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00:00It would be a Herculean task under any circumstances but I think it's made all the more challenging by the fact that this is the same health care system that's going to have to be caring for lots and lots of people who still get covered. We're going to need to do all that we can to suppress transmission of the disease during this period and also to introduce new therapeutics. It's going to be months and months and months before everyone is vaccinated. And in that time unfortunately hundreds of thousands of people are going to be getting coded at this point two hundred thousand a day. As a practical matter how many vaccines are we're going to need now in terms of doses but how many different suppliers of vaccine. Because one is not good enough is it. One is unlikely to be enough given how long it takes to manufacture and how many millions and millions of people need to be vaccinated. But of course the more different vaccines are introduced the more complex the distribution is because they may have different dosing requirements different storage requirements different distribution systems. So ideally we get as many doses of each vaccine as we can to minimize complexity and maximize distribution. I also wonder whether as happened last spring frankly some of the people who are most vulnerable the most head of the food with the least resources to deal with it. We're talking about low income. We're talking about naughty groups particularly in urban centers but also for that matter Native Americans. We've had just portion from these people didn't have that great a health care system supporting them to begin with today. This is compounding all sorts of disparities in our system. Of course in health care where the people with the most health vulnerabilities such as diabetes high blood pressure they're the most likely to get covered and the least likely to have access to the health care resources. But that's only part of it. There are also the economic disparities that line up as well. People who are least likely to be able to do their jobs from their homes are also and that's more likely to be exposed to the disease are also the ones with the biggest disease burden and then the fewest economic resources to weather a recession that's been generated by the pandemic. So people who are losing their jobs may be losing their health insurance. This is all exacerbating disparities that line up for the most vulnerable populations. They may also be the people least likely to take a vaccine. There is some longstanding distrust of the health care system that has been well justified by past inequities that I think will make people differentially likely to take up a vaccine that's offered go forward to the time that we have wide vaccinations and we're past all the social distancing. Look back and say what would we have changed or learn to change about the health care system. Because of this crisis. So I think that we have perhaps learned that there is an even bigger return to harmonising the way that people get insurance and the way they get care to make it less likely that you lose your insurance when you lose your job to make sure there are fewer people who fall between the cracks. That's really important for long term health. And maybe there will be more momentum for ensuring a more robust insurance safety net. Well I wonder about exactly that. We've spent a good part of the last four years debating whether we should have the Affordable Care Act at all. It did not get everybody insured. There's some still like 26 million people uninsured but it took down that number rather substantially. What are the prospects do you think that we can because of this covered 19 crisis turn that back around and address those holes left behind by the Affordable Care Act. Well there are still some states that haven't expanded their Medicaid programs and they may be more likely to do so in the coming years. Also I think there are ways that we can make sure that people get to keep their insurance when they transition from one job to another or when their income goes up and down around that Medicaid eligibility threshold. Having more continuous coverage could be achieved by harmonizing the state insurance marketplaces and Medicaid programs also making sure that people have options for insurance they don't depend on their jobs. That was one particularly salient consequence of our system during the pandemic was that people were losing their jobs at a time when they needed health insurance and health care the most. So having a system that doesn't tie your insurance to your job might be helpful in those circumstances.

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Distributing Covid-19 Vaccine Will Be a Herculean Task: Baicker

University of Chicago Harris School of Public Policy Dean Katherine Baicker warns that the health care system will be strained by the challenge of distributing Covid-19 vaccines while also caring for Covid-19 patients. She joins David Westin on "Bloomberg Wall Street Week." (Source: Bloomberg)

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