
by Katie Delahaye Paine
I served on the board of directors and later the advisory board of Anthem Blue Cross Blue Shield of New Hampshire. So I know a lot more about the business than most. When I first worked with what was then BCBS, they were a old-fashioned, non-profit insurance company. Over the years, the company grew, improved and ultimately was sold to for-profit Anthem. As a public company, the need to deliver shareholder return became a major focus. Under Anthem's guidance the old BCBS continues to dominate the insurance marketplace in NH.
In some ways, we could see today's debate over health care reform coming. As I have said many times, "you become what you measure," and the key performance indicator that we on the board looked at every month was cost per member per month vs. revenue per member per month. When revenue exceeded costs, it was good. When costs exceeded revenue, we dropped providers or cut back payments.
For a for-profit corporation, that's just good sense. But it's no surprise that it could lead to horror stories of people losing insurance just when they needed it the most.
The question is, after a summer of bashing by the Obama administration, can the health insurance companies rebuild their reputations? The short answer is yes, but it won't be easy.
First of all, insurance companies have never had that great a reputation anyway. The nature of their business puts them at the awkward intersection of commerce and compassion. Even before the current debate they were the corporations that people loved to hate, commonly viewed as taking advantage of those who most needed their services.
Add to that politics, or, more specifically, politicians. As I said, the fundamental motivation of for-profit insurance companies is shareholder return. Put that together with the fact that decisions regarding health insurance are primarily made by employers (not individuals), and you see why the weakest voice in the debate is the individual policy holder. This plays perfectly into the hands of politicians, whose reelection depends on those individuals. No politician has ever won votes by championing the cause of big bad corporate insurance companies over the needs of the people.
But the bigger problem for insurance companies is their own ham-handed astroturfing (see "The Dark Side of PR," also in this month's issue), such as United Health's use of employees to generate the appearance of support for their points of view, and providing false data as talking points from its wholly-owned subsidiary the Lewin Group. In the pre- social media days, faux protests and facts might have gone unnoticed, at least until the debate was over and the votes were cast. But today, it's just too easy (and frankly fun for many bloggers) to expose corporate America's efforts at media manipulation. So they backfire, and insurance companies have been shooting themselves in the foot.
To restore
their reputations, insurance companies will need to turn away from
the dark side of PR and start investing in activities that prove
them to be open, honest, and reliable. It will take an enormous
amount of transparency and trust-inspiring good
deeds
before
most
Americans
will ever trust
them again. ![]()

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