Showing posts with label Power. Show all posts
Showing posts with label Power. Show all posts

Public Opinion - Extracts: The Making of a Common Will

Walter Lippmann published Public Opinion in 1922. Following is a short extract describing the role of leadership in creating public acceptance. The entire book is available online for free through Project Gutenburg.

The established leaders of any organization have great natural advantages. They are believed to have better sources of information. The books and papers are in their offices. They took part in the important conferences. They met the important people. They have responsibility. It is, therefore, easier for them to secure attention and to speak in a convincing tone. But also they have a very great deal of control over the access to the facts.
Every official is in some degree a censor. And since no one can suppress information, either by concealing it or forgetting to mention it, without some notion of what he wishes the public to know, every leader is in some degree a propagandist. 

Strategically placed, and compelled often to choose even at the best between the equally cogent though conflicting ideals of safety for the institution, and candor to his public, the official finds himself deciding more and more consciously what facts, in what setting, in what guise he shall permit the public to know. 

That the manufacture of consent is capable of great refinements no one, I think, denies. The process by which public opinions arise is certainly no less intricate than it has appeared in these pages, and the opportunities for manipulation open to anyone who understands the process are plain enough. 

The creation of consent is not a new art. It is a very old one which was supposed to have died out with the appearance of democracy. But it has not died out. 

It has, in fact, improved enormously in technic, because it is now based on analysis rather than on rule of thumb. And so, as a result of psychological research, coupled with the modern means of communication, the practice of democracy has turned a corner. A revolution is taking place, infinitely more significant than any shifting of economic power. 

Within the life of the generation now in control of affairs, persuasion has become a self-conscious art and a regular organ of popular government. None of us begins to understand the consequences, but it is no daring prophecy to say that the knowledge of how to create consent will alter every political calculation and modify every political premise. 

Under the impact of propaganda, not necessarily in the sinister meaning of the word alone, the old constants of our thinking have become variables. It is no longer possible, for example, to believe in the original dogma of democracy; that the knowledge needed for the management of human affairs comes up spontaneously from the human heart. Where we act on that theory we expose ourselves to self-deception, and to forms of persuasion that we cannot verify. 

It has been demonstrated that we cannot rely upon intuition, conscience, or the accidents of casual opinion if we are to deal with the world beyond our reach.

Public Opinion - Extracts: The Enlisting of Interest

Walter Lippmann published Public Opinion in 1922. Following is a short extract describing how to engage and hold public attention. The entire book is available online for free through Project Gutenburg.

When public affairs are popularized in speeches, headlines, plays, moving pictures, cartoons, novels, statues or paintings, their transformation into a human interest requires first abstraction from the original, and then animation of what has been abstracted.
We cannot be much interested in, or much moved by, the things we do not see. Of public affairs each of us sees very little, and therefore, they remain dull and unappetizing, until somebody, with the makings of an artist, has translated them into a moving picture. Thus the abstraction, imposed upon our knowledge of reality by all the limitations of our access and of our prejudices, is compensated. 

Not being omnipresent and omniscient we cannot see much of what we have to think and talk about. Being flesh and blood we will not feed on words and names and gray theory. Being artists of a sort we paint pictures, stage dramas and draw cartoons out of the abstractions.

A “clear” thinker is almost always a good visualizer. But for that same reason, because he is “cinematographic,” he is often by that much external and insensitive. 

For the people who have intuition, which is probably another name for musical or muscular perception, often appreciate the quality of an event and the inwardness of an act far better than the visualizer. They have more understanding when the crucial element is a desire that is never crudely overt, and appears on the surface only in a veiled gesture, or in a rhythm of speech. 

Nevertheless, though they have often a peculiar justice, intuitions remain highly private and largely incommunicable. But social intercourse depends on communication, and while a person can often steer his own life with the utmost grace by virtue of his intuitions, he usually has great difficulty in making them real to others. When he talks about them they sound like a sheaf of mist. For while intuition does give a fairer perception of human feeling, the reason with its spatial and tactile prejudice can do little with that perception. 

Therefore, where action depends on whether a number of people are of one mind, it is probably true that in the first instance no idea is lucid for practical decision until it has visual or tactile value. But it is also true, that no visual idea is significant to us until it has enveloped some stress of our own personality. Until it releases or resists, depresses or enhances, some craving of our own, it remains one of the objects which do not matter. 

Pictures have always been the surest way of conveying an idea, and next in order, words that call up pictures in memory. But the idea conveyed is not fully our own until we have identified ourselves with some aspect of the picture. The identification, or what Vernon Lee has called empathy, may be almost infinitely subtle and symbolic. The mimicry may be performed without our being aware of it, and sometimes in a way that would horrify those sections of our personality which support our self-respect.

In sophisticated people the participation may not be in the fate of the hero, but in the fate of the whole idea to which both hero and villain are essential. But these are refinements. In popular representation the handles for identification are almost always marked. You know who the hero is at once. And no work promises to be easily popular where the marking is not definite and the choice clear. But that is not enough. 

The audience must have something to do, and the contemplation of the true, the good and the beautiful is not something to do. In order not to sit inertly in the presence of the picture, and this applies as much to newspaper stories as to fiction and the cinema, the audience must be exercised by the image. 

Now there are two forms of exercise which far transcend all others, both as to ease with which they are aroused, and eagerness with which stimuli for them are sought. They are sexual passion and fighting, and the two have so many associations with each other, blend into each other so intimately, that a fight about sex outranks every other theme in the breadth of its appeal. There is none so engrossing or so careless of all distinctions of culture and frontiers. 

The sexual motif figures hardly at all in American political imagery. Except in certain minor ecstasies of war, in an occasional scandal, speak of it at all would seem far-fetched...But the fighting motif appears at every turn. Politics is interesting when there is a fight, or as we say, an issue. And in order to make politics popular, issues have to be found, even when in truth and justice, there are none,--none, in the sense that the differences of judgment, or principle, or fact, do not call for the enlistment of pugnacity. 

[Footnote: Cf. Frances Taylor Patterson, Cinema Craftsmanship, pp. 31-32. “III. If the plot lacks suspense: 1. Add an antagonist, 2. Add an obstacle, 3. Add a problem, 4. Emphasize one of the questions in the minds of the spectator.,..”]

But where pugnacity is not enlisted, those of us who are not directly involved find it hard to keep up our interest. For those who are involved the absorption may be real enough to hold them even when no issue is involved. They may be exercised by sheer joy in activity, or by subtle rivalry or invention. 

But for those to whom the whole problem is external and distant, these other faculties do not easily come into play. In order that the faint image of the affair shall mean something to them, they must be allowed to exercise the love of struggle, suspense, and victory. 

In order then that the distant situation shall not be a gray flicker on the edge of attention, it should be capable of translation into pictures in which the opportunity for identification is recognizable. Unless that happens it will interest only a few for a little while. It will belong to the sights seen but not felt, to the sensations that beat on our sense organs, and are not acknowledged. 

We have to take sides. We have to be able to take sides. In the recesses of our being we must step out of the audience on to the stage, and wrestle as the hero for the victory of good over evil. We must breathe into the allegory the breath of our life. 

Propaganda: Extracts - Introduction

Propaganda by Edward Bernays

Propaganda is a Latin word meaning 'to spread' or 'to propagate'. In 1622, it was originally used to describe the mission of a new administrative body in the Catholic Church called the Congregatio de Propaganda Fide (Congregation for Propagating the Faith). Its activity was aimed at "propagating" the Catholic faith in non-Catholic countries.

Until the 20th Century, its meaning was largely apolitical and amoral. But thanks to Edward Bernays the power of persuasion became an essential tool in prompting acceptance of WWI.  The, after the war, he re-purposed that success into developing a new field of marketing goods and concepts. He outlined the methods behind propaganda in what became the textbook for the practice, aptly named "Propaganda".

Following are excerpts from Mark Crispin Miller's Introduction in the 2005 edition. They explain the derivation and evolution of the concept.

(Promotional text on back cover)
Originally published in 1928, this manual of mass manipulation provides a detailed examination of how public discourse and opinion are shaped and controlled in politics, business, art, education and science. 

In a world dominated by political spin and media manipulation, Propaganda is an essential read for all who wish to understand how power is used by the ruling elite of our society.

About the Author
The nephew of Sigmund Freud, Edward Bernays (1891-1995) pioneered the scientific technique of shaping and manipulating public opinion, which he called "engineering of consent." 

During World War I, he was an integral part - along with Walter Lippmann - of the U.S. Committee on Public Information (CPI), a powerful propaganda machine that advertised and sold the war to the American people as one that would "Make the World Safe for Democracy." The marketing strategies for all future wars would be based on the CPI model.

Over the next half century, Bernays, combining the techniques he had learned in the CPI with the ideas of Lippmann and Freud, fashioned a career as an outspoken proponent of propaganda for political and corporate manipulation of the population, earning the moniker "father of public relations." 

Among his powerful clients were President Calvin Coolidge, Procter & Gamble, CBS, the American Tobacco Company and General Electric. In addition, his propaganda campaign for the United Fruit Company in the early 195Os led directly to the CIA's overthrow of the elected government of Guatemala.

(Front cover text detail)
Only through the active energy of the intelligent few can the public at large become aware of and act upon new ideas.

Propaganda bears the same relation to education as to business or politics. It may be abused. It may be used to over-advertise an institution and to create in the public mind artificial values. There can be no absolute guarantee against its misuse.

A presidential candidate may be "drafted" in response to "overwhelming popular demand," but it is well-known that his name may be decided upon by half a dozen men sitting around a table in a hotel room.

Governments, whether they ore monarchical, constitutional, democratic or communist, depend upon acquiescent public opinion for the success of their efforts and, in fact, government is government only by virtue of public acquiescence.

As civilization hos become more complex, and of the need for invisible government has been increasingly demonstrated, the technical means have been invented and developed by which opinion may be regimented.

Nowadays the successors of the rulers, those whose position or ability gives them power, can no longer do what they want without the approval of the masses, they find in propaganda a tool which is increasingly powerful in gaining that approval.

Democracy is administered by the intelligent minority who know how to regiment and guide the mosses.

An entire party, a platform, on international policy is sold to the public, or is not sold, on the basis of the intangible element of personality.

INTRODUCTION by Mark Crispin Miller

Prior to World War One, the word propaganda was little-used in English, except by certain social activists, and close observers of the Vatican; and, back then, propaganda tended not to be the damning term we throw around today. The word had been coined in 1622, when Pope Gregory XV, frightened by the global spread of Protestantism, urgently proposed an addition to the Roman curia. 

The Office for the Propagation of the Faith (Congregatio de propaganda fide) would supervise the Church's missionary effort in the New World and elsewhere: "They are to take account of and to deal with each and every concern for the spread of the faith throughout the world." 

Far from denoting lies, half- truths, selective history or any of the other tricks that we associate with "propaganda" now, that word meant, at first, the total opposite of such deception. Of "the sheep now wretchedly straying" the world over, Gregory wrote:

Especially it is to be desired that, inspired by divine grace, they should cease to wander amidst heresies through the unhappy pastures of infidelity, drinking deadly and poisonous water, but be placed in the pasture of the true faith, that they may be gathered together in saving doctrine, and be led to the spring of the water of life.

The word seems to have retained its strongly Catholic aura well into the 19th century; and, often, when the user stressed that Roman origin, the word would be pejorative.

"Derived from this celebrated society [the Congregatio de propaganda fide], the name propaganda applied in modern political language as a term of reproach to secret associations for the spread of opinion and principle which are viewed by most governments with horror and aversion," writes the British chemist William Thomas Brande in 1842. However, while the word then could be used to make a sinister impression, it did not automatically evoke subversive falsehood, as it has since the 1920s.

In his English Traits (1856), for instance, Emerson uses propagandist as an adjective not at all suggestive of the stealthy spread of some pernicious creed or notion. He describes the British a "still aggressive and propagandist, enlarging the dominion of their art and liberty" - a passage that associates propaganda not with alien subversion but the most enlightened rule:

Their laws are hospitable, and slavery does not exist under them. What oppression exists is incidental and temporary; their success is not hidden or fortunate, but they have maintained constancy and self-equality for many ages.

Prior to the war, the word’s derogatory use was far less common than its neutral denotation. Here for example, is the calm (and accurate) definition given in the Oxford English Dictionary:

''Any association, systematic scheme, or concerted movement for the propagation of a particular doctrine or practice."

Thus was propaganda generally perceived not a an instrument for striking "horror and aversion" in the souls of government officials, but as an enterprise whose consequences might seem horrid - or innocuous, or even beneficial, depending on its authors and their aim (and the perceiver's point of view). 

A campaign to improve public health through vaccination, sanitary cooking or the placement of spittoons was, or is, no less a propaganda drive than any anti-clerical or socialist or nativist crusade. Evidently this fact was apparent to those few who used the word - which did not become a synonym for big black lies until the Allies made the word familiar to the masses of Great Britain and America. Until then, propaganda was a term so unimportant that there is no definition for it in the great 1911 Encyclopedia Britannica (which does include a short entry for propagate).

The war had a complex effect on the repute of propaganda. Although the practice had, albeit unnamed, been variously used by governments for centuries (Napoleon was especially incisive on the subject, as well as an inspired practitioner), it was not until 1915 that governments first systematically deployed the entire range of modern media to rouse their populations to fanatical assent. 

Here was an extraordinary state accomplishment: mass enthusiasm at the prospect of a global brawl that otherwise would mystify those very masses, and that shattered most of those who actually took part in it. The Anglo - American drive to demonize "the Hun,” and to cast the war as a transcendent clash between Atlantic “civilization" and Prussian "barbarism," made so powerful an impression on so many that the worlds of government and business were forever changed.

Now "public opinion" stood out as a force that must be managed, and not through clever guesswork but by experts trained to do that all-important job. Thus the war improved the status of those working in the field of public suasion. Formerly, the lords of industry and commerce had often seen the advertising agent as a charlatan, associated with the tawdry bunkum used to peddle patent medicines and cigarettes, and trying to sell a service that any boss with half a brain could surely manage on his own.

The nascent field of public relations also had been disesteemed by those atop the social pyramid, who saw that sort of work as necessary only on the vaudeville circuit and on Broadway. The great Allied campaign to celebrate (or sell) Democracy, etc., was a venture so successful, and, it seemed, so noble, that it suddenly legitimized such propagandists, who, once the war had ended, went right to work massaging or exciting various publics on behalf of entities like General Motors, Procter & Gamble, John D. Rockefeller, General Electric.

And so, from the signing of the Versailles Treaty to the Crash of 1929, there was high excitement in the booming field of peace-time propaganda. That reborn generation of admen and publicists, no longer common hucksters but professionals, sold their talents to Big Business through a long barrage of books, essays, speeches and events extolling the miraculous effects of advertising and/or publicity - i.e., propaganda, as the proponents of the craft, and their corporate clients, often kept referring to it, quietly.

According to the propagandists' evangelical self-salesmanship (many of them were in fact the son of ministers), their revolutionary "science" would do far more than make some people richer. Just as during the war, propaganda would at once exalt the nation and advance the civilizing process, teaching immigrants and other folk of modest means how to transform themselves, through smart consumption, into happy and presentable Americans. 

Throughout the Twenties, as propaganda's earnest advocates devoutly pushed that faux-progressive line, "propaganda" seemed - at least to those who peddled it - a wondrous new progressive force, capable of brightening every life and every home. That quasi-religious pitch was memorably made in book like Earnest Elmo Calkins's Business the Civilizer (1928), Bruce Barton's best-selling parable The Man Nobody Knows (1925), and, less distinctively, in countless other works of what we might call propaganda propaganda. 

Like its wartime prototype, the post-war propaganda drive was an immense success, as it persuaded not just businessmen but journalists and politicians that "the manufacture of consent," in Walter Lippmann's famous phrase, was a necessity throughout the public sphere.

And yet, for all its honking boosterism, that sales campaign was oddly hobbled from the start, because the product's very name had come into the news, and into common conversation, as a dirty word. Ironically, the same great war drive that had made that alien term "propaganda" commonplace had also made the neutral term pejorative. At the very moment of the propagandists' triumph as professionals, in other words, to be referred to as a "propagandist" was an insult. 

This was no accident, but a paradoxical result of the war propagandists' winning enterprise: for the propagandists had themselves besmirched the word by using it always and only in dark reference to the enemy. "We did not call it propaganda, for that word, in German hands, had come to be associated with deceit and corruption," writes George Creel, director of the U.S. Office of War Information, in How We Advertised America (1920). 

The Germans having trashed the word, Creel claims, the Americans never used it to refer to their own output, but - rightly - favored other, more exalted term instead: "Our effort was educational and informative throughout, for we had such confidence in our case as to feel that no other argument was needed than the simple, straightforward presentation of facts".

That passage is itself, of course, a stunning bit of propaganda, as it bluntly reconfirms the Manichaean plot that Creel & Co. had hammered home throughout the war: Germans always lie, Americans always tell the truth. How the German propaganda "had come to be associated with deceit and corruption" is a question Creel would rather not address, preferring instead to bury it in that sly (if sly it was) passive construction. 

There is much to say about Creel's obfuscation, or evasion, of the fact that his own propagandists had "associated" German propaganda with "corruption" and "deceit"-- and did so just as Creel does in that passage. At this point, however, our main concern is not propaganda's crucial self-effacement, but the darkening effect of Allied propaganda on the elusive word itself.

In World War One it was the propaganda of our side that first made "propaganda" so opprobrious a term. Fouled by close association with "the Hun," the word did not regain its innocence - not even when the Allied propaganda used to tar "the Hun" had been belatedly exposed to the American and British people. 

Indeed, as they learned more and more about the outright lies, exaggerations and half-truths used on them by their own governments, both populations came, understandably, to see “propaganda” as a weapon even more perfidious than they had thought when they had not perceived themselves as its real target. Thus did the word's demonic implications only harden through the Twenties, in spite of certain random efforts to redeem it.

Edward Bernays's Propaganda (1928) was the most ambitious of such efforts. Through meticulous descriptions of a broad variety of post-war propaganda drives - all of them ingenious, apparently benign in purpose and honest in their execution - Bernays attempts to rid the word of its bad smell. His motivation would appear to be twofold. 

Bernays always deemed himself to be both "a truth-seeker and a propagandist for propaganda," as he put it in another apologia in 1929. On the one hand, then, his interest would be purely scientific; and so his effort to redeem the word is based to some extent on intellectual necessity, there being no adequate substitute for propaganda. In this Bernays was right (and never quite gave up his preference for that word over all the euphemisms). His wish to reclaim the appropriate term bespeaks a serious commitment to precision; Bernays was not one to hype anything -- not his clients' wares, and not his craft.

In Propaganda, as in all his writings, there is none of the utopian grandiosity that marks so many of the decade's other pro-commercial homilies. Bernays's tone is managerial, not millenarian, nor does he promise that his methodology will turn this world into a modern paradise. His vision seems quite modest. 

The world informed by "public relations" will be but "a smoothly functioning society," where all of us are guided imperceptibly throughout our lives by a benign elite of rational manipulators. Bernays derived this vision from the writings of his intellectual hero, Walter Lippmann, whose classic Public Opinion had appeared in 1922.

From his observations on the Allied propaganda drives' immense success (and his own stint as a U.S. war propagandist), and from his readings of Gustave Le Bon, Graham Wallas and John Dewey, among others, Lippmann had arrived at the bleak view that "the democratic El Dorado" is impossible in modern mass society, whose members - by and large incapable of lucid thought or clear perception, driven by herd instincts and mere prejudice, and frequently disoriented by external stimuli - were not equipped to make decisions or engage in rational discourse. "Democracy therefore requires a supra-governmental body of detached professionals to sift the data, think things through, and keep the national enterprise from blowing up or crashing to a halt".

Although mankind surely can be taught to think, that educative process will be long and slow. In the meantime, the major issues must be framed, the crucial choices made, by "the responsible administrator." "It is on the men inside, working under conditions that are sound, that the daily administration of society must rest."

While Lippmann's argument is freighted with complexities and tinged with the melancholy of a disillusioned socialist, Bernays's adaptation of it is both simple and enthusiastic: “We are governed, our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of." 

These "invisible governors” are a heroic elite, who coolly keep it all together, thereby "organizing chaos," as God did in the Beginning. "It is they who pull the wires which control the public mind, who harness old social forces and contrive new ways to bind and guide the world." While Lippmann is meticulous-indeed, at times near-Proustian-in demonstrating how and why most people have such trouble thinking straight, Bernays takes all that for granted as “a fact." 

It is a sort of managerial aristocracy that quietly determines what we buy and how we vote and what we deem as good or bad. "They govern us," the author writes, "by their qualities of natural leadership, their ability to supply needed ideas and by their key position in the social structure."

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.