Bittersweet Victory

The senate finally has the 60 votes it needs to avoid a filibuster from the increasingly ridiculous Republicans, who, for purely political reasons, have pulled out every trick in the book to obstruct health care reform. While this is certainly a good thing, my sentiments are mixed. On the one hand, health care will be extended to 31 million new people. On the other hand, Senator Reid's bill has way too many silly sweetheart deals, crazy payment schemes, and takes away the strongest lever for bringing down health care costs, i.e. the public option.

Some highlights of the "compromises" Democrats have made to get the bill passed:

• Nebraska's Ben Nelson was able to get extra Medicaid funding for his state. Reminds me of a 1st round draft pick petulantly holding out for a better contract.
• The ability for states to choose if their insurance exchange will pay for abortions.
• A two-tiered insurance system for people who want to have an abortion. I.e. you have to buy extra insurance in case you think you might want to have an abortion at some point. Ironically, the Catholic Church AND Pro-Choice both oppose this part of the bill.
• At least two national insurance providers chosen by the Office of Personnel Management, the same folks who run Congress' health plan.
• Higher penalties on "Cadillac" health plans excluding plans for people in high-risk jobs like police, firefighters, miners, and longshoremen.
• Higher penalties on the rich - 0.9% of income if you make $200K as an individual or $250K as a family.
• A tax on indoor tanning salons in lieu of a tax on plastic surgeons. I wonder if Beverly Hills has its own lobbyist.

All in all, I think this bill is necessary and it would be a disaster if it didn't pass in some form or another. Sadly, I think the forest is being lost for the trees - in my mind we have to pass health care reform to get three achieve three big outputs. 1) Cover as many people as possible. 2) Don't allow Insurance Companies to "cherry pick" customers. 3) Keep costs low by increasing competition and rewarding efficiency.

Health Insurers Caught Paying Facebook Gamers Virtual Currency To Oppose Reform Bill

This is unbelievable. Thanks to Jeff for bringing it to my attention.

Health Insurers Caught Paying Facebook Gamers Virtual Currency To Oppose Reform Bill

Am pasting the article below, but credit goes to the authors from the link above:

Health insurance industry trade groups opposed to President Obama's health care reform bill are paying Facebook users fake money -- called "virtual currency" -- to send letters to Congress protesting the bill.

Here's how it's happening:

Facebook users play a social game, like "FarmVille" or "Friends For Sale." They get addicted to it. Eager to accelerate their progress inside the game, the gamers buy "virtual goods" such as a machine gun for "Mafia Wars." But these gamers don't buy these virtual goods with real money. They use virtual currency.

The gamers get virtual currency three ways:

• Winning it playing the games
• Paying for it with real money
• By accepting offers from third-parties -- usually companies like online movie rentals service Netflix -- who agree to give the gamer virtual currency so long as that gamer agrees to try a product or service. This is done through an "offers" provider -- a middleman that brings the companies like Netflix, the Facebook gamemakers, and the Facebook gamemaker's users together.

It's this third method that an anti-reform group called "Get Health Reform Right" is using to pay gamers virtual currency for their support.

Instead of asking the gamers to try a product the way Netflix would, "Get Health Reform Right" requires gamers to take a survey, which, upon completion, automatically sends the following email to their Congressional Rep:

"I am concerned a new government plan could cause me to lose the employer coverage I have today. More government bureaucracy will only create more problems, not solve the ones we have."

OMGPOP CEO Dan Porter spotted the survey and took a screenshot for us. (Click on the image at the right to expand it.)

What is this practice called?

Paying people to act like political supporters is called "astroturfing," because its fake grass-roots campaigning. So maybe this should be called Virtual astroturfing. Virtual-turfing? Astroturfing 2.0?

Who are the people behind this?

Get Health Reform Right describes itself as a "project of organizations whose shared mission is to ensure consumers continue to have access to employer-sponsored healthcare plans."

We are concerned about federal legislation that would create new government bureaucracies that would unravel the workplace healthcare system where more than 160 million people get their coverage.

Under the "Who We Are" tab on GetHealthReformRight.org, the following organizations are listed:

• Association of Health Insurance Advisors
• America’s Health Insurance Plans
• American Benefits Council
• BlueCross BlueShield Association
• Council of Insurance Agents & Brokers
• Healthcare Leadership Council
• Independent Insurance Agents & Brokers
• National Association of Health Underwriters
• National Association of Insurance and Financial Advisors
• National Retail Association

Who are the gamers filling out the survey and sending emails to Congress?

Facebook gamers tend to fall into two groups: women in their 30s and 40s and teenagers of both sexes.

Is this legal?

Astroturfing, which involves real money, is not illegal, We can't imagine virtual curreny astroturfing would be illegal either. Whether or not it's ethical is a different question.

Who is profiting from this?

According to OMGPOP CEO Dan Porter, the middleman facilitating this transaction in multiple Facebook games is called Gambit. Up until a few weeks ago, these games included big hits like Zynga's Mafia Wars and FarmVille. Zynga has since removed all offers from its games. On its Web site, Gambit says its clients include:

• #1 MySpace Developer
• 20%+ of top 10 Facebook applications
• SmallWorlds.com
• School Vandals
• Foopets.com
• 2 Top 100 websites
• ...and over 150+ more

One important thing to remember:

Gambit is just the platform here, bringing three parties together: gamers seeking currency, game-makers seeking monetization, and companies (and, apparently lobbying groups) looking for customers.

OMGPOP CEO Dan Porter tells us it's most likely the case that Get Health Care Reform agreed to pay an ad agency for every letter-writer it recruited. Dan supposes it was this third-party that bundled the above survey with several others and submitted it into Gambit's offer network.

Update: We reached out to Gambit CEO Noah Kagan for clarification. He told us:

"It's not that Dan is wrong. But we don't run hot political issues. You don't have any evidence that this is from Gambit. We don't condone this in our system. Sometimes stuff does happen, but we've been very proactive in making sure that there's not negative offers in our system."

To this, Dan replied:

"My point all along had little to do with the Gambit platform. We are testing it in house and will deploy it and it has controls for how conservative a partner wants to be. I wouldn't use them if I didn't think it would provide value for our users in a safe way. Gambit and every other offers company simply bundle in offers from outside vendors. The primary distributers of this fake activism are companies you will never know, like webclients.net doing business under eltpath.com. [They] distribute this stuff to sources all over the web from from freecomputer4u to sweepstakes promotions to offer providers."

The response from Get Health Care Reform:

We've also contacted Get Health Care Reform using an email address listed on their Web site. We received the following message back:

Google tried to deliver your message, but it was rejected by the recipient domain. We recommend contacting the other email provider for further information about the cause of this error. The error that the other server returned was: 553 553 sorry, that domain isn't in my list of allowed rcpthosts (#5.7.1) (state 14).

How the Senate bill would contain the cost of health care : The New Yorker

Gawande has a new article out on the health care bill

How the Senate bill would contain the cost of health care : The New Yorker

Dr. Gawande writes:

Turn to Page 621 of the Senate version, the section entitled “Transforming the Health Care Delivery System,” and start reading. Does the bill end medicine’s destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is … pilot programs. … Where we crave sweeping transformation, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here’s the interesting thing—history suggests otherwise.

Gawande draws parallels to the history of American agriculture when the country slowly updated farming practices through a series of government-guided pilot programs. He argues that the health care bill will achieve the same end result, even though there is no one big hammer to control costs, just a lot of little ones.

Pick up the Senate health-care bill — yes, all 2,074 pages — and leaf through it. Almost half of it is devoted to programs that would test various ways to curb costs and increase quality. The bill is a hodgepodge. And it should be.

There is a danger in drawing parallels to other industries - I know that as a consultant - it is one of our downfalls when we try to draw a line with only one data point - but seems like an interesting parallel. Agriculture was their health care - a major source of the economy that needed a major overhaul to keep America competitive.

Regardless, I'm continually impressed by Gawande's thinking and prose.

Getting the Facts Straight on Health Care Reform

Wow, just read an awesome article by an MIT economist Jonathan Gruber in the NEJM. Finally someone has provided a cogent, well researched, and passionate rebuttal to all of the scurrilous talk that's been flying around in Congress. I was feeling a little down about health care reform watching the news, but reading this article has made me believe again! We absolutely must pass something substantial this year, and Gruber has basically bashed every possible argument against reform.

Slightly random

This is not health care related. I saw this small article buried in the nytimes -

Darpa Puts On Contest to Find 10 Red Balloons Across U.S. - NYTimes.com

It reminded me of the Xprize that Kedar had posted a few months back about developing a health care system. DARPA - the military research unit - is putting up a $40k to see which group can identify the location of ten balloons on one day located throughout the country.

I don't get it. They say it's to learn about behavior of creative groups in collaborative situations. I think it takes its cue from the Netflix $1 million prize which was for a group that could improve the netflix movie suggestions software. When I read between the lines, however, it feels like you could replace the word "balloon" with "terrorist" and you get a sense of what the agency is trying to learn. But haven't we for ages posted reward signs for wanted criminals and relied on the public citizenry to assist the police and military in finding "red balloons" ? I don't get. What are they trying to get out of this experiment?

Sorry for the random non-health care post. Was just really curious to me.