Insuring Healthy Profits

(Please Note: I published this in May 2020 on Medium. Meanwhile, the trending flock had moved to Substack. So rather than continue chasing monetized platforms, I've made this a simple blogpost.  As the daily US covid case count hovers near 300,000 on this second day of Jan 2021, consider this thought as we head into further rounds of "healthcare reform". Doctors Without Borders may be the last best hope the majority of us in this country have of getting any care at all in the covid aftermath.)

Aside from the existential threat currently occupying our White House, another culprit in this uniquely American response to the coronavirus crisis has, thus far, escaped scrutiny. That scoundrel 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 summarized this travesty in a forceful critique of the legislative process leading up to the Affordable Care Act. 

For further commentary on the Liz Fowler/Max Baucus synergy, see these posts by Physicians for a National Healthcare Program.

The demand to reform healthcare didn’t arise without cause. It was grounded in the egregious practices of the insurance companies themselves. There are far too many examples to recount here, but rescission, the retroactive cancellation of an insurance policy, may best represent the single-minded ROI profit grab that characterizes the industry as a whole. Perhaps for that reason, Michael Moore made rescission a 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 may be 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

Here is a link to the Blue Cross Blue Shield video, called Mantra, at the base of this sales campaign. 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

In the absence of official national healthcare leadership, the insurance industry led us to believe it had assumed the role. After all, it was the sole expert authority at gathering data, managing provider networks, assessing risk, and of course, guaranteeing the healthy ROI that could reduce costs. Now, insurance was even our best friend and cheerleader!

So, like the mantra asks, “When was the last time you felt free? Free of worry, free of fear, free of uncertainty?” And, specifically, how are you feeling right now 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 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.

Perhaps this US pandemic response fiasco of will open our eyes to how fraudulently we’ve been encouraged to misplace our trust. Though even in the midst of a monumental health crisis, 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 I wonder how well the court 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.

A Peachoid of a Name

Throughout my life I've seen my last name, Gaffney, misspelled in some interesting and even unimaginable ways. But there is one place on earth where that's not likely to happen. Gaffney, South Carolina.  

I discovered my namesake place via Al Giddings, the acclaimed underwater cinematographer. In the 70's I got a NAUI certification at the Bamboo Reef, a diving school he founded in Berkeley CA. Then had more direct interaction with him during his work on the Abyss in the late 80's.

Reactor - Al Giddings
Giddings and his crew were prepping for the shoot while I was working at Adolph Gasser camera rentals in San Francisco. Most of the underwater shots would be done in an abandoned South Carolina nuclear reactor, repurposed as a production studio. 

This was a unique approach to underwater cinematography so Giddings experimented with rental equipment in deciding how to convert the reactor.  I scheduled many of their equipment reservations and even had the pleasure of delivering some items to his Oakland studio. 

At the time, Giddings also owned a large ranch in Montana. Since I grew up there it gave us reason for occasional bits of connective chatter. 

When the crew returned the equipment after six months at the reactor, they brought me a postcard from the town where they stayed, Gaffney, South Carolina. Of course, the name impressed me but even more memorable was the metal structure that proudly announced it. 

I've kept the card all these years though have seldom thought about the town until it came up by chance during some research. Based upon its marketing campaign for the Peachoid, Gaffney, South Carolina most certainly has a sense of humor.  I plan to visit as soon as the pandemic resolves. And have a feeling, no one there will misspell my last name. 

The Digital Divide is 25

Since the start of the pandemic, the phrase "digital divide" has probably been used more times than in its entire prior history. For too many people, it seems like this was first they had heard of it.

The concept was actually introduced during the Clinton administration. Since then, cascades of auspicious government programs have spent billions of dollars to resolve it. Yet the divide remains. In some cases, no different than in 1995.

The current fix is called The Rural Digital Opportunity Fund (RDOF). Its second funding phase takes place on October 29, 2020. As stated on the FCC website, 386 Applicants May Bid for Up to $16 Billion in Support to Bring Broadband to Up to 10.25 Million Unserved Americans.

Introduced about six months before Covid-19 first hit the US, the RDOF will award an unprecedented total of $20 billion over various project stages. Yet despite the broadband deficits exposed by the pandemic, there is no good reason to believe this fund will finally be the one that fills the gap.

The state of US telecommunications access is like a mountain of twisted old-time phone chords with an earpiece trapped somewhere inside. Legislation, technology, public funding, corporate interests, and essential human needs are a scrambled maze of demand with no immediate solution but plenty of opportunity for lucrative obfuscation.

Under the control of a select few mega-media players such as Comcast NBCUniversal, the telecom industry has secured the luxury of eluding any reference to its concerted heist of a public resource.

One of the more fortunate consequences of the pandemic, though, is that "we the people" are again appreciating the democratic architecture of the pre-corporate Net and its potential to realize the vision Harley Hahn so reverently described in his 1994 guide, The Internet : Complete Reference.

In learning how to use the Internet, you are embarking upon a great adventure. You are about to enter a world in which well-mannered people from many different countries and cultures cooperate willingly and share generously. They share their time, their efforts, and their products. (And you will, too.)

...Thus, the Internet is much more than a computer network or an information service. The Internet is living proof that human beings who are able to communicate freely and conveniently will choose to be social and selfless.

The computers are important because they do the grunt work of moving all the data from place to place, and executing the programs that let us access the information. The information itself is important because it offers utility, recreation, and amusement.

But, overall, what is most important is the people. The Internet is the first global forum and the first global library. Anyone can participate, at any time: the Internet never closes. Moreover, no matter who you are, you are always welcome. You will never be excluded for wearing the wrong clothes, having the wrong colored skin, being the wrong religion, or not having enough money.

The Internet was designed, developed, and implemented with US taxpayer funding.
We the People must claim our right to own it.

Free Geek Provides Computers During COVID19 Crisis

For the sake of profit, technology has became a status marketing game of having the "New New Thing". Free Geek, in contrast, is an outstanding example of making the most of what's available. It's located in Portland but their mission needs to be universal. This story also clearly illustrates the illusion of universal access to technology from both a hardware and online access standpoint.

A good portion of requests come from students who suddenly need to get online in order to participate in K-12 education or college. Many people are reaching out on behalf of aging parents who are no longer able to visit their doctors. Others are desperate for access to mental health or addiction treatment services. 

Free Geek is currently handling several hundred requests a week, but the nonprofit is struggling to keep up with the monumental spike in demand. 

“The real limitation for us is having the technology to give away or sell at a low price,” Shohoney said. Their biggest need is for laptops with webcams and built-in microphones and speakers. 

 #digitaldivide #digitalrights @FreeGeek #nonprofittechnology #digitalinclusion #internetaccess #socialgood #internet #technology

OPB: Portland's Free Geek Provides Low Cost Computers During Coronavirus Crisis

The Copper Mind Project

: to communicate knowledge to
: to give character or essence to
: to be the characteristic quality of
: to remove from place by violence
: to lacerate mentally or emotionally
: to pierce with sound

Copper Mind is a personal reflection of how landscape informs identity. And how obliterating a landscape rends the identity of those who were raised in it.

This rough draft introduction previews the project theme. The next phase is in production.