Deadly Spin (4 page)
Authors: Wendell Potter
One of the horror stories that we could not keep from being published, and that led to the creation of our rapid-response system, appeared in the
Hartford Courant
on August 8, 1996, under the headline “New Health Care Concern: Drive-Through Mastectomies.” Reporter Diane Levick, one of the country’s most knowledgeable and aggressive health care journalists, reported that at least two HMOs in Connecticut were requiring hospitals to discharge breast cancer patients on the same day they underwent a mastectomy unless their surgeon could prove that an overnight stay was “medically necessary.” The two HMOs were CIGNA and ConnectiCare.
The HMOs had instituted the discharge guidelines after an actuarial firm that publishes guidelines on medical practices and procedures had noted that mastectomies were being done in some parts of the country on an outpatient basis. The move outraged local surgeons and lawmakers. After Levick broke the story, dozens of other reporters did similar stories across the country.
Word of these “drive-through mastectomies” and of “drive-through deliveries” (insurers were also telling hospitals to discharge new mothers on the same day they had their baby) touched off a national backlash against HMOs that led to laws in many states mandating a stay of at least one overnight for breast-surgery patients and new mothers.
In 1997, after handling dozens of horror stories and keeping many others out of the media, I was rewarded with a promotion to the corporate PR staff, which meant I would have to relocate my family from Connecticut to Philadelphia. They were not happy to leave our home in West Hartford, but the increase in salary was too good to turn down. I thrived in my new role, and by 2002 I was leading the corporate communications department. When I left the company in May 2008, I was its top PR executive.
During my years at CIGNA, in addition to my responsibilities at the company, I became increasingly active at the industry level. I really felt I had arrived at the top of my profession when I became a regular on the Amtrak Metroliner to Washington. I worked closely with my counterparts at other big insurers on numerous trade association committees and task forces. We often met at the offices of the PR firms we hired to set up coalitions and front groups to promote the industry’s political agenda, which was mostly an ongoing effort to keep what the industry considered “anti-managed-care legislation” from being enacted.
By then, the HMO backlash had reached Congress, and several bills were introduced every year to force insurers to change or stop using entirely many of the practices that enabled them to pay less for medical care, such as refusing to include certain doctors and hospitals in their provider networks and refusing to pay for certain doctor-ordered care unless they could be convinced that it was necessary. To ensure that the bills would never pass, my peers and I hired some of Washington’s biggest PR firms to plan and implement stealth campaigns to manipulate public opinion on one issue or another as part of a broader strategy to kill any legislation the industry didn’t like.
One of the most successful stealth campaigns we launched was in response to bipartisan efforts in Congress to pass a Patient’s Bill of Rights. The insurance industry was opposed to many of the consumer protections in the bill, one of which would have forced insurers to make an external review process available to enrollees who were denied coverage for doctor-ordered treatments. Insurers also didn’t like the fact that the bill would have given enrollees an expanded right to sue their insurer and employer for wrongful denials of coverage. Using a PR firm, Porter Novelli, we formed a front group called the Health Benefits Coalition, which conducted a fearmongering campaign to convince the public—and lawmakers—that enactment of a Patient’s Bill of Rights would lead to a tidal wave of frivolous lawsuits that would cause health insurance premiums to skyrocket.
I didn’t feel then that we were doing anything unethical or underhanded. We were all well read and well educated and could hold our own at any cocktail party, regardless of the subject. We were charming and articulate and sophisticated. We all wore nice clothes and ate at the best restaurants and had kids in good schools and houses in the right zip codes. We knew people in Congress and the White House. We talked every day to reporters at the
Wall Street Journal
and the
New York Times.
We were powerful and influential—not nearly as much so as our CEOs, of course, but what we did and said mattered. The American dream didn’t get any better than this.
In my job, I talked about people who were uninsured, but only in terms of their numbers. They were all numbers—they didn’t have names or faces or families. I also talked about CIGNA’s millions of members—who likewise had no names or faces or families.
I talked about the billions of dollars in premiums and fees that CIGNA took in from those millions of members and the hundreds of millions of dollars that the company earned from these premiums and fees every single quarter.
I talked about the company’s business model and things like earnings per share and the medical-loss ratio and what was going on in Washington.
I lived and worked in this abstract world, far away from my days on Spear Branch Road and in Kingsport. But I had begun to ask myself whether managed care—especially as it was being administered by big for-profit corporations—was really the solution to the country’s worsening health crisis.
It took a movie, a trip back home to Tennessee, and the tragic death of a seventeen-year-old girl—just three years younger than my own daughter—for me to see that it was not.
What happened next made me see the world and the work I was doing from an entirely different perspective. I was about to undergo a fundamental shift that would change the direction of my life.
C H A P T E R I I
M
OST
of the two thousand people who crowded into the Grand Théâtre Lumière at the Cannes Film Festival early on Saturday morning, May 19, 2007, for the world premiere of
Sicko
, Michael Moore’s indictment of the U.S. health care system, rose to their feet at the end of the film and gave Moore and his new documentary an astonishing fifteen-minute standing ovation.
One young man, however, could not stay to applaud because of an urgent assignment. Largely unnoticed, he slipped out of the theater and made his way to his hotel room, where he placed a call to the organization in Washington, D.C., that not only had covered his trip to the French Riviera and his ticket to the premiere but also paid his salary.
Dialing America’s Health Insurance Plans, he was immediately patched into a conference call where dozens of insurance executives, including me, waited anxiously on the line. All knew of the threat to the industry; none knew any specifics. Moore had kept such tight control over the release of his film that none of us knew exactly what it was about. Would it focus on big pharmaceutical companies, as early rumors had suggested, or on the insurance industry?
As he read from the extensive notes he had taken in the back of the dark theater, AHIP’s reconnaissance agent confirmed our worst fears: Private health insurance companies played the role of the villain.
Which companies were in the movie, we wanted to know, and how badly were they portrayed?
I was cautiously optimistic. Because there had not been a single Moore sighting at any of CIGNA’s facilities or any reports that he had interviewed anyone associated with the company, I thought there was a good chance he had chosen other targets. I was hoping especially that archrival Aetna had been in his sights.
But I was wrong: CIGNA was among the first companies in the line of fire. My phone would soon be ringing off the hook with calls from reporters and TV producers wanting to get my reaction to the claims of people in the film who said we had refused to pay for needed medical care. I also knew, though, that I would get a lot of support from AHIP, which was poised to mount a massive PR campaign to discredit Moore and his movie.
Industry leaders had already agreed to provide the resources for a campaign to attack the movie because of the concern that it would persuade more Americans to support a Medicare-for-all, government-run health care system that would marginalize, if not eliminate, the role of private insurance companies. Industry-commissioned polls had been showing for several years that many Americans, worried about rapidly rising insurance premiums and reports of insurance companies refusing to pay for necessary medical treatments, were not as opposed to such a system as they used to be. Several years had passed since the fear-based propaganda campaigns financed by special interests had scared Americans away from Bill and Hillary Clinton’s health care reform proposal. There had been only occasional need for fearmongering during the industry-friendly Bush years.
Another big concern was the timing of Moore’s film. The campaigns for the Democratic and Republican presidential nominations were in full swing. If Moore’s movie attracted big audiences and generated a lot of positive buzz, it might embolden one or more Democratic candidates to join Representative Dennis Kucinich (D-Ohio) in endorsing the expansion of Medicare to cover everybody. If the man or woman elected in 2008 favored such a radical restructuring of the American health care system, the increasingly profitable insurance industry would find itself in a war for survival.
After hearing the report from Cannes, we knew that was a real possibility. Moore’s movie compared the U.S. system, dominated by large for-profit insurance companies, with the nonprofit, government-run systems of Canada, France, the United Kingdom, and even Cuba, all of which have attained universal coverage for their citizens while spending far less for care that’s as good as, if not better than, the care Americans receive. Not surprisingly, considering the anticorporate theme of Moore’s previous documentaries, the U.S. system did not fare well in the comparison.
AHIP—and every PR person in the health insurance industry—had been trying to get information about Moore’s intentions since July 2004, when he had mentioned to a reporter that his next film would be about the U.S. health care system. Most of us had feared it was just a matter of time before he and his film crew began showing up at our corporate headquarters demanding to talk to our CEOs, or worse, waiting at their homes.
In anticipation of those tactics—which he had used in most of his other films—I met with corporate security to develop a plan to make sure that managers at every CIGNA office knew what to do in the event that Moore showed up at their doorstep. I also scheduled media-training sessions with all of the company’s top executives, equipping them with pithy things to say and pointers on how not to look like a deer caught in the headlights if they got ambushed leaving their home or getting out of their limo.
Above all, we in the industry strove to keep our activities and plans close to the vest. Fearful that an internal memo or e-mail might be leaked to the media or wind up in Moore’s hands, AHIP advised all of its member companies not to put Moore’s name or anything remotely related to his project in writing. AHIP didn’t want insurance companies to appear to be on the defensive. In December 2004, it was disclosed that at least six drug companies had been warning their employees, in internal e-mails, to keep an eye out for Moore. When one of the e-mails was leaked, Moore went straight to the media with it, knowing that the drug companies had unwittingly given him exactly what he needed to generate early interest in his movie.
Determined to avoid the same scenario, insurers were giving their employees the same instructions, but not in writing. AHIP was so cautious that its staff was instructed to use the code term “Hollywood” in communications to company executives about Moore and his movie.
In one of her few written communications about Moore, AHIP president Karen Ignagni sent a note to her board of directors in late 2004 about “health care and Hollywood.” Ignagni had charged AHIP’s communications staff and PR agencies with the task of searching for every mention of the movie they could find, and they had come across a brief story in the blog Cinematical, which read in part, “Though he’s clearly passionate about exposing the problems with American health care, Moore still seems to be struggling a bit with the film—after all, he says, ‘everyone knows that health care is a mess in this country.’ His goal, then, seems to be less education than motivation: Moore hopes that [
Sicko
] ‘pushes health care to the top of the public agenda’ and, presumably, forces politicians to get involved.”
IT NEVER HURTS TO PLAN AHEAD
In late May 2007, ten days after
Sicko
’s Cannes premiere, the top public relations executives of the country’s biggest health insurers flew to Philadelphia to be briefed on AHIP’s multipronged strategy to discredit both Moore and his movie.
The meeting was being held in Philadelphia instead of Washington because the chair of AHIP’s Strategic Communications Committee was CIGNA’s CEO, H. Edward Hanway, and he wanted to host the meeting close to home. It was the second time in two weeks that the group had met there. Three days before
Sicko
’s premiere, they had convened to hear Bill McInturff, partner and cofounder of Public Opinion Strategies, a national Republican and corporate research firm, disclose the results of four focus groups and three national polls his firm had conducted for AHIP in recent months to determine Americans’ attitudes on the need for health care reform.
McInturff, who was later to be lead pollster for the 2008 McCain-Palin campaign, has had a long association with the health insurance industry, going back to the early 1990s. He earned his chops when he teamed up with the political consultants and creative team at ad agency Goddard Claussen to create the “Harry and Louise” commercials, which helped scuttle the Clinton health care reform plan in 1994. He has played a key role ever since in helping the industry defeat any federal legislation that has posed a serious threat to insurers’ profitability.
Much of McInturff’s work has been devoted to what he describes as “ ‘combat message development,’ not simply monitoring public opinion, but developing messages to defend and promote client interests on complex public policy issues.”
McInturff began his presentation by making it clear—and showing the evidence—that Americans were rapidly losing confidence in the private health insurance market. His first slide showed that there had been a significant shift in recent years and that a majority of people, according to his polls, were now saying the government should do more to solve the many problems that plagued the American health care system. Even more troublesome, a fast-growing percentage also embraced the idea that a government-run, publicly funded health care system—like the ones Moore portrayed in
Sicko
—should be implemented in the United States.
As a result of this trend and in anticipation of the first national debate on reforming the health care system since insurers had played a key role in killing the Clinton reform plan, AHIP had recently restructured its Strategic Communications Committee to include only CEOs. It had originally been made up of member companies’ top PR people, and I had served on the committee as CIGNA’s representative, but AHIP’s board reasoned that the committee’s recommendations would have greater clout throughout the industry if CEOs were perceived to have created them. (The PR chiefs, including me and my peers from the other companies that would be attending the second Philadelphia meeting, now comprised the Strategic Communications
Advisory
Committee.)
Also traveling to Philadelphia for the meeting were AHIP’s Mike Tuffin and Robert Schooling, senior vice president of the Washington-based PR firm APCO Worldwide. Tuffin and Schooling would be the main presenters of the industry’s strategy against
Sicko
.
APCO was founded in 1984 by one of Washington’s biggest law firms, Arnold & Porter, which is well known for its representation of the tobacco industry. From one office in Washington, APCO has grown into an international operation with offices in twenty-nine locations throughout North America, Europe, Asia, and Africa. On its Web site, APCO has referred to itself as “a global communications consultancy” specializing in “influencing decision-makers and shaping public opinion by crafting compelling messages and recruiting effective allies.”
One of the deceptive practices of which APCO has a long history is setting up and running front groups for its clients. In 1993, Philip Morris hired APCO to organize a front group called the Advancement of Sound Science Coalition in response to the U.S. Environmental Protection Agency’s ruling that secondhand tobacco smoke was a carcinogen. Philip Morris also hired APCO to manage what it called a “massive national effort aimed at altering the American judicial system to be more hostile toward product liability suits” and to build a coalition to advocate for tort reform. According to the Center for Media and Democracy, the tobacco industry paid APCO almost a million dollars in 1995 to implement behind-the-scenes tort reform efforts and specifically to create chapters of “grassroots” citizens’ groups called Citizens Against Lawsuit Abuse.
A 1995 APCO pamphlet described how the firm helped corporations advance their goals by influencing lawmakers, drafting legislation and regulations, and creating business coalitions tailored to specific issues: “We [APCO] use the most effective, up-to-date technology and campaign tactics to help you achieve your legislative and regulatory goals … [We have] built numerous national and state coalitions on a variety of issues including the environment, science, energy, trade, intellectual property, education, tort reform and health care … [We] apply tactics usually reserved for political campaigns to target audiences and recruit third-party advocates. Our staff has the political field experience and has written the direct mail, managed the telephones, crafted the television commercials and trained the grassroots volunteers. We apply these hard-learned skills and tactics to mobilize hundreds, even thousands, of constituents. Or, when just the ‘grasstops’ are needed, we recruit just a few of a target’s key friends or contributors to join us. No matter the issue, we bring together coalitions that are credible, persuasive and cost-effective.”