Deadly Spin (31 page)

We will never be free of spin, but we can be wise to it, and we can push back against it. There is too much at stake not to try.

Acknowledgments

As I have thought about the many people I wanted to thank for helping me with this book, Stella Chambers and Bill Roesgen kept coming to mind. Mrs. Chambers, my senior year English teacher at Ketron High School in Kingsport, Tennessee, was the first person to suggest that I might be able to make a living as a writer. With her help, I landed my first job as a journalist, as Ketron’s correspondent to the
Kingsport Times-News
, a newspaper that would play a big role four decades later in my decision to make a radical change in my life and career. I can’t recall what I wrote about the goings on at Ketron that was deemed newsworthy, but somehow my dispatches attracted the attention of the paper’s editor, Bill Roesgen, who hired me as a summer intern straight out of high school. I loved being a reporter so much that I decided to major in journalism when I got to the University of Tennessee. So thank you, Mrs. Chambers, and thank you, Bill Roesgen. I’m certain I would never have written this book if not for you.

There were many others who played a more direct role in the creation of
Deadly Spin.
I am especially indebted to a group of friends and former and current co-workers from my days in the newspaper business and, more recently, in the health insurance industry and at the Center for Media and Democracy. Thank you, Deborah Bowditch, Barney DuBois, Avram Goldstein, Katie Hall, Anne Landman, and Dave MacHenry for helping me in the research and writing of the manuscript. Thanks also to my friend, former CIGNA colleague, and lawyer, Gabrielle Sellei. The many contributions you all made to the book were invaluable.

I am also indebted to Kirby Kim, my agent at William Morris Endeavor, and to the team at Bloomsbury Press who helped in the shaping, editing, and promotion of the book: Peter Ginna, George Gibson, Pete Beatty, Peter Miller, and Michelle Blankenship.

Long before I had the first thought of writing a book, many other people helped to make it inevitable that I would switch sides in the health care reform debate and become what many people have called a whistle-blower. Thank you especially Rev. Bill Golderer, Rev. Rodger Broadley, Rev. Michael Pergola, Joy Anderson, Rick Jacobs, Trudy Lieberman, Jonathan Cohn, Margie Maxwell, and Rob Scott for listening and asking the important questions I needed to answer for myself. Thank you Jamie Court, Michael Morrill, Len Nichols, Dr. Bob Crittenden, and Dr. Walter Tsou for helping me make important connections in the political and policy worlds. Thank you Richard Kirsch and your team at Health Care for America Now, especially Jacki Schechner, Doneg McDonough, Tara Straw, Ethan Rome, and, once again, Avram Goldstein, not only for the vital work you did to make sure that the bill Congress finally passed was worth passing but also for the support you gave me when I raised my hand to help in some way.

I had been a secret admirer of John Stauber and the Center for Media and Democracy, the organization John founded in 1995 to expose spin and propaganda, even while I was spinning for the insurance industry. Thank you, John, for being a flack’s worst nightmare and for welcoming me to the CMD team as you were preparing to retire and hand the reins of the organization to the incomparable Lisa Graves. Thank you, Lisa, for the opportunity to work with you and learn from you and for the truly remarkable support you have given me. And thank you Nikolina Lazic, Page Metcalf, Sari Williams, and Mary Bottari at CMD. I have never been a part of a team I have enjoyed more. I mean that sincerely.

Two other people I am especially grateful to are Sen. Jay Rockefeller of West Virginia, who afforded me the opportunity to testify before his Senate Commerce, Science, and Transportation Committee in what was to become my first of many public appearances as an industry critic and reform advocate, and to Bill Moyers, whose July 2009 interview with me on his
Bill Moyers Journal
on PBS made it possible for me to reach a national audience with my story.

Finally, thank you Stan Brock of Remote Area Medical and thank you, thank you, Nataline Sarkisyan. The world is a much better place because of you.

Notes

INTRODUCTION

1
.   
Taking the Risk out of Democracy: Propaganda in the U.S. and Australia
, Alex Carey, University of New South Wales Press, 1995.

2
.    Karen Ignagni, president of America’s Health Insurance Plans (AHIP), White House, March 5, 2009.

3
.    “Health Insurance and Mortality in U.S. Adults,” Andrew P. Wilper et al.,
American Journal of Public Health
, December 2009, 99: 2289–95.

4
.   
The Hidden Persuaders
, Vance Packard, David McKay Company, 1957, 32.

5
.   
The Invisible Persuaders
, David Michie, Bantam Press, 1998.

CHAPTER III: PERCEPTION IS REALITY

1
.   
Cutlip & Center’s Effective Public Relations
, Glen M. Broom, Prentiss Hall, 2009, 3.

2
.    Public Relations Society of America,
http://www.prsa.org/AboutPRSA/PublicRelationsDefined
.

3
.   
Toxic Sludge Is Good for You
, John Stauber and Sheldon Rampton, Common Courage Press, 1995, 17.

4
.   
The Unseen Power: Public Relations—A History
, Scott M. Cutlip, Lawrence Erlbaum Associates, 1994, 52–53, 97.

5
.   
The Father of Spin
, Larry Tye, Henry Holt and Company, 1998, ix.

6
.    Ibid., 23–31.

7
.   
Toxic Sludge
, Stauber and Rampton, 292–94.

8
.    Public Relations Society of America,
http://www.prsa.org/AboutPRSA
.

9
.    Franco did not admit to or deny the charges but did enter into an agreement with the SEC not to violate the agency’s regulations in the future.

10
.    “Wal-Mart Stores Inc.: Publicist Enlists Bloggers to Combat Negative News,”
Wall Street Journal
, March 7, 2006.

11
.    “Wal-Mart vs. the Blogosphere,” Pallavi Gogoi, BusinessWeek.com, Oct. 18, 2006, accessed at
http://www.msnbc.msn.com/id/15319926
.

12
.    “Book of Tens: Agencies of the Decade,”
Advertising Age
, Dec. 14, 2009, accessed at
http://www.edelman.com/news/2010/Ad_Age_AgencyAList.pdf
.

13
.   
Toxic Sludge
, Stauber and Rampton, 6–8.

14
.   
Propaganda
, Edward Bernays, Ig Publishing, 2005, 37.

15
.   
The Biography of an Idea: Memoirs of Public Relations Counsel Edward L. Bernays
, Simon and Schuster, 1965, 652.

16
.   
Mein Kampf
, Adolf Hitler, vol. 2,
A Reckoning
, chap. 6, “War Propaganda,” accessed at
http://www.hitler.org/writings/Mein_Kampf/mkv1ch06.html
.

17
.   
The Later Years: Public Relations Insights 1956–1986
, Edward L. Bernays, Howard Pen Hudson Associates, 1986, 115.

18
.   
Later Years
, Bernays, 139.

19
.   
Effective Public Relations
, Broom, 25.

CHAPTER IV: REMOTE AREA MEDICAL IN
WISE COUNTY, VIRGINIA

1
.   
How to Lie with Statistics
, Darrell Huff, W. W. Norton & Company, 1952, 100–121.

2
.    “Changes in Health Insurance Coverage, 2007–2008: Early Impact of the Recession,” Kaiser Commission on Medicaid and the Uninsured, October 2009.

3
.    “Average Family Health Insurance Policy: $13,375, Up 5%,”
USA Today
, Sept. 16, 2009.

4
.    “Employers, Workers, and the Future of Employment-Based Health Benefits,” Employee Benefits Research Institute, February 2010.

5
.    “More Small Firms Drop Health Care,”
Wall Street Journal
, May 26, 2009.

6
.    “Behind Aetna’s Turnaround: Small Steps to Pare Cost of Care,”
Wall Street Journal
, Aug. 13, 2004.

CHAPTER V: HEALTH CARE HISTORY,
REFORM, AND FAILURE

1
.   
http://www.youtube.com/watch?v=fRdLpem-AAs
.

2
.   
PBS Newshour
, March 30, 2007.

3
.   
The Social Transformation of American Medicine
, Paul Starr, Basic Books, 1982, 237.

4
.    Ibid., 243.

5
.   
One Nation Uninsured: Why the U.S. Has No National Health Insurance
, Jill Quadagno, Oxford University Press, 2005, 17.

6
.    Ibid., 19.

7
.   
Social Transformation
, Starr, 253.

8
.    The Blue Shield plans, which initially only provided coverage for medical care provided by physicians, developed separately from Blue Cross plans, which in their early years only covered hospital care. The first Blue Shield plan was organized in California in 1939.

9
.   
Social Transformation
, Starr, 261–66.

10
.   
One Nation Uninsured
, Quadagno, 23.

11
.   
Critical: What We Can Do About the Health-Care Crisis
, Senator Tom Daschle, Thomas Dunne Books, 2008, 49.

12
.   
Social Transformation
, Starr, 277.

13
.   
Critical
, Daschle, 51.

14
.    Ibid., 52.

15
.   
Social Transformation
, Starr, 285.

16
.   
Critical
, Daschle, 53.

17
.    Ibid.

18
.    Ibid., 59.

19
.    Ibid., 63.

20
.   
Social Transformation
, Starr, 381.

21
.   
One Nation Uninsured
, Quadagno, 116.

CHAPTER VI: CONSUMER-DRIVEN CARE

1
.    “How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007,” Cathy Schoen et al.,
Health Affairs
, June 2008. Respondents to the Commonwealth Fund survey were identified as underinsured if they spent 10 percent or more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income.

2
.    “Health Care Access Problems Surge Among Insured Americans,” Doug Trapp
American Medical News
, July 21, 2008.

3
.    “CIGNA Ex-CEO Hanway’s Retirement Payments Near $111 Million,”
Wall Street Journal
, March 19, 2010.

4
.   
The Great Risk Shift
, Jacob S. Hacker, Oxford University Press, 2006, 37.

5
.    “CIGNA Choice Fund (SM) Study Provides New Insights on Consumer Decision-Making in Consumer-Driven Health Plans,” http://newsroom.cigna .com/article_display.cfm?article_id=669.

6
.    “Healthier, Wealthier and Wiser? An Overview of Consumer-Driven Health Care,” Roberta W. Goodman, UnitedHealth Group, 2005.

7
.    PricewaterhouseCoopers news release, July 18, 2005.

8
.    “Workers May Be in for Health Plan Sticker Shock,”
USA Today
, Oct. 21, 2005.

CHAPTER VII: IT’S ALL ABOUT THE MONEY

1
.    “What Happened to Health Care Reform?” Paul Starr,
American Prospect
, Winter 1995, 20–31.

2
.    “The Demise of the Clinton Plan,” Theda Skocpol,
Health Affairs
, Spring 1995, 66–85.

3
.    “National Health Expenditure Data,” Center for Medicare and Medicaid Services, accessed at
http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf
.

4
.    “Lost Cause,” Peter H. Stone,
National Journal
, September 1994.

5
.    “Killing Health Care Reform,” Thomas Scarlett,
Politics
, October/November 1994, 34.

6
.    “Shaping Public Opinion: If You Don’t Do It, Somebody Else Will,” Blair Childs, seminar, Chicago, Dec. 9, 1994.

7
.   
Toxic Sludge Is Good for You
, John Stauber and Sheldon Rampton, Common Courage Press, 1995, 96.

8
.   
My Life
, William Jefferson Clinton, Alfred A. Knopf, 2004, 62.

9
.    “Demise,” Skocpol, 66–85.

10
.    Ibid.

11
.    “What the For-Profit Trend in Health Care Really Means,” Paul Wynn,
Managed Care
, June 1996, accessed at
http://www.managedcaremag.com/archives/9606/MC9606.profit.shtml
.

12
.    “Nonprofit Health Insurers: The Financial Story Wall Street Doesn’t Tell,” Susan R. Barrish, Alliance for Advancing Nonprofit HealthCare,” accessed at
http://www.healthleadersmedia.com/pdf/white_papers/wp_alliance_011904.pdf
.

13
.    “Kathleen Sebelius,” WhoRunsGov.com,
http://www.whorunsgov.com/profiles/kathleen_sebelius
.

14
.    “CareFirst Sale Rejected by Md. Insurance Commissioner,” Jo Becker,
Washington Post
, March 6, 2003, accessed at
http://www.carefirstwatch.com/news/news.cfm?ID=41
.

15
.    “CEO Total Compensation for Selected Blue Cross-Blue Shields, U.S. Medicare Program, 2007,” Health Care for America Now.

16
.    Testimony of David Balto, senior fellow, Center for American Progress Action Fund, before the U.S. House of Representatives, Judiciary Committee, Subcommittee on Courts and Competition Policy, on H.R. 3596, Health Insurance Industry Antitrust Enforcement Act of 2009, accessed at http://judiciary.house.gov/hearings/pdf/Balto091008.pdf.

17
.    “AMA Study Shows Competition Disappearing in the Health Insurance Industry,” American Medical Association, Feb. 23, 2010, accessed at
http://www.ama-assn.org/ama/pub/news/news/health-insurance-competition.shtml
.

18
.    “Premiums Soaring in Consolidated Health Insurance Market: Lack of Competition Hurts Rural States, Small Businesses,” Health Care for America Now, May 2009, accessed at http://hcfan.3cdn.net/1b741c44183247e6ac_20m6i6nzc.pdf.

19
.    “A Handshake That Made Healthcare History,” Globe Spotlight Team,
Boston Globe
, December 28, 2008, accessed at
http://www.boston.com/news/health/articles/2008/12/28/a_handshake_that_made_healthcare_history
.

20
.    “Premiums Soaring,” Health Care for America Now.

21
.    “UnitedHealth CEO McGuire Gives Back $620 Million,” Peter Lattman,
Wall Street Journal
, Dec. 7, 2007, accessed at http://blogs.wsj.com/law/2007/12/07/unitedhealth-ceo-mcguires-gives-back-620-million.

22
.    Securities and Exchange Commission filings.

23
.    “The Explosion of Executive Pay and the Erosion of American Prosperity,” William Lazonick, University of Massachusetts Lowell and Université Montesquieu-Bordeaux IV, Feb. 24, 2010.

24
.    “Medical Benefit Ratios of Private Insurers, Public Medicare Plan, 1993 to 2007,” Health Care for America Now, October 2010, accessed at http://hcfan.3cdn.net/15b2e716998ad2bdd0_ktm6bz8u0.pdf.

25
.    “Health Insurers Falsely Claim Rising Costs Justify Soaring Premiums,” Health Care for America Now, March 2010, accessed at http://hcfan.3cdn.net/578b1f7456962bfa7a_r6m6bhcjn.pdf.

26
.    Ibid.

27
.    Securities and Exchange Commission filings.

28
.    “Report to the Congress: Medicare Payment Policy,” Medicare Payment Advisory Commission, March 2009, accessed at
http://www.medpac.gov/documents/Mar09_EntireReport.pdf
.

29
.    “A Scrappy Insurer Wrestles with Reform,” Reed Abelson,
New York Times
, May 16, 2010.

CHAPTER IX:
ERISA
STYMIES THE SARKISYANS, AND US

1
.    “ERISA: Barrier to Health Care Consumers’ Rights,” National Association of Insurance Commissioners, 2000.

2
.   
Making a Killing: HMOs and the Threat to Your Health
, Jamie Court and Francis Smith, Common Courage Press, 1999, 122.

3
.    “Employee Health Plan Protections Under ERISA,” Karl Polzer,
Health Affairs
, September/October 1997, 93–102.

4
.    For more information about Nataline’s Legacy Fashion Show, contact Hilda Sarkisyan at [email protected].

CHAPTER X: A VICTORY, OF SORTS

1
.    “Obamarama,”
Chicago Reader
, March 17, 2000, accessed at http://www1.chicagoreader.com/obama/000317.

2
.    “Did Obama Campaign on Public Option?” Mark Murray and Domenico Montanaro, MSNBC, Dec. 23, 2009, accessed at http://firstread.msnbc.msn.com/archive/2009/12/23/2159620.aspx. Also see “Did Obama Campaign on the Public Option? Yes but Not Entirely,” Sam Stein, Huffington Post, Dec. 22, 2009,
http://www.huffingtonpost.com/2009/12/22/did-obama-campaign -on-the_n_401204.html
.

3
.    “Obama Proposes $634 Billion Fund for Health Care,” Ceci Connolly,
Washington Post
, Feb. 26, 2009, accessed at
http://www.washingtonpost.com/wp-dyn/content/article/2009/02/25/AR2009022502587.html
.

4
.    “Karen Ignagni,” WhoRunsGov.com,
http://www.whorunsgov.com/Profiles/Karen_Ignagni
.

5
.    “Fat Paydays for Key Players on Both Sides of Health Care Debate,” Justin Elliott, Talking Points Memo, March 18, 2010, http://tpmmuckraker.talkingpointsmemo.com/2010/03/health_care_lobby_players_fat_pay_days.php.

6
.    “Unlikely Lobbyist Will Lead H.M.O.’s into Battle,” Robert Pear,
New York Times
, July 12, 1999, accessed at
http://www.nytimes.com/1999/07/12/us/unlikely-lobbyist-will-lead-hmo-s-into-battle.html?sec=health&spon=&pagewanted=all
.