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Transcript: The Rachel Maddow Show, 9/22/21

Guests: Tim Reid, Barbara Lee, Vin Gupta


Largest hospital in Alaska struggles to care for patients as COVID inundates intensive care units. Supporters of Trump`s election fraud claims to seek office to control elections. Interview with California Democratic Congresswoman Barbara Lee.


RACHEL MADDOW, MSNBC HOST: And thanks to you at home for joining us this hour. Happy to have you here.

We are following breaking news out of the great state of Alaska where Alaska`s Republican Governor Mike Dunleavy has just announced that Alaska has now become the second state in the country to declare that all its hospitals statewide will now be shifting to crisis standards of care. What that means in English is that hospital care is now being rationed at hospitals in Alaska.

In practical terms, that means that people who are less likely to survive get moved down the priority list in terms of whether or not they get an ICU bed, whether or not they get certain intensive forms of treatment and care. People less likely to survive will not get those resources. They will be moved down the line. Instead, in an effort to save as many human lives as possible, these hospitals now have permission and guidance to prioritize giving treatment to people who are more likely to live.

And that is as bad as it sounds. It means that some people will not be admitted to the hospital, even though they need to be hospitalized. Other people who might previously have been given curative treatment, treatment to cure them and save them instead will just be given comfort care to try to make things easier for them.

And it`s a sort of anodyne phrase, crisis standards of care. But it is a terrible thing, and it is a thing that we really haven`t confronted before as a country. Now we`ve got it in place, though, in one of Montana`s major medical centers. They moved to crisis standards of care this week. We`ve also got it in every hospital in the state in Idaho as of last week, and in every hospital in the state in Alaska as of tonight.

And all of this, of course, is because of the huge influx of very sick COVID patients, swamping and effectively breaking the hospital systems in these states so that they can no longer provide care along the ethical and sort of technical guidelines that they`ve always followed. And it`s not just COVID patients who are going to suffer from this rationing in these hospitals. It means everybody who needs to go to the hospital for any reason has reason to worry.

"The Idaho Statesman" newspaper recently described this "crisis standards of care" system for Idaho as being like the whole state was being put on a DNR. The whole state was being given a do not resuscitate order, whether you wanted one or not.

"The Anchorage Daily News" yesterday described what`s been happening at Alaska`s largest hospital in Anchorage where they actually as an individual hospital started crisis standards of care before the whole state did tonight. "The Anchorage Daily News" reporting, quote, a triage team using a specific formula to prioritize patients most likely to recover has been asked to help with patient care decisions. One decision, there were four patients who required a special kind of dialysis called continuous renal replacement therapy. Four patients required that, but only two of the four could get it. Of the two patients who did not receive the therapy, one of them died. The other one survived but remains hospitalized now in a palliative care setting, in a comfort care setting.

Another decision at the hospital involved deciding which patient got intubated because there were not enough beds in the ICU. Another patient died at a rural Alaska hospital because they needed cardiac catheterization. They were, quote, waiting for a bed to free up so we could transfer them, said the hospital chief of staff. And that patient died.

Providence, Alaska, the hospital that previously set up crisis standards of care. They set up a three-person wellness team at the hospital to help their own doctors and nurses who are struggling with these kinds of decisions, because imagine if you were a doctor or a nurse trained to provide extreme -- going to -- trained to go to the most extreme end of the range possible to save the lives of your patients, and you`re now in a situation where you`re triaging people.

You`re not likely to make it. You`re less likely to make it than these other people, so we`re going treat them, not you. I mean, the psychological effect that that has on doctors and nurses in this circumstance cannot be overstated. And that has been the terrible situation this week already at Alaska`s largest hospital, Providence Alaska in Anchorage. But now, tonight, the state`s governor has announced that all hospitals in the state are moving to those same standards.

And it may not just be Idaho and Alaska. Hospitals in Kentucky, hospitals in Montana and several other states have reported that they are teetering on the brink of the same designation, but this announcement in Alaska tonight is new, and we have never as a country had multiple states rationing care like this simultaneously. We`ve just never had it.


And forgive me for just putting this in personal terms for a second, but people say getting vaccinated or not is a personal decision, as if it only affects you. I hear that a lot, explicitly, particularly on conservative media and from conservative politicians. It`s a personal decision, as if it only affects you.

I hear that a lot, explicitly, particularly on conservative media and from conservative politicians. It`s a personal decision. It only affects you.

Well, these dire circumstances we are now seeing in multiple states, unprecedented crisis standards of care statewide in two states in the country and additional hospitals in other states, rationing of care so that people who would live with normal hospital standards are dying instead, I mean, these circumstances in multiple states now show that your personal decision whether or not to get vaccinated, it has really tangible consequences for a whole lot of other people who aren`t you.

I mean, to put it in blunt terms, the personal decision by someone in Alaska to not get vaccinated right now ultimately results in someone else dying in Anchorage because that person can`t get the dialysis treatment that would save their life and that they would otherwise be able to get if it weren`t for the hospitals being overwhelmed by people who are sick specifically and only because they chose not to get the shot to protect them from COVID.

They keep saying -- you keep hearing it as this mantra on the right. Even from people ought to know better in the conservative media that it`s a personal decision, that it only affects you, that it doesn`t affect people who aren`t vaccinated. Well, tell that to the family of the person who just died in Anchorage because they couldn`t get that form of dialysis they would otherwise be able to get because that hospital is overrun, and the standards is that allowed that death to happen are now in place statewide in every hospital in Alaska and in every hospital in Idaho, and they`re going into effect in other individual hospitals in other states now too.

That is because people are not getting vaccinated. Your decision whether or not to get vaccinated can be a life or death determining factor for somebody else who did get vaccinated, but gets in a car wreck or needs dialysis, or needs a heart catheterization procedure, something that they won`t be able to get because of all the unvaccinated people filling up the hospitals. This is not complicated math, and it is not -- yeah, it may be a personal decision, but it`s a decision that has consequences way beyond your personal corporeal self.

Forgive me. I`m sorry. The situational story in Alaska is a story of national significance and it needs a lot more attention than it`s get, and it should affect all of our thinking about how we are taking care of ourselves and our loved ones when it comes to keeping ourselves from getting COVID.

The government is in the middle of its approval process right now on vaccine booster shots. The FDA just an hour or so ago announced they have approved the use of Pfizer booster shots for people age 65 and up. Also for people with health factors that make them severe risk for COVID, and also for people who have, quote, frequent institutional or occupational exposure to COVID. Again, just within the last hour, the FDA approving booster shots for those groups. We`re going to have the latest on that decision.

We`re also going to talk with a doctor who is both a COVID expert and who is also part of the U.S. military response to try to rescue these overrun hospitals, timely discussion. That`s ahead tonight.

We`re also going to be speaking tonight with one of the members of Congress who was at the White House today in a long series of meetings between President Biden himself and lots of different Democrats from both the House and the Senate, Democrats who need to figure out amongst themselves how they`re going to pass this legislation, which they all supposedly want to pass that includes the bulk of President Biden`s agenda on infrastructure, on climate change, on support for child care and all sorts of things.

All of these Democrats supposedly support all of these items and all of these priorities. They have legislation before them that they can pass that would make these things a reality. It looks like they can pass it even without any Republican support. The question is can the Democrats get out of their own way and do it. President Biden is now personally trying to broker the discussions and the decisions among these different groups of Democrats to get them all to yes.

Progressive members of Congress, the liberals are the ones who frankly are pushing hardest to get it all done. President Biden met with some of them tonight at the White House as well as taking meetings with the conservative Democrats who have really been holding things up.

So it has been an intense day of those negotiations, again, personally involving the president, bringing lots of Democrats from Congress into the White House today. We`re going get a live report in just a moment from one of those members of Congress who has just left those White House discussions. She is one of my all-time favorite people to talk to in all of congress. She is going to be with us in just a few minutes.

The first guest we`re going to speak with tonight, though, is a reporter, a reporter from "Reuters" who has been working a beat that really ought to have been over by now, a beat that should have been a time-limited thing that expired under its own weight.


But apparently, no, we are still living it.

This was the front page story in this morning`s "New York Times." you see there in the upper left-hand corner, the first column there, Trump campaign knew vote case was groundless. Conspiracies debunked. Internal memo rebutted fraud claims against two companies.

That A-1 front page story today in "The New York Times" was based on filings from this lawsuit in Colorado. It`s a defamation lawsuit brought against the Trump campaign and a number of other Trump world figures by a man who worked at one telephone voting machine companies that has been singled out by Trump world conspiracy folks as one of the supposed villains behind their secret satanic, alien, communist Lizard people scheme by which the election was stolen from Donald Trump.

His company and he personally were singled out by the people who advanced this conspiracy theory. That lawsuit is proving to be a bit of a treasure trove. That lawsuit is also the basis for this reporting tonight in "The Washington Post" covering some of the same territory. That internal documents obtained from the Trump campaign by virtue of this lawsuit now show that the campaign knew that these screwball claims about the election supposedly being stolen, all these lurid, ridiculous claims about the voting machine companies, the Trump campaign looked into these things formally and knew they were false while they nevertheless propagated them to the American people and the media and the courts. Quote, the documents which were included in a defamation suit in Colorado brought a former Dominion executive against the Trump campaign and others revealed as early as mid-November 2020, staffers for the Trump campaign formally vetted and disproved key allegations that later fueled efforts to overturn President Biden`s victory.

That memo prepared by Trump campaign staff disproving the stolen campaign election myth, it`s even posted online now in its entirety by "The New York Times". You can see yourself Trump`s own campaign spelled out in detail that all of this stuff about the voting machine companies and Venezuela and Hugo Chavez and the communists and all this other nonsense that they`ve been spewing, they knew it was wrong. They put in print that they knew it was wrong, while Trump and others were freely, repeatedly, and still to this day insistently flogging that nonsense to the press and to the public.

And we will see how that plays out legally in terms of that consequential confirmation case that`s under way in Colorado. But I will tell you, in addition to that -- that news, that -- the news of that internal memo from the Trump campaign way Wisconsin shows that the Trump campaign knew it was false while they were still publicly flogging it, we have also learned that for the same lawsuit, for the same case, there have been depositions taken under oath from a whole bunch of the people directly involved in propagating the fake story about the supposedly stolen election from the very beginning, depositions from people like Rudy Giuliani, but also lots of other figures who were involved in concocting this conspiracy theory in the first place.

Those depositions are part of this case. The transcripts of those sworn depositions are technically part of the public record. Why don`t we know what`s in them yet? It`s kind of a logistical bug. The Colorado court system does not make documents like that easy to get, even when they are technically available to the public as part of a publicly filed lawsuit.

I will tell you right now, we are going to get those depositions. We are going to get those documents eventually, as will other news organizations, and you will see when that happens the benefit of that to the country when that happens is that thanks to this lawsuit, we are going to get way more visibility than we have ever had before into who created this myth in the first place and how.

The creation of this falsehood, which should have collapsed in on itself by now, but which actually is still growing, which has more sway over Republican voters and Republican politics today than it did just months ago, we`re to be get thanks to this lawsuit the inside story of who did it and how they made up this scam conspiracy theory about the election being stolen. The scam conspiracy theory that increasingly has Republican voters and Republican politicians in its grip.

And that visibility into the origins of the myth, the creation of the conspiracy, it`s coming just in time. Because the so-called audit of the presidential election results from Arizona organized by Republicans in the Arizona legislature, the results of the Arizona Cyber Ninjas audit are going to be released on Friday.


The audit organizers have just announced the roster for their roll-out of their audit results on Friday afternoon, including remarks to be made by the Cyber Ninjas guy, this Florida man who somehow got plucked by Arizona Republicans out of obscurity from among the ranks of random QAnon promoters online. He got plucked out of obscurity by them to be put in charge of doing whatever it is they just did to millions of actual ballots that were cast in the 2020 election in Arizona and all the voting machines and equipment used to cast and tally the vote there.

He is going to be there explaining his findings, as will randomly one of the other speakers announcing the audit results is a guy who claims he invented email. Okay. He`s going to talk to -- what is he doing there? I don`t know. He is one of the speakers.

But as ridiculous as it is, this whole mishegoss about the legislation and there being grounds to be suspicious of the election results, we need to change all the rules around voting to make sure that this can never happen again because it was stolen and Trump really should be present, this whole mishegoss as stupid as it is, is going to go nuclear the day after tomorrow. It is going to go nuclear for these folks when they say in Arizona, whatever it is they`re going to say about bamboo fibers and UV lights and anomalies and alien fingerprints and secret COVID cures they discovered that you can make at home out of flaming hot cheetos and mothballs. Or whatever it is they say, it is going to set this stuff on fire on the Trumpist right and in the Republican Party and among the conservative base the day after tomorrow.

And this all should have collapsed in on itself by now because it is all created out of whole cloth. But instead it really is still coming to a head for Republicans and for conservative media.

And to that end, importantly, "Reuters" today has an investigative report into how this myth, this fantasy as ridiculous as it is going to shape who actually gets to run the real next elections in our swing states, who gets to administer the elections, who gets to count the vote, who gets to decide if there is a meaningful dispute about the vote that ought to be adjudicated by, hmm, maybe themselves.

Here is the report today, quote, "Reuters" special report: Backers of Trump`s false fraud claims seek to control next elections. Quote, Reuters interviewed 9 of the 15 declared candidates for secretary of state in five battleground states -- Arizona, Georgia, Wisconsin, Michigan, and Nevada and reviewed public statements by all of those candidates, 10 of the 15 candidates have either declared outright that the 2020 election was stolen from Donald Trump or they have called for their state`s results to be invalidated or further investigated, 10 of the 15.

Only two of the candidates interviewed by "Reuters" said outright that Joe Biden won the election.

The team at "Reuters" goes on to show how huge amounts of money are pouring into these secretary of state races in battleground states. Secretary of state races usually do not get this kind of attention. But this year for some reason, these secretary of state races, which again, these are the people who run elections a the state level, they have somehow become the top priority elections for the Republican Party and specifically for Donald Trump`s political operation.

So how does that play out in a state like Arizona where Republicans there are now just two days away from proclaiming that the presidential election was all wrong and definitely stolen and really it looks to them like Trump should have won?

Well, here is "Reuters" today. Quote, in Arizona Democratic Secretary of State Katie Hobbs is running for governor, leaving her secretary of state seat open in an open race. She won by a single percentage point in 2018. Both parties expect another extremely close race for secretary of state next year.

Trump last week endorsed Mark Finchem for Arizona secretary of state, praising his, quote, powerful stance on the massive voter fraud. The state lawmakers now seen as a favorite in the Republican primary for the secretary of state`s race. Quote, in addition to promoting voter fraud claims and calling for Arizona to decertify Biden`s win, Finchem has also expressed views linked to the QAnon conspiracy theory which casts Trump as a savior figure and elite Democrats as a cabal of Satan-worshipping pedophiles and cannibals.

Finchem was a featured speaker at the rally in Washington before the capitol attack, a warm-up for the bigger gathering at which Trump himself spoke. He said at that gathering, quote, when you steal something, that`s not really a win. That`s a fraud.

One of Finchem`s competitors for the nomination for secretary of state in Arizona is a state representative named Shawnna Bolick. She has proposed a law that would empower the Republican legislature to overrule the straight secretary of state certification of popular state results in the state of Arizona. The Republican-controlled legislature could overrule the certification of who won the election and just declare who they themselves thought won the election.

"Reuters" somewhat dryly calls this, quote, a drastic change in how America chooses presidents. Yeah, you think? A state votes for the Republican candidate for president but Democrats control the state legislature and so Democrats who control the state legislature are huh-uh, we`re not counting that. We`re saying the state picked the Democrat, or vice versa.

Republicans control the state legislature, but the state`s voters actually pick the Democratic candidate, the Democratic candidate for president that year. Well, the Republicans in the legislature can say no, no, no, we don`t like, we don`t like who the voters picked. We prefer that the state`s electoral votes go to our guy from our party.

Yeah, that, to put it mildly would be a change in the way we choose presidential candidates in this country.

The whole conspiracy theory about the election being stolen really is just made up. We are getting more and more detailed information about that all the time with more to come. But it is growing and growing and in growing in importance on the right.

On Friday of this week, it really is about to go nuclear, and they meanwhile are using it to literally try to take over the actual administration of real elections by putting in charge of elections Republicans that not only buy into the big lie, at least some of them are pledged basically to concretely do the work to undo election results in the future if those election results don`t go Republicans` way. It is really happening. It is under way.

Joining us now someone of the reporters on that remarkable investigative piece for "Reuters". Tim Reid is a national political correspondent at "Reuters".

Mr. Reid, thank you very much for being with us tonight.

Now I can see that you`re talking to me, but I cannot hear you. Can you do anything to fix that in the control room?

Mr. Reid, it is not your fault. Yes going to take a quick break, sort it out. We`ll be right back with you right after this.

We`ll be right back. Stay with us.



MADDOW: Today right on time, "Reuters" published this remarkable new investigative piece in the form of a special report. Backers of Trump`s false fraud claims seek to control next elections. "Reuters" interviewed 9 of the 15 declared Republican candidates for secretary of state in Arizona, Georgia, Wisconsin, Michigan, Nevada. They reviewed public statements by all of the candidates.

Of those 15 candidates, 10 of them have either declared that the 2020 election was stolen or called for their state`s results to be invalidated or further investigated.

Joining us now is one of the reporters on that remarkable piece for "Reuters". Tim Reed, national political correspondent at "Reuters".

Mr. Reed, I believe we have sorted out our technical gremlins. I hope you`re there and you can hear me.

TIM REID, NATIONAL POLITICAL CORRESPONDENT, REUTERS: I can hear you great. Thanks for having me.

MADDOW: Great. I`m sorry about the earlier hiccup there.

REID: No problem.

MADDOW: Thank you for being here. Thanks for this reporting by you and your colleagues.

Talk to us about what kinds of powers these secretary of state candidates would have if they were successful in their election efforts and how close those powers get to the sorts of doubts that they`re expressing about election results that have already happened in their states.

REID: Right. So generally speaking, the secretary of state in the individual states is the top election official in that state. So they`re in charge of running elections and they`re in charge of how votes are tallied. It`s important also to remember that in a presidential election, it`s basically the totals from each county and each state that are then tallied up and sent to the secretary of state certification.

So if the secretary of state can maybe cast doubt on the vote total in an individual county or the entire state vote total, they have potentially an enormous amount of power to delay the certification of an election results or even potentially overturn that result.

MADDOW: Given those powers, it seems like it would be not just disqualifying, it would be a scandal in normal terms for somebody competing for one of those jobs to say that they do not believe in the integrity of their state`s electoral process. They believe that previous elections were falsely decided, that they should be investigated or overthrown. The results should be thrown out.

It seems like the sort of thing that would be either you`d want to keep quiet or you would expect to cause a huge furor if you opened up about them. But it seems like in this case with these 15 candidates who you and your colleagues looked at and talked to in many instances, this is in fact the grounds on which they are running for these -- for these jobs. This is essentially the platform they`re taking to the voters.

REID: That is correct. If you look at campaign websites, for example, pretty much every single candidate, their top issue, their number one issue is voter integrity or election integrity.

And actually, it`s not just these candidates for secretary of state. I mean, nearly the entire Republican Party on Capitol Hill are now running or talking about voter fraud or voter integrity. So, it`s an issue that`s really got a firm grip on the party.


Candidates obviously believe that without talking about voter fraud or election integrity, they probably won`t win a primary. And already former President Trump, he`s endorsed three of these secretary of state candidates, which is an extremely rare thing for a former president to be endorsing candidates for secretary of state at the state level.

MADDOW: You and your colleagues also discovered that people tied to the former president are providing considerable funding to some of these candidates who are, again, pledging that previous election results should be overthrown and implicitly thereby by promising they would overthrow future election results if they felt they were similarly compromised.

There is a money story here as well as just an endorsement story, is there not?

REID: Very much so. There are several conservative groups that are involved in either the funding of these secretary of state candidates or the funding of Republicans generally who are espousing the lie that the last election was stolen. And there is already a record amounts of money being raised in some of these secretary of state races.

In Georgia, for example, where Brad Raffensperger, the current secretary of state stood up to president Trump and refused to overturn the election result there, he`s facing an extremely strong challenge from a Georgia congressman named Jody Hice. Hice has already raised about $580,000 to his secretary of state race, an extraordinary sum of money for a secretary of state race.

And already candidates generally in Georgia have raised over a million dollars, which again, is unprecedented amounts of money for a secretary of state race.

MADDOW: And former President Trump heading back to Georgia this weekend to raise more money for that candidate and others alike with the same message.

Tim Reid, national political correspondent at "Reuters", thank you to you and your colleagues for this reporting. It`s really valuable. I appreciate you making time tonight. Thank you.

REID: Thanks for having me.

MADDOW: All right. Much more to come tonight. Stay with us.



MADDOW: Right now, President Biden and Democrats in Congress are dealing with two sort of crises on Capitol Hill, both of which have a real-time crunch to them. The first one is that Republicans are apparently unanimously dead set on forcing the country into a pointless entirely avoidable, entirely self-inflicted financial crisis by refusing to fund the government and refusing to raise the debt ceiling.

Under President Trump, the government added like $8 trillion to the debt. Republicans voted for all of that. But now they won`t vote to raise the debt court of appealing to account for it.

So if we are going to hit the debt ceiling, that`s a real crisis ahead there financially, and possibly a government shutdown alongside it. Again, all of that totally avoidable, but Republicans apparently want that. The other major issue the Democrats have right now is the question of whether they alone without Republicans are going to band together and pass both moving parts of President Biden`s domestic agenda.

That issue was the subject of back-to-back-to-back meetings that President Biden took all day at the White House. The first was with the Democratic leaders in the House ands Senate, Nancy Pelosi and Chuck Schumer. The second was a meeting with Democratic conservatives or moderates, and then the final meeting was with Democratic liberals, progressives, all with the aim of President Biden persuading all of them, persuading everybody to move together, to get everyone to yes, as they say.

"Politico" reports that after the second meeting with the moderates, conservative West Virginia Senator Joe Manchin said President Biden told him, quote, please just work on it. Give me a number and tell me what you can live with and what you can`t.

Congresswoman Pramila Jayapal, chair of the House Progressive Caucus, she was on the show last night. She released a third and final statement that said, quote, I reiterated what I consistently said. Progressives will vote for both bills because we proudly support President Biden`s entire Build Back Better package. But a majority of our caucus, our 96-member caucus will only vote for the small infrastructure bill after the big Build Back Better Act passes.

Desperate to know how all these meetings went.

We have just the person to ask. Joining us now is a member of the progressive caucus who attended the last of the meetings today with President Biden, California Democratic Congresswoman Barbara Lee.

Congresswoman Lee, it`s always a real pleasure to have you here. Thank you for making time.

REP. BARBARA LEE (D-CA): Thank you, Rachel. I`m really happy to be here with you again.

MADDOW: So there is a reflexive thing in the beltway media which is when you have nothing else to write, just write Democrats in disarray and hope that the facts follow. And you can present some -- present whatever is going on in that frame. I usually do not accept that frame, but I am desperate to know how these meetings went at the White House and how you feel things are going in terms of this goal that everybody seems to share about getting these bills passed.

LEE: Sure, Rachel. I don`t think the Democrats are in disarray. First of all, this was a very constructive conversation with the president about the urgent need to deliver for the American people. We have always said we made a deal. There is an agreement that both of these bills will move forward, even though in the smaller bill, for example, in the infrastructure bill there is not everything that I would support or want, but I agreed that I would support that.

We have to have investments in child care, the child tax credit, climate. We have to address the housing crisis, health care.


And, you know, this is so important because so many women, for example, are out of work, and they can`t get back to work if they can`t afford child care. And so I believe the president is showing extraordinary leadership by meeting with all of us and trying to figure out how to get to total unity within our caucus. And I believe that we looked at and talked about where we could reach common ground right now, and there are some areas, and we look to a path forward.

Finally, I do have to say I think we do need a little bit more time, because I believe we can be unified as Democrats and come out with two bills which we agreed upon that would really speak to the aspirations and the needs of the American people.

MADDOW: When you say you need more time, do you believe that the deadlines, or at least the target dates that have been agreed to thus far should be pushed back and might be pushed back?

LEE: I think they should be pushed back, because I believe the longer we have to talk and negotiate, because this is a negotiation, and we have to bring people together and try to find the path forward. And the president is a very fine negotiator.

Our speaker has said very clearly that we have to have both packages. So has Senator Schumer. We just need time I believe to be unified as a caucus to make sure that both of these bills move forward based on the agreement that we made.

This is a transformational moment. This is an inflection point. We have so many needs which have been neglected for decades. And so, we cannot let this go down in any way, shape, or form. This is a transformational moment, as I said, and we have no option but to make sure that both of these bills pass.

MADDOW: Sort of famously, when President Biden was vice president to President Obama, according to both of them, the arrangement that they made when they decided to become a pair, when they decided to become running mates was that Vice President Biden would always be the last man in the room on any important decision. Whatever meetings were taken, whatever discussions would happen, he would be the last person to meet with the president before a decision was made. I note that vice president Biden today chose to meet with the progressives, chose to meet with the liberals last at the end of all those other meetings with the leadership and the moderates and the conservatives.

I wonder if that does give you more insight, gives you any sort of advantage in terms of understanding what sticking points might have arisen earlier in the day or where the president thought the most difficult points were that need needed to be smoothed over?

LEE: Sure. I think that -- and I have to say that the president is listening to a variety of members of the caucus to make sure that he understands everyone`s points of views. But we did learn that there are many areas that we care about all together, unified. For example, we want to make sure that we deliver immediately to the American people, that they can feel and know that we are impacting their lives, that they have money in their pockets, good paying jobs that we`re addressing the climate crisis.

So, the urgency President Biden communicated that that was felt by the moderates and the other members that he`s met with today, and we have this sense of urgency that we have to act right now on behalf of American people. So we have no option. And finger we have just a little bit more time, the Democrats will be unified and come out with two bills that we can pass.

MADDOW: California Democratic Congresswoman Barbara Lee. Congresswoman Lee, it is always a pleasure to have you here. Come back whenever you have stuff to talk to us about. Thanks for helping us understand what happened today at the White House. I appreciate it.

LEE: Thank you very much. Nice being with you again.

MADDOW: All right. Lots more to come tonight. Stay with us.



MADDOW: It`s been a week since the state of Idaho activated what`s called crisis standards of care statewide. It allows any hospital in the state to ration care basically amid the huge influx of COVID patients in Idaho. As I mentioned at the top of the show, tonight we have just learned that another state is activating crisis standards of care statewide. This time it is Alaska. Facilities across that state have been reporting that they`ve been becoming increasingly overwhelmed for some time now. Alaska`s new case rate is now the highest in the country per capita.

And it`s not just Idaho and Alaska. Montana`s largest hospital is also announcing now that it may soon move into crisis standards of care as well, aka rationing. Montana`s Republican governor announced yesterday that he is dispatching National Guard troops to help in six different regions across the state. Tennessee is also requested more National Guard troops to come bolster hospitals all over the state.

Now the governor of Washington state, which actually has a fairly high vaccination rate, Governor Jay Inslee of Washington is also asking for additional federal personnel to come in and bolster Washington hospitals, in part because of wash over in the eastern part of the state from the overwhelmed hospitals in Idaho. People can`t get into Idaho hospitals so they are seeking care in eastern Washington.

These states are -- and others are just drowning in COVID cases, and they`re looking for all the help they can get. Dr. Vin Gupta is a critical care pulmonologist who you have seen before on this show and others on NBC. He is generally based in Washington state.

But tonight, he is going to join us from Ohio where he is on duty with the U.S. Air Force Reserves in his capacity as an ICU doctor for their critical care transport team for air response.

These critical care air transport teams re highly specialized. Essentially, they create a portable intensive care unit for use on airplanes so they can deliver ICU level care at 30,000 feet while transporting critically ill patients from point A to point B. These critical transport teams are an amazing thing that the U.S. military does.


And they were created, what they are meant for is to transfer critically wounded soldiers from places like Bagram in Afghanistan to Germany to U.S. military hospitals elsewhere. And then, of course, on to Walter Reed at home in the United States.

COVID has changed the focus and now those skills and equipment and teams are being used to move critically ill COVID patients around the country.

Earlier today, Dr. Gupta posted this photo of himself and his colleagues in front of one of the military planes being used to transport patients under these circumstances. He said, quote, best job in the world, working with some of the most talented ICU respiratory therapists and nurses in service to our beautiful country.

Joining us now is Major Vin Gupta, critical care pulmonologist, affiliate, assistant professor at the Institute for Health Metrics and Evaluation, a part of the University of Washington.

Dr. Gupta, thank you for taking time to join us tonight, especially in the middle of all you are involved in.

DR. VIN GUPTA, CRITICAL CARE PULMONOLOGIST: Rachel, thank you for the privilege of being here.

MADDOW: Let me ask if I adequately explained what this deployment is like for you, this activation is like for you in terms of your air force reserve service.

GUPTA: You know, Rachel, thank you for highlighting this. A lot of our members in the CTAC community, CTAC critical care transport team, that are active duty, they`re deployed across the world right now and some of us as reservists have been deployed, I`ve been deployed in Arizona for COVID response, we are training up in southern Ohio for the threats that lie ahead, because I think your viewers can see ICU is static, on the ground, complex care.

But now, it`s no longer stationary. We have mobile ICU care for the reasons that you mentioned. COVID has stretched hospitals thin so we`re transiting patients from Alaska down to Seattle, from Boise down to Spokane. That is part of the fact that yes, we have a decentralized health care system but at the end of the day, the most advanced therapies are in some of our biggest health systems across the country and you need to be able to move people.

MADDOW: It is remarkable to think, I mean, I guess there is a lot of precedent for things developed for military use being repurposed for civilian use in times of crisis. That is a lot of the way that national security infrastructure gets built is we imagine some day there will be a civilian use for some of these things. I can`t imagine doing your training for this sort of thing reservist and active duty service members doing training for this type of thing developed literally for wounded soldiers to be brought to U.S. military medical treatment facilities off battle field.

I can`t imagine that anybody involved in this program ever thought it would have to be deployed domestically in any considerable size.

GUPTA: Well, that is why I think it`s great we`re talking about this because millions of dollars of taxpayer money are used to sustain this incredibly agile capability from the Air Force. And a team consists of an ICU doc like me, an ICU nurse, and respiratory therapist. We can manage a ten bed facility in the field or transport a critically ill patient from COVID or injured soldier from down range back to the United States. There is a lot we can do because we have specialized equipment. We can be safe at 30,000 feet.

So expect to hear more about this type of team and this capability moving forward because it has changed.

MADDOW: Let me ask you, Dr. Gupta, about the other news we`ve been following on COVID which is right before we came on the air tonight. The FDA did authorize the use of booster shots for people age 65 and older, people at risk of developing severe COVID, because of other health concerns they have, and for people who have frequent institutional or occupational exposure to COVID. The FDA is going to recommend booster shots for people in all of those circumstances.

Let me ask you what your reaction is to this decision by the FDA. We`ll hear from the CDC on the same matter soon and presumably people will be getting further guidance on the other vaccines besides Pfizer soon thereafter.

What is your reaction to this change in policy?

GUPTA: Well, it dramatically broadened who can access a booster shot in the weeks ahead, Rachel. What I`ll say right now for anybody out there that wants to get a booster shot and already have two doses of the vaccine you have to be either on chemotherapy or on a high dose of a steroid to be considered high risk for COVID or to be a complication.

This has changed. The FDA announcement today has changed the definition of high risk. We don`t know what that is. Could it be the tens of millions of people with diabetes, which is a high risk condition, COPD, lung disease, or heart disease, the leading cause of disability across the country?

All of these are high risk conditions that predispose you, Rachel, to severe outcomes if you are exposed to COVID. Depending on how they define that we could be talking about a broad swath of the country getting access to boosters.


MADDOW: Even as a huge swath of the country remains unvaccinated at all with all the consequences we are seeing for that everywhere.

Major Vin Gupta, critical care pulmonologist, affiliate, assistant professor of the Institute of Health Metrics and Evaluation, part of the University of Washington, thank you for your service in the Air Force Reserve, thanks for being with us tonight, Dr. Gupta.

GUPTA: Thanks for having me.

MADDOW: All right. We`ll be right back. Stay with us.


MADDOW: One last piece of news to share before we go tonight. You know how we were in a really big fight with France and France was really mad at us? That has parentally all better now. The fight is over.

French President Macron agreed today after speaking with President Biden that France will unrecall their ambassador to the U.S. and send the ambassador back to Washington. The fight was over a nuclear submarine deal that the U.S. government made with Australia in which France basically felt like the U.S. had stolen that deal from them. After getting very mad and recalling their ambassador today there was a phone call between President Biden, President Macron. It apparently lasted about a half hour.

At the end of it, the two presidents seemed to have patched things up. The ambassador is coming back. They announced plans the two presidents will meet in person next month. It`s weird, right? President gets on the phone with another world leader and things get better. Temperature drops. Things don`t get worse. Things don`t get insane. It is weird right? I almost forgot how that feels. It`s nice.

That`s going to do it for us tonight. We will see you again tomorrow.


Good evening, Lawrence.