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Republican Senator Bill Cassidy discusses the coronavirus response, vaccines, and how states like his own, Louisiana, hope to reopen. He joined Edward-Isaac Dovere on an episode of The Ticket: Politics From The Atlantic.

Listen to their full conversation here:

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What follows is an edited and condensed transcript:

Edward-Isaac Dovere: Do you feel like you come at this public-health crisis as a doctor, or are you coming in at it more as a senator?

Senator Bill Cassidy: Everybody is a product of their life experience. That’s true of me. My medical practice was one in which 99 percent of my patients were either uninsured or poorly insured on Medicaid. 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. 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.

Dovere: 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, you can already 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?

Cassidy: We already see a robust set of laws and 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.

I think that politics is just our current form of working out issues as if we were thinking aloud. And there’s always gonna 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.

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

Cassidy: Yeah, but that’s the current law. One is that the uptake of the 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 communities, if you will, to kind of dictate that. It doesn’t take a federal law.

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

Dovere: Is it governors who are making the calls? Is it the president? Is it mayors?

Cassidy: Science should make the call. Epidemiology should make the call. And we should base it 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 Shreveport 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. Let’s build out from there for their micro-systems—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.

Dovere: Have you been back and forth to Louisiana over this time? The Senate was out of session for a while, but has been in session since the beginning of May, roughly. What does your travel look like?

Cassidy: I fly nonstop to limit the transfer. I wear a mask on the plane. 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.

Dovere: 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 10, when I flew home. I would just imagine that it’s a really weird experience.

Cassidy: 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.

Dovere: There was the committee hearing this week, 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, some senators who were calling in by videoconference. There was, at one point, a dog barking in the background. I think we discovered that that was Senator [Lamar] Alexander’s dog from Tennessee. It must be so strange to have government work this way.

Do you think that this should be the future? The Senate’s tried to figure out how to work from home, but that’s been something a lot of your colleagues in both chambers have been pushing back against.

Cassidy: 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 gonna run into people who you otherwise would not run into if you’re in person.

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

Cassidy: 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. The tools are money, computer-support data systems, technical systems. 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 Bel 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. 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 make a pronouncement that applies to them both. That is the only way we get out of this crisis.

Dovere: The infection rate, the death rate in America, 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?

Cassidy: Well, I think Italy probably has a higher rate than we? In Italy, I think most of the people who died are over 80 with at least three conditions that would predispose them. Certainly, in the United States, people who are elderly with underlying conditions have dominated those who are sick now. Clearly the people being affected are 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 strategies laid out on what to do with the results of the testing. And they also have the best strategy as regards to surveillance, should there be a surge once reopening occurs. 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. 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. We have greater variety in our studies. The federal government should point it 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.

It’s our vaccine technology the Chinese and the Iranians and the Russians are trying to steal. We’ve got the best scientists going after this. At some point, we are going to step forward 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 cockiness. I just say that as kind of an observation through history. I do think that we have the ability to recover from this. It just takes thinking, hard work, commitment, and belief.

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