Deadly Spin (5 page)

While APCO mentions some of its clients on its Web site under the heading of “Client Success,” it doesn’t disclose all of them. You will find no mention of AHIP there. That’s because AHIP does not want the public to know anything about the PR strategies the firm creates and the front groups it sets up for the insurance industry.

At the time of the Philadelphia meeting, Tuffin had recently returned to AHIP from APCO, where he had served as a top account executive whose clients had included the pharmaceutical industry. Before APCO and his first stint at AHIP, he’d been the senior director of strategic communications at the trade group Pharmaceutical Researchers and Manufacturers of America and, earlier, the communications director at GOPAC, a Republican political action committee.

Schooling, who had joined APCO in 1995 after working as a senior field director for the National Association of Homebuilders, came from the other side of the political aisle. In the early part of his career, he had been a field director for the Democratic Congressional Campaign Committee.

For the strategy meeting, AHIP had encouraged the PR people to attend in person rather than calling in. It did not want to risk the chance that anyone other than those specifically invited would be able to hear how the industry planned to discredit Moore and his film. Secrecy was paramount. There would be no handouts. A secure conference call line was set up for those few who could not attend in person, and they were given passwords—but only after the meeting started—so they could view the PowerPoint presentations on their office computers. The “save” and “print” functions were disabled so that no one could keep any evidence, other than their own handwritten notes, that the meeting had taken place.

To drive the point home, the first slide of the presentation warned that any communications we disseminated in writing, even to employees, could wind up on Moore’s Web site.

Though the movie would not reach American screens for another month, AHIP and APCO had created a comprehensive PR campaign, elements of which, we were to learn, were already being implemented.

The initial thrust of the campaign would be an attempt to shift the media’s focus away from Moore’s agenda as much as possible and to position health insurers as part of the solution rather than part of the problem. Tuffin said that when any of us talked to the media about
Sicko
, we should acknowledge the compelling stories and personal tragedies in the film but then try to change the subject to how insurers contribute to the American health care system.

Schooling added that it was imperative for all of us to redouble our efforts to educate the public on the positive things the industry does. Hanway suggested that every company should begin collecting positive stories to counter the negative ones in the movie. Schooling said that APCO would work with any company’s PR team to help place positive stories in the media. While this effort was under way, APCO would work behind the scenes to “reframe the debate” by mounting a campaign against government-run health care systems. Schooling said the strategy to do that would be bifurcated. On the one hand, insurers would need to stay on message by continuing to talk about how they can help solve problems relating to access, cost, and quality of care. On the other hand, AHIP and APCO would recruit allies to communicate what industry spokespeople could not do with credibility—that Moore was a nut whose ideas on reform would be a disaster for the country.

Tuffin and Schooling said they had already begun recruiting conservative and free-market think tanks, including the American Enterprise Institute and the Galen Institute, as third-party allies. Those allies, they said, would be working aggressively to discredit Moore and his movie.

They then mentioned an ally that most of us had never heard of, Health Care America. It had been created by AHIP and APCO for the sole purpose of attacking Moore and his contention that people in countries with government-run systems spent far less and got better care than people in the United States. The sole reason Health Care America exists, they said, was to talk about the shortcomings of government-run systems.

Unlike the Galen Institute and AEI, Health Care America was a front group, funded by money from the health insurance industry and other special interests, that APCO would set up and run out of its offices. Although Schooling didn’t disclose this at the meeting, the person who would serve as the media contact for Health Care America would be APCO employee Bill Pierce, a man who had served in the top communications job at the Blue Cross and Blue Shield Association, another insurance trade group, and as a public affairs officer at the Department of Health and Human Services during the George W. Bush administration, before joining APCO as a senior vice president.

Creating Health Care America—which would spring into action as soon as
Sicko
hit theaters in the United States—was deemed necessary because of the steady and alarming erosion in Amerians’ opposition to government-run systems, as borne out by McInturff’s research. Health Care America would lead the effort to restore Americans’ fear of government-run health care.

While Health Care America and the industry’s allies would be doing the fearmongering, AHIP and insurers would try to persuade the public as well as lawmakers that the industry had a legitimate reason to exist. One of the key messages AHIP would stress in every media interview about health care reform during the coming months was that this time the industry would be “bringing solutions to the table,” and would be willing to make certain concessions when Congress began drafting reform legislation. This would be the part of its PR charm offensive that insurers would want the public to see.

The part they would not want the public to see, however, was their effort to depict Moore as such a polarizing figure—loved by left-wingers and liberal activists but viewed with suspicion by more conservative voters—that Democrats would talk positively about
Sicko
at their own peril. The goal was to make Moore radioactive to centrist Democrats in particular. The plan included recruiting political pundits, including some Democrats, to articulate that threat. AHIP and APCO would also reach out to political reporters and try to frame the movie as an effort on the part of Moore and other liberals to drive the agenda to the political left.

Tuffin and Schooling wrapped up their presentation with a “worst-case scenario” plan. If
Sicko
showed signs of being as influential in shaping public opinion on health care reform as
An Inconvenient Truth
had been in changing attitudes about climate change, then the industry would have to consider implementing a plan “to push Moore off the cliff.” They didn’t elaborate, and no one asked what they meant by that. We knew they didn’t mean it literally—that a hit man would be sent to take Moore out. Rather, an all-out effort would be made to depict Moore as someone intent on destroying the free-market health care system and with it, the American way of life.

TOO BAD THE CIA ISN’T THIS EFFICIENT

A few days later, my assistant brought me a one-and-a-half-inch-thick unmarked three-ring binder. The only indications that it came from AHIP were a few references in the table of contents to a white paper the organization had produced on the Canadian health care system and a few other documents on AHIP’s reform proposals.

The binder contained responses to just about any conceivable question a reporter might ask about the movie or government-run systems, but in keeping with AHIP’s ban on even mentioning Moore or
Sicko
in writing, there were no specific references to either. AHIP sent the binder to all of the PR chiefs who participated in the Philadelphia meeting to equip us with negative anecdotes and statistics about any of the health care systems depicted in
Sicko
and to remind us to always mention in our conversations with anyone about the movie that Americans do not want a government takeover of their health care system.

The phrase “government takeover” is one that has tested extremely well over the years and has been central to every campaign the industry has conducted in recent decades to defeat reform efforts, including the Clinton proposal in 1994. The industry has paid McInturff and other consultants and pollsters millions of dollars to craft and test such phrases in focus groups and surveys. Knowing from that research that many Americans react negatively to more government involvement in their lives, particularly if it involves higher taxes, AHIP ensured that a warning against a government takeover was included in the briefing packets for lawmakers in Washington, the industry’s business allies, and conservative pundits, talk show hosts, and editorial writers.

Two weeks after the Philadelphia meeting, I was on a cross-country reconnaissance mission of my own. Although the AHIP staffer who saw the movie in Cannes provided a pretty good report, he did not give many details about how CIGNA was portrayed in the film.

After hearing that the first public screening of the movie would be held in Sacramento on June 12, I asked the head of our state government affairs unit if she could finagle a ticket for me. I wanted to be as prepared as possible to answer questions from the media when they began to flood in. The best way to do that would be to see the movie myself. Terry McGann, CIGNA’s longtime lobbyist in Sacramento, was able to score a couple of tickets for a colleague and me from California State Assembly speaker Fabian Núñez, a Democrat from Los Angeles.

The screening was an unofficial premiere. The official premiere would be held four days later in the Michigan town of Bellaire, which is near where Moore and his wife live. Moore had been persuaded by the California Nurses Association and Physicians for a National Health Program—both advocates of a single-payer health care system in the United States—to show the movie in Sacramento first because California lawmakers had twice approved bills creating a single-payer system in the state. Had Governor Arnold Schwarzenegger not vetoed both bills, California would have been the first state in the nation to ban private insurance companies and operate its own government-run health care system, like many of those depicted in
Sicko
.

After picking up our tickets in McGann’s office, my colleague and I walked to the theater, trying to blend in with the thousands of politicians, state government employees, doctors, and nurses who were already in line to see the movie. Once inside, we went to the very back row and took out our pens and notebooks, ready to capture the details of the stories told in the movie by people who claimed that CIGNA had refused to pay for care their doctors had said they needed.

It seemed as if there were more stories about CIGNA than about any other company, although I didn’t pay as much attention to how badly Moore treated our competitors. Probably one of the most memorable vignettes in the whole movie was about a hearing-impaired little girl, Annette Noe, whose doctors said she needed cochlear implants in both of her ears. CIGNA initially paid for only one, saying that implantation in both ears would be “too experimental.” The girl’s father, Doug Noe, was one of twenty-five thousand people who had responded to Moore’s call for health insurance horror stories. Undoubtedly, one of the reasons Annette’s story made it into the movie is that her father told the CIGNA representative he had been dealing with that he had been in touch with Moore.

“Has your CEO ever been in a movie?” Noe asked the CIGNA guy.

The next scene showed CIGNA’s fifty-eight-story glass-sheathed headquarters in Philadelphia, where I worked. What viewers heard next was the CIGNA representative calling back and leaving good news on the Noes’ answering machine. CIGNA would pay for both implants after all.

I cringed when I heard that, but I wasn’t surprised. The squeaky wheel gets the grease in the managed care world. That wasn’t the first time CIGNA had delivered good news after a member had complained to the media about a denial. It would not be the last, either.

But the movie had an effect on me that I didn’t expect. Because of all the experience I’d had handling “horror stories” like the ones depicted, I knew that they were a common occurrence—that many Americans found themselves in similar situations every day. I also found the film very moving and very effective in its condemnation of the practices of private health insurance companies. There were many times when I had to fight to hold back tears. Moore had gotten it right. If I hadn’t been with a colleague, I probably would have joined all the others in the audience in giving the movie a standing ovation, just as the people at Cannes did when it was first screened.

The next day, the front group that APCO had set up to discredit
Sicko
issued a statement warning against “a government takeover” of health care:

“Health Care America, a non-partisan, non-profit health care advocacy organization, released the following statement in response to a California rally held by Michael Moore and a variety of advocates in support of a government takeover of our health care system.

“The reality is that government-run health systems around the world are failing patients—forcing them to forgo treatments or seek out-of-pocket care in other countries.”

Bill Pierce was listed as the contact person for Health Care America, but if you had dialed the phone number listed for him at the organization, you would have reached him at his desk at APCO in Washington.

A week later, Moore held another screening, this one in Washington. He invited members of Congress, but few showed up. He also invited the heads of the big health care trade associations. None of them attended.

The industry, however, was prepared for the event. An ad targeting the movie appeared in Washington’s newspapers. The message: “In America, you wait in line to see a movie. In government-run health care systems, you wait to see a doctor.” The sponsor: Health Care America.

For several weeks after that screening, APCO sent me and other PR chiefs daily reports of the stories it had placed in the media via Health Care America as well as the commentaries and op-eds APCO’s recruits had had published in newspapers and other media outlets from coast to coast.