Big Insurance, Big Tobacco and You (spins in healthcare reform opposition)

[Guest guest]

_http://www.prwatch.org/node/8482_ (http://www.prwatch.org/node/8482)

Big Insurance, Big Tobacco and You

Submitted by _Anne Landman_ (http://www.prwatch.org/user/5684) on August

6, 2009 - 4:47pm.

* _corporate campaigns_ (http://www.prwatch.org/taxonomy/term/301)

* _democracy_ (http://www.prwatch.org/taxonomy/term/60)

* _tobacco_ (http://www.prwatch.org/taxonomy/term/102)

The health care consulting firm the _Lewin Group_

(http://www.sourcewatch.org/index.php?title=Lewin_Group) says that _114 million

people_

(http://republicans.waysandmeans.house.gov/News/DocumentSingle.aspx?DocumentID=1\

35531)

may lose their employer-sponsored health insurance if Congress includes a

" public option " in its health reform plan. Several Republican Congress

members recently _cited the figure_

(http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072203696\

..html) in opposing a public health

insurance option.

It's an alarming statistic, but it's not true.

The figure was based on assumptions the _Lewin Group_

(http://www.sourcewatch.org/index.php?title=Lewin_Group) made about how many

businesses would

switch their employees to a public plan. The _Congressional Budget Office_

(http://www.sourcewatch.org/index.php?title=Congressional_Budget_Office)

(CBO) came to a _very different conclusion_

(http://www.cbo.gov/ftpdocs/104xx/doc10431/07-02-HELPltr.pdf) , saying that

under the proposed law, about " 20

million fewer people would be uninsured nationwide compared with

projections under current law, " and that " in the aggregate, the number of people

obtaining coverage through an employer would change very little. " The Lewin

Group assumed all employers in the country would switch to a public plan, while

the CBO assumed only smaller employers would be able to make the switch.

It's a vast difference, but the bill leaves the number entirely open, which

permits the wild variations in estimates.

The Lewin Group's extreme estimate is suspect not just because it based it

on an outside assumption, but because the _Washington Post_

(http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072203696\

..html)

recently revealed that the Lewin Group, which is often referred to by those

opposing health care reform as a " non-partisan " and " independent " research

firm, is really a wholly-owned subsidiary of _UnitedHealth Group_

(http://www.sourcewatch.org/index.php?title=UnitedHealth_Group) , one of the

largest

private insurers in the country. UnitedHealth owns the Lewin Group under its

subsidiary _Ingenix_ (http://www.sourcewatch.org/index.php?title=Ingenix) ,

which was sued by the state of New York in 2008 for wide-scale fraud.

Ingenix created and disseminated a skewed database of physician reimbursement

rates, which was subsequently used by insurers all over the country, result

ing in huge number of citizens being bilked. Here's how the scam worked: In a

typical insurance scenario, an " out-of-network " doctor might charge $200

for an office visit but is told that the going rate is $77. The insurer then

usually pays just 80% of that figure, leaving the patient to pay the $138

difference. The lawsuit against Ingenix was based on how that " $77 rate "

got set in the first place. The number was derived from a database of claims

data that was created and maintained by Ingenix, and that Ingenix sold to

other insurers around the country. The New York Attorney General described

the arrangement as " an industry-wide scheme perpetrated by some of the

nation’

s largest health insurance companies to defraud consumers. " UnitedHealth

ultimately _settled the suit for $350 million_

(http://www.reuters.com/article/rbssManagedHealthCare/idUSN1531133620090115)

and agreed to shut down

Ingenix's medical billing information service, which was the focus of the

probe.

As the Center for Media and Democracy's _Wendell Potter_

(http://www.sourcewatch.org/index.php?title=Wendell_Potter) , former public

relations

executive for _Cigna_ (http://www.sourcewatch.org/index.php?title=Cigna) and

_Humana_ (http://www.sourcewatch.org/index.php?title=Humana) , has written, the

insurance industry is taking these and other flim-flams straight from the

_tobacco industry_

(http://www.sourcewatch.org/index.php?title=tobacco_industry) 's playbook.

Big Tobacco: A great teacher

Big Tobacco's finely-tuned PR techniques were highly effective at stalling

regulation. Cigarettes were conclusively linked to certain deadly diseases

in the mid-1950s, but the government didn't require health warnings on

cigarettes until fully a decade later, in 1965. In 1993, the _U.S.

Environmental Protection Agency_

(http://www.sourcewatch.org/index.php?title=U.S._Environmental_Protection_Agency\

) classified _secondhand smoke_

(http://www.sourcewatch.org/index.php?title=secondhand_smoke) as a " Group A

known human

carcinogen, " the same classification the agency gives asbestos, radon and vinyl

chloride. Despite this, laws protecting workers from on-the-job exposure to

secondhand smoke have been passed only recently, and when they do pass,

they are local or state laws -- not federal. Even the new _FDA tobacco law_

(http://www.sourcewatch.org/index.php?title=FDA_regulation_of_tobacco_legislat

ion) took decades to come about, even though the _Surgeon General_

(http://www.sourcewatch.org/index.php?title=Surgeon_General_of_the_United_States\

_Pub

lic_Health_Service) officially declared cigarettes harmful back in 1964.

It is also clear that the new law was crafted to disproportionately benefit

_Philip _ (http://www.sourcewatch.org/index.php?title=Philip_)

, the company that drove the law's creation and passage after a ten

year-long, secret internal " _Regulatory Strategy Project_

(http://www.sourcewatch.org/index.php?title=Regulatory_Strategy_Project) . "

Not only is the tobacco industry a pioneer in manipulating public opinion

and perception, it doesn't hesitate to stoop low to achieve its goals. An

examination of tobacco industry tactics can help show what the health

insurance industry might do next to scuttle reform of the U.S. health care

system.

The _TobaccoWiki article about tobacco industry PR tactics_

(http://www.sourcewatch.org/index.php?title=Tobacco_industry_public_relations_st\

rategies)

describes time-tested corporate PR strategies, like commissioning favorable

research, reframing the debate onto more advantageous terms, fostering

public confusion, changing the focus of the issue, broadening the issue,

staging fake " grassroots " uprisings, generating controversy where there really

is none, manipulating the media and legislators, undermining science,

creating phony economic statistics, inducing fear among the public and

harassing

and intimidating opponents, to name a few.

How low can corporate lobbying go? Some examples...

The depths to which desperate industries stoop to manipulate the public

are best illustrated by tobacco industry documents. In the _words of Philip

_ (http://legacy.library.ucsf.edu/tid/rdf12a00) , one method is to

" create a bigger monster. "

In the early 1990's, this industry was fighting a " monster " of its own:

smoking bans. The industry needed to create bigger monsters, to take people's

minds off their desire to have clean indoor air. A 1993 _Tobacco Institute_

(http://www.sourcewatch.org/index.php?title=Tobacco_Institute) (TI) _memo_

(http://legacy.library.ucsf.edu/tid/byr30c00) outlines strategies the

tobacco industry could use to fight smoking bans.

To prevent the public from becoming sympathetic towards restaurant workers

who fell ill from breathing _secondhand smoke_

(http://www.sourcewatch.org/index.php?title=secondhand_smoke) on their jobs,

authors _Joanna Hamilton_

(http://www.sourcewatch.org/index.php?title=Joanna_Hamilton) and _ G.

Sparber_ (http://www.sourcewatch.org/index.php?title=_G._Sparber) of

the TI lobbying firm Sparber & Associates, recommended promoting the idea

that restaurant workers -- particularly immigrant workers from South America

-- were spreaders, rather than victims, of disease:

Since restaurant workers are largely incapable of speaking out for

themselves, we believe the only way that the " restaurant workers as victims of

[the environmental tobacco smoke] " issue can grow is if the anti-smokers can

generate sympathy for them ... The best way of countering the [anti-tobacco

advocates], is to encourage third parties to increase public awareness of

the public health threat posed by restaurant workers. It may be hard to

generate public concern over restaurant worker exposure to ETS, when the public

is more concerned about contracting rare, Central American strains of

tuberculosis from restaurant workers.

Another strategy they recommended was to portray smoking bans as an attack

on low-income workers and small businesses, now a common theme for

industries threatened with regulation:

IV. Portray restaurant smoking bans as hitting the " little guy " by focusing

the issue on down-scale restaurants. COMMENT: Banning smoking to protect

public health is a less attractive issue when it becomes a case of upper

middle class political activists telling blue-collar workers whether they can

smoke a cigarette with their beer and hamburger platter.

The TI's plan constantly reinforces the need to deploy these tactics using

_third parties_

(http://www.sourcewatch.org/index.php?title=Third_party_technique) , like state

and national restaurant associations, to help cloak the

tobacco industry's involvement. A 1993 _Philip _

(http://www.sourcewatch.org/index.php?title=Philip_) _planning document_

(http://legacy.library.ucsf.edu/tid/tba35e00) found in the files of _Ted

Lattanzio_

(http://www.sourcewatch.org/index.php?title=Ted_Lattanzio) , Director of _Philip

Worldwide Regulatory Affairs_

(http://www.sourcewatch.org/index.php?title=Philip__Worldwide_Regulatory_A\

ffairs) , describes a novel

strategy to deal with public's awareness that children are disproportionately

affected by secondhand smoke:

Shift the debate on ETS [environmental tobacco smoke] and children to: Are

our schools and day care centers making children sick? ... Feed available

information to National School Board Association in D.C. Feed information to

Oprah, et. al. Get sick children on the shows. Research newspaper

clippings of parents who keep children at home because of school environment --

pass those on. Why? Shift the debate.

Philip actually produced an estimated budget for the proposed

program to blame schools and day cares for making children sick: $100,000.

Fabricating buzz phrases

Another technique pioneered by the tobacco industry is the creation of

alternative language and phraseology for use in discussing the issue. A 1993

_presentation_ (http://legacy.library.ucsf.edu/tid/luq22e0) prepared by the

advertising agency _Young and Rubicam_ (http://www.s

ourcewatch.org/index.php?title=Young_and_Rubicam) (Y & R) for Philip

suggests terminology to

use in public discussions about secondhand smoke, to help take the focus

off the health issue and " help forestall further smoking bans and

restrictions in public/work places. " The paper suggests using terms like

" indirect

smoke " and " incidental smoke " instead of secondhand smoke. To describe public

health advocates, Y & R suggested introducing new terms like " HVE's - Highly

vocal extremists, " and " ASA's - Anti-smoking Alarmists. " They suggest

referring to smoking bans as " exclusionary remedies, " and " reactionary " and

" knee-jerk legislation. " They also suggest terms like " On-site absentees " for

people who come to work, but who must go outside the building to smoke, or

" Corporate MIA's, " for people who are " missing in action " while they go

outside to smoke. They suggest referring to EPA science as " scare du jour, "

" selective analysis, " and " alarmist science. "

The tobacco industry did in fact _adopt such phrases_

(http://legacy.library.ucsf.edu/tid/twu39e00/pdf?search= " 2501342729 " ) in their

advertising.

Now, it's Big Health Insurance's turn

With its back to the wall, the health insurance industry is following Big

Tobacco's playbook: skewing public perception, stirring up fear, and

manipulating policy makers. It is recruiting " independent " and " credible " _third

parties_ (http://www.sourcewatch.org/index.php?title=Third_party_technique)

like the Lewin Group to crank out favorable studies, reports and

statistics, and publicize their results. It is determining which buzzwords

scare

people the most (like " socialism " ) and incorporating them into arguments that

emanate from talk show hosts and other opinion leaders. It is using the

code-phrase " personal responsibility, " which is often industry-speak for

shifting greater costs, or other burdens, onto consumers. Republicans' use of

terms like " rationing " and " government-controlled health care " is designed to

instill fear and distract from the fact that, as _Wendell Potter told Bill

Moyers_ (http://www.pbs.org/moyers/journal/07102009/profile.html) , Americans

are already suffering from Wall Street-controlled health care, where

insurance bureaucracies stand between individuals and their doctors, and, in

some cases, ration health care by _denying life-saving procedures_

(http://cbs2.com/local/nataline.sarkisyan.CIGNA.2.615167.html) .

Big Insurance has adopted Philip ' _ " Echo Chamber " _

(http://www.sourcewatch.org/index.php?title=Echo_chamber) lobbying technique in

which

lobbying firms assure politicians hear pro-industry arguments coming at them

from

every quarter of their districts. In the insurance debate, though,

corporate efforts to manufacture " grassroots opposition " to reform has reached

a

shrill new low, as we discover that _professional lobby groups_

(http://thinkprogress.org/2009/07/31/recess-harassment-memo/) like

_FreedomWorks_

(http://www.sourcewatch.org/index.php?title=FreedomWorks) and _Americans for

Prosperity_

(http://www.sourcewatch.org/index.php?title=Americans_for_Prosperity) are

behind the coordinating the unruly, threatening _mob scenes_

(http://tpmdc.talkingpointsmemo.com/2009/08/rep-doggett-mob-scene-born-of-fanati\

cis

m.php) now occurring at Democratic town-hall meetings, to scare

representatives out of voting for a public option.

A group with the vague name " League of American Voters " is paying to run a

_TV ad campaign_

(http://www.youtube.com/watch?v=PdgeSw3QqYk & NR=1 & feature=fvwp) that features a

credible figure -- a doctor in a white coat -- and

photos of bleak, empty hospital beds and seniors posing with bottles of

medicine. The doctor warns of dire dangers if health care reform is enacted,

like

rationing of care and long delays in getting cancer treatment. It turns

out that the League of American Voters is housed at the very same Washington,

D.C. address as a slew of other pro-business, conservative supposed

" grassroots " citizen groups that lobby for business interests, like _Americans

for

Tax Reform_

(http://www.sourcewatch.org/index.php?title=Americans_for_Tax_Reform) , the

_American Family Business Institute_

(http://www.sourcewatch.org/index.php?title=American_Family_Business_Institute)

, and the Property

Rights Alliance.

The health insurance industry has indeed taken Big Tobacco's playbook and

is expanding on it. If all goes according to Big Insurance's plans, people

will be misled and frightened enough to doom themselves to a watered-down,

cobbled-together " solution " to the health care crisis that will have little

or no effect on corporate profits. The upside is that we can learn from

past lessons and from dealing with the tobacco industry. We now know far more

about corporate propaganda and lobbying campaigns that we used to. By this

time, legislators, journalists and citizens should be able to see through

the insurance industry's manipulative lobbying techniques and misleading

claims and call them out for the self-serving propaganda that they are.