Focus group bromides obscure real intentions.
Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.
That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.
Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.
“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”
Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”
Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”
Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”
And so on: “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”
Translation: “First off, we want you to suspend disbelief for a moment and forget that if health plans really cared a whit about expanding coverage, they would have ended their routine practices of refusing to sell coverage to people with preexisting conditions and charging exorbitant rates years ago. That’s why 50 million Americans are uninsured. As for that premium tax, even though we stand to gain billions every year because of the individual mandate and the subsidies the government will provide to help low-income families pay their premiums, we don’t want to give up a dime of those billions to help the government pay for the expanded coverage we’ve been in favor of for so long. So we’ll have a campaign designed to mislead people into thinking that their premiums will have to increase and that their coverage might somehow have to be disrupted as a result of the tax. We’d love to be able to say that we are so grateful for the billions in new revenue that we will agree not to pass the tax along to our customers. We’d love to say that, we’d even consider doing it — if only our shareholders would let us.”
Wait, there’s more: “Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”
Translation: “We have Democrats as well as Republicans in our pocket. And look how we’ve worked in ‘affordable’ and ‘peace of mind’ into our little statement again. Aren’t we good at this? And we know ‘choice’ and ‘competition’ are two words that test especially well. So well, in fact, that we and our allies named one of the front groups we set up a few months ago, the one we’re using to try to control how the state health insurance exchanges operate, the ‘Choice and Competition Coalition.’ And instead of focusing on how we can — and do — get between you and your doctor whenever we want to, please suspend disbelief once again and just think of us as your doctor’s helper. Doctors don’t know best, silly. We do. So trust us.”
Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.
Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.
Wendell is a Senior Analyst at the Center for Public Integrity where this first appeared on 7/2/2012.
{ 5 comments… read them below or add one }
“Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.
Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.”
WENDELL, I CAN’T WAIT! YOUR INSIDE INFORMATION AS A FORMER INDUSTRY EXECUTIVE IS INVALUABLE. I NEED YOUR PERMISSION TO PRINT TODAY’S BLOG AND HAND OUT TO OUR PATIENTS…AS HANDOUT # 1…WITH MORE TO COME ON THIS SPECIFIC SUBJECT OF TALKING POINTS AND TRANSLATIONS. IT’S LIKE PROPHECY COMING FROM AN INSIDER AND THIS IS WHAT TRANSPARENCY SHOULD BE ALL ABOUT: TAKING A BITE OUT OF THIS GAME OF WORDS!
BY THE WAY, I HAVE TWO OF YOUR AUTOGRAPHED BOOKS IN TWO OF MY TREATMENT ROOMS FOR PATIENTS TO READ. IT’S AMAZING THE QUESTIONS IT GENERATES. I WOULD ALSO LIKE TO RESPECTFULLY SUGGEST YOU BLOG ON THE “TAX” PORTION OF THIS BILL. IT IS NOT WELL UNDERSTOOD AND QUITE FRANKLY, BREAKS MY HEART TO HEAR FROM A PATIENT WITH AN ALREADY DEVASTATING PRE-EXISTING CONDITION HOW HE/SHE DOESN’T LIKE THE BILL “BECAUSE OF THE TAX”. EDUCATION IS KEY. THANKS FOR ALL YOU DO.
Many excellent points, including that insurers could have included many years ago, instead of finding ways to exclude anyone who might actually need health care. It would be like auto insurers excluding anyone who owns a car.
I become distressed when I hear the terms “health care” and “health insurance” used interchangeably. They are entirely different things. What we need is health Care. More and more, having health Insurance doesn’t translate to receiving health Care. Those who have watched their insurance change to include more “cost sharing” are now paying for health insurance policies make receiving health Care cost-prohibitive and nearly useless. For many a move, often sudden, to a health insurance plan with a deductible of several thousand dollars means no health Care, with no corresponding salary adjustment, means the end of quality health Care. Incurring even hundreds of dollars of medical bills is not possible, especially in today’s economy.
Similarly, preventive services, which are admirable, and which we like to think of as early detection and treatment, and life-saving, lose their effectiveness because those of us with huge deductibles (plus coinsurance after that is met!), know that there is no point in getting an early diagnosis when we would not be able to afford the treatment. Oh, wait.. another cost saving/cost sharing feature.
Even an urgent health matter cannot be treated, because now providers all request payment up front. If you do not have the several thousand dollars ($10,000 total deductible + coinsurance for me), they won’t schedule your procedure, it’s that simple.
They don’t even call my health Insurance a plan or policy. It’s just a legal document, a legal agreement.
What bothers me the most about this is not that I ended up with lousy health Insurance coverage, it is the merciless attitude of others who are saying “I have mine – sucks to be you!”.
@Miss,
You make excellent points but the ACA will still give us health insurance not health care.
I support expanded Medicare for all. The ACA is NOT universal health care. The consumer protections are good and necessary. But middle-class individuals getting their health insurance through their employers are still going to be paying high premiums for crappy coverage (high deductibles, high out-out-pocket maxes, etc.). And insurers will still be able to deny our doctor ordered care, disability benefits, etc.
When middle-class individuals realize that the ACA means they are paying more in taxes without getting any better health care coverage or access to care, they will be screaming against this so-called “universal health care” without realizing that Obamacare is not universal health care at all.
The reformers say that the ACA is not perfect but is a first step towards a true national health service. I disagree. The increase in taxes will very likely turn large numbers of people away from the idea of universal health care in the U.S. It could also happen that over time the consumer protections will be stripped while the individual mandate is kept.
Donna Smith of Sicko wrote an excellent piece about this called, “Middle class healthcare reform? Bend over” on May 17, 2009. You can view it at http://www.commondreams.org/view/2009/05-17-0
I agree with the points above. The major positive about the ACA is that it gives states the right to devise their own exchanges or plans, as long as specific criteria are met. This opens the door for individual states to adopt a single payer health care system, which is the only true solution to health care for all. As Wendell indicated above, you can bet that Big In$urance will swoop in and use any means available to stop this from happening.
We must all get involved at the state level, and work aggressively with our governments to implement a single payer health plan, as Vermont has already done. CA, MT, MD, and MN also have vigourous movements to this end. We must act quickly and decisively. The insurance industry will not go quietly, but we must defeat them. I believe that they will still retain a market, but more along the lines of nonessentials, such as plastic surgery and other elective procedures.
I disagree that the ACA is not a good idea. I think it is one small step in the right direction. I hope we take many more steps, and I am for universal healthcare. I’m also employed in insurance administration and I would like to see the end of a for-profit provider of health Care. The insurance industry likes to suggest that we have become lazy and out of touch, and because of that, we don’t negotiate our medical care expenses and we don’t contribute to cost savings or cost containment practices. I disagree. I think the health Insurance companies have no incentives or concerns beyond their own pockets. Profits and stock value is the focus of the health Insurance companies. The health Insurance policies have evolved into simple contracts that don’t even refer to the word “benefit”. They are designed to take in money, and pay out no money.
We’ve reached the point now where having health Insurance doesn’t equate to receiving health Care, so it’s time to throw out for-profit health Insurance.
I am currently considering whether health insurance should be tied to one’s employment at all, after hearing this suggested just the other day. In the same conversation, I heard of doctors who do not take health Insurance of any kind and therefore do not have to employ anyone to do the health Insurance administrative tasks that include pre-authorizations, filing (and sometimes re-filing) claims. Their fee is posted and payment is made at the time of service. The most expensive office visit is $56 for 45 minutes. And you actually do get the full 45 minutes with the physician. My current doctor charges $250 for this type of visit. Wow.
There is nothing horrible or evil about universal health Care on the federal level. It is comparable to Medicare, which, by expanding it to include all, would spread the risk out to a larger group that would include more healthy persons and would work the way group insurance was originally set up to work. And it did work until the profit-makers got greedy and found ways to effectively keep us trapped by limiting affordable health Insurance coverage.