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    Managed Care Debate Heats Up the Airwaves

    By Howard Kurtz
    Washington Post Staff Writer
    Tuesday, July 28, 1998; Page A02

    A clear villain has emerged in the first wave of industry ads opposing stricter regulation of health maintenance organizations: Washington.

    And who better personifies the massive reach of the federal government than that liberal stalwart, Sen. Edward M. Kennedy? That's why the Democratic senator from Massachusetts is the unwitting star of a radio spot -- complete with scary organ music -- being broadcast across the country by the Health Benefits Coalition, representing 32 major business groups.

    A Kennedy-like voice calls for "scalpel" and "sutures" until he's "stitched together enough new government regulations on HMOs to put Washington in control of everyone's health care." Even he recoils in horror: "Oh no! Frankenstein's monster!"

    At a time when Congress seems determined to respond to a growing chorus of complaints about HMOs, the major health care and insurance companies and their business allies are trying to shift the focus to an equally unpopular target, the federal bureaucracy.

    Taking a leaf from the tobacco industry, which recently shredded anti-smoking legislation with a $40 million television and radio blitz that focused on a big-government tax-and-spend message, the health care ads are an attempt to derail a potentially popular push for tighter regulation. The industry used this approach to great effect in 1994, when its $15 million barrage of "Harry and Louise" ads helped sink President Clinton's health care reform package.

    "There's plenty of distrust toward 'big government' out there," said Mike Murphy, a Republican media consultant whose firm is making TV spots for the American Association of Health Plans. "We're trying to make the debate a little more complicated, just like real life. The solution may not be as easy as you think. . . . All we have to do is remind people that there's no free lunch."

    In contrast to the tobacco battle, when anti-smoking groups could not afford television ads, the health care coalitions have not been able to monopolize the airwaves. The AFL-CIO has launched a TV campaign in support of the so-called Patients' Bill of Rights legislation, sponsored by Kennedy and Rep. John D. Dingell (D-Mich.) and backed by the White House, which would place restrictions on managed-care groups and require them to cover more services.

    "Our message is basically that Americans and working families really want and need protection from the health care industry," said union spokeswoman Naomi Walker. "The scaremongering they typically do is just not going to work. People feel pretty deeply that the health care industry needs some regulation."

    The air war is just beginning. The AFL-CIO has spent about $1 million on television spots in 21 House districts and five senators' states, aimed at lawmakers who might be persuaded to back the Kennedy-Dingell legislation. The Health Benefits Coalition, which includes the Chamber of Commerce, National Association of Manufacturers and Health Insurance Association of America, has spent $2 million on radio ads in 15 markets, including Washington. The managed care association is running its TV ads in Washington for now but mapping a national strategy.

    Other groups, from the Business Roundtable to outfits with names such as the Patient Access to Specialty Care Coalition, are weighing in with spots on various sides of the issue.

    Not everyone is convinced that advertising will carry the day on this emotional subject. "It's very, very difficult," said Charles N. Kahn III, incoming president of the Health Insurance Association of America. "Any ad that we run is going to be a tough sell."

    The dueling advertising messages might best be described as a battle to define the bad guys.

    One Murphy ad for the health plans association, the trade group for managed-care organizations, begins with a narrator warning of "the politicians' new game" -- whacking away at a colorful piñata meant to symbolize HMOs. "The politicians' new laws and regulations could cause nearly 2 million hard-working Americans to lose their health coverage," the narrator says. "Some game. Politicians win votes while families lose health coverage."

    A second ad, featuring a small businessman in Illinois, uses the tag line: "When politicians play doctor, real people can get hurt."

    The estimate of 2 million people losing insurance is based on a study commissioned by the managed-care group. But a report this month by the nonpartisan Congressional Budget Office undercuts the idea that costs would soar under the Democratic legislation. The report said increased regulation would drive up the average premium by 4 percent, and another 1.2 percent for legislation that would give patients the right to sue their health plans for malpractice. This, Democrats say, would translate into a monthly rise of about $2 per person.

    The "Frankenstein's monster" ad for the Health Benefits Coalition charges that the Kennedy measure "creates 359 new federal mandates and 3,825 new federal bureaucrats." These figures come from a study commissioned by the National Association of Manufacturers.

    "The real monster is the current health care system," said Kennedy's spokesman, Jim Manley. He said the industry is diverting attention from the issues with "a rather poor imitation of a Massachusetts accent."

    Dan Danner, the coalition's chairman and vice president of the National Federation of Independent Business, maintained that the Kennedy approach "goes too far. It will have a huge impact on cost and ultimately will result in millions of people losing coverage."

    The AFL-CIO commercial features a harried nurse saying: "These bureaucrats from the insurance companies. They routinely deny care, and they make decisions that only doctors should be making." A narrator adds that "the insurance industry is spending millions to block a law in Congress that would protect our rights, and our lives."

    The charge that insurance companies "routinely deny care" is impossible to quantify but suggests, without documentation, that patients are frequently denied vital services.

    © Copyright 1998 The Washington Post Company

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