Sicko

“Dand Tilt, i dounht membur Yuu on the turnip Truck you musta feeled off four I got on.”

“
Peech Truk!  (LOL)

[ the birthplace and boyhood home of Joel Chandler Harris is less than 100 miles distant from my own, as the crow flies.  Nurture or Nature?  Who's to say? ]

And Mister Fox, he lay low.

”

“Stovie , in the future another stupid war will come and Moore, in his last days , will make a of movie ; 'Cindy and the last of the Bush family mistakes, part1'.”

“Bush shouldn't start wars against Al-Qaeda.”

“No al-Qaeda in Iraq, pre-invasion (contrary to Bush-Cheney hallucinations).  Post-invasion, 'brand' taken up by guerillas.”

“LOL...talk about high quality thread degeneration....”

“Government healthcare for all! I mean, look at the swell job they're doing with Medicare and the V.A.”

“Sure, take them out of the Executive Branch ---

(or Whatever branch Cheney is in this week)”

“
[The following memo was written by Barclay Fitzpatrick, VP of Corporate Communications for Capital BlueCross]

I was able to see Sicko last night in Lancaster. There were about 30 other viewers in the theatre covering all age groups. I have attached the well-written memo from one of our partners, which describes cases used in the movie, to the end of my memo. Also attached are the latest talking points from BCBSA. I will focus on impact to our brands, issues, and suggested strategies in this memo.

The Movie
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.

While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market. Here are some examples:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad treatment of members.
* BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection.
* BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature.
* BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding inaccuracies in applications to enable post-treatment payment denials.
* A BCBSA card is shown while the narrator describes how they (insurers) got wealthy.

In typical Moore fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich. Nixon Oval Office tapes are used to show how the initial idea of a 'less care = profit' enterprise was supported by the administration and became the HMO paradigm. Legislators are presented as bought stooges for the political agendas of insurers and big Pharma. Insurers are middlemen in the Medicare Modernization Act - which is presented as a trick to charge seniors more for their prescription drugs.

Doctors are barely touched - only in the course of discussing the AMA's work to sink early efforts in the 40's and 50's to start universal health care. He takes efforts to show that doctors live well in other countries despite the existence of universal health care. In follow-up interviews, Moore has stated that he has spoken to and knows many doctors, and "doctors aren't the problem".

In the second half of the movie, Moore walks us through individual stories of the Canadian, British, French, and Cuban health care systems where everything is free and - he reminds us repeatedly - no one is ever denied service because they can't pay. In addition to health care, the government provides free day care, college, and someone to do your laundry. Everybody gets along and takes care of each other and life is beautiful because there is universal health care. As a viewer, you are made to feel ashamed to be an American, a capitalist, and part of a 'me' society instead of a 'we' society - and the lack of universal health care is held up in support of that condemnation.

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.

As a health care industry educated viewer it is easy to pick out where Moore is cultivating misperceptions to further a political agenda, but you will also recognize that 80%+ of the audience will have their perceptions substantially affected. In demonstration of its impact, an informal discussion group ensued outside the theatre after the movie. While some people recognized how one-sided the presentation was, most were incredulous and "I didn't know they (the insurers) did that!" was a common exclamation followed by a discussion of the example.

The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as Moore's efforts in the movie and surrounding PR activity are seen by more of the community. The impact on industry savvy Sales' contacts should be minimal, while the impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of Moore's films nor the way this one appears to be headed. If popular, the movie will have a negative impact on our image in this community.

There should be no doubt that many of our employees will be asked what they think of the movie by friends, family, and neighbors. We should anticipate that our customer service people will be asked about particular cases from the movie and if we follow similar policies. Word and phrases we have routinely used to date in policy change communications or denial letters, such as "Investigational", will be seen as affirming the film's contentions. The national BCBSA response - while coming out against the film's divisiveness and focusing on the positive work of the Blues - steers media inquiries about policies and denials back to the plans themselves.

There are 4 key areas of misperception cultivated by the movie that we should consider in any messaging strategy:

1. That the industry is all about HMO's. Moore cultivates this further in his interviews. The reality is that HMO's are a minority product and have been for some time.
2. The movie attacks insurers for a profit motive, but makes no distinction among for-profit and non-profit insurers, and in its execution places the Blue Plans together with the for-profit insurers.
3. All plans and employees - from leaders to service representatives - are painted as motivated by profit to deny claims, and only those with crisis of conscience have come forward to confess their sins.
4. 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). 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.

Suggestions
I believe the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve (aligns with BCBSA strategy), and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness. We will convene a team to consider other approaches and work on potential messages for media inquiries, customer service, and employees.

Confidential Memo (from partner)

SiCKO - viewed on 6/26/2007

Takeaways

* The main theme of the movie is that American society needs to focus on the "we" and not the "me" in healthcare.

o This broad message is an overlay for the specific criticisms of the healthcare industry - the movie asks where the morality of the American public lies and contrasts America's approach to health care unfavorably with other nations.

* SiCKO does not go into any depth about how health insurers operate how the health insurance business works - instead it fixates on what it characterizes as the profit incentive to deny care to patients (e.g. examples of barriers to getting health insurance if you are not healthy; examples of people being denied expensive tests or procedures; examples of efforts to deny reimbursement after care has been received.)

* The film draws no distinction between not-for-profit and for-profit insurers - in fact the Blue Cross/Blue Shield brand is intermixed with the for - profit brands as background reference points. o One scene shows a Blue Cross / Blue Shield logo as Michael Moore's voice over begins, "While the healthcare companies get wealthy..."

* The health insurers that get the most airtime are:

o Kaiser Permanente
o Humana
o CIGNA
o Blue Cross of California
o Aetna

* No Pharma companies are mentioned - but SiCKO suggests in multiple instances that prescription drugs are overpriced

o At a pharmacy in London, prescription drugs are £6.65, no matter how large the dose
o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100

Further Notes

* Some of the examples of denial of care highlighted in the film:

o A woman with Kaiser Permanente takes her 18-month daughter to the hospital in an ambulance, only to be told to go to an in-network hospital. By the time they reach the second hospital, her daughter has stopped breathing and dies 30 minutes later in ER.

o A woman with Blue Shield of California has a tumor but is denied requests to get an MRI, or to see a specialist. While on vacation in Japan she is given an MRI, and eventually returns to the U.S. to demand treatment from her insurer.

* In the ensuing court case, a doctor admits to denying her request without having reviewed it.

o Blue Cross of California approves one woman's $7,500 treatment, but the approval is later denied for her failure to report a previous medical incident - a yeast infection.

* "They're just looking for a way out," she says

* Other examples of how health insurers avoid paying for treatment:

o One graph (from Humana) shows that doctors with the highest % of denials get a bonus.

o Michael Moore interviews a former health insurance employee who specialized in denying care to patients retroactively - by finding inconsistencies in their medical records.

o A 5-minute piece in the beginning of the movie .

* The film also focuses on the politicians and the funds they raise from Pharma and other player in the health care industry and alleges that the system has been heavily influenced by lobbyists and contributions.

Barclay Fitzpatrick
Vice President
Corporate Communications
Capital BlueCross
(w) 717-541-7752
(c) 717-329-3648
barclay.fitzpatrick@capbluecross.com

MichaelMooreTalkingPoints61807.doc

Blue Cross and Blue Shield Association
Talking Points in Response to Michael Moore's "Sicko"
June 2007

1) The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer.

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by Michael Moore and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government.

3) The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States.

4) The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information. In addition:

o The Blues recently created Blue Health Intelligence a data resource that will shine light on emerging medical trends and treatment options in an unprecedented way. To further the use of evidenced-based medicine, BCBSA has called upon Congress to establish an independent, payer-funded institute that will study the comparative effectiveness of new and existing medical treatments and procedures.

o Blue Cross and Blue Shield companies are at the forefront of healthcare transparency by providing their members with online access to real-time information related to provider quality and the cost of common healthcare services. In addition, the Blues have committed to making personal health records available to their members by 2008.

o We are working to ensure that Medicare is funded appropriately and that seniors continue to have access to comprehensive benefits.

5) The Blues are proud of these efforts and we will continue to work with consumers, providers, employers and the government to provide Americans with the healthcare services and information they need to lead full, healthy lives.

”

“I think the excellent article by Star Parker explains why the libbies prefer SHOCK movies over Talk Radio.

http://www.kitsapsun.com/news/2007/jul/28/star-parker-let-the-fairness-doctrine-rest-in/

The visual film medium lends itself more to the liberal message. You can pick out instances that support what you want to say, show them in a funny and entertaining way, and you have a hit.

Conservative talk radio works because talk radio is a medium of the mind and of thinking and discourse. This works well for conservative and free-market ideas, which get sold on thought and logic.

Liberals will resent this assertion, but the liberal message is emotional, not logical. This is why it doesn't work on talk radio. Liberalism operates by provoking emotions such as guilt, fear and envy. This works in sound bites and visual media, but not on talk radio.”

“"discourse" I love it when folks use that word.

Michel Foucault would be proud of you. ;)”

“Da actuary in my undies
keeps the gov off my back
wonders of modern medicine
can't keep me from smokin' crack.”

“Hey tilt -
Don't forget The Color Purple.

Eatonton is also the home of Alice Walker. Why would you select praising Joel over Alice - ain't racist, is ya? LOL!

For whatever reason, the black landowners of the Reconstruction era managed to retain their property. To this day, there are a number of of land-rich black folk across Putnam County. In fact, my dad got permission of one to hunt quail on his property (waaay back when we used to have quail). We would always drop a few off at the house as we cut out after a day of chasing pointers and English setters...”

“Days like this make me glad that I dont live where I must wait months for service, and that I have good healthcare. Without the details I need a battery of a minimum 5 tests. I went in today for a "consultation" and was able to get 2 of the 5 done while there. The other 3 will be done thurs and friday.I am outta work for a week but no biggy. No waiting, no fuss no muss.”

“Oh yeah - My Cousin Vinnie.

MCV was filmed primarily in Jasper County, but much was also filmed in Putnam. I have actually licked a park bench on the Monticello square where Marissa Torme(sp?) sat!

Ummmmmm! Marissa!”

“I, Creek Dancer , being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead politicians who couldn't pass ninth-grade biology if their lives depended on it, or lawyers / doctors interested in simply running up the bills. If a reasonable amount of time passes and I fail to ask for at least one of the following:

New backpacking gear of any kind

Glass of wine

Chocolate

Sex

Chocolate

Donuts

Chocolate

French fries

Pizza

Ice cream

Chocolate

Sex

Chocolate


It should be presumed that I won't ever get better. When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes and call it a day.”

“I haven't seen Moore's movie but there's been a consistent theme in this thread. Everyone talks about socialized medicine like you CAN'T get private care. Well, guess what: there are plenty of private doctors available in countries that have socialized medicine available and supply healthcare to ALL of their citizens. Pay to play still applies there as it does there. And guess what: it's still reserved for the rich.

Ever wonder why if the USA is such an amazing place for healthcare, yet we have the one of the worst infant mortality rates in the world given domestic earnings? It's called complete lack of primary care for its citizens.”

“Then move, b!tch.”

“I'd call it complete lack of motivation to provide for oneself.”

“I'd just prefer to get a working system in my country of origin. I'd figure for someone living out of the back of their truck, it might be a priority for you, Gojo.
last edited: 7/31/07 1:20:48 PM”

“Turned insurance down just days ago. Yep. I'm one of the 40,000,000,000,000 Americans w/o health insurance. My choice, it is.

I do have truck insurance, tho.”

“Ever wonder why if the USA is such an amazing place for healthcare, yet we have the one of the worst infant mortality rates in the world given domestic earnings? It's called complete lack of primary care for its citizens.”
roseymonster
1:04:27 PM
7/31/07

I know that's one of the comon beliefs in the U.S., unfortunately, it's just not true!
Here's an excerpt from one of many, many, many articles I could point to that explain the reasos for our Infant Mortality rate.

"Better and more affordable medical care actually has worsened the rate of prematurity, and likely the rate of infant mortality, by making fertility treatment widespread. According to a 2006 Institute of Medicine report, the numbers of women using assistive reproductive technology doubled from 1996 to 2002. At least half of their pregnancies culminated in multiple births (twins or more), which are at high risk of premature delivery.

Meanwhile, no amount of money or resources seems to reduce the rate of preterm births."”

“That logic could be used for state investments in education. Why is it that when state's invest more in education, there isn't a direct relationship to test scores? Because money (i.e. - big government) isn't always the answer.”

“Wanderer, please. RoseyO'donaldMonster is just another drop in the Hate America First pus bucket. Don't waste your breath on b!tches like him...”

“Cool. So when you need medical care, whatcha gonna do, Gojo?

No thanks for putting words in my mouth, Gojo. I'm actually quite the opposite of "Hate America First". I just want it to be as good as it can possibly be.

Ok Wanderer. Point taken re infants. How about higher levels of health problems in minorities that could have been prevented if they had access to primary health care? Right, right. I hear it already from the I-can-live-outta-the-back-of-my-truck-so-can-you-set: they're just not trying hard enough...
last edited: 7/31/07 1:47:11 PM”

“So when you need medical care, whatcha gonna do, Gojo?

Uh... go to my doctor?

Or are you referring to medical marijuana? In that case, I'll go to Kimenems.”

“Right. Well, glad you can afford to pay out of pocket for hospital stays. Must be nice.
last edited: 7/31/07 1:48:38 PM”

“That's Rosey O'doughnuts gojo, get your terms correct. ;-)”

“Hospital stays? Suppose I may pass through the morgue...


“I will not die here,
pushing a pen beneath a lamp;
My boots will be muddy,
And my clothes will be damp.
Not clutching my chest
At the local mall,
But losing my grip
As I scale a cliff wall.
Not drawing last breath
Under bright O.R. light,
But missing the trail
In the darkness of night.
Not at a desk
On a hectic workday,
But searching for windmills
And dragons to slay.
Not in the embrace
Of a grieving, sweet wife;
By the grip of a bear
Will I lose my life.
Not in a pileup
While driving my truck,
But at the end of the road,
Alas out of luck.
It's time of happening?
Only fate would so dare!
The concern is not "when?"
Instead, mine is "where?"””

“Thass cool. I am a firm supporter of the Hemlock Society.”

“Somebody hikin' with you better take a lota chocolate :)
last edited: 7/31/07 3:03:06 PM”

“Point taken re infants. How about higher levels of health problems in minorities that could have been prevented if they had access to primary health care? Right, right.
roseymonster
1:42:12 PM
7/31/07

Rosey, I'm in the healthcare software business, for the last 1.5 years I've been exclusivly focusing our business on FQHC's (Federally Qualified Health Centers). The reason? They have more money than private clinics! There is more being spent on them than any other segment of the market! They are often times using technology that private clinics can't financially justify. Anyone who tells you "the underserved community" whether they be inner-city or rural, doesnt have access to healthcare just doesn't know what they're talking about. I could fill this board with articles about all the legislation in the works to provide $$ for Healthcare Information Technology to this market.”

“Everyone is throwing money at information technology.

I am talking about on the ground services.”

“There are more clinics being formed almost every day because of the funding they're getting from the government. I can guarantee you that the vast majority of people have access to healthcare, including illegal immigrants, migrant farworkers, inner-city residents, etc. I work every day with the clinics providing services to these groups. The biggest single problem is way too many don't want to take advantage of it, or put forth any effort on their part to comply! Here's just one example that came across my desk 10 minutes ago!



Millions of Patients Not Taking Rx Drugs Properly, Report Finds
Poor medication adherence could increase U.S. health costs by more than $175 billion annually, the report found. The Agency for Healthcare Research and Quality plans a campaign to encourage patients to take medications as prescribed. AP/Peoria Journal Star, AP/Houston Chronicle.

Here's the link if you want to read the complete article: http://www.californiahealthline.org/articles/2007/7/31/Millions-of-Patients-Not-Taking-Rx-Drugs-Properly-Report-Finds.aspx
last edited: 7/31/07 3:59:28 PM”

“I saw the story on that. What is the point? They are geriatrics who can't keep straight the dozens of pills they have to take every day? That's MY point. How about traveling nurses who make house visits to make sure these folks understand what they are supposed to take and when?

The system is broken, that is for certain.”

“You obviously didn't READ the article before replying, here's an excerpt: "The report also finds that adherence is an issue that crosses age groups..."

The point is this: Most people who complain about the healthcare system only know rumors & BS partial-truths from crap sources like Michael Morons movie.

Yes, there's lot's wrong with the system, I am in no way defending it in its' entirety, BUT to say that people don't have access to healthcare is just plain wrong in most cases.”

“Do you dudes charge Moore for the ads you do?”

“".... in most cases."


Hmm.”

“WOW so private medical care will not be outlawed in SOcialized medicine...I guess that is why people are SUING the Canadian Government to be allowed to open private insurance services and private hospitals?

Rosey...go back to the original name Palmer.”

“Rosey, universal health care would do no more for minority health than public education does for minority prospects for a higher education. You can lead a horse to water but you can't make them drink. Minorities that want to succeed will, those that want to be treated as if they still live in slave housing except without the requirement of work will continue with poor healthcare. They will no more follow a health plan, safely take prescription drugs, seek medical advice, etc as they seek education.

This is coming from someone whose kids were in a school located in the 'inner city' with a predominately minority population.”

“Point taken, XL (granted Canada is hardly the only country with a one-payer system and healthcare in Canada is provincial. People in Quebec, for example, are allowed to carry private insurance and use it freely at private hospitals.).
last edited: 8/01/07 2:13:08 PM”

“Who here has ever used public medical services? Examples?”

“What the #&%!$ are public medical services?”

“Allow me to clarify. This would be using the system be it medicare, medicaid, county clinic, etc. Basically, anything where you are getting publically subsidized medical care (not including private insurance through a public employer).

Is that clear?”

“I have. #&%!$ you all.”

“Rosey, I spend all day working with Community Health Clinics - that's what I do for a living! Do you have any specific areas of interest?”

“Not really. I am just looking for people who have received services and their impressions.”

“Great and Not Great.”

“I think you'll find that peoples' experiences with CHCs are virtually identical to a private / commercial clinic. Some will be happy, some will whine & complain, and everything in-between. I can tell you that the reporting requirements are WAAAY more stringent in a CHC than they are in a private clinic. Since the gov't is picking up the tab, they want a lot of detail about the services provided. The good part of that is that there is A TON of information available about the services offered / performed. If you're really into it, there are websites where you can look up a lot of that data.

One thing that CHCs do FAR better than private clinics is chronic disease management follow-up. Thus, if you have diabetes, hypertension, etc., you will usually get routine follow-up communications from your CHC telling you wht you're due for, vs. a private clinic that can't afford to provide that service since they don't get paid for it! In fact... that's one of the reasons one could argue that a CHC provides better health care than a private physician!”