America’s largest health insurance and services conglomerate thinks
a health reform bill is likely to pass. And it has a plan already for
making maximum profit out of the change. Here’s an internal document
from United Health Group to its employees that sees killing traditional
Medicare as a big profit opportunity, and the two years of delay before
most reforms go into effect as a chance to make the law more to its
liking.
The document is posted down below in plain text, rather than linked, to protect the person or persons who sent it to me.
Bottom
line: Cheer the likely passage of even a weak bill, but beware the
tricks that insurers can pull to make it work to their advantage, not
yours.
It’s significant that United Health, and presumably other
insurers, think the reform bill is going to become law. The industry’s
army of lobbyists probably has a better sense of how each member of
Congress is going to vote than the Congressional leadership. So the
insurer is backing away from its protests, and its push to get employees to lobby their legislators against the bill.
It’s turning instead to the next opportunity:
From the "Dear employees" message:
Most
provisions in health care legislation take effect in 2013 and then
continue building from there. A lot can and will occur between now and
then. …
We should not be distracted by the headlines of the “final” days of the current legislative process.
One
of the things that will occur before 2013 is the writing of specific
regulations to put the law into practice. United Health wants to see
tougher requirements for every American to buy insurance, and in order
to keep its profits growing, wants more power to deny them care. That,
at least, its my translation of the following insurance-speak:
*We
want balanced reform. All Americans should have access to health care
coverage. That coverage is only sustainable if everyone participates,
and if consumer demand for health care and health care delivery
processes and costs are managed responsibly.
Of
course, the insurance companies would be "managing" the consumption of
medical treatment and doctors’ requests for such treatment, i.e.
"health care delivery processes." The worst thing that could happen, in
the view of insurers, would be effective rate regulation that allows insurance companies to make a fair profit, but not to gouge patients.
United
Health also sees up to 40 million potential and profitable new
customers in Medicare. It wants to pull them out of traditional
Medicare and into for-profit Medicare Advantage plans managed by United Health. The word "modernization"in insurance-speak here means "privatization:"
*The
health care system needs to be modernized… made more effective,
efficient and affordable. It can and must deliver better, more
consistent quality at a lower cost. We believe the private sector has
the best resources and innovative capacity to achieve that end.*Modernizing
the fee-for-service Medicare system should be a national priority
because of the pressure on funding and the impact to the national
budget.
Later on, the memo gets a specific:
We
can outperform fee-for-service Medicare in most of our markets, if we
focus on and commit to that goal. That will protect Medicare Advantage
for seniors and open up the rest of the Medicare market — that’s more
than 40 million seniors and growing.
By "outperform,"
United Health does not mean it can provide the same or better level of
care for less money. Medicare Advantage plans, including UHG’s,
currently cost U.S. taxpayers 14% more than regular Medicare, and these
excess costs are speeding the insolvency of the whole program. What
Medicare Advantage patients get is very slick marketing, bells and
whistles like "free" gym memberships–and tough HMO-style restrictions
on doctors and treatment if they happen to fall seriously ill.
The
memo also promises to back some useful things, like paying doctors and
hospitals for better health outcomes, instead of a system that
encourages too much testing and warps the doctor-patient relationship.
But the bottom line is the bottom line in for-profit insurance–it’s
the most important thing.
Remember all of that fear-mongering talk about government "coming for your Medicare"
by reducing Medicare Advantage overpayments? That was always hooey.
It’s insurance companies that are really coming for your Medicare, and
saying so. In the next two years, they intend to find new ways to keep
their overpayments flowing–even if your children and grandchildren are
saddled with the bill.
The good news is that forewarned is forearmed. It doesn’t have to turn out that way.
Here’s the whole memo, from CEO Stephen Hemsley (2008 compensation $3.24 million):
To: All Employees
From: Steve Hemsley
Date: March 17, 2010
Subject: Reform: Update and Outlook
Most
Washington “insiders” believe a health care reform bill, likely the
bill passed last December by the Senate, will be considered soon, and
possibly approved by the House of Representatives. If enacted, the bill
could be signed into law by President Obama shortly thereafter. Right
now there continues to be considerable maneuvering and media attention
as Congressional leaders try to round up enough votes to pass the bill.
This
development is not unexpected; it has long been assumed that any reform
bill capable of advancing would likely resemble whatever bill the
Senate was able to approve.
We are concerned, as are many
experts, that this legislation falls well short of achieving true and
sustainable reform. It offers expanded coverage, but does not go far
enough in controlling the underlying costs of health care that would
pay for and sustain that expansion. Nor does it go far enough to ensure
Americans can and will obtain appropriate health care coverage to
enable needed changes, like addressing pre-existing conditions and
guaranteed issue practices.
The distortions that arise from such
imbalanced legislation will place even greater financial pressures on
individuals, businesses and taxpayers. We have seen similar, adverse
outcomes where other attempts to reform health care fell short — most
recently in Massachusetts.
Most provisions in health care
legislation take effect in 2013 and then continue building from there.
A lot can and will occur between now and then.
We should not be
distracted by the headlines of the “final” days of the current
legislative process. We are better served by recommitting ourselves to
the baseline beliefs we have held for many years:
*We want
balanced reform. All Americans should have access to health care
coverage. That coverage is only sustainable if everyone participates,
and if consumer demand for health care and health care delivery
processes and costs are managed responsibly.
*The health care
system needs to be modernized… made more effective, efficient and
affordable. It can and must deliver better, more consistent quality at
a lower cost. We believe the private sector has the best resources and
innovative capacity to achieve that end.
*Modernizing the fee
for service Medicare system should be a national priority because of
the pressure on funding and the impact to the national budget.
While
we all wish the proposed legislation was more balanced and better
addressed rising costs — and we will continue advocating to make it so
— we have to stay focused on our core goal of making high quality
health care more accessible and more affordable for all Americans. The
likely outcome under the current legislation is that there will be
accelerating health care costs and any number of problems across the
system. That means there is an even greater need for the capabilities
and experience we bring to the health care system…and our ability to
execute on making high quality health care more accessible and more
affordable for all Americans will gain even greater importance.
*Managing
Costs: Aggressively optimizing our operating and medical costs becomes
critically important for us to be more competitive than any other
operation in our space. It allows us to free resources to dedicate to
other critical areas, such as modernization, integration, quality and
reputation building efforts — and, most importantly, new, innovative
products and services. Having the very best cost position delivers a
huge value benefit to the people we serve and to our enterprise.
*Innovation:
Our customers are searching for new solutions, simpler experiences and
services that are easier to use — like accessible help in comparing
prices of medical treatments and health care services so they can make
more informed decisions, payments to hospitals and care providers based
on better medical outcomes, a whole spectrum of health plans like the
Diabetes Health Plan that give people the resources and support they
need to effectively manage their health and health care, truly managed
high risk pools and many of the other ideas you are working to develop
today.
*Fundamental Execution: We talked for two years about
“fundamental execution.” It has helped our businesses and we still can
do more. The impact and response to our strengthened service culture,
close attention to detail and building market relationships has been
very positive. Consistent, flawless execution on technology deliveries
and service commitments remains critical — on time, on budget, on
specification. Our customers expect us to deliver great service,
affordable, effective products and innovations that add measureable
value. If we consistently take integration and quality to performance
levels no one else has ever delivered, we will find this effort pays
quality and cost reduction dividends. We saw the first glimpse of that
this year, but there is much more to be pursued. Consistent fundamental
execution is the table stakes for a future of innovation and growth.
*Outperforming
fee-for-service Medicare: We can outperform fee-for-service Medicare in
most of our markets, if we focus on and commit to that goal. That will
protect Medicare Advantage for seniors and open up the rest of the
Medicare market — that’s more than 40 million seniors and growing.
*Managing
Medicaid: State Medicaid programs will be awash in a sea of newly
eligible citizens. State programs have limited resources and
capabilities to respond to the influx. We must be prepared to move
quickly and effectively to support the overload and perform well for
the people we serve and the government sponsors of their health care.
*Modernizing
the health care system: On so many levels, the health care system
remains inefficient, needlessly complex, over-regulated, consumer
unfriendly and costly. We have the ideas, capabilities and resources to
make it better for the U.S. and for people everywhere — to truly help
people live healthier lives individually and on a large scale. Leading
the modernization of the health care system will give us distinction
among our peers and in the minds of the people we serve and solidify
our value across many markets.
Once this reform stage is past,
the nation will confront the tough realities of making the system work
better for more people — work that we know so well and that requires
the unique capabilities and expertise we can deploy. A track record of
proven execution and innovation will win the confidence of federal and
state leaders who will be confronted with translating legislative
intent into realities.
By focusing on executing well in
everything we do, we will be right there when what’s needed are proven
methods to help people make better health care choices while slowing
the rise in health care costs. The value that we add cannot be
legislated away.
Thanks.
