Letter about Leaked Internal Memo, distributed by Michael Moore

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."

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.

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.

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.

* 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..."

* 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 Â£6.65, no matter how large the dose
o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100

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.

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.

* 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.

Blue Cross and Blue Shield Association,br> 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.

To Mr. Moore,

Here's your free health care:

Yes, you may be in pain. Maybe you've heard of a silly movie's saying, "Life is pain. Anyone telling you differently is selling you something." Hey, you're Catholic, right? Give it up for the Church.

No, you won't be made to go before your time. No mercy killing assisted suicides. God's still in charge of these sort of appointments.

Yes, the Sacraments will always be made available...exorcisms included (which will be in the category of "fun", Spiritual Joy, and not just free of charge).

Paid in full via the Blood of Christ (also Present in the Holy Eucharist).

Yes, you'll still have to die to get into Heaven.

Yes, there's still the possibility of going to Hell, but that's all up to you should your reject every helping hand Jesus gives you.

No, you aren't required to accept this type of health care system, but if you're devoid of the spirit and all things spiritual, then yes, you will have to pay for what you want in this world and yes, you get what you pay for.

No, your version of socialized medicine exemplified by communist/socialist nations will not work on nations less shackled by such criminals.

No, I'm not buying into your media hype and emotional/spiritual attacks.

Yes, I'm warning all who'd listen or even be in ear shot of these lies.

And yes, I fully expect that you'd make my life more difficult for stating resistance to seeking comfort and pleasure for what is to whither, die, and corrupt. Yes, I know that I'm weak, will get tired, maybe even get caught off guard and (gasp) scared and nervous; but, I fully expect Jesus to be there when I need Him the most simply because He said He'd be there for me.

. . . nobody is denied service because they can't pay. They're just placed on a waiting list . . .

That goes along with what was related to me by one of my professors, told to him by a cousin in Canada -- the "Tale of Two Heart Attacks" as he called it.

One heart attack: Fifty-ish female, low-level executive in oil industry, minor chest pains centered. Immediate care in an emergency room, follow-up one week later.

Second heart attack: Seventy-ish pensioner (retired postal employee), chest pains radiating into left arm. Immediate care in an emergency room, follow-up scheduled for two months later. Never made it.

Nationalized health care is rationed health care. Middle-class proponents of national health care envision being in the same waiting room as Bill Gates or Paris Hilton, but I found from neighbors I had while living in Naples (Italy, not Florida) that such is not the case.

The more influential, wealthy, and "important" people get shunted into a much more streamlined, effective, and resource-laden track than the common folk. Average Joes find over-worked, quota-driven junior doctors, bottle-necks at clinics and procedures that demand expensive or scarce resources (MRIs, for example). Think about the average contact you have had with government employees and bureaucrats, then think about them being in charge of your health/life.

From your synopsis of the movie, here’s what is unfair with it: Individual bad instances in the U.S. system are compared to an idealization of foreign systems.

ALL systems balance cost and benefit, even ours. Our system is way tilted toward balancing the two at a very high level of cost, and, as a consequence, we generally get the best quality medical care in the world, and we have little patience with anything short of perfection. Many procedures that aren’t covered overseas are routine here, and patients here even expect access to procedures that are expiramental.

In universal health care systems, where care is “free” to the patient, costs are managed by government budgets. To keep costs under control, there are: relatively low pay for doctors, relatively low quality health care (both as compared to the U.S. system), denial of services to lower priority patients, and erratic waiting lines. In Canada, many people carry supplemental private insurance so that if the waiting line is too long at the free government hospital, they can come to the U.S.

Another difference between the U.S. system and the socialized systems, is that in our system you can identify and hold actual people accountable: Doctors, hospitals and insurance companies. If anything, our litigation system is too costly, and we might want to curtail it a bit. But, in the socialized system, you can’t sue anybody and politicians can always claim they’re on your side. In a socialized system, a denial of care is simply a bureaucratic snafu and nobody is really at fault. Therefore, in our system, people are evil and in a socialized system, people are good. This is wog wash. Rationing health care through budgets, exempting individuals involved in the delivery of health care from accountability, is not morally superior to rationing health care through a market process and holding individuals involved in the delivery of health care accountable.

The socialized system appeals to simple-minded people who want to think in terms of “intentions” instead of results. Thus, a socialists compares the exception to the rule in a relatively free market to an idealization of a socialist system.

Three more things about the U.S. system. It is not a free market system. Insurance companies operate under a long list of mandated coverages and individuals and small businesses are prohibited from joining into cooperatives (which could by-pass the onerous mandates faced by insurance companies). When HMOS were getting too good in controlling costs, the government slapped them down with “the patient’s bill of rights.” (HMOS were doing a pretty good job at controlling costs, especially those that are organized as mutuals.)

In Japan, they have a much more free market in health care than in the U.S. And, I might say, people freely act in a more personally responsible way over there as well. Over there, almost 80 percent of health care costs are paid out of pocket, and insurance is used only for expensive procedures and hospitalization. There, cost and benefit are balanced at a remarkably low level of cost and high level of quality.

Steve Forbes, way back in 1996, proposed Medical Savings Accounts in order to revive something of a free market in health care in our country. But, we are currently diverted with the War in Iraq from pursuing anything of a Republican agenda in this country,

Anyone remember the costs involved with hildabeastcare?

I recall Rush Limbaugh talking about it, so-called FREE health care would have cost each and every one of us that works, (in 1993 dollars, an additional $700 per month in additional taxes. A family with both husband and wife a total of $1400 per month. For those of us that live near a major metropolitan area, the costs would be more due to the issue of problematic births (crack cocaine babies).

If hildabeastcare care was passed by congress, in '93, what do you think the tax rate would be today in 2007/2008 dollars? 10%,25%, or higher??
(A liberal coworker and I had a conversation about this, he believed the company would pay the funds, I told him, more then likely they would pay no more then they do now, or even less, and we would be responsible for the remainder! The look on his face was priceless!)

One of the talk radio hosts commented about the Canadian system, saying that a Canadian had told him that the health care was great in Canada, as long as you don't get sick, you may not live long enough for the care to begin!

Nationalized health care is rationed health care.

Exactly.

Middle-class proponents of national health care envision being in the same waiting room as Bill Gates or Paris Hilton, but I found from neighbors I had while living in Naples (Italy, not Florida) that such is not the case.

Socialized health care creates a permanant caste system of those with clout and those without. It creates an instant underground system of bribes to providers of care to cut in front of the line. It limits the types of drugs available and institutionalizes the barrier between the haves and have-nots.

In the end, those who can afford it buy private insurance in addition to the socialized system and end up paying twice. They pay for the government's "cut" of the money, and again for insurance so they can get treatment to save their own lives and those of their loved ones.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.