Friday, August 28, 2009

Mr. Potter's Lullaby

After reading Nick Kristof’s column in the New York Times yesterday (available here), I was moved to investigate his chosen subject, former insurance industry executive Wendell Potter. After a quick Google search, I found an interview of Mr. Potter conducted by Bill Moyers that I thought might be good viewing. So last night, my wife and I sat down after getting our daughter to bed and began an evening of emotional distress.

The video (from PBS’s Bill Moyers’ Journal) with Potter (available here) was, to say the least, unsettling. In it, Mr. Potter describes how the largest insurance agencies in the country deplore competition and have worked tirelessly over the years not only to consolidate their hold on the market by buying up smaller companies, but to convince the public that any insurance not offered and provided through them is a wrong headed and un-American idea.

He talks specifically about the insurer’s aggressive pursuit of profits and the lengths to which they go to maintain them. Two such practices described were the canceling of policies as soon as holders are diagnosed with conditions that are expensive to treat, and increasing premiums on smaller business whose employees file expensive or too frequent claims so that the small business is priced out and forced to cancel coverage.

He describes the industry organization, Americas Health Insurance Plans (AHIP), and their concerted efforts in the early 1990’s to control the messages and talking points that most Americans would see and hear on the news or TV commercials. He is blatant in his descriptions of pressure being applied and bribes offered to legislators by the industry and their lobbyists. The goal was to direct the conversation away from fact and towards ideological lines, thus obfuscating any real attempt at conversations about reform. Quite simply, they wanted things to stay just as they were and they used every way possible to portray anyone who suggested reform as a danger to our society.

Potter’s description of the AHIP’s response to Michael Moore’s film, “Sicko” in 2007 is nothing short of astonishing. The coordination and logistics utilized to try and cut off debate about health care reform and blunt the impact of Mr. Moore’s film illustrate just how desperate the industry is to remain in control of health care in this country. Their companies are at stake, as well as the fortunes of the executives who run them, and they fight as though they have everything to lose – because they do.

The information gleaned from the video was not surprising. Neither my wife nor I were shocked to hear that Cigna and other insurers don’t want competition and that they are willing to lie and manipulate the message through media to maintain the status quo. What was surprising, and disturbing to watch, was this man – who has worked in the industry for decades and helped design the PR responses to such threats to their crystal towers – sit there and explain why he now decides to come forward and let the rest of America know just what he has been doing for the past 15-20 years. He claims he was moved when he attended a health fair in Virginia at which thousands of people sought care because they had no insurance and no access to affordable care because of it.

His descriptions of what he saw and how it moved him only served to infuriate me. He had never seen people suffer and go without because they had no ability to pay for care. It had never dawned on him that people who were removed from his company’s roles would be left with no way to pay for care they needed. He had lived in that ivory tower and had never bothered to look down and see what was under him. I was nauseous as he described flying on the Cigna corporate jet, eating a meal on a gold rimmed plate with gold plated utensils while his company worked diligently at not paying for the care of policy holders who had dutifully paid in their premiums.

I don’t know what to make of all of this yet. I’m still too unsure and unconvinced of this man’s motives to be sure he’s telling us all that we need to know. I don’t doubt anything he said, but I suspect that there’s much more and worse that we should have heard.

One thing is very clear though - the insurers have attempted to make their own actions invisible as much as possible. They have levied accusations of rationing and denying care against an as yet unexisting government run insurance plan, yet they themselves conduct these practices. It’s like Fox News accusing another network of bias while denying their own.

The former administration taught us all that if you accuse your opponent of something you yourself are doing, they spend lots of time and effort trying to disprove a negative and you are free to do whatever you want. Advocates of universal health have been defending the idea from almost everyone; meanwhile Cigna and its brethren are hiking rates and dropping expensive policy holders.

It’s enough to make me sick.

Friday, August 21, 2009

Getting Closer

Health care reform, so we are being told, is being debated hotly all across the country. From town hall meetings to lunch rooms everywhere, people are arguing (sometimes forcefully) about how to remake the health care system better and reduce costs while still having a viable system. We have heard everything, from the arguments that “Obama Care” will kill grandma, to those that say anyone in the U.S., even illegals should get whatever they need for care.

I have been arguing for reform for a long time. Many of my friends and coworkers in the health care field disagreed for many years about what things should look like in any reform of the system. One friend in particular and I used to spar over what each of us thought should be included, and what the likelihood was that anything would ever really change.

My friend Mike is an ER physician. His career has involved taking care of people with life-threatening injuries, conditions and traumas as well as those with nothing more than a hang nail they feel needs to be evaluated. While he would be the first to tell you he has not seen it all, he has actually seen most of it and the rest is really just more of the same. His opinions, however, are not always based on his professional experience. They are often based on his ideological slant. He is a financial conservative who abhors large government spending and waste. Thus, for years he has argued against any government run single payer system due to his fear of spiraling cost and added bureaucracy that would stand in between his patients and himself. His biggest argument to me was often that the population would never accept any system that made patients more responsible for their own outcomes and limited care to reasonable levels.

We have been going back and forth on this for years. But last week, all that changed. When I started to talk to him about the proposals being considered in the House of Representatives, he became frustrated. He had actually tried reading the bill online and after more than 300 of the 1017 pages, he turned to me and said, “You know, you and I could fix this whole thing in about 10 pages and have a better system than the mess this is going to create.” He is right, of course. He looked at me and then told me that the only way to really do this and do it right would be to cover the basics for all citizens (preventative care, office visits, necessary tests and hospitalizations, medications, etc.), figure out how much that will cost, and then tax something everyone needs or uses so that no one escapes paying in something to keep the system solvent. Then the legal reforms would need to be put in place to protect providers from unreasonable lawsuits.

It was simple. It was brilliant. It would work. It was exactly what I had been saying to him for several years. The difference now, is that he believes the public will go for it. I don’t know what really changed his mind, but he has become convinced that not only is it possible, but now the above plan is the only real option.

I smiled and told him he was starting to sound like a Democrat. Not because he was really, but because it made him mad. That’s the kind of friend I am. Then I sat back and thought, “Hell, if the two of us have come to consensus, the debate is really not all that hard”. If a staunch fiscal conservative and a borderline socialist can agree on how to fix this mess, we need to hold the policy makers accountable – or go after their jobs.

So here’s your warning politicians – get your act together and get it done or else you won’t be getting emails and letters from people like me, you’ll be getting challenged for your coveted positions. Now shut up and get back to work.