By Wendell Potter on September 15, 2009

September 14th I addressed a gathering at the Center for American Progress in Washington, DC and delivered these remarks:

It is easy to think of efforts to influence lawmakers as the exclusive domain of K Street lobbyists. Much has been said and written about the millions of dollars the special interests are spending on lobbying activities and the hundreds of lobbyists who are at work as we speak trying to shape health care reform legislation. Very little by comparison has been written about the millions of dollars that special interests are spending on PR activities to accomplish the same goal and that are vital to successful lobbying efforts.

One of the reasons I left my job at CIGNA, where I headed corporate communications and was part of the Legal & Public Affairs division, was because I did not want to be involved in yet another PR and lobbying campaign to kill or gut reform. I finally came to question the ethics of what I had done and been a part of for nearly two decades to influence decision-making and bill writing on Capitol Hill.

When I testified before the Senate Commerce Committee in late June, I told the senators how the industry has conducted duplicitous and well-financed PR and lobbying campaigns every time Congress has tried to reform our health care system, and how its current behind-scenes-efforts may well shape reform in a way that benefits Wall Street far more than average Americans. I noted that, just as they did 15 years ago when the insurance industry led the effort to kill the Clinton reform plan, it is using shills and front groups to spread lies and disinformation to scare Americans away from the very reform that would benefit them most. The industry, despite its public assurances to be good-faith partners with the President and Congress, has been at work for years laying the groundwork for devious and often sinister campaigns to manipulate public opinion.

The industry goes to great lengths to keep its involvement in these campaigns hidden from public view. I know from having served on numerous trade group committees and industry-funded front groups, however, that industry leaders are always full partners in developing strategies to derail any reform that might interfere with insurers' ability to increase profits. My involvement in these groups goes back to the early '90s when insurers joined with other special interests to finance the activities of the Healthcare Leadership Council, which led a coordinated effort to scare Americans and members of Congress away from the Clinton plan.

A few years after that victory, the insurers formed a front group called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights. While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion's share of its funding and guidance from the big insurance companies and their trade associations.

Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington's biggest PR firms. The PR firm provided all the staff work for the Coalition while an executive with the NFIB, which has long been a close ally of the insurance industry, served as a front man.

One of the key strategies of the Health Benefits Coalition as it was gearing up for battle in late 1998 was to stir up support among conservative talk radio and other media. Among the tactics the PR firm implemented for the Coalition was to form alliances with important conservative groups, such as the Christian Coalition and the Family Research Council, to get them to send letters to Congress or appear at HBC press conferences. The Health Benefits Coalition also launched an advertising campaign in conservative media outlets. The message was that President Clinton owed a debt to the liberal base of the "Democrat" Party and would try to pay back that debt by advancing the type of big government agenda on health care that he failed to get in 1994. The tactics worked. Industry allies in Congress made sure the Patients' Bill of Rights would not become law.

The insurance industry has funded several other front groups since then whenever the industry was under attack. It formed the Coalition for Affordable Quality Healthcare to try to improve the image of managed care in response to a constant stream of negative stories that appeared in the media in the late '90s and the first years of this decade. It funded another group with a different name about the same time when lawyers began filing class action lawsuits on behalf of doctors and patients. Like the Health Benefits Coalition, this one, called America's Health Insurers, was created by and run out of a powerful Washington-based PR firm.

The insurance industry called on that same firm again in 2007 to help blunt the impact of Michael Moore's movie, Sicko. The PR firm created and staffed a front group called Health Care America specifically to discredit Moore and to demonize the health care systems featured in the movie. The media contact for Health Care America was a vice president at the firm who had served previously in PR roles at the Blue Cross Blue Shield Association and in the Bush administration.

The PR firm also activated conservative allies and enlisted the support of conservative talk show hosts, writers and editorial page editors to warn against a "government-takeover" of the U.S. care system. That is a term the industry uses often to scare people away from any additional involvement of the government in health care. Health Care America also placed ads in newspapers. One such ad, which appeared in Capitol Hill newspapers, carried this message, "In America, you wait in line to see a movie. In government-run health care systems, you wait to see a doctor."

The PR firm's work on behalf of the industry included feeding talking points to conservatives in the media and in Congress and placing columns and op-eds written for the industry's friends in conservative and free-market think tanks like the American Enterprise Institute, Heritage, CATO, the Manhattan Institute and the Galen Institute.

With this history, you can rest assured that the insurance industry is up to the same dirty tricks, using the same devious PR practices it has used for many years, to kill reform this year, or even better, to shape it so that it benefits insurance companies and their Wall Street investors far more than average Americans.

The creation and funding of front groups and the use of shills on Capitol Hill and in the media are not the only tactics PR people use to support and enhance lobbying efforts. Other activities include, of course, the implementation of grassroots and grass-tops campaigns. But a much more subtle tactic is to provide supposedly accurate and objective information to "educate" members of Congress and their staffs.

Business Week recently described how health insurers, United Health Group in particular, have been hard at work behind the scenes providing a treasure trove of data to key senators. If lawmakers believe the information and date the insurers are feeding them is comprehensive and objective, they are mistaken. Corporate representatives, especially the PR people who work with the media and who write talking points, are masters at the selective use of data and disclosing only the information their employers want to be disclosed.

What does this all mean for our country and our democracy?

During my 20 years in corporate communications and public affairs, I participated in the steady growth and influence of largely invisible persuasion -- and at a time when newsrooms are shrinking and investigative journalism seems to be vanishing. The number of PR people long ago surpassed the number of working journalists in this country. And that ratio of PR people to reporters will continue to grow. The clear winners as this shift occurs are big, rich corporations and other special interests. The losers are average Americans, most of whom are completely unaware how their thoughts and actions are being manipulated to achieve corporate goals on Capitol Hill.


Wendell Potter is the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin.

Wendell Potter

Wendell Potter is CMD's honorary Senior Fellow on Health Care (since May 2009). He writes a regular column for the Center for Public Integrity.

Comments

Dear Mr. Potter,

I congratulate you on stepping away from the insurance business, finding your true voice, and sharing your knowledge with the American people. I too worked for the insurance industry for several years and left to save my mind and soul. To the extent you need me to vouch for you, I heartly attest that your testimony is accurate and your message is essential.

After leaving the business, I became a lawyer and had the honor of representing an insured who's policy was recinded after she was diagnosed with cancer. On cue, upon receiving a claim, the company ordered medical records for the singular purpose of searching for any possible "misrepresention" in the insureds application. They rescinded the policy, finding that the insured had failed to report that a doctor had once given her a sample antacid (which appeared in the medical records). The insured argued that she did not know she was supposed to report the free antacid. on the application (Notably, the application language is incomprehensible, even to a lawyer, and during depositions of claims personnel, none could agree on the meaning of any application terminology). The insured argued that she and her husband had filled out the application to the best of their ability. Before she died (and left her husband bankrupt with medical bills) the insured said about the application process: "If they had wanted medical records, why didn't they just ask?" If they declined to underwrite us, we would have looked elsewhere for coverage. Now its too late." In my opinion, the rescission violated nearly every basic principle of contract law. Unfortunately, the judge (elected via campaign contributions from you know who) upheld the rescission.

Though you speak eloquently, Mr. Potter, I would like to add my own less-eloquent 2 cents that may help people understand the insurance industry:

At its core, the insurance industry is essentially a Mob that sells "protection" and runs a booky-joint operation. The insureds pay premium in advance--essentially betting they will get health care; the insurer accepts the bet (taking and investing this cash to make the real money! remember AIG?)--essentially betting the insureds will not get health care. Non-negotiable insurance application and policy language is carefully drafted to better the odds that the insured will not get health care. (Even when the company has to use "rescission" to win, it still makes investment profit on the premium dollars fronted by the insureds). Concurrently, the insurers monopolize the health care industry, and buy shills of every sort and throughout every sphere, to back up their bets (all paid for with your premium dollars and their investment returns on your dollars). The insurance industry functions the same way in other lines of business, whether it insures your home, car, business, life, etc.

The mere fact that they can function "legally" is a testament to their power.

Thank you, Shoshana. Your analogy of the Insurance industry to the mob makes it an "easy to grasp" concept for those of us who aren't in the industry.

Mr. Potter, thank you for all that you are doing to enlighten the common person about the insurance industry and their dirty little practices. I sincerely hope that enough people in Congress are heeding your words so that the right kind of reform can be attained. Unfortunately, I weep for my fellow citizens who rail against "death panels" and "socialism" and "government take-over". They have no idea that they're railing against their own best interests.

How do you fix "stupid"?

Again, thanks for fighting the good fight!

Mr. Potter,

Thank you for what you've done and what you are doing. Please run for office. We need people like you in office.

John L. Myers IV

Houston, Texas
johnlmyers4th@gmail.com

Having also worked in communications in the healthcare industry, I am aware of the clever games that are played by various players to spin their position and influence policy makers and public opinion. However, insurance companies are not the only players with a stake in this game, and they are certainly not the only group guilty of manipulating information to favor their position. It seems to me that all of the special interests - from doctors and hospitals to insurers to pharmaceutical companies and device manufacturers to lawyers to employers and unions - are all fighting to exert the greatest influence on our elected officials, and we the people are the ultimate losers. You can bet that we will pay handsomely for whatever "solution" is ultimately implemented, with little regard to the actual value of the benefit provided.

if we didn't have you, Wendell, we'd have no dogged undeniably true voice to speak out. Whew, I'm grateful.

For decades I've been drumming on the "casino for suits" phrase describing Wall Street, but recently saw the phrase "Casino Capitalism" -- a very handy formulation of The Big Enemy which is the metastasizing amok casino capitalism which is devouring what shreds of soul the nation has left. It sucks all the oxygen out of the beloved-community movement which has yet to comprehend casino capitalism's uber-ruthlessness. Indeed, what sane mind could?

They can defeat all kind, wise efforts with a single word (socialism) -- we must get the max-three words to fight back. You give us the true info -- among us we need to come up with a few silver-bullet phrases to fight back against the silver forked-tongued giga-greedy like Aetna's Ron Williams & United Wealthcare's Hemsley and their legions of invisible orcs-in-suits bent upon Burning the Shire.

Dear Mr Potter,

Thank you very much for all you have done to expose the truth about the insurance industry.

I have an approach to health care reform that liberals and conservatives alike have a hard time arguing against. Please consider promoting it as a compromise in health care reform that will bring all Americans together to the fight to bring big insurance to it's knees....

I am self employed and buy my own insurance. I have found that it is FAR more economical to buy a catastrophic only plan and pay for most of my medical expenses out of pocket.

Most people do not see the disaster our health care system is in because they are basically "given" fancy comprehensive plans from their employer. Then they are completely out the loop as to who gets paid for what. There is NO FREE MARKET IN HEALTH CARE and that is what is driving up costs.

We all NEED insurance for the rare times in our lives when our medical bills exceed what we can reasonably afford. We do NOT need insurance to take as much as 5X the going rate for our otherwise affordable health care so that they can turn around and control which doctors we can see, which procedures we can have, and have the ultimate power to deny coverage!

Too many people are dying or going bankrupt because they don't have access to affordable health care. WE NEED REFORM that will bring health care costs down and make health care affordable to EVERYONE. We need it NOW!

Consider this as a simple and immediate approach to health care reform:

- Set up a government financial aid program that protects all Americans in the rare event that their medical costs become more than 10% of their family's annual income. (catastrophic health insurance for all) This would protect EVERY ONE of US from facing bankruptcy in the event of a medical crisis and break our DEPENDENCE on our current insurance plan.

- Require employers to allow their current employees to opt out of their company insurance plan and receive their premiums (average $1000/mo per family) in the form of a salary increase or tax-free medical savings account (transferable to a retirement plan). This would give money back to the people to make their own health care choices.

This plan would:

- SAVE most families thousands of dollars a year.

- Give people the freedom to choose an employer, change jobs, or start their own business without concern for health insurance.

- Bring DOWN the cost of health care because people would be paying attention to their medical bills, shopping around, and demanding quality care at a reasonable cost.

- People could shop around *IF* they CHOOSE to purchase a health maintenance plan. This would bring down the costs.

- Save a ton of paperwork in medical billing and pre-authorization forms.

- Give the American people more FREEDOM then they have ever had in making their own health care decisions.

This makes too much sense! And it would appeal to those who are truly fiscal conservatives, not just ideologues.

Keep talking!

If we didn't have you, Wendell, we'd have no dogged undeniably true voice to speak out. Whew, I'm grateful.

For decades I've been drumming on the "casino for suits" phrase describing Wall Street, but recently saw the phrase "Casino Capitalism" -- a very handy formulation of The Big Enemy which is the metastasizing amok casino capitalism which is devouring what shreds of soul the nation has left. It sucks all the oxygen out of the beloved-community movement for a sturdy, decent public option. Our naiver beloved-community has yet to comprehend casino capitalism's uber-ruthlessness. Indeed, what sane mind could?

They can defeat all kind, wise efforts with a single word (socialism) -- we must get the max-three words to fight back. You give us the true info -- among us we need to come up with a few silver-bullet phrases to fight back against the silver forked-tongued giga-greedy like Aetna's Ron Williams & United Wealthcare's Hemsley and their legions of invisible orcs-in-suits bent upon Burning the Shire.

Thank you for writing this article. It is easy to understand and does a great job of showing how the public and law makers are being"invisibly" manipulated in a way that further enhances corporate profits at the consumer's expense, once again.

We desperately need a public option for health care. If this doesn't happen the public will be worse off than ever. Forcing people to get insurance will be a bonanza for the insurers. In Alabama 90 percent of employer based health care is provided through Blue Cross. Just think what Blue Cross stands to make if even half of those without health coverage are forced to get coverage without a public oprion.

Baucus' plan is unacceptable. Americans need to wake up. The biggest threat to the well-being of americans in this country is not so much big government as it is big business. Someone has to curtail the greed-motivated efforts of big business. I hope we can make some headway on this with health care legislation.

Thanks again for the article, your personal convictions, and the stand you have taken. I'm sure it's not been an easy switch for you.

This guy is killing the health care debate with independents every time he speaks. He looks and sounds like a MSNBC robot, parroting back everything they say. If he was a VP of Communications, then he must have had pictures of someone, what a joke. He comes across as a bitter ex-insurance industry guy who is trying to get back at the people who laughed at him behind his back...we need a real industry spokes person, not a Dick Morris has been.

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