Health Care Reform #2 Issue in 2008 Election

The Kaiser Family Foundation is conducting a series of polls on how health care issues is impacting the 2008 presidential election. Their first poll was in March and the most recent in October. From the very beginning, health care was identified by respondents as the most important domestic issue, and the second most important issue overall, respondents want the new president and Congress to address. (The number one issue is Iraq.)

The Kaiser Foundation keeps tweaking the wording of their question which makes it challenging to compare some of the results over time. However, regardless of how they ask the question, health care reform ranks higher than the economy, immigration, and education, to name just a few additional hot button issues. And it holds this distinction among Democrats, Republicans and Independents. In other words, health care reform is an equal opportunity hot button.

Consider the latest poll. The question was “What do you think is the most important problem for the president and congress to address?” The results were:

All respondents:
1. Iraq (54%)
2. Health care (29%)
3. Economy (16%)
4. Immigration (12%)
5. Frustration with government (6%)
6. Terrorism (5%)

The top four issues were identical among Republicans, Democrats and Independents, although the percentages changed a bit. For example, Health care was the top issue for 22 percent of Republicans, 36 percent of Democrats and 31 percent of Independents. (Republicans were a bit more concerned about terrorism and Democrats with education.)

Interestingly, the top four issues haven’t changed since the tracking surveys started in March. However, since June, health care has become an increasingly more common response. The surveys asked respondents what “two issues would you most like to hear the presidential candidates talk about.” 21 perecent said health care in June. 30 percent listed health care in August 30 and by October the percentage mentioning health care had risen to 38 percent. To put it in perspective, in the October survey, 44 percent mentioned Iraq. Health care reform is still the number two issue in the campaign, but it’s an increasingly important number two.

This isn’t surprising. As I noted in previous posts on California public opinion polls (August post, September post), voters are constantly and consistently hearing that the health care system is broken. They can’t escape the publicity surrounding the film Sicko or ignore the news surrounding health insurer’s behavior. Given this drumbeat, public opinion can’t help but be swayed. 

Within health care issue, two issues emerge: the cost of care and the uninsured. The saliency of these sub-issues varies by political party. Republicans, by more than a two-to-one margin, want presidential candidates to talk about “reducing the costs of health care and health insurance” rather than “expanding health insurance coverage for the uninsured.”  Democrats are nearly equally split on the two issues: 41 percent want to hear about coverage; 38 percent want to hear about costs. While Independents want to hear about costs (39 percent) a bit more frequently than about coverage (30%).  For all groups, “improving the quality of care and reducing medical errors” was the third most mentioned issue followed by “reducing spending on government programs like Medicare and Medicaid.” Only seven percent of all respondents mentioned this last issue.

The tracking polls contain more nuggets of information and I’ll be reporting on them as they’re published. The biggest takeaway for now is that the issues of importance in the 2008 election are solidifying, but they’re not locked in stone. Outside events could change what voters care about. And who is nominated will influence the issues as well. However, regardless of what happens, health care reform will be among the issues that matter when voters cast their ballots. Which means it will be on the agenda of both Congress and the new president come 2009.

Agents Need to Deliver Value — And Let People Know About It

It’s not that anyone wants to do away with agents. OK, let me rephrase that. Single payer advocates would like to do away with agents. They also want to do away with insurance companies, too, so it would be wrong to take this personally. Most of the folks working on health care reform don’t think that way. In fact, part of the problem is they don’t think think about agents — and the value we add to the system — much at all. As a result, a lot of the reform proposals out there are likely to eliminate agents and brokers from certain market segments,  or at the very least, greatly diminish what we can contribute. This isn’t intentional, but it could be the result. And, of course, from the squirrel’s rabbits point of view, whether the truck runs them over intentionally or inadvertently, it’s still roadkill.

But it’s not only the truck’s fault. As insurance professionals we need to take responsibility for selling our value. And for earning it every day in our interactions with our clients.

Ross Pendergraft, who is Media Relations Chair for the Los Angeles Association of Health Underwriters recently circulated an email which is spot on, so much so, I’ve reprinted it below. (For those who aren’t aware of the background, Oprah devoted a recent show to health care reform. Her guests included Michael Moore, director of the film Sicko,and Karen Ignagni, president and CEO of America’s Health Insurance Plans, a trade organization. NAHU is the National Association of Health Underwriters, a professional organization representing insurance agents and brokers). 

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After viewing The Oprah Winfrey Show, “Sick in America: It Can Happen to You,” I have a NAHU challenge. The America public needs to know that there are Health Insurance Agents able to assist people with their insurance claims especially when they are too sick and vulnerable.

Case in point: 1. The Oprah show highlighted three individuals with severe medical conditions, each having a battle with their insurance carrier. There was not one single mention that a Health Insurance Agent could have assisted these individuals with their ordeal. 2. Karen Ignagni, president of America’s Health Insurance Plans, in her commanding performance supporting the health insurance industry, never once mentioned anything about a Health Insurance Agent and the support the agent could have provided.

I would encourage everyone to read the transcript from the show (Summary of Oprah program, “Sick in America: It Can Happen to You) and, better yet, to watch the show.

When I watched the movie Sicko I was extremely disturbed by the many half-truths that Michael Moore broadcast leaving me very little respect for Mr. Moore. However, I have to say after watching Oprah, I found myself starting to resonate with some of the beliefs that Michael Moore has with regards to our country’s health care problem.

Rather than accept my comments, go to the Oprah Message Board and see what the American public has to say after viewing the show. I would also encourage all health insurance agents to respond to the Oprah show.

I love this from the show: Although Karen Ignagni admits that America’s current health care system has its faults, she says a government takeover is not the answer. “There’s no perfect system. What we need to do is craft something that’s uniquely American. We have to take responsibility in insurance plans of doing a better job dealing with mistakes, dealing with people who are falling in the cracks, good physicians and good hospitals,” she says.

Respectively,
Ross Pendergraft

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Agents can make a huge difference in the health care outcomes for their clients. We serve as counselors when consumers shop for coverage and advocates when they encounter problems. Both NAHU and CAHU strive hard to get this message out to decision makers and opinion shapers. The reality is, however, that every agent needs to take responsibility for delivering this message. It starts with asking the question, “Do I add value to the products I sell?” If the answer is “yes,” then make sure your clients — and their legislators — know (CAHU’s current Operation Drumbeat communication provides a sample letter your clients can use as a starting point). If the answer is “no,” then it’s time to turn your business over to an agent who can provide meaningful services to your client or to change your ways before legislators, inadvertently or not, changes your business for you.

Sicko — Again

I thought, or at least hoped, we were done talking about Sicko, Michael Moore’s film on America’s health care system. But with a lull in the action up in Sacramento, the movie is having a bit of renaissance — or maybe it’s just the inevitable backlash. Recently, John Stossel of ABC’s 20/20 news program took Mr. Moore to task for distortions and inaccuracies in Sicko. The first segment focused on Mr. Moore’s claim in the film that Cuba’s health care system is superior to America’s. It’s less than six minutes long. The next week, however, the entire program was devoted to Stossel versus Moore in an examination of health care systems here and abroad.

Who won depends on where you stood before the interview, but most neutral observers seem to think Mr. Stossel came out ahead.  The interview can be viewed at on You Tube in six segments: Part 1. Part 2; Part 3; Part 4; Part 5; and Part 6.

For the past several months, if not years, advocates of government run programs have been bombarding the public with horror stories about health care in the United States and, especially, about the evils of our current insurance system. ABC’s 20/20 is the first national broadcast I’ve seen questioning this drumbeat. To defenders of the current system it will be reassuring. To those attacking the system it will be an example of corporate America defending one of its own: the insurance industry. To non-partisans I think it will be eye opening and educational. It’s also the kind of program agents will want to share with their clients. Those wishing to can buy a DVD of the program at ABC’s online store.

For those in Los Angeles, there’s Sicko-related event worth taking a look at. On Thursday, September 27th, the Pacific Research Institute and Americans for Free Choice in Medicine are presenting  a program entitled “Sicko and Its Malcontents: Health Care on Film” Promised is a debate on the accuracy, impact and purpose of films like Sicko and of others which attack the Canadian and European health care systems as vehemently as Mr. Moore attacks America’s. PRI and AFCM are both conservative/libertarian-leaning groups, so the emphasis is likely to be that government-run systems increase taxes while reducing access to health care. Interestingly, however, the moderator will be Los Angeles City Councilman Bill Rosendahl. For many years before entering politics, he hosted a cable talk show and is, I believe he is a single payer advocate. The event should be interesting — and it’s free. (Really free. Taxes will not rise as a result of the event. OK, parking at the event is $8.00, but you might find something on the street).

Soon the Legislature will fully engage in health care reform again. Until then, well, we’ll always have Sicko.

Field Poll Reflects Non-Stop Industry Drubbing

On Wednesday, the venerable Field Poll released its latest survey on California voters’ attitudes towards health care reform. It shows a remarkable shift in public opinion since Field’s previous survey, conducted in December 2006 and released in January 2007.

By remarkable, I mean earthshaking. Consider the percentage of respondents preferring to make change within the current system versus those willing to chuck the whole thing and start over with a new, government-based system:

  • In December, 55 percent supported changes within the system; now just 33 percent do
  • In December 24, percent supported a governorment-run single payer system; now 36 percent do.

This kind of shift ranks pretty high on the political Richter scale. It’s not the Big One, but it is a big one, rattling the nerves of every politician within its reach — meaning every officeholder in the State Capitol. And it’s enough to have them worried about the after shocks.

This shift, however, shouldn’t be surprising. In fact, the surprise would have come if the public’s attitude toward the health care system had not changed since December. Since then we’ve had:

  • Governor Arnold Schwarzenegger introduce comprehensive reforms to fix a system he describes — at least weekly — as broken.
  • Legislators from both parties and both houses introducing their own reform packages to change a system in need of tweaking (the Republican characterization) or to fix a system that is severely broken (the Democratic presentation) — but in any case, both are proclaiming a need for change.
  • A tremendous publicity campaign behind Michael Moore’s film, Sicko, in which he uses his considerable skill and talent to demonstrate that the system is severely broken and we’d all be better off French.
  • Senator Sheila Keuhl and her allies bringing thousands to the State Capital in support of her single payer bill, SB 840, not once but several times to proclaim the current system is broken beyond repair.
  • Democratic Presidential candidates holding more debates than anyone should have to endure, and each proclaiming at each event that they have the solution for America’s broken health care system.
  • Health plans behaving badly as if to demonstrate that parts of the system are truly broken, and regulators having a grand time doing their appropriate job of pointing this out.

And the list could be expanded easily expanded, but you get the point. If someone tells you something is broken often enough you’re going to believe that something is broken. And in this case, there are problems which need addressing, so the drumbeat of criticism has significant credibility.

No industry or person can withstand this kind of consistently repeated negative news — just ask John Kerry, a war hero until he was Swiftboated in the 2004 campaign. Well, now the insurance industry is being Swifboated. As noted, some of it is deserved, some of it is self-inflicted, and some of it is just politics. Even an industry with a large resevoir of public goodwill would be damanged, and the health insurance industry seems genetically incapable of generating much goodwill.

So it is no surprise the Field Poll shows an tremendous swing in the public’s attitude towards the health care industry:

  • In December, 51 percent said they were satisfied with the health care system; now just 28 percent are.
  • In December, 44 percent said they were dissatisfied with the health care system; now 69 percent are.

So the health care system as we know it is doomed, right? We’ll be mimicking the Canadians by January, is that it?

Well, maybe not. There will be changes, sooner than later. But then, some change is needed. Virtually everyone agrees on that. The real question then is, what kind of change? I don’t think it will be a single-payer system. The Governor won’t do a 180-degree flip on that one just because of a poll. My biggest concern is that in their haste to respond to the need for health care reform, the Legislature and the Governor will pass unartful reform, overflowing with unintended and dire consequences.

What the poll will impact is the enthusiasm with which certain groups pursue initiatives for next year’s ballot. If you’re looking for a vote of the people to enact substantial change, the August Field poll is a strong wind in your sails. Getting the signatures should be, to maul the metaphor, a breeze.

But advocates of government-monopoly health care shouldn’t get too excited about the poll. The industry has taken a huge number of hits. So much so, it can’t fall much lower. So this is as good as it gets for single payer backers. By next February or November or whenever an initiative is voted upon, the numbers will have changed — they always do.

A European’s View of Sicko

I’m actually getting a bit bored of all the Sicko hullabaloo. To his credit, however, Michael Moore has created quite a conversation. Here’s an interesting take from Jurgen Reinhoudt, a research assistant at the conservative American Enterprise Institute. Mr. Reinhoudt is from the Netherlands and, besides researching single payer systems, he’s seen one first hand. The anecdotes he tells are frightening and he ably takes Mr. Moore to task for his one-sided, biased movie.

Discussing Sicko: Agent Resources

June 29th marks the release of Michael Moore’s latest film, Sicko. The movie is a brutal attack on America’s health care system. It reflects Moores stated hope that the film sparks a movement “to eliminate private, profit-making health-insurance companies. There’s absolutely no room for them in this country,” he has said.

Michael Moore is an Ocsar-winning director and is generating tremendous publicity for his film. He has or will be appearing on Oprah, Leno and Letterman. He’s already testified on behalf of SB 840, the single payer bill now be considered by California’s Legislature. So it is highly likely you’ll be asked by clients and friends as to what the fuss is all about.

Fortunately, there are several resources available to help you respond to these questions:
The “Three Myths of a Single-Payer Health Care Delivery System” Presentation. This PowerPoint presentation — complete with speaker’s notes — debunks the myths of single-payer system superiority.

Janet Trautwin’s Letter to the Editor Published in Time Magazine.
NAHU’s Executive Vice President and CEO directly takes on Michael Moore and Sicko. The text of her letter is below.

Daniel Weintraub’s Column in the Sacramento Bee. While Weintraub usually writes favorably concerning single payer reform proposals, in this column he writes a thorough critique of the errors in Moore’s film.

On the Fence Films This is independent film maker Stuart Browning’s site with several short films on powerfully illustrating the failings of Canada’s single payer system.

Agents should review these resources prior to June 29th and to make use of them. The tremendous publicity for Sicko will mean local radio stations, community organizations and others will be receptive to hearing alternative views to Michael Moore. Become the expert they want to hear from and get the message out: yes, America’s health care system needs reforming, but what Moore proposes isn’t the way.

Fortunately, Health Underwriters has alternatives. In addition to CAHU’s Healthy Solutions plan, the National Association of Health Underwriters will be unveiling it’s health care reform plan during its national convention in Denver this coming week.Agents have an important perspective on the health care system. We also have a responsibility to share it. I hope these resources help.

The following is Janet Trautwein’s letter to the editor published by Time Magazine on June 6th:
“Filmmaker Michael Moore romanticizes the government-run health-care system in Canada [May 28]. I wonder if he really understands what a single-payer system would mean for Americans. The government would hold a monopoly over health-care coverage, offering one insurance plan with no alternatives. If the government decided to reduce funding or deny coverage for certain medical technologies or procedures, patients would have to forgo their use or pay for it out of pocket. Under the current system, if people are dissatisfied with their plan, they can simply switch insurance carriers. No one denies the moral imperative for reform to provide health-care access to all Americans, but a single-payer system is not the answer.”

Moore’s Solution: Eliminate For-Profit Health Plans

Michael Moore has made it clear one purpose of his film, Sicko, is to build support for eliminating for-profit health plans. For example, the Dow Jones Newswires recently reported Moore as hoping his film “film sparks a movement ‘to eliminate private, profit-making health-insurance companies. ‘There’s absolutely no room for them in this country,’ he said.

Moore’s take seems to be that pursuit of profits is a direct conflict with health care financing. Health care is too important to let for-profit companies to participate in this sector.

But food is important. So is shelter and transportation. Should all of these functions be taken over by the government? Moore notes that police services are government supported. That’s true. Yet there’s also a huge for-profit security industry in this country. So why the fixation on the health insurance industry? Especially since many of the practices he deplores in his films are also engaged in by non-profit health care companies?

So, two requests for comments:
1. Please post your take on why for-profit concerns should be removed from health care, but not other important needs such as food and housing; and
2. Please share your experiences with for-profit, non-profit and government heatlh care coverage in the context of whether one type of entity is better than another.

Thanks.

More on Michael Moore’s “Sicko”

Michael Moore continues to seek publicity for his new film, Sicko, which blasts the American health care system. My earlier post warned about the dangers of basing public policy on anecdotes. But as I noted there, I hadn’t seen the film.

Sacramento Bee reporter Daniel Weintraub has and he’s written a very intiguing column titled, “Moore on health insurance: Entertaining but flawed.” His views are interesting in that he’s written very favorably concerning single payer systems (the solution Moore advocates), yet his column takes Moore and his film down several notches. I urge you to read the entire column, but to whet your appetite, here’s some excerpts:

“At turns funny, shocking and just plain sad, the documentary builds a solid indictment of private health insurance.”

“But while his film might be effective as propaganda, it is also flawed. It is a hodgepodge of anecdotes, hasty conclusions and glaring omissions layered one on top of another until the viewer is almost forced to submit to Moore’s thesis.”

“He blames all of the industry’s bad behavior on the profit motive. But one of his biggest villains — Kaiser Permanante — is a nonprofit. And while he does a gut-wrenching segment on Los Angeles hospitals dumping homeless patients back on the street after they are treated, he mentions only in passing that one of the guilty parties is a public hospital owned by the government. Aren’t those the same people he wants to put in charge of all of our health care?”

“He tells the gripping story of a man who died of cancer after his health plan refused to pay for experimental treatment. But he never asks his audience to consider that no matter what kind of system we have, it will not provide unlimited care, especially experimental care. There will always be a gatekeeper. Under a single-payer plan, that person would be a government employee — some might even say a bureaucrat. Would that really be any better?”

For better or worse, Sicko is a film all of us concerned about health care reform are going to have to see. Hopefully we can view it with as open a mind, and as deep an insight, as Weintraub.

Here’s a pdf of the column: Daniel Weintraub: “Moore on health insurance: Entertaining but flawed” 

Here Comes Michael Moore

Get ready. Michael Moore, the director of Farenheit 911 and other documentaries is taking on America’s health care system. His stated goal for his new film, Sicko, is to do away with insurance companies, turn all health care coverage over to the government and regulate pharmacies as if they were utilities.

The movie will be in theaters everywhere come the end of June and I can’t comment on the details until I’ve seen it (I know that doesn’t stop others, but I’ve never understood how someone can criticize a piece of work they’ve never seen). I have seen the trailer, however, and read interviews Moore has given. It’s clear this film will be like his others: blatantly confrontational, heavily anecdotal, and chock full of “gotcha’s.”

So, saving comments on the content of the film for a after-release post, it seems to me the film will be a two-edged sword. On the one hand it will raise awareness of the need to fix what’s wrong in the current health care system. On the hand, by relying on anecdotes to make its case for reform, it may lead distract from reasoned, thoughtful debate.

The power of movies is immense. They not only help people think, they help them to feel.  Moore is an artist and his use of sight and sound brings his anecdotes home. He makes his anecdotes compelling and motivating.

He’s not alone in this. You won’t see Stuart Browning of On the Fence Films sitting down with Oprah Winfrey or Jay Leno (Moore is already booked). But his short films taking to task the Canadian single-payer system are as devastating as Sicko is likely to be. And like Moore, they are emotionally charged.

Bringing emotion to the health care reform debate is important — but if meaningful solutions are going to emerge it will take thoughtful analysis, vigorous debate among people of good faith with open minds, and the leadership required to make difficult choices. Hopefully the cinematic fireworks sparked by the Moores and Brownings will focus attention and inspire the passion to face up to problems in the health care system. To the extent they distract and polarize, however, they will make reaching a solution harder and the debate uglier.