that he was appealing to a core group of supporters for President Trump and, in doing these interviews, really trying to shore up support for his position.
What that has meant for Azar is he's gotten a boost within the administration and within this core group of Trump supporters. But at the same time, he's further alienated a health department where most career health professionals don't share these views. They don't think that the Trump administration should be cracking down on funding for abortion clinics and also broader reproductive health strategies around the country. But it seems like Secretary Azar has made the calculation that it's better to appeal to the anti-abortion constituency at present even if that means turning off some of the people who work directly for him.
GROSS: So you've reported that both Alex Azar, the head of Health and Human Services, and Seema Verma, the head of Medicare and Medicaid, both really go out of their way to try to please Trump. They are also - Verma and Azar - kind of at war with each other.
DIAMOND: Oh, not kind of; they're absolutely fighting it out.
GROSS: OK. Thank you for the (laughter) clarification. So how does their desire to please Trump feed into both how they're handling the epidemic and feed into the feud that they're having with each other? And that feud is very distracting from the real job at hand, which is dealing with the epidemic.
DIAMOND: President Trump has made it clear through his actions, through his tweets, that an official's place in his administration can be decided in a moment. And I think that has leaders like Alex Azar and Seema Verma constantly aware that they need to be reinforcing their relationship with the president, whether that means going on TV, as Alex Azar has done for months and months, and immediately praising the president as the bravest leader on hospital price transparency or the most courageous leader in fighting the drug industry. Seema Verma has also been effusive of about the president and looking to praise him at every turn in a way that we would not have seen during the Obama administration or even during the George W. Bush administration.
More recently, the two of them have owned different parts of President Trump's healthcare agenda. Seema Verma was tasked with coming up with the replacement to Obamacare. That's a job that she really wanted. It got her a lot of face time with President Trump - so far has not been able to deliver on that. And her team would say, her allies would say that Secretary Azar has undermined her in that effort by taking potshots at the plan and doing other things to slow down her efforts to come up with a replacement. To be fair, Republicans have tried and failed to replace Obamacare for years. This is not just a Seema Verma issue.
Meanwhile, Alex Azar has been the point person on President Trump's goal of lowering drug prices. Azar has pitched himself as the fixer. He worked in the drug industry at Eli Lilly, and now he knows all the secrets and is going to close all the loopholes. But so far, a lot of the plans that the Trump administration has put forward have either fallen apart, been blocked in the courts, have yet to take effect. So Alex Azar also hasn't been able to deliver. And that means both of them are conscious, Azar and Verma, of the need to show Trump that they are delivering. And they have competed at times for taking credit on other priorities, like hospital price transparency.
When the coronavirus task force was being assembled and Alex Azar became the leader, my understanding is he did box out Seema Verma. He didn't push to have her on the team, even though she oversees these programs, like Medicare, like Medicaid, where many millions of Americans who are covered by those programs now will want to go test - be tested for coronavirus. And their feud dates back to a simple workplace fight, I think, which is - Alex Azar is technically Seema Verma's boss, but Seema Verma has done a lot of things to go around her boss, and Azar simply does not abide that.
GROSS: Well, let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Dan Diamond. He's a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back after a break. This is FRESH AIR.
(SOUNDBITE OF MUSIC)
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, and he's been covering the Trump administration's response to the coronavirus.
So you've reported that Alex Azar of Health and Human Services and Seema Verma of Medicare and Medicaid both want to please President Trump. How have they gone about trying to please him during this period of the epidemic? And is that leading them to say or do things that they otherwise wouldn't do? In other words, are they doing things that shouldn't be done or needn't be done or are unnecessarily time-consuming just because they want to stay in Trump's good graces?
DIAMOND: I think they are both trying to show that they're incredibly active and aggressive in public, but some of the decisions behind the scenes haven't always reflected the best judgment of career professionals. In the case of Alex Azar, he did go to the president in January. He did push past resistance from the president's political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump - Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.
But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that's partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear - the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.
Meanwhile, Seema Verma, since being added to the team, has announced all kinds of actions that could be seen as cracking down on the problem - dispatching a team of investigators to Washington state, where there has been a major outbreak of corona virus, predominantly in local nursing homes. But I've talked to officials who say that Seema Verma, in an effort to show that she's cracking down, may actually be creating more problems by having her investigators demanding paperwork, demanding answers at a moment when these nursing home officials are just trying to provide basic patient care to people who have been infected by coronavirus.
GROSS: Well, let's take a look at Robert Redfield, who's the head of the Centers for Disease Control. And he was a well-known AIDS researcher, and you say he was a favorite of Christian conservatives when Trump appointed him in 2018. He helped fight HIV-AIDS in Africa, but his approach was to emphasize abstinence and to recommend condoms only as a last resort. Can you tell us more about that?
DIAMOND: Dr. Redfield emerged in the 1980s and 1990s during the AIDS epidemic, and he was seen in some corners as a very important figure in fighting the AIDS epidemic for his willingness to attack this problem as a scientist at a moment when some conservatives were turning away. But he did highlight abstinence as the best preventive measure, saying that the best way to avoid AIDS was holding off on sex until marriage. He wrote the introduction to a book about 30 years ago called "Christians In The Age Of Aids," where he conflated the public health problem of spreading AIDS and HIV with living in a biblical way and the need to, I quote, "reject false prophets" who were suggesting that Americans should use condoms and free needles.
Those views, Redfield has said more recently, are things that he has broadened from. He has walked away from some of those earlier, stricter positions. But Redfield is still seen in some corners as a suboptimal leader of our public health agency, and it's not just because of these views; it's because of his lack of high-end management experience. If you're looking at some of the breakdowns in fighting the coronavirus outbreak, they may not be because Dr. Redfield had these views 30 years ago; they may be more likely that he is not in position to make big, sweeping and aggressive decisions in the middle of an outbreak, which is tough for anyone but certainly a career scientist who may not have been in a management role like this one.
GROSS: So is there a decision, for better or worse, that Redfield was largely responsible for that has changed the course of the epidemic in the U.S. for better or worse?
DIAMOND: It's hard to know in the middle of the crisis. But I do think, Terry, we've seen a pattern of behavior from CDC that's been troubling. The failure to roll out lab tests as promised - that's a CDC problem. The failure to plan ahead for shortfalls in the materials needed to work on tests in the future - that's something that CDC director Redfield admitted this week. And at some level, that goes to the leader. These are management decisions, whether the organization is being proactive and running smoothly or whether it's in chaos at a moment when we really need to count on the CDC to protect us.
GROSS: Vice President Pence not only is now leading the task force against the coronavirus, he also has close ties to several people in key health positions right now. Seema Verma, who is the head of Medicare and Medicaid, was his health care consultant when he was the governor of Indiana. Jerome Adams, who is the surgeon general, was in the Pence administration. When Alex Azar was in Indiana as a senior executive at the pharmaceutical company Eli Lilly, he became connected to Mike Pence.
So it seems like Mike Pence has been very influential on several levels in dealing with the coronavirus and in working with the people and maybe even helping appoint the people connected with fighting the virus now. Let's look at Pence's own health care policy in terms of epidemiology when he was the governor of Indiana. So tell us a few key things about Pence in Indiana.
DIAMOND: When Mike Pence was governor in Indiana, there was a major outbreak of HIV, an outbreak that public health officials said was largely preventable. One step that Pence could have taken was allowing for needle exchange so people who were infected with HIV and injecting drugs wouldn't necessarily infect others. But as governor, Pence held off on that. That was seen as a policy by lots of conservatives as something that was essentially rewarding drug users and not a position that Pence wanted to get behind. The local Planned Parenthood clinic had been closed because of state cuts that Pence supported. Planned Parenthood does more than provide abortions; it can help in a public health crisis by providing low-cost or free services like HIV testing.
While Pence eventually pushed the right measures, the fact that it took him weeks to do so was really concerning at the time. And when he was named to lead the coronavirus task force, a lot of people rightly seized on that episode as an example of an epidemic, an outbreak that he did too little to stop.
But I think, Terry, there's also a counterargument. Pence learned from that outbreak that the measures that he had in place were wrong and that there needed to be a more aggressive response. He worked with Jerome Adams, at the time his health commissioner, to take those right measures. Now Jerome Adams is on the task force. And I think if there's a silver lining, it's that that experience six years ago in Indiana could be a way for Mike Pence to see a path forward on the need for aggressive action on coronavirus.
GROSS: If you're just joining us, my guest is Dan Diamond. He's a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back after a short break. This is FRESH AIR.
(SOUNDBITE OF AARON PARKS' "SMALL PLANET")
GROSS: This is FRESH AIR. If you're just joining us, my guest is Dan Diamond, a reporter for Politico. He investigates health care policy and politics, including the Trump administration's response to the coronavirus.
In your work covering the coronavirus epidemic, you've been covering the official government response, trying to find out what's happening behind the scenes, and you've also written about certain feuds within the department, like, you know, within the Trump administration and how those feuds are contributing to how the Trump administration is handling the epidemic. And just this week, one of the stories that you broke was about this email breakdown in Medicare and Medicaid. And there wasn't enough communication about the email breakdown, so Medicare and Medicaid missed a certain number of emails. They were out of the loop for a while. I mean, that just contributed to the general chaos. So what's the larger significance of stories like that?
DIAMOND: HHS, the health department, was in the middle of navigating the emergency funding package that they were going to ask Congress to supply to fight coronavirus. This was about two weeks ago. And the day that they were hammering this out, officials realized their emails weren't working; their emails had crashed - not just for 20 minutes or two hours, but in some cases up to 11 hours.
And the reason those emails crashed was because Seema Verma's part of the department had run this massive email test at the exact same time without telling anyone, and it took down the system. This was the latest in a series of different IT decisions that Seema Verma and her team had made. It led to frustration in the moment and some bad feelings to the point that the career IT division of the health department - so these are not Trump appointees; these are people who have worked in the government for years - made the call to just take away email responsibility from Seema Verma and assign it to a different part of HHS.
That story in and of itself might not be a big deal except for what it says about what is happening inside the health department, where different parts of the team are not talking to each other. And it also reveals what the priorities are. After I started reporting the story, I was told that Seema Verma got really upset not just about my report but that she had lost control of her emails and, in the middle of this crisis, was negotiating with the White House, trying to get the White House to intervene on giving her her email back. I'm not sure that these are the things that we want our senior health officials to spend time on as they're trying to fight coronavirus. And that's one of several examples I could give you from the past few weeks.
GROSS: What's another?
DIAMOND: About two weeks ago, my colleague Nancy Cook and I reported that the White House had soured on Alex Azar leading the coronavirus response. He was asked about it in congressional testimony because we broke the story while he was on Capitol Hill, waved it away by saying, you know, didn't trust anonymous sources in Politico. But by the end of the day, Mike Pence had replaced him. And by the next morning, there was a new coordinator brought in, Debbie Birx, to help run the response, too. That's what people saw in public.
Behind the scenes, Azar and his team did know that he was at risk of being replaced, spent a fair amount of time just trying to shore up his standing, calling officials at the White House, on Capitol Hill, just trying to make sure that he didn't lose the job of running the coronavirus response. At that point, we were several weeks into fighting this thing. And in a working, functional administration, the amount of effort just to keep a job, just to fend off these internal fights, I don't know if that would be happening. Since Day 1, there were people trying to get him replaced as the leader of this effort. And Alex Azar also had to spend a lot of political capital fighting to keep this job at a time when we probably would want his efforts focused elsewhere.
GROSS: Like on fighting the virus, not on fighting for his job (laughter).
DIAMOND: Yes, on fighting the threat to the American people, not fighting who has which title.
GROSS: Is the information you're getting saying, basically, that it's too late to prevent a wide outbreak in the U.S.?
DIAMOND: The information that I have is the outbreak is almost certainly coming at some level, but what health officials can still do is slow the outbreak, mitigate the outbreak, for a bunch of very good reasons. One reason is because there's only so much capacity in the system if everyone gets sick or significant amounts of people get sick at the same time.
In a previous life, I worked for a hospital consulting firm, and hospitals used to have many more beds than they do now. They very aggressively have cut back on their capacity because they didn't want to have a lot of empty wards that they weren't using. That may make sense at normal times, but in a crisis moment, it means there's only so many beds to go around. Health officials don't want a crunch of people rushing to the hospital at the same time. It's bad for coronavirus patients, and it's just as bad for everyone else if doctors are spread thin and worn down.
The efforts that are now at play are figuring out where the outbreaks are, imposing quarantines in some cases to try and stop spread or slow it and, simultaneously, work on vaccines or treatments. But those might be months and months away. So in the interim, because the population does not have immunity, it's thought that the coronavirus will spread either by people already in the United States, people coming from different countries - given that the outbreaks are all around the world now. There's very little we can do other than all quarantine ourselves in our homes, and that's no way to live.
GROSS: All right, well, thank you so much for your reporting, and thank you for being on our show. Dan Diamond, I really appreciate it.
DIAMOND: Terry, thanks for having me. I just wish it was for a happier topic.
GROSS: Dan Diamond investigates health care policy and politics for Politico. If you'd like to catch up on FRESH AIR interviews you missed - like this week's interview with writer James McBride, who has a new novel called "Deacon King Kong," or RuPaul, whose show "RuPaul's Drag Race" is now in its 12th season, or New York Times Lebanon bureau chief Ben Hubbard, author of a new book about Saudi Arabia's young, enigmatic leader Crown Prince Mohammed bin Salman - check out our podcast. You'll find lots of FRESH AIR interviews.
(SOUNDBITE OF BRAD MEHLDAU'S "BLACKBIRD")
GROSS: FRESH AIR's executive producer is Danny Miller. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Mooj Zadie, Seth Kelley and Thea Chaloner. Therese Madden directed today's show. I'm Terry Gross.
(SOUNDBITE OF BRAD MEHLDAU'S "BLACKBIRD")
March 12, 20201:20 PM ET
Heard on Fresh Air
TERRY GROSS
Fresh Air
44-Minute Listen ondemand.npr.org/anon.npr-mp3/npr/fa/2020/03/20200312_fa_01.mp3?orgId=427869011&topicId=1031&d=2656&p=13&story=814881355&siteplayer=true&size=42404313&dl=1
Politico reporter Dan Diamond says infighting at the Department of Health and Human Services and the need to flatter Trump impeded the response to the coronavirus.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross.
We're going to talk about how President Trump and some members of his administration have mismanaged the coronavirus outbreak, helping fuel the crisis. My guest Dan Diamond is a reporter for Politico who investigates health care policy and politics, including the Trump administration's coronavirus response. He's written about dysfunction and infighting within the administration and how that's slowed the response to the spread of the virus and led to some counterproductive decisions. The virus has spread to the point where, yesterday, the World Health Organization declared it a pandemic, which is defined as the worldwide spread of a new disease.
Dan Diamond, welcome back to FRESH AIR. Tell us your main takeaways from the president's speech last night.
DAN DIAMOND: Well, Terry, I guess we can start with the good, such as it was. On Wednesday night, nearly two months after the first U.S. case of novel coronavirus was detected, President Trump finally treated this outbreak with the seriousness it deserves. He's given press conferences where he said the cases would effectively go away. He has posted tweets, even on Monday where he compared this to the flu. This is not the flu. The flu does not lead the National Basketball Association, the NBA, to suspend its season.
I think it's a positive that the president seems to finally realize the severity of the problem. Unfortunately, his short remarks contained a lot of mistakes and misinformation. The president said that travel from Europe would be suspended for 30 days. That wasn't completely correct. The White House had to immediately walk that back. U.S. citizens and their families and legal permanent residents can still come back. The president said that cargo would be banned from Europe. That would have been a huge blow to the economy, especially given that some crucial medical supplies come from the EU. But it turned out that Trump misspoke again; cargo will still be allowed.
The president said that health insurers had waived the cost of treatment for coronavirus. That's no small thing. Patients who are afflicted can end up in the hospital for weeks. That could have been a multibillion-dollar decision. But as my Politico colleague Sarah Owermohle first reported, insurers had only waived the cost of testing, and that had already been established in White House meetings.
And then the broader moves and the president's language confounded and concerned public health experts. The president repeatedly leaned into phrases like, this is a foreign virus, that Europe is now a source of America's problems. On one level, he's right; the virus came out of China, and that country's leadership has a lot to answer for in how they initially screwed up the response. I think the Trump administration did have good reason to shut down China travel in late January, given the uncertainty about the new outbreak.
But at this point, the virus is here. It's silently spreading. And locking down more borders may not help us very much and only alienate allies that we need to fight a global war on disease. As I was walking into the studio, Terry, I saw the European Union had put out a statement slamming the U.S. for taking this step without even informing them.
GROSS: What are some of the things you wish he had addressed in the speech that he didn't?
DIAMOND: Well, in his remarks, the president didn't address the biggest problem - that our domestic health infrastructure is not ready for this, partly because of his administration. We're still wildly behind on testing that was botched by the Centers for Disease Control. We don't have enough supplies, like respirators. Our hospitals and doctors are almost certainly going to face real challenges as demand spikes. And I think listeners should be clear-eyed that what's happening in Italy, in Spain, with their hospitals and ICUs totally slammed, that could happen here, too, in the next two weeks.
GROSS: We seem to be entering, like, a new phase of the epidemic. Yesterday, the World Health Organization declared the virus a pandemic. The NBA suspended the season. Tom Hanks and Rita Wilson have been diagnosed with the virus. So have we reached a new stage? And what does that mean?
DIAMOND: Well, in many ways, the World Health Organization was just confirming what public health experts have said now for days or even weeks. This virus is here. It is around the world. It is spreading. It is putting many people at risk.
But I do think, Terry, we will look back on Wednesday and, in the span of about an hour and a half, remember that moment as the moment when the United States really began to grapple with this virus - between the president's sober remarks; immediately followed by Tom Hanks, famous actor, announcing that he had this virus; the National Basketball Association suspending its season; here in D.C., a senator's office announcing that an aide had tested positive for coronavirus. A lot happened in a short amount of time to bring the virus home to many different people in many different parts of the United States.
At the same time, there's still a number of folks and perhaps even listeners who will hear this, who will have heard the president's remarks and still shrug it off, and part of that is because of the president himself playing it down and convincing some percentage of Americans, some of his followers, that this was not a big deal until he said so last night.
GROSS: Among the things the president didn't address last night is giving advice to states and cities about, you know, protocols for gatherings, advice to hospitals about how to handle protocol, like, what the protocol should be. Do you know if there are any federal protocols coming out of the administration to states and cities, to hospitals and health care workers, any set of standards that they're advising, you know, states, cities, hospitals, churches, synagogues, public places to follow? Or is it every city, every state is making these decisions on their own?
DIAMOND: At this point, there is guidance coming from the CDC, the Centers for Disease Control, to help hospitals, help health care workers figure out who to diagnose, who to treat, who should be tested. Those guidances (ph) have been a work in progress and consistently behind where they probably need to be - running behind.
Cities, states, localities in the United States do have a fair amount of control and sway over what they choose to do. And some in California have been extremely aggressive in moving to ban public gatherings, to lock down certain events. California Governor Gavin Newsom, late last night, said that all events in the state, he recommended, should be canceled for over 250 people. So if you're having a convention, if there's a sporting event, a concert, anything 250 people and up should be put off for the rest of the month because those can be vectors to lead to significant infections among a lot of people if one person is spreading the virus.
But at this point, we do not have, from the White House, any clear directive on what the country should do. And with his bully pulpit, with that national address, that could have been an opportunity for the president to deliver a stark but probably necessary message on what local leaders should do; he didn't do it.
GROSS: You know, you've written that the biggest mistake so far the Trump administration has made with the coronavirus is not having test kits and testing sooner. What went wrong?
DIAMOND: As one official has said, Terry, the question might not be what went wrong; it's what went right? The Trump administration and health officials knew back in January that this coronavirus was going to be a major threat. They knew that tests needed to be distributed across the country to understand where there might be outbreaks. But across the month of February, as my colleague David Lim at Politico first reported, the tests that they sent out to labs across the country simply did not work. They were coming back with errors.
The CDC, the Centers for Disease Control, recognized that and promised that new tests would be distributed soon. But one day turned into two days turned into three days turned into several weeks, and in the meantime, we know now coronavirus was silently spreading in different communities, like Seattle. By the time that the Trump administration made a decision to allow new tests to be developed by hospitals by clinical laboratories, it was a step that was seen as multiple weeks late. And now as we talk in March, there are concerns that maybe there aren't enough materials to keep producing tests down the line - so a series of planning failures and missed opportunities to really get ahead of a problem.
GROSS: And it might be hard for the labs that actually conduct the tests to keep up with the need.
DIAMOND: The Trump administration has argued that there's a surplus of tests, that anyone who wants a test can get one. And there is some truth to that. Now tests have been churned out. But the sheer number of people who can run these tests, the number of labs that can perform them, right now it's still fairly limited. And even if there is raw supply for now, there are only so many labs that can do the tests and deliver results.
GROSS: Why didn't the U.S. use the World Health Organization's test?
DIAMOND: If you or your listeners know the answer to that, I would love...
(LAUGHTER)
DIAMOND: ...To have someone tip me off because that is a question that I've been trying to solve and my colleagues have been looking to solve, too. The World Health Organization did have a working test. Someone somewhere made the decision that the U.S. was going to go its own way, and that started a chain reaction of not having a working test and then having these delays for weeks - so certainly a failure, not necessarily the worst failure but the one that started us down this path.
GROSS: It's almost embarrassing, nationally, that the United States is so far behind other countries in terms of its ability to conduct tests for the virus.
DIAMOND: I think at this point, Terry, South Korea, in the past 24 hours, has probably done more tests for coronavirus than the United States has done in the past two months. South Korea can do 10,000 tests per day. At last count, we have done somewhere between 5,000 and 8,000 tests.
GROSS: What do you think the impact is of the lost time?
DIAMOND: I think it's been a shame for public health writ large, and I think it's been horribly concerning for local leaders. We are flying blind, as the coronavirus threatens the United States. If there is an outbreak, if hundreds of people are infected in a certain city, it's been nearly impossible until recent days for officials to get a handle on that, and that means it's hard to make decisions about whether schools should be canceled or classes pushed off at a local college or conferences delayed.
Some of the measures being taken are smart, preventive efforts to keep people from catching this virus, but some are simply aggressive measures because, in the absence of not knowing, it's always safer to do more rather than less. And if we don't know how far coronavirus has spread, there are only so many public health staff who can deploy to fight this problem, and their efforts are being spread very thin because they don't know where to target.
GROSS: Well, let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back. This is FRESH AIR.
(SOUNDBITE OF JOAN JEANRENAUD'S "DERVISH")
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. So what is your assessment - since you cover the health agencies, what's your assessments of how much - that has gone wrong as a result of, like, bad political decisions, incompetence, just bad luck?
DIAMOND: I don't use this word lightly, Terry, but I'd say that this testing failure and the broader response to the coronavirus has been a catastrophe. The reasons it is a catastrophe, some are on the Trump administration itself; some are simply bureaucratic breakdowns. And if I'm apportioning blame - in the middle of a crisis, it's hard to tell at all times who made what decision when, but certainly, the Trump administration failed to plan for this moment. There were leadership failures, like failing to think through the implications of not having a testing strategy in place. There were leadership failures in allowing feuds to fester for months and months that - in the middle of a crisis, those cracks have widened and caused delays in making simple decisions.
At the same time, there are also low-level bureaucratic failures that are enough to make a person cry. There was a New York Times story this week about the team in Seattle of flu researchers who wanted to use their research to help uncover where coronavirus might be spreading, but because of complicated regulations, they were not technically supposed to use their data that had been collected for the flu to also search for coronavirus. And they tried for weeks to get permission from local leaders, from national leaders, especially, and just couldn't get it. They were being passed from bureaucrat to bureaucrat. Finally, they went ahead and helped uncover the Seattle coronavirus outbreak but then were told to knock it off.
And I look at these decisions and, in the moment, can somewhat understand why a mid-level official might say we have to follow policy and procedure. But in the middle of a crisis, turning to bureaucratic rulebooks is not the way to address this, and that has left the U.S. just a step behind at every step of the way.
GROSS: Trump has made it clear he wants low numbers. He didn't want people who tested positive from a cruise ship to be evacuated and then quarantined because the numbers would go up, and he didn't want those numbers to go up. It would look bad; it would make him look bad. So what do you think the most consequential decisions he's made so far are in terms of the virus, decisions for better or worse?
DIAMOND: When President Trump went on air and did a press conference talking about his concern over the, quote, "numbers" and didn't want a cruise ship with infected Americans to necessarily dock and have the passengers evacuated because he was worried about the numbers, it was a remarkable statement for a president to say. The president has been obsessed with the numbers, obsessed with the optics of how this looks, which is not what you want the U.S. president to be focused on. The president's decisions on coronavirus, Terry, are, I think, an outgrowth of how he has approached government the past three years. There were so many ticking time bombs that never actually exploded, crises that were averted because either the economy was sailing along, the president's tweets were papered over. But now we are in a crisis moment where these decisions matter.
And when I look back on what the president did or did not do, one major piece of behavior is his attack on what some might call the steady state, the career civil servants across the government who work for multiple presidents and bring expertise. The president has driven a lot of those people away. That has weakened the response across government. It has made it harder to coordinate some of these efforts. And in this current moment, there were teams that were either cut or turned away or minimized that could have been useful to fighting a pandemic.
GROSS: Are there cuts the Trump administration made to the public health infrastructure that have left us more undefended? For example, wasn't there a National Security Council health task force that was disbanded under Trump?
DIAMOND: That's right. The president famously axed a team in the White House about two years ago that was focused specifically on pandemic preparedness. He cut funding for a program that predicted when viruses could jump from animals to humans basically around the same time that this new coronavirus appears to have jumped from animals to humans in China. And there are big parts of the bureaucracy that he has either tried to cut or otherwise alienated and driven people away. I do think, Terry, it's possible that some of these moves have been overly emphasized. Several officials pointed out to me that the White House pandemic preparedness team was made up of just three or four people. And if that's the dividing line between a pandemic or not, the United States is perhaps more vulnerable than we realize. And we still have career scientists like Tony Fauci, who's clearly a star, working to fight this outbreak. But it does come back to the president bigger picture. He's chased off experts when we need them most, and he's claimed that he can get scientists back when he needs them, which is just not true.
GROSS: Something I found very interesting - and I'd love to hear your take on this - is that Tucker Carlson, who, of course, has a show weekday nights on Fox News - he has been one of Trump's strongest advocates. And Trump seems to listen, you know, to watch Tucker Carlson's show. So I don't know if he said this on the air, but I was on the Fox News website, and he had something in print on the website that was headlined, "The Coronavirus Will Get Worse. Our Leaders Need To Stop Lying About That." And that was Tuesday of this week. And by our leaders, I will assume he means people in the Trump administration and perhaps the president himself. What do you make of that?
DIAMOND: Well, I haven't seen Tucker Carlson's piece, but I will say that the president has made a number of false claims, spread misinformation and frankly has hindered the overall government response, whether that was the president claiming that the number of cases would go from 15 - which was a number that he fixated on based on the number of Americans who were initially detected in the early weeks to have come back from China or perhaps had a close relationship to someone who had returned from China where the infection had originally spread - the president maintaining that number of infected Americans would quickly go to near zero, which - every official I talked to said was not the case. Officials have been preparing for two months for this to sweep across the United States, and the president misled the American people by suggesting that this was under control when, by all accounts, it was never going to be.
The president also has taken multiple opportunities at press conferences to riff on things that frankly have no relevance to the coronavirus fight. The press conference he gave about a week ago at the Centers for Disease Control was so rambling and wide-ranging that Sen. Elizabeth Warren and Sen. Ed Markey are asking Mike Pence to explain what the president was even talking about when the president, at one point, appeared to compare CDC's response to the coronavirus outbreak to how the media and Democrats treated his impeachment, a comparison that doesn't make a lot of sense both in reflection and also in the moment. He has also created an environment where his aides have been afraid to tell him bad news, and that has skewed what the Trump administration ends up pursuing. If the president is only willing to look at the most optimistic scenario, it makes it very hard to do worst-case planning.
GROSS: My guest is Dan Diamond, a reporter for Politico who has been investigating the Trump administration's response to the coronavirus. After a break, we'll talk about the members of the administration who are in charge of managing the crisis and what their backgrounds are and what their track records have been. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF JOHN WOJCIECHOWSKI'S "TWIRL")
GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dan Diamond, a political reporter who has been investigating the Trump administration's response to the coronavirus. Diamond has been covering health care policy and politics for about 10 years. He's been writing about how President Trump and some members of his administration have mismanaged the coronavirus outbreak, helping fuel the crisis.
So how America responds to the coronavirus is in the hands of people most Americans don't know much about. So let's take a look at who are some of our health policy leaders right now, what their backgrounds are and what they're doing. Let's start with Alex Azar, who's the head of Health and Human Services. He took over after Tom Price was forced out, and he was forced out in large part because of an investigative article that you did showing that he'd used government funds for a private jet.
DIAMOND: The Tom Price exit at the health department really was the inciting incident for so many feuds that continue today. And, yes, Politico did a series of investigative stories that led to his ouster about 10 days after our first story. And I say our because I was teamed up with my wonderful colleague Rachana Pradhan. Alex Azar has been like the Forrest Gump of Republican politics, where, if you were making a clip reel of the past 25 years, Azar would pop up in so many notable moments. He clerked for conservative Justice Antonin Scalia on the Supreme Court. He worked on the Whitewater investigation of President Bill Clinton. And then he was a lawyer working on the Florida recount in 2000, Bush v. Gore. Because Bush won, Alex Azar was rewarded with senior jobs in the Bush administration, ending up as the No. 2 official at the health department before he then went and worked in the private sector at Eli Lilly, a major pharmaceutical company.
What's also interesting about Alex Azar isn't just the jobs he had. It's the people he met along the way. When President Trump chose Brett Kavanaugh to be on the Supreme Court a few years ago, Alex Azar was at the celebration for Kavanaugh. The two of them are very, very close. On the Whitewater investigation, both of them - Azar and Kavanaugh - worked with another man named Rod Rosenstein, who ended up helping lead investigations into President Trump in the past few years. And Azar are also became friends with young conservatives in the 1990s and 2000s, like Laura Ingraham, who is now the Fox News host who, when Alex Azar and the health department are criticized, has been a force pushing back and inviting the secretary on her show to help him get his side of the story out. Overall, Secretary Azar has brought order to a health department that was very dysfunctional when he arrived, but his management style has similarly alienated people like Seema Verma, the surgeon general and many others too.
GROSS: What is it about his management style that's so alienating?
DIAMOND: Well, it depends who you talk to because some would say he's the manager that the health department needs, that he has put difficult performers in line and managed out the biggest problems. But his critics would say that Alex Azar doesn't brook (ph) folks who might be ambitious and have ideas different from him and cuts them out entirely.
GROSS: My impression is that he is anti-abortion. He has described HHS as the department of life. He described the Trump administration as the most pro-life administration in the country's history. He said that in a very admiring way. How has that affected him as the leader of HHS? And was he appointed in part because of his anti-abortion position?
DIAMOND: Secretary Azar has had private views of being anti-abortion for years and years. I've talked to friends and colleagues who say what he has said recently in public is what he has thought in private for decades. What I think is notable, Terry, is that Alex Azar has leaned into his anti-abortion thoughts and bona fides at a moment when his job was most at risk. Secretary Azar has led the health department for two years. The most significant statements he's made about the health department being the department of life, giving very effusive interviews where he praises the president's crackdown on abortion funding, for instance, that's happened a lot in the past few months because his own job was so at risk, I've been told, that he was appealing to a core group of supporters for President Trump and, in doing these interviews, really trying to shore up support for his position.
What that has meant for Azar is he's gotten a boost within the administration and within this core group of Trump supporters. But at the same time, he's further alienated a health department where most career health professionals don't share these views. They don't think that the Trump administration should be cracking down on funding for abortion clinics and also broader reproductive health strategies around the country. But it seems like Secretary Azar has made the calculation that it's better to appeal to the anti-abortion constituency at present even if that means turning off some of the people who work directly for him.
GROSS: So you've reported that both Alex Azar, the head of Health and Human Services, and Seema Verma, the head of Medicare and Medicaid, both really go out of their way to try to please Trump. They are also - Verma and Azar - kind of at war with each other.
DIAMOND: Oh, not kind of; they're absolutely fighting it out.
GROSS: OK. Thank you for the (laughter) clarification. So how does their desire to please Trump feed into both how they're handling the epidemic and feed into the feud that they're having with each other? And that feud is very distracting from the real job at hand, which is dealing with the epidemic.
DIAMOND: President Trump has made it clear through his actions, through his tweets, that an official's place in his administration can be decided in a moment. And I think that has leaders like Alex Azar and Seema Verma constantly aware that they need to be reinforcing their relationship with the president, whether that means going on TV, as Alex Azar has done for months and months, and immediately praising the president as the bravest leader on hospital price transparency or the most courageous leader in fighting the drug industry. Seema Verma has also been effusive of about the president and looking to praise him at every turn in a way that we would not have seen during the Obama administration or even during the George W. Bush administration.
More recently, the two of them have owned different parts of President Trump's healthcare agenda. Seema Verma was tasked with coming up with the replacement to Obamacare. That's a job that she really wanted. It got her a lot of face time with President Trump - so far has not been able to deliver on that. And her team would say, her allies would say that Secretary Azar has undermined her in that effort by taking potshots at the plan and doing other things to slow down her efforts to come up with a replacement. To be fair, Republicans have tried and failed to replace Obamacare for years. This is not just a Seema Verma issue.
Meanwhile, Alex Azar has been the point person on President Trump's goal of lowering drug prices. Azar has pitched himself as the fixer. He worked in the drug industry at Eli Lilly, and now he knows all the secrets and is going to close all the loopholes. But so far, a lot of the plans that the Trump administration has put forward have either fallen apart, been blocked in the courts, have yet to take effect. So Alex Azar also hasn't been able to deliver. And that means both of them are conscious, Azar and Verma, of the need to show Trump that they are delivering. And they have competed at times for taking credit on other priorities, like hospital price transparency.
When the coronavirus task force was being assembled and Alex Azar became the leader, my understanding is he did box out Seema Verma. He didn't push to have her on the team, even though she oversees these programs, like Medicare, like Medicaid, where many millions of Americans who are covered by those programs now will want to go test - be tested for coronavirus. And their feud dates back to a simple workplace fight, I think, which is - Alex Azar is technically Seema Verma's boss, but Seema Verma has done a lot of things to go around her boss, and Azar simply does not abide that.
GROSS: Well, let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Dan Diamond. He's a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back after a break. This is FRESH AIR.
(SOUNDBITE OF MUSIC)
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dan Diamond, a reporter for Politico who investigates health care policy and politics, and he's been covering the Trump administration's response to the coronavirus.
So you've reported that Alex Azar of Health and Human Services and Seema Verma of Medicare and Medicaid both want to please President Trump. How have they gone about trying to please him during this period of the epidemic? And is that leading them to say or do things that they otherwise wouldn't do? In other words, are they doing things that shouldn't be done or needn't be done or are unnecessarily time-consuming just because they want to stay in Trump's good graces?
DIAMOND: I think they are both trying to show that they're incredibly active and aggressive in public, but some of the decisions behind the scenes haven't always reflected the best judgment of career professionals. In the case of Alex Azar, he did go to the president in January. He did push past resistance from the president's political aides to warn the president the new coronavirus could be a major problem. There were aides around Trump - Kellyanne Conway had some skepticism at times that this was something that needed to be a presidential priority.
But at the same time, Secretary Azar has not always given the president the worst-case scenario of what could happen. My understanding is he did not push to do aggressive additional testing in recent weeks, and that's partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear - the lower the numbers on coronavirus, the better for the president, the better for his potential reelection this fall.
Meanwhile, Seema Verma, since being added to the team, has announced all kinds of actions that could be seen as cracking down on the problem - dispatching a team of investigators to Washington state, where there has been a major outbreak of corona virus, predominantly in local nursing homes. But I've talked to officials who say that Seema Verma, in an effort to show that she's cracking down, may actually be creating more problems by having her investigators demanding paperwork, demanding answers at a moment when these nursing home officials are just trying to provide basic patient care to people who have been infected by coronavirus.
GROSS: Well, let's take a look at Robert Redfield, who's the head of the Centers for Disease Control. And he was a well-known AIDS researcher, and you say he was a favorite of Christian conservatives when Trump appointed him in 2018. He helped fight HIV-AIDS in Africa, but his approach was to emphasize abstinence and to recommend condoms only as a last resort. Can you tell us more about that?
DIAMOND: Dr. Redfield emerged in the 1980s and 1990s during the AIDS epidemic, and he was seen in some corners as a very important figure in fighting the AIDS epidemic for his willingness to attack this problem as a scientist at a moment when some conservatives were turning away. But he did highlight abstinence as the best preventive measure, saying that the best way to avoid AIDS was holding off on sex until marriage. He wrote the introduction to a book about 30 years ago called "Christians In The Age Of Aids," where he conflated the public health problem of spreading AIDS and HIV with living in a biblical way and the need to, I quote, "reject false prophets" who were suggesting that Americans should use condoms and free needles.
Those views, Redfield has said more recently, are things that he has broadened from. He has walked away from some of those earlier, stricter positions. But Redfield is still seen in some corners as a suboptimal leader of our public health agency, and it's not just because of these views; it's because of his lack of high-end management experience. If you're looking at some of the breakdowns in fighting the coronavirus outbreak, they may not be because Dr. Redfield had these views 30 years ago; they may be more likely that he is not in position to make big, sweeping and aggressive decisions in the middle of an outbreak, which is tough for anyone but certainly a career scientist who may not have been in a management role like this one.
GROSS: So is there a decision, for better or worse, that Redfield was largely responsible for that has changed the course of the epidemic in the U.S. for better or worse?
DIAMOND: It's hard to know in the middle of the crisis. But I do think, Terry, we've seen a pattern of behavior from CDC that's been troubling. The failure to roll out lab tests as promised - that's a CDC problem. The failure to plan ahead for shortfalls in the materials needed to work on tests in the future - that's something that CDC director Redfield admitted this week. And at some level, that goes to the leader. These are management decisions, whether the organization is being proactive and running smoothly or whether it's in chaos at a moment when we really need to count on the CDC to protect us.
GROSS: Vice President Pence not only is now leading the task force against the coronavirus, he also has close ties to several people in key health positions right now. Seema Verma, who is the head of Medicare and Medicaid, was his health care consultant when he was the governor of Indiana. Jerome Adams, who is the surgeon general, was in the Pence administration. When Alex Azar was in Indiana as a senior executive at the pharmaceutical company Eli Lilly, he became connected to Mike Pence.
So it seems like Mike Pence has been very influential on several levels in dealing with the coronavirus and in working with the people and maybe even helping appoint the people connected with fighting the virus now. Let's look at Pence's own health care policy in terms of epidemiology when he was the governor of Indiana. So tell us a few key things about Pence in Indiana.
DIAMOND: When Mike Pence was governor in Indiana, there was a major outbreak of HIV, an outbreak that public health officials said was largely preventable. One step that Pence could have taken was allowing for needle exchange so people who were infected with HIV and injecting drugs wouldn't necessarily infect others. But as governor, Pence held off on that. That was seen as a policy by lots of conservatives as something that was essentially rewarding drug users and not a position that Pence wanted to get behind. The local Planned Parenthood clinic had been closed because of state cuts that Pence supported. Planned Parenthood does more than provide abortions; it can help in a public health crisis by providing low-cost or free services like HIV testing.
While Pence eventually pushed the right measures, the fact that it took him weeks to do so was really concerning at the time. And when he was named to lead the coronavirus task force, a lot of people rightly seized on that episode as an example of an epidemic, an outbreak that he did too little to stop.
But I think, Terry, there's also a counterargument. Pence learned from that outbreak that the measures that he had in place were wrong and that there needed to be a more aggressive response. He worked with Jerome Adams, at the time his health commissioner, to take those right measures. Now Jerome Adams is on the task force. And I think if there's a silver lining, it's that that experience six years ago in Indiana could be a way for Mike Pence to see a path forward on the need for aggressive action on coronavirus.
GROSS: If you're just joining us, my guest is Dan Diamond. He's a reporter for Politico who investigates health care policy and politics, including the Trump administration's response to the coronavirus. We'll be right back after a short break. This is FRESH AIR.
(SOUNDBITE OF AARON PARKS' "SMALL PLANET")
GROSS: This is FRESH AIR. If you're just joining us, my guest is Dan Diamond, a reporter for Politico. He investigates health care policy and politics, including the Trump administration's response to the coronavirus.
In your work covering the coronavirus epidemic, you've been covering the official government response, trying to find out what's happening behind the scenes, and you've also written about certain feuds within the department, like, you know, within the Trump administration and how those feuds are contributing to how the Trump administration is handling the epidemic. And just this week, one of the stories that you broke was about this email breakdown in Medicare and Medicaid. And there wasn't enough communication about the email breakdown, so Medicare and Medicaid missed a certain number of emails. They were out of the loop for a while. I mean, that just contributed to the general chaos. So what's the larger significance of stories like that?
DIAMOND: HHS, the health department, was in the middle of navigating the emergency funding package that they were going to ask Congress to supply to fight coronavirus. This was about two weeks ago. And the day that they were hammering this out, officials realized their emails weren't working; their emails had crashed - not just for 20 minutes or two hours, but in some cases up to 11 hours.
And the reason those emails crashed was because Seema Verma's part of the department had run this massive email test at the exact same time without telling anyone, and it took down the system. This was the latest in a series of different IT decisions that Seema Verma and her team had made. It led to frustration in the moment and some bad feelings to the point that the career IT division of the health department - so these are not Trump appointees; these are people who have worked in the government for years - made the call to just take away email responsibility from Seema Verma and assign it to a different part of HHS.
That story in and of itself might not be a big deal except for what it says about what is happening inside the health department, where different parts of the team are not talking to each other. And it also reveals what the priorities are. After I started reporting the story, I was told that Seema Verma got really upset not just about my report but that she had lost control of her emails and, in the middle of this crisis, was negotiating with the White House, trying to get the White House to intervene on giving her her email back. I'm not sure that these are the things that we want our senior health officials to spend time on as they're trying to fight coronavirus. And that's one of several examples I could give you from the past few weeks.
GROSS: What's another?
DIAMOND: About two weeks ago, my colleague Nancy Cook and I reported that the White House had soured on Alex Azar leading the coronavirus response. He was asked about it in congressional testimony because we broke the story while he was on Capitol Hill, waved it away by saying, you know, didn't trust anonymous sources in Politico. But by the end of the day, Mike Pence had replaced him. And by the next morning, there was a new coordinator brought in, Debbie Birx, to help run the response, too. That's what people saw in public.
Behind the scenes, Azar and his team did know that he was at risk of being replaced, spent a fair amount of time just trying to shore up his standing, calling officials at the White House, on Capitol Hill, just trying to make sure that he didn't lose the job of running the coronavirus response. At that point, we were several weeks into fighting this thing. And in a working, functional administration, the amount of effort just to keep a job, just to fend off these internal fights, I don't know if that would be happening. Since Day 1, there were people trying to get him replaced as the leader of this effort. And Alex Azar also had to spend a lot of political capital fighting to keep this job at a time when we probably would want his efforts focused elsewhere.
GROSS: Like on fighting the virus, not on fighting for his job (laughter).
DIAMOND: Yes, on fighting the threat to the American people, not fighting who has which title.
GROSS: Is the information you're getting saying, basically, that it's too late to prevent a wide outbreak in the U.S.?
DIAMOND: The information that I have is the outbreak is almost certainly coming at some level, but what health officials can still do is slow the outbreak, mitigate the outbreak, for a bunch of very good reasons. One reason is because there's only so much capacity in the system if everyone gets sick or significant amounts of people get sick at the same time.
In a previous life, I worked for a hospital consulting firm, and hospitals used to have many more beds than they do now. They very aggressively have cut back on their capacity because they didn't want to have a lot of empty wards that they weren't using. That may make sense at normal times, but in a crisis moment, it means there's only so many beds to go around. Health officials don't want a crunch of people rushing to the hospital at the same time. It's bad for coronavirus patients, and it's just as bad for everyone else if doctors are spread thin and worn down.
The efforts that are now at play are figuring out where the outbreaks are, imposing quarantines in some cases to try and stop spread or slow it and, simultaneously, work on vaccines or treatments. But those might be months and months away. So in the interim, because the population does not have immunity, it's thought that the coronavirus will spread either by people already in the United States, people coming from different countries - given that the outbreaks are all around the world now. There's very little we can do other than all quarantine ourselves in our homes, and that's no way to live.
GROSS: All right, well, thank you so much for your reporting, and thank you for being on our show. Dan Diamond, I really appreciate it.
DIAMOND: Terry, thanks for having me. I just wish it was for a happier topic.
GROSS: Dan Diamond investigates health care policy and politics for Politico. If you'd like to catch up on FRESH AIR interviews you missed - like this week's interview with writer James McBride, who has a new novel called "Deacon King Kong," or RuPaul, whose show "RuPaul's Drag Race" is now in its 12th season, or New York Times Lebanon bureau chief Ben Hubbard, author of a new book about Saudi Arabia's young, enigmatic leader Crown Prince Mohammed bin Salman - check out our podcast. You'll find lots of FRESH AIR interviews.
(SOUNDBITE OF BRAD MEHLDAU'S "BLACKBIRD")
GROSS: FRESH AIR's executive producer is Danny Miller. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Mooj Zadie, Seth Kelley and Thea Chaloner. Therese Madden directed today's show. I'm Terry Gross.
(SOUNDBITE OF BRAD MEHLDAU'S "BLACKBIRD")