Most of our readers will have heard the story of the turtle and the scorpion:
Being a poor swimmer, a scorpion asks a turtle to carry him across the river on the turtle’s back.
“Are you out of your freakin’ mind?” the turtle says. “You’ll sting me the first chance you get. Everyone knows that that’s how scorpions are.”
“Oh come on”, replied the scorpion, “I wouldn’t do that. If I were to sting you we’d both drown. That would be foolish.”
Convinced by this logic, the turtle lets the scorpion climb on his back and proceeds to ferry him across the river. Just when they reached the middle, the scorpion stings the turtle and they both begin to sink.
“For crying out loud!”, wailed the turtle, “why the heck did you do that? Now we’re both going to drown.”
“”I’m sorry,” the scorpion said. “You see I couldn’t help it. It’s my nature.”
This story came to mind when reading a recent post by the inimitable Dr. Roy Poses, who typically writes about the role of money and corruption in healthcare on the Health Care Renewal blog. In his post, Dr. Poses calls our attention to the story of one Wendell Potter, a former head of public relations for Cigna – one of the largest private health insurers in the United States. In the midst of the negotiations that led to ObamaCare, Mr. Potter apparently had a change of heart and became a critic of the tactics used by private health insurers. In November of 2010 he published a book called Deadly Spin:An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.
I’ve not yet read Deadly Spin, but Dr. Poses’ post describes a number of typically offensive and despicable techniques that private health insurers typically use to manipulate public opinion and plead innocence while abusing both their customers and the public trust. These include making promises that they have no intention of keeping, using misinformation to discredit some of the factual assertions made in Michael Moore’s movie Sicko, and sending a “spy” to the funeral of a 17 year-old girl who had died because Cigna refused to pay for her liver transplant. However by far the most interesting aspect of the post is the completely integral role that the health insurance industry played in crafting the ObamaCare law and helping to sell it to the general public.
It seems that “large chunks” of the law were actually written by insurance company lobbyists behind the scenes, and they met with President Obama and members of administration many times while doing so. Insurance lobbyists were integral to including the mandate that individuals purchase private insurance policies or face a government-imposed fine. (That would be the mandate that a Federal judge in Florida recently decided was unconstitutional.) The notorious lobbying group America’s Health Insurance Plans (AHIP) also managed to kill the so-called “public option”, and launched a fake “grass roots” campaign to sow fear about various aspects of the bill that it did not like by using a front organization called Health Care America.
Of course, none of this will be news to readers of Dr. Rich’s Covert Rationing Blog, which has always contended that health insurers were largely behind much of the ObamaCare initiative all along. However it is sad that the cynical Dr. Rich had to be so right about it. It can only be to egg people like him on that one of the major justifications that President Obama and his Democratic colleagues now frequently uses to argue against repeal of the clearly mis-named “Patient Protection and Affordable Care Act” is that doing so would hand control of American healthcare back to the insurance companies. As they’ve done here:
“In one of the most animated speeches of two days of debate, Rep. George Miller, D-Calif., said repeal would return power to insurance companies. ‘Has anybody, any family in America, any single mother, any spouse, any child, any grandparent met a more bureaucratic system than the American health insurance system? There is no more bureaucratic system.'”
“WASHINGTON—Republican repeal of President Barack Obama’s health care overhaul law would take away personal freedoms and put power back in the hands of insurance companies, the administration’s top health official said Tuesday.”
The irony, in case anyone could miss it, is that insurers and their political allies have not only been in charge of much of the “reform” process all along, but still are. This is hardly surprising when we remind ourselves that the interests of the government and the interests of private insurers really aren’t that far apart. After all, the government itself is the biggest health insurer of them all. Anyone who doubts that the interests of private insurers and the interests of our various state and federal governments as insurers are in close alignment need only look to the words of Wendell Potter for some uncomfortable confirmation:
As Wendell Potter and Dr. Poses point out (intentionally or unintentionally), the rhetoric used by private insurance companies is virtually identical to that used by government regulators, the folks in Medicare and the Department of Health and Human Services and other officials. From Dr. Poses’ post:
“‘Potter shows then-Cigna chairman Edward Hanway’s leading role in “a multi-milllion-dollar public relations and advertising campaign” in the run-up to the 2008 presidential election, designed to ‘divert the public’s and the media’s attention’ away from the central fact of millions of uninsured and underinsured sick people, toward other problems that were harder to blame on insurers: aging Americans, extravagant doctors, expensive technology, and consumers demanding costly operations they don’t need.’
Note that the usual dogma one sees in the medical and health care research/ policy literature about the causes of US health care’s excess costs, declining access and poor quality are just as listed above: an aging population, high doctors’ fees and excessive utilization, technology that appears to be ever costlier (unlike technology everywhere but health care), and patients’ unreasonable demands.”
Alert readers will recognize some of this language from my last post on “pay-for-performance”, in which President Obama himself railed against doctors because they dared to remove tonsils in exchange for – God forbid – money. But on any given day of the week one is more than likely to find more than enough examples of what Mr. Potter is talking about coming from government and insurance company sources alike. And one addition worth adding is all of the time and effort that insurers and government representatives spend in re-directing the public’s attention toward “quality”, even though only 11% of Americans believe that improving quality and reducing errors is the most important problem we have in healthcare. Consider this exchange when HHS Secretary Kathleen Sebelius and former Senator Tom Daschle were specifically asked “how do we contain raising healthcare costs”:
“Kathleen Sebelius answers:
For too long, Americans have been at the mercy of insurance companies who, using faulty assumptions and loopholes, have gamed the system at the expense of middle class families—hiking up premiums to unfair and unsustainable levels and dropping health care coverage when people are most in need.
But with the passage of the Affordable Care Act, the balance of power is shifting back to the American people.
The new law contains the broadest package of health care cost-cutting measures in American history: investing in prevention; reimbursing providers based on the quality, not quantity, of care they provide; and setting new rules that hold insurers accountable…
The new law also encourages hospitals and providers to find new ways to provide higher quality care and avoid unnecessary hospital readmissions. Through Accountable Care Organizations that take responsibility for the cost and quality of the care received by patients, national pilot programs that bundle payments for the full course of a patient’s care and other innovative initiatives, the Affordable Care Act will help improve quality and reduce cost for patients…
Senator Thomas Daschle answers:
…Fourth, we need to stop unnecessary care, which may account for $700 billion of all care provided in the United States. Defensive, proprietary (is it a business or practice?) and market-driven medicine (those drug ads), along with fraud and abuse, account for much of the unnecessary care.
Finally, we must have far better management of chronic illness. There is too much inefficiency in the health care marketplace today. Accountable Care Organizations can contribute greatly to an improved system…”
Or take a look at this “U.S. Health Care Costs” background brief from the Kaiser Family Foundation. It reads as if it was taking dictation from Mr. Potter’s comments.
Clearly the political and appointed Leaders who are guiding America’s healthcare policies have far more in common with insurance companies executives than they do dividing them. They all think like insurers because they all are health insurers. The only difference is profit status (for-profit or non-profit), and the source of the premiums (tax dollars as opposed to premiums paid directly by businesses and individuals). This has some very important implications for you and your family. None of our policy makers are ever going to think like healthcare providers, not only because they’re not healthcare providers, but because they don’t have the same financial or social interests as your doctor. Basically your doctor is interested in two things: making a living and dealing with you and your health on an individual basis. Insurers and governments don’t deal with individuals, they deal with masses. It’s their nature.
And don’t even bother imagining that governments or insurers are ever going to think like patients. (This is in spite of all of those folksy stories they like to tell about Mrs. Smith who was denied insurance after she contracted leprosy while being treated for cancer caused by making apple pie.) For one thing patients consume resources – a great inconvenience when the need to balance the budget precludes building that new bridge to nowhere in the home district. And for another, they don’t have anything in common with you and your family when it comes to healthcare coverage. Their insurer can never drop them, no matter how sick they get. They can never be denied coverage, will never be uninsured for as long as they have their job, will always have access to the best facilities and probably pay little or nothing for their coverage. But most importantly, most of them have never been really sick. It’s extremely difficult for people who have always been well to relate to or understand the problems and frustrations faced by people who are sick and treated in the U.S. healthcare system. They’ve never done the paperwork. They’ve never dealt with having to keep track of prescriptions split between local and distant mail-order pharmacies. They’ve never been denied the referral or the pre-authorization. They don’t see all of the fancy and complicated healthcare information technology or ill-conceived “quality” initiatives as barriers to care. It’s their nature.
In a nutshell, this is why no insurance agency – public or private – can possibly be expected to work in the interest of patients and providers without being pushed, prodded and watched like a hawk at every turn. Of course they’ll make promises they have no intention of keeping. Of course they’ll try to stiff providers and deny coverage at every opportunity. Of course they’ll require mountains of paperwork and ask everyone to jump through hoops just in order to receive the most basic care – it’s just another sly way of rationing the benefits. Of course they’ll distract with farcical programs that claim to insist on “quality” while utilizing mandatory guidelines that fit only a fraction of the population. They can’t help it.
Yup. It’s their nature.