Public Opinion of Healthcare

I just finished watching The Rainmaker, a 1997 film directed by Francis Ford Coppola.? The film stars Matt Damon as a young lawyer who ends up with a case involving Great Benefit, an insurance company accused of denying a legitimate claim which results in the death of a covered member.? Matt Damon’s client is the mother of the son who died because treatment was denied by Great Benefit.? In the end, he wins a $50MM lawsuit against Great Benefit who then files bankruptcy.? No one gets paid.? The film also co-stars Danny DeVito who describes Great Benefit at the end of the movie as “a bad slot machine that never pays off”.? I’ve seen the movie before and it is how a lot of people see an insurance company.

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In the movie, Great Benefit is depicted as a corrupt organization that routinely denies claims in order to wear down the will of the claimant, and in doing so, walks away from thousands of claims per year that should have been paid.? In the trial, the testimony is that the legal settlements that may arise on those denied claims is less than the value of those claims that were denied, so Great Benefit scores a win.? The term “lottery” is used where Great Benefit counts on the low likelihood that any of the policyholders would ever complain, let alone seek legal counsel.? Great Benefit’s actions are seen as deplorable.?

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I have found that most people outside of my industry have a view of insurance that is closely aligned with the theme of the movie.? By believing that the insurance is out to get them, the idea of a denied claim becomes fodder for social media who will pick up on the anger and magnify it greatly.? As mentioned in other sections of this book, all of this anger and frustration causes people to lose sight of facts.?

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I will go back and blame the healthcare industry for where public opinion has landed.? The healthcare industry could have told any one of the stories I have shared in this book to explain how things work.? Instead of describing the mechanics of the system, the healthcare industry sat there and allowed the public opinion to fester to the point that no one trusts any of the major players in the industry.? Providers have also become victim to the distain that the average person harbors about healthcare.? You all should have, could have and would have done better to tell the story.? Because all of you were either afraid to tell the story or were adverse to conflict, here I am telling a story that is long overdue.

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Let’s go ahead and pull over and talk about the concept of conflict.? I’ve mentioned this before where I was critical of a former CEO who was adverse to any type of conflict.? Let me also be clear that when the word “conflict” is used, everyone immediately has visions of a full-blown fistfight.? Not true.? Right there – yes, right there is the problem.? People do not know how to address conflict.? I’ve watched many go hide in the corner and pull the blanket over their head, hoping it blows over.? I do not see that you can be a leader (notice I said leader, not someone in charge) unless you can address conflict.? Where people do not agree on an approach, you need to find someone who can cut through the minutia to find something that everyone will support.?

Conflict was part of healthcare long before I entered the industry and will there long after I’m retired.?

Because so many in healthcare lack the skill to address conflict, and they sit in the corner hiding from the disagreements hoping that it all goes away, the truth about the industry remains a mystery.? No one is willing to stand up and clear the air for fear of an adverse reaction.? As I look back on the countless number of opportunities to inform the American consumers of the inner workings of healthcare, I see where this has all slid into the ditch and has become the specter.

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So, how do we fix the perception???? I’ll give another analogy for you to understand.? Let’s say that I know virtually nothing about refrigerators.? I hear that a refrigerator will keep your food fresh for a long, long time and if you put the food in the refrigerator, it will last longer.? With that, I say okay and buy a refrigerator.? Wanting the best, I buy the top of the line model.? When I get it home, I put my food in the refrigerator and a few days later I can’t stand to open the door because of the smell!? Now I’m mad as hell and I start a post on social media about how refrigerators are rip-offs and I hate them.? What went wrong?? I didn’t understand the refrigerator enough to use it properly.? What I didn’t know was that there was a plug in the back and that by consuming electrical power, the refrigerator would keep my food fresh by cooling the interior of the refrigerator.? That’s what’s wrong with the perception of healthcare.

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If people understood that prior authorization was a tool to keep costs from spiraling out of control, and had my car repair analogy to better understand the decision process, they’d support the concept.? In fact, they’d insist that their provider paint the healthcare picture by creating a clinical argument that was solid with lots of valid diagnosis codes.? Heaven forbid that we actually justify spending money in healthcare!? I realize that this book will draw fire from a lot of healthcare providers who think that I am selling out to “the other side”, but that’s how I see it after investing my career in the space.? I could have written this book to be sensational and jumped on the same bandwagon that I read on social media, but instead, I’m giving people the facts.?

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I read a regular series of posts on social media that defame the healthcare system.? Whether it is some publicly traded insurance company making money or a stock buyback or executive compensation, it is all in the same vein.? The idea in those posts is to get people so pissed off that you create the torch and pitchfork image of the original Frankenstein movie.? That’s not how I roll and it’s not the objective of this book.? Information is one thing but tainted twisted purpose-driven comments that lead the reader to the wrong place are another.? Contrary to our current media structure, I’m here to give people an objective view of healthcare.? They tell me that controversy sells, let’s see how people view my perspectives.

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So, let’s go back to the public opinion of healthcare.? Where do we go next and do we care?? Some would say to leave it alone because everyone needs healthcare so why bother to try and change the perception.? That kind of thinking sounds like the US auto industry in the early 70s where everyone became complacent with their product quality since no one else’s product was any better than theirs so why improve quality?? Certainly we can do better.? I am a proponent of providing information to the consumer to make better decisions, thus this book.? We are all better off knowing what we are dealing with in all aspects of life.? Healthcare is common to us all so why not understand the system?? Why not indeed!

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My contemporaries, and also my colleagues that are newer to the industry, as well as those new professionals, need to work to change the mindset.? I do not see any other alternative to altering public opinion other than providing factual information.? Again, factual information, not sensational spin.? As I write this book, I think of all of the people who have blurted out comments over the years that affirmed their disgust with the healthcare system.? I recall an individual in the early 1990s who boldly declared that “hospitals are a rip-off”.? That comment stuck with me as I made my living at the time in a large health system.? I can also hear my father say things critical of doctors.? I recall him saying once that doctors cut up old people and then sock it to the insurance company.? Yeah, he said that.? He sees the healthcare system in a dim light too.

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I’m also going to digress a moment about people’s view of healthcare when it comes to the facilities themselves.? Going back to sometime in the late 70s when I was a kid, I recall my father complaining about a new grocery store being built in our town.? His view was that the old established grocery store was just fine but he had heard on the news how people “demanded” better shopping experience and he concluded that all of this new construction and building expensive buildings was just adding to the cost of groceries.? Yes, he was right.? It added to the cost.? He became frustrated at the notion that people demanded (in an economic sense) grand, fancy and unnecessary costs where in the end, you couldn’t take it home with you but you bought it anyway.? He was correct in his assessment.? However, if your competitors do it, so do you.? It is that simple.

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When I look at healthcare facilities, I see grand structures and the very best of materials.? I also see the very best décor and environments.? I believe that healthcare has followed in the footsteps of banks where marble walls and floors with grand ornate structures are seen as a sign of stability.? No one wants to go into a bank that is some old run-down building with worn out carpet.? Likewise, no one wants to surrender their healthcare to a place that looks old and outdated.? Because of people’s expectations, if we don’t provide a new and modern structure to come and visit, we cannot compete against those that do.? In the end, yes, all of this adds to the cost of healthcare as it is part of the talent and technology investment.? No, I’m not advocating that we start moving healthcare centers into vacant malls and shopping centers from the 1980s.? I suppose that we could renovate any of those to support healthcare, however, people would see it as a third-rate facility and it wouldn’t compete with modern buildings.? Well dad, you made your point.

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As I wrap up this chapter, I want to journey back to a time in my past when I sat in our living room and watched the CBS Evening News with my family.? I remember Walter Cronkite talking about healthcare fraud, doctors convicted of misdeeds and the costs associated with the healthcare system.? Those images are vivid in my mind to this day.? This all goes back to a time when healthcare was beginning to become an industry of its own and with the spotlight not only on the miracles of modern medicine; the spotlight was on the bad players in the space, as well.? Today, we live in the shadow of those images from our past.? I wished that we could have done more to inform our citizens.