Insuring Healthy Profits

(Note: This was first published on Medium in May 2020 at the start of the pandemic.)

Aside from the existential threat currently occupying our White House, another culprit in this uniquely American response to the coronavirus has, thus far, escaped scrutiny. It is the Health Insurance Industry.

Insisting on a “uniquely American” solution to the shameful state of US healthcare coverage was how Senator Max Baucus dismissed national appeals for a universal health plan during legislation of the Affordable Care Act. 

As Democratic chair of the powerful Senate Finance Committee which led the effort on health care reform, Baucus was gifted with financial support from the health insurance industry and given direct legislative guidance from Elizabeth Fowler and Michele Easton, two industry insiders who revolved between seats in for-profit corporate healthcare and Baucus’ staff office. 

In fact, Elizabeth Fowler, a VP and lobbyist for Wellpoint (Anthem) Blue Cross Blue Shield, was so involved in crafting the Patient Protection and Affordable Care Act (Obamacare) that Baucus himself thanked her during a congressional hearing two days after the bill was signed into law. 
(Citation at the end of the Congressional transcript)
I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her profession lifetime goal. She put together the White Paper last November — 2008 — the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came. She is an amazing person. She is a lawyer; she is a Ph.D. She is just so decent. She is always smiling, she is always working, always available to help any Senator, any staff. I thank Liz from the bottom of my heart. In many ways, she typifies, she represents all of the people who have worked so hard to make this bill such a great accomplishment.
Bill Moyers delivers a compelling critique of the legislative process leading up to the Affordable Care Act. 

See these posts by Physicians for a National Healthcare Program for related commentary.

The demand to reform healthcare arose with good reason. It was grounded in the corrupt practices of insurance companies themselves. An outstanding example called rescission, the retroactive cancellation of an insurance policy, typifies the ruthless profit-centric ROI focus of the industry as a whole. No wonder that Michael Moore made rescission the centerpiece of Sicko, his documentary about the failed state of US healthcare.

Yet against this backdrop of calls for universal health coverage, the industry succeeded in leveraging a perpetual government handout for itself. Even more mind boggling is how thoroughly it reformed its image in the eyes of the American public. 

Health insurance corporations now insured our freedom from fear with their expertise at evaluating and eliminating risk. Blue Cross and Blue Shield’s latest Live Fearless campaign is a glossy feel good example.

Ad Copy:
To Live Fearless is to live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield behind you. Screenshot - April 30 2020 (click image to view full size)

A link to the Blue Cross Blue Shield video at the base of this sales campaign, called Mantra, has been repeatedly blocked. Below is the transcribed script.

(Ad script with child’s voice-over)
When was the last time you felt free? Free of worry, free of fear, free of uncertainty?
It’s time to uncover that feeling again. Because you are protected.
With the compassion of a cross that’s been trusted for eighty years.
The security of a shield accepted by over ninety percent of doctors and specialists.
And the power of a card that opens doors in all fifty states.
Giving you the freedom to love, to dream, to dare, to believe, to laugh, to dance…like no one is watching.
Blue Cross Blue Shield. Live Fearless.
Blue Cross Blue Shield boasts about the reach of its influence:
“Enrolling more than half of all U.S. federal employees, the Federal Employee Program covers roughly 5.6 million members, making it the largest single health plan group in the world.”

“Our 36 BCBS companies serve more than 17 million unionized workers, retirees and their families — more than any other insurer.” Screenshot - April 30 2020 (click image to view full size)

In the absence of official national healthcare leadership,the insurance industry told us to believe it had assumed the role, proclaiming its unrivalled competence at gathering data, managing provider networks, assessing risk, and of course, guaranteeing the healthy ROI needed to reduce costs. Insurance was even our federally approved best friend!

So, like the mantra asks, “When was the last time you felt free? Free of worry, free of fear, free of uncertainty?” But add this question to the do you feel about our uniquely American scheme for insuring the provision of healthcare?

In the midst of this pandemic, most people are too worried about losing health coverage to consider the role that insurers have played in the chaotic US response. The little commentary insurers have released neglects to mention their responsibility for keeping us “free from worry, fear and uncertainty” with their self-proclaimed expertise at assessing and preparing for possibilities.

Instead, they gasp with surprise at the “unexpected” explosion of this health crisis. Yet, Nassim Taleb (The Black Swan), Bill Gates, and public health author, Laurie Garrett, have all stated that this pandemic is not an unexpected Black Swan event. Preparation and planning could have, at the very least, significantly lessened its impact, especially regarding the shortage of resources.  Only the timing was unknown.

By their own design, insurers are at the center of our uniquely American system, coordinating resources, personnel and communication among a broad array of unconnected entities. The following 2007 CDC Health Insurer Pandemic Influenza Preparedness Checklist outlines the expectations around that fact.

Checklist Introductory Text:
In the event of an Influenza pandemic, national and regional health insurers will have several key responsibilities: protecting their employees’ health and safety, providing coverage and related services to their enrollees, and coordinating access to care through the provider community. Pandemic influenza planning is critical and will help limit the negative impact on our economy and society. To assist health insurers in their efforts, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed the following checklist. It identifies important, targeted activities health insurers can do now to prepare for a pandemic. 
Insurer responsibilities outlined on the last page of the list:
  • Collaborate with health-care providers — especially hospitals — and other entities, such as home-health providers, labs, pharmacies, and durable medical equipment providers, and share pandemic plans to better understand each other’s capabilities and needs. Ensure that single point-of-contact information is available for each of these partners.
  • Work with public health agencies, professional organizations, and local partners to develop and disseminate advice to primary-care providers regarding strategies for office-based assessment and management of patients with influenza-like illnesses during a pandemic, as well as strategies for keeping offices open during an outbreak.
  • Collaborate with federal, state, and local public health agencies and/or emergency responders to participate in their planning processes and share pandemic plans, so that the capabilities and needs of each are understood by all. Obtain updated business and after-hours single point–of-contact information.
  • Identify employees and enrollees who would receive a pandemic vaccine first, as it becomes available, based on state health department recommendations.
  • Work with state or local health departments to determine respective roles in vaccine distribution, administration, and record keeping, and communicate those roles to members, employees and providers.
  • Communicate with local and/or state public health agencies and/or emergency responders about the assets and/or services your company could contribute to the community during a pandemic.
  • Share pandemic plans with plan sponsors, employers, customers, and clients.
  • Share successful response strategies, best practices, and lessons learned with other health insurers, businesses, and organizations in your communities, chambers of commerce, and associations to improve overall preparedness and response efforts.
  • Develop “what if” scenarios and conduct practice drills to test your plan, and revise plans based on lessons learned. Participate in drills conducted by local, state, or national governments to test linkages between the company and relevant authorities.
click image to view full size

Maybe the fiasco of US pandemic response will open our eyes to the fraud we’ve been encouraged to trust. Even in the midst of this monumental health crisis, though, odds of that happening seem to have waned. In a recent ruling, the Supreme Court was nearly united in awarding $12 billion to health insurers who claimed it was their due from Obamacare losses.

I am not in his political camp, but I applaud Justice Samuel Alito, the sole dissenter, who said, “the court’s ruling has the effect of providing a massive bailout for insurance companies that took a calculated risk and lost.”

Risk assessment is the self-proclaimed forte of health insurance companies so it's worth asking how well the other Justices scrutinized those losses for fraud.

One thing, though, has become painfully clear in this flaming national fustercluck. The US health insurance system will most certainly remain Uniquely American because no other place in the world would want it.