Fw: BlueCross Secret Memo Re: 'Sicko'

[Guest guest]

BlueCross Secret Memo Re: 'Sicko' ... "You would have to be dead to be unaffected by 's movie..."

July 6th, 2007

Friends,

An employee who works at Capital BlueCross has sent us a confidential memo written and circulated by its Vice President of Corporate Communications, Barclay Fitzpatrick. His job, it seems, was to go and watch "Sicko," observe the audience's reaction, and then suggest a plan of action for how to deal with the movie.

The memo, which I am releasing publicly in this email, is a fascinating look at how one health care company views "Sicko" -- and what it fears its larger impact will be on the public. The industry's only hope, the memo seems to indicate, is if the movie "flops."

Mr. Fitzpatrick writes: "In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich."

No. You don't say! That can't be!

BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just saw. "You would have to be dead to be unaffected by 's movie," he writes. "Sicko" leaves audiences feeling "ashamed to be...a capitalist, and part of a 'me' society instead of a 'we' society."

He walks out of the theater only to witness an unusual sight: people -- strangers -- mingling and talking to each other. "'I didn't know they (the insurers) did that!' was a common exclamation followed by a discussion of the example," according to Fitzpatrick.

He then assesses the film's impact: "[T]he impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films ... If popular, the movie will have a negative impact on our image in this community."

The BlueCross memo then suggests a strategy in dealing with "Sicko" and offers the BCBS "talking points" to be used in discounting the film.

My heartfelt thanks to the employee who sent this to me.

And now a word from me to Capital BlueCross:

How 'bout a debate? No more secret memos and hand wringing about the millions seeing "Sicko." Just me and your CEO openly debating the merits of a system that kills thousands of innocent Americans every year.

In the meantime, I hope you don't mind me sharing your thoughts and impressions in your well-written memo. And if the rest of your executive team hasn't seen "Sicko," it opens in an additional 100 cities tonight for a total of over 700 screens across North America. Attendance went up a whopping 56% on the 4th of July, higher than any other film in the theaters right now. But don't be scared, and certainly don't be ashamed to be a capitalist. Greed is good! Especially good for you. There's nothing like having the pre-existing condition of being rich, should you ever get sick and need help.

Yours,

mmflint@...www.michaelmoore.com

P.S. Join me at noon EST, today, when I'll be chatting with U.S. Steelworkers, the California Nurses Association, and whoever stops by to talk about "Sicko" and the industry's attempt to stop this movement. Check my website for details.

[The following memo was written by Barclay Fitzpatrick, VP of Corporate Communications for Capital BlueCross]

I was able to see Sicko last night in Lancaster. There were about 30 other viewers in the theatre covering all age groups. I have attached the well-written memo from one of our partners, which describes cases used in the movie, to the end of my memo. Also attached are the latest talking points from BCBSA. I will focus on impact to our brands, issues, and suggested strategies in this memo.

The MovieYou would have to be dead to be unaffected by 's movie, he is an effective storyteller. In Sicko presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit. Denial for treatments that are considered "experimental" is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit.

While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market. Here are some examples:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad treatment of members.* BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection.* BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature.* BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding inaccuracies in applications to enable post-treatment payment denials.* A BCBSA card is shown while the narrator describes how they (insurers) got wealthy.

In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich. Nixon Oval Office tapes are used to show how the initial idea of a 'less care = profit' enterprise was supported by the administration and became the HMO paradigm. Legislators are presented as bought stooges for the political agendas of insurers and big Pharma. Insurers are middlemen in the Medicare Modernization Act - which is presented as a trick to charge seniors more for their prescription drugs.

Doctors are barely touched - only in the course of discussing the AMA's work to sink early efforts in the 40's and 50's to start universal health care. He takes efforts to show that doctors live well in other countries despite the existence of universal health care. In follow-up interviews, has stated that he has spoken to and knows many doctors, and "doctors aren't the problem".

In the second half of the movie, walks us through individual stories of the Canadian, British, French, and Cuban health care systems where everything is free and - he reminds us repeatedly - no one is ever denied service because they can't pay. In addition to health care, the government provides free day care, college, and someone to do your laundry. Everybody gets along and takes care of each other and life is beautiful because there is universal health care. As a viewer, you are made to feel ashamed to be an American, a capitalist, and part of a 'me' society instead of a 'we' society - and the lack of universal health care is held up in support of that condemnation.

The Impact's movies are intentionally intense and his objective in Sicko seems to be to revive the earlier Clinton efforts - not to achieve universal coverage with this movie, but to push the topic to the top of the agenda. He will be just as successful whether proponents mount momentum or discussion entails key stakeholders defending why it won't work.

As a health care industry educated viewer it is easy to pick out where is cultivating misperceptions to further a political agenda, but you will also recognize that 80%+ of the audience will have their perceptions substantially affected. In demonstration of its impact, an informal discussion group ensued outside the theatre after the movie. While some people recognized how one-sided the presentation was, most were incredulous and "I didn't know they (the insurers) did that!" was a common exclamation followed by a discussion of the example.

The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as 's efforts in the movie and surrounding PR activity are seen by more of the community. The impact on industry savvy Sales' contacts should be minimal, while the impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films nor the way this one appears to be headed. If popular, the movie will have a negative impact on our image in this community.

There should be no doubt that many of our employees will be asked what they think of the movie by friends, family, and neighbors. We should anticipate that our customer service people will be asked about particular cases from the movie and if we follow similar policies. Word and phrases we have routinely used to date in policy change communications or denial letters, such as "Investigational", will be seen as affirming the film's contentions. The national BCBSA response - while coming out against the film's divisiveness and focusing on the positive work of the Blues - steers media inquiries about policies and denials back to the plans themselves.

There are 4 key areas of misperception cultivated by the movie that we should consider in any messaging strategy:

1. That the industry is all about HMO's. cultivates this further in his interviews. The reality is that HMO's are a minority product and have been for some time.2. The movie attacks insurers for a profit motive, but makes no distinction among for-profit and non-profit insurers, and in its execution places the Blue Plans together with the for-profit insurers.3. All plans and employees - from leaders to service representatives - are painted as motivated by profit to deny claims, and only those with crisis of conscience have come forward to confess their sins.4. Perhaps most damaging of all, completely fails to address the most significant driver of health care costs - our own lifestyle choices - and seeks to focus attention and efforts on the alluring 'quick-fix' of universal health care. It has taken a generation of poor nutrition and exercise to get obesity and related health issues - and subsequent costs - to their current levels, and 's movie fails to acknowledge the causal relationship or need to change (he briefly touches the subject in a non-memorable way). Contrast this to the recent Health Care Symposium held in burg - where a panel of representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers agreed on one thing - that there was no quick fix and that Health and Wellness was the critical area of focus.

SuggestionsI believe the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve (aligns with BCBSA strategy), and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness. We will convene a team to consider other approaches and work on potential messages for media inquiries, customer service, and employees.

Confidential Memo (from partner)

SiCKO - viewed on 6/26/2007

Takeaways

* The main theme of the movie is that American society needs to focus on the "we" and not the "me" in healthcare.

o This broad message is an overlay for the specific criticisms of the healthcare industry - the movie asks where the morality of the American public lies and contrasts America's approach to health care unfavorably with other nations.

* SiCKO does not go into any depth about how health insurers operate how the health insurance business works - instead it fixates on what it characterizes as the profit incentive to deny care to patients (e.g. examples of barriers to getting health insurance if you are not healthy; examples of people being denied expensive tests or procedures; examples of efforts to deny reimbursement after care has been received.)

* The film draws no distinction between not-for-profit and for-profit insurers - in fact the Blue Cross/Blue Shield brand is intermixed with the for - profit brands as background reference points. o One scene shows a Blue Cross / Blue Shield logo as 's voice over begins, "While the healthcare companies get wealthy..."

* The health insurers that get the most airtime are:

o Kaiser Permanenteo Humanao CIGNAo Blue Cross of Californiao Aetna

* No Pharma companies are mentioned - but SiCKO suggests in multiple instances that prescription drugs are overpriced

o At a pharmacy in London, prescription drugs are £6.65, no matter how large the doseo In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100

Further Notes

* Some of the examples of denial of care highlighted in the film:

o A woman with Kaiser Permanente takes her 18-month daughter to the hospital in an ambulance, only to be told to go to an in-network hospital. By the time they reach the second hospital, her daughter has stopped breathing and dies 30 minutes later in ER.

o A woman with Blue Shield of California has a tumor but is denied requests to get an MRI, or to see a specialist. While on vacation in Japan she is given an MRI, and eventually returns to the U.S. to demand treatment from her insurer.

* In the ensuing court case, a doctor admits to denying her request without having reviewed it.

o Blue Cross of California approves one woman's $7,500 treatment, but the approval is later denied for her failure to report a previous medical incident - a yeast infection.

* "They're just looking for a way out," she says

* Other examples of how health insurers avoid paying for treatment:

o One graph (from Humana) shows that doctors with the highest % of denials get a bonus.

o interviews a former health insurance employee who specialized in denying care to patients retroactively - by finding inconsistencies in their medical records.

o A 5-minute piece in the beginning of the movie .

* The film also focuses on the politicians and the funds they raise from Pharma and other player in the health care industry and alleges that the system has been heavily influenced by lobbyists and contributions.

Barclay FitzpatrickVice PresidentCorporate CommunicationsCapital BlueCross(w) 717-541-7752© 717-329-3648barclay.fitzpatrick@...

TalkingPoints61807.doc

Blue Cross and Blue Shield AssociationTalking Points in Response to 's "Sicko"June 2007

1) The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer.

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government.

3) The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States.

4) The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information. In addition:

o The Blues recently created Blue Health Intelligence a data resource that will shine light on emerging medical trends and treatment options in an unprecedented way. To further the use of evidenced-based medicine, BCBSA has called upon Congress to establish an independent, payer-funded institute that will study the comparative effectiveness of new and existing medical treatments and procedures.

o Blue Cross and Blue Shield companies are at the forefront of healthcare transparency by providing their members with online access to real-time information related to provider quality and the cost of common healthcare services. In addition, the Blues have committed to making personal health records available to their members by 2008.

o We are working to ensure that Medicare is funded appropriately and that seniors continue to have access to comprehensive benefits.

5) The Blues are proud of these efforts and we will continue to work with consumers, providers, employers and the government to provide Americans with the healthcare services and information they need to lead full, healthy lives.

---

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[Guest guest]

's movie and Democrat control of congress will shake these fuckers up.

That's called leverage.

Nothing but good comes out of it.

Fw: BlueCross Secret Memo Re: 'Sicko'

BlueCross Secret Memo Re: 'Sicko' ... "You would have to be dead to be unaffected by 's movie..."

July 6th, 2007

Friends,

An employee who works at Capital BlueCross has sent us a confidential memo written and circulated by its Vice President of Corporate Communications, Barclay Fitzpatrick. His job, it seems, was to go and watch "Sicko," observe the audience's reaction, and then suggest a plan of action for how to deal with the movie.

The memo, which I am releasing publicly in this email, is a fascinating look at how one health care company views "Sicko" -- and what it fears its larger impact will be on the public. The industry's only hope, the memo seems to indicate, is if the movie "flops."

Mr. Fitzpatrick writes: "In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich."

No. You don't say! That can't be!

BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just saw. "You would have to be dead to be unaffected by 's movie," he writes. "Sicko" leaves audiences feeling "ashamed to be...a capitalist, and part of a 'me' society instead of a 'we' society."

He walks out of the theater only to witness an unusual sight: people -- strangers -- mingling and talking to each other. "'I didn't know they (the insurers) did that!' was a common exclamation followed by a discussion of the example," according to Fitzpatrick.

He then assesses the film's impact: "[T]he impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films ... If popular, the movie will have a negative impact on our image in this community."

The BlueCross memo then suggests a strategy in dealing with "Sicko" and offers the BCBS "talking points" to be used in discounting the film.

My heartfelt thanks to the employee who sent this to me.

And now a word from me to Capital BlueCross:

How 'bout a debate? No more secret memos and hand wringing about the millions seeing "Sicko." Just me and your CEO openly debating the merits of a system that kills thousands of innocent Americans every year.

In the meantime, I hope you don't mind me sharing your thoughts and impressions in your well-written memo. And if the rest of your executive team hasn't seen "Sicko," it opens in an additional 100 cities tonight for a total of over 700 screens across North America. Attendance went up a whopping 56% on the 4th of July, higher than any other film in the theaters right now. But don't be scared, and certainly don't be ashamed to be a capitalist. Greed is good! Especially good for you. There's nothing like having the pre-existing condition of being rich, should you ever get sick and need help.

Yours,

mmflintaolwww.michaelmoore.com

P.S. Join me at noon EST, today, when I'll be chatting with U.S. Steelworkers, the California Nurses Association, and whoever stops by to talk about "Sicko" and the industry's attempt to stop this movement. Check my website for details.

[The following memo was written by Barclay Fitzpatrick, VP of Corporate Communications for Capital BlueCross]

I was able to see Sicko last night in Lancaster. There were about 30 other viewers in the theatre covering all age groups. I have attached the well-written memo from one of our partners, which describes cases used in the movie, to the end of my memo. Also attached are the latest talking points from BCBSA. I will focus on impact to our brands, issues, and suggested strategies in this memo.

The MovieYou would have to be dead to be unaffected by 's movie, he is an effective storyteller. In Sicko presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit. Denial for treatments that are considered "experimental" is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit.

While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market. Here are some examples:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad treatment of members.* BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection.* BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature.* BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding inaccuracies in applications to enable post-treatment payment denials.* A BCBSA card is shown while the narrator describes how they (insurers) got wealthy.

In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich. Nixon Oval Office tapes are used to show how the initial idea of a 'less care = profit' enterprise was supported by the administration and became the HMO paradigm. Legislators are presented as bought stooges for the political agendas of insurers and big Pharma. Insurers are middlemen in the Medicare Modernization Act - which is presented as a trick to charge seniors more for their prescription drugs.

Doctors are barely touched - only in the course of discussing the AMA's work to sink early efforts in the 40's and 50's to start universal health care. He takes efforts to show that doctors live well in other countries despite the existence of universal health care. In follow-up interviews, has stated that he has spoken to and knows many doctors, and "doctors aren't the problem".

In the second half of the movie, walks us through individual stories of the Canadian, British, French, and Cuban health care systems where everything is free and - he reminds us repeatedly - no one is ever denied service because they can't pay. In addition to health care, the government provides free day care, college, and someone to do your laundry. Everybody gets along and takes care of each other and life is beautiful because there is universal health care. As a viewer, you are made to feel ashamed to be an American, a capitalist, and part of a 'me' society instead of a 'we' society - and the lack of universal health care is held up in support of that condemnation.

The Impact's movies are intentionally intense and his objective in Sicko seems to be to revive the earlier Clinton efforts - not to achieve universal coverage with this movie, but to push the topic to the top of the agenda. He will be just as successful whether proponents mount momentum or discussion entails key stakeholders defending why it won't work.

As a health care industry educated viewer it is easy to pick out where is cultivating misperceptions to further a political agenda, but you will also recognize that 80%+ of the audience will have their perceptions substantially affected. In demonstration of its impact, an informal discussion group ensued outside the theatre after the movie. While some people recognized how one-sided the presentation was, most were incredulous and "I didn't know they (the insurers) did that!" was a common exclamation followed by a discussion of the example.

The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as 's efforts in the movie and surrounding PR activity are seen by more of the community. The impact on industry savvy Sales' contacts should be minimal, while the impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films nor the way this one appears to be headed. If popular, the movie will have a negative impact on our image in this community.

There should be no doubt that many of our employees will be asked what they think of the movie by friends, family, and neighbors. We should anticipate that our customer service people will be asked about particular cases from the movie and if we follow similar policies. Word and phrases we have routinely used to date in policy change communications or denial letters, such as "Investigational", will be seen as affirming the film's contentions. The national BCBSA response - while coming out against the film's divisiveness and focusing on the positive work of the Blues - steers media inquiries about policies and denials back to the plans themselves.

There are 4 key areas of misperception cultivated by the movie that we should consider in any messaging strategy:

1. That the industry is all about HMO's. cultivates this further in his interviews. The reality is that HMO's are a minority product and have been for some time.2. The movie attacks insurers for a profit motive, but makes no distinction among for-profit and non-profit insurers, and in its execution places the Blue Plans together with the for-profit insurers.3. All plans and employees - from leaders to service representatives - are painted as motivated by profit to deny claims, and only those with crisis of conscience have come forward to confess their sins.4. Perhaps most damaging of all, completely fails to address the most significant driver of health care costs - our own lifestyle choices - and seeks to focus attention and efforts on the alluring 'quick-fix' of universal health care. It has taken a generation of poor nutrition and exercise to get obesity and related health issues - and subsequent costs - to their current levels, and 's movie fails to acknowledge the causal relationship or need to change (he briefly touches the subject in a non-memorable way). Contrast this to the recent Health Care Symposium held in burg - where a panel of representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers agreed on one thing - that there was no quick fix and that Health and Wellness was the critical area of focus.

SuggestionsI believe the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve (aligns with BCBSA strategy), and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness. We will convene a team to consider other approaches and work on potential messages for media inquiries, customer service, and employees.

Confidential Memo (from partner)

SiCKO - viewed on 6/26/2007

Takeaways

* The main theme of the movie is that American society needs to focus on the "we" and not the "me" in healthcare.

o This broad message is an overlay for the specific criticisms of the healthcare industry - the movie asks where the morality of the American public lies and contrasts America's approach to health care unfavorably with other nations.

* SiCKO does not go into any depth about how health insurers operate how the health insurance business works - instead it fixates on what it characterizes as the profit incentive to deny care to patients (e.g. examples of barriers to getting health insurance if you are not healthy; examples of people being denied expensive tests or procedures; examples of efforts to deny reimbursement after care has been received.)

* The film draws no distinction between not-for-profit and for-profit insurers - in fact the Blue Cross/Blue Shield brand is intermixed with the for - profit brands as background reference points. o One scene shows a Blue Cross / Blue Shield logo as 's voice over begins, "While the healthcare companies get wealthy..."

* The health insurers that get the most airtime are:

o Kaiser Permanenteo Humanao CIGNAo Blue Cross of Californiao Aetna

* No Pharma companies are mentioned - but SiCKO suggests in multiple instances that prescription drugs are overpriced

o At a pharmacy in London, prescription drugs are £6.65, no matter how large the doseo In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100

Further Notes

* Some of the examples of denial of care highlighted in the film:

o A woman with Kaiser Permanente takes her 18-month daughter to the hospital in an ambulance, only to be told to go to an in-network hospital. By the time they reach the second hospital, her daughter has stopped breathing and dies 30 minutes later in ER.

o A woman with Blue Shield of California has a tumor but is denied requests to get an MRI, or to see a specialist. While on vacation in Japan she is given an MRI, and eventually returns to the U.S. to demand treatment from her insurer.

* In the ensuing court case, a doctor admits to denying her request without having reviewed it.

o Blue Cross of California approves one woman's $7,500 treatment, but the approval is later denied for her failure to report a previous medical incident - a yeast infection.

* "They're just looking for a way out," she says

* Other examples of how health insurers avoid paying for treatment:

o One graph (from Humana) shows that doctors with the highest % of denials get a bonus.

o interviews a former health insurance employee who specialized in denying care to patients retroactively - by finding inconsistencies in their medical records.

o A 5-minute piece in the beginning of the movie .

* The film also focuses on the politicians and the funds they raise from Pharma and other player in the health care industry and alleges that the system has been heavily influenced by lobbyists and contributions.

Barclay FitzpatrickVice PresidentCorporate CommunicationsCapital BlueCross(w) 717-541-7752© 717-329-3648barclay.fitzpatrickcapbluecross

TalkingPoints61807.doc

Blue Cross and Blue Shield AssociationTalking Points in Response to 's "Sicko"June 2007

1) The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer.

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government.

3) The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States.

4) The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information. In addition:

o The Blues recently created Blue Health Intelligence a data resource that will shine light on emerging medical trends and treatment options in an unprecedented way. To further the use of evidenced-based medicine, BCBSA has called upon Congress to establish an independent, payer-funded institute that will study the comparative effectiveness of new and existing medical treatments and procedures.

o Blue Cross and Blue Shield companies are at the forefront of healthcare transparency by providing their members with online access to real-time information related to provider quality and the cost of common healthcare services. In addition, the Blues have committed to making personal health records available to their members by 2008.

o We are working to ensure that Medicare is funded appropriately and that seniors continue to have access to comprehensive benefits.

5) The Blues are proud of these efforts and we will continue to work with consumers, providers, employers and the government to provide Americans with the healthcare services and information they need to lead full, healthy lives.

---

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[Guest guest]

I think the topic of HMOs, etc. will be big at election time. I know

the movie made me think who are we going to vote for in 2008 that can

fix this.

>

>

> BlueCross Secret Memo Re: 'Sicko' ... " You would have to be dead to

be unaffected by 's movie... "

>

> July 6th, 2007

>

> Friends,

>

> An employee who works at Capital BlueCross has sent us a

confidential memo written and circulated by its Vice President of

Corporate Communications, Barclay Fitzpatrick. His job, it seems, was

to go and watch " Sicko, " observe the audience's reaction, and then

suggest a plan of action for how to deal with the movie.

>

> The memo, which I am releasing publicly in this email, is a

fascinating look at how one health care company views " Sicko " -- and

what it fears its larger impact will be on the public. The industry's

only hope, the memo seems to indicate, is if the movie " flops. "

>

> Mr. Fitzpatrick writes: " In typical fashion, Government and

business leaders are behind a conspiracy to keep the little guy down

and dominated while getting rich. "

>

> No. You don't say! That can't be!

>

> BlueCross V.P. Fitzpatrick seems downright depressed about the

movie he just saw. " You would have to be dead to be unaffected by

's movie, " he writes. " Sicko " leaves audiences feeling " ashamed

to be...a capitalist, and part of a 'me' society instead of a 'we'

society. "

>

> He walks out of the theater only to witness an unusual sight:

people -- strangers -- mingling and talking to each other. " 'I didn't

know they (the insurers) did that!' was a common exclamation followed

by a discussion of the example, " according to Fitzpatrick.

>

> He then assesses the film's impact: " [T]he impact on small business

decision makers, our members, the community, and our employees could

be significant. Ignoring its impact might be a successful strategy

only if it flops, but that has not been the history of 's

films ... If popular, the movie will have a negative impact on our

image in this community. "

>

> The BlueCross memo then suggests a strategy in dealing with " Sicko "

and offers the BCBS " talking points " to be used in discounting the

film.

>

> My heartfelt thanks to the employee who sent this to me.

>

> And now a word from me to Capital BlueCross:

>

> How 'bout a debate? No more secret memos and hand wringing about

the millions seeing " Sicko. " Just me and your CEO openly debating the

merits of a system that kills thousands of innocent Americans every

year.

>

> In the meantime, I hope you don't mind me sharing your thoughts and

impressions in your well-written memo. And if the rest of your

executive team hasn't seen " Sicko, " it opens in an additional 100

cities tonight for a total of over 700 screens across North America.

Attendance went up a whopping 56% on the 4th of July, higher than any

other film in the theaters right now. But don't be scared, and

certainly don't be ashamed to be a capitalist. Greed is good!

Especially good for you. There's nothing like having the pre-existing

condition of being rich, should you ever get sick and need help.

>

> Yours,

>

>

> mmflint@...

> www.michaelmoore.com

>

> P.S. Join me at noon EST, today, when I'll be chatting with U.S.

Steelworkers, the California Nurses Association, and whoever stops by

to talk about " Sicko " and the industry's attempt to stop this

movement. Check my website for details.

>

> [The following memo was written by Barclay Fitzpatrick, VP of

Corporate Communications for Capital BlueCross]

>

> I was able to see Sicko last night in Lancaster. There were about

30 other viewers in the theatre covering all age groups. I have

attached the well-written memo from one of our partners, which

describes cases used in the movie, to the end of my memo. Also

attached are the latest talking points from BCBSA. I will focus on

impact to our brands, issues, and suggested strategies in this memo.

>

> The Movie

> You would have to be dead to be unaffected by 's movie, he is

an effective storyteller. In Sicko presents a collage of

injustices by selecting stories, no matter how exceptional to the

norm, that present the health insurance industry as a set of

organizations and people dedicated to denying claims in the name of

profit. Denial for treatments that are considered " experimental " is a

common story, along with denial for previous conditions, and denial

for application errors or omissions. Individual employees from Humana

and other insurers are interviewed who claim to have actively pursued

claim denial as an institutionalized goal in the name of profit.

>

> While Humana and Kaiser Permanente are demonized, the BlueCross and

BlueShield brands appear, separately and together, visually and

verbally, with such frequency that there should be no doubt that

whatever visceral reaction his movie stirs will spill over onto the

Blues brands in every market. Here are some examples:

>

> * Horizon BlueCross/BlueShield is picked out early in the film in a

collage of stories citing bad treatment of members.

> * BCBSA is cited for rejecting a woman for coverage due to a high

BMI - " too fat " is written across the screen over a copy of her

application denial letter, which describes the BMI rejection.

> * BlueShield of California denied coverage for a diagnostic test,

which the patient later received overseas. Patient sues BS of CA and

medical director admits to not 'seeing' the actual denial letter,

which was given an electronic signature.

> * BlueCross of California denied payment for a major surgery after

they discovered a previous yeast infection, then dropped the person

for coverage. This is followed by an interview with a person who

claims to have been a specialist at finding inaccuracies in

applications to enable post-treatment payment denials.

> * A BCBSA card is shown while the narrator describes how they

(insurers) got wealthy.

>

> In typical fashion, Government and business leaders are

behind a conspiracy to keep the little guy down and dominated while

getting rich. Nixon Oval Office tapes are used to show how the

initial idea of a 'less care = profit' enterprise was supported by

the administration and became the HMO paradigm. Legislators are

presented as bought stooges for the political agendas of insurers and

big Pharma. Insurers are middlemen in the Medicare Modernization Act -

which is presented as a trick to charge seniors more for their

prescription drugs.

>

> Doctors are barely touched - only in the course of discussing the

AMA's work to sink early efforts in the 40's and 50's to start

universal health care. He takes efforts to show that doctors live

well in other countries despite the existence of universal health

care. In follow-up interviews, has stated that he has spoken to

and knows many doctors, and " doctors aren't the problem " .

>

> In the second half of the movie, walks us through individual

stories of the Canadian, British, French, and Cuban health care

systems where everything is free and - he reminds us repeatedly - no

one is ever denied service because they can't pay. In addition to

health care, the government provides free day care, college, and

someone to do your laundry. Everybody gets along and takes care of

each other and life is beautiful because there is universal health

care. As a viewer, you are made to feel ashamed to be an American, a

capitalist, and part of a 'me' society instead of a 'we' society -

and the lack of universal health care is held up in support of that

condemnation.

>

> The Impact

> 's movies are intentionally intense and his objective in Sicko

seems to be to revive the earlier Clinton efforts - not to achieve

universal coverage with this movie, but to push the topic to the top

of the agenda. He will be just as successful whether proponents mount

momentum or discussion entails key stakeholders defending why it

won't work.

>

> As a health care industry educated viewer it is easy to pick out

where is cultivating misperceptions to further a political

agenda, but you will also recognize that 80%+ of the audience will

have their perceptions substantially affected. In demonstration of

its impact, an informal discussion group ensued outside the theatre

after the movie. While some people recognized how one-sided the

presentation was, most were incredulous and " I didn't know they (the

insurers) did that! " was a common exclamation followed by a

discussion of the example.

>

> The unfortunate reality for Capital BlueCross is that as the market

leader, we will be affected both in brand and as employees as 's

efforts in the movie and surrounding PR activity are seen by more of

the community. The impact on industry savvy Sales' contacts should be

minimal, while the impact on small business decision makers, our

members, the community, and our employees could be significant.

Ignoring its impact might be a successful strategy only if it flops,

but that has not been the history of 's films nor the way this

one appears to be headed. If popular, the movie will have a negative

impact on our image in this community.

>

> There should be no doubt that many of our employees will be asked

what they think of the movie by friends, family, and neighbors. We

should anticipate that our customer service people will be asked

about particular cases from the movie and if we follow similar

policies. Word and phrases we have routinely used to date in policy

change communications or denial letters, such as " Investigational " ,

will be seen as affirming the film's contentions. The national BCBSA

response - while coming out against the film's divisiveness and

focusing on the positive work of the Blues - steers media inquiries

about policies and denials back to the plans themselves.

>

> There are 4 key areas of misperception cultivated by the movie that

we should consider in any messaging strategy:

>

> 1. That the industry is all about HMO's. cultivates this

further in his interviews. The reality is that HMO's are a minority

product and have been for some time.

> 2. The movie attacks insurers for a profit motive, but makes no

distinction among for-profit and non-profit insurers, and in its

execution places the Blue Plans together with the for-profit insurers.

> 3. All plans and employees - from leaders to service

representatives - are painted as motivated by profit to deny claims,

and only those with crisis of conscience have come forward to confess

their sins.

> 4. Perhaps most damaging of all, completely fails to address

the most significant driver of health care costs - our own lifestyle

choices - and seeks to focus attention and efforts on the

alluring 'quick-fix' of universal health care. It has taken a

generation of poor nutrition and exercise to get obesity and related

health issues - and subsequent costs - to their current levels, and

's movie fails to acknowledge the causal relationship or need to

change (he briefly touches the subject in a non-memorable way).

Contrast this to the recent Health Care Symposium held in burg -

where a panel of representatives from Government, Insurance,

Hospitals, Business, Physicians, and even Lawyers agreed on one

thing - that there was no quick fix and that Health and Wellness was

the critical area of focus.

>

> Suggestions

> I believe the most successful strategy will not be in attacking the

movie for its weaknesses or misperceptions, but in distancing

ourselves and our brand from the groups and motivations he attacks,

demonstrating the good that we do and achieve (aligns with BCBSA

strategy), and in articulating our disappointment that he did not

address the truly relevant issue of improving our health and

wellness. We will convene a team to consider other approaches and

work on potential messages for media inquiries, customer service, and

employees.

>

> Confidential Memo (from partner)

>

> SiCKO - viewed on 6/26/2007

>

> Takeaways

>

> * The main theme of the movie is that American society needs to

focus on the " we " and not the " me " in healthcare.

>

> o This broad message is an overlay for the specific criticisms of

the healthcare industry - the movie asks where the morality of the

American public lies and contrasts America's approach to health care

unfavorably with other nations.

>

> * SiCKO does not go into any depth about how health insurers

operate how the health insurance business works - instead it fixates

on what it characterizes as the profit incentive to deny care to

patients (e.g. examples of barriers to getting health insurance if

you are not healthy; examples of people being denied expensive tests

or procedures; examples of efforts to deny reimbursement after care

has been received.)

>

> * The film draws no distinction between not-for-profit and for-

profit insurers - in fact the Blue Cross/Blue Shield brand is

intermixed with the for - profit brands as background reference

points. o One scene shows a Blue Cross / Blue Shield logo as

's voice over begins, " While the healthcare companies get

wealthy... "

>

> * The health insurers that get the most airtime are:

>

> o Kaiser Permanente

> o Humana

> o CIGNA

> o Blue Cross of California

> o Aetna

>

> * No Pharma companies are mentioned - but SiCKO suggests in

multiple instances that prescription drugs are overpriced

>

> o At a pharmacy in London, prescription drugs are £6.65, no matter

how large the dose

> o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents,

instead of $100

>

> Further Notes

>

> * Some of the examples of denial of care highlighted in the film:

>

> o A woman with Kaiser Permanente takes her 18-month daughter to the

hospital in an ambulance, only to be told to go to an in-network

hospital. By the time they reach the second hospital, her daughter

has stopped breathing and dies 30 minutes later in ER.

>

> o A woman with Blue Shield of California has a tumor but is denied

requests to get an MRI, or to see a specialist. While on vacation in

Japan she is given an MRI, and eventually returns to the U.S. to

demand treatment from her insurer.

>

> * In the ensuing court case, a doctor admits to denying her request

without having reviewed it.

>

> o Blue Cross of California approves one woman's $7,500 treatment,

but the approval is later denied for her failure to report a previous

medical incident - a yeast infection.

>

> * " They're just looking for a way out, " she says

>

> * Other examples of how health insurers avoid paying for treatment:

>

> o One graph (from Humana) shows that doctors with the highest % of

denials get a bonus.

>

> o interviews a former health insurance employee who

specialized in denying care to patients retroactively - by finding

inconsistencies in their medical records.

>

> o A 5-minute piece in the beginning of the movie .

>

> * The film also focuses on the politicians and the funds they raise

from Pharma and other player in the health care industry and alleges

that the system has been heavily influenced by lobbyists and

contributions.

>

> Barclay Fitzpatrick

> Vice President

> Corporate Communications

> Capital BlueCross

> (w) 717-541-7752

> © 717-329-3648

> barclay.fitzpatrick@...

>

> TalkingPoints61807.doc

>

> Blue Cross and Blue Shield Association

> Talking Points in Response to 's " Sicko "

> June 2007

>

> 1) The Blue Cross and Blue Shield Association (BCBSA) and the 39

Blue Cross and Blue Shield companies are committed to improving the

U.S. healthcare system for our nearly 100 million members through

continuous innovation that reflects the ever-changing healthcare

landscape and the needs of the consumer.

>

> 2) The Blues recognize the need for improvement of both the

coverage and delivery of healthcare. But the divisive tone set forth

by and his movie " Sicko " is not helpful. Positive

change to our healthcare system can be best achieved through shared

responsibility, not recrimination. To ensure Americans have access to

the best healthcare that is both timely, efficient, and of high

quality, requires the collective contribution of all stakeholders --

consumers, providers, employers and the government.

>

> 3) The Blues participation in the Health Coverage Coalition for the

Uninsured is a primary example of how the broader healthcare

community is working together to reduce the number of uninsured in

the United States.

>

> 4) The Blues are working on myriad initiatives that ensure

Americans have access to quality and affordable healthcare. Each day,

Blue Plans across the country are bringing healthcare value to their

members in a number of ways such as new advances in health

information technology and greater access to cost and quality

information. In addition:

>

> o The Blues recently created Blue Health Intelligence a data

resource that will shine light on emerging medical trends and

treatment options in an unprecedented way. To further the use of

evidenced-based medicine, BCBSA has called upon Congress to establish

an independent, payer-funded institute that will study the

comparative effectiveness of new and existing medical treatments and

procedures.

>

> o Blue Cross and Blue Shield companies are at the forefront of

healthcare transparency by providing their members with online access

to real-time information related to provider quality and the cost of

common healthcare services. In addition, the Blues have committed to

making personal health records available to their members by 2008.

>

> o We are working to ensure that Medicare is funded appropriately

and that seniors continue to have access to comprehensive benefits.

>

> 5) The Blues are proud of these efforts and we will continue to

work with consumers, providers, employers and the government to

provide Americans with the healthcare services and information they

need to lead full, healthy lives.

>

>

>

> ---

> You are currently subscribed to Mike's Message as: max.walker@...

>

> To unsubscribe click on the link below:

>

> http://go.netatlantic.com/u?id=46901619Q & l=michaelmoore

>

[Guest guest]

" Free " health care isn't all it is cracked up to be. I have seen many

Australian, and UK parents say this. ANd I was listening to the

radio recently about how in Britian, men are not treated for prostate

cancer. Because it is something for the most part that happens later

in life, they do not treat it. Why? Because there is such a long

waiting list to get to a doctor for this treatment, they will be dead

before getting the treatment.

No thanks for this 'free universal' health care. Do you really

honestly think that you will get the medical treatment you need if it

is all 'free'? There is nothing for free. It is being paid for by US,

the taxpayers. I am sick of more of my money being taken from me and

my family by our government. We already work almost 6 months out of

the year for our government. If we could keep more of our own hard

earned money, we could afford to go to the doctor.

No, I don't need the government to keep my money. I don't need 'them'

to tell me how to spend and invest it. The government has never ran

anything well. There is too much corruption. All the government does

is take, take, and take. They alreay throw our money away left and

right. What makes you think they can run 'free' health care using OUR

money? If you think you have a hard time getting help for your vaccine

injured kids now, with universal health care, do you really think you

will get to use the doctors of your choice? No, you will not. DAN

doctors will be a thing of the past. And vaccine choices? You will not

have a choice. ANd this country will destroy its health and future

completely with more and more mandated vaccine policy. No one will

escape the insanity that is destroying lives everyday.

J

> >

> >

> > BlueCross Secret Memo Re: 'Sicko' ... " You would have to be dead to

> be unaffected by 's movie... "

> >

> > July 6th, 2007

> >

> > Friends,

> >

> > An employee who works at Capital BlueCross has sent us a

> confidential memo written and circulated by its Vice President of

> Corporate Communications, Barclay Fitzpatrick. His job, it seems, was

> to go and watch " Sicko, " observe the audience's reaction, and then

> suggest a plan of action for how to deal with the movie.

> >

> > The memo, which I am releasing publicly in this email, is a

> fascinating look at how one health care company views " Sicko " -- and

> what it fears its larger impact will be on the public. The industry's

> only hope, the memo seems to indicate, is if the movie " flops. "

> >

> > Mr. Fitzpatrick writes: " In typical fashion, Government and

> business leaders are behind a conspiracy to keep the little guy down

> and dominated while getting rich. "

> >

> > No. You don't say! That can't be!

> >

> > BlueCross V.P. Fitzpatrick seems downright depressed about the

> movie he just saw. " You would have to be dead to be unaffected by

> 's movie, " he writes. " Sicko " leaves audiences feeling " ashamed

> to be...a capitalist, and part of a 'me' society instead of a 'we'

> society. "

> >

> > He walks out of the theater only to witness an unusual sight:

> people -- strangers -- mingling and talking to each other. " 'I didn't

> know they (the insurers) did that!' was a common exclamation followed

> by a discussion of the example, " according to Fitzpatrick.

> >

> > He then assesses the film's impact: " [T]he impact on small business

> decision makers, our members, the community, and our employees could

> be significant. Ignoring its impact might be a successful strategy

> only if it flops, but that has not been the history of 's

> films ... If popular, the movie will have a negative impact on our

> image in this community. "

> >

> > The BlueCross memo then suggests a strategy in dealing with " Sicko "

> and offers the BCBS " talking points " to be used in discounting the

> film.

> >

> > My heartfelt thanks to the employee who sent this to me.

> >

> > And now a word from me to Capital BlueCross:

> >

> > How 'bout a debate? No more secret memos and hand wringing about

> the millions seeing " Sicko. " Just me and your CEO openly debating the

> merits of a system that kills thousands of innocent Americans every

> year.

> >

> > In the meantime, I hope you don't mind me sharing your thoughts and

> impressions in your well-written memo. And if the rest of your

> executive team hasn't seen " Sicko, " it opens in an additional 100

> cities tonight for a total of over 700 screens across North America.

> Attendance went up a whopping 56% on the 4th of July, higher than any

> other film in the theaters right now. But don't be scared, and

> certainly don't be ashamed to be a capitalist. Greed is good!

> Especially good for you. There's nothing like having the pre-existing

> condition of being rich, should you ever get sick and need help.

> >

> > Yours,

> >

> >

> > mmflint@

> > www.michaelmoore.com

> >

> > P.S. Join me at noon EST, today, when I'll be chatting with U.S.

> Steelworkers, the California Nurses Association, and whoever stops by

> to talk about " Sicko " and the industry's attempt to stop this

> movement. Check my website for details.

> >

> > [The following memo was written by Barclay Fitzpatrick, VP of

> Corporate Communications for Capital BlueCross]

> >

> > I was able to see Sicko last night in Lancaster. There were about

> 30 other viewers in the theatre covering all age groups. I have

> attached the well-written memo from one of our partners, which

> describes cases used in the movie, to the end of my memo. Also

> attached are the latest talking points from BCBSA. I will focus on

> impact to our brands, issues, and suggested strategies in this memo.

> >

> > The Movie

> > You would have to be dead to be unaffected by 's movie, he is

> an effective storyteller. In Sicko presents a collage of

> injustices by selecting stories, no matter how exceptional to the

> norm, that present the health insurance industry as a set of

> organizations and people dedicated to denying claims in the name of

> profit. Denial for treatments that are considered " experimental " is a

> common story, along with denial for previous conditions, and denial

> for application errors or omissions. Individual employees from Humana

> and other insurers are interviewed who claim to have actively pursued

> claim denial as an institutionalized goal in the name of profit.

> >

> > While Humana and Kaiser Permanente are demonized, the BlueCross and

> BlueShield brands appear, separately and together, visually and

> verbally, with such frequency that there should be no doubt that

> whatever visceral reaction his movie stirs will spill over onto the

> Blues brands in every market. Here are some examples:

> >

> > * Horizon BlueCross/BlueShield is picked out early in the film in a

> collage of stories citing bad treatment of members.

> > * BCBSA is cited for rejecting a woman for coverage due to a high

> BMI - " too fat " is written across the screen over a copy of her

> application denial letter, which describes the BMI rejection.

> > * BlueShield of California denied coverage for a diagnostic test,

> which the patient later received overseas. Patient sues BS of CA and

> medical director admits to not 'seeing' the actual denial letter,

> which was given an electronic signature.

> > * BlueCross of California denied payment for a major surgery after

> they discovered a previous yeast infection, then dropped the person

> for coverage. This is followed by an interview with a person who

> claims to have been a specialist at finding inaccuracies in

> applications to enable post-treatment payment denials.

> > * A BCBSA card is shown while the narrator describes how they

> (insurers) got wealthy.

> >

> > In typical fashion, Government and business leaders are

> behind a conspiracy to keep the little guy down and dominated while

> getting rich. Nixon Oval Office tapes are used to show how the

> initial idea of a 'less care = profit' enterprise was supported by

> the administration and became the HMO paradigm. Legislators are

> presented as bought stooges for the political agendas of insurers and

> big Pharma. Insurers are middlemen in the Medicare Modernization Act -

> which is presented as a trick to charge seniors more for their

> prescription drugs.

> >

> > Doctors are barely touched - only in the course of discussing the

> AMA's work to sink early efforts in the 40's and 50's to start

> universal health care. He takes efforts to show that doctors live

> well in other countries despite the existence of universal health

> care. In follow-up interviews, has stated that he has spoken to

> and knows many doctors, and " doctors aren't the problem " .

> >

> > In the second half of the movie, walks us through individual

> stories of the Canadian, British, French, and Cuban health care

> systems where everything is free and - he reminds us repeatedly - no

> one is ever denied service because they can't pay. In addition to

> health care, the government provides free day care, college, and

> someone to do your laundry. Everybody gets along and takes care of

> each other and life is beautiful because there is universal health

> care. As a viewer, you are made to feel ashamed to be an American, a

> capitalist, and part of a 'me' society instead of a 'we' society -

> and the lack of universal health care is held up in support of that

> condemnation.

> >

> > The Impact

> > 's movies are intentionally intense and his objective in Sicko

> seems to be to revive the earlier Clinton efforts - not to achieve

> universal coverage with this movie, but to push the topic to the top

> of the agenda. He will be just as successful whether proponents mount

> momentum or discussion entails key stakeholders defending why it

> won't work.

> >

> > As a health care industry educated viewer it is easy to pick out

> where is cultivating misperceptions to further a political

> agenda, but you will also recognize that 80%+ of the audience will

> have their perceptions substantially affected. In demonstration of

> its impact, an informal discussion group ensued outside the theatre

> after the movie. While some people recognized how one-sided the

> presentation was, most were incredulous and " I didn't know they (the

> insurers) did that! " was a common exclamation followed by a

> discussion of the example.

> >

> > The unfortunate reality for Capital BlueCross is that as the market

> leader, we will be affected both in brand and as employees as 's

> efforts in the movie and surrounding PR activity are seen by more of

> the community. The impact on industry savvy Sales' contacts should be

> minimal, while the impact on small business decision makers, our

> members, the community, and our employees could be significant.

> Ignoring its impact might be a successful strategy only if it flops,

> but that has not been the history of 's films nor the way this

> one appears to be headed. If popular, the movie will have a negative

> impact on our image in this community.

> >

> > There should be no doubt that many of our employees will be asked

> what they think of the movie by friends, family, and neighbors. We

> should anticipate that our customer service people will be asked

> about particular cases from the movie and if we follow similar

> policies. Word and phrases we have routinely used to date in policy

> change communications or denial letters, such as " Investigational " ,

> will be seen as affirming the film's contentions. The national BCBSA

> response - while coming out against the film's divisiveness and

> focusing on the positive work of the Blues - steers media inquiries

> about policies and denials back to the plans themselves.

> >

> > There are 4 key areas of misperception cultivated by the movie that

> we should consider in any messaging strategy:

> >

> > 1. That the industry is all about HMO's. cultivates this

> further in his interviews. The reality is that HMO's are a minority

> product and have been for some time.

> > 2. The movie attacks insurers for a profit motive, but makes no

> distinction among for-profit and non-profit insurers, and in its

> execution places the Blue Plans together with the for-profit insurers.

> > 3. All plans and employees - from leaders to service

> representatives - are painted as motivated by profit to deny claims,

> and only those with crisis of conscience have come forward to confess

> their sins.

> > 4. Perhaps most damaging of all, completely fails to address

> the most significant driver of health care costs - our own lifestyle

> choices - and seeks to focus attention and efforts on the

> alluring 'quick-fix' of universal health care. It has taken a

> generation of poor nutrition and exercise to get obesity and related

> health issues - and subsequent costs - to their current levels, and

> 's movie fails to acknowledge the causal relationship or need to

> change (he briefly touches the subject in a non-memorable way).

> Contrast this to the recent Health Care Symposium held in burg -

> where a panel of representatives from Government, Insurance,

> Hospitals, Business, Physicians, and even Lawyers agreed on one

> thing - that there was no quick fix and that Health and Wellness was

> the critical area of focus.

> >

> > Suggestions

> > I believe the most successful strategy will not be in attacking the

> movie for its weaknesses or misperceptions, but in distancing

> ourselves and our brand from the groups and motivations he attacks,

> demonstrating the good that we do and achieve (aligns with BCBSA

> strategy), and in articulating our disappointment that he did not

> address the truly relevant issue of improving our health and

> wellness. We will convene a team to consider other approaches and

> work on potential messages for media inquiries, customer service, and

> employees.

> >

> > Confidential Memo (from partner)

> >

> > SiCKO - viewed on 6/26/2007

> >

> > Takeaways

> >

> > * The main theme of the movie is that American society needs to

> focus on the " we " and not the " me " in healthcare.

> >

> > o This broad message is an overlay for the specific criticisms of

> the healthcare industry - the movie asks where the morality of the

> American public lies and contrasts America's approach to health care

> unfavorably with other nations.

> >

> > * SiCKO does not go into any depth about how health insurers

> operate how the health insurance business works - instead it fixates

> on what it characterizes as the profit incentive to deny care to

> patients (e.g. examples of barriers to getting health insurance if

> you are not healthy; examples of people being denied expensive tests

> or procedures; examples of efforts to deny reimbursement after care

> has been received.)

> >

> > * The film draws no distinction between not-for-profit and for-

> profit insurers - in fact the Blue Cross/Blue Shield brand is

> intermixed with the for - profit brands as background reference

> points. o One scene shows a Blue Cross / Blue Shield logo as

> 's voice over begins, " While the healthcare companies get

> wealthy... "

> >

> > * The health insurers that get the most airtime are:

> >

> > o Kaiser Permanente

> > o Humana

> > o CIGNA

> > o Blue Cross of California

> > o Aetna

> >

> > * No Pharma companies are mentioned - but SiCKO suggests in

> multiple instances that prescription drugs are overpriced

> >

> > o At a pharmacy in London, prescription drugs are £6.65, no matter

> how large the dose

> > o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents,

> instead of $100

> >

> > Further Notes

> >

> > * Some of the examples of denial of care highlighted in the film:

> >

> > o A woman with Kaiser Permanente takes her 18-month daughter to the

> hospital in an ambulance, only to be told to go to an in-network

> hospital. By the time they reach the second hospital, her daughter

> has stopped breathing and dies 30 minutes later in ER.

> >

> > o A woman with Blue Shield of California has a tumor but is denied

> requests to get an MRI, or to see a specialist. While on vacation in

> Japan she is given an MRI, and eventually returns to the U.S. to

> demand treatment from her insurer.

> >

> > * In the ensuing court case, a doctor admits to denying her request

> without having reviewed it.

> >

> > o Blue Cross of California approves one woman's $7,500 treatment,

> but the approval is later denied for her failure to report a previous

> medical incident - a yeast infection.

> >

> > * " They're just looking for a way out, " she says

> >

> > * Other examples of how health insurers avoid paying for treatment:

> >

> > o One graph (from Humana) shows that doctors with the highest % of

> denials get a bonus.

> >

> > o interviews a former health insurance employee who

> specialized in denying care to patients retroactively - by finding

> inconsistencies in their medical records.

> >

> > o A 5-minute piece in the beginning of the movie .

> >

> > * The film also focuses on the politicians and the funds they raise

> from Pharma and other player in the health care industry and alleges

> that the system has been heavily influenced by lobbyists and

> contributions.

> >

> > Barclay Fitzpatrick

> > Vice President

> > Corporate Communications

> > Capital BlueCross

> > (w) 717-541-7752

> > © 717-329-3648

> > barclay.fitzpatrick@

> >

> > TalkingPoints61807.doc

> >

> > Blue Cross and Blue Shield Association

> > Talking Points in Response to 's " Sicko "

> > June 2007

> >

> > 1) The Blue Cross and Blue Shield Association (BCBSA) and the 39

> Blue Cross and Blue Shield companies are committed to improving the

> U.S. healthcare system for our nearly 100 million members through

> continuous innovation that reflects the ever-changing healthcare

> landscape and the needs of the consumer.

> >

> > 2) The Blues recognize the need for improvement of both the

> coverage and delivery of healthcare. But the divisive tone set forth

> by and his movie " Sicko " is not helpful. Positive

> change to our healthcare system can be best achieved through shared

> responsibility, not recrimination. To ensure Americans have access to

> the best healthcare that is both timely, efficient, and of high

> quality, requires the collective contribution of all stakeholders --

> consumers, providers, employers and the government.

> >

> > 3) The Blues participation in the Health Coverage Coalition for the

> Uninsured is a primary example of how the broader healthcare

> community is working together to reduce the number of uninsured in

> the United States.

> >

> > 4) The Blues are working on myriad initiatives that ensure

> Americans have access to quality and affordable healthcare. Each day,

> Blue Plans across the country are bringing healthcare value to their

> members in a number of ways such as new advances in health

> information technology and greater access to cost and quality

> information. In addition:

> >

> > o The Blues recently created Blue Health Intelligence a data

> resource that will shine light on emerging medical trends and

> treatment options in an unprecedented way. To further the use of

> evidenced-based medicine, BCBSA has called upon Congress to establish

> an independent, payer-funded institute that will study the

> comparative effectiveness of new and existing medical treatments and

> procedures.

> >

> > o Blue Cross and Blue Shield companies are at the forefront of

> healthcare transparency by providing their members with online access

> to real-time information related to provider quality and the cost of

> common healthcare services. In addition, the Blues have committed to

> making personal health records available to their members by 2008.

> >

> > o We are working to ensure that Medicare is funded appropriately

> and that seniors continue to have access to comprehensive benefits.

> >

> > 5) The Blues are proud of these efforts and we will continue to

> work with consumers, providers, employers and the government to

> provide Americans with the healthcare services and information they

> need to lead full, healthy lives.

> >

> >

> >

> > ---

> > You are currently subscribed to Mike's Message as: max.walker@

> >

> > To unsubscribe click on the link below:

> >

> > http://go.netatlantic.com/u?id=46901619Q & l=michaelmoore

> >

>

[Guest guest]

And it will get worse. I took bioethics last fall at UT. There is a

very strong push for those deemed less-than-worthy to be allowed to

starve to death (I'm not talking Terri here, I'm talking newborns with

Down Syndrome & simple intenstinal blockage), expensive life-saving

treatments refused (70 yr old grandma might not be worthy of triple

bypass), etc. It's already going there, but without choices, it's

gonna get really bad, really quick.

Debi

>

>

> " Free " health care isn't all it is cracked up to be. I have seen many

> Australian, and UK parents say this. ANd I was listening to the

> radio recently about how in Britian, men are not treated for prostate

> cancer. Because it is something for the most part that happens later

> in life, they do not treat it. Why? Because there is such a long

> waiting list to get to a doctor for this treatment, they will be dead

> before getting the treatment.

> No thanks for this 'free universal' health care. Do you really

> honestly think that you will get the medical treatment you need if it

> is all 'free'? There is nothing for free. It is being paid for by US,

> the taxpayers. I am sick of more of my money being taken from me and

> my family by our government. We already work almost 6 months out of

> the year for our government. If we could keep more of our own hard

> earned money, we could afford to go to the doctor.

> No, I don't need the government to keep my money. I don't need 'them'

> to tell me how to spend and invest it. The government has never ran

> anything well. There is too much corruption. All the government does

> is take, take, and take. They alreay throw our money away left and

> right. What makes you think they can run 'free' health care using OUR

> money? If you think you have a hard time getting help for your vaccine

> injured kids now, with universal health care, do you really think you

> will get to use the doctors of your choice? No, you will not. DAN

> doctors will be a thing of the past. And vaccine choices? You will not

> have a choice. ANd this country will destroy its health and future

> completely with more and more mandated vaccine policy. No one will

> escape the insanity that is destroying lives everyday.

> J

>

>

[Guest guest]

United Healthcare, one of the worst of the lot, also directed employees to respond only:We don't have any comment on the film itself. We're here to provide you with the best possible service. Is there anything else I can help you with?"Best possible service, my butt. By the by, physicians also get end-run by the insurance companies. They rarely get covered at 100% for those vaccines they "have to" administer, so they lose money on it.The nation would be much better off without insurance companies or managed care. We keep our money, our companies up our salaries by the amount they pay for those benefits, eliminate the middle man, pay fee-for-service for everything and decide for

ourselves who is in our "network". Might as well, they aren't covering half of what ASD parents are paying for medical care anyway. Fw: BlueCross Secret Memo Re: 'Sicko'

I think the topic of HMOs, etc. will be big at election time. I know

the movie made me think who are we going to vote for in 2008 that can

fix this.

>

>

> BlueCross Secret Memo Re: 'Sicko' ... "You would have to be dead to

be unaffected by 's movie..."

>

> July 6th, 2007

>

> Friends,

>

> An employee who works at Capital BlueCross has sent us a

confidential memo written and circulated by its Vice President of

Corporate Communications, Barclay Fitzpatrick. His job, it seems, was

to go and watch "Sicko," observe the audience's reaction, and then

suggest a plan of action for how to deal with the movie.

>

> The memo, which I am releasing publicly in this email, is a

fascinating look at how one health care company views "Sicko" -- and

what it fears its larger impact will be on the public. The industry's

only hope, the memo seems to indicate, is if the movie "flops."

>

> Mr. Fitzpatrick writes: "In typical fashion, Government and

business leaders are behind a conspiracy to keep the little guy down

and dominated while getting rich."

>

> No. You don't say! That can't be!

>

> BlueCross V.P. Fitzpatrick seems downright depressed about the

movie he just saw. "You would have to be dead to be unaffected by

's movie," he writes. "Sicko" leaves audiences feeling "ashamed

to be...a capitalist, and part of a 'me' society instead of a 'we'

society."

>

> He walks out of the theater only to witness an unusual sight:

people -- strangers -- mingling and talking to each other. "'I didn't

know they (the insurers) did that!' was a common exclamation followed

by a discussion of the example," according to Fitzpatrick.

>

> He then assesses the film's impact: "[T]he impact on small business

decision makers, our members, the community, and our employees could

be significant. Ignoring its impact might be a successful strategy

only if it flops, but that has not been the history of 's

films ... If popular, the movie will have a negative impact on our

image in this community."

>

> The BlueCross memo then suggests a strategy in dealing with "Sicko"

and offers the BCBS "talking points" to be used in discounting the

film.

>

> My heartfelt thanks to the employee who sent this to me.

>

> And now a word from me to Capital BlueCross:

>

> How 'bout a debate? No more secret memos and hand wringing about

the millions seeing "Sicko." Just me and your CEO openly debating the

merits of a system that kills thousands of innocent Americans every

year.

>

> In the meantime, I hope you don't mind me sharing your thoughts and

impressions in your well-written memo. And if the rest of your

executive team hasn't seen "Sicko," it opens in an additional 100

cities tonight for a total of over 700 screens across North America.

Attendance went up a whopping 56% on the 4th of July, higher than any

other film in the theaters right now. But don't be scared, and

certainly don't be ashamed to be a capitalist. Greed is good!

Especially good for you. There's nothing like having the pre-existing

condition of being rich, should you ever get sick and need help.

>

> Yours,

>

>

> mmflint@...

> www.michaelmoore. com

>

> P.S. Join me at noon EST, today, when I'll be chatting with U.S.

Steelworkers, the California Nurses Association, and whoever stops by

to talk about "Sicko" and the industry's attempt to stop this

movement. Check my website for details.

>

> [The following memo was written by Barclay Fitzpatrick, VP of

Corporate Communications for Capital BlueCross]

>

> I was able to see Sicko last night in Lancaster. There were about

30 other viewers in the theatre covering all age groups. I have

attached the well-written memo from one of our partners, which

describes cases used in the movie, to the end of my memo. Also

attached are the latest talking points from BCBSA. I will focus on

impact to our brands, issues, and suggested strategies in this memo.

>

> The Movie

> You would have to be dead to be unaffected by 's movie, he is

an effective storyteller. In Sicko presents a collage of

injustices by selecting stories, no matter how exceptional to the

norm, that present the health insurance industry as a set of

organizations and people dedicated to denying claims in the name of

profit. Denial for treatments that are considered "experimental" is a

common story, along with denial for previous conditions, and denial

for application errors or omissions. Individual employees from Humana

and other insurers are interviewed who claim to have actively pursued

claim denial as an institutionalized goal in the name of profit.

>

> While Humana and Kaiser Permanente are demonized, the BlueCross and

BlueShield brands appear, separately and together, visually and

verbally, with such frequency that there should be no doubt that

whatever visceral reaction his movie stirs will spill over onto the

Blues brands in every market. Here are some examples:

>

> * Horizon BlueCross/BlueShiel d is picked out early in the film in a

collage of stories citing bad treatment of members.

> * BCBSA is cited for rejecting a woman for coverage due to a high

BMI - "too fat" is written across the screen over a copy of her

application denial letter, which describes the BMI rejection.

> * BlueShield of California denied coverage for a diagnostic test,

which the patient later received overseas. Patient sues BS of CA and

medical director admits to not 'seeing' the actual denial letter,

which was given an electronic signature.

> * BlueCross of California denied payment for a major surgery after

they discovered a previous yeast infection, then dropped the person

for coverage. This is followed by an interview with a person who

claims to have been a specialist at finding inaccuracies in

applications to enable post-treatment payment denials.

> * A BCBSA card is shown while the narrator describes how they

(insurers) got wealthy.

>

> In typical fashion, Government and business leaders are

behind a conspiracy to keep the little guy down and dominated while

getting rich. Nixon Oval Office tapes are used to show how the

initial idea of a 'less care = profit' enterprise was supported by

the administration and became the HMO paradigm. Legislators are

presented as bought stooges for the political agendas of insurers and

big Pharma. Insurers are middlemen in the Medicare Modernization Act -

which is presented as a trick to charge seniors more for their

prescription drugs.

>

> Doctors are barely touched - only in the course of discussing the

AMA's work to sink early efforts in the 40's and 50's to start

universal health care. He takes efforts to show that doctors live

well in other countries despite the existence of universal health

care. In follow-up interviews, has stated that he has spoken to

and knows many doctors, and "doctors aren't the problem".

>

> In the second half of the movie, walks us through individual

stories of the Canadian, British, French, and Cuban health care

systems where everything is free and - he reminds us repeatedly - no

one is ever denied service because they can't pay. In addition to

health care, the government provides free day care, college, and

someone to do your laundry. Everybody gets along and takes care of

each other and life is beautiful because there is universal health

care. As a viewer, you are made to feel ashamed to be an American, a

capitalist, and part of a 'me' society instead of a 'we' society -

and the lack of universal health care is held up in support of that

condemnation.

>

> The Impact

> 's movies are intentionally intense and his objective in Sicko

seems to be to revive the earlier Clinton efforts - not to achieve

universal coverage with this movie, but to push the topic to the top

of the agenda. He will be just as successful whether proponents mount

momentum or discussion entails key stakeholders defending why it

won't work.

>

> As a health care industry educated viewer it is easy to pick out

where is cultivating misperceptions to further a political

agenda, but you will also recognize that 80%+ of the audience will

have their perceptions substantially affected. In demonstration of

its impact, an informal discussion group ensued outside the theatre

after the movie. While some people recognized how one-sided the

presentation was, most were incredulous and "I didn't know they (the

insurers) did that!" was a common exclamation followed by a

discussion of the example.

>

> The unfortunate reality for Capital BlueCross is that as the market

leader, we will be affected both in brand and as employees as 's

efforts in the movie and surrounding PR activity are seen by more of

the community. The impact on industry savvy Sales' contacts should be

minimal, while the impact on small business decision makers, our

members, the community, and our employees could be significant.

Ignoring its impact might be a successful strategy only if it flops,

but that has not been the history of 's films nor the way this

one appears to be headed. If popular, the movie will have a negative

impact on our image in this community.

>

> There should be no doubt that many of our employees will be asked

what they think of the movie by friends, family, and neighbors. We

should anticipate that our customer service people will be asked

about particular cases from the movie and if we follow similar

policies. Word and phrases we have routinely used to date in policy

change communications or denial letters, such as "Investigational" ,

will be seen as affirming the film's contentions. The national BCBSA

response - while coming out against the film's divisiveness and

focusing on the positive work of the Blues - steers media inquiries

about policies and denials back to the plans themselves.

>

> There are 4 key areas of misperception cultivated by the movie that

we should consider in any messaging strategy:

>

> 1. That the industry is all about HMO's. cultivates this

further in his interviews. The reality is that HMO's are a minority

product and have been for some time.

> 2. The movie attacks insurers for a profit motive, but makes no

distinction among for-profit and non-profit insurers, and in its

execution places the Blue Plans together with the for-profit insurers.

> 3. All plans and employees - from leaders to service

representatives - are painted as motivated by profit to deny claims,

and only those with crisis of conscience have come forward to confess

their sins.

> 4. Perhaps most damaging of all, completely fails to address

the most significant driver of health care costs - our own lifestyle

choices - and seeks to focus attention and efforts on the

alluring 'quick-fix' of universal health care. It has taken a

generation of poor nutrition and exercise to get obesity and related

health issues - and subsequent costs - to their current levels, and

's movie fails to acknowledge the causal relationship or need to

change (he briefly touches the subject in a non-memorable way).

Contrast this to the recent Health Care Symposium held in burg -

where a panel of representatives from Government, Insurance,

Hospitals, Business, Physicians, and even Lawyers agreed on one

thing - that there was no quick fix and that Health and Wellness was

the critical area of focus.

>

> Suggestions

> I believe the most successful strategy will not be in attacking the

movie for its weaknesses or misperceptions, but in distancing

ourselves and our brand from the groups and motivations he attacks,

demonstrating the good that we do and achieve (aligns with BCBSA

strategy), and in articulating our disappointment that he did not

address the truly relevant issue of improving our health and

wellness. We will convene a team to consider other approaches and

work on potential messages for media inquiries, customer service, and

employees.

>

> Confidential Memo (from partner)

>

> SiCKO - viewed on 6/26/2007

>

> Takeaways

>

> * The main theme of the movie is that American society needs to

focus on the "we" and not the "me" in healthcare.

>

> o This broad message is an overlay for the specific criticisms of

the healthcare industry - the movie asks where the morality of the

American public lies and contrasts America's approach to health care

unfavorably with other nations.

>

> * SiCKO does not go into any depth about how health insurers

operate how the health insurance business works - instead it fixates

on what it characterizes as the profit incentive to deny care to

patients (e.g. examples of barriers to getting health insurance if

you are not healthy; examples of people being denied expensive tests

or procedures; examples of efforts to deny reimbursement after care

has been received.)

>

> * The film draws no distinction between not-for-profit and for-

profit insurers - in fact the Blue Cross/Blue Shield brand is

intermixed with the for - profit brands as background reference

points. o One scene shows a Blue Cross / Blue Shield logo as

's voice over begins, "While the healthcare companies get

wealthy..."

>

> * The health insurers that get the most airtime are:

>

> o Kaiser Permanente

> o Humana

> o CIGNA

> o Blue Cross of California

> o Aetna

>

> * No Pharma companies are mentioned - but SiCKO suggests in

multiple instances that prescription drugs are overpriced

>

> o At a pharmacy in London, prescription drugs are £6.65, no matter

how large the dose

> o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents,

instead of $100

>

> Further Notes

>

> * Some of the examples of denial of care highlighted in the film:

>

> o A woman with Kaiser Permanente takes her 18-month daughter to the

hospital in an ambulance, only to be told to go to an in-network

hospital. By the time they reach the second hospital, her daughter

has stopped breathing and dies 30 minutes later in ER.

>

> o A woman with Blue Shield of California has a tumor but is denied

requests to get an MRI, or to see a specialist. While on vacation in

Japan she is given an MRI, and eventually returns to the U.S. to

demand treatment from her insurer.

>

> * In the ensuing court case, a doctor admits to denying her request

without having reviewed it.

>

> o Blue Cross of California approves one woman's $7,500 treatment,

but the approval is later denied for her failure to report a previous

medical incident - a yeast infection.

>

> * "They're just looking for a way out," she says

>

> * Other examples of how health insurers avoid paying for treatment:

>

> o One graph (from Humana) shows that doctors with the highest % of

denials get a bonus.

>

> o interviews a former health insurance employee who

specialized in denying care to patients retroactively - by finding

inconsistencies in their medical records.

>

> o A 5-minute piece in the beginning of the movie .

>

> * The film also focuses on the politicians and the funds they raise

from Pharma and other player in the health care industry and alleges

that the system has been heavily influenced by lobbyists and

contributions.

>

> Barclay Fitzpatrick

> Vice President

> Corporate Communications

> Capital BlueCross

> (w) 717-541-7752

> © 717-329-3648

> barclay.fitzpatrick @...

>

> Talking Points61807. doc

>

> Blue Cross and Blue Shield Association

> Talking Points in Response to 's "Sicko"

> June 2007

>

> 1) The Blue Cross and Blue Shield Association (BCBSA) and the 39

Blue Cross and Blue Shield companies are committed to improving the

U.S. healthcare system for our nearly 100 million members through

continuous innovation that reflects the ever-changing healthcare

landscape and the needs of the consumer.

>

> 2) The Blues recognize the need for improvement of both the

coverage and delivery of healthcare. But the divisive tone set forth

by and his movie "Sicko" is not helpful. Positive

change to our healthcare system can be best achieved through shared

responsibility, not recrimination. To ensure Americans have access to

the best healthcare that is both timely, efficient, and of high

quality, requires the collective contribution of all stakeholders --

consumers, providers, employers and the government.

>

> 3) The Blues participation in the Health Coverage Coalition for the

Uninsured is a primary example of how the broader healthcare

community is working together to reduce the number of uninsured in

the United States.

>

> 4) The Blues are working on myriad initiatives that ensure

Americans have access to quality and affordable healthcare. Each day,

Blue Plans across the country are bringing healthcare value to their

members in a number of ways such as new advances in health

information technology and greater access to cost and quality

information. In addition:

>

> o The Blues recently created Blue Health Intelligence a data

resource that will shine light on emerging medical trends and

treatment options in an unprecedented way. To further the use of

evidenced-based medicine, BCBSA has called upon Congress to establish

an independent, payer-funded institute that will study the

comparative effectiveness of new and existing medical treatments and

procedures.

>

> o Blue Cross and Blue Shield companies are at the forefront of

healthcare transparency by providing their members with online access

to real-time information related to provider quality and the cost of

common healthcare services. In addition, the Blues have committed to

making personal health records available to their members by 2008.

>

> o We are working to ensure that Medicare is funded appropriately

and that seniors continue to have access to comprehensive benefits.

>

> 5) The Blues are proud of these efforts and we will continue to

work with consumers, providers, employers and the government to

provide Americans with the healthcare services and information they

need to lead full, healthy lives.

>

>

>

> ---

> You are currently subscribed to Mike's Message as: max.walker@. ..

>

> To unsubscribe click on the link below:

>

> http://go.netatlant ic.com/u? id=46901619Q & l=michaelmoore

>

Building a website is a piece of cake. Small Business gives you all the tools to get online.

[Guest guest]

The HMO business model is designed to squeeze the doctor/hospital at the same time that the supply of healthcare is rationed to the consumer.

Nobody wins but the people with the stock options.

Fw: BlueCross Secret Memo Re: 'Sicko'

I think the topic of HMOs, etc. will be big at election time. I know the movie made me think who are we going to vote for in 2008 that can fix this.>> > BlueCross Secret Memo Re: 'Sicko' ... "You would have to be dead to be unaffected by 's movie..." > > July 6th, 2007 > > Friends, > > An employee who works at Capital BlueCross has sent us a confidential memo written and circulated by its Vice President of Corporate Communications, Barclay Fitzpatrick. His job, it seems, was to go and watch "Sicko," observe the audience's reaction, and then suggest a plan of action for how to deal with the movie. > > The memo, which I am releasing publicly in this email, is a fascinating look at how one health care company views "Sicko" -- and what it fears its larger impact will be on the public. The industry's only hope, the memo seems to indicate, is if the movie "flops." > > Mr. Fitzpatrick writes: "In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich." > > No. You don't say! That can't be! > > BlueCross V.P. Fitzpatrick seems downright depressed about the movie he just saw. "You would have to be dead to be unaffected by 's movie," he writes. "Sicko" leaves audiences feeling "ashamed to be...a capitalist, and part of a 'me' society instead of a 'we' society." > > He walks out of the theater only to witness an unusual sight: people -- strangers -- mingling and talking to each other. "'I didn't know they (the insurers) did that!' was a common exclamation followed by a discussion of the example," according to Fitzpatrick. > > He then assesses the film's impact: "[T]he impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films ... If popular, the movie will have a negative impact on our image in this community." > > The BlueCross memo then suggests a strategy in dealing with "Sicko" and offers the BCBS "talking points" to be used in discounting the film. > > My heartfelt thanks to the employee who sent this to me. > > And now a word from me to Capital BlueCross: > > How 'bout a debate? No more secret memos and hand wringing about the millions seeing "Sicko." Just me and your CEO openly debating the merits of a system that kills thousands of innocent Americans every year. > > In the meantime, I hope you don't mind me sharing your thoughts and impressions in your well-written memo. And if the rest of your executive team hasn't seen "Sicko," it opens in an additional 100 cities tonight for a total of over 700 screens across North America. Attendance went up a whopping 56% on the 4th of July, higher than any other film in the theaters right now. But don't be scared, and certainly don't be ashamed to be a capitalist. Greed is good! Especially good for you. There's nothing like having the pre-existing condition of being rich, should you ever get sick and need help. > > Yours, > > > mmflint@...> www.michaelmoore. com > > P.S. Join me at noon EST, today, when I'll be chatting with U.S. Steelworkers, the California Nurses Association, and whoever stops by to talk about "Sicko" and the industry's attempt to stop this movement. Check my website for details. > > [The following memo was written by Barclay Fitzpatrick, VP of Corporate Communications for Capital BlueCross] > > I was able to see Sicko last night in Lancaster. There were about 30 other viewers in the theatre covering all age groups. I have attached the well-written memo from one of our partners, which describes cases used in the movie, to the end of my memo. Also attached are the latest talking points from BCBSA. I will focus on impact to our brands, issues, and suggested strategies in this memo. > > The Movie> You would have to be dead to be unaffected by 's movie, he is an effective storyteller. In Sicko presents a collage of injustices by selecting stories, no matter how exceptional to the norm, that present the health insurance industry as a set of organizations and people dedicated to denying claims in the name of profit. Denial for treatments that are considered "experimental" is a common story, along with denial for previous conditions, and denial for application errors or omissions. Individual employees from Humana and other insurers are interviewed who claim to have actively pursued claim denial as an institutionalized goal in the name of profit. > > While Humana and Kaiser Permanente are demonized, the BlueCross and BlueShield brands appear, separately and together, visually and verbally, with such frequency that there should be no doubt that whatever visceral reaction his movie stirs will spill over onto the Blues brands in every market. Here are some examples: > > * Horizon BlueCross/BlueShiel d is picked out early in the film in a collage of stories citing bad treatment of members.> * BCBSA is cited for rejecting a woman for coverage due to a high BMI - "too fat" is written across the screen over a copy of her application denial letter, which describes the BMI rejection.> * BlueShield of California denied coverage for a diagnostic test, which the patient later received overseas. Patient sues BS of CA and medical director admits to not 'seeing' the actual denial letter, which was given an electronic signature.> * BlueCross of California denied payment for a major surgery after they discovered a previous yeast infection, then dropped the person for coverage. This is followed by an interview with a person who claims to have been a specialist at finding inaccuracies in applications to enable post-treatment payment denials.> * A BCBSA card is shown while the narrator describes how they (insurers) got wealthy. > > In typical fashion, Government and business leaders are behind a conspiracy to keep the little guy down and dominated while getting rich. Nixon Oval Office tapes are used to show how the initial idea of a 'less care = profit' enterprise was supported by the administration and became the HMO paradigm. Legislators are presented as bought stooges for the political agendas of insurers and big Pharma. Insurers are middlemen in the Medicare Modernization Act -which is presented as a trick to charge seniors more for their prescription drugs. > > Doctors are barely touched - only in the course of discussing the AMA's work to sink early efforts in the 40's and 50's to start universal health care. He takes efforts to show that doctors live well in other countries despite the existence of universal health care. In follow-up interviews, has stated that he has spoken to and knows many doctors, and "doctors aren't the problem". > > In the second half of the movie, walks us through individual stories of the Canadian, British, French, and Cuban health care systems where everything is free and - he reminds us repeatedly - no one is ever denied service because they can't pay. In addition to health care, the government provides free day care, college, and someone to do your laundry. Everybody gets along and takes care of each other and life is beautiful because there is universal health care. As a viewer, you are made to feel ashamed to be an American, a capitalist, and part of a 'me' society instead of a 'we' society - and the lack of universal health care is held up in support of that condemnation. > > The Impact> 's movies are intentionally intense and his objective in Sicko seems to be to revive the earlier Clinton efforts - not to achieve universal coverage with this movie, but to push the topic to the top of the agenda. He will be just as successful whether proponents mount momentum or discussion entails key stakeholders defending why it won't work. > > As a health care industry educated viewer it is easy to pick out where is cultivating misperceptions to further a political agenda, but you will also recognize that 80%+ of the audience will have their perceptions substantially affected. In demonstration of its impact, an informal discussion group ensued outside the theatre after the movie. While some people recognized how one-sided the presentation was, most were incredulous and "I didn't know they (the insurers) did that!" was a common exclamation followed by a discussion of the example. > > The unfortunate reality for Capital BlueCross is that as the market leader, we will be affected both in brand and as employees as 's efforts in the movie and surrounding PR activity are seen by more of the community. The impact on industry savvy Sales' contacts should be minimal, while the impact on small business decision makers, our members, the community, and our employees could be significant. Ignoring its impact might be a successful strategy only if it flops, but that has not been the history of 's films nor the way this one appears to be headed. If popular, the movie will have a negative impact on our image in this community. > > There should be no doubt that many of our employees will be asked what they think of the movie by friends, family, and neighbors. We should anticipate that our customer service people will be asked about particular cases from the movie and if we follow similar policies. Word and phrases we have routinely used to date in policy change communications or denial letters, such as "Investigational" , will be seen as affirming the film's contentions. The national BCBSA response - while coming out against the film's divisiveness and focusing on the positive work of the Blues - steers media inquiries about policies and denials back to the plans themselves. > > There are 4 key areas of misperception cultivated by the movie that we should consider in any messaging strategy: > > 1. That the industry is all about HMO's. cultivates this further in his interviews. The reality is that HMO's are a minority product and have been for some time.> 2. The movie attacks insurers for a profit motive, but makes no distinction among for-profit and non-profit insurers, and in its execution places the Blue Plans together with the for-profit insurers.> 3. All plans and employees - from leaders to service representatives - are painted as motivated by profit to deny claims, and only those with crisis of conscience have come forward to confess their sins.> 4. Perhaps most damaging of all, completely fails to address the most significant driver of health care costs - our own lifestyle choices - and seeks to focus attention and efforts on the alluring 'quick-fix' of universal health care. It has taken a generation of poor nutrition and exercise to get obesity and related health issues - and subsequent costs - to their current levels, and 's movie fails to acknowledge the causal relationship or need to change (he briefly touches the subject in a non-memorable way). Contrast this to the recent Health Care Symposium held in burg -where a panel of representatives from Government, Insurance, Hospitals, Business, Physicians, and even Lawyers agreed on one thing - that there was no quick fix and that Health and Wellness was the critical area of focus. > > Suggestions> I believe the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve (aligns with BCBSA strategy), and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness. We will convene a team to consider other approaches and work on potential messages for media inquiries, customer service, and employees. > > Confidential Memo (from partner) > > SiCKO - viewed on 6/26/2007 > > Takeaways > > * The main theme of the movie is that American society needs to focus on the "we" and not the "me" in healthcare. > > o This broad message is an overlay for the specific criticisms of the healthcare industry - the movie asks where the morality of the American public lies and contrasts America's approach to health care unfavorably with other nations. > > * SiCKO does not go into any depth about how health insurers operate how the health insurance business works - instead it fixates on what it characterizes as the profit incentive to deny care to patients (e.g. examples of barriers to getting health insurance if you are not healthy; examples of people being denied expensive tests or procedures; examples of efforts to deny reimbursement after care has been received.) > > * The film draws no distinction between not-for-profit and for-profit insurers - in fact the Blue Cross/Blue Shield brand is intermixed with the for - profit brands as background reference points. o One scene shows a Blue Cross / Blue Shield logo as 's voice over begins, "While the healthcare companies get wealthy..." > > * The health insurers that get the most airtime are: > > o Kaiser Permanente> o Humana> o CIGNA> o Blue Cross of California> o Aetna > > * No Pharma companies are mentioned - but SiCKO suggests in multiple instances that prescription drugs are overpriced > > o At a pharmacy in London, prescription drugs are £6.65, no matter how large the dose> o In Cuba, one bankrupt 9/11 worker's inhaler costs 5 cents, instead of $100 > > Further Notes > > * Some of the examples of denial of care highlighted in the film: > > o A woman with Kaiser Permanente takes her 18-month daughter to the hospital in an ambulance, only to be told to go to an in-network hospital. By the time they reach the second hospital, her daughter has stopped breathing and dies 30 minutes later in ER. > > o A woman with Blue Shield of California has a tumor but is denied requests to get an MRI, or to see a specialist. While on vacation in Japan she is given an MRI, and eventually returns to the U.S. to demand treatment from her insurer. > > * In the ensuing court case, a doctor admits to denying her request without having reviewed it. > > o Blue Cross of California approves one woman's $7,500 treatment, but the approval is later denied for her failure to report a previous medical incident - a yeast infection. > > * "They're just looking for a way out," she says > > * Other examples of how health insurers avoid paying for treatment: > > o One graph (from Humana) shows that doctors with the highest % of denials get a bonus. > > o interviews a former health insurance employee who specialized in denying care to patients retroactively - by finding inconsistencies in their medical records. > > o A 5-minute piece in the beginning of the movie . > > * The film also focuses on the politicians and the funds they raise from Pharma and other player in the health care industry and alleges that the system has been heavily influenced by lobbyists and contributions. > > Barclay Fitzpatrick> Vice President> Corporate Communications> Capital BlueCross> (w) 717-541-7752> © 717-329-3648> barclay.fitzpatrick @... > > Talking Points61807. doc > > Blue Cross and Blue Shield Association> Talking Points in Response to 's "Sicko"> June 2007 > > 1) The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer. > > 2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government. > > 3) The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States. > > 4) The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information. In addition: > > o The Blues recently created Blue Health Intelligence a data resource that will shine light on emerging medical trends and treatment options in an unprecedented way. To further the use of evidenced-based medicine, BCBSA has called upon Congress to establish an independent, payer-funded institute that will study the comparative effectiveness of new and existing medical treatments and procedures. > > o Blue Cross and Blue Shield companies are at the forefront of healthcare transparency by providing their members with online access to real-time information related to provider quality and the cost of common healthcare services. In addition, the Blues have committed to making personal health records available to their members by 2008. > > o We are working to ensure that Medicare is funded appropriately and that seniors continue to have access to comprehensive benefits. > > 5) The Blues are proud of these efforts and we will continue to work with consumers, providers, employers and the government to provide Americans with the healthcare services and information they need to lead full, healthy lives. > > > > ---> You are currently subscribed to Mike's Message as: max.walker@. ..> > To unsubscribe click on the link below:> > http://go.netatlant ic.com/u? id=46901619Q & l=michaelmoore>

Building a website is a piece of cake. Small Business gives you all the tools to get online.

[Guest guest]

A small point to consider, but...

The Dems are heavily invested in Big Pharma as well.

During the Burton Hearings, Waxman (D-CA) was fighting

the investigation into MMR and Thimerosal every step

of the way.

It was the Clinton Administration which placed the FDA

on fasttrack to rush drugs to the market (began in

1993).

It was a Kennedy sponsored bill, signed by Clinton

which made compliance with Federal vaccination

policies part of receiving AFDC (probably the primary

reason vaccine avoiders now tend to be well off).

I am not saying that a change in House is not good;

periodic small fires is good for the health of the

forest. I am saying that simply switching one set of

prostitutes for another is more an exercise in form

over substance.

We need to make sure that the replacement member in

Congress are actually working towards substantive

changes for the better and not just flipping the coin

over.

Re: Fw: BlueCross Secret Memo Re: 'Sicko'

Posted by: " H " stratpat@...

henrycoleman99

Fri Jul 6, 2007 6:06 am (PST)

's movie and Democrat control of congress will

shake these fuckers up.

That's called leverage.

Nothing but good comes out of it.

________________________________________________________________________________\

____

Looking for a deal? Find great prices on flights and hotels with

FareChase.

http://farechase./

[Guest guest]

All points well taken.

However, the threat of universal healthcare often gives these guys the willies.

I always look for leverage when I negotiate. This would be useful leverage.

The Democrats are far worse on forced vaccines. They actually believe in most of this.

The Republicans tend to be less reliant on mandates- but they are absolutely psychotic when it comes to liability. Especially problematic because mistakes happen in all systems.

The bottom line is that Poli Sci majors who wish to cure the world, but who don't understand the underlying technology or the limitations of practice are more dangerous than virtually anyone. Especially when it comes to our kids.

I should know, I was one.

Re: Fw: BlueCross Secret Memo Re: 'Sicko'

A small point to consider, but...The Dems are heavily invested in Big Pharma as well. During the Burton Hearings, Waxman (D-CA) was fightingthe investigation into MMR and Thimerosal every stepof the way.It was the Clinton Administration which placed the FDAon fasttrack to rush drugs to the market (began in1993).It was a Kennedy sponsored bill, signed by Clintonwhich made compliance with Federal vaccinationpolicies part of receiving AFDC (probably the primaryreason vaccine avoiders now tend to be well off).I am not saying that a change in House is not good;periodic small fires is good for the health of theforest. I am saying that simply switching one set ofprostitutes for another is more an exercise in formover substance.We need to make sure that the replacement member inCongress are actually working towards substantivechanges for the better and not just flipping the coinover.Re: Fw: BlueCross Secret Memo Re: 'Sicko' Posted by: "H " stratpatgis (DOT) net henrycoleman99 Fri Jul 6, 2007 6:06 am (PST) 's movie and Democrat control of congress willshake these fuckers up.That's called leverage.Nothing but good comes out of it. __________________________________________________________Looking for a deal? Find great prices on flights and hotels with FareChase.http://farechase./

[Guest guest]

> However, the threat of universal healthcare often gives these guys the

willies.

Gives me the willies, too.

I'd be dead if Hillarycare had passed.

Barrett of QuackWatch actually wrote the bill she was trying to get

through.

All of us, and all of our doctors, would have been felons under it.

Andy

[Guest guest]

My dad had his prostate removed on the NHS pretty quickly with no problems!

Fw: BlueCross Secret Memo Re: 'Sicko'

And it will get worse. I took bioethics last fall at UT. There is avery strong push for those deemed less-than-worthy to be allowed tostarve to death (I'm not talking Terri here, I'm talking newborns withDown Syndrome & simple intenstinal blockage), expensive life-savingtreatments refused (70 yr old grandma might not be worthy of triplebypass), etc. It's already going there, but without choices, it'sgonna get really bad, really quick. Debi>> > "Free" health care isn't all it is cracked up to be. I have seen many> Australian, and UK parents say this. ANd I was listening to the> radio recently about how in Britian, men are not treated for prostate> cancer. Because it is something for the most part that happens later> in life, they do not treat it. Why? Because there is such a long> waiting list to get to a doctor for this treatment, they will be dead> before getting the treatment.> No thanks for this 'free universal' health care. Do you really> honestly think that you will get the medical treatment you need if it> is all 'free'? There is nothing for free. It is being paid for by US,> the taxpayers. I am sick of more of my money being taken from me and> my family by our government. We already work almost 6 months out of> the year for our government. If we could keep more of our own hard> earned money, we could afford to go to the doctor.> No, I don't need the government to keep my money. I don't need 'them'> to tell me how to spend and invest it. The government has never ran> anything well. There is too much corruption. All the government does> is take, take, and take. They alreay throw our money away left and> right. What makes you think they can run 'free' health care using OUR> money? If you think you have a hard time getting help for your vaccine> injured kids now, with universal health care, do you really think you> will get to use the doctors of your choice? No, you will not. DAN> doctors will be a thing of the past. And vaccine choices? You will not> have a choice. ANd this country will destroy its health and future> completely with more and more mandated vaccine policy. No one will> escape the insanity that is destroying lives everyday.> J> >

[Guest guest]

The case you are referring to occurred in Bloomington, Indiana. That

is in the US: http://tinyurl.com/2l8xp2

Carolyn

> >

> >

> > " Free " health care isn't all it is cracked up to be. I have seen

many

> > Australian, and UK parents say this. ANd I was listening to the

> > radio recently about how in Britian, men are not treated for

prostate

> > cancer. Because it is something for the most part that happens

later

> > in life, they do not treat it. Why? Because there is such a long

> > waiting list to get to a doctor for this treatment, they will be

dead

> > before getting the treatment.

> > No thanks for this 'free universal' health care. Do you really

> > honestly think that you will get the medical treatment you need

if it

> > is all 'free'? There is nothing for free. It is being paid for by

US,

> > the taxpayers. I am sick of more of my money being taken from me

and

> > my family by our government. We already work almost 6 months out

of

> > the year for our government. If we could keep more of our own

hard

> > earned money, we could afford to go to the doctor.

> > No, I don't need the government to keep my money. I don't

need 'them'

> > to tell me how to spend and invest it. The government has never

ran

> > anything well. There is too much corruption. All the government

does

> > is take, take, and take. They alreay throw our money away left and

> > right. What makes you think they can run 'free' health care using

OUR

> > money? If you think you have a hard time getting help for your

vaccine

> > injured kids now, with universal health care, do you really think

you

> > will get to use the doctors of your choice? No, you will not. DAN

> > doctors will be a thing of the past. And vaccine choices? You

will not

> > have a choice. ANd this country will destroy its health and future

> > completely with more and more mandated vaccine policy. No one will

> > escape the insanity that is destroying lives everyday.

> > J

> >

> >

>

[Guest guest]

For every case reported, how many babies are quietly starved to death

across the country & not reported...

-- In EOHarm , " thefitzenreiterfamily "

<thefitzenreiterfamily@...> wrote:

>

> The case you are referring to occurred in Bloomington, Indiana. That

> is in the US: http://tinyurl.com/2l8xp2

>

> Carolyn

>