Let’s say you ran a lobbying organization that may (or may not) be staring into a political storm. And say that you’d just lost a battle with opponents within the health care industry that you thought you’d won in 2003.
Now, say you “believe” that the 47 million people — who are uninsured in part (but to be fair, only in part) due to your members’ greed, political choices and incompetence over the years — represent a market for your members.
Say your organization had some members who could possibly adapt to a new world, where tightly regulated organizations were contracted under strict terms to provide care to the whole population in a social insurance scheme — with appropriate risk-adjustment and other mechanisms in place to promote the care management you say your members do so well.
And say then it had other members, who are mere sharks and who would go out of business the minute they were banned from cherry-picking only the best customers and selling them quasi-fraudulent products.
Say then, that even those members whose CEOs may have claimed they could adapt to a different kind of world, are being exposed as behaving very, very badly in the current environment. In fact they’re being sued by the second biggest City in the nation and are in violation of what the state insurance commissioner (who is an elected Republican) flat out states is the law, even while they fight in court for the right to behave badly.
Say that eventually, as in today, Thursday, Congress is noticing
enough of the bad behavior of those members, even though it’s mostly
been in far off California, that it’s holding hearings about it for the first time.
Given all that’s going on you probably have two choices:
1. You could get all your members to sign a code of conduct in which
they promise to never, ever do the really bad things they’ve been doing
again, stop fighting the current regulators in their respective states about it,
and promise to use their lobbying power to promote a social insurance
system that looks like the one in the Netherlands. Bear in mind that according to the leading commentator on health care in the country Uwe Reinhardt that in the Netherlands:
"The system is so tightly regulated and so many transfers are
made among people to make sure everyone can afford the insurance and
everyone has access to the same care that it’s really just a social
insurance system in disguise. It’s not even vaguely close to the U.S.
2. You create an astroturf campaign
to go out and talk to the great unwashed which will come back and
generate political “support” for the plan you’ve already created which
essentially means that you get to do what you’re already doing, but you
get paid more by the taxpayer to do it.
Bear in mind, that you get paid $1.3 million a year to make this decision (as well as to be beaten up in public by Oprah & Michael Moore).
Bear in mind Choice 1 involves your members who could survive in a scenario of real reform
tossing the low-lifes under the bus. This is something they just refused to do
in the recent battle you lost, when they had chance to make a
compromise and keep more money in Medicare Advantage by doing so. And of course that may mean that their
super-profits of the last few years are over. (And judging by some of
their stock prices, Wall Street thinks that’s already happening.)
So what would you do?
OK, you don’t need to guess.