Andy Slavitt: Lessons from a deeply courageous career in healthcare and public service

Andy Slavitt’s resume has always reflected his mission: to help people get the healthcare they need. On Wish I Knew, he shares why the most profound experiences of his life have all been risks. With Steven Kraus, Partner at Bessemer, Andy recounts stories his career in public health, government, and entrepreneurship. He shares why naiveté can be an asset to new entrepreneurs, the lessons from kindergarten that CEOs would be wise to heed, and why handling crises is the best way to build your confidence as a leader.


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Andy Slavitt

Andy Slavitt is a health care advocate, advisor, entrepreneur, investor, government official, and expert. He was President Biden’s White House Senior Advisor for the Covid response and led many of the nation’s most important health care initiatives, serving as President Obama’s Head of Medicare and Medicaid and overseeing the turnaround, implementation and defense of the Affordable Care Act. Today he is a General Partner at Town Hall Ventures where he works with leaders at the intersection of healthcare and entrepreneurship

Today Andy Slavitt is General Partner at Town Hall Ventures. He shares the winding path that brought him here—including some surprising lessons he learned along the way.

Entrepreneur. Government official. Podcast host. Health insurance executive. Investor. Public health expert. While this list could easily represent a whole panel discussion, we’re talking about the resume of a single person—Andy Slavitt. He’s had an incredibly multi-faceted career, although one that has one clear throughline: helping people get the healthcare they need.

We sat down with Andy as part of our Wish I Knew podcast series, and he shared with us why naiveté can be an asset to new entrepreneurs, the lessons from kindergarten that CEOs would be wise to heed, and why handling crises is the best way to build your confidence as a leader.

Sometimes naiveté is an unexpected asset as an entrepreneur

After studying finance at Wharton, Andy started his professional career working for Goldman Sachs. He had asked somebody as a student, “What's Goldman Sachs?” And they said, “It's where all the best people work. It's the hardest job to get.” Andy decided right then, that was the job he wanted. “I was absolutely following the herd,” he says. “Because I really didn't know what I wanted to do.” He eventually returned to school, opting to do his MBA at Harvard, followed by a consulting gig at McKinsey, where he met his now-wife.

But shortly after, in the late 90s, a terrible tragedy forever changed the trajectory of his life. His friend and college roommate Jeff—a doctor completing his post-residency—was diagnosed with a brain tumor. Jeff’s wife Lynn had recently given birth to twins, and when Jeff tragically passed away six months later, his wife was left with a pile of medical bills on top of her massive grief and responsibility to raise two one-year old children. Lynn and the twins moved to California to live with Andy and his wife. Witnessing this tragic series of events stirred something deep in Andy.

This experience led Andy to found HealthAllies in 1999 to help Americans without health insurance to get the care they needed—a service that was way ahead of its time, filling an incredibly important gap in the healthcare ecosystem. “If you'd asked me a year before if I'd ever be an entrepreneur, I would've said no,” says Andy. “I'm not a natural risk-taker. Yet in my life, the most profound experiences I've had were all huge risks.”

Andy’s first year of entrepreneurship was rife with lessons learned the hard way. “There are a lot of things that it's good that I didn't know,” says Andy with a laugh. “Because I don't think you can do it with full knowledge. I think there’s a certain amount of naiveté that allows you to go for it.”

One of Andy’s biggest initial shocks was learning “if you build it they will come” is a total myth. “This was the dot com era,” he explains. “Everybody was registering websites like shoes.com and feet.com and toes.com with great optimism. When we launched healthallies.com, we hired a whole bunch of people to work in the call center. And I remember the moment we turned it on. We just assumed that we were gonna get flooded.” And … crickets. But by then, Andy had taken that irrevocable first step into entrepreneurship and was determined to see it through.

Remembering what you learned in kindergarten can take CEOs a surprisingly long way

After four years of running HealthAllies, Andy sold the company to UnitedHealth Group. “At one point they said, ‘Well we have two choices. We'll either buy you, you can have access to these members, or we will crush you and you'll have access to none of these members.’” The choice was obvious. 

Andy climbed the corporate ladder at UnitedHealth Group for the next decade, eventually serving as the Group Executive Vice President for Optum, a subsidiary of UnitedHealth Group. He was in this seat when Obama's Administration launched healthcare.gov in 2013. This was an historic moment where Americans could now shop online for insurance coverage through the Affordable Care Act. But the website crashed just two hours after launch. And the government shut down that same day, due to a lack of funding. The situation was dire.

“This was a threatening moment to our future of being able to solve big problems as a country,” says Andy. “I think if this failed as it started, Congress would've been loath to launch anything significant again, and in particular in healthcare,” says Andy. “So I called them and asked if they needed help.”

Andy was quickly thrown into a crash course in crisis management as he put all of his strength into trying to salvage the rollout. He had an instinct that the issue was less of a technology problem and more of a management problem. “The situation was bad in every possible way, but the biggest problem was that nobody would talk to each other. Everybody was pointing fingers at everyone else … and everyone was right. The hardware collapsed. The software had 6,000 bugs in it. I basically had the job of saying, ‘How do we fix it fast?’ I knew that if we could do it, it would be really a rallying cry that we could do hard things.”

“We got it done in five weeks,” says Andy. “We did it because we had no choice.” Not long afterwards, millions of Americans were insured. “The real high was when I listened to the conversations from the call center. Folks who'd never had insurance in their life now had some amount of safety and security. That's a good feeling.” This triumph was a testament to Andy’s skill as a leader and a problem solver. But Andy attributes his success to something far more fundamental. “It was a crazy, stressful, traumatic experience,” says Andy. “But ultimately a lot of our success came down to applying the stuff we learned in kindergarten: get people to work on teams together, play the right way, and build the right culture.”

Nothing is more powerful than direct conversations with those affected most by problems

In 2017, the high of helping people started to wear off as the new administration began its campaign to repeal the Affordable Care Act. Andy started calling up his inner circle. He was steadfast in his intention: “We’re not gonna let it happen.” He gathered together a group of folks, mostly former Obama staffers. “We would meet two to three times a week by phone. And we each had different responsibilities. My responsibility was to be the most vocal voice against repeal,” he says.

When the House voted to repeal the ACA just before the summer break, they went back home for recess. Andy noticed that only ten of the Republicans were having Town Halls with their communities. “So I sent out a tweet to them that said, “Hey, at least go talk to people. And if you don't, then I may come to your district and have a Town Hall where I offer my own explanation. And of course, you're welcome to attend and we can have a little friendly debate,” says Andy. 

A couple months later, Andy had met with 16 communities around the country. “I met with 40,000 Americans face-to-face, hearing their healthcare stories, their fears of losing it, and what mattered to them most,” he says. “I learned about the power of grassroots organizing and how that could work in Washington. That experience changed me in a really profound way.”

It wasn’t long after that fight over the ACA’s repeal that Andy left the world of public service to found his investment firm in 2018. “Town Hall Ventures gets its name from that activity. I found the meeting space where the public sector and the private sector come together to solve problems to be a good vision for this country.” To this day, Town Hall Ventures is dedicated to funding companies that provide a range of services to folks needing medical care, from outpatient treatment for substance abuse disorders to home-delivered meals.

Handling a few crises is the best way to build confidence

But Andy couldn't escape public service forever because the outbreak of COVID-19 was around the corner and would overwhelm the country in ways that were previously unimaginable. “I connected with people in the Trump administration and the message I basically heard was, this is not a thing that the president's gonna talk about,” says Andy. He couldn't just sit there and do nothing. “I took it upon myself to write a note to all the governors and mayors in the country in February 2020,” he says. “I told them what was about to happen. I told them, you probably need to staff up. You probably need to put a plan in place. This is gonna hit your state.”

Andy was acting as a private citizen and an ex-public official, but his sense of duty was immense. “We launched the biggest communication ever called the #stayhome campaign, that was seen by a hundred million people,” says Andy. “We literally launched out of my living room. These were things that the government should be doing. We were tracking down ventilators, we were buying masks, we were distributing them across the country.”

When Biden took office in 2021, Andy’s phone started ringing. Biden’s team wanted Andy to step in officially, but Andy was determined not to. At this point, he was running Town Hall Ventures and had obligations in the role and a responsibility to his investors. He needed to stay focused. But the phone kept ringing. Andy said to them, “‘I’ve said that I can't three times. But you’ve asked me three times, so this must be a total effing mess.’ And they said, ‘It's a disaster.’” Andy made a compromise. He’d join as a special government employee, a status that limited his service to 130 days. Andy was assigned a very specific task—help get people vaccinated.

“Over time you gain confidence that you can accomplish hard things once you start doing it,” says Andy. “I've now been involved in several crises to fix. You can do almost anything for a limited time period. Your mentality changes with one time bound task—you can run hard.”


Andy Slavitt: If you’d asked me a year before that if I’d ever be an entrepreneur, I would’ve said no. It’s one of the things I struggle with as an investor, and I think all of us who invest need to understand our own proclivities towards risk and figure out how to factor those in. But I, I’m generally speaking, not someone who takes risk in yet in my life.

The most profound experiences I’ve had were huge risks. 

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David Cowan: Welcome to Wish I Knew the show about the revelatory aha moments that founders, CEOs and leaders discover along their own business journeys and why taking risks leads to growth. I’m your host, David Cowan. And on today’s episode of Wish I Knew We’re Going where No episode of Wish I Knew has gone before, and that’s the intersection of healthcare and politics. Presidents, all of whom served through their own distinct healthcare crises 

Andy Slavitt: today after almost a century of trying today after. Over a year of debate today, after all the votes have been talli, health insurance reform becomes law in the United States of America.

A good life for American families also requires the most affordable, innovative, and high quality healthcare system on earth. Before I took office health insurance premiums had more than doubled in just five years. I move quickly to provide affordable alternatives. Our new plans are up to 60% less expensive and better.

Next week, I’ll be leading out the path ahead to continue our fight against Covid 19. To get us to July 4th, this is our target date to get life in America closer to normal, and began to celebrate our independence from the virus together with our friends and our loved ones as we to celebrate Independence Day.

David Cowan: In just the last decade, we’ve seen the introduction of the Affordable Care Act, also known as Obamacare, and several serious attempts to repeal it. And during all that, we were hit by the historic Covid 19 pandemic, an associated tumult that’s exposed cracks in the system. You would think that healthcare should be a basic function of our government, but it seems like we still can’t agree on how healthcare should be delivered and paid for, and even whether everyone’s entitled to basic healthcare as a human right.

The result is a constantly changing complex system of federal services, state programs, and private insurance plans that are hard for any patient to navigate. To help us understand how we got here and what’s coming, today’s episode of Wish I Knew Features the person known as the Savior of healthcare.gov, the highly respected healthcare expert and entrepreneur, Andy Slavitt.

Andy Slavit started as an entrepreneur and became not only a healthcare advisor, but also an author and the host of his own podcast in the Bubble with Andy Slavitt. Above all, you may know him for his role in repairing healthcare.gov back in 2013 or more recently as an advisor to the Covid 19 response in the Biden administration.

In between. He served as acting administrator of the Centers for Medicare and Medicaid Services and started his own investment firm called Town Hall Ventures. Speaking with Andy today is none other than Bessemer’s healthcare partner Steve Kraus. Steve is also the host of a podcast called A Healthy Dose.

Today they unpack everything from Andy’s decision to form a company to how he got involved in politics in the first place. And a whole lot more. Without further ado, here’s today’s conversation with Andy s slt.

Steve Kraus: All right, well I’m excited to welcome my friend, colleague, Andy s slt to wish I knew. Podcast today. Andy. Welcome. Thanks, Steve. Andy, you’re a man who has worn many hats in your life. I was trying to count public, official entrepreneur, podcast host, health insurance exec, public health expert. I’m sure there’s many more.

I’m curious when you know you meet folks, like how do you describe yourself? Like what do you do? 

Andy Slavitt: Well, I enjoy it all. I mean, I’m blessed to have a lot of variety in my life. I think most people. You know, my parents’ friends probably know me from the, my podcast because I’m guessing my mom is one of the shameless promoters of, of the podcast.

But you know, most of the people who know me know that I spend considerable amount of my time these days on Town Hall, which is the firm that we works very closely with Bessemer and invests in healthcare opportunities alongside you and others. But, you know, at any given day, in any given phone call, you know, a slightly different hat might have to come on.


Steve Kraus: family background, what did your parents do for careers? Did you have any direction in terms of the business sense from your family at all? 

Andy Slavitt: You know, my grandparents were immigrants and my father pretty traditional. He was an attorney. The big, big, big influence on me and had a big heart and I think could have cared less about business or Morton or Goldman Sachs was not pressed with any of that stuff.

Funny you asked me this. My sister just sent me something that he sent us on Valentine’s Day. The year he died, which was 2003 that she had saved. And he said something to the effect of when my ticket gets punched, the biggest thing that I feel about is that my kids are good people and will be decent people and will be kind to others.

And you know, he succeeded with my sister, succeeded with my younger brother, he succeeded with you. It’s arguable whether he succeeded with me, but I do think some of the public service that I’ve done, I think about my dad a lot when I do that and wonder what he would be thinking. 

Steve Kraus: Yeah, I mean, when I think of you, I think of a do-gooder, which is a compliment.

I hope you take it like someone who wants to make the world a better place. It sounds like that really came from your father, which is great. Let’s go back, you know, call it 40 years. What did Yana, Andy s SLT wanna do when you were headed off to Penn? Or what were your aspirations 40 years ago? 

Andy Slavitt: Well, I really liked to write and 

Steve Kraus: write like a journalist, write like 

Andy Slavitt: pros.

Right, like journalist and I thought I would be, and I hadn’t done it yet, but I thought I would like to write books. 

Steve Kraus: Why a journalist? What was it about that I’m curious. 

Andy Slavitt: I was the editor of my high school paper. Hmm. And at college I, and I stayed an English major, but I also was a finance major in Wharton.

And you know, came outta college in the eighties, so it was Prime Wall Street time. And went right to Goldman Sachs because at the time, Steve, if you asked me what Goldman Sachs actually did, I said, oh, they do investment banking. And he said, what’s that? I would’ve had no answer for you. None whatsoever.

Steve Kraus: It’s interesting that D that doesn’t strike me like you, cuz when I think about you, I think about someone who’s got kind of a true north of where, what they wanna do. And it sounded like you followed the hurt a little bit there. Oh, 

Andy Slavitt: I did. I mean, look, my first. My first job was Mc Goldman Sachs, and then my first job outta business school went to HBS, was McKinsey.

So I was absolutely following the herd cause I really didn’t know. I really didn’t know what I wanted to do, but, but look, I met my wife at McKinsey, so that was a good decision and I think a lot of us, my generation at least grew up financially much less secure. And so like, We were getting out of college and we had to earn money and we had to have a stable job.

So we took these very safe choices at the time. And so I just asked somebody, what’s Goldman Sachs? And said, it’s where all the best people are working. It’s the hardest job to get. And I decided right then, that was the job I wanted mostly because it was a thing to achieve and a place to be in because I thought I was smart enough to think that’s the kind of job that’ll give you choices in what you do next.

Didn’t ask whether I’d enjoy it, whether I’d be fulfilled or the things that kids these days consider when they take a job and. The truth is like I was probably a glorified FedEx shipper for, for three years at Goldman, and we were reminded frequently that the executive assistants made more money than the analysts out of undergrad because they were worth more to the company than we were.

You know, that was kind of thing a partner would tell you back then. So 

Steve Kraus: you know, Goldman Sachs, McKinsey, Barry, formulaic jobs, you look great brands as we talked about. Then you become an entrepreneur. How did that, that shift happen? Like talk us through that and tell the listeners a little bit about your, it’s probably your first company, right?

And how it came to be in, 

Andy Slavitt: you know, when I was 30 or 31, my roommate from college who was, you know, we were both recently married, he was in his post-residency cause he wasn’t yet making any money. He got diagnosed with a brain tumor, started feeling numbness in his arm. He had twins. They were a year old and he died within six months.

And he had told his wife, Lynn, that we would take care of things and so his wife and their. And the twins, Josh and Judy moved across the country to California to, to move in with my wife and our new baby. And that sort of got me going on. What eventually led to me starting the company, I started and leaving where I was, you know, the gist of it was to help people who were sick and couldn’t pay their medical bills because that was the situation that, uh, Lynn was in.

This was sort of, Way before the Affordable Care Act, this was late nineties and started a company to help people who didn’t have insurance or had some insurance, but not enough, get access to care. 

David Cowan: This healthcare company that Andy founded was called Health Allies, and it was way ahead of its time filling an incredibly important gap in the healthcare ecosystem back in 1999.

Steve Kraus: What compelled you to not only take the family in, which is obviously being an amazing friend? But then to start the company, it’s really 

Andy Slavitt: fascinating. What’s even crazier about it, Steve, is I’m not a natural risk taker. Hmm. Like Puda asked me a year before that if I’d ever be an entrepreneur, I would’ve said no.

It’s one of the things I struggle with as an investor, you know? And I think all of us who invest need to understand our own kind of proclivities towards risk. Mm-hmm. 

Steve Kraus: That’s fascinating. Cause I actually definitely think of you as, as someone who takes on risk. So I wanna, I wanna touch upon that, but, but let’s first, second.

Go to Health Allies, you know, we’ll have a lot of entrepreneurs listening this podcast. I’m curious what, what are the lessons? What do you wish 

Andy Slavitt: you knew? There’s a ton of stuff I wish I knew. Yeah. I mean, you know, actually there’s a lot of things That’s good I didn’t know because I don’t think you do it with full knowledge.

I think you do it with a certain amount of naivete that allows you to kind of go for it. And so, It was hard. I mean, I’m not someone who takes risk and yet in my life, the most profound experiences I’ve had, they’re all huge risks. Yeah. And they felt like risks. It really is something that I’ve done, I wouldn’t say on a whim, but there’s things that I’ve done because I thought at the moment, they’re the things I had to do, not because I felt.

Like, Hey, this is an easy thing, or this is a risk freak thing. This, this entrepreneurial journey is hard and it’s lonely and it’s what makes it worse is that people love you when you’re winning and they want nothing to do with you when you’re not. And I try to remember that, you know, we have a lot of companies we’ve invested on this point up to, up to like over 30.

And you know, we have dealt with entrepreneurs during hard times and I try to play back some of the how, how was I feeling? Because both. Parties can get frustrated with one another from time to time. And at the end of the day though, living through that journey is very, very hard. I will say one thing, Steve, I’ll put a plug in for the one thing that’s made all that easier, and that’s my wife and my, my marriage.

It is a lot easier to take those risks when you’ve got a great family and a supportive spouse and you know, my wife was always encouraging me to like just follow those things and that, you know, that I think made it easier throughout time. 

 Steve Kraus: What, what was the most naive thing headed in that you held?

Naive belief or naive, you know, decision you made or, 

Andy Slavitt: oh, customer acquisition for sure. I mean, we launched this thing, you know, this was, so Steve, this is the.com era, right? 99? Yeah. This is like right. This is everybody’s putting shoes.com and feet.com at toes.com, and so, We launched this health allies.com and we hired like a whole bunch of people to work in the call center, and I remember the moment we turned it on.

We just assumed that we were gonna get flooded, and I thought, okay, that didn’t happen. So then the next naive thing I thought was, okay, I just need great marketing. But I hired a great chief marketing officer who was able to do almost absolutely nothing for us because I. Marketing is practice, but sales are where the game is at.

And I was actually very, very good at sales. I just always believed that sales was the most underrated and underrepresented part of any company. So we started to tick off when I sort of, after I stopped experimenting with someone else, will figure out how to attract customers. Just getting out and pounding the pavement myself, building big relationships and you know, that opened up the doors.

But you know, you assume you’ve got an idea. If you build it, they will come. People are gonna come to it. I, and I really didn’t understand how that stuff worked. The internet was so new that it felt like it. We were working in dark arts, but I think the way I look at these things is we all gain a lot from whatever experiences we have if we really look at them as development experiences.

And I learned a lot from that. Ultimately, I think I did the right and best thing by selling the business when I did to United Health Group and, and that began yet another leg of my journey. 

David Cowan: After four years of growing Health Allies, which was now a workforce of 25 people, Andy was faced with a decision that many entrepreneurs come up against to sell or not to sell.

United Health Group was, and still is one of the largest health insurance companies in the us And Andy was given two options in 2003 when it came to potentially selling his company to them. 

Andy Slavitt: We, we had a partnership with United, we had a partnership with AIG and they had access to millions and millions of members.

And those are members that at one point they said, we’d love to do a deal with you and get your access to all our members. And then they came to us one day and said, well, we have two choices. Um, as we’ve thought about it, we’ll either buy you, you can have access to these members, or we will crush you and you’ll have access to none of these members.

David Cowan: It felt like a classic David versus Goliath story. Andy thought long and hard, but as we heard earlier, he ultimately sold his company to United Health Group. 

Steve Kraus: United Health Group. For those who don’t know the company well, is. Extraordinarily well run, especially during the time that you were there, and frankly is an important part of the American healthcare ecosystem, it and its peers.

Yet at the same time, Andy, I, I’m always struck by how bad of a reputation, you know, health insurance companies have. Right. And so I’m just curious, how did you reconcile selling to the big bad insurance company and, and, and then what were the most formative aspects of that experience? Cause I, I think it was pretty formative 

Andy Slavitt: in your career.

Without a doubt. It was interesting because to use your expression, it was a bit of a do-gooder company. Hmm. We were helping people with who were uninsured and underinsured and the fact that, as you say, the big bad corporate insurance company wanted to buy us and serve people who were uninsured and underinsured was interesting to me and I thought reflected something about their strategy, which was actually cover all bases, be very aggressive moving to new markets.

Now, the reason United has a flawed reputation, Is because as good as United is for its shareholders, you’d much rather be a shareholder than you would a customer or an employee unless you’re an employee shareholder. And I think all companies sort of tend to favor one or the other. 

Steve Kraus: As a leader of such a large scale organization, do you think you have to make that explicit choice between stakeholders in order to be 

 Andy Slavitt: successful?

I think if you don’t make it explicitly, it happens implicitly based upon your culture. Everybody talks about how customers are super important, but you have to see what, what are the actions that essentially comes down to, what do you talk about in the boardroom? 

David Cowan: Andy climbed the corporate ladder at United Health Group for a decade.

Eventually serving as the group executive Vice President for Optum, a subsidiary of United Health Group. He was in this position when President Obama’s administration launched healthcare.gov on October 1st, 2013. It was an historic moment. For the first time, there’d be a website where people could go to shop for insurance coverage through the Affordable Care Act, but the United States of America suffered the worst nightmare.

Of every startup when this website crashed just two hours after launch, and it didn’t help that the government shut down that same day due to a lack of funding, and that shutdown lasted for 16 days. 

Andy Slavitt: This was a threatening moment, not just to Obama, but I think to our future, being able to solve big problems as a country.

I think if this failed as it started, we would’ve lost confidence. I think Congress would’ve been loath to find anything significant again. In particular in healthcare, but I called them, they didn’t call me and asked if they needed help. And you know, when you make a call like that picture, what do you expect?

You expect it to be ignored. You expect that they’re going to, you know, if even if you get through to somebody, they’re gonna say, you know, thanks, appreciate it. No, thanks. I think I called on a Tuesday and on Friday they announced that we were gonna lead the turnaround. And at the end of the press conference, the new chief of staff announced that it would be fixed within five weeks.

And. I, we literally had no information, hadn’t seen the site. You know, one of the things I learned was that no one else called, and I don’t think I, I don’t think I was the great choice. I think I was the only choice. How bad was it, Andy? It was bad 

David Cowan: coming up. What’s already bad gets even worse. And Andy’s thrown into a crash course in crisis Management 1 0 1 and trying to salvage the rollout of healthcare.gov.

Although as he tries to fix one problem, other cracks start to show themselves in the American healthcare system. Stay tuned.

When America’s new Health Insurance Exchange website crashed, Andy had a feeling it was less of a technology problem and more of a management and organization problem. And remember, he only had five weeks to solve 

Andy Slavitt: it. It was only after a couple weeks that I realized what a favor we’d been done by saying five weeks.

Because what that did was it eliminated all of the smart. Genius ideas. You just, cuz you didn’t have time for any of that stuff. All you had time for was hard work. You know, this is where Todd Park and I became very, very close. Todd is the founder of a company called Devoted Health. You know, we called ourselves, he was the CTO and I was the c e o of the effort to turn it around.

And it was bad in every possible way, but the biggest initial problem was that nobody would talk to each other. Everybody was pointing fingers. Nobody would do any work. And when I called this the CEO of Verizon, which was the company that had the ran the hardware network, he said basically, we’re not, I’m not worried about us because the software won’t work.

And when I called the people who built the software, they said, we don’t even need to bother fixing this because hardware can’t hold it up. Hmm. And so everybody’s pointing fingers and they were both right. The hardware collapsed. The software had 6,000 bugs in it. I think only one in 20 people could get through the website.

And I just basically had the job of saying, how do we fix it and fix it fast? Cuz I knew that if we could do it, it would be really a rallying cry that we could do hard things. Did you get done in five weeks? We did. We did because we had no choice. And not long afterwards, we had millions and millions of people insured.

We had the website fixed. It was crazy, stressful, traumatic experience, and a lot of it involved, a lot of stuff that we learn over. Time and some of the stuff we learned in kindergarten, which is get people to work on teams together, get people to play the right way, build the right culture, and bring tons of resources.

And those first three weeks, it was not getting any better. It was only, I remember those last two weeks that it, that it finally started to click. Wow. 

Steve Kraus: That’s 

Andy Slavitt: amazing. Thank you. Yeah, look and look, 15 million people have coverage from the A exchanges. Now they 10 million through Medicaid expansion, which is part of the law.

Of course, there’s other elements of the law that you and I know well, which are some of the reforms around how healthcare’s paid for, and that’s created a whole entrepreneurial wave. So yeah, you can look at it a lot of ways, but I tell you like the real high you get is. Thinking about all the people who you get to listen into the conversations they have in the call center who’ve never had insurance in their life, who now have some amount of safety and security, and that’s, that’s a good feeling.

Steve Kraus: So you obviously, after the healthcare.gov served as the Acting Administrator Center for Medicare and Medicaid Services. Any similarities between your leadership as entrepreneur to, you know, to serving and, and, and running an organization that big? Because I know, you know, obviously, A lot of successful entrepreneurs, you know, wanna go on in public service, maybe something even in politics.

 I’m just curious, are there any, any parallels that you took from the, from the experiences? 

Andy Slavitt: Oh yeah. I mean, all the people in that job before me had been policy people or political people. I was not a policy person, but you know, running an organization doesn’t feel. A whole lot different in the main. In fact, if anything, in a government agency, they’re not as aligned towards their goals and their plans.

They really are just sort of serving the public and dealing with what Congress hands them and implementing laws. But you know, not with a lot of strategic purpose. I’ll give you one example. One of the things that I believed, and I think I know you believe as well, Steve, was that we needed to really invest more in primary care.

And prevention. So we didn’t spend so much money in hospitalizations and specialty care. It’s one of those things in healthcare where we look backwards from other countries in the world who invest a lot in primary care and people are generally healthier. And so, you know, I said to my team, this is one of my goals, and they said, well, how do you wanna do it?

And I said, I don’t care how we do it. You tell me how we should do it, which is not a way they typically work in government. And I said, come to me with options. Hmm. And they wrote an options paper for me, and we ended up changing a bunch of things that’s resulted over the last few years in about 15 billion moving from specialty care into primary ed care and mental healthcare.

I include mental healthcare when I talk about primary care. And a lot of the way the healthcare system operates now seven, eight years later. You could trace back to some of those things we did back then when we were pursuing that goal. And I’m sure there’s plenty of people listening to this podcast who have served in government, but there are probably a lot more that if maybe thought from time to time that they might want to.

And I would really, really encourage that because first of all, you just have so much to add. Whatever perspective and angle you have as an angle they probably don’t have in the government. Yeah. You gotta go in and be a good listener and see how they do things. You can’t go in and be the I’m the private sector guy who’s gonna fix you that.

We, we saw that experiment with the last president. It doesn’t always work, but it also just enrich your life. I mean, I will say, you know, I’ve, I’ve gotten way more out of service than I’ve contributed. It’s an incredible feeling. Andy learned 

David Cowan: soon enough that working for the government where power often shifts from one party to the other was a tricky business.

In 2017, the Republican party under a new administration became keen on repealing the Affordable Care Act. That incredible feeling Andy had carried with him for helping to save healthcare.gov was giving way to a sense of dread. 

Andy Slavitt: Among all of the things, the repeal part of the story was in some ways the most fascinating because as soon as Donald Trump won for president, he said, we’re gonna repeal the aca.

Paul Ryan said, we’re gonna repeal the aca. Mitch McConnell said, we’re gonna repeal the aca. And as I was leaving, I called different CEOs and different folks and I called one governor who said, Andy, I appreciate all your efforts, but it’s over. It’s gonna be repealed and all that work’s gonna be for nothing.

And I said to him, that’s wrong. And he said, what do you mean that’s wrong? I said, that’s wrong, because they don’t have a plan and because we’re not gonna let it happen. And I didn’t know what I meant by we’re not gonna let it happen. But when I left a group of us who were a lot of former Obama folks, basically dedicated a year plus to our life, you know, there was an article in the Wall Street Journal about us, we were called the Shadow Cabinet, the Resistance, and we would meet two to three times a week by phone.

And we each kind of had different responsibilities. My responsibility was really as the most vocal. Voice against repeal. And one of the things that I did was when the house voted to repeal the ACA just before the summer break, and they went back home for recess, and I noticed that only 10 of the Republicans were having town halls with their communities.

So I sent out a a tweet and. The tweet said, Hey, at least go talk to people. And if you don’t, then I may come to your district and have a town hall for you and I’ll do my own explanation. And of course if I come, you’re welcome to attend and we can have a little friendly debate or I’ll see the floor to you, but if you don’t do this, I’m gonna come have a town hall.

And that, that Steve was literally based on 30, 45 minutes worth of thinking went into that. And, you know, a couple months later, you know, I’ve, I’ve been in 16 communities around the country. I met with 40,000 Americans face-to-face, hearing their healthcare stories, finding healthcare, the fear of losing it, what mattered to them.

And I learned something about the power of grassroots organizing and how that could work in Washington. And that sort of changed me in a, in a really profound way. But ultimately, You know, it, people may remember John McCain’s final vote, but we did a lot of work up until that vote, including many calls with McCain and the staff and the governor that day, including rallying millions and millions of people.

And that was, that was quite a big event. And, and of course, town Hall Ventures got, gets its name. From that activity because I found the, the meeting space where public sector, private sector come together and talk about their challenges and solve problems to be, I think, a good vision for what this country needs to get back to 

David Cowan: in 2018.

Not long after that, fight over the ACA a’s repeal. Andy left the world a public service to form his own investment firm. Town Hall Ventures, the companies he’s funded provide a range of services from outpatient treatment for substance abuse disorders. To home delivered meals, but Andy couldn’t escape public service forever because a little something called Covid 19 was about to uproot life as we knew it at first.

It was just something that Andy and his peers were talking about among themselves. 

Andy Slavitt: And then the next thing you knew, I was getting calls from the mayor of New York City and the governors, and I decided I needed to see what the Trump administration was doing about it. I connected in with people in the Trump administration and the message I basically heard was, this is not a thing the president’s gonna talk about.

And in fact, when the c d started to talk about it, they pushed them back and said, you know, this is not the message. So, of 

David Cowan: course Andy, being Andy, couldn’t just sit there and do nothing. 

Andy Slavitt: So I took it upon myself to write a, a note to all the governors and mayors in the country. This was kind of in February telling them.

This is what’s gonna happen. You probably need to staff up, you, you probably need to put a plan in place. This is gonna hit your state. And, and then spent a lot of time both working with the Trump administration from the outside, working with a lot of the governors and mayors, working on communication efforts on initiatives to halt the spread, relaunch the biggest communication effort called the hashtag stay home campaign, which was seen by a hundred million people.

Yeah. That we literally launched out of my living room. And you know, all of these were things that. Government should be doing. We were tracking down ventilators, we were buying masks, we were getting ’em to, to different places. And you’re, you’re doing this 

Steve Kraus: as a private citizen X public official. 

Andy Slavitt: Yeah, exactly.

Just doing what I was in the position to be able to do, to help, like I think a lot of people, for a while there, everybody was sort of working on the same team and everybody was on the same page. People were ringing bells out of their windows in New York and making masks, and there was a feeling of people were scared, but people were feeling like they needed to pull together.

And I was hopeful that that would last. It didn’t last, but I was hopeful that it would and, and then I started the podcast and when there was not a lot of information out there, I was one of people who was trying to explain what was going on, or at least what I saw. You were 

Steve Kraus: obviously one of the people that the Biden administration were gonna call to ask to help when he took office, but.

You’re doing so and had to make that decision a much more politicized environment. I’m curious, was it obvious to you you were gonna do this or were there real concerns when you took the job? 

Andy Slavitt: Well, Steve, as you know, I have a couple of partners. We have investors. So you have obligations that you take really seriously.

And when we had gone and raised our most recent fund, Kind of the principal diligence question at the time was, is Slavit gonna go serve in the administration? Right? And I said, 100% no. And then of course my wife and I just became empty nesters, moved to California, bought a house, and we were settling in and I thought I was off the hook.

And I got a call after the election saying, Hey, what are you thinking about? Are you thinking about coming back? Would you consider coming back? And I said, still, no. And they said, well, what if it was just an 18 month gig? And I said, all your gigs are 18 months, so that’s not giving me anything. And then right around Christmas I got called again.

I. And they said, Hey, we, we’d really like you to consider coming into the administration. And I said, I said I can’t three times, so, but I’m worried now that you’ve asked me three times that this must be a total effing mess. And they said it’s a disaster. There’s no transition going on with the administration.

And we don’t know how many vaccines are being produced. The vaccines are being produced. There’s no tracking system to get them into people’s arms. We get thousands of people dying every day and we need you. Now I knew at the time I was far from the only person who could do what they needed me to do, but I was a known quantity.

People knew that I know government and how government works and knew that I knew how the private sector works. So there was a, a package of things I. That made them able to go a lot quicker if they brought me in. So I thought about it and my wife wasn’t happy about it. I wasn’t happy about it. I talked to my partners and you know, one of them was pretty unhappy about it, but I thought about it some more and was able to negotiate a situation where I could come back for a very limited period of time.

Andy was 

David Cowan: offered the role of a special government employee, a status that limited his service to 130 days. Andy was assigned a very specific task, help get people 

Andy Slavitt: vaccinated, and it was a very straightforward mission, which I liked. So eventually I called all of our investors and said, Hey, this is a situation.

Any one of you can veto this. But everyone encouraged me to do it. They said the country, if it, it’s hard to put ourselves back in that mindframe, Steve, but this was like a P point in time when nothing in the. Country could move forward because we were losing so many people and N nobody could get vaccinated.

And people said, yeah, if you can really fix this and you can really help, you should go do this.

Steve Kraus: Crises are something that you’re able to lead through. What is it about you or your upbringing or that allows you to do that? Cuz you clearly mastered that skill? 

Andy Slavitt: Well, I think you get confidence in. Oh look, I looked at, I’ve learned a ton from everybody that I’ve worked for and worked with over time and you get confidence.

I think that you can accomplish hard things once you start doing it. I’ve now been involved in several crises to to fix, and the nice thing about crisis, the easy thing about a crisis is you can get anything you want and call the c e O of Hewlett Packard and get the best equipment I can call the c e O of Walgreens and say, I need you to distribute vaccines more quickly in stores.

I can call anybody I want. And with the power of that, And you can get a lot done. So there’s a certain operational freedom you have in those climates, but it’s, you know, part of it is crazy, Steve, part of it is awful. And part of it’s really fun because these are some of the most visible operational projects in the world.

And at the end of each day, I had to go in front of the press and report on our progress. 

Steve Kraus: Not only do you like a good crisis, Andy Slava, but you like a good timeline too, about five weeks, you know, 

 Andy Slavitt: 140 days. It helps, I mean, particularly for someone like me who, as I said, doesn’t love risk, you know, you mitigate your risk.

You’re like, I’m gonna get this done in the best possible shape. And you know, anybody can. You can do almost anything for a limited time period too. So your mentality changes because you can run hard and look, I mean, and there’s people who serve overseas in the military in Afghanistan. That’s real service.

That’s real dangerous service for putting their life on the line. The time period is unlimited. The things they come back with if they do come back are traumatic and can last a lifetime. And I was facing none of that. I was trying to basically help something that I would in a way that I was capable of adding some value.

How do you tell your kids? You said no to that when you’re asked to help. I don’t wanna pretend like it’s a tire burden. I mean, you feel very privileged to be working on a big problem and you know, working with world leaders and all those kinds of things that you have to do in those kinds of situations.

So I decided to do it. And you know, just basically lived in an apartment a block from the White House and for four months straight, did literally nothing but work on this. One 

Steve Kraus: of the things I love most about our jobs is, you know, you get to look at lots of different leaders and I always just love to try to learn what’s their best quality.

And so you’ve had the great privilege to work with Obama and Biden, and I’m curious what’s their superpower as a 

Andy Slavitt: leader? Each one of those, Obama and Biden are, are different characters. Yeah. They’ve got. Different strengths. You know, president Obama’s a gifted speaker and an incredibly disciplined, thoughtful person who, you know, inspires you because he’s got tremendous values and is a good listener.

And I think his strengths are pushing in in that regard. That’s not the right answer for every situation. You know, Biden is quite a bit different. Biden is still very much a blue collar guy. He’s still a. We can work it out guy, someone who is deeply rooted with his senate, friends with his family, and is very passionate, committed to working people unions and really believes that he understands the country and what people go through and how people struggle in a very real way.

Yeah. Interesting.

Steve Kraus: All right, so Andy, wanna have our guests get to know you a little bit more personally, so I have some rapid fire questions for you if you’re willing to take a shot. These are, are you ready? I’ll take a shot. All right. What are you reading or what are you watching? Currently 

Andy Slavitt: reading a book on the development of the wine growing regions in France.

And why am I reading it? Because it’s a total escape. 

Steve Kraus: What’s your favorite place that isn’t your home or your work? 

Andy Slavitt: I’m just gonna say Park City, Utah. You a skier? Ooh, a little bit, but it’s a place where I’m around good friends. Um, I could name many more spectacular places, but being around good friends is a great opportunity.

Great privilege. If you could have a 

Steve Kraus: stage walkout song, what would it be? 

Andy Slavitt: Something by Van Morris in the Dead or Bruce. Ah. And pick any song you 

 Steve Kraus: got me with Bruce. I’m a huge Bruce fan. What, uh, what skill that you don’t have, would you love to learn? 

]Andy Slavitt: So I’m the least handy person in the world. My wife has to like, I mean, she’s super handy.

Same with me and, and like I feel totally helpless and hopeless. Right, 

Steve Kraus: right. What do you wish you could do more of in your 

 Andy Slavitt: life? Spend more time with our boys. Mm-hmm. They’re 25 and 21 now they live in New York, we live in California. So anytime we could sort of figure out how to get them both together, just sounding just to watch young people grow up into adults and, you know, watch them start to move into their own lives.

 So finally, 


Steve Kraus: you know, on, on the podcast, wish I Knew, we end each episode with a parting thought for our listeners as they embark on their own personal and professional journeys. And so I’ll ask you, This question, what do you wish you knew in your career, either before it all began or as it was unfolding?


Andy Slavitt: I wish I knew how, how much the opportunity for leadership would be there if he just worked hard and were a good person. And read the room a little bit. I mean, whatever leadership means to you, whether it’s at a national level, whether it’s within a company, whether it’s in your community. But I think when you’re a younger person, you see the people who are sort of at the head of the room who are a little bit older and you think.

How am I ever gonna get there? It feels very mysterious when you’re younger. So wherever you are in your career, your life, if you think you’re really early, you can start now. I mean, you really can. And it’s amazing, amazing to watch some of these younger people who are. Really, really inspiring and I’m sure you’ve got work with a number of, within your firm or in your portfolios.


Yeah. That’s part of our job. It is. It’s really great. And working with you, Steve, 

Steve Kraus: even though I’m an old man now, I used to be young when he knew me first. 

Andy Slavitt: Yeah. But you know what? Our job is to help each other, you know mean I’m very new to this as you know, but they’re people like you who instantly, when I came into it, helped me from the start.

And that’s always been the thing if, if Steve could help me. He doesn’t, he would. And if I could help Steve, I would. And you got that in your, much more powerful, it doesn’t have to be a cutthroat business all the time, but there are probably elements of it that have to be to some degree. But there are elements that should never be.

And you know, I thank you for that. And I think I wouldn’t be here out of severe if we didn’t have our friends and people supporting us. Feeling 

 Steve Kraus: is a hundred percent mutual, my friend. I always leave a conversation with you. Having learned something and, and being inspired and so on behalf of so many people in the nation, thank you for all you’ve done.

Thanks for joining us on Wish I Knew, and uh, we’ll be seeing you soon I’m sure. 

David Cowan: See you to Bruce Coast.

That’s it for today’s episode of Wish I Knew. You can find and follow the show on Apple, Spotify, Amazon Music, or anywhere you listen to podcasts or at bvp.com/wish I knew. An extra special thank you to Andy Slavitt for joining us on today’s episode. Wish I Knew was a podcast by Bessemer Venture Partners.

The show is created by our very own Karen Lee and Christine DERs. I’m your host, David Cowan. Our show is produced by the team at Philia Media. Our lead producer is Molly Getman. Our executive producer producers Kate Walsh. Were engineered by Evan Viola. Our theme music is by Terry Devine King at Audio 

Additional Music by Blue dot Sessions. And remember the nice thing about leading during a crisis. It’s your opportunity to get anything you want. We’ll see you on our next episode.

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