Originally posted at the Center for Public Integrity on February 2, 2012
Insurance firms
seeking to sow doubt about proposed single-payer system.
MONTPELIER, Vermont --
You can't see them. They're hidden from view and probably always will be. But
the health insurance industry's big guns are in place and pointed directly at
the citizens of Vermont.
Health insurers were
not able to stop the state's drive last year toward a single-payer health care
system, which insurers have spent millions to scare Americans into believing
would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers
last May demonstrated they could not be bought nor intimidated when they became
the first in the nation to pass a bill that will probably establish a
single-payer beachhead in the U.S.
When he signed Act 48
into law on May 27, surrounded by dozens of state residents who worked for many
years to achieve universal coverage, Governor Peter Shumlin expressed great
pride in what had been accomplished.
<blockquote>"We gather here today
to launch the first single payer system in America, to do in Vermont what has
taken too long--to have a health care (system) that is the best in the world,
that treats health care as a right and not a privilege, where health care
follows the individual, not the employer," Shumlin said./<blockquote>
The problem for
Shumlin and his allies is this: it will take five years before Vermont can
fully implement its new system, partly because the federal health care reform
law prohibits states from undertaking more far-reaching reforms until 2017
unless granted waivers from the feds to do so. And though Vermont's
Congressional delegation is on board to pursue a waiver that would let the
state set up a single payer system two years from now, the insurance industry's
friends in Washington are not keen to let that happen. That's because they want
to use those five years to persuade Vermonters that they really don't want to
go the single payer route after all.
During my 20 years as
a health insurance PR executive, I was involved in numerous efforts to make the
very term "single payer" toxic to most Americans. We even spent hundreds of
thousands of premium dollars in 2007 to help finance the operation of a front
group, called Health Care America, for the sole purpose of trashing a movie --
Michael Moore's "Sicko" -- that put single payer systems abroad in a favorable
light. You can rest assured that the industry will spend much, much more to
make sure that Vermont does not succeed.
I have observed in
Vermont over the past several days just how the invisible hand of the insurance
industry is working. Insurers know their efforts will be more effective if they
can get others -- third party advocates, they call them -- to carry out them out.
I recognized the campaign because the tactics are the same as those used in
previous attempts to kill reforms insurers don't like.
Part of the strategy
is to get key groups of individuals to begin raising doubts, to get Vermonters
to second-guess themselves. Among the first groups the insurers have targeted
are those most easily spooked -- certain business owners and physicians,
especially specialists who thrive in the current system.
Last Wednesday,
legislators got a sampling of what they're in for. At a hearing on creation of
the state's health care exchange, or marketplace -- mandated by the federal
reform law -- employers worried about losing the ability to choose from numerous
competing insurers. And they worried too about not being able to shift their
employees into benefit plans with high deductibles. Insurers and employers have
been collaborating for the past several years in a mutually beneficial effort
to shift more of us into high-deductible policies. The higher the deductible,
the less insurers and employers have to pay for our care. This collaboration
has been so successful that increasing numbers of American families filing for
bankruptcy are, at least theoretically, insured.
At a hearing a few
days earlier in Rutland, this one for health care providers, several physicians
were, wittingly or not, using some of the same industry talking points I used
to write for insurers' allies.
Dermatologist Dan
McCauliffe was one of several doctors there who suggested that patients needed
to pay more -- not less -- out of their own pocket for care. Ironically, this
skin doctor joined other physician specialists in arguing that health care
costs would never stabilize until patients had "more skin in the game," a term
my former colleagues used frequently as we tried to spin the "advantages" of
high-deductible plans. According to statistics from the American Medical
Association, dermatologists are among the highest paid specialists, making on
average more than $230,000.
So why do insurers care
so much about Vermont? Even though Vermont is a small state where most
for-profit insurers have little business, the insurers don't want a single
state to go single payer. Just last week, single payer advocates in California
fell just a few votes short of getting a bill to the floor of the Senate for a
vote. If Vermont succeeds, California lawmakers might actually get the votes
they need.
Health insurers make
enormous amounts of money off of us, something they cannot do so effectively in
other countries, especially Canada. The four largest insurers, United,
WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly
$220 billion in revenues last year. For years insurers have been successful in
persuading Americans to believe something that is at best debatable -- that they
play a useful role in the U.S. health care system. They are nervous that if
Vermont proves to the rest of the country that health insurers are about as
useful as teats on a boar, they might have to figure out another way to make a
few billion bucks.