Bill Cassidy

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Welcome to The Ticket.

I'm Isaac Dover.

So, earlier this week, the Senate held a hearing that I think it's fair to say was a bit surreal.

Dr.

Anthony Fauci, Robert Redfield, and other members of the White House coronavirus task force testified before the Senate Health Committee.

They were self-quarantining, though, because a West Wing staffer had tested positive, so they had to join by video conference.

Everything is a video conference now, and the Senate is no exception.

We got to hear the chairman's dog barking in the background, see the strange art and memorabilia senators sat in front of, and in the hearing room itself, senators were spaced six feet apart, with some wearing masks.

You might have seen that bandana that Tim Kaine was sporting, like he was off to rob a train.

So for today's episode, I'll talk with one of the members of that committee and someone who's got a unique perspective on the outbreak.

Before he was a politician, Louisiana's Bill Cassidy was a doctor.

He worked as a gastroenterologist, often with patients with little or no insurance.

He also ran a mass immunization drive in his home state.

When the coronavirus started to hit, Cassidy was one of the earliest Republicans to raise alarm.

He joined me by phone this week, even though we're both in Washington.

We talk about mandatory vaccinations, running the government right now, and how he says state should approach reopening.

Take a listen.

Hey, Bill Cassidy here.

Hi, Senator.

How are you?

It's Isaac Dover.

Hey,

I'm good, man.

Let me get my cup of coffee.

I'm ready to go.

That's important.

So, where are we finding you today in the midst of all this craziness?

I'm in my office at the Capitol.

We have been voting today.

So, you can actually be productive if you get used to working remotely.

But we do walk up to the floor to vote, and then we have a lunch where everybody shares concerns.

It must just be so odd being in the Capitol.

The Senate is a place that everybody spends a lot of time together in in close quarters, those lunches.

And now it just is very different.

My assistant went to the rotunda today, and he said he was in there by himself in the rotunda, where normally there are throngs of people in the middle of the day coming to see the, you know, the kind of memorial to the great folks in our nation's history.

He was by himself, and he just took a video of being in the rotunda by himself.

And anyone who's been in the rotunda can just imagine: wait, the middle of the day on a Thursday, and you're by yourself.

So that's kind of the experience you're having on a regular basis.

I have never walked through the rotunda without having to dodge at least three or four tourists whose eyes are darting in directions that are not looking in front of them, so make it very difficult to get around them.

I want to start

in thinking about

how you got to where you are.

Before I got into journalism, going all the way back, I thought about being a doctor.

That's what my mom wanted me to do.

I think she probably would have preferred it, honestly.

But she's gotten over it a little bit.

You did all of it.

You went to medical school, you were practicing, and then you decided to leave medicine for politics.

Can you

just explain that thought process, how that transition happened for you?

My medical practice always had a great degree of, if you will, broader public service.

So of course I treated patients and you serve a patient one at a time.

But I also taught with Elshu's medical school.

So in a very real sense, served as the educator for the residents and the medical students.

And then did multiple public health programs in which, for example, one, we vaccinated 36,000 children over six years against hepatitis B.

at no cost to the parent or to the school system.

And I frankly enjoyed that tremendously.

So I can see laced within my activities this kind of broader perspective.

But then you hit your late 40s and you love what you do.

I was doing research and teaching and lecturing and enjoying it all, but you're just a little bit kind of discontent.

And I think God sometimes put discontentment into lives just to move you out of a resting place into another part.

And that's what happened to me.

At some point, somebody leaned back and asked, would you like to run for state senate?

I said, yes.

I had the support of my wife, who recognized that I would be happier doing something a little different than what I was doing.

And the rest has been as it's been.

The state Senate into the House and then to the U.S.

Senate.

Does that perspective continue to inform how you look at this?

Do you feel like you come at these questions, especially now with what we're dealing with the public health crisis, as a doctor, or are you coming at it as a senator more?

Everybody is a product of their life experience.

That's true of me.

My medical practice was one in 99% of my patients were either uninsured or poorly insured on Medicaid.

And I worked in a public hospital, but that still informs me.

And so, if we have a program, I'm thinking, how would that affect my patients back home?

Would they be able to access this?

If we're asking somebody to go and get a drive-through test for coronavirus, One of my patients who had to take two buses in order to get to her appointment, would she be able to go to a drive-through testing site for coronavirus?

The answer is, of course, no.

And so it continues to inform.

Now, as a physician, and it's coronavirus, my public health experience vaccinating children for hepatitis B, I used to give lectures regarding viruses and antibodies and immunologic response.

I never thought I would use that again.

That's clearly come into force.

I'm glad you bring up the vaccines question because even though it seems like we are at least a while off from having a vaccine for the coronavirus, it's already becoming a fight, or you can see the fight brewing, people saying whether they want to get the vaccine or not, whether it'll be mandatory or not.

What is your take on that given your experience and how you do come at this stuff?

So we already see a robust set of laws and kind of workplace requirements that I think would apply very nicely to coronavirus.

Schools have pre-matriculation requirements, which is to say the child has to be vaccinated unless there's a contraindication against certain vaccine preventable diseases before she or he enrolls, including measles, mumps, rubella, hepatitis B, hepatitis A.

Hospitals can commonly require all employees to have the flu shot because obviously you don't want the employee communicating infection to other people.

So I think we already have a pretty robust set of laws and regulations that'll govern.

I think most people are going to want the vaccine.

Hard to think they won't.

But at the same time, if you get the vaccine and if it's effective, hopefully it does not matter if another does not wish to have it.

But does it make sense to you how this has become already a political issue, that people are saying, no, I don't, it's infringing on me to say that I should get vaccinated?

I think that politics is just our current form of working out issues as if we are thinking aloud.

And there's always going to be somebody with a contrary opinion.

But as we think out loud, we as a society will become reconciled to certain viewpoints.

I don't fault somebody saying they don't wish to be vaccinated, and I don't fault somebody who wishes to say it should be mandatory that everybody is.

It is part of the discussion, and I think we actually do better as a nation if we have that full, robust discussion, because I'd like to think that wisdom prevails.

And wisdom prevails is for you that there would be widespread vaccination.

Right.

Yeah, but that's the current law.

One, you can see that the uptake of flu vaccine, which is a voluntary vaccine, has continued to increase.

But where it's required, people take it up

as the coronavirus has caused such problems i'm sure every employer will have some requirement to have it and that apparently is allowed so i think we can kind of allow our uh communities if you will to kind of dictate that it doesn't take a federal law what do you think about face masks uh do you wear a face mask I do when I'm, you know, when it's indicated.

If I'm outside, the breeze is blowing 20 miles an hour and I'm by myself, I don't.

Sure.

But if I'm walking down the hall and there's 10 people coming to me, I do.

Face masks work you can look at the incidence of flu in Hong Kong that when they began wearing face masks the influenza virus infection rate decreased and so I think that there's you know empiric evidence that wearing a face mask will decrease respiratory or you know airborne viruses at this point we know that it's almost capricious.

Most people who have complications from coronavirus are older with underlying risk factors, but not everybody.

And so you might breathe on grandma and she ends up in the ICU, even though she's otherwise healthy.

So I do it not only for myself, but for others.

Yeah, I mean, that's the thing about the face masks is that, and again, I'm the one who never got it together to go to medical school, but what we are told is that it is about protecting ourselves and each other.

And it's about if both people are wearing masks, then the risk of infection is so much lower.

But then it gets filtered into the political process

and it has become already, again, like the vaccine, we don't know when we're going to have a vaccine and how that'll work.

But with face masks, we're already seeing people saying, no, you can't make me wear a face mask.

And then it seems like we're running up against this question of people saying what their idea of personal liberty is versus the idea of everybody working together as a society to keep the infection rate low.

So how do you reconcile that?

Well, again, going back to a national dialogue, I think that there's a state representative who died in Louisiana 54 years old.

And so the state representatives and the state senators, of course, are very aware of his death.

And he died of coronavirus infection.

So I'd like to think that knowing somebody who died is going to influence your behavior.

On the other hand, let's take the perspective of somebody who lives in a community with very low prevalence.

in which

you know the coronavirus is just not there as best you can tell but they're being asked to wear a mask.

Now there has to be some sort of rhyme and reason beyond everybody has to do it.

It should be that we know from surveillance testing or from some other method of analysis that we're actually having spread of coronavirus in this community.

I grant you it can come in surreptitiously.

People don't know it's there.

I grant you that.

But there's other areas in which it seems fairly well documented that there's a very low incidence of infection.

So I think it would help if there there was some nuance in the recommendations.

I was texting with my sister-in-law in Mobile, Alabama, and I said, well, probably the incidence of coronavirus is different in Huntsville, very north of the state, and Mobile, which is on the Gulf Coast.

Should you have a blanket rule for the entirety of Alabama, or should there be some kind of recognition that maybe Huntsville has something different going on than Mobile?

So that same sort of principle.

I think people would be more accepting if they saw the rationale, the transparency behind the decision-making process.

Yeah, and I think that you're talking about another state, but just in Louisiana, obviously there are different rates of incidence of the coronavirus in different places.

New Orleans has been a hotspot, essentially.

And then there are other parts of the state where there are almost no infections.

So how do we sort it out?

I think that that's the problem here.

Is it governors who are making the calls?

Is it the president?

Is it

mayors?

What do we do here?

Science should make the call.

Epidemiology should make the call.

And we should base it upon upon micro-communities.

When I say micro-communities, think of a school or a workplace or a neighborhood.

Now, it's one thing to say we're going to do the entire state of New York or Louisiana or Florida, the entire city of Shreport or Baton Rouge or New Orleans.

That just becomes too big.

But you can say, I'm going to look here where the incidence of infection currently is.

It's in Baton Rouge.

But it's not just generally distributed.

It is in certain census tracts within Baton Rouge.

By the way, we've looked at this, and yes, that is the case.

And it's not just within certain census tracts, there's some areas in which we see, even within that census tract, there's an issue.

That's where you target your resources.

If you can target your resource there, one, you help prevent the spread of infection, the complications if it does spread, but ideally, you're able to prevent it from spreading elsewhere.

Let's imagine this high-incidence neighborhood as somebody who works as a nurse.

in a nursing home.

Knowing that she, one, you might screen her at the nursing home, you'd follow her back to her neighborhood, but then you'd check her contacts, is a way to build upon these systems we already have.

Novel coronavirus is a reportable disease.

Where does someone live who has it?

Let's build out from there for their micro system, either the neighborhood or their place of work, and you can actually begin a containment strategy.

That's what I mean by science guiding what we do.

All right, let's take a short break.

We'll be back with more with Senator Bill Cassidy in a moment.

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Do you worry about rural communities having their guard down too soon and maybe it's sneaking up on them the way that it snuck up on New York City?

Obviously, it's very different because part of what happened in New York is that

they're just in such close quarters there between the subways and everything else.

So the transmission would be different, but it does seem like we could end end up with rural communities that think we don't have anything to worry about and then all of a sudden are kind of overwhelmed and don't have the level of hospitals and medical resources that more urban communities would have.

You got a lot packed into that question.

Yes, I'm worried about the, but I am worried about the rural communities in the sense that oftentimes they are less well provided for by physicians and hospitals.

There's a higher rate of poverty and a higher rate of disability.

On the other hand,

if your R0 or your R0 has to be less than one,

it's a lot easier to get it less than one if your neighbor lives a mile away.

You happen to get infected because your son comes home and then goes back to the big city.

Well, really, you're not going to interact with your neighbor as much over the next two weeks.

Therefore, you're less likely to spread.

So there's kind of a dueling there.

But on the other hand, one thing Congress has done that I was pushing for and the administration implemented was to expand telehealth.

So part of our problem of providers, now we have telehealth that can go into the rural areas more easily and provide that service which otherwise would not be there because there's not the doctor.

Similarly, we've expanded the use of home health so they can drop off a blood pressure monitor, a home oxygen monitor, a pulse oximeter, etc., so that we can monitor folks so that they don't have to come in.

The really interesting thing is about how this paradigm shift is going to continue long after the virus goes away, or at least is contained.

Rural health will now be telehealth, much greater than it ever would have been had it not been for the introduction of coronavirus.

Yeah, and that has all sorts of repercussions in itself.

I wonder,

because I want to come back and talk about what the life in the Senate is like at this point.

So have you been back and forth to Louisiana over this time?

The Senate was out of session for a while, has been in session since the beginning of May, roughly.

So what does your travel look like?

Yeah, so I fly non-stop, you know, to limit kind of transfer.

The airlines are doing a great job of, you know, allowing social distancing on the plane.

I wear a mask on the plane.

So, yes, obviously I have gone back and forth.

I'll fly home again this weekend.

And is there a certain risk?

Yes, there is a certain risk.

But at some point, we have to live with that risk because we cannot stay locked down for 18 months.

Yeah, I was before the pandemic hit, I was on a plane at least once a week doing some kind of reporting travel.

I have not been on a plane since March 10th when I flew home.

I would just imagine that it's a really weird experience.

You obviously were flying a lot yourself beforehand and flying a little bit less now.

You know, it's kind of nice, frankly.

I got a whole row to myself.

I spread out my papers after wiping everything down.

I got two desks down, so I got my computer here and I got my notebook there.

So anyway,

I'm going to my grave with a smile on my face.

There was the committee hearing this week

that

was with Anthony Fauci testifying.

It was a very strange committee hearing.

A lot of people watched it.

There were some senators who were there in person, some of whom were wearing masks, and there were some senators who were calling in by video conference.

There were at one point a dog barking in the background.

I think we discovered that that was Senator Alexander's dog from Tennessee.

It must be so strange to have government work this way.

Actually, I didn't notice.

Yeah, I've noticed.

I noticed

they're not.

But think about it.

Were questions asked that were appropriate or inappropriate, but asked in a normal format?

Yes.

Were the answers given and were they given well?

Yes.

If there are slides to be shown, were they shown?

Yes.

So I think that we're making a lot over the format.

in which we meet and the accoutrements that people use.

I think we should be focusing upon the content that is being discussed.

And there I felt the content was probably even better than a normal committee hearing.

And certainly there was better participation.

The sooner we get over the cosmetics of our different life, I think the sooner we will adjust to the, hmm, still the same quality, but it's just a little different.

Do you think that this should be the future like Congress, the Senate needs to figure out how to work

from home, do remote work?

Because that's been something that a a lot of your colleagues in both chambers have been pushing back against.

For the Senate, I think there is an advantage to be here.

I think it demonstrates that you can safely work and still get something accomplished.

You're going to run into people who you otherwise would not run into if you're in person.

My son goes to a school.

They set up their new office building, I'm told, similar to what Apple and the other big tech companies do, in which there is the bathroom and the kitchen and a water fountain all placed.

So you have to walk from your pod and bump shoulders with somebody who is in another silo, if you will.

It is the intent of industrial design to bring people together to not let them be atomized.

I fully believe in that.

That you run into somebody and you, oh, I've got to ask you about something.

And that triggers creativity.

So I think that will be lost if we're doing everything over Zoom.

I think, frankly, I'm glad the Senate comes back as we are.

Yeah, it's something that, and just my experience not being in a newsroom the last couple months, you feel the effect of it, that fortuitous bumping into someone, even someone you don't work with normally or on the way to the elevator, it can change what happens in

small ways and big ways.

Yeah.

Let's talk data quickly, and I just have a couple more questions for you.

Do you feel like the White House is making its decisions based on data?

Well, I don't watch the hearings, and so I often ask for my impression of the news conferences, and I just, you know, I'm always, I just don't watch them.

I'm busy.

But

may I redirect your question a little bit to see how I think to give, but maybe to come at the answer at a different approach.

It's very senatorial of you.

Well,

I think, because I thought about this.

And so my answer doesn't quite easily fit with your question.

This administration has made the decision to allow governors to lead the way.

So it isn't so much that

the president is saying, I've got data for the whole country and therefore I'm making a pronouncement.

He is saying, governors, I'm giving you the tools by which you can, the tools are money, the tools are computer support, data systems, technical assistance, period.

Here's your tools.

You figure out what's best for your state.

And so really, the pronouncements are not nearly as important as what John Bill Edwards does in Louisiana or Ron DeSantis does in Florida.

They are the ones who are making the granular.

Now let's take that a little bit further.

I mentioned earlier, the micro community is more important than the whole state.

Shreveport is different than New Orleans, if you know the geography of Louisiana, that's Northwest.

So it's really more important for my Louisiana Department of Health to be doing an analysis of the numbers in each region than it is for the President of the United States to be making a pronouncement that applies to them both.

That is the only way we get out of this crisis.

So let's just close with this.

The infection rate, the death rate in America, and the number of deaths is higher than anywhere in the world.

And we are seeing that other countries are ahead of us in doing some of the reopening.

We don't know how it'll work out, whether they'll have to close up again.

Why do you think it has, at least so far, been so much worse in America than it has been elsewhere?

Well, let's think.

I think Italy probably has a higher rate than we.

So in Italy, I think most of the people who died were over 80 with at least three conditions that would predispose them.

Certainly in the United States, people who are elderly with underlying conditions has dominated those who are sick.

Now,

clearly, the people being affected are at high risk they've been affected.

But it's certainly gone beyond that.

The Germans and the South Koreans have done the best.

The Germans and the South Koreans have had the best strategy by how to test and the best strategy laid out what to do with the results of the testing.

And they also have the best strategy as regards surveillance should there be a surge once reopening occurs.

So it goes back to what I said earlier.

If we're not doing as well as others, that means that on a state and local level, we have to have a better strategy.

Now, we can say the federal government should point the direction in what that strategy should be.

I agree with that.

But I would also say there's going to be a difference in rural Louisiana versus Manhattan.

as regards what that strategy will be.

So it has to be a choice of strategies.

We're not like South Korea where most people live in the capital city or Germany which has 90 million people over something less than the size of Texas.

So we have greater variety in our settings.

Federal government should point in a direction, but we really need state and local governments to come up with a strategy for those different sections to limit the spread of disease.

And you think American could get back to leading the world in all the ways that we think of ourselves as doing?

Right now, we're sort of on our back feet.

We're on our back back feet, but it's our vaccine technology the Chinese and the Iranians and the Russians are trying to steal.

So we've got the best scientists going after this.

At some point, we are going to step forward and with these strategies and they're going to work and we're going to reopen our economy.

You know, never bet against the United States.

I don't say that with hibrit and I don't say that with cockiness.

I just say that as kind of an observation through history.

And I do think that we have the ability to recover from this.

It just takes thinking, hard work, commitment, and belief.

That's a good place to end.

Senator, thanks for taking the time to be here.

And good luck keeping safe in the Capitol and getting back to Louisiana.

Hey, thanks for having me.

I enjoyed it.

That'll do it for this week of the ticket, Politics from the Atlantic.

Thanks to Kevin Townsend for producing and editing this episode, and to Catherine Wells, the executive producer for Atlantic Podcasts.

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