Who Will Be at the Table? Part II

What lurks under the insurers' gesture of friendship?

During the campaign, Barack Obama promised his cheering crowds that, when he rolled up his sleeves to work on health care, he would “have insurance company representatives and drug company representatives at the table. They just won’t be able to buy every chair.” Now is a good time to take a look at just what kind of seats special interest groups will have at Obama’s table, and what they’re doing to bring the public around to their ways of thinking. This is the second of an occasional series of posts that will analyze their activities and how the media are covering them. The entire series is archived here.

Who woulda thunk it? That AHIP, American’s Health Insurance Plans, the big bad industry trade group trashed by the media fifteen years ago for torpedoing the Clinton health reforms, would turn out to be Mr. and (Ms.) Nice Guy. Its public persona is downright friendly; conciliatory and helpful. The group, as some in the media have put it, has moved beyond Harry and Louise, the infamous advertising duo who supposedly turned the tide against the earlier reform efforts. (Those efforts were defeated for factors more complicated than either Harry or Louise, but let’s move on.)

Lately, press coverage of AHIP has been so positive that president Karen Ignani and her PR staff must clap their hands with glee every time they pick up a newspaper. A recent Wall Street Journal story read like an AHIP press release. Perhaps that’s not too surprising, since another Journal story, published a few weeks before, also gave AHIP a decidedly positive spin. Said the Journal:

The insurance industry may provide the best case study of how things have changed. Two years ago, America’s Health Insurance Plans proposed a coverage plan, and since then the group has worked with other interests to help build momentum for action. The group’s board made a conscious decision to be a “productive participant” in the debate this time, said Ms. Ignani. She said members are excited by a variety of aspects of the Democratic approach, including the idea that every American would have coverage.

A Boston Globe story quoted Ignani saying that her group began working on reform strategies two full years ago, out of a sense of responsibility and pragmatism. In the Los Angeles Times, Ignani said: “We are coming to the table with a specific set of proposals. We believe reform needs to be comprehensive, and it needs to happen now.” Even Ted Kennedy’s office issued a statement praising AHIP: “The insurance industry has advanced serious proposals that deserve serious analysis and consideration.”

The Globe’s story, and another one by Politico, did try to temper the media’s AHIP adulation with a bit of balance. Both quoted a representative from the liberal coalition Health Care for America Now, who was skeptical of AHIP’s motives and proposal. In the Politico story, HCAN national campaign manager Richard Kirsch explained:

What they’re trying to do politically is to get ahead of health care reform and shape health care reform in such a way to protect their bottom line as opposed to actually fixing the problems in the health care system.

In the last graph came a comment from Rose Ann DeMoro, who heads the California Nurses Association and is a vocal opponent of the insurance companies. “What their proposal does is privatize profits and socialize risk,” she said.

In most of today’s formulaic writing and reporting, the requisite “balance quotes” come toward the end, serving to obscure the article’s dominant story line. In this case, the media’s dominant story line is the same one that AHIP wants it to tell—that insurance companies are good guys and team players this year. When the balance quotes that begin to pick apart what the trade group is really saying are relegated to the end of an article—almost as an afterthought—they are not very effective.

We need a new journalistic paradigm for examining what the special interests, including the insurers, are up to—one that deeply examines what their proposals really mean, and who will benefit from them. Politico’s examination was much too brief. It noted that AHIP’s insurance proposals did not include an option for a public plan that would compete with private insurance policies sold by the group’s members. Health reform advocates see the public option as a necessary ingredient in mix of proposals for change. An AHIP spokesman told Politico: “We don’t think there will be a need to get the government in the insurance business.”

AHIP’s self interest is now emerging, and so are the beginnings of a fight to protect its turf. Despite polite comments from their PR types, insurers will fight to the death on this one. The last thing they want is competition from a more efficient public program that might offer more comprehensive coverage at less cost.

The press needs to look critically at another of the industry’s major proposals—its offer to insure every American, no matter how sick, in exchange for requiring every American to have health insurance. That means if people don’t get it at work or from public programs like Medicare or Medicaid, they will have to buy it in the so-called individual market, where companies are already at the drawing boards dreaming up new policies to sell. Robert Laszewski, who blogs at Health Care Policy and Marketplace Review and who has been around insurance reform efforts before, says “AHIP’s proposal is “not a proposal for reform. It’s a Trojan horse.” The industry knows that no reform will cover everyone.

This fall, a report by consulting firm The Lewin Group said that, under Obama’s plan, 45 percent of the currently uninsured would remain without coverage. With people still uninsured, companies could still pick and choose only the healthiest for coverage. It will be business as usual for the carriers.

An industry insider put it another way: “They are not doing anything that puts their skin in the game.” If by some chance everyone is covered, insurers will win big. Think of the business that will flow to AHIP members. No wonder Karen Ignani is excited by Democratic approaches that include the idea of every American having coverage. What a deal! That’s a new storyline for the media, one that the public just may want to hear.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.