BlueCross Secret Memo Re: ‘Sicko’ … “You would have to be dead to be
unaffected by Moore ’s movie…”
July 6th, 2007
Friends,
An employee who works at Capital BlueCross has sent us a confidential memo
written and circulated by its Vice President of Corporate Communications,
Barclay Fitzpatrick. His job, it seems, was to go and watch “Sicko,” observe
the audience’s reaction, and then suggest a plan of action for how to deal
with the movie.
The memo, which I am releasing publicly in this email, is a fascinating look
at how one health care company views “Sicko” — and what it fears its larger
impact will be on the public. The industry’s only hope, the memo seems to
indicate, is if the movie “flops.”
Mr. Fitzpatrick writes: “In typical Moore fashion, Government and business
leaders are behind a conspiracy to keep the little guy down and dominated
while getting rich.”
No. You don’t say! That can’t be!
BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just
saw. “You would have to be dead to be unaffected by Moore ’s movie,” he
writes. “Sicko” leaves audiences feeling “ashamed to be…a capitalist, and
part of a ‘me’ society instead of a ‘we’ society.”
He walks out of the theater only to witness an unusual sight: people –
strangers — mingling and talking to each other. “‘I didn’t know they (the
insurers) did that!’ was a common exclamation followed by a discussion of
the example,” according to Fitzpatrick.
He then assesses the film’s impact: “[T]he 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 … If popular, the movie
will have a negative impact on our image in this community.”
The BlueCross memo then suggests a strategy in dealing with “Sicko” and
offers the BCBS “talking points” to be used in discounting the film.
My heartfelt thanks to the employee who sent this to me .
And now a word from me to Capital BlueCross:
How ’bout a debate? No more secret memos and hand wringing about the
millions seeing “Sicko.” Just me and your CEO openly debating the merits of
a system that kills thousands of innocent Americans every year.
In the meantime, I hope you don’t mind me sharing your thoughts and
impressions in your well-written memo. And if the rest of your executive
team hasn’t seen “Sicko,” it opens in an additional 100 cities tonight for a
total of over 700 screens across North America . Attendance went up a
whopping 56% on the 4th of July, higher than any other film in the theaters
right now. But don’t be scared, and certainly don’t be ashamed to be a
capitalist. Greed is good! Especially good for you. There’s nothing like
having the pre-existing condition of being rich, should you ever get sick
and need help.
Yours,
Michael Moore
mmflint@aol.com
www.michaelmoore.com
P.S. Join me at noon EST, today, when I’ll be chatting with U.S.
Steelworkers, the California Nurses Association, and whoever stops by to
talk about “Sicko” and the industry’s attempt to stop this movement. Check
my website for details.
[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.
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