Sniffer Report: AHIP Pushed the Button and…

The Sniffer

The Sniffer

e=mc2 (Excessive-influence = moola x congressional-greed squared)

America’s Health Insurance Plans pushed the button on their “nuclear option” bomb to blast health care reform into oblivion.  The safety was released, the countdown went to zero, and “click!”

This is what AHIP and Big Medicine wanted to hear:

bravo_test_s atomic mushroom cloud(Click on the photo)

Instead they heard this, from the President of the United States:

In fact, the insurance industry is rolling out the big guns and breaking open their massive war chest – to marshal their forces for one last fight to save the status quo. They’re filling the airwaves with deceptive and dishonest ads. They’re flooding Capitol Hill with lobbyists and campaign contributions. And they’re funding studies designed to mislead the American people.

It’s smoke and mirrors. It’s bogus. And it’s all too familiar. Every time we get close to passing reform, the insurance companies produce these phony studies as a prescription and say, “Take one of these, and call us in a decade.” Well, not this time. The fact is, the insurance industry is making this last-ditch effort to stop reform even as costs continue to rise and our health care dollars continue to be poured into their profits, bonuses, and administrative costs that do nothing to make us healthy – that often actually go toward figuring out how to avoid covering people. And they’re earning these profits and bonuses while enjoying a privileged exception from our anti-trust laws, a matter that Congress is rightfully reviewing.

Don’t think for one second that AHIP has conceded or surrendered.  As the bills move through the process of being reconciled, the intensity of the pressure on Congress and YOU and ME, will intensify into a political nuclear storm, the likes of which we have never seen.  The days before the final votes in the Senate and the House will be filled with a Big Medicine-financed noise that would turn an Orc to stone.

President Obama, however, did not stop there:

Last November, the American people went to the polls in historic numbers and demanded change. They wanted a change in our policies; but they also sought a change in our politics: a politics that too often has fallen prey to the lobbyists and the special interests; that has fostered division and sustained the status quo. Passing health insurance reform is a great test of this proposition. Yes, it will make a profound and positive difference in the lives of the American people. But it also now represents something more: whether or not we as a nation are capable of tackling our toughest challenges, if we can serve the national interest despite the unrelenting efforts of the special interests; if we can still do big things in America.

I repeat here what I posted on August 15, 2009:

There are times in the history of a nation, that certain reforms, regardless of the opposition, and, yes, even despite the fears of some must be overcome and guaranteed for all as part of the Common Good.  One of those times was the Emancipation Proclamation abolishing slavery.  One of those times was the ratification of the 19th Amendment of the Constitution of the United States granting women the right to vote.  One of those times was Brown v. The Board of Education decision of the United States Supreme Court that revolutionized equality in education for all U. S. citizens.  Many more could be mentioned.

Now is the time for health care to be added to those moments of sublime national change, to join those great reforms, cast as the finest, hardest steel into our Nation of Laws as an inalienable right and an eternal Blessing of Liberty.


Sniffer Report: The Countdown to Annihilate Health Care Reform is Running

The Sniffer: Big Medicine's Atomic Radiation Detected!

The Sniffer: Big Medicine's Atomic Radiation Detected! Credit: Smith Detection, UK

Update: The Senate Finance Committee voted 14-9 today, 13 Oct, (Olympia Snowe, R-ME, was the sole Republican to vote with the Democratic majority) to pass the Health Care Reform Legislation they have been working on since January.

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For years Big Medicine–led by America’s Health Insurance Plans (AHIP)–has been planning to obliterate the next attempt at health care reform.  I call it their “nuclear option.”

For the past year I’ve been sleuthing between the lines of the great media Sturm und Drang over health care reform legislation for clues to what AHIP was up to, which turned out to be far easier than I ever imagined. I assumed that they were trying to surreptitiously maneuver their anti-health reform nuclear device into position.  Only it wasn’t very surreptitious.  They were clumsy, overplayed their hand, their corporate brow becoming sweatier by the week.  So, today, AHIP released a study that was supposed to turn us all to stone.  Or something like that.  It had to be outrageously expensive to commission. Therefore the anticipated effect should have been just as extreme, reasserting their ascendancy over all things health care related.  MSNBC reported:

The study commissioned by America’s Health Insurance Plans marked a shift in strategy by the industry, which had been working for months behind the scenes to help shape health care legislation. With the Senate panel set to vote on legislation the industry fears could result in a loss of revenue, the insurers went on the attack, in dramatic fashion.

Maybe MSNBC can’t say AHIP’s plan has come apart at the seams, is in disarray, and the attack is a panic attack, but I can.  I’m writing political commentary.  AHIP should have called PhRMA and asked for a few semi’s filled with tranquilizers sent over to their headquarters.  But then AHIP would have to exercise rescission on itself for a pre-existing condition, a psychiatric anxiety disorder.  Or else, raise the rates on themselves so high for filing a claim that no one in AHIP could afford their own insurance.  To my way of thinking that leaves the Big Wigs of AHIP with the sole option of chewing on their fingernails.

Despite hundreds of millions of our health care dollars spent on lobbying and advertising by AHIP–the money we pay for the health insurance that is supposed to cover our medical costs–the wave of public sentiment, including many progressive politicians, for universal health care, a public option, and a right to medical care has grown higher and stronger.  It has begun to crest, a powerful rolling tube of determination racing toward the shore.

The strategies of Big Medicine, on the other hand, have been not at all as successful as they believed their money and influence should be.  They are angry; they are frustrated.  No one, they believe, has the right to interfere with their carefully crafted system that keeps the people at the top fabulously wealthy while the common rabble who pay them grow less and less healthy, creating desperation for medical care at any price those at the top choose to charge.  No one!  It must be stopped regardless of the consequences.

Today, instead of stunned submission, they got unbridled derision.

As reported by the Associated Press, the new report was immediately blasted for its conspicuous conspicuousness:

Questions about the technical soundness of the industry analysis by the PricewaterhouseCoopers firm was a big part of the discussion Monday. The release of the study late Sunday on the eve of the federal Columbus Day holiday had Democrats crying foul.

“The misleading and harmful claims made by the profit-driven insurance companies are politicking for corporate gain at its worst,” said Sen. Jay Rockefeller, D-W.Va.

You can read AHIP’s defense of the report by their spokesperson, Nancy Ignagni, who was interviewed by the News Hour’s Margaret Warner, by clicking here.  I watched the interview.  Nancy looked very grim and used lots of insurance jargon as a way to sound quite peckish and put-out with all of us mere peons who immediately recognized this report was the biggest crock of bantha poodoo since George the 43rd declared “Mission Accomplished” in, what was it, 1383.

Courtesy Getty Images

Courtesy Getty Images

Nevertheless, it is zero hour.  The anti-health care reform atomic bomb is in position.  AHIP has its finger on the button.  They will not be trifled with.  The so-called “report” (undoubtedly a work of fiction so cleverly devised it would make Dan Brown envious) is the start of the count-down clock.

Make no mistake about it.  AHIP will push that button.  Only the will of the American People, demanding from the President and the Congress no compromise on the establishment of Universal Health Care will determine whether or not the bomb goes off.

bravo_test_s atomic mushroom cloud

Amputating the Finger to Save the Ring

There are many ways to do things wrong.  A couple of weeks ago I woke up with my left hand seriously swollen.  It was a reasonably good reproduction of the hand of the Stay-Puft Marshmallow Boy.  I headed to the Urgent Care Center to have it looked at.  The first thing out of the nurse’s mouth was, “We’re going to have to cut off your wedding ring.  If it cuts off the circulation anymore, you could lose your finger.”

Cutting off my wedding ring had not been part of the plan.  Although it was very tight, my ring finger didn’t hurt, and I just assumed the doctor would give me something to get rid of the swelling, my hand would return to its normal size, and I’d go my merry way.  Besides, having been married some thirty-two years, I’d guess that easily around twenty years had gone by since I’d even been able to get the ring off.

The decision actually was pretty easy to make.  Gold rings can be repaired and dead fingers can’t.  Within minutes, the nurse and her CNA were sawing away at my ring with a special device designed to cut the metal and not my finger.

Once the ring was sliced through, then came the hard part. Pulling the ring over my hyper-sized fleshy knuckle proved to be the painful part of the process.  As they say, see illustration below:

David's Swollen Hand and Ring Finger

David's Swollen Hand and Ring Finger

Within a few hours, my hand returned to its normal size and I retain a healthy ring finger.  My wedding ring can be repaired, as well.

But as I said in my lede, there are wrong ways to do things.  That happened today in the Senate Finance Committee when two different amendments for a public health plan, supported strongly by at least 65% of Americans according to recent national NYT/CBS poll, were defeated by a combination of Republicans (who have spent zillions of dollars as well as bazillions of hours trying to either wound to kill health care reform) and a group of Democrats (who, in the Senate, are referred to I think as Donkey Blue Dung Beetles).

Here’s my analogy.  The public option is the “ring finger” in the health care reform hand.  It is essential since people hands have had five fingers for a long time.  The ring finger, however, has become controlled by Big Medicine, and they have come up with this outrageous lie that their ring is soooooooo important and big, that the public plan ring finger should be amputated.  See illustration below:

Gigantic Engagement Ring. Credit: www.lovetoknow.com

Gigantic Engagement Ring. Credit: http://www.lovetoknow.com

Yep, save the ring; amputate the finger.  We won’t be able to  wear it on the hand, so we’ll just have to wear it like a crown, to remind us daily that Big Medicine is King/Queen of American Health Care.

Thanks, Max.  You’re doin’ a heckava job there making sure the American health care disaster is complete success.  Heckava job.

There Will Never Be Another Tax Cut

Huh??  What do you mean there will never be another tax cut? Congress can vote to cut taxes anytime it wants.  Have you lost your mind, Waggoner?

Consider this statement:

Using tax levels consistent with the past half century in America, then subtracting entitlement payments as currently promised for Social Security, Medicare and Medicaid, The Heritage Foundation (another conservative think tank) estimates that sometime just before 2020, there won’t be enough money in the federal treasury for anything but the entitlement programs.

It was written by Bruce Brattain, owner of Wisdom River Partners, who, among his many talents, is an elder care consultant.  Now, don’t roll your eyes over the word “consultant.”  Start reading a few of the pieces in his blog, aninconvenientbruce, and you’ll instantly realize, this is one very astute observer who has his finger on the pulse of a number of national issues.

And, just to entice you more to go read the entire article from which this quote was taken; it’s not what you think it is.

Now.  Please. Go read what Bruce has to say.  Oh, and be prepared to not only to have your assumptions challenged in a classic Extreme Thinkover manner, get ready to be entertained by a guy with one wicked wit!  Click here.

Then come back to my post for this:

Post Script:  I just watched PBS’s The News Hour:

In an ongoing series of conversations on health reform, Jeffrey Brown speaks with Robert Laszewski, a former insurance executive and skeptic of a public insurance option.

Laszewski, in this interview, lays out the manifesto for Big Medicine’s opposition to health care reform.  He is articulate, clearly believes in his cause, and goes over their case against the public plan point by point.

And proves the argument for implementing a public option in the health care reform legislation so beautifully, I almost jumped up from the couch to give him a standing ovation.

Huh?   Two times in one post?  Read the interview of Robert Laszewski, former insurance executive and Big Medicine consultant by Jeffrey Brown.  Click Here.

The Myth of the Free Market Health Care Reform

I offer my readers two examples of why the “free market” system alone is systemically incapable of creating or sustaining any semblance of real health care reform:

  1. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.
  2. The free market requires that any product related to health care for real human beings actually is designed to make a profit for the owners/shareholders of that business.

That is not a typo.

“Hunter,” one of the contributors to the Daily Kos, wrote a letter to the President making his case for free market health care.  Here are his concluding paragraphs:

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Hunter didn’t make this up.  This is, indeed, the reality of health care in the free market.  I urge you to read the complete letter.  You’ll love the part about the gold-plated utensils and its vital relationship to your health care dollar.

Paul Krugman, Nobel-winning economist and New York Times columnist, however, just puts the nails in the free market myth coffin:

There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

I urge you to read the complete post from Dr. Krugman’s blog.

It really comes down to this.  If you are chuckling, you understand that health care reform is about real people needing real medical care when they need it, without the cost or lack of access costing them their lives or livelihoods.

If you are experiencing blustery consternation and wanting to call me a socialist, communist, or worse (none of which apply, because I am a dyed-in-the-wool capitalist), you need to make a decision.  Do you want to live in a country that is healthy and prosperous because health care is delivered through a collaboration of the government, mission-driven non-profit organizations and private enterprise, or…

Well, do you want to or not?  The myth that free market health care reform will be achieved is dead.  As Paul Krugman points out there are many things the free market can do very well.  Health care is not on that list.

I care enough about you as a person and as an American to support a portion of my taxes being spent to ensure you can get the medical care you need when you need it, because I know in the long run we will be better off–you, me, and 300 million of our fellow Americans.

Radiation Sniffer: On Alert for the Nuclear Option

In my post of July 3, I made the bold suggestion that the various Big Medicine groups could very well be planning to “drop the bomb” on the whole effort toward Universal Health Care, either before the legislation was finalized and voted on, or perhaps even after.  I called this the “Nuclear Option.”

Do not assume for a micro-second they have given up. They are preparing the Nuclear Option. One all-out attack on universal health care, with no regard for collateral damage, just the health of America. In the Board Rooms of the Insurance Megacorps, Big Pharma, Corporate Hospitals, and dozens of other stakeholders firmly anchored in the Status Quo, they are planning to bring this down. Once and for all, to obliterate the very notion of universal health care so completely, that it will never threaten their companies and profits again.

The question is, in all fairness, even though my hypothesis using organizational theory predicts the likelihood of an attempt to prevent UHC from becoming law, or destroying it after it is passed, is there any evidence to support it?  I also stated,

The door for the Nuclear Option is now open. Why? Because the real-life environment to which we are applying my theory is not just one company; we are applying it to a multifaceted industry that has for decades successfully resisted and obstructed the move toward universal health care. And they know that by conspiring together and pooling their resources, they can potentially create a huge wall of resistance. This strategy has a flaw, however. A significant percentage of companies in the industry are supportive of UHC, and are already changing the practice of their organizations to successfully ride the transformative wave. This fact only serves to increase the opponents’ anxiety. Who has the most to lose?

The political and economic environment is volatile and turbulent.  What I needed was a “radiation sniffer,” so to speak, a virtual monitor that would look for “leakage” that might be evidence of the Nuclear Option being planned.  At the same time, I needed an operational definition for “sniffing radiation” that would naturally provide boundaries against my finding “evidence” under every rock just to prove my hypothesis.

That set up two basic choices.  One would be to look for evidence that claimed outright that this group or that was planning to use their version of the Nuclear Option.  The other was to look for evidence that the players known to be facing the biggest losses were playing their game very close to the vest; in other words to look for evidence where what was not being said was more important that what was.

I chose the second.  This is why:

Therefore, if the individuals on the [Big Medicine] Boards and their Executive Management fail to manage their anxiety about the turbulence and the implications of transformative change in motion, and as they realize their historical resources for influence (i.e., lobbying) are waning, they will tend to take the most conservative stance to defend the survival of the organization, and that stance will tend to be to preserve the status quo at all cost.

And, the status quo has been for decades to work politically behind the scenes through lobbying and other forms of influence.  The job of the Public Relations department is to create a public face for the organization that oozes altruism and the common good over the corporation’s true mission to make as much profit as possible using every Machiavellian principle in the book.

Preparing the Nuclear Option requires planning, stealth, subterfuge, and sleight of hand.  In Board rooms around the country listen for the clink of glasses filled with expensive hooch, accompanied by the toast, “They’ll never see it coming!”

Am I skeptical and mistrusting of organizational motivations?  Of course I am.

Here is my first example for possible radiation, in a piece written by David Herzenhorn and Sheryl Gay Stohlberg for the New York Times, July 7th, titled “Health Deals Could Harbor Hidden Costs:”

Rather than running advertisements against the White House, the most influential players in the industry are inside the room negotiating with administration officials and leading lawmakers, like Senator Max Baucus, chairman of the Finance Committee.

“The very groups we have been talking to have been the most vocal opponents of health care reform; they are now becoming the vocal proponents for health care reform,” said Rahm Emanuel, the White House chief of staff.

How very “chummy” of them.  Sniff, sniff.

The Radiation Sniffer is now fully operational and on-line.  Watch for more to come.  Or if you find something interesting, send to me and I’ll check it out.

Universal Health Care Confronts the Nuclear Option

The Nuclear Option (just for those of you who are stilled mired in Bush-speak, it is pronounced “new-klee-ur” not “new-cue-lar”).  In this case I’m not talking about the U.S. Senate rule called “reconciliation.”

No, in this case I’m wondering what is going on in the minds of those who have so adamantly and vociferously have opposed Universal Health Care in the United States.  Yesterday, Paul Krugman New York Times columnist, wrote in his blog,

Yes, we can

Get more or less universal coverage, that is. The CBO scoring on an incomplete bill sent everyone into a tizzy — and also led to an avalanche of bad reporting, with claims that it said terrible things about the public option. (There was no public option in the bill.)

Now the real thing has been scored — and it’s OK. Something like 97 percent coverage for people already here, at a total cost somewhere in the $1 trillion range. Bear in mind that the Bush tax cuts cost around $1.8 trillion over a decade. We can do this — and have no excuse for not doing it.

In the minds of the opponents of UHC, however, nothing has changed.  That’s what worries me.  In fact, as the evidence mounts that assuring every American has access to health care can be a reality and not doom the economy (as they have so desperately hoped), the opponents are realizing the End-Game is upon them.  They are losing.  Not only has every traditional method of obstruction not worked, or not worked well, the vast majority of Americans are solidly against them.  Heard any good anti-health care spin from Rush, Karl, John Boehner, or Mitch McConnell in the past couple of weeks?  If they were gaining ground with their argument, neither the election in Iran or Michael Jackson’s death could drown them out.  Not even South Carolina Governor Sanford’s adventures in Wonderland would diminish their clarion call for Big Medicine.

Their voices have faded to background static.

Do not assume for a micro-second they have given up.  They are preparing the Nuclear Option.  One all-out attack on universal health care, with no regard for collateral damage, just the health of America.  In the Board Rooms of the Insurance Megacorps, Big Pharma, Corporate Hospitals, and dozens of other stakeholders firmly anchored in the Status Quo, they are planning to bring this down.  Once and for all, to obliterate the very notion of universal health care so completely, that  it will never threaten their companies and profits again.

Am I paranoid?  Well, even if you are not paranoid doesn’t mean they’re not out to get you anyway.

I’m not paranoid, actually.  I’m well read in organizational theory (it was the corner stone of my doctoral dissertation in educational policy and management), and I understand how organizations respond in unstable ecologies and economic turbulence.  When resources are threatened, the people running the organization will tend to react in predictable ways.  When the operational environment changes more quickly than expected, or in ways unanticipated, the predictable management responses are more and more stressed.  If those responses lack the ability to guide the organization through transformational change (like, oh, General Motors), the likelihood of the company failing is very high.

Keeping all that in mind, when the entire global environment, e.g., the country’s health care system, begins to collapse because of a rapid set of ecological changes so powerful the only way to survive is to change transformatively (an analog of the evolutionary concept of “punctuated equilibrium”), only those institutions that have the capacity to change at the same rate and direction required for survival will likely survive.

How, then, does the Nuclear Option fit in this model?  Organizations use their resources to influence and improve their ability to survive in the existing ecological conditions, and eliminate competition for both the resources they need to exist and to improve their chances for greater access to those resources.  But here’s the rub: Organizations are “communities of fate.”  They are actually aggregates of individuals whose investment (personally and professionally) in the success of the organization varies from person to person.  In a corporation, those who have have highest investment are typically the Board of Directors and the Shareholders.  But they have to rely on managers and workers, to both produce and protect their investment.

The managers and workers have a much different perspective on the degree to which they consider the company their community of fate.  When the organization encounters increasing turbulence in its environment, the willingness of the people actually doing the work to cast their fate to ensure its success is much less certain.  If the situation worsens to the degree the survival of the company is in question, the confidence the managers and workers have in the Board’s decision making ability to, specifically save their jobs, can change very quickly.  Some workers will leave the company and look for more stable employment.  Others will stick with it until the bitter end, if it comes to that.  But if you work for an Enron, the house of cards can collapse on top of you regardless of your loyalty.

The pressure on the Board and the managers to keep the organization both alive and solvent can increase rapidly, especially in the situation where the environment and resources are changing at a rate unprecedented in history.  Even organizations that survived earlier transformational evolutionary changes may not survive the current one.  Because of the anxiety generated by the environmental turbulence, the shareholders put more pressure on the Board and managers to preserve their investment and continue to pay dividends.  The workers who are loyal to the company also put pressure on their supervisors to help preserve their jobs.  But loyalty to the community of fate by the worker is always much riskier, because the Board and the managers can, at  any time, cut positions that can eliminate the most loyal employees under the stated intent of protecting the viability of the organization by reducing personnel costs.  This trauma to the community of fate, however, is no guarantee the organization will survive the changing ecology.  It may, instead, guarantee its demise.

Now, here’s the part, as I build the case for the Nuclear Option, that I as an organizational theorist suggest sets the stage:  The critical decisions of the Board over time to adjust to the turbulence is a not a function of taking the most conservative stance in context, but is a function of the individual members of the Board and the Executive Managements’ ability to manage their anxiety in the midst of the turbulence, and at the same time abandon the mimetic* solutions traditionally used to control that anxiety across the organizational or industrial environment.  [*mimesis: from “mime.”  A concept in organizational ecology that says Company A will observe Company B, and adopt a successful process to “avoid reinventing the wheel.”  Over time this mimed process may become an industry standard.  The down side is that when the environment changes, continuing to adopt the mimed process may limit innovation and increase the chances of organizational failure.]

Therefore, if the individuals on the Board and the Executive Management fail to manage their anxiety about the turbulence and the implications of transformative change in motion, and as they realize their historical resources for influence (i.e., lobbying) are waning, they will tend to take the most conservative stance to defend the survival of the organization, and that stance will tend to be to preserve the status quo at all cost.  As organizational rigidity increases, adaptibility and innovation are stifled.

The door for the Nuclear Option is now open.  Why?  Because the real-life environment to which we are applying my theory is not  just one company; we are applying it to a multifaceted industry that has for decades successfully resisted and obstructed the move toward universal health care.  And they know that by conspiring together and pooling their resources, they can potentially create a huge wall of resistance.  This strategy has a flaw, however.  A significant percentage of companies in the industry are supportive of UHC, and are already changing the practice of their organizations to successfully ride the transformative wave.  This fact only serves to increase the opponents’ anxiety.  Who has the most to lose?

The portion of the industry that opposes UHC has powerful political and social connections.  The Republican Party, although reduced in its influence at the last election still has significant resources at its disposal, as well as a core of voters, who for numerous reasons at least state they don’t want to pay for UHC.

This set of circumstances, powered by huge finances, politics, ideology, and desperation creates the possibility that those who have the most to lose as they perceive it are going to try and “drop the bomb” on the universal health care.  Whether they make their move before the Congress acts, or, have a strategy to destroy it even after it has been signed into law, I can’t tell.  But I believe they are well into their planning and will indeed act.

A final note.  Another principle, not from organizational theory, but from psychohistory, is also undoubtedly in play in this situation.  Speaking not literally, but figuratively:  “Violence is the final refuge of the incompetent.”