As New York approaches the peak of the coronavirus epidemic, there has been growing scrutiny of the public health response, both at the national level and more locally. On Tuesday, City & State conducted a live video interview with the chairmen of the state Legislature’s health committees – state Sen. Gustavo Rivera and Assemblyman Richard Gottfried – who are paying close attention to the actions of President Donald Trump and Gov. Andrew Cuomo. The two lawmakers weighed in on why New York has been hit so hard, what should have been done sooner, and what the next steps are for New Yorkers and city, state and federal governments. The following transcript has been edited for length and clarity.
City & State: Can you assess the response to the coronavirus? In short, how are we doing – in New York, New York City, nationally?
Gottfried: Well, I think our biggest strength is that we have at the state level and in New York City two really superb health departments that have a long and strong and professional record on public health, and that's really served us well as it often does. I think our leadership, Gov. Cuomo and Mayor de Blasio, others around the state, have done a very good job of doing what we can with the resources we have to care for people, to make sure we prepare, to get the population to be washing their hands and socially separating – a whole lot better at messaging and preparing New Yorkers than the national government has, that's for sure. Our main shortcoming, I think, has been the resources that we have available. Our public health and a lot of our health care resources have been living on a shoestring for a long, long time, so when we hit something like this we really have problems.
Rivera: In comparison to the federal government, which has been an absolute disaster, we certainly have been doing better. I do think there are some things that we needed to do more aggressively earlier. Certainly, we can compare the situation to, for example, South Korea or Taiwan. South Korea, in particular, had the first case on the same exact day as the United States of America. In this state, we have been doing as much as we can, but I will tell you that we definitely have to talk about the federal government's failure here because this is a problem, a crisis that impacts everyone. It does not just impact one state. It impacts the entire country and therefore requires a federal response. But as far as the state is concerned, we have been moving more aggressively than other places. We did not do early decisive action quickly enough, but I think that some of it has been taking hold. We do have to have conversations about what our health infrastructure is, and what is going to happen after the crisis subsides and what this governor, who has ably led us as an executive, at the same time has chosen to do things to the public health system, which is going to have an immense negative impact, and we need to make sure that we do not ignore the callous actions of this governor during this budget just because he is far more effective than the sociopath in the White House.
City & State: New York has been one of the most hard-hit places. Why is that?
Rivera: I think part of it is the reality of New York City. It is a heavily urban environment. Many people use public transportation, and obviously social distancing is difficult when you're sitting on a bus or in the train. There is that, and there is also an issue in the health infrastructure that we will certainly be discussing. There was some early decisive action. Places like Taiwan or South Korea acted very swiftly. The reason I mention those two is because both of these are democracies. There is an argument that is made by some. China can do these types of things because they are a totalitarian government. Well, Tawain and South Korea are both very healthy democracies. There is a way that we can deal with public health crises without taking away people's freedom. We have to be honest about the reality of this virus, this disease. But we can still do so while doing things in a democratic sense. So I do think the city was impacted worse because of those things. I am hoping that we are seeing a plateau. I am not sure that that is the case, but I hope that we are.
Gottfried: Mentioning Taiwan, one thing to remember about Taiwan is that since the late 1990s, they had a single-payer healthcare system. And so when someone in Taiwan thinks, “Gee, I have this cough, I wonder if I should go to the doctor or should I see if it gets better.” And before you know it they are dead from COVID-19. In Taiwan, they don't have to worry about whether they're going to have to pay a co-pay. They just go, and that makes a big difference.
City & State: As The New York Times just reported, a top advisor to President Donald Trump had warned that failure to contain could lead to hundreds of thousands of deaths and trillions of dollars in economic losses. This was in January. Was there a grave governmental oversight? Was there a major blind spot in our society? When did you first realize we would have a full-blown crisis?
Gottfried: First of all, I think anybody who isn't living under a rock knows this, our national government blew this from the start and continues to. And even before the start, when in 2017 the Trump administration shut down the national pandemic preparedness office in the White House. I mean, how dumb can you get? I guess we know. So, when did I first have a sense that something really big was coming here? I'm not sure when, but I think pretty much from the time that it was clear that there was something big going on in China, it was clear that there was certainly a major chance that it would hit us like a tidal wave. Things that could become pandemics don't always. SARS and swine flu and a couple of other things were very minor factors in America and most other countries than COVID-19 has turned out to be. Part of what makes New York different is that, on an ordinary day, we are about as socially undistanced as a community can be. People come here and come and go from all over the world. That's part of what makes New York City great. It also makes us vulnerable, and public health people have been saying that for a long time.
Rivera: At the beginning of March, whenever that was, that vote that came before the Assembly and the Senate, which both Dick and myself voted against, to expand the governor's powers, it probably happened a couple of days before that. There's a good friend of mine, whose father is an epidemiologist, just recently retired, one of the top in his field. She had a conversation with him, I had a conversation with her and she kind of laid out everything that has happened so far. This is somebody I trust innately, and she was talking to someone who is so experienced in this. So she was laying it out while it was happening and while we were not aggressively testing. One of the things that both South Korea and Taiwan did, for example, is that they set up fever clinics. Because there is a single-payer system, everyone knows that anybody could just walk into a clinic, and if you had a fever, you would be checked out. Immediately, you were given a test. One of the things South Korea did very early was that they got all the private companies together, and said, ‘You develop a test very quickly, right now.” This was back in January. The same time we saw the first case here. They go to the clinic, find out if they have a fever. If they have a fever, they are tested on-site. If they are positive, they go to a facility, not shut away and just set up strictly for people who are positive. They were told to call their families, let them bring you stuff. You could go there. You would be separated from your family immediately. All of these things, all of these resources that we did not do. She was describing the actions that South Korea and Taiwan had taken back in January, and she described it as geometric spread. At the point, where you have one person being a vector and that vector infecting two, three, four people. That's when you would see the numbers go up. As she was describing it, it just got scarier and scarier. I knew a while back, about a month ago, and we see a lot of this coming to pass.
City & State: Turning to the lack of testing – is that primarily or solely the fault of the federal government? Does New York state bear any responsibility? Is it past the point of trying to test everyone?
Rivera: First, the failure as far as the tests absolutely belong to the federal government. They ignored the facts early on. They ignored that there were tests available that they could actually very quickly approve to get into circulation in the U.S. That's the first thing that belongs to the federal government. The state government did within its capacity, it actually ramped up tests more than a lot of other folks, so I'm glad that was the case. But the reason why I was shaking my head as far as not testing everybody, since now we are past the point at which we could have stopped the pandemic, at this point we are at mitigation. It is, as we have said many times, flattening the curve. That simply means making sure that you don't put too many people in the health care system because of the capacity, it will collapse if we go above a certain point. It is about mitigation.
But there will come a point – the vaccine that is being developed, at best, we are talking about an 18-month window. This is not going to be available, if at all, until next year. So the idea that we would not do a lot of testing between now and then is very problematic. Once we have plateaued and are on the waiting part, it is not about taking the foot off the gas as far as social distancing and then ramping up the testing to go back to surveillance, so that we can identify the people that are positive, make sure that we separate them from their families and keep them in places where they can be looked after. These are the things that we have to make sure we can identify … if we take the foot off the gas of the measures that we have to take, then the spread is going to come back. It is going to continue to be catastrophic.
Gottfried: We also need to remember that testing has a lot of value, but it's a very particular value. If you find out that someone is positive, there are things you need to do very quickly: isolate them, treat them, etc. But if you find out that you are negative or that your neighbor is negative, that doesn’t mean you're all off the hook. Someone negative today, in the morning, could be infected by the end of the day. It's not like you can just divide society into those who tested positive and those who didn't. There will always be a lot of people that do not test either way and could be infecting anybody else.
City & State: Is the federal government preparing for this, once we get past the peak in New York. Is the state doing anything on that front?
Rivera: I am not aware of any action from the state in this regard. The fact that I have is that I have because we have a sociopath in the White House who is not only impatient, not very intelligent, but also does not understand governance. So you have somebody who was not prepared back in January, for the sake of keeping the numbers down. As he himself said, let's keep the numbers down. In other words, not test people to not get the numbers go up, which helped the damn spread. Now, we're dealing with an ongoing problem. This, going forward, is going to be even more problematic, because this is not something that's going to end overnight. We have to make sure that we're going to be prepared for the long-term and have a very deep conversation about how we are organized as a freakin’ society and as a government. I believe we need to take this opportunity. For those who care about the most vulnerable, for those who care about a more just society, this is not only an opportunity but an obligation to have those conversations. Sadly, the national government, not this administration, they are not playing a part in it. They're looking at this as a messaging problem. That's how they identified at first. This was not a public health problem. It was a messaging problem. Let's keep the numbers down. Now that we are in full-on public health crisis mode, what is going to happen immediately after, this is a rolling thing. This is not going to be like two weeks, and it's going to be done. So I'm very concerned about what's happening at the national level, and the lack of ability that they have to be able to deal with this is a long-term issue.
City & State: How is it possible that those who appear not meet the new testing criteria, like CNN’s Chris Cuomo, manage to get tested for COVID-19? What's your take on all this?
Gottfried: Alas, it is a bedrock in our society that people with wealth and power are able to take advantage of a lot of things that the rest of us struggle for. Getting tested is one of them. I think what's important is that we do what we can to make sure that the testing that goes on is based on a common set of criteria. If we start off by saying that people who think they may have symptoms are the first who ought to get tested, that ought to apply across the board, rich or poor. Because if someone is infected, they can be infecting any of us, rich or poor. They have the same right to treatment, whether they're rich or poor. I don't know if we will ever achieve a society in which wealth and power do not get you privilege. What we do need to make sure to do is to make sure the people who don't have wealth and power are, whether it's health care, education or anything else, able to get what they really need. And that goes for testing like a lot of other things.
Rivera: I remember thinking of this sometime in early March – although it does seem like seven years ago – but it was only the beginning of March, this famous British actor, Idris Elba, who was completely healthy, got on Instagram and said, I'm positive for COVID-19. That's one of the things that clicked for me. And then there was an NBA team that had all of its employees and players tested. Then we were like, how many tests were there? We figured out there they took up a whole bunch of tests that were a good chunk of the total number of tests available for that entire state. It's power and privilege. This is the argument that we've always made. Health is a human right. It should be treated as such. Just because you're wealthy doesn't mean that you should have access to other things that people that other people don't have access to, when it relates to things like health care. The argument that I've always made about this is that, if you need to transport yourself from point A to point B, you get in a Corolla and the other person gets in a Mercedes, you're both going to get to the end. But health care is not that. It's not treated like that. It's not a car. Just because you can afford a Mercedes doesn't mean that you're the only one that should get to the end. If you can only afford a Corolla, well, guess what, you're going to have to save up for the Mercedes more or less, or you can't get on the road at all. And that's what our health care system is organized. So it's totally unfair. The idea that people who are wealthy, particularly those folks who are not symptomatic at this moment are getting tested. They should not be getting tests.
City & State: There are clear disproportionate impacts on lower-income neighborhoods. There have been reports that New York City's greatest concentration of COVID-19 cases is in Queens, Jackson Heights, Corona Elmhurst neighborhoods, and that in the Bronx residents have died at a rate double that of the city. What can the city and state do to combat the wealth disparity with COVID-19?
Rivera: It just underlines everything that we've been talking about as far as how unequal the system is. If you have a lack of infrastructure, if you have the type of work that is done by many of the folks whom I represent, there are times like this when all of a sudden, we reconsider who is essential in our society. We have a lot of people working from home because they can, but they're privileged in that regard. And many of my constituents don't have that ability. They still have issues with landlords who, even with the 90-day moratorium on evictions, are still giving them a hard time. I'm still getting calls to my office from my constituents who are fearful of getting kicked out of their house. In this regard, we need to recognize that there are these inequalities and then pump resources there where they're needed. We are asking the governor to actually expand testing ability in the Bronx, to actually put a larger field hospital in the Bronx. There are a couple of locations that are being looked at right now. And put more resources onto the ground here. Certainly, deal with the immediate crisis, but then take two steps back and then think about how we actually reorganize the system as a whole. This is the conversation that we've been having last year. I believe that City & State might have been at a couple of them. We did hearings across the state on the New York Health Act, which gave us an opportunity to hear from every corner of the state about the inequalities that the current system actually forces down on some communities and individuals. This is just another way of underlining that. When you look at my constituents, I am very, very worried about the way it's going to happen here in the next seven to 10 days because the colors are shifting. The colors that you saw on that map that the city published related to community districts and then where it was highest. They are currently in Elmhurst, Queens, and things are getting darker and darker in the Bronx. I'm very, very concerned about that. Also, I've gone out a few times to get supplies or something, to go to the supermarket. There are many folks in my community that I've had to have conversations with, because they were not socially distancing. Saturday was the last time that I left the house. All these things together make me incredibly concerned. We have to deal with the crisis immediately, but then, again, take two steps back and think about how we actually recognize that there is an obligation that we actually have to do far more than just deal with the immediate crisis.
Gottfried: We also need to think about this term “essential employees.” There are an awful lot of people who we are rightfully recognizing as essential. But, you would never know that from what we pay them, whether you’re talking about nurses or EMTs or sanitation workers or people who work in supermarkets and deliver food. We’ve all recognized that these are essential people to the functioning of our lives in different ways. It doesn’t show in their paychecks.
City & State: You mentioned the New York Health Act, which you both sponsor. What difference would having single payer health care system in place before and during this pandemic have made?
Rivera: A couple of quick things and I’m sure Dick will have a few things to say about this. First, when you’re talking about somebody who feels like they’ve been exposed or have symptoms, the fact is that you wouldn’t have to think about whether you would go get tested or go to your doctor. If you’re not insured at all, which is a situation for many New Yorkers right now, they don’t know what they’re going to do. There’s a concern that if you are insured, and we’ve already seen this, people who are insured, they might have the test cost waived, but what if they get treatment? There’s a story I was reading about a lady, who after she survived, she was hospitalized, she was intubated, and afterwards came back home and found a surprise bill for I don’t know how many thousands of dollars that she’s not going to be able to pay – because she’s insured, but she’s underinsured. And also, the conversation that we’ve had about how rates would be structured, they would be structured in a way so that it pays for the cost of the service. The rates would mean that many institutions that are safety-net and currently teetering on the edge would not be teetering on the edge. Say for example, St. Barnabas Hospital, which is at the heart of my district, 90% of its folks are Medicaid patients. The Medicaid rates are very low. A place like Mount Sinai and NYU Center, they have a lot of commercial payers so they’re fine, they’re sitting on millions of dollars. But a hospital like St. Barnabas is under water. Having more fair rates, which is what our bill will call for, would actually mean that safety-net hospitals would be much better off. In a situation like this, they wouldn’t be tethering on the edge and thinking about how they’re going to survive even during a time when they have to provide services to the most vulnerable.
Gottfried: Part of the economics of the New York Health Act is that every year we spend tens of billions of dollars on insurance companies, administrative costs, on the administrative costs of doctors and hospitals and others to fight with insurance companies. This is money that ought to be back in people’s pockets or being spent to make people healthy. If you lose your job because your company had to let go of you because of COVID-19, you lose your health coverage in most cases, which means if you do go to the hospital, who’s going to pay for all the care they’re going to give you? Under the New York Health Aact you wouldn’t be losing your coverage, your doctor, your hospital would be getting paid in full. And we’d have a system that treats people as if they matter.
City & State: The state budget was finalized late last week. While you’re criticitizing the approach of the federal government, why is the governor cutting Medicaid in the middle of a pandemic?
Rivera: No! I can’t explain that. You’re asking me to go into the governor’s mind. That’s not a place I want to go. Look, I’ve said this before and I want to make sure I say it again. Just because we have somebody who is a effective at being an executive and has demonstrated, in comparison to the White House, that they know what a crisis is and they know how to deal with it, we cannot ignore that the same guy who is sitting at that table with the press every day and saying, “We can’t put a price tag on people’s lives,” which is right, then goes into a back room with the Legislature and says, “We have to put a price tag on people’s lives.” The same guy who sits at that table and says that the public health system is going to be the one that’s going to be hardest hit by this crisis, and he’s right, then goes into negotiations with the Legislature and says: “I’m going to cut that exact same system that I know is going to get hit worst.” I do not understand why you would cut Medicaid under the best of circumstances. If you want to find fraud and inefficiency, we all want that. None of us want public money to be wasted, but to insist, to demand that the way to deal with this crisis of whatever is happening within Medicaid is during a pandemic, to cut money to that same system that’s going to be hit hard, just because you’re taking the nails out of a two-by-four that you’re going to hit me over the head with doesn’t mean that you’ll hit me over the head with a two-by-four. That is what he is saying that he wants to do. And the budget that passed is going to do that. Immediately when the crisis is declared over at the national level, cuts go into effect. The impact that’s going to have on nursing homes, on hospitals, on those same institutions that are providing the care for those who are most vulnerable right now is irrational. Don’t ask me to go into his head, please.
Gottfried: I’ve been the chair of the Health Committee though I think five governors. Things don’t change that much from one to another. The Medicaid cuts we were dealing with this year made no sense whatsoever. They’re going to kill people. They’re going to be cruel. Particularly the cuts in home health care. They are driven by a focus on an artificial spending cap that has no relation to the cost of care, the need for care, or the number of people who need to be enrolled in Medicaid. It makes no sense whatsoever. It made no sense when the governor proposed it in January, when hardly anybody had heard of COVID-19, the name hadn’t even been invented yet. It makes even less sense now that we’re in the midst of this pandemic. We in this country invest so much less in our public sector, in human services, in education, than every other industrial democracy on the planet. And we pay a price for that every year. What the governor forced on us in Medicaid this year is one of the worst.
NEXT STORY: Politicians answer the call to fight COVID-19