Soon after newly sworn-in President Bill Clinton announced in 1993 that his wife would lead an effort to make sure every American had access to health care, I was on a plane from Louisville, Kentucky — where I led public relations for Humana, one of America’s largest health insurance companies — to Washington, D.C. I had a clear mandate: Make sure the Clintons’ “Health Security Act” never became law.
I began working behind the scenes to help craft a strategy to protect the bottom line of the health insurance industry.
Health care costs back then were rising, tens of millions of people were uninsured, and opinion polls revealed strong public support for a national, publicly financed insurance system. Candidate Clinton had promised sweeping reforms. When he announced that Hillary Clinton would lead the reform effort, I began working behind the scenes to help craft a strategy to protect the bottom line of the health insurance industry — by manipulating and misrepresenting democratic will so that the public rejected the very policies that would have delivered the reform they sought.
My destination in D.C. was the office of the Healthcare Leadership Council, a little-known group that the CEOs of big insurance, hospital, drug and medical device companies had formed a few years earlier to kill any health care reform proposals they didn’t like. Our efforts paid off. Thanks largely to the council’s multipronged attack, which included lobbying by corporate chief executives and PR efforts to persuade reporters and television news anchors to use the industry’s preferred language about the Clinton plan, Congress never even voted on the Health Security Act.
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A quarter-century after my first trip to Washington to derail reform, we are right back where we were then. Health care costs continue to exceed overall inflation by wide margins, and, despite gains made under the Affordable Care Act, the number of people without health insurance is once again increasing at a fast clip: It’s back up to around 30 million. Polls in the last year once again show similar levels of support for what we now call “Medicare for All,” just as they did for the equivalent idea at the start of the Clinton health care debate.
And we are seeing the same dynamic play out in terms of the politics and policy conversation. After watching the first three Democratic debates and accompanying media coverage, I find that the industry strategy has been more effective in manipulating journalists and pollsters than I could have ever predicted. I feel compelled to speak up and help set the record straight when so many politicians and journalists are using talking points that come straight from health insurance central casting scripts.
The industry knows from years of focus group message testing that terms like “socialized medicine” and “government-run health care” scare many Americans and that many of us respond favorably to terms like “choice” and “competition.” Based on this knowledge, there were several big lies I helped craft — and that are still in circulation today.
The first was industry propaganda that duped Americans into believing that the free market can work in health care as it does in other sectors of the economy. The reality is that U.S. health care is a classic example of market failure. For a free market to function, consumers need to know how much a good or service will cost them and then decide whether to purchase it accordingly. But price transparency is largely nonexistent in health care. Moreover, patients often lack agency in the treatment they receive. An unconscious victim of a car accident, for instance, has no ability to decide on the procedures being done or caregivers operating on them. Yet when they are revived, they will be responsible for whatever bill is sent out.
A second deception was persuading voters that reforms the industry opposed would result in “a government takeover of health care” — a claim that Republican pollster Frank Luntz popularized in 2009 building off similar language we crafted in the 1990s. The Clinton plan’s “managed competition” would have resulted in more regulation but not the elimination of insurance companies; nothing close to a government takeover. That false claim was repeated so often in the debate over the Affordable Care Act that PolitiFact chose it as 2010’s “Lie of the Year,” since the ACA did not seize control of hospitals or even include a public health plan to compete with private insurers.
This time, the outfit running the industry’s propaganda campaign is a Washington PR firm that last year launched a group called the Partnership for America’s Health Care Future (of which the Healthcare Leadership Council is listed as a member). In ads and press releases, the partnership has peddled a third tried-and-true industry lie that I helped craft years ago: that Medicare for All is “one-size-fits-all health care.”
The reality is that Medicare for All legislation in the House and Senate would give people many more options. That’s because, unlike a private health insurance plan, Medicare does not limit the choice of health care providers to ever-changing “networks” of doctors and hospitals. Instead, you could go to any doctor or hospital that accepts Medicare (which is virtually all of them). And current Medicare for All proposals would provide a means of budgeting to ensure that all hospitals, including rural hospitals currently closing by the dozens in the private insurance marketplace, remain open.
And finally there’s the industry lie that Medicare for All would be too expensive and disruptive. The reality is that the current system, controlled and frequently disrupted by private insurance companies and aided by the lawmakers over which they hold sway, is the one that’s too expensive and unsustainable. Legislators over the years have enacted bills that have benefited large companies at the expense of consumers. As just one example, in 2003 Congress passed a bill adding a pharmacy benefit to the Medicare program that prohibited the government from negotiating directly with drug companies for lower prices.
Americans also spend more on health care than people in other countries because of the high administrative costs unique to our system. Approximately 30 percent of our health care expenditures are the result of administration, about twice what it is in Canada. And private insurers in the United States devote 17 percent or more of their revenues on average to administration, compared to Medicare’s 2 percent.
Ditch the “government-run” and “government takeover” language because this isn’t what they’re advocating.
Journalists, media organizations and polling companies — but especially politicians on both sides of the aisle — have an obligation to drop the insurance industry’s framing. There are much more accurate terms that can be used.
These include referring more accurately to what Bernie Sanders and Elizabeth Warren are proposing by calling it a publicly financed, privately delivered health care system. Ditch the “government-run” and “government takeover” language because this isn’t what they’re advocating. And don’t refer to what we have now as a free market system, either, since it’s not.
Changing the framing would allow us to have an authentic public debate about what kind of health care system the American people need.