Scott Pelley’s extraordinary juvenile meltdown over being fired from Sixty Minutes, recalled a moment in my life when I was facing the meat grinder that most “guests” on the program dreaded.
As one of the first generation of healthcare economists, in 1985 I had been lifted out of a comfortable slot on the faculty at Johns Hopkins where I had been writing about the economics of health care. I had a particular focus on the rapacious behavior of hospitals in the early days of Medicare and Medicaid when they were doing everything possible to inflate the costs of care because they could pass them on to an unwitting government.
In retrospect, the story of how I was recruited by the commercial health insurance industry (not the once non-profit Blue Cross plans) to head their industry association, then 212 individual companies, is still hard to believe. When asked “Why me?” the head-hunter explained that the leadership of the association, all chairman of insurance companies including Travelers, Prudential, and Aetna, worried that political forces seemed to be coalescing around some kind of government takeover of their companies. The recruiter explained they thought they needed “an intellectual” who could develop a defensive strategy. While I had organized the nation’s first academic center focused on hospital finance, founded the first large scale hospital data company, and had visibility in the policy world, I was not a D.C. lobbyist and knew nothing about the dynamics of the insurance industry.
The industry’s worries were well founded. Left leaning politicians, egged on largely by academics, urged Americans to be embarrassed because the U.S. was the only industrialized country without government health coverage. While this brand of advocacy never took hold with voters -- contemporaneous polls showed that most people were content with their coverage either from, say, Mutual of Omaha or their then local Blue Cross plan, -- the out-of-pocket costs of care, generally thought of as “co-payments,” were growing.
Perhaps the real Achilles' heel was that the friction related to recovering reimbursement from the carriers was an arduous process. People hated it! Many times I’ve thought that if the insurance market had ever decided to be “user-friendly,” there might never have been Obamacare.
All this as predicate to my having spent a July afternoon in 1991 in a conference room in Washington parrying with Ed Bradley, then Sixty Minutes’ most skilled dirt-digging story-making “investigative reporter.”
As I remember it, he asked if he could interview me over a case where someone with coverage “discovered” that they really didn’t have insurance. Of course, Sixty Minutes’ normal operating procedure was to never do much more than hint about the story they wanted to talk about. Ambushing usually produces a certain kind of flustered spontaneity.
Obviously, all interviews were taped and many stories ignited charges that the show had edited interviews to sound more scandalous than the facts might support. I hired a consultant whose practice was focused on getting people ready to be on Sixty Minutes. Only in Washington! He provided valuable advice -- record the interview and make sure Ed Bradley knew we too were recording.
The interview began with a hostile question. “How can you live with yourself knowing that the companies you work for won’t pay for drugs that could have saved this lady’s life?” Ah ha, I thought, the old complaint that carriers kill people because they wouldn’t pay for drugs that some doctor thought could possibly save his patient’s life.
This was easy going for me. Bradley kept pushing the story line that never revealed that the doctor most likely had prescribed a drug far distant from what the manufacturer told the FDA the drug was engineered to do. To this day every carrier employs its own physicians and pharmacists to determine if the patient’s doctor’s belief that the drug prescribed might, just might, work in a specific “off use” circumstance. Having worked on the Hopkins medical campus for over a decade, living among some of the most respected physicians in the world, I came to understand that few doctors should be taken seriously on all matters.
Having stuck to my guns arguing that when insurance companies are watchful in reviewing “experimental” drugs, and any doctor prescribing an “off label” use is engaging in unregulated experimentation which could end up being harmful to the patient, Bradley was flummoxed. As if in a football game, he asked for a time out. Recalling my consultant’s advice, I did not leave Bradley out of my sight. Unbelievably, Bradley took counsel with his producer asking how to get me to say that insurance companies should honor the so-say of any physician. Bradley was not a skilled whisperer. I heard the Sixty Minutes crew’s plan to lay a trap that I was fully visible to me.
Armed, I was able to subtly taunt Bradley as someone who was after drama, not truth. To my mind, Sixty Minutes might have performed a public service, namely, delving into the challenge of how society might see the dangers of off label pharmaceutical use, mostly based on unfounded gossip shared by physicians at professional society meetings -- seldom the result of bench scientists probing secondary uses of already approved compounds.
Despite a week of CBS hyping the show, when the interview aired, it was largely a yawn. To me Sixty Minutes is remembered as a televised version of yellow journalism, not the helpful public servant that it thought of itself.
