Episode 77: How to Vaccinate and Heal the Economy

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This is The WealthAbility® Show with Tom Wheelwright. Way more money, way less taxes.

Tom Wheelwright:
Welcome to the WealthAbility show, where we're always discovering how to make way more money and pay way less taxes. Hi, this is Tom Wheelwright, your host, founder, and CEO of WealthAbility. The vaccine rollout is a mess. We've got COVID now for a year. The economy we know isn't going to recover until we get coronavirus under wraps here somewhat. I'm very excited to discuss today how do we get the virus under wraps and how do the vaccines play a role in this? We may even get to do masks play a role in this because I know that's still a big controversy here. I'm very fortunate to have on our show today, Dr. Elizabeth Rosenthal, who is an expert in big medicine, basically big pharma. She wrote the book An American Sickness, how healthcare became big business and how you can take it back. She was, for many years, as I understand with the New York Times as a correspondent and now Editor in Chief of Kaiser Health News. Elizabeth, welcome so much to the WealthAbility Show.

Elizabeth Rosenthal:
Thanks for having me.

Tim Wheelwright:
Tell us a little bit about yourself, Elizabeth, Dr. Rosenthal, where you came from and why are you reporting on the coronavirus these days?

Elizabeth Rosenthal:
Well, sure. I come from a medical family. I went to medical school, Harvard Med. No shabby place. Trained in internal medicine and worked in an ER for a number of years. Then, my true love had always been writing. I realized that how society deals with healthcare problems that I was seeing in the emergency room were really more troubling than the actual problems in the emergency room often. I went to the New York Times, became a healthcare reporter, spent a wonderful 22 years there, wrote a book called An American Sickness, How Healthcare Became Big Business and How You Can Take It Back. When I say you, I do include business owners and entrepreneurs in that you, because that's a drag on entrepreneurship, the price of healthcare in our country.

Elizabeth Rosenthal:
Then, I went to become an editor of Kaiser health news, which is a kind of entrepreneurial startup news organization that deals with health and health policy. We're mostly foundation funded. We are totally foundation funded, actually, none of it from healthcare foundations or people with a financial interest in healthcare, put it that way. We give away all our content for free. We are hugely busy this year. We were very busy before COVID because of the cost that healthcare was imposing on companies and individuals in this country. Of course, since COVID, that's only been amplified, not because of the cost, but because of the financial impact of the COVID crisis, which we are hopefully crawling out of now but boy, not as fast as I would like.

Tim Wheelwright:
It's slow. Thank you for addressing the business owners. That's our crowd here is business owners, entrepreneurs, investors, and one of the things we want to make sure we get to before we finish here is what we can actually do. It strikes me, my general thought of what's going on right now is this whole vaccine rollout is just a mess. I don't understand. Okay. We have thousands and thousands of pharmacies that give flu shots every year. Why do we need stadiums? Why can't we just roll it out through the pharmacies? I happen to know a lot of, we have a lot of clients that are independent pharmacies. They're they know their patients. They know who's who's at risk. They know these things, and yet we seem to be ignoring the pharmacies and instead going to stadiums and things like that. What's going on and what can be done about it?

Elizabeth Rosenthal:
Well, I think the problem is for many years that we have had no national strategy on how to address this COVID crisis. It's been like every county to themselves, every hospital to themselves, every business to themselves, every man to themselves, which is why we have the craziness now of people signing up in 10 different places and clicking on websites five times a day to see if they can score a vaccine appointment. I call it like knock out your neighbor, which is exactly the opposite of what we want. Right? Some places it is being done by pharmacies, other places it's being done in stadiums. Other places at hospitals. There is no standard. California has 58 counties and each county is doing it totally differently. Good luck to people who are trying to get a shot now and not just like people who want one, we're talking about eligible older people who just can't get what the government has told us we should do. You know?

Elizabeth Rosenthal:
I think what we need is a central direction and how are we going to do this. At this point, I only kind of half jokingly say, “Just let the army do it.” You just need someone who knows how to do this.

Tim Wheelwright:
It's a legitimate option. It's a legitimate option. The army Corps of engineers, that's what they're good at is logistics, is that perhaps the solution?

Elizabeth Rosenthal:
I wouldn't have said it was a solution at the beginning, but now that we've messed it up in so many different ways, we have so many different problems to fix that that may be where we're headed. Now, many of us in healthcare look back to World War II, when the president could say to a toy maker, “Look, we need you to make airplane parts tomorrow.” And they did it. Maybe we'll see something like that.

Tim Wheelwright:
President Biden has talked about invoking the War Powers Act, right?

Elizabeth Rosenthal:
Yeah. Which I think is now called the Defense Production Act.

Tim Wheelwright:
Defense Production Act. I'm sorry. The Defense Production Act.

Elizabeth Rosenthal:
Rebranding. Right?

Tim Wheelwright:
Yeah. Exactly. Exactly. It's like, people are no longer liberals now they're progressives. Again, rebranding here, right? All right. What do you think is going to be the effect here? What do you think can happen and what can people do about it?

Elizabeth Rosenthal:
I hope it will get better. I'm an optimist. I think talking about invoking things is different than actually invoking them.

Tim Wheelwright:
For sure.

Elizabeth Rosenthal:
I think for any of your listeners, a hundred million doses in a hundred days seems pathetic, frankly, it sounds aspirational. Everyone's saying, “Oh, this is going to be tough.” No, we're doing that right now. We need more. 100 million doses in a hundred days only means that less than a sixth of the country is vaccinated by April. That will not let us get back to normal very quickly at all. The question I'm asking, and my reporters are asking as journalists, as physicians, as a person who wants a vaccine is what is stopping us from ramping up production? We all like to say, “This is war.” Why aren't we treating it like war? Why aren't we saying “All hands on deck.”

Tim Wheelwright:
Why aren't we? What have you found? You've done all this digging. What have you found? Why aren't we treating it that way? Why don't we have more production of the vaccine?

Elizabeth Rosenthal:
I can tell you in a few days once my reporters have finished their work. I think it's partly that we in this country are very reluctant to deploy that tactic. We want to let companies do what they do. If you say to Pfizer, “Sorry, guys, we need you to set up another production line of vaccine.” They have to not make something else that they're making, right?

Tim Wheelwright:
That's true.

Elizabeth Rosenthal:
Should we compensate them for that? People are understandably reluctant to do that, particularly at this late stage of the pandemic where we've arrived at this tragic moment, because we've had basically months of a stumbling, incoherent response frankly. I was looking at the total death toll in South Korea, a nation of over 50 million people, 1300 in the entire nation. We've had more, twice that many healthcare workers die alone in the US. We are in real trouble. That's why I think at this point, yes, it is a war, and yes, maybe we need dramatic action. You asked me about the pharmacists and pharmacies.

Tim Wheelwright:
Yeah. We've got this, we all get flu shots every year. It's already set up, we have a distribution out. I wondered the same thing about the ACA, we had Medicare, why don't we let people opt into Medicare if they need to, or something like that. I don't understand creating a whole new system when you have a system that seems to work. Now, I get the Pfizer vaccine has the special, it's got to be colder than Alaska in winter, but the Moderna vaccine doesn't seem to have those requirements. Why not just distribute it straight through the pharmacy network?

Elizabeth Rosenthal:
Well, I think part of the problem is we, the pharmacists at most of our pharmacies are busy with other stuff. These, we were looking at in my newsroom, the mixing instructions for the Moderna vaccine, which is the easy one to use, right? The one that doesn't require ultra cold storage, you have to freeze for exactly two hours. Then you set it still for 15 minutes, then you shake, but not stir. Unlike the flu vaccine, which comes in single dose shots, right, the pharmacists picks up the shot and just puts it in the arm, these come in batches. They have to be drawn up. They have to be used within a certain amount of time. That is likely to change.

Elizabeth Rosenthal:
I mean, that is one of the things we could say to drug makers. We want these, and it will happen, we want these in single dose formulations. That apparently takes more science. It takes, we've heard, for example, one of the things that's a rate limiting step is the little glass vials that they put the vaccine in. Could we tell [inaudible 00:11:28] stop making mustard glasses and make these little vials. I expect much of that will get better. The point at the beginning was we want to get these vaccines out there. As always, things don't always come out initially in the most user-friendly form. I expect they will be more user-friendly. I don't know if you asked your pharmacists if they have time to do the kind of elaborate preparation while they're handing out prescriptions for all the usual stuff. I would guess many don't.

Tim Wheelwright:
My question is whether we've asked them, because I have pharmacists that are clients and they would be happy to do it, they would drop everything for it. The pharmacists I know are so concerned about their patients and they really do care about their patients. They know their patients. I mean, not the big pharmacies, but the small independent pharmacies, they all know their patients. They know them by name, they know what their health issues are, and certainly they could administer it. Let me ask you a question that's been on my mind. We've taken the American Airlines approach, if you will, to distributing the vaccine.

Tim Wheelwright:
In other words, if you're in rows 18 through 30, you get on and then rows 1 through 29 and then, whatever. I mean, we've taken that approach as opposed to the Southwest airlines approach, which is “Get in line and we're just going to get you on.” Now, what we know for a fact is that Southwest Airlines has the best, fastest boarding procedures in the history of airlines. The question is, would we be better off with a really get in line as opposed to being so, “Okay, we have to do this group. Then we have to do this group. Then we have to do this group.” I'm in a high risk group but I'm still thinking don't we just want to get everybody vaccinated. Isn't that the most important thing?

Elizabeth Rosenthal:
Well, here I have to disagree a little bit because I think everyone who gets on a Southwest flight kind of has similar needs and risks when they get on that flight. COVID has very different implications for different populations. I think we can and we should have in an organized way said, “These are the populations that need this first.” And we open it up to them. Or, you said your pharmacists know their communities. One of the ironies of this pandemic is we were all worried in healthcare policy that, oh, the rural areas are going to be left out when the vaccine comes. No, they've actually done much better because of just what you said, the health department there, they know the thousand people, they know the over 65s. They know the vulnerable, they got them vaccinated.

Elizabeth Rosenthal:
In other countries what they've done is to say, “Okay, we know everyone in this country who's over 65.” They send them a email or a text and say, “This is your date. This is your appointment. This is when you're going to get your vaccine.” You can not waste your hours on the website trying to score anymore, or open it up and wait on the five hour lines we are seeing in many right states now of people in walkers. I'm just like-

Tim Wheelwright:
As it turns out, we do know that information because when you apply for Medicare, you're a certain age. On your tax return, it says if you're over that age. Certainly, we have that information. What I'm hearing from you is you see this as a pure, really the issue is a disorganization logistics issue. This is, and then a production issue on top of that.

Elizabeth Rosenthal:
Yeah. I think it's logistics and production. Some person asked me, what are you a social, are you talking about socialism? I'm like, because I'm talking about some planning and I'm like, “No. Every good business knows how to do production and logistics.” This is what a smart, organized, it's about organization and direction and clarity, which I think as an editor, probably as a business person, that's the essence of success.

Tim Wheelwright:
Of course it is. I mean, we all know that's why Amazon has been so successful and Walmart has been so successful during COVID. That's why, because they're all about logistics.

Tim Wheelwright:
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Tim Wheelwright:
Let me shift gears just a little bit. We have, there's concern about mutations right now. Will the vaccines actually offer enough protection even as the virus mutates?

Elizabeth Rosenthal:
Yes. I think all the available evidence so far is that the vaccines are directed towards a part of the coronavirus that is on all of the mutations. It should work regardless of the strain. Like most vaccines, I hear all these people arguing. Well, this one, and this is what I fear with this opening up crazy way we've done this. “Oh, I hear that Madonna is 95% effective in the J&J one that's coming up, maybe it's only 70%.” They're all effective. It's good. Very few vaccines are a 100% effective, but all of them will give you protection. If other vaccines are an example, many vaccines, if you get the shot, even if you get sick, which we know some people get the COVID vaccine will still get COVID, some of them may not show symptoms. You will probably get a much milder case. Me, when it's my turn, I will be there. I will be there.

Tim Wheelwright:
Okay. Next question. This is very personal to me. I'm one of these people who carries an EpiPen with me, with the goal in life to never ever, ever, ever use it.

Elizabeth Rosenthal:
Right.

Tim Wheelwright:
Now I hear doctors say with a straight face that going in anaphylactic shock is an okay reaction. I'm sorry, but those of us who have had anaphylactic reactions would say that 30 seconds from death is not an okay result. What do we know about, because we first heard about this right when they did the first vaccinations, right, in Great Britain, there were some immediate, a couple of healthcare workers went in anaphylactic shock. The question is, are we seeing this slow down? I mean, is this something people, I say, well, only 2% of the population, but that's still [crosstalk 00:18:53]-

Elizabeth Rosenthal:
That's a lot of people.

Tim Wheelwright:
That's a lot of people. Okay. The question is, so should those people like myself, should we just be going, “Look, I'm going to wait.” And wait until they get all the testing done before even try this.

Elizabeth Rosenthal:
Yeah. I think part of the problem with COVID is that old expression, we're building the plane as we fly it. Right? We're learning things every day. Where I find fault is that we don't have good data. We should have much better data about how many people are getting serious allergic reactions from these vaccines. Those data are kind of trickling in in ways that I find very unsatisfactory. I can pay my mortgage in three seconds over the phone. Why can't reaction reports be instantaneous? We do know that the Pfizer and the Moderna vaccines are more, what we call immunogenic, than a lot of vaccines, than the ordinary flu vaccine, which means that people who are prone to reactions are more likely to get them. Not hugely, but more likely.

Tim Wheelwright:
Does that mean that the AstraZeneca vaccine that comes out, which is a completely different model than the two that are out, will that be less likely to have that consequence?

Elizabeth Rosenthal:
Maybe, because it's a very different kind of vaccine. The two that are out now are MRNA vaccines, so they are totally novel. The goal of the vaccine is to provoke an immune response. What I would say right now is take whatever vaccine you're offered, but if I had a history of anaphylaxis and I'm talking as a physician and as a journalist, what I would do is I would not get my vaccine at a street clinic or maybe even a pharmacy. I would have it at a hospital because anaphylaxis, as you say, is scary, it's serious, so is COVID. Anaphylaxis is very treatable, as unpleasant as it may be, but you need to be in a healthcare setting when you get it.

Tim Wheelwright:
That's good advice. You talk about, you started out talking about this really is, there's a business side of this and not just big business, but of course, those of us with our own businesses, we have all of our employees and we're worried about them getting COVID. We're also worried about them getting the vaccine. Are they going to have reactions to the vaccine? There's a lot of that. We've actually had an attorney, an HR attorney on the show to ask, talk to about do you force them to get the vaccine, do you allow them to get vaccine, what do you do? The question that I have for you is since you brought it up, is what do you think business owners should be doing when it comes to the vaccine and the coronavirus in general?

Elizabeth Rosenthal:
I think, and I feel really bad for business owners because it has been kind of dumped in their laps, right? Like, “Deal with it.” I work for a healthcare foundation, and we're not sure what we should do about it. I think people are flying pretty blind. I think it partly depends on what kind of business you have. Is it one that requires people facing? My opinion after nearly 10 months of working on Zoom is that we have lost something important from not being in an office. I would like to have people back in an office. We're not yet. I think businesses should encourage people to get the vaccine, particularly older employees. They might want to stagger having older employees come back to the office early. I am a big believer in mask wearing.

Elizabeth Rosenthal:
I have to say, people say to me, “We're not going back to the office with masks.” I'm like, “I don't know. We can have a meeting in masks.” I lived in, I was a New York Times reporter in Beijing where people wear masks a lot. I was there during SARS. I worked as a doctor. I spent hours in an operating room with a mask on. You can do a lot with a mask on you. It's a cultural norm and will it totally prevent COVID? No. Just think of it as your surgeon is standing over your open abdomen and an operating room with a mask on so the germs from his mouth don't get into your intestine. You know it works. It may not be perfect, but we will be wearing masks for a while at work if we're back offices, I think we should, me, if I ran an office, I might mandate it, but I think it's the right thing to do.

Elizabeth Rosenthal:
I think once the majority, what I've observed about mask wearing across the country is once it becomes the norm in a city, then everyone just does it. It becomes the norm. Where it's harder to do is, you don't need a mandate, I go out in Washington, DC without a mask and little kids yell at me because “Where's your mask?”

Tim Wheelwright:
For sure. I'm just going to ask the question, because this is, I think, one of the big, I actually think this is one of the big misunderstandings of mask wearing. You make the point that it's not the patient in the operating room that's wearing the mask, it's the physician that's wearing the mask. The physician is not protecting themselves from the patients so much as they're protecting the patient from the physician. I think that's one of the big misunderstandings. I've always understood the primary benefit of wearing your mask was that because I don't know if I have COVID, okay, and there's no way I can know, because even if I've been tested, doesn't mean I don't have it and it just hasn't shown up yet.

Tim Wheelwright:
The responsibility really is for me to wear a mask so that you don't get sick, not to protect myself. I mean, I happen to want to protect myself too. I'm a mask wearer, but I'm highly susceptible to this thing and I'd be really, really sick. I don't want it. I don't want the long-term effects. I don't want the short term effects. My wife is extraordinarily high risk because of asthma. I don't want her to get it. We're very careful in our little pod. We're very, very careful, but it's always interesting to me that when I hear people say, “Well, you can't make me wear a mask because if I get it, that's my problem.” I'm going, “Wait a minute. That's not, I don't think that's the issue.”

Elizabeth Rosenthal:
Yeah. That's not the issue. I mean, I like to use the analogy of smoking in restaurants, right? Yeah, sure, people can smoke if they want, but they don't have a right to ruin my dinner. I think it's, particularly in offices where hopefully there's some kind of camaraderie or caring about your coworkers, you're wearing a mask. This is not just if you've had a negative COVID test, my big worry is that after people have gotten vaccinated, they'll say, “Oh, I don't need a mask anymore.” We do not know yet if getting a vaccine stops you from getting mild cases of COVID. We know you can, and you can spread it, maybe. Even after you get a vaccine, it's thinking about your coworkers and your friends and your family is, and probably it will save you too. It will give you some protection. The main reason is to think about the company, which is why companies say all sorts of things like no smoking in our building.

Tim Wheelwright:
My favorite one is no shoes, no shirt, no service, right?

Elizabeth Rosenthal:
Right.

Tim Wheelwright:
We seem to be okay with that one, but we're not okay wearing a mask, which I find fascinating. No judgment here. It's just fascinating to me to see the difference. When you look at, so what we can do, what I'm hearing from you is we want, you're encouraging everybody to get the vaccine as soon as you can get it, make sure that you're in the environment that is appropriate for you to get it in. Right? Your indication is you think people ought to be wearing masks. Okay. I can't disagree with that. I'm a big fan. You think that the vaccines will, even if they're not a hundred percent effective against any mutations of the virus, they will be enough to prevent the massive deaths that we've been seeing.

Elizabeth Rosenthal:
Yes.

Tim Wheelwright:
Did I hear that right?

Elizabeth Rosenthal:
I think, yes. I think we're now at a point where people should feel relieved, but also be more careful because I know it's the Anthony Fauci thing, the light at the end of the tunnel, it is there now. It's not like I can't wait, this is going to go on forever. It is going to end. The more you kind of follow through on things right now, the quicker it will end, the sooner you'll get back to normal life. It's just the right thing to do for our country to get the economy going back. I mean, I feel terribly, I'm not sure about your clientele, but restaurants, small businesses are suffering.

Tim Wheelwright:
There's so much suffering in the business world. I am not a big fan, I will admit I'm not a fan of shutdowns. I don't even think they're legal. I'm not a fan because you're just trading deaths. That's all you're doing. Okay? Entrepreneurs work all their life to become an entrepreneur. We have businesses, we have over 4 million businesses that have gone under permanently as a result of the shutdowns, not a result of the virus, a result of the shutdowns.

Tim Wheelwright:
To me, anything we can do to mitigate the shutdowns is a good thing. What I'm hearing is it's the vaccines, it's the mask, it's those things that we can actually do so that we don't have to be shut down or the government doesn't feel they have to shut us down so that we can continue business in some form. Then what we're always saying is, I'm always telling people, look, this is a great time to look at how you do business and maybe there's a different way you can do business. Zoom actually has been a terrific boost for our business from the standpoint that more people are online and we do a lot of online education.

Elizabeth Rosenthal:
For me, if I distributed CARES Act money, I would say, “I'll pay your bar to go dark for a month maybe so that you can reopen safely.” The goal is to reopen safely. I look forward to that, I think by this Summer, if we get our acts together with vaccination and just masking, being a little more careful and organization, that can happen. It's going to be some work, but it shouldn't be just the, as it is now, the biggest, we got a terrible statistic today. The hospitals have all been out there getting subsidies from the government, right? Because they say they've been losing money during COVID. Many of them are only 3% or 4% down for the year. Small businesses are way worse off.

Elizabeth Rosenthal:
Why are we supporting big businesses who, yes, the airlines have suffered, but we haven't been very smart about who we're helping. If we say we want to be a nation of entrepreneurs and people who make it for themselves, we haven't been very smart in how we've supported those folks so far. At this point, maybe lessons learned, hopefully there won't be a next time, but what we need to do is support them so they can make it. The ones who made it this far can make it through the next few months until Summer and life returns.

Tim Wheelwright:
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Tim Wheelwright:
Dr. Elizabeth Rosenthal author of the book An American Sickness, How Healthcare Became Big Business and How You Can Take It Back. Highly recommend taking back your own healthcare. I'm a big believer in that. Thank you so much. Any final words, Dr. Rosenthal, for us?

Elizabeth Rosenthal:
Just that there is light at the end of the tunnel. That we can do this now. I wouldn't have said this seven, eight months ago. My mom died of COVID early on. It was a very, very difficult time. I'm from New York. It is a real disease. It can be very serious. In some people it's not. We have a solution now, and we just need to make a plan and follow the plan, which we've seemed to have had a lot of trouble doing thus far, but this is not an unsolvable problem. It's not rocket science. We can do this.

Tim Wheelwright:
Thank you so much. Remember everyone that really healthcare is a part of your business, health care and keeping our employees healthy is a major part of what we're doing and making sure that the employees also are comfortable and happy. I know some employees, they're fine going to the office, some aren't. We've actually given our employees some options on that. Just remember that when we take care of this virus, when we take care of the health of our employees, we're always going to make way more money and pay way less tax.

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