Big Blue's Secret memo about Sicko!

I have discovered the a VP for BlueCross wrote a memo about the movie Sicko! which someone leaked to Micheal Moore. Although Moore's web site lambasts many elements in this memo, I found a few additional points worth mentioning.

Barclay Fitzpatrick, VP for Corporate Communications for Blue Cross saw Sicko! and reported his experience in the (no longer) secret memo. The single most interesting part of his 4 page description and commentary comes from the fact that he did not take issue with any of the factual information presented in the film. He decries its "divisiveness," and "divisive tone" but does not deny the accuracy of the cases or data it presents. For example:

You would have to be dead to be unaffected by Moore's movie, he is an effective storyteller. In Sicko Moore presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit. Denial for treatments that are considered "experimental" is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit.

Let's take this apart one piece at a time. First, "selecting stories, no matter how exceptional to the norm..." How does one establish a norm? Is a norm true in 90% of the cases? 51% of the cases? He does not say. "Denial for treatments that are considered "experimental" is a common story." But he does not say that this "common story" is false. He also ignores (and in so doing, confirms as undisputed) that Moore shows these "exceptional to the norm" stories simply do not happen in countries with universal health care. Most importantly, the sentence: "Individual employees from Humana and other insurers ... who claim to have actively pursued claim denial as an institutionalized goal" does not in itself dispute the claim. The wording deftly implies falsehood without actually stating such outright. Think about it. If the "claims" were false and such never happened in the industry, would not the writer state such in a memo designed to give guidance for "damage control?" He also fails to mention Laura Pimo's testimony, which Moore makes the centerpiece of the film's section on the inner workings of the Health Insurance industry. She testified under oath before a Congressional committee bluntly admitting that she wrongly denied coverage to a person who died for lack of medical care. When evaluating damage control memos you should look at what the writer does not say as much as what he does. Barclay Fitzpatrick crafted an astonishing evasion of the blindingly obvious.

Second, in a list of "key areas of misperception cultivated by the movie" he mentions

"Perhaps most damaging of all, Moore completely fails to address the most significant driver of health care costs - our own lifestyle choices - and seeks to focus attention and efforts on the alluring 'quick-fix' of universal health care. It has taken a generation of poor nutrition and exercise to get obesity and related health issues - and subsequent costs - to their current levels, and Moore's movie fails to acknowledge the causal relationship or need to change (he briefly touches the subject in a non-memorable way)."

I remember the part of the movie Fitzpatrick refers to as touching on "the subject in a non-memorable way." Moore interviews a doctor in England, discovering that the doctors there receive bonuses for reducing the number of smokers in their practice, or lowering the blood pressure or cholesterol levels of their patients. Gee, I found it memorable. (Or maybe he refers to Moore's passing mention that our mortality rate is just above that of Slovakia, making us 43rd in the world. If so the fact that he failed to note the difference in physicians incentives between the U.S. and Britain speaks volumes in itself). Fitzpatrick continues:

"Contrast this to the recent Health Care Symposium held in Harrisburg - where a panel of representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers agreed on one thing - that there was no quick fix and that Health and Wellness was the critical area of focus."

If "health and wellness" is truly the critical factor, then why doesn't the U.S. health insurance industry reward doctors the way the British one does? And why do they expect that doctors can educate their patients about healthier living if they are forced to see so many a day that they can only spend 5 to 10 minutes with each one? Also, this Panel at the "Health Care Symposium" did not include patients (but it did include "even lawyers!"). This omission tells us how much health insurance executives cares about patients. Along the same lines, the attempt to blame costs on our poor habits fails to explain how obesity influences the cost of MRIs? The 18-month old who died while traveling from one ER to an "in-network" one did not look obese, nor did the young woman denied chemotherapy for cancer. But I understand when cancer goes untreated a person can really slim down a lot.

More guilt by omission occurs in another part of the memo:

" The Impact
Moore's movies are intentionally intense and his objective in Sicko seems to be to revive the earlier Clinton efforts - not to achieve universal coverage with this movie, but to push the topic to the top of the agenda. He will be just as successful whether proponents mount momentum or discussion entails key stakeholders defending why it won't work. [emphasis mine]

I find the last 5 words fascinating, especially the word "defending." Not "explaining," not "proving," not "demonstrating." Also who are the "key stakeholders" anyway? My guess would be the "representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers" mentioned above (not patients). And the memo does not state why "it [universal healthcare] won't work" nor do the "talking points" at the end give so much as a sketchy reason why "it won't work." That "it" works in other countries Fitzpatrick does not dispute, another telling omission. If it works in France and Britain, why will it not work in the U.S.? Any concrete reasons? All the memo gives are condescending descriptions of Universal health care as an "alluring 'quick-fix'" and that in other countries "Everybody gets along and takes care of each other and life is beautiful because there is universal health care," as well as the references to Moore's "diviseness" mentioned above. My favorite quote along these lines is "Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination." OK, so who's sharing responsibility for the dead people? You know, the ones that prompt medical attention (or any medical attention at all) could have saved? Who is "sharing responsibility" for the September 11th volunteers who do not have insurance? Who is sharing responsibility for Edith Rodriguez, who bled to death in an ER last may, vomiting blood while the nurses ignored her? The government managed to take responsibility for the health care of the prisoners at Guantanamo (and other prisoners in our penal system). I would never suggest denying medical care for prisoners. I only wonder why rest of us can't have the same treatment as a prisoner. For the uninsured (and uninsurable) the medical care a prisoner receives constitutes a vast improvement over his present situation.

Health insurance companies have the money and the power to dictate policy. Fitzpatrick laments that in Sicko! "Legislators are presented as bought stooges for the political agendas of insurers and big Pharma." If you didn't want us to see them as your stooges you shouldn't have shoveled millions of dollars (paid for with members' premiums) into their re-election campaigns. Universal health care works in other industrialized countries and the main reason we do not have it in the U.S. is that people like Barclay Fitzpatrick, people who occupy positions of power and influence but do not hold elective office nor find themselves subject to any accountability except to their boards or stockholders, who lie by omission or misdirection, who write secret memos, will not allow it to work.