For Profit Insurance
"We Shouldn't Fear Government Involvement in Our Health Care System"
Published July 12, 2009 @ 04:22PM PT
This is my second post on Wendell Potter’s interview on Bill Moyers Journal. You can read the first part, or you can go straight to PBS.org to watch the whole program online.
Wendell Potter was a top-ranked executive at Cigna when the insurance industry began to bat down the outrage produced by Michael Moore’s Sicko. That playbook of how they pressured Congress to take no action whatsoever in the face of Moore’s documentary should be very familiar to those watching the political dance going on in Washington. Focus on the minority of “disaster” stories from those in England in Canada, even if those stories don’t represent the average experience. Use your lobbying power to influence Democrats, especially centrist Democrats. Threaten political reprisal. Mock those who are advocating reform as being out-of-touch – a neat trick coming from executives who, as Potter mentions in the previous clip, flew in corporate jets and ate lunch with gold-plated silverware.
All of this was to obfuscate the central truth of Moore’s message – a truth that threatened the industry’s profits. As defined by Potter, that truth is “That we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie.”
It’s a shame that the clip cuts off where it does, as Potter goes on to make an eloquent case that if we don’t reform health care, it will change all the same – just in a direction that none of us want:
You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.
And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don't want the government to take away your choice of a health plan. It's more likely that your employer and your insurer is going to switch you from a plan that you're in now to one that you don't want. You might be in the plan you like now.
But chances are, pretty soon, you're going to be enrolled in one of these high deductible plans in which you're going to find that much more of the cost is being shifted to you than you ever imagined.
"What Country Is This?" - Potter on Bill Moyers
Published July 12, 2009 @ 12:07PM PT
I’ve written about Wendell Potter, the former executive at Cigna and Humana whose Congressional testimony helped pull away the curtain on how private, for-profit insurance companies look at themselves – as entities more beholden to shareholders than their customers. On Friday night, he was the guest on Bill Moyers Journal. PBS.org has the whole program online, but they’ve also released clips like the one below on YouTube. If you don’t have time to watch the whole thing – which I highly recommend – these bite-size chunks are must-see.
You often hear people who know very little on the topic proclaim that people come from across the world to receive health care in the United States. That may be – but it’s just as typical these days for Americans to become “medical tourists” to other countries because of cost. Far more typical, and sometimes far more shocking, are free clinics for those who are uninsured and have nowhere else to go. They tend to be in rural areas and are typified by the “health care expedition” or makeshift clinic near where Potter grew up. The experience of seeing the clinic first hand (and taking pictures) helped change his mind on how beneficent the industry he worked for truly was. It’s hard to fly in corporate jets and eat lunch with gold-plated silverware when you’ve seen how your company’s obsession with lowering their “medical losses” – the term used by the industry when they have to actually pay for care – is affecting real people.
Watch the first of these clips below:
Health Inaction Networks
Published July 11, 2009 @ 03:03PM PT
More from the front lines of for-profit insurance’s ongoing propaganda war…
They’ve got pleasing colors and always make sure to spotlight smiling doctors or “regular folks.” They sport enthusiastic phrases like, “Building Better Health Care” and “Let’s build on health care that is already working… until it works for everyone!” They sport links to Facebook, ways to sign up for updates, and online tools to email your members of Congress. They seem to be incredibly positive about health care.
They’re not.
Beyond the glossy exterior and the “can-do” vibe of the new for-profit insurance “grassroots” health care Web sites, their main objective is transparent: kill the public health competitor. I wrote about Wellpoint, which operates in California as Anthem Blue, where it was the only insurer who spent millions of dollars to advertise against the California push for universal coverage. They’ve been telemarketing their members to push them against the public plan for months, all while they unapologetically refused to discontinue the profitable practice of rescissions, whereby the insurance plans of paying customers who have been diagnosed with expensive illnesses are canceled. Now they’re up with a new Web site for the WellPoint Action Network, “a broad coalition of people from around the country who are working together to help make health care work better for all Americans.” Note, in case you were confused – if you have corporate sponsorship and branding on your site, it’s probably not “grassroots.” But the whole point of the site is not health care reform – it’s about opposing the creation of “a government-run health plan.”
You’re not going to find a lick of any other policy on the site. The action, in this case, is about creating inaction in Congress.
I wrote about the site Get Health Reform Right, a similar “grassroots” attempt by private insurance to advocate for getting health reform “right” – “right” in this case means “with no public health insurance option to keep us honest.” We’re running a campaign right now where you can email both their “Tell Your Story” line and, more importantly, to your member of Congress – to tell the one that you believe we SHOULD get health reform right, and to tell the other that letting private insurance protect their profits over people is not getting it right.
We’ve got their attention. I was forwarded an email talking about, well, us:
FYI - Our coalition consumer website Get Health Reform Right has been seen by one of the opposition blogs and they are sending the site emails disagreeing with us ... its been a handful of emails, but we suspect it will continue and will probably been seen other places over the next few days.
Below I've posted the Blog from which it is emanating.
On the positive side, recruitments on our side have continued to grow with over nearly 100,000 no government-run program letters sent in the past week.
We'll obviously monitor closely and let you know if any additional activity occurs.
It’s signed by the Executive Vice President of the Association of Health Insurance Advisors. I appreciate the capital B on Blog (even as I’m not certain how you can have “over nearly 100,000” letters.) But you have it from the horse’s mouth – this is all about a policy of “no government-run program”s.
And they’re pretending to be you to make the point.
Who's In the News Today?
Published July 06, 2009 @ 07:27PM PT
It's the calm before the storm. With the July 4 recess over, Congress will once again be taking up comprehensive health care in both chambers. There are a lot of balls still up in the air with regards to timing, and even more for policy. The House bill is still more or less on track for a full vote by the end of July, but the Senate bill may be pushed back to August 7 or later. Given the likely difficulty in reconciling a progressive Senate Health, Education, Labor and Pensions bill with a "bipartisan" Senate Finance bill, I wouldn't write that date in pen.
So before we return to our regularly scheduled debates about affordability, circus-like amendment process, and largely-ignored speeches from the House floor about rationing, socialism, and other Frank Luntz greatest hits, here's a quick roundup of who managed to make news over the holiday weekend:
1.) Chuck Schumer will not be denied
Say this for the senior Senator from New York - once he owns an issue, he's not letting go. Months ago, Schumer was designated the point man on getting the public health insurance option into the Senate Finance Committee bill. Since then, he has blasted away at how non-competitive insurance companies are during a committee hearing, make himself the go-to guy for negative quotes about the "trigger", joined Sherrod Brown of Ohio and the president as the most frequent public defenders of the public plan, and even seemed to begin to wear down Kent "Co-Op" Conrad's resistance to the idea.
He raised quite a few eyebrows on "Face the Nation" on Sunday when he boldly declared, "Make no mistake about it, the president is for this strongly. There will be a public option in the final bill." But he made the calculus behind his thinking even more clear in an interview with the Huffington Post that could basically be summarized as, "Democrats have 60 votes - what the hell are we waiting for?" (His actual quote was, "If you did a consensus within the Democratic Party, you would find the level-playing-field public option to be the answer. And now that we have 60 votes, it seems to me like we don't have to turn it inside out for something we don't like.")
Spoken like a man who, as head of the DSCC for the last two cycles, knows what he's talking about.
2.) Wendell Potter will not be silent
Potter is the former Cigna and Humana executive who two weeks ago delivered dramatic testimony pulling back the curtain on the business practices of the for-profit insurance industry. It's hard to forget his description of health insurance as "a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it."
AHIP and others in the industry may have hoped that would be the last they'd hear from him. No chance. Potter is now a blogger with the Center for Media and Democracy, and he's already hard at work "call[ing] out misleading statements and statistics, outright lies and illogical assertions by opponents of meaningful health care reform-and to rat out the front groups that insurers and other special interests are funding to kill reform or, failing that, shape it to their benefit."
You can bet I just added him to my "must read" list.
3.) The revolving door for lobbyists is alive and well, and working on health care
A frightening graphic in the Washington Post today details just how frequently the Congressional bodies who are now working on reform legislation are being lobbied by people who use to work for them. As the caption reads, "at least 50 former employees of the Senate Finance Committee or its members now lobby on behalf of the health-care industry, in many cases for more than one client." The graphic tells a tale all by itself, particularly for Max Baucus and Chuck Grassley, who are now being lobbied by their former chief of staff and former health policy advisors, who represent many, many, many clients among Big Pharma, Big Insurance and hospitals or nursing homes:
We all knew that the forces of the status quo were well-funded, well-researched, and well-connected. But I don't think any of us quite realized that in addition to their money, their influence and their access, they had one advantage that those of us at the grassroots just don't have: the buddies of those who are calling the shots.
(Photo credit: Atomische on Flickr.)
CBO-KAY! Senate HELP Bill Rebounds
Published July 01, 2009 @ 10:35PM PT
Republicans have made hay for the past few weeks on how Ted Kennedy’s bill cost too much ($1 trillion dollars) and covered too few (only an additional 16 million). Of course, that score was on a partial bill, one that the Congressional Budget Office itself claimed “[does] not represent a formal or complete cost estimate for the draft legislation” (italics theirs.) It also lacked the details on the individual mandate, the employer “pay or play” mandate, and the public health insurance option. But Kennedy and Chris Dodd have kept at it, undeterred from the catcalls, and have finally delivered the goods. According to Jon Cohn on The Treatment, the new, full bill is in.
The results? A price tag of $600 billion over ten years (chew on that, Senate Finance Committee!) and coverage for an estimated 97% of the uninsured.
Imagine that – you actually include shared responsibility in an individual mandate and an employer mandate, new revenue, a robust public option competing on cost and generous expansions of public coverage through Medicaid, and the damn thing works.
First of all, this kills the sticker shock stories, at least for a few days. Second, it restores the notion that you can have health care reform without some version of pay or play or the public plan, but it’s cheaper to include them, no matter how politically problematic. Third, it shows the Senate Finance Committee’s reaction to the initial incomplete estimate was, to be blunt, wrong. They immediately began to cut subsidies and then cut them some more. But if I’m reading this correctly, the HELP bill hasn’t cut any subsidies – they’re still funded on a sliding scale at up to 400% of the Federal Poverty Line. The cost of the bill is down anyway. This is also good news for the House draft bill’s ultimate score, since the two bills have much in common.
The most intriguing news of all: according to Jon’s analysis, this CBO score doesn’t take into account any of the Obama Administration’s proposals for cost-savings in Medicare or new revenue – meaning we already have concrete proposals on the table from the White House to pay for nearly the whole thing, presuming that Medicaid expansion (which for jurisdiction reasons cannot be in this bill) costs an additional $400-$600 billion.
I’ll post a link to the full bill as soon as someone uploads it (updated -- see below). From my perusal and first reaction, these revisions make the bill somewhat less generous than the first released “principles” document (which is looking more and more like it was a trial balloon). The subsidies up to 500% of poverty are out, as is the public plan that would force providers to participate if they accepted Medicare and charge them 110% Medicare rates. But for all that, this is a strong bill which covers most of the bases of the common blueprint that most of the 2008 presidential candidates laid out.
Private Insurance Begins Its Propaganda War
Published June 30, 2009 @ 09:41PM PT
As if it wasn’t bad enough that private, for-profit insurance routinely makes its money by getting between us and our doctor, now they want to get between us and real health care reform. They’ve put a Web site to advocate for keeping things exactly as they are, thank you very much, and they're not afraid to cherry-pick facts like they cherry-pick customers. The propaganda war has begun.
We’ve known that this day must come. Yes, we’ve heard Karen Ignagni, CEO of America’s Health Insurance Plans, tell President Obama that “we understand we need to earn a seat at the table” on health care reform. But few of us thought it would last. We heard her at a Senate Finance Committee hearing talk about how the insurance industry needed more regulation, and even claim that with additional regulation, our reform plan wouldn’t need the public health insurance option, designed to compete with private insurance and “keep it honest.” It seemed rational. We knew that couldn’t last, either. After all, there was too much money in it for them.
Today, an email went out from a new Web site, GetHealthReformRight.org, warning in spooky terms that because of the current House bill, “Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.” It urges, “Congress should build on the current employer-sponsored healthcare system that is already working for more than 160 million Americans.” Presumably this means Congress should not follow the will of 72% of the American people and 50% of Republicans and create a public competitor to private insurance.
This of course is the same employer-sponsored and profit-drive health care system that one of its former executives admitted to Congress is “a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.”
The Web site in question is beautifully done. If I put together a parody site, it would look a lot like this.
- Picture of doctors and nurses who sort of look nice but also vaguely sinister? Check!
- A “Myths vs. Facts” page that relies on half-truths and exaggeration? Check out this most excellent sentence: “A recent study estimates that up to 119 million people with private coverage would be shifted into the new government plan almost overnight.” If you read this blog, you know a.) this would be people choosing the plan, not shifting into it, b.) the Lewin Group study only says 119 million would shift if the public plan had straight-up Medicare rates, was open to everyone, and forced doctors to participate – three conditions that are in zero of the Congressional proposals on the table, and c.) overnight is a laughable exaggeration. Buddy, ain’t nothing happening overnight, no matter how successful the public plan is. (More myths debunked by Jason Rosenbaum – go check his post out!)
- A “What’s at Stake” page more interested in scaring people than being factual? Try this opening sentence on for size: “If you are one of the over 160 million American workers receiving healthcare from your employer, you should know your coverage may be at risk.” There's a germ of truth here -- but it’s called “You’ve got private insurance, and that’s how they make their profits.”
- A “Media Center” page that cherry-picks press stories on reform? Well, let’s see: articles and editorials in praise of Republicans “plan,” articles suggesting Obama is rushing or misguided, an article on those poor nasty reform advocates beating up on poor Conservatives for Patients Rights mastermind Rick Scott… need I say anymore?
- And the coup de grace – their sponsorship page lists “organizations whose shared mission is to ensure consumers continue to have access to employer-sponsored healthcare plans” – plans that they happen to sell. From America’s Health Insurance Plans to the National Association of Insurance and Financial Advisors, the gang’s all here!
I guess we can stop waiting for the insurance industry to earn that seat at the table...
The Public Plan as Proxy Fight
Published June 29, 2009 @ 11:06PM PT
Today seems to be “Don’t forget, the public health insurance option is not all that important” day. Both Ezra Klein and Jon Cohn wrote posts reminding us that despite its prominence in the debate, health care involves a lot more than a public plan in order to be successful. On a literal level, they’re right – health care is a complicated beast, which is why only a page of Max Baucus' 89-page white paper and only a sentence in Barack Obama’s 25-page campaign plan even mention having a public plan. But the reality is that the fight over the public plan has turned into a proxy war over the fate of health care reform itself. As such, it is not only a fight worth focusing on, but a fight worth winning.
It did not have to be this way. Certainly, there are many places where conservatives and enemies of reform could have drawn a line in the sand. Medicaid and SCHIP eligibility expansion have always triggered exhausting fights between progressives and conservatives whenever they've come up; at the state level, the losers erected complex rules and means testing to suppress eligibility when they could not win the federal legislative fight. But no one is currently batting an eye as Medicaid expansion would be upped to 150% of poverty for all adults, not just the blind, elderly or disabled. Additional regulation of the insurance industry has been fought tooth and nail for decades now. But America’s Health Insurance Plans are willing to give up on pre-existing conditions, some individual rating (generally only the most offensive kinds, like discrimination by gender) and say the right words about wanting to be responsible players. But they’re not giving this up willingly – they'll explicitly give this up only if it kills the public plan. Big Pharma should have no dog in the public plan race at all – certainly, they not only made a killing off of the government-financed and operated Medicare Part D, but they made enough profits to even give up half of the doughnut hole willingly. Pharma will sell drugs no matter what. Yet they too want to see the public plan go down. We could have created subsidies for health insurance premiums to middle- and low-income Americans decades ago, but it was seen as a giveaway and a moral hazard by conservative thinkers. Now, as long as there’s no public plan, the legislators will consider it. The insurance industry has relied for years on "confusing" customers by hiding exclusions or coverage exceptions to give you less coverage than you think you're paying for. At the same time, conservatives in Congress created Medicare Part D, a program that goes to extraordinary lengths to maximize choices in as opaque a fashion as possible, creating an organizational bias against consumers and towards the participating drug plans that rivals the private insurance market. But now they’re both willing to allow a transparent marketplace like a Health Exchange, comparing like to like and putting power into the hands of the consumer -- so long as a public health insurance option isn't in it.
Really?
Either everyone who was naturally inclined to be against reform had a massive change of heart, of they know they’ll never have to make these concessions.
Why are so many so willing to give up so much – unless they knew that dooming the public health insurance option either would yield reform that was incapable of truly changing the game or that the political infighting among Democrats looking for a plan that works and Democrats looking for a bipartisan plan would ultimately sink the effort? In effect, break this link in the chain, and you break the whole chain.
From a pure policy perspective, as Jonathan and Ezra point out, this reasoning is questionable. But the political why should be obvious – the public health insurance option comes the closest to the fictionalized “socialized medicine” that has less terrified the public and more terrified dodgy Democrats for generations now. It has nothing to do with the policy itself which, with its embrace of competition, market share and negotiating clout, reads like the ultimate free market experiment. It has to do with what our limited political debate is always about on health care – whether health care should have government rules set upon it like anything that puts the health, safety, and well being of out citizenry, or whether it should be treated like a commodity, to be traded, individually determined and used to generate private wealth. Despite usually having a better, purer, more comprehensive and sage policy, progressives have historically lost the dogfight.
If there were no public plan, enemies of reform would have to invent it (which, technically, the did under Bill Clinton, who went to great lengths to construct a system that ran entirely through private insurance, only to be tarred as “socialized medicine” all the same.)
But it’s missing the point to walk away from the public plan, as members of the Senator Finance Committee are attempting to do, or to downplay its importance, as Ezra and Jonathan do. At the end of the day, Lindsay Graham, Frank Luntz and John Boehner aren’t really talking about the public health insurance option when they imaginatively inveigh against a “Washington takeover of health care.” They’re talking about whether we have anything in reform that changes the game at all.
(Photo credit: Duo de Hale on Flickr.)
