Health Care Reform Villains

In December 2007, with the first contest of the 2008 primaries approaching, Prospect Executive Editor Mark Schmitt wrote what would become one of the most influential articles of the campaign. In the piece, Schmitt contended that voters were witnessing a "theory of change" primary, in which Democratic voters were making a choice between three competing theories about how you get things done in Washington. Hillary Clinton argued that it was about being prepared and working hard; John Edwards argued that it was about confrontation; and Barack Obama contended that he could bring all parties to the table and achieve reform by treating everyone as though they were operating in good faith.

What will probably turn out to be the most contentious debate of the Obama presidency -- health care reform -- is now moving into its most intense phase, and the Obama theory of change is about to be put to the test.

Despite how it has sometimes been characterized, Obama's impulse to treat everyone respectfully and take their ideas seriously isn't based on a naive belief that he can bring everyone around to his position. But it does presume that if you don't start by vilifying your opponents, you can force them to be constructive and perhaps mitigate their eventual opposition to your plan. There's another key element to this strategy: If the public sees you as reasonable and magnanimous, it makes your opponents look even more petty and self-interested if they slap away the open hand you have extended.

The campaign against health care reform is just now gearing up -- the focus groups completed, the talking points assembled (noticed how many times you’ve heard Republicans warning about "government bureaucrats getting between you and your doctor” in the last couple of weeks?), the ads are being shot, and the forces opposed to reform are ready to throw down. So the time is nearing when the administration has to stop reaching out and start fighting back.

If the administration wants to win this fight, it's going to have to explain the issue to the public in a way it hasn't before. Unfortunately, political debate in America isn't an arena where competing ideas get a full and fair airing and the public chooses between them. Political debate is where stories are told and identities are defined. The key to prevailing in this kind of conflict is defining just who people should be mad at. But up until now, the administration has hesitated to tell the story of health care reform in a way that makes clear who the bad guys are.

But last week, it was given an opportunity to tell that story. At a hearing of the House Energy and Commerce Subcommittee on Oversight and Investigations, Rep. Bart Stupak of Michigan asked executives from three of the nation's largest insurance companies whether they would commit to ending the practice of "rescission" unless there was evidence of intentional fraud or misrepresentation. They all said no.

The video of this hearing is strikingly reminiscent of the 1994 hearing in which tobacco company executives famously announced their absurd belief that nicotine was not addictive. Only in this case, the executives weren't saying that they didn't believe they were destroying people's lives; they were saying that they had no intention to stop destroying people's lives.

What is "rescission"? Here's how it works. As Stupak's committee, investigations by a couple of news organizations and some state insurance commissioners, and lawsuits by policyholders have revealed, many insurance companies routinely take the opportunity of a serious accident or illness by one of their policyholders to launch an investigation to see whether they can drop the policyholder from coverage. They don't do this when you first sign up for your policy -- instead, they cash your premiums every month, waiting until you actually file a major claim. At that point, they begin poring over all your past medical records and every form you ever filled out for them, to see if they can find a reason to claim that you violated the terms of your policy. It doesn't even have to have anything to do with the illness in question -- for instance, the Los Angeles Times cited the case of a nurse in Texas who was booted from her insurance policy "after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne."

Rest assured, the insurance companies are working hard to deny coverage to people who have become sick or injured. "One employee, for instance," reported the Times, "received a perfect 5 for 'exceptional performance' on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care."

Think about this for a moment. Somewhere in America today, a woman is sitting in her doctor's office, experiencing the worst moment of her life, as she learns she has breast cancer. Death is staring her in the face. She's wondering whether she'll be there to raise her children or meet her grandchildren. But there's something she doesn't know as she walks out of the office and begins to plan how to tell her family that she could be dead soon.

What she doesn't know is that because she was just diagnosed with cancer, her insurance company is launching an investigation of her, in the hopes that they can find a mistake on one of the many forms she's filled out over the years. One of their employees is poring through her records, and that employee's job is to see if the company can come up with some rationale, any rationale, for cutting off her coverage, so they won't have to pay for the treatment for her cancer. And of course, once they do drop her, she won't be able to get coverage from any of the other insurance companies. Because she has cancer.

Although it's a word that often gets thrown around too lightly, we can call the insurance companies' action for what it is: evil. If you're looking for a villain in the story of health care reform, there it is. The people who do this to other human beings -- who say, "One of our customers has cancer? Quick, let's see if we can cut off his coverage!" -- are the same people who will be pouring money into fear-mongering attack ads and putting the screws to wavering senators, telling everyone that if the government gets too involved in health care, then terrible things will happen.

If the administration wants to win this fight, it ought to start talking about this practice every day. They ought to make sure that every American knows exactly what rescission is. They ought to have the video of the insurance company executives pledging to continue rescission playing on a continuous loop in the White House press room.

Given all the skill they displayed during the election, one might imagine that the Obama administration some time ago constructed an intricate strategic plan to pass health care reform, with every eventuality anticipated and a perfect riposte ready for every attack. Perhaps they have such a plan ready to go. If they do, it might be time for them to get it up and running.

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