The author, who has worked as an executive in the PR department of the insurance industry describes his full awakening as to how unscrupulous his industry is. He notes that PR people create “perceptions without any public disclosure of who is doing the persuading or for what purpose.” He shows us how the insurance companies confuse their customers and dump the sick in an effort to please Wall Street investors. One side effect of this PR is that it then becomes talking points for politicians and others. They can simply repeat the often misleading, intentionally provocative talking points. There are, in fact, large trade groups, such as the America’s Health Insurance Plans (AHIP) who lobby for insurance company issues. The author demonstrates this when discussing the film Sicko, which was about the health insurance industry. This event mobilized top executives from the country’s biggest health insurers to develop a multipronged strategy to discredit Moore and his movie. Catch phrases were popular, such as “government takeover,” which were used to discredit any healthcare reform efforts. Another interesting concept is “crisis management,” which is the “organized, orchestrated communications response to a negative event,” that is, an event negative to the insurance industry. Fearmongering also works well to convince people to actually take positions contrary to their own best interests. Purging is the way many small businesses across the country stopped offering coverage to their employees; exorbitant rates simply made it unprofitable to continue to offer employees health insurance. All it takes is one illness or accident for the insurance company to “hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether – leaving workers uninsured.”
One event that opened the author’s eyes was something called Remote Area Medical (RAM), which provides healthcare to impoverished people around the world. Imagine when it became obvious that much of their service was needed right here in the U.S. Another reason for the author leaving was something nefarious called policy rescission. In this case, a way is found, such as finding something trivial in the insured’s application, to retroactively cancel the insurance of a policyholder who racked up large medical bills. A congressional investigation into this practice found that three insurers had canceled nearly twenty thousand polices over a five-year period. Of course, this was before the Affordable Care Act.
We are then treated to a history of healthcare, its reforms and failures. We see how going back even to the late 19th century, no president was able to overcome organized opposition to reform until Lyndon Johnson’s creation of Medicare and Medicaid. Even then there was much opposition. At the time, Reagan called Medicare “socialism,” and argued that it was a “foot in the door” to a totalitarian takeover. Later we got The Affordable Care Act in 2010. We witnessed four previous failures to implement a national healthcare program: during Franklin Roosevelt’s New Deal era, under President Harry Truman, in the 70’s (think Watergate ending a presidency), and lastly the Clinton healthcare debacle. They were all done in by America’s free-market health care system. Behind a lot of the push back over the decades has been the American Medical Association. During Truman’s time, they referred to public health care as “socialized medicine” and an extension of communistic control of the world. Really, I’m not kidding. Later on, in the 60s, the for-profit insurance companies then only agreed to Medicare because the aging population’s health care was affecting their bottom line. By 1992, when Bill Clinton was elected, the for-profit insurance companies “had consolidated their control over the health care system even more successfully than the AMA.” In time, consumer-driven plans were the only option for many Americans regardless of their age, health status, or income. Managed-care plans would see a death spiral as the consumer-driven plans cherry-picked the youngest and healthiest customers. In time, as more people were forced into the consumer-driven plans, the deductibles and out of pocket expenses were aggressively increased. This created the illusion that insurance companies were keeping the cost of coverage affordable, but they were really playing a shell game. The bottom line: don’t get sick; you can’t afford it.
After the Clinton failure to pass health care reform, the insurance companies diverted attention to satisfying Wall Street investors by limiting spending on health care. How? The author tells us, “Rescinding individual policies, purging small-business customers, denying claims, cheating doctors, pushing new mothers and breast cancer patients out of the hospital prematurely, and shifting cost to consumers…” Not only that, but since 1996, health insurers have been involved in over four hundred corporate merges resulting in a near collapse of competitive and dynamic health insurance markets. Bigger size made it easier to rig the system. As health insurance premiums went up, from 2000 to 2008, the ten largest insures paid their CEOs a total of $670 million. Compare this income to of the administrator of the Center for Medicare and Medicaid Services of $176,000 per year. Greed ran deep. From 2000 to 2008, the author notes, “insurers raised family premiums 2.5 times faster than the rate of medical inflation, 3.3 times faster than that of wages, and 4.6 times faster than that of general inflation. Wall Street financial imperatives trumped the needs of millions of Americans. After the 2008 recession, the insurance companies made record profits! How: by covering 2.7 million fewer Americans in private health plans in 2009 verses 2008.
In the chapter “An End too Soon,” the author discussed the heartbreaking case of a young girl battling cancer and in need of a liver transplant, which was denied by the insurance company. It’s a sad story, but demonstrates what length insurance companies will go to in order to save money. Another chapter delves into the Affordable Care Act. Here again we see the insurance company PR going to great lengths to create spin. For example, allies of the insurance companies began sending e-mails to millions of people with false claims about the contents of the pending bills, and predictably the polls showed that people actually bought into the manufactured imagery. The author then talks about how companies deal with negative information about their products. A classic example is the tobacco industry. These industries have a playbook to follow. It involves promoting “junk science,” social engineering, conferences, books, media events, newspaper articles, video new releases. All the while the industry keeps secret the fact that they are behind the information campaign. Another example involving big oil is the BP rig explosion in the gulf. There’s also big soda and big banks, all pulling from the cigarette maker’s playbook. It goes like this, “Distract people from the real problem; generate fear; split communities with rhetoric, pitting one group against another; encourage people to doubt scientific conclusions; question whether there is really a problem; and say one thing in public while working secretly to do the opposite.”
Nevertheless, the author has confidence that one day we will have “one of the finest and most equitable health care systems in the world,” and that all big corporations will ultimately become more socially responsible. Why does he think this way? It is because people will demand it. It can’t come too soon.
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