Monday, October 12, 2009

The return of Harry and Louise?

It was only a matter of time, I suppose, before the interest groups that stand to make or lose billions of dollars would come out swinging against the pending health reform bills.

It wasn't supposed to be this way, of course. President Obama reached out early and often to different interest groups to try to keep them at the table, and for the most part, he succeeded in getting the most powerful among them - health insurers, labor unions, physicians, hospitals, and drug manufacturers - to hold their fire. Until now, that is.

With Congress inching toward a consensus on health reform legislation, the health insurance industry decided that now was the time to make its opposition known to the bill being considered by the Senate Finance Committee. America's Health Insurance Plans (AHIP), the successor trade association to the group that funded the "Harry and Louise" ads that helped kill Clinton's health reform plan, today released a report which claims that most Americans will pay thousands of dollars more in health insurance premiums if the Senate bill becomes law. Calling it a "blistering new attack" by the insurance industry, the AHIP-funded study by PricewaterhouseCoopers will provide "ammunition to Republicans attacking the legislation and might intensify the concerns of some Democrats who worry that the bill does not provide enough help to low- and middle-income people to enable them to buy insurance," writes Robert Pear in today's New York Times.

The timing of AHIP's report appears to be designed to undermine and potentially delay approval of the bill tomorrow by the Senate Finance Committee, the last of the congressional committees to complete action on health reform legislation.

Politics aside, is AHIP correct that the Senate Finance Committee bill will raise premiums? Ezra Klein, blogs in the Washington Post that "seriously engaging with its methodology probably gives it more credit than it deserves, making this seem like an argument between two opposing sides as opposed to a predictable industry hit job. But totally ignoring its claims means some of them might live unchallenged." He then proceeds to take apart most of the key assumptions behind the PricewaterhouseCoopers analysis.

I don't think AHIP will be the last stakeholder to try to mount public opposition to key elements in the bills. There is a sense among interest groups that time is running out on them, and if they want to make the bills more to their liking, they will have to go public with their opposition. Some of the grounds for their opposition, I am sure, will have merit and should be considered by Congress in crafting a final bill.

The problem is that we may be approaching a period where powerful interest groups that up until now have been saying "yes . . . but" to health reform will switch to "hell no . . . unless" each of their own particular objections are met, which of course is not possible. This in turn could cause public support to collapse, costing us the best chance in a generation to extend coverage to millions of Americans. Just ask Harry and Louise.

Today's question: What do you think of the insurance industry's decision to release a report, on the eve of the Senate Finance vote, claiming that most of us will see higher premiums if the plan passes?


Jay Larson MD said...

It is not surprising to see that the health care insurance industry is fighting back.

I am not too sure that reform will be profitable for the health care insurance industry. Remember, with reform comes some increased regulation. No more cherry picking.

Bean counters from the health care insurance industry have probably just finished crunching the numbers. Taking on previously denied customers with chronic illness may be more expensive than adding in the premiums from the young and healthy. That means less profits. For these big boys, profit is everything.

Many have said that the health care insurance industry is getting a sweet deal from reform because Max Baucus has received campaign funds from the insurance industry. Based on this recent attack, the health care insurance industry is obviously not getting a sweet deal with reform.

They have also pointed out that Liz Fowler (Max's chief of staff for the Senate Finance Commitee Health care section) has worked at Well Point. A potential conflict of interest. I know Liz. She has spent most of her career in public service or doing health services research, but the two years with WellPoint seems to get all the attention. She wasn’t even a lobbyist for the health care insurance industry.

It will be interesting if the health care industry prostests too much. They may not kill the legislation, but enourage more support for the public option. Time will tell.

Rich Neubauer MD said...

For me, one of the hardest questions in interpreting how the public has responded to the health care reform debate is why so many have fervently, even vehemently, opposed reforms that would actually be in their personal best interest. As a corollary, why the significant benefits that would accrue to the economy and health of the nation as a whole from a systematic overhaul of how we deliver care, seems at times not to be driving the debate quite to the extent that it should.

I can think of two reasons to explain this. First, the power of expertly devised advertising. Second, blind adherence to a “free market ideology” that has proven time and again to work poorly for health care.

To be sure, advertising theory and practice have advanced in leaps and bounds and has become a science of its own. Colors, music, attention to the heart-strings and more. All can be used to manipulate individual and group emotion in proven and even predictable ways. And when you have a lot of money to use these powerful tools, you have a huge advantage in manipulating public opinion. In the case of health care reform, the powerful interests who would like to maintain the status quo have lots of money and also the advantage of this being a very complex set of issues that allows them to twist “factual” information to fit their message. Debunking half-truths and lies merely seems like catch up.

Blind adherence to ideology may be the other reason. A significant segment of our population seems to cling to market solutions in all instances. I’m reminded of Jared Diamond’s book “Collapse” when thinking about this. He makes a convincing analysis that societies have perished when unable to adapt to new circumstances due to ideologic or cultural barriers to change, even when it was clear that they were consuming themselves or ensuring doom in the process.

There was certainly no accident or coincidence in the insurance industry report coming out when it did. I am certain that they have a carefully mapped out strategy, backed up by lots of dollars. They will now proceed to systematically convince the public of the righteousness of their cause.

james gaulte said...


What have the insurance premiums done in Massachusetts following their version of health care reform?

James Gaulte

David said...

I try to stay cynical---but I can't keep up!

In fairness, the proponents of the bill will yell "foul--self interest!" if any group opposes the bill, regardless of whether the argument or analysis is right or wrong. And, or course, organizations will usully act in the best interests of their shareholders, and even members! These facts obligate us to have our eyes wide open and to listen carefully and not just dogmatically follow the party-line.

On another note, the Post reported that the House leaders are planning to drop the SGR fix from HR3200, returning it to an annual event where we all rally in Washington, feed the PAC and candidates with contributions and get a last minute reprieve with a 0.5% uptick in Medicare.

My question, will the AMA support reform without a permanent fix to the SGR? Will Congress have the stomach for continuing the annual SGR fix dance after enacting major reform?

Dr Gaulte is correct---Massachusetts premiums have indeed risen for emplyers (up 10% this year) while co-pays and cost shring with employees have increased as well.

Health reform that expands coverage is the right thing to do, but without steps to rein in costs, it will likely be unaffordable in the long run.

Christie said...

Since we do not, and cannot know, what Congress is doing, any comment is superfluous.

Closed doors is their modus operandi. Are you naive enough to believe the College will be made privy to their actions?