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Mike's Letter
<http://www.michaelmoore.com/words/message/index.php?id=
215>
Friday, July 6th, 2007
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
[EMAIL PROTECTED]
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
[EMAIL PROTECTED]
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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