Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans
Foreword
Deadly Spin is a revelation about America's health care system unlike anything else you've seen. There are a lot of books and articles about health care reform, but none of them provide the insider's perspective like this one. Introduction
As a senior public relations executive, or "spinmeister," for two decades with two of the largest for- profit health insurance companies in the United States -- Humana and CIGNA -- it was my job to enhance those firms' reputations. But as one of the industry's top public relations executives and media spokesmen, I also helped create and perpetuate myths that had no other purpose but to sustain those companies' extraordinarily high profitability. --- I was a behind-the-scenes leader in every industry effort to kill any reform legislation that threatened insurance company profits. ... Although I told people during that period that I never lied to a reporter, the reality is that I often did -- but in such subtle ways that I could never even acknowledge to myself that I was purposely trying to mislead. The health insurance industry today is dominated by a cartel of large, for- profit corporations. By necessity and by law, the top priority of the officers of these companies is to "enhance shareholder value." I will also attempt to explain why it is vital to understand the role of the public relations industry -- the spin machine -- in our public discourse and in our lives, how to recognize it, and what we can do about it. What I hope to accomplish in this book is to pull the curtain back to reveal the techniques employed by practitioners of the dark arts of PR -- from the use of "third- party advocates" to the creation of front groups, from the staging of PR "charm offensives" to the selective disclosure of information and misinformation -- which influence people's thoughts and actions in ways that advertising cannot. PR people do not create ads that can be seen or heard or touched. They create perceptions without any public disclosure of who is doing the persuading or for what purposes. Chapter I
After handling dozens of horror stories and keeping many others out of the media, I was rewarded with a promotion to the corporate PR staff, To ensure that the bills would never pass, my peers and I hired some of Washington's biggest PR firms to plan and implement stealth campaigns to manipulate public opinion on one issue or another as part of a broader strategy to kill any legislation the industry didn't like. Using a PR firm, Porter Novelli, we formed a front group called the Health Benefits Coalition, which conducted a fearmongering campaign to convince the public -- and lawmakers -- that enactment of a Patient's Bill of Rights would lead to a tidal wave of frivolous lawsuits that would cause health insurance premiums to skyrocket. Chapter II
APCO was founded in 1984 by one of Washington's biggest law firms, Arnold & Porter, which is well known for its representation of the tobacco industry. From one office in Washington, APCO has grown into an international operation with offices in twenty-nine locations throughout North America, Europe, Asia, and Africa. On its Web site, APCO has referred to itself as "a global communications consultancy" specializing in "influencing decision-makers and shaping public opinion by crafting compelling messages and recruiting effective allies." One of the deceptive practices of which APCO has a long history is setting up and running front groups for its clients. The tobacco industry paid APCO almost a million dollars in 1995 to implement behind-the-scenes tort reform efforts and specifically to create chapters of "grassroots" citizens' groups called Citizens Against Lawsuit Abuse. … [We] apply tactics usually reserved for political campaigns to target audiences and recruit third-party advocates. Our staff has the political field experience and has written the direct mail, managed the telephones, crafted the television commercials and trained the grassroots volunteers. Tuffin said that when any of us talked to the media about Sicko, we should acknowledge the compelling stories and personal tragedies in the film but then try to change the subject to how insurers contribute to the American health care system. While Health Care America and the industry's allies would be doing the fearmongering, AHIP and insurers would try to persuade the public as well as lawmakers that the industry had a legitimate reason to exist. One of the key messages AHIP would stress in every media interview about health care reform during the coming months was that this time the industry would be "bringing solutions to the table," and would be willing to make certain concessions when Congress began drafting reform legislation. This would be the part of its PR charm offensive that insurers would want the public to see. If Sicko showed signs of being as influential in shaping public opinion on health care reform as An Inconvenient Truth had been in changing attitudes about climate change, then the industry would have to consider implementing a plan "to push Moore off the cliff." They didn't elaborate, and no one asked what they meant by that. We knew they didn't mean it literally -- that a hit man would be sent to take Moore out. Rather, an all-out effort would be made to depict Moore as someone intent on destroying the free-market The phrase "government takeover" is one that has tested extremely well over the years and has been central to every campaign the industry has conducted in recent decades to defeat reform efforts, including the Clinton proposal in 1994. Chapter III
[First I] should explain how public relations evolved into such a powerful yet largely invisible force in our society. Human beings have distorted information for as long as they've communicated -- with gestures, sounds, nuanced words, or whatever it takes to bring other people around. Whether it's as brazen as a pyramid or as subtle as a white lie, this art form -- often called spin -- has become as much a part of our culture as the media we depend upon to connect and inform us. They are experts in every medium, and they use their considerable resources to build and maintain strong, positive images for their clients. They cultivate contacts and relationships among journalists and other media gatekeepers. They walk a fine line between contributing to the so-called marketplace of ideas and warping public understanding to their clients' ends. Oftentimes, this line is so creatively blurred as to disappear. Cutlip & Center's Effective Public Relations, the encyclopedia, if not the bible, of the industry, defines PR as "the management function that establishes and maintains mutually beneficial relationships between an organization and the publics on whom its success or failure depends." ... That definition emphasizes the two-way nature of PR, as opposed to the one-way communication that characterizes propaganda or advertising. To be sure, PR has been -- and is being -- used to good ends. Even the noblest of causes can benefit from the services of a communications expert to clarify facts, disseminate information, and counter unfair arguments. And there are plenty of ethical PR people out there to do this. But with PR so intricately woven into every major industry and movement in today's mass media reality, the stakes of spin have become incredibly high. And ethics do slip. PR often crosses the line into misleading, withholding, or simply lying. And when it does, society suffers -- sometimes tragically Gossip, innuendo, and deception were common in publications and politics in the earliest years of the United States. Businesses manipulated the new nation's mass media as early as the 1830s, when the New York Sun, one of the early penny presses, offered to publish free "puff" stories (promotional material presented as regular news) for its advertisers. In the same period, American showman P. T. Barnum regularly pushed the limits of spin to a point that seems shocking even today. One of the first and most notable public relations men was Ivy Lee, who is credited with developing the concept of "crisis management," the organized, orchestrated communications response to a negative event -- one of the basic practices of today's PR. Lee issued his famous "Declaration of Principles," emphasizing the public's need for accurate information. The statement (now part and parcel of most modern public relations textbooks) proved to be a milestone in establishing the new field of PR -- separating it from the old image of publicity pushers, who by then were considered little more than hucksters and snake oil salesmen. The declaration, which Lee sent to newspapers, read in part, "This is not a secret press bureau. All our work is done in the open. In brief, our plan is, frankly, and openly, on behalf of business concerns and public nstitutions, to supply to the press and public of the United States prompt and accurate information concerning subjects which it is of value and interest to the public to know about." ... Lee reportedly advised Rockefeller to improve his personal image by carrying dimes in his pockets and giving them to children in public. ... While Lee is considered by many to be the father of modern public relations, a contemporary of his, the flamboyant Edward Bernays, engineered some of the most far-reaching, successful, and outlandish PR campaigns in history. Bernays was said to think of himself as a "unique counselor" to organizations, someone who melded the influence of the media with the science of psychology. He is generally credited with coining the term "public relations counselor," which he used in his 1923 book, Crystallizing Public Opinion, the first book devoted to PR. Bernays orchestrated a campaign that equated cigarettes with slenderness, grace, and beauty. He enlisted third-party "experts" to warn against the adverse effects of desserts, in terms of both weight gain and tooth decay, and to declare that cigarettes were a great alternative and could do everything from clean your teeth to make you a better dancer. Between 1937 and 1942, the Institute for Propaganda Analysis worked to expose domestic propaganda that the group considered a potential threat to American democracy. Although the group was disbanded during World War II (reportedly because of the wartime conundrum of examining not only enemy propaganda but Allied tactics as well), the IPA left a notable legacy: its list of eight "Rhetorical Tricks" used by propagandists remains strikingly relevant to PR today. It includes the following basic propaganda/PR ploys: 1. Fear Organizations with the most to lose are most likely to resort to fearmongering. Their information may mention the loss of jobs, a threat to public health, or a general decline in social values, standard of living, or individual rights. It may also vilify a specific cause or even a specific person in order to create the desired point of view.
2. Glittering generalities This approach arouses strong, positive emotions by using words and phrases like "democracy,""patriotism," and "American way of life." Virtually all types of organizations use the tactic to create support for themselves, but when combined with negative messaging, the implications can be insidious.
3. Testimonials Celebrities or recognized experts are frequently recruited or hired to provide testimonials about a product, cause, company, organization, or candidate. Good examples are the photos of famous athletes on Wheaties boxes and the endorsements of causes of all stripes (from animal rights to the right to own guns) by actors and musicians.
4. Name-calling Blatant insults can be a very effective public relations tool. The organization doing the name-calling may associate the target of the insults with a negative or unpopular cause or person. Defending against name-calling can be difficult. Negative terms tend to stick, even if they are undeserved.
5. Plain folks Anytime a business executive poses with rank-and-file employees or customers, he or she is claiming to be "of the people." The same goes for politicians who attempt to identify themselves with their constituents; with every election cycle come the candidates who claim to be "Washington outsiders" even if they've been in office for years. Being identified with "plain folks" is both good business and good politics, but it raises the possibility of being labeled a hypocrite.
6. Euphemisms PR practitioners often select words that obscure the real meaning of actions or concepts. The tactic is sometimes called "doublespeak." For instance, an employee may be "transitioned" rather than "fired," and a "lie" may be called a "strategic misinterpretation."
7. Bandwagon The overriding bandwagon message is that everyone else is doing or supporting this -- and you should, too. Opinion polls can create the impression that a large percentage of people are on the bandwagon, but poll results may reflect only a designated sliver of the population, and they can be shaped in advance by structuring questions to trigger an expected response.
8. Transfer Similar to testimonials, the transfer approach involves the approval of a respected individual or organization. The IPA described transfer as "a device by which the propagandist carries over the authority, sanction, and prestige of something we respect and revere to something he would have us accept." When skilled PR professionals do their jobs ethically, society benefits. For example, initiatives to end disease and poverty, to find missing children, to promote literacy, and to reduce violence have benefited from well-designed and well-executed PR campaigns. But PR tactics are also used to create subversive front groups, discredit legitimate individuals or organizations, spread false information, distort the truth, and instill fear. "Astroturfing." The term means creating a false grassroots movement so that a carefully crafted campaign or event seems to be happening spontaneously. PR also crosses the line when trying to repress or create doubt about information that could be harmful to a client. Hitler wrote, "The receptivity of the great masses is very limited, their intelligence is small, but their power of forgetting is enormous. In consequence of these facts, all effective propaganda must be limited to a very few points and must harp on these in slogans until the last member of the public understands what you want him to understand by your slogan. As soon as you sacrifice this slogan and try to be many-sided, the effect will piddle away, for the crowd can neither digest nor retain the material offered." The best public relations is invisible. Good PR usually gets free media space because it is presented as unbiased information. News releases explaining what happened at an event are commonly written before the event takes place. Corporate executives go through "media training" to prepare them for speaking directly to reporters. Mock press conferences are held to give execs practice. All good executives, like politicians, are taught the cardinal rule: Stay on message. PR people are good at manipulating news media because they understand them. A large number of practitioners are former reporters -- like Lee and Bernays (and me) -- who know what kinds of stories get attention, as well as who decides what gets coverage and what doesn't. Conversely, news outlets are increasingly dependent on public relations departments and agencies for content. As budgets drop, especially at newspapers, there are fewer reporters and fewer resources for investigative journalism. Canned information from companies is used "as is" more frequently, often without fact-checking. With years of practice, I had learned how to respond with a pithy remark if I wanted to be quoted and how to "baffle them with bullshit" if I didn't. Soon after I joined the company, a colleague gave me a framed E. B. White quote as an inside joke: "Be obscure clearly." I became a master at doing just that. My staff and I also compiled a news summary every morning of all significant stories about CIGNA and the insurance industry that had appeared in the media over the preceding twenty-four hours. I never wanted any of our executives to be out of the loop or blindsided because they hadn't seen an important story. As chief gatekeeper, I decided who was worthy of interviewing our CEO and how much time they got with him once I'd determined the access to be in the company's best interest. Chapter IV
The industry's spin, in other words, was going to be something like this: Health care costs are out of control because new treatments and technologies are more expensive than ever, the population is getting older and sicker, too many people are seeking care they don't really need, and health care providers are all too willing to provide this care that people don't need. Chapter V
Strong conservative governments in Europe called this "turning benevolence into power" -- a strategy generally credited with creating the social welfare measures that actually kept Communism from becoming a dominant force. Chapter VI
According to a study by the Commonwealth Fund, the number of underinsured Americans reached twenty-five million in 2007 -- up 60 percent since 2003.1 As an insurance industry PR executive, I had the responsibility of helping create the perception that the high-deductible and so-called limited-benefit plans that insurers and employers were forcing Americans into were consumer-friendly and essential weapons in the industry's battle against escalating health care costs. Knowing that doctors were much better liked and respected than HMO executives, the consultants recruited physicians to appear in a series of ads and commercials to testify why they thought managed care was a good thing for their patients. Rather than admit responsibility for the failures, insurance executives pointed the finger of blame at their customers, the "consumers" of health care, and, of course, the providers of care. Hanway, who left CIGNA in 2009 at age fifty-seven with a $111 million retirement package,3 was a leader in what Yale University political science professor and author Jacob Hacker calls the "personal responsibility crusade" -- a euphemism for pushing risks, and costs, formerly borne by institutions onto individual Americans. Proponents of HSAs argued that by spending their own money for care instead of relying on an insurance company, people would become more prudent "shoppers" of health care. Knowing that studies on the underinsured like the ones from the Commonwealth Fund and the Center for Studying Health System Change would slow -- if not halt -- the trend toward consumerism, the big insurers began churning out their own "store-bought studies" to counter reality. the selective disclosure of information to support a particular point of view, With cutbacks in newsrooms, there were fewer reporters covering the health insurance industry than in years past, and the ones who were left were often so busy that they had little time to probe. I was frequently amazed at how little media scrutiny there was of the industry and at how much my colleagues and I could get away with in dealing with reporters. More often than not, they were quite willing to settle for what we fed them, even if it was pabulum.