Former medical director of Oregon’s largest insurer has a few choice words for the health insurance industry at large
August 18, 2009 -- I’ve been inside our health industry as the medical director for Oregon’s largest commercial insurer and have seen what happens when big money is involved, and public policy is crucial to future profits.
I can honestly tell you that the resources spent on influencing the public are enormous, and the information is inevitably biased to the interests of its source -- be that an insurance company, a hospital system or a professional association.
When Wendell Potter, who was in charge of corporate communications for CIGNA, appeared on the Bill Moyers’ Journal (PBS, July 10) he quoted Dante to explain his decision to leave the company and speak out: "The hottest places in hell are reserved for those who, in times of moral crisis, maintain neutrality."
When President Obama appeared on national television with representatives from “big PhARMA,” hospitals and health plans, they talked about their “voluntary” agreement to control costs. As the president’s plan unfolded, these special interest groups rapidly backpedaled on what they meant when they agreed to support his reform proposal. They want us to trust them, but they only want legislation without teeth that could really bite.
Wendell Potter told us about the strategy employed by America’s Health Insurance Plans (AHIP), the industry trade group, to make us fear change. They talk about a “government takeover” or “socialized medicine” because they know many people shudder when they hear those words. AHIP’s strategy has been to “highlight horror stories of government-run systems.”
Now the public option in President Obama’s plan is being singled out. Why? Because it poses the biggest threat to the profitability of insurance companies, hospitals and medical practices – as well as pharmaceutical and medical device manufacturers. They’d rather have us spend more money to expand the current system to cover the uninsured without threatening present levels of payment and over-use of products and services.
Millions of dollars are being spent every week by health insurers and others to convince you to fear change, using cherry-picked horror stories about long lines and delayed care in Canada and England to inflame your fears of “socialized medicine.”
France’s healthcare system, which only comprises 6 percent of its GDP, is rated among the best liked in the world by its citizens (not an uncritical lot, as a group), and by Americans who’ve needed care in France. England’s National Health Service has created a successful balance of its people’s health, quality, access and cost.
Recently an online posting captured my own thoughts when a woman wrote, “I’d rather some faceless government bureaucrat ration my care than a faceless bureaucrat at an insurance company.”
Even though I’m among those bureaucrats, I have to agree. If a government official isn’t doing what we feel is right, we can find ways to make our voices heard. Try that with the CEO of a large private insurer. Even your employer can’t hope to have a very meaningful influence on decisions, at a high enough level to matter. The largest employers, with rare exceptions, have a tough time doing that.
Most of the messages from the industry reflect their desire to cast themselves in the best possible light, and to decrease your desire for change—either by making you fear it, or by falsely assuring you it’s really not needed (except for more money to feed what we have). Exceptions, such as the web education effort by Regence, “What does it really cost,” and a few others, are nice to see, but they do more to prove the rule than to give real reason to be reassured.
Money talks in business, and healthcare long ago became a “business,” where good financial performance breeds inertia, and poor performance brings ideas to find more revenue by providing more services—rather than aggressive use of proven strategies to improve quality and thereby reduce overall costs. Money especially talks in the insurance business, and health insurance behaves mostly like insurance in general, cheery advertising notwithstanding.
So, when you see the messages our industry wants you to see -- on TV and the newspapers -- ask yourself what’s behind them – what are their motives?
No one’s going to bring you “socialized medicine” with providers employed by government in our lifetimes --- of that you may be confident—unless we get so broke that it’s the only remaining option in the face of an even more massive lack of access to care.
But unless we create strong public-type options, and have the ability to comparison shop, we won’t be able to turn the tide and slow down the quickening pace of rising healthcare costs.
Tell your representatives in Congress you’re not afraid of a strong “public” option, that you don’t believe good end-of-life care means “euthanasia for the sick,” and that you don’t believe the bunk being put forth by some people in our industry.
And if you haven’t already seen the Bill Moyers’ essay on the influence of industry money in health and other public policy, click here. It’s well worth your while.
Dr. Don Thieman now works for an Oregon nonprofit health plan that serves indigent members.
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