Ya gotta do your research.
That’s a basic lesson in the business world, but one that some seem to forget. The latest example – actually there are two – comes courtesy of Grace-Marie Turner of the Galen Institute. Ms Turner sent me an email, copied below.
Dear Mr. Paduda,
Every day, another politician promises to “fix” health care.
With that in mind, the Galen Institute recently launched a YouTube video contest asking average Americans to create persuasive, 90-second videos bringing attention to the dangers of government health care and the benefits of free market reforms. The contest was inspired by the “First Do No Harm” principle. Doctors follow it — shouldn’t politicians?
Today, we’re announcing the winners of our contest. You can view the entries, along with the winning videos, here:http://www.youtube.com/groups_videos?name=firstdonoharm.
If you’re interested in doing a post on our contest, please feel free to contact me via telephone or e-mail or use the press release below.
All best,
Grace-Marie Turner
President, Galen Institute
Alexandria, VA
Here’s my response:
Ms Galen:
Thanks for your email.
I disagree with the premise and the purpose of your “campaign”. You are erecting a strawman based on a distortion of the plans currently under serious consideration and in so doing not contributing to the dialogue but rather distorting it.
It is unfortunate that you are not able or willing to engage on the merits of the current proposals but instead have resorted to fearmongering and obfuscation. There should be an open and honest debate; this effort damages your organization’s credibility and does not contribute to meaningful discussion.
Sincerely,
Joseph Paduda
Principal
Health Strategy Associates, LLC
The two research blunders committed by Ms Turner are:
a) sending me this press release. Obviously the good folk at Galen have not read this blog or any of my other articles on health care/reform/insurance/policy.
b) deciding this would be an effective way to engage in, and perhaps change the course of, the health care debate. Galen and the right-wing think tanks are rapidly slipping into irrelevance, and with this nonsensical PR effort Turner is accelerating the process. Instead of engaging in a thoughtful, intelligent, fact-based debate, Galen has resorted to the shopworn tactic of trying to scare the pants off common folks.
There are solid, reasonable arguments against a public plan option, single payer, connectors and other aspects of health reform proposals currently under consideration. That’s not to say I agree with some or all of them, but I do believe they are helpful.
It is indeed unfortunate that Ms Turner’s contribution is nothing more than a reminder of why McCarthyism was so destructive.

The chances of meaningful healthcare reform look increasingly likely. Whether it will be reform we can afford is an entirely different question.
We’ll be taking a look at the differences this time around, and today will begin with the role of the health insurance industry.
Don’t expect to see Harry and Louise return to the small screen (TV or computer); while there may be an occasional sighting, the sponsors of the original edition have refused to let the aging couple out of the retirement home. Fearing a catastrophic backlash, health insurers are doing everything possible to be kindler, gentler, and easier to work with. They’ve got a long way to go, but their path is clear. A 2008 USA Today/Kaiser Family Foundation/Harvard School of Public Health poll had the industry with a 40 percent favorability rating with the public, lower than banks, airlines and drug companies, and half the approval rating of doctors.
Many view insurers as part of the problem, and with the continuous drumbeat of bad press, they aren’t doing themselves any favors. The public and the powerful do not trust healthplans, who have not given either constituency any reason to do so.
To the extent the insurers are able to stay at the table, they are finding their influence is dramatically lower than it was even twelve months ago. Particularly in the House, where Reps. Waxman and (even more so) Stark (D CA) are the powers behind reform, the health insurance industry has few supporters willing to publicly advocate for their views. In the Senate, it’s not so much that health plans have more friends as fewer enemies, and the friends they do have are reduced to yelling from outside the door.
Healthplans did this to themselves. Medicare Advantage was seen by most as a flat-out hand-out to insurers, who grew fat and profitable from overpayments funded by taxpayer dollars. The health insurance industry way overplayed its hand. Braying about the power and brilliance of private industry and its obvious ability to easily outperform the stumbling bumbling bureaucracy while seeking huge subsidies from that selfsame government was a doomed strategy. Hypocrisy is always a tough sell.
The industry is now all-but-prostrate at the feet of Congress, offering to give up medical underwriting, stop charging sick folks higher premiums, and even reduce health care costs – in return for an requirement that everyone buy health insurance. This last is no concession at all, adding huge revenue dollars while also aligning the industry with the powers that be. Win-win indeed; in retrospect this is so obviously good for the health insurance industry that it is amazing Harry and Louise weren’t pushing for universal coverage back in 1992. What’s new is the revelation that underwriting is not only expensive, but unpopular.
Health plans should count themselves very lucky that the President and key Senators refuse to engage in discussion about single-payer, instead proposing to build a new health insurance/care system on top of the existing (mostly) private insurance infrastructure.
But they can’t entirely give up their old ways, as evidenced by the public battle over the public plan option. This is where the industry may well make a catastrophic mistake. The public doesn’t like health plans, seeing them as mean-spirited, bureaucratic, monolithic entities ensconced in huge office buildings with leaders that are paid way too much for their ability to reject patient’s pleas for care while raising rates every few months and underpaying physicians. Now these private insurers and their advocates on the Hill are complaining about the unfairness of a public plan option, one wherein the government would ‘compete’ with private insurers.
In today’s world, the industry’s arguments against a public plan ring false. Opponents complain about faceless bureaucrats coming between patients and doctors; their lobbyists may have forgotten this was the health industry’s business model, but the public sure hasn’t. On a macro scale, voters traumatized by the failure of the mortgage and banking industry are loathe to trust yet another big financial industry to do the right thing; there has been precious little indication that the industry is in any way interested in that strategy.
All but lost in the debate has been the question of cost reduction. The industry’s pledge to reduce costs by two trillion dollars over ten years was quickly withdrawn, after President Obama masterfully maneuvered the industry and their supporters into a made-for-TV press event wherein he lauded them for that commitment. I’d expect to see a replay of that confab more than once as the debate heats up, and insurers will find themselves squirming on an increasingly hot seat as they try to spin their past statements. In so doing they’ll just dig themselves an increasingly deep hole – aren’t healthplans supposed to control costs? If so, why can’t you? And if you can’t, why, exactly, are we relying on you as the foundation for a new health system?
If meaningful reform happens, the primary beneficiaries will include healthplans. Yet another example of why it’s always better to be lucky than good.

I’ve been asked to do a point-counter point with Jacob Hacker, one of the more vocal supporters of a Medicare-for-All program.
It’s my contention that Hacker overstates the case for Medicare, and in so doing weakens the case for a public plan option. Specifically, he argues that Medicare has lower administrative costs and does a better job holding down medical trend. I disagree.
Medicare has an unfair advantage over private plans: it doesn’t need to maintain reserves, earn profits to attract capital, or pay premium taxes. These result in big dollar ‘savings’ over private plans. It is also important to note that Medicare’s cost structure is dramatically different in other ways.
1.) Medicare has no underwriting or sales expenses or marketing costs. No commissions, either. This saves a lot of admin dollars. This differential would disappear in a health connector-type system, with the playing field leveled by dramatically reducing commercial healthplans’ marketing costs and elimination of their underwriting expense.
2.) Medicare has one-time enrollment and dis-enrollment, and greatly simplified eligibility processes. This cuts their costs, but would not continue under a connector model.
There’s more here.