If last year’s attacks on the health-care reform law seemed familiar, it’s because you’ve seen same the tactics before, writes Wendell Potter in his new book Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans (Bloomsbury Press).

They are the same tactics used by the tobacco industry against anti-smoking initiatives, by the fossil fuel industry campaign against global warming research, and by the food and beverage industry against taxes on high-sugar snacks and soda pop, he writes.

Indeed, not only are the tactics the same, Potter writes, they are often orchestrated by the same alliance of well-connected PR firms, industry-funded front groups, right-wing think tanks and supportive conservative media outlets, all following a time-tested playbook of PR spin.

Potter is in a good position to know: he was part of that spin machine, a master of the dark arts of PR, serving for 20 years as a communications officer major health insurers, most recently as the senior PR executive for the industry giant CIGNA.

It was a job, Potter writes, that for many years he enjoyed: he enjoyed the work, the pay, the perks and the prestige.

Disillusionment

But as Potter recounts in his book a series of events led him to question the morality of that work, among them: watching Sicko, Michael Moore’s scathing documentary exposé on the U.S. health insurance industry (“Moore had gotten it right,” Potter writes); visiting a health-care charity event in rural Virginia where he saw thousands of uninsured men, women and children standing in line in the rain to get basic health services (“I felt as if I’d stepped into a movie set or a war zone.”, and finally finding himself using his PR skills to defend his company’s decision to refuse to pay for a young girl’s liver transplant, a decision that may well have led to her death (“Just thinking about it caused me to ache.”).

Wendell Potter Photo by Emily Potter

These and other experiences led him to conclude that the  primary interest of his employers and other health insurance companies was to boost profits and stock prices even at the expense of patient welfare

“It became clearer to me than ever,” he writes, “that I was part of an industry that would do whatever it took to perpetuate its extraordinarily profitable existence.”

Ultimately, in 2008, he quit is high-paying job at CIGNA, because, Potter writes, he “could no longer serve in good conscience as a spokesman for an industry whose routine practices amount to a death sentence for thousands of Americans a year.”

Shortly, afterwards, as the debate of health-care reform heated up and he began to see opponents to reform mouthing talking points that he had written, Potter felt compelled to speak out and he soon began writing, giving interviews and testifying repeatedly before Congress about health insurance industry practices.

Potter dedicates a portion of his book to telling the story of how he gradually became disillusioned with his work but most of the book focuses on the art of PR spin and how various industry groups–including insurers, drug companies and the American Medical Association (AMA), for example–have skillfully used PR to block health-care reform for decades.

In the 1960s, for instance, the AMA enlisted an actor named Ronald Reagan to produce a record in which Reagan describes Medicare as a sinister socialist plot. (You can listen to that recording below.)

How-to manual

Potter’s book could serve as a handy “how-to” book for anyone who wants to manipulate public opinion and isn’t too bothered by ethics.

Potter lays out the key elements:

• First, hire an well-connected PR firm, one that has cultivated friendly relations with influential politicians, journalists and pundits;

• then launch a “charm offensive” emphasizing your company’s desire to work with its opponents to find solutions, while at the same time creating “front” organizations (which should always have the words “American” or “Freedom” in their names, Potter notes) that can go on the attack;

• and, finally, enlist the help of conservative think-tanks, columnists and television personalities to give those attacks an air of legitimacy.

This was the exact playbook was followed by the health insurance industry during the debate over the new health-care legislation, Potter says: Publicly, it pledged to work with President Obama and the Democrats on reform, while at the same time behind the scenes supported front groups that alleged reform would bring rationing, death panels and socialism.

Fox News

Leaked emails from Fox News published online yesterday support Potter’s charge that conservative news organizations actively collaborate in these PR initiatives.

In the email, Bill Sammon, Fox New’s Washington managing editor, instructs the network’s reporters to use the phrase “government option” when referring to the “public option”, which at the time was being promoted by the Democrats.

Bill Dimiero, a reporter for MediaWatch, a left-leaning media watchdog group, included the email in his story Fox boss caught slanting news reporting.

From: Sammon, Bill
Sent: Tuesday, October 27, 2009 8:23 AM
To: 054 -FNSunday; 169 -SPECIAL REPORT; 069 -Politics; 030 -Root (FoxNews.Com); 036 -FOX.WHU; 050 -Senior Producers; 051 -Producers
Subject: friendly reminder: let’s not slip back into calling it the “public option”

1)      Please use the term “government-run health insurance” or, when brevity is a concern, “government option,” wheneverpossible.

2)      When it is necessary to use the term “public option” (which is, after all, firmly ensconced in the nation’s lexicon), use the qualifier “so-called,” as in “the so-called public option.”

3)      Here’s another way to phrase it: “The public option, which is the government-run plan.”

4)      When newsmakers and sources use the term “public option” in our stories, there’s not a lot we can do about it, since quotes are of course sacrosanct.

Dimiero points out that just a few months before Republican PR consultant Frank Luntz coached Fox News’ Sean Hannity on just this point:

Potter fears that as traditional news sources, newspapers in particular, contract, more and more of our information will be generated by PR firms and transmitted to us unfiltered without the analysis that professional journalists can bring to bear.

So now it is more important than ever for all of us to be more savvy PR professional works, Potter argues. “To understand why you believe some of the things you believe and do some of the things you do, it’s important for you to understand what PR people do and how they do it.”

His book is a good primer for anyone interested in learning about the science of spin, whether it comes from the right or the left.

Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans. Bloomsbury Press. Hardcover $26.00 288 pp. Kindle $14.30. Bloomsbury Press.

Ronald Reagan on the threat of Medicare:

To learn more:

• Listen to Ross Reynold’s interview with Wendell Potter on KUOW.

• Read Ben Dimiero’s article on MediaWatch: Fox boss caught slanting news reporting

• Visit the websites of Center for Media and Democracy, a liberal PR industry watchdog that reveals who is behind the spin at www.prwatch.org and their wiki site  www.sourcewatch.org

• Read PR consultant Frank Luntz’s memo to Republican on how to couch their attack on health-care reform: The Language of healthcare 2009

He is also an outspoken critic of those who say vaccines cause autism.

As a result, he has been called, among other things, a prostitute for the pharmaceutical companies and has received threats against his own life and that of his children.

Every week he gets hate mail.

In his powerful and absorbing book Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, Dr. Offit examines the the theories of those who hold that vaccines cause autism as well as the claims of others who have held out false hopes of unproven autism cures.

Parents of children with autism are understandably impatient with mainstream medicine, which has failed to identify a cause or offer a cure, Dr. Offit notes.

“Many parents of children with autism are tired of the glacial pace of medical research,” he writes, “and tired of slogging through hours of behavioral therapy, and tired of watching children improve at rates so slow it’s hard to tell if they are improving at all.”

It is no wonder parents grasp at hope when it is offered.

One of the first to offer such a hope was Bruno Bettelheim, a Viennese-born psychoanalyst who blamed autism on cold and unfeeling parents, in particular, the mothers of autistic children.

Bettelheim said he could cure children of autism by replacing their mothers’ “black milk” with a nurturing, supportive environment.

His claims soon caught the media’s attention. He was invited on such national programs as The Dick Cavett Show and The Today Show. Eventually, however, his ideas and treatment approach were discredited.

That such a bizarre theory that so cruelly shamed parents was given credence shows how desperate parents, and how credulous the media, can be.

But parents are not the only people who are vulnerable to the promise of a cure or at least a treatment, Offit shows; therapists, teachers and health-care providers are vulnerable as well.

Offit describes how, in the 1990s, a professor of special education began to promote an autism treatment called “facilitated communication”.

The theory on its face is strange. It held that autistic children were uncommunicative because they were not able to master the motor activity required for speech.

This disability could be overcome, the theory held, with facilitated communication in which an adult “facilitator”, by providing “counterweight”, helped guide the autistic child’s hands to letters on a keyboard so the child could communicate what they were thinking.

“The results were amazing,” Offit writes. “With the help of facilitators, children with autism typed out messages that filled their parents with hope.”

“I am trapped in a cage and I want to get out”, one wrote.

“I am intelligent and educated,” wrote another.

“Autism held me hostage for seventeen years but not any more because now I can talk.:

An institute was formed, and thousands of parents, teachers, therapists and healthcare providers were trained in the technique. “By 1993, hundreds of schools and centers for disabled children had adopted facilitated communication,” Offit writes.

But there were skeptics. How was it that children who in other tests had been found to be severely retarded were now able to write sophisticated poetry, essays, and engage in philosophical discussions? And how was it that they could type long paragraphs free of spelling errors?

So someone did a simple experiment. In the experiment, the child and facilitor would be shown a picture and they would then work together to type out the name of the object of the picture, standard facilitated communication.

The trick was that the facilitator and the child could not see the image the other was viewing.

What the researchers found was that when, for example, both the child and the facilitator were shown the picture of a key, the child would type out the word key.

But when the child was shown the picture of a cup and the facilitator was shown a picture of a hat, the child typed out the word hat.

“Clearly, the facilitator was subconsciously doing the typing,” writes Offit.

Yet, despite the evidence, many parents and practitioners continue believe in “the miracle of facilitated communications”, writes Offit.

Offit goes on to describe other theories that continue to have staunch advocates despite scientific evidence that theories are not true.

Perhaps, the most fervent of these advocates are those who blame vaccines for autism despite the fact that repeated studies conducted in the U.S. and abroad have failed to find a link.

These anti-vaccine activists not only do nothing to help those with autism, Dr. Offit argues, but they put children in danger by discouraging vaccinations that prevent dangerous infectious diseases.

Dr. Offit’s accounts of how the anti-vaccine ideas gain currency, passionate support, and media attention, and how they then come unravelled when subject to scientific scrutiny is fascinating journalism.

Autism’s False Prophets is a thoughtful, passionate book that anyone who is interested in autism or the autism debate should read.

Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure
Paul A. Offit, M.D.
September, 2008 
Cloth, 328 pages, 12 illus.
ISBN: 978-0-231-14636-4
$24.95 / £14.95

In “Dear Governor: About That Healthcare Crisis“, Edmonds editor and publisher D.J. Wilson has put together a highly readable collection of articles by 20 people with expertise in Washington’s health system who provide a variety of ideas on a way forward.

By an large, the contributors are not academics but rather people working on the ground, in clinics and hospitals, with community organizations, unions and patient groups, or for health plans, consumer advocacy groups and nonprofits.

As a result, their arguments tend to be direct and their proposals practical.

Dear Governor: About That Healthcare Crisis
Edited by D.J. Wilson
Paperback. 195 pp.
Edmonds Publishing Group
$24.00 

In his introduction, Wilson notes that health-care reform ideas coming out of universities often prove to be “ideas without a constituency.” As a result, he says, they carry no weight with lawmakers and are unlikely to succeed.

For this book Wilson wanted ideas with a constituency, so he went to people who represent different interest groups in the state, though he uses the more politically correct term “stakeholders”, and asked them “If your had 10 minutes with the Governor, or any one individual, what would you say?”.

The result is highly, readable collection of short, to-the-point articles that focus on problems that are specific to our state.

The articles address the issues many of us may already be aware of, in particular: the high and increasing cost of healthcare, the perverse incentives that promote high-cost, high-tech procedures over low-cost preventive care, and the generally chaotic, fragmented nature of our current health-care system.

The changes proposed by the contributors, however, are not radical but instead tend to be modest and incremental.

A great deal of faith, for example, is placed in the promise of electronic medical records, for the most common recommendation is for the institution of incentives and subsidies to speed the adoption of information technology.

But while electronic medical records will no doubt greatly reduce costs and improve care, one has to wonder whether there is something more fundamentally wrong with a system that at this late date still hasn’t embraced a technology that almost every other industry has adopted and, indeed, been revolutionized by.

Among some of the other issues discussed are the need for more primary care providers, for improved rural services, for better outreach to under-served minorities, for more health education and promotion, and for more support of efforts to improve quality and reduce medical errors.

All the ideas seem good, some stronger than others,  but as you read along, you did begin to hunger for someone to cut the Gordian Knot that seems to be binding up the system so much that it can’t seem to implement many of these changes spontaneously.

The contributor who came closest to that was Kathleen O’Connor, founder of CodeBlueNow!, an advocacy group trying build a popular consensus on health-care reform.

O’Connor called for setting up a health insurance pool similar to that offered to Federal Employees, including members of Congress, from which everyone including individuals could purchase insurance.

As with the Federal Employee Health Benefit Plan, insurers who want to be included would have to agree to provide a certain basic set of services and would not be able to refuse to insure individuals with pre-existing medical conditions as they can now. The system would also force insurers in the pool to compete on the basis of price and service and, thus, would likely help control costs and improve quality.

Most of the contributors, however, call for less far-reaching, more middle-of-the-road, incremental reform. For example, the most conservative voice was that of the conservative blogger Eric Earling, who gave fairly high praise for the recently adopted Massachusetts health reform plan, which is, afterall, a plan adopted by arguably the bluest state in the Union.

Indeed, it would been nice to have at a few contributors representing the “extremes” of debate, say, one contributor arguing for single-payer Canadian-style system and one for a market-based voucher system. 

But, that said, “Dear Governor” provides a fresh, engaging collection of articles by people who are likely to have a significant voice in the upcoming health-care reform debate in Washington state.

It’s good to know what they think.

A list of the contributers is below:

Forward:

• William H. Gates, Co-Chair, Bill & Melinda Gates Foundation

Introduction:

• D.J. Wilson, Editor, Edmonds Publish Group.

Contributors:

• Karen Keiser, member of the Washington State Senate
• Jesus Hedrnandez, executive director Community Choice Healthcare Network
• Renee Beebe, Founder & Lactation Consultant, Northwest Association for Postpartum Support
• Rick MacCornack, Executive Director South Sound Health Communication Network
• Larry Loo, CEO, Puget Sound Health Partners
• Ted Bridge, Pediatrician , Federal Way Pediatric Clinic
• Rose Cantwell, President of the Board, South County Senior Center
• Stan Flemming, President, Pacific Northwest University of Health Sciences
• Greg Vigdor, President & CEO, Washington Health Foundation
• Peter Gelpi, CEO, Clarity Health Systems
• Patricia Briggs, CEO, Northwest Physicians Network
• James Hereford, Executive Vice President, Group Health Cooperative
• Eric Earling, Contributing Editor, Sound Politics
• David Rolf, President, Service Employees International Union, Local 775
• Donald Fisher, President & CEO, American Medical Group Association
• Kathleen O’Connor, Founder & CEO, CodeBlueNow!
• Tom Fritz, CEO, Inland Northwest, Health Services
• Richard Cooper, CEO, The Everett Clinic
• Russ Sarbora, CIO, Community Health Plan of Washington
• Mary McWilliams, Executive Director, Puget Sound Health Alliance.

First in a series of LocalHealthGuide reviews on books about health-care reform

In his book, “Critical: What We Can Do About the Health-Care Crisis“, Daschle, a former Senate Majority Leader and veteran of health-reform battles, points to two key reasons why President Bill Clinton’s health-care reform proposal failed in the early 1990s.

The first, Daschle says, was that despite having run on the promise of health-care reform in 1992 election, Clinton put off submitting a plan to Congress in order to deal with the economy and the North American Free Trade Agreement first.

As a result, the bill, a 1,342-page behemoth, was not delivered to Congress until late November 1993, by which time the bill’s opponents had built an impressive organization that crushed the initiative with a barrage of attacks.

“The health-care debate might have played out differently if President Clinton had launched it in the spring of 1993 when he still had some momentum from is election victory,” Daschle writes.

That was a mistake that Daschle and Obama are are not likely to make again. 

The second reason for failure of the Clinton initiative, Daschle writes, was that proposal was far too detailed, allowing its opponents to undermine its support by attacking specific items, picking it apart, even though there was broad public support for health-care reform in general.

With so many competing special interests, ranging from patients groups to insurers, Congress is essentially incapable to instituting responsible health-care reform, Daschle writes.

So much is at stake, Daschle says, that short-term, and short-sighted, political jockeying will inevitably trump sound, far-sighted policy making. 

Sen. Tom Daschle

To bring that kind of judgement into play, Congress needs to create a National Health Board that will have the independence to make difficult and politically dangerous decisions that Congress is often incapable of making, Daschle writes.

This board would be modeled after the National Reserve Board, which as created by Congress to manage monetary policy with the charge to keep inflation in check and unemployment low.

Though by no means perfect, the Board has arguably done a better job at attaining those goals than Congress could ever have hoped to do, Daschle points out.

Daschle, like Obama, proposes reform that builds on the existing health-care system rather than a major overhaul. The current system of employer-based insurance would remain as would Medicaid and Medicare. 

The biggest change would be the creation of a insurance-purchasing pool, similar to Federal Employees Health Benefits Program, where individuals and small businesses could purchase insurance plans with defined benefits from competing insurers.

No one could be excluded from purchasing from this pool so that no one would be unable to get insurance because they had a pre-existing condition, such as diabetes. 

One of the main jobs of the National Health Board would be place conditions on those insurers who want to participate in this insurance pool by drawing up guidelines of best practices, promoting drugs and treatments of proven cost-effectiveness, and ranking services and therapies by their health and costs.

The Board’s standards would likely influence the policies and practices of other insurers as well, Daschle argues, improving the quality of care and reducing costs overall.

Daschle’s book not an exhaustive analysis of the the U.S. health-care system. But it is a highly, readable outline of one approach to health-care reform, an approach that is very likely to be similar to that taken by the new administration in the coming year.

Critical:What We Can Do About the Health-Care Crisis
Sen. Tom Daschle
St. Martin’s Press
Hardback: $23.95
Paperback due out August 2009