1) Don't remind people about what really killed reform the last time around.
[I]t became really clear to me that the industry is resorting to the same tactics they've used over the years, and particularly back in the early '90s, when they were leading the effort to kill the Clinton plan.
2) Don't talk about what the industry has been up to in the years since.
I was beginning to question what I was doing as the industry shifted from selling primarily managed care plans, to what they refer to as consumer-driven plans. And they're really plans that have very high deductibles, meaning that they're shifting a lot of the cost off health care from employers and insurers, insurance companies, to individuals. And a lot of people can't even afford to make their co-payments when they go get care, as a result of this.3) Don't call attention to the yawning social distance between places like Wise County, Tennessee, and the world occupied by the insurance industry's upper management.
I went home, to visit relatives. And I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued...
It was being held at a Wise County Fairground. I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.
But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.
And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.
It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? I just it just didn't seem to be a possibility that I was in the United States...
Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.
And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.
4) Don't examine the way incentives work at the top of the insurance industry.
[W]hen you're in the executive offices, when you're getting prepared for a call with an analyst, in the financial medium, what you think about are the numbers. You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations. That's what you think about, at that level. And it helps to think that way. That's why you-- that enables you to stay there, if you don't really think that you're talking about and dealing with real human beings.
5) Pay no attention to how the industry wields media and political power to marginalize critics and stiffle criticism.
[F]rom the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned...
The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern....
[P]art of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, "Look, you don't want to believe this movie. You don't want to talk about it. You don't want to endorse it. And if you do, we can make things tough for you."
...By running ads, commercials in your home district when you're running for reelection, not contributing to your campaigns again, or contributing to your competitor.
6) Ignore the revolving door.
The relationships-- an insurance company can hire and does hire many different lobbying firms. And they hire firms that are predominantly Republican and predominantly Democrat. And they do this because they know they need to reach influential members of Congress like Max Baucus. So there are people who used to work for Max Baucus who are in lobbying firms or on the staff of companies like Cigna or the association itself.
7) Keep quiet about the industry's real reasons for opposing a public option.
The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so...
[Private insurers] spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.8) Say nothing about the role of Wall Street in shaping how insurers treat their customers.
[T]here's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.
So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.
I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio...
And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.
9) Don't follow the money.
[A] big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead...
[K]eep in mind, what they want to do is enhance their profits. Enhance shareholder value. That's number one. And the way that the business that they're in is health care, certainly. But their primary motivation is to reward their shareholders.
Most of the shareholders are large, institutional investors and hedge funds. Hedge fund managers are the ones who look at the stock. And investors for large organizations. It's not mom and pop investor.
10) Above all, trust industry players when they say (again) that they want reform too.
[T]hey will continue this charm offensive, until there's actual legislative language. And what that means, of course, is that right now, you're not really seeing the bills before the House and the Senate that will actually be voted on. When we see the actual legislation, when there's something before Congress... you'll start seeing a lot more criticism of it.
And the special interests will be attacking this or that. The AMA will be upset about something. The pharmaceutical industry will be upset about something. The insurance industry will not like this or that. It's, you know, a lot of money is made in this country off sick people. And then you'll start seeing a lot more of the behind-the-scenes attacks on this legislation, in an attempt to kill it. The status quo is what would work best for these industries....
[I]t happened in '93 and '94. And just about every time there has been significant legislation before Congress, the industry has been able to kill it. Yeah, the status quo works for them. They don't like to have any regulation forced on them or laws forced on them. They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not-- you know, they'll not do anything after say this plan fails.
Say nothing happens. They're saying now what they did in '93, '94. "We think preexisting conditions is a bad thing," for example. Let's watch and see if they really take the initiative to do anything constructive. I bet you won't see it. They didn't then....
The strategy is as it was in 1993 and '94, to conduct this charm offensive on the surface. But behind the scenes, to use front groups and third-party advocates and ideological allies. And those on Capitol Hill who are aligned with them, philosophically, to do the dirty work. To demean and scare people about a government-run plan, try to make people not even remember that Medicare, their Medicare program, is a government-run plan that has operated a lot more efficiently.
There we have it--ten valuable lessons on how to lose the debate, from a man whose job was helping to make sure we always will lose it. Next up: How to ignore all the facts that are on your side.
Let's just sum this thus:
ReplyDelete'Don't think, just do as you are told.'
Or...
'I feel your pain.'
Or my favorite on the hubris meter..
'I own it.'