On the morning of June 22, 2012, Malcolm Gladwell addressed a large crowd of health insurance professionals assembled at the Salt Palace Convention Center in the heart of Salt Lake City, Utah. The event was part of a four-day conference put on every year by America’s Health Insurance Plans, the powerful health insurance mega-lobby better known as AHIP. That year, the conference’s theme was the Supreme Court decision on President Obama’s healthcare reform law:
It’s Decision Time.
The decisions that will shape our nation’s health care are near. The Supreme Court Decision. The Presidential election. Implementation decisions within health plans that are shaping the delivery of care.
Institute2012, June 20-22 in Salt Lake City, will address these factors head on. There’s not a better place to learn firsthand how these decisions will affect your organization’s efforts immediately, tomorrow, and beyond.
Gladwell was part of a lineup that included Chief Medical Officer of WellPoint Inc, as well as former Bush Administration spokesman Ari Fleischer. But Gladwell received top billing. He was scheduled to wrap up the last day of the conference, so he could work his magic and send health insurance professionals home feeling happy, entertained and ready for another grueling week at the office.
What exactly is AHIP? Well, it’s another one of those bland acronyms that conceals something sinister and awful—well, awful for everyone but a handful of health insurance plutocrats and the corporate speakers who rake in sweet fees at its events.
AHIP is a powerful lobby organization defending the interests of the health insurance industry that fights against universal healthcare and basically against anything that might bring America into line with the civilized world’s approach to healthcare. It represents roughly 1,500 for-profit health insurance companies in the U.S. and is notorious for a bottomless lobbying budget, as well as cutthroat and manipulative public relations campaigns. In recent AHIP has done perhaps more than any other corporate group to crush meaningful healthcare reform in America. To give you an idea of just how serious they are, it was recently revealed that AHIP gave the Chamber of Commerce over $100 million to lobby against government-run health insurance during Obama’s push for healthcare reform. That’s on top of spending huge amounts of money on astroturf campaigns and public relations offensives to smear anything advocating universal healthcare, such as Michael Moore’s film Sicko.
In other words: AHIP fronts for and represents companies that make money by denying medical care to the sick.
And that’s alright by Gladwell. His history of fronting for Pharma and Big Tobacco has shown clearly shown that he has no qualms about working for industries that profit off misery, pain and death. The 2012 AHIP conference was not the first paid gig that Gladwell’s did for the health insurance industry. He had spoken at an AHIP conference at least once before in 2005 and, in his vague disclosure statement, signaled that he had done many similar engagements over the course of his career, writing that he had given talks to “groups of doctors, hospitals, insurers, as well as Pharmacy Benefit Managers and groups funded by the National Institutes of Health.”
The fact that AHIP and other health insurance organizations routinely paid Gladwell tens of thousands of dollars to entertain them at their corporate events does not come as a surprise. Gladwell’s connection to the for-profit health insurance industry goes back to his training at the National Journalism Center, an organization that had been attacking healthcare reform as one of its core objectives. A 1996 Philip Morris memo happened to mention its work with the National Journalism Center on fighting healthcare reform:
We also co-sponsored in December a policy minibriefing on health care for a broad cross-section of the Center’s Alumni Council, and are now working with the Journalism Center in the development a major health care reform policy conference (tentatively scheduled for late April/early May) that will debunk the myths of the Clinton plan, explain the ill-advised proposals to fund any such plan with excise taxes, and promote alternative, market-driven plans. The forum will be chaired by Sen. Gramm (R-TX), and will have considerable participation from legislators, media and friendly policy group personnel.
Whatever they taught at the National Journalism Center, it must have made a big impression on young Gladwell, because he started boosting for the health insurance companies almost as soon as he graduated from college, stepping in to defend the industry at key times when it was threatened by reform.
Malcolm Gladwell’s decades-long history of shilling for the health insurance industry provides a perfect example of the mix of undisclosed conflicts of interest, lucrative speaking fees and journalistic fraud and corruption that has become such a defining characteristic of Gladwell’s career. It’s worth examining this in detail and putting it into its proper historical context, especially because Malcolm Gladwell has recently refashioned himself into a supporter of healthcare reform.
As a business reporter for the Washington Post in the early and mid-1990s, Malcolm Gladwell frequently wrote about the topic of healthcare and health insurance. And it just so happened that his articles seemed always in sync with the interests and policy priorities of private health insurance companies.
In March 1992, while Bill Clinton was campaigning for President, Gladwell wrote a Washington Post article titled “Why Canada’s Health Plan Is No Remedy for America.” In it, he made a case against creating a Medicare-type program that would cover all Americans, arguing that if the “national health-insurance system were adopted in the United States, the way residents in the Washington region would receive care from hospitals and doctors would change almost beyond recognition”—and by “change” he meant “change for the worse.” According to Gladwell, universal coverage would have devastating effects on the country’s medical system. It would translate into lower overall quality of care and—scariest of all—would lead to medical rationing, forcing doctors to make decisions about who gets medical care and who doesn’t.
Medical rationing—it’s the same old PR scare the health-insurance lobby whips out every time it feels under threat, just like it did during President Obama’s push for healthcare reform in 2009, when Rep. Michele Bachman and other Tea Party Republicans kept screaming about concentration camps and government-mandated “death panels” that would put grandmas to death because it cost too much to care for them.
That same year, in 1992, Gladwell wrote another article for the Washington Post on the health insurance industry, this one titled “Reforming the Health Care System: An American Paradox.” Among other things, Gladwell claimed Americans were happy with the medical system and blamed the rising costs of medical care not on insurance companies or for-profit hospitals, but on the labor costs of nurses and medical staff. Gladwell concluded the article with a bleak outlook: the only thing that healthcare industry can do is to limit the amount of time patients spend with doctors.
How did Gladwell come to that conclusion? Well, it helped that all the experts he quoted in the article had worked for or received funding directly from the health insurance industry: One expert was Leonard Schaffer, a Blue Cross of California executive. The other was John Hoff, whom Gladwell described as a “health care specialist and lawyer in Washington.” What Gladwell failed to mention was that Mr. Hoff had worked for the Heritage Foundation and the American Enterprise Institute, both corporate think-tanks that have been long involved in the fight against healthcare reform. The third quoted expert was John Sheils, a man Gladwell simply described as “a Washington health economist.” In reality, Sheils worked for the Lewin Group, a management consulting company that provided services for the health insurance industry, and is now an actual subsidiary of UnitedHealth Group, the largest health insurance company in America. UnitedHealth Group made over $5 billion in profits in 2011.
How’s that for objective news?
What’s interesting is that the speech Malcolm Gladwell delivered at the 2012 AHIP conference in Salt Lake City made almost the same argument as this 1992 Washington Post article: it blamed the sorry state of America’s healthcare system on high labor costs while completely ignoring the role of private health insurance companies. Although in 2012, Gladwell smartly ditched the politically charged word “labor” and, using a bit of his PR magic, replaced it with a quirky, seemingly harmless description of the problem. Instead of saying “labor,” he explained that the U.S. medical system was broken because it did not eliminate “chauffeurs”—by which he meant that the medical industry wasn’t replacing its workers with machines and automation fast enough. According to Gladwell, medical customers needed to assume control of their own medical well being.
How would consumers “assume control”? By administering their own medical care, that’s how!
Gladwell held up the iPhone as an example of cutting-edge technology that could be used to spruce up the medical healthcare system and to drag it kicking and screaming into the future by being used to “significantly reduce the number of physician office visits.” That’s right. The problem with healthcare had nothing to do with for-profit health insurance companies funneling their customers’ premiums into executive bonuses and dividend payouts for shareholders, while giving nothing of value to their customers in return. It’s because people still have the antiquated idea that medical care should be administered by trained medical professionals—as in doctors and nurses. Notice how Gladwell frames cutting medical care, reducing face-to-face time with doctors and engineering mass layoffs of medical professionals as positive developments. It’s all about empowering consumers!
A decade earlier, he was still much more candid about his position on private health insurance. In 2000, four years after leaving the Washington Post, Gladwell took part in a Washington Monthly forum on healthcare that explored the differences between Canada and the U.S. He did not mince words, saying that he considered Canadian medical care to be “third world.” As a Canadian national who lived in the country until his early twenties, Gladwell’s opinion carried a lot of weight. And he put that “credibility” to full use, describing a 1984 incident in which an eye injury he received falling off a bike was misdiagnosed and nearly led to life-threatening complications. This was supposedly due to the fact that Canada had to ration medical care because of a lack of CT scans. Gladwell then used this single incident to illustrate a broader point he said applied to the entire Canadian public healthcare system.
Gladwell’s claim that Canada’s healthcare system was more likely to lead to death did not hold water, but it did sound suspiciously similar to a claim made in a 2010 anti-healthcare reform ad run by the Koch-funded Americans for Prosperity. The ad featured a Canadian woman, who said that she was forced to seek treatment for her brain tumor in the United States or face imminent death: “If I had waited for treatment in my government-run health care system, I’d be dead.” It didn’t take long for a Canadian newspaper to discover that the woman’s “brain tumor” was not a tumor, nor was it in her brain. It was actually a non-life-threatening cyst … on her pituitary gland!
So in 2000, Malcolm Gladwell’s proclamations on healthcare were straight out of the lobbyist handbook. Yet by 2005, Gladwell had apparently flip-flopped on the healthcare issue, suddenly proclaiming that his previous assessment was wrong: maybe government-run healthcare wasn’t totally evil after all. What made him change his mind? Well, that’s not clear. But the explanation Gladwell gave on his blog for his sudden conversion was not at all convincing: “The bigger reason is simply that I woke up one day and realized what much smarter people than me realized a long time ago…”
Considering that Gladwell spent almost half his life in Canada under a government-run healthcare system, the explanation just didn’t make any sense. The man had been broadcasting health insurance propaganda since the early 1990s, and that’s the only excuse he could come up with?
The real answer is simpler: times had changed.
By the mid-2000s, Americans weren’t buying the whole free-market tough medicine talk. Between 60 to 70% supported single-payer, Medicare-for-all healthcare programs. Even doctors began to support single-payer reform. “Where only 18 percent of AMA members favored single-payer reform in 1992, the figure had soared to 42 percent by 2004,” wrote the American Prospect in 2008, noting that a solid 70 percent of pediatric cardiologists were in favor of a single-payer system in 2003.
It’s very rare for 70% of Americans to agree on anything, but as far as healthcare was concerned, a clear consensus had emerged: Americans no longer bought AHIP’s lies about government-run healthcare being a slippery slope to rationing, death panels and medical totalitarianism.
In this kind of environment, it was no longer useful or even convincing for Gladwell to stick to his old, hardline position favoring private health insurance. In fact, doing so would have likely damaged his reputation and blown his “objective journalist” cover. It was obvious to everyone that private healthcare was not a solution, and only libertarians, regressive right-wingers and obvious corporate shills were pushing that position.
But while an overwhelming majority of Americans were aligned against private health insurance companies, Gladwell’s underlying beliefs and assumptions hadn’t shifted a bit. He was still firmly on the side of the private health insurance industry. But now, instead of extolling the virtues of free-market medicine, he was whitewashing the role that the health insurance lobby played in corrupting and perverting America’s healthcare system.
The most recent and shameless example: In 2005, Gladwell had an article published in the New Yorker that was supposed to be, among other things, an exploration of why America is one of the few developed countries without some form of universal healthcare. In reality it was an insidious piece of health insurance propaganda that did two things: 1) it whitewashed the role of corporate front groups like AHIP in snuffing meaningful healthcare reform, and 2) it put the blame squarely on unions and organized labor.
The article made no mention of corporate lobby groups like AHIP. In fact, in Gladwell’s version of healthcare history, these groups simply did not exist.
Redacting the role of corporate lobby groups in attempts to derail universal healthcare, and pinning these attempts instead on unions is whitewashing of the most treacherous, disgusting kind. It’s an interpretation of history that completely ignores the role played by the big business, the medical lobby and all sorts of corporate advocacy groups that aligned time and time again to stomp out any possibility of universal healthcare following World War II. You’d expect this sort of corporate revisionism from right-wing pundits like Rush Limbaugh or Michael Savage, but not from the New Yorker‘s top writer.
This was not an honest mistake on Gladwell’s part. Corporate interference in healthcare reform is not an obscure historical fact. It pops out as soon as you start researching the subject. There are plenty of historical examples of unions supporting universal healthcare, even as corporate interests did their best to undermine it.
One example: the government-run universal healthcare program proposed by President Truman in 1945, which was supported by unions but defeated as a result of a fierce lobbying and red-baiting campaign by corporate interests, including the powerful American Medical Association. Gladwell didn’t have to hit the library stacks to dig up this historical information—the website of Harry S. Truman Library spells it out very simply and clearly.
Gladwell’s telling of healthcare history is so out of whack with even the most mainstream accounts, it makes sense to quote at length from Paul Starr’s Pulitzer Prize winning history of the American healthcare system, The Social Transformation of American Medicine. Here is how it describes the public relations campaign following Truman’s re-election in 1948: “…the AMA thought armageddon had come. It assessed each of its members an additional $25 just to resist health insurance and hired Whitaker and Baxter to mount a public relations campaign that cost $1.5 million in 1949, at that time the most expensive lobbying effort in American history … So successful was the campaign in linking health insurance with socialism that even people who supported Truman’s plan identified it as “socialized medicine,” despite the administration’s insistence it was not. Support in public opinion polls, among those who had heard of Truman’s plan, dropped from 58 to 36 percent by 1949; three quarters of those who had heard of the plan knew of the AMA’s opposition.”
This is the history that Malcolm Gladwell left out.
Gladwell’s revisionism was as much about defending the interests of the health insurance industry as it was about self-preservation. After all, Malcolm Gladwell has been and still is a crucial part of the corporate propaganda apparatus used to crush democratic reform. By writing corporations out of the history, Gladwell was also writing himself out of history, and covering up his crimes against journalism and the public’s trust.