The Health Care Industry vs. Health Reform

Wendell PotterI'm the former insurance industry insider now speaking out about how big for-profit insurers have hijacked our health care system and turned it into a giant ATM for Wall Street investors, and how the industry is using its massive wealth and influence to determine what is (and is not) included in the health care reform legislation members of Congress are now writing.

Although by most measures I had a great career in the insurance industry (four years at Humana and nearly 15 at CIGNA), in recent years I had grown increasingly uncomfortable serving as one of the industry's top PR executives. In addition to my responsibilities at CIGNA, which included serving as the company's chief spokesman to the media on all corporate and financial matters, I also served on a lot of trade association committees and industry-financed coalitions, many of which were essentially front groups for insurers. So I was in a unique position to see not only how Wall Street analysts and investors influence decisions insurance company executives make but also how the industry has carried out behind-the-scenes PR and lobbying campaigns to kill or weaken any health care reform efforts that threatened insurers' profitability.

I also have seen how the industry's practices -- especially those of the for-profit insurers that are under constant pressure from Wall Street to meet their profit expectations -- have contributed to the tragedy of nearly 50 million people being uninsured as well as to the growing number of Americans who, because insurers now require them to pay thousands of dollars out of their own pockets before their coverage kicks in -- are underinsured. An estimated 25 million of us now fall into that category.

What I saw happening over the past few years was a steady movement away from the concept of insurance and toward "individual responsibility," a term used a lot by insurers and their ideological allies. This is playing out as a continuous shifting of the financial burden of health care costs away from insurers and employers and onto the backs of individuals. As a result, more and more sick people are not going to the doctor or picking up their prescriptions because of costs. If they are unfortunate enough to become seriously ill or injured, many people enrolled in these plans find themselves on the hook for such high medical bills that they are losing their homes to foreclosure or being forced into bankruptcy.

As an industry spokesman, I was expected to put a positive spin on this trend that the industry created and euphemistically refers to as "consumerism" and to promote so-called "consumer-driven" health plans. I ultimately reached the point of feeling like a huckster.

I thought I could live with being a well-paid huckster and hang in there a few more years until I could retire. I probably would have if I hadn't made a completely spur-of-the-moment decision a couple of years ago that changed the direction of my life. While visiting my folks in northeast Tennessee where I grew up, I read in the local paper about a health "expedition" being held that weekend a few miles up U.S. 23 in Wise, Va. Doctors, nurses and other medical professionals were volunteering their time to provide free medical care to people who lived in the area. What intrigued me most was that Remote Area Medical, a non-profit group whose original mission was to provide free care to people in remote villages in South America, was organizing the expedition. I decided to check it out.

That 50-mile stretch of U.S. 23, which twists through the mountains where thousands of men have made their living working in the coalmines, turned out to be my "road to Damascus."

Nothing could have prepared me for what I saw when I reached the Wise County Fairgrounds, where the expedition was being held. Hundreds of people had camped out all night in the parking lot to be assured of seeing a doctor or dentist when the gates opened. By the time I got there, long lines of people stretched from every animal stall and tent where the volunteers were treating patients.

That scene was so visually and emotionally stunning it was all I could do to hold back tears. How could it be that citizens of the richest nation in the world were being treated this way?

A couple of weeks later I was boarding a corporate jet to fly from Philadelphia to a meeting in Connecticut. When the flight attendant served my lunch on gold-rimmed china and gave me a gold-plated knife and fork to eat it with, I realized for the first time that someone's insurance premiums were paying for me to travel in such luxury. I also realized that one of the reasons those people in Wise County had to wait in long lines to be treated in animal stalls was because our Wall Street-driven health care system has created one of the most inequitable health care systems on the planet.

Although I quit my job last year, I did not make a final decision to speak out as a former insider until recently when it became clear to me that the insurance industry and its allies (often including drug and medical device makers, business groups and even the American Medical Association) were succeeding in shaping the current debate on health care reform. While the thought of speaking out had crossed my mind during the months leading up to the day I gave notice, I initially decided instead to hang out my shingle as a consultant to small businesses and nonprofit organizations.

I decided to take the shingle down, though, at least for a while, when I heard members of Congress reciting talking points like the ones I used to write to scare people away from real reform. I'll have more to say about that over the coming weeks and months, but, for now, remember this: whenever you hear a politician or pundit use the term "government-run health care" and warn that the creation of a public health insurance option that would compete with private insurers (or heaven forbid, a single-payer system like the one Canada has) will "lead us down the path to socialism," know that the original source of the sound bite most likely was some flack like I used to be.

Bottom line: I ultimately decided the stakes are too high for me to just sit on the sidelines and let the special interests win again. So I have joined forces with thousands of other Americans who are trying to persuade our lawmakers to listen to us for a change, not just to the insurance and drug company executives who are spending millions to shape reform to benefit them and the Wall Street hedge fund managers they are beholden to.

Take it from me, a former insider, who knows what really motivates those folks. You need to know where the hard-earned money you pay in health insurance premiums -- if you lucky enough to have coverage at all -- really goes.

I decided to speak out knowing that some people will not like what I have to say and will do all they can to discredit me. In anticipation of that, here are some facts:

  • I am not doing this because my former employer was pushing me out the door or because I had become a disgruntled employee. I had not been passed over for a promotion or anything like that. As I noted earlier, I had a financially rewarding career in the industry, and I'm very grateful for that. I had numerous promotions, raises, bonuses, stock options and stock grants over the years. When I left my last job, I was as close on the corporate ladder to the CEO as any PR person has ever climbed at the company. I reported to the general counsel, the company's top lawyer, whose boss is the chairman and CEO, a man I like and worked closely with over many years.
  • The decision to leave was entirely my own, and I left on good terms with everybody at the company. In fact, I agreed to postpone my last day at work by more than two months at the company's request. My coworkers gave me a terrific going-away party, and I received dozens of kind notes from people all across the country including friends at other companies and at America's Health Insurance Plans, the industry trade association.

I still consider all of them my friends. In fact, the thing I have missed most since I left is working as part of a team, even though I eventually came to the conclusion that I was playing for the wrong side. Being a consultant has its advantages, but I have missed the camaraderie. After a few months, I thought that maybe I should consider working for another company again. At one point, a former boss told me that another insurer had posted a PR job and encouraged me to contact a former CIGNA executive who worked there about it. Against my better judgment, I did, but I immediately decided not to pursue it. The last thing I wanted to do was to go from one big insurer to another one. What the hell was I thinking?

I'm writing this because, knowing how things work, I'm fully expecting insurers' PR firms to quietly feed friends of the industry (which include a roster of editorial writers and pundits, lawmakers and many others who fall under the broad category of "third-party advocates,") with anything they can think of to discredit me and what I say. This will go on behind the scenes because the insurers will want to preserve the image they are working so hard to cultivate -- as a group of kind and caring folks who think only of you and your health and are working hard as real partners to Congress and the White House to find "a uniquely American solution" to what ails our system.

I expect this because I have worked closely with the industry's PR firms over many years whenever the insurers were being threatened with bad publicity, litigation or legislation that might hinder profits.

One of the reasons I chose to become affiliated with the Center for Media and Democracy is because of the important work the organization does to expose often devious, dishonest and unethical PR practices that further the self interests of big corporations and special interest groups at the expense of the American people and the democratic principles this country was founded on.

After a long career in PR, I am looking forward to providing an insider's perspective as a senior fellow at CMD, and I am very grateful for the opportunity to speak out for the rights and dignity of ordinary people. The people of Wise County and every county deserve much better than to be left behind to suffer or die ahead of their time due to Wall Street's efforts to keep our government from ensuring that all Americans have real access to first-class health care.

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


I got my insurance premium down from 900 ish to around 300/ mo. With the new 10k deductible it covers practically nothing but it was all I can afford. Unless work improves, I may have to let it go. I love my country and this situation is just horrible.

After working 20 years in the industry and getting stock, stock options, pension, and other benefits--during that entire time not having any qualms about the work he did and the communications he led--Mr. Potter now suddenly finds himself aghast at the insurance industry practices. Too little too late Mr Potter

We can only judge that in retrospect. You know, by results. Bill Moyers was Lyndon Johnson's press secretary. Would you call everything he's accomplished since then too little, too late? (Assuming you're not a right-winger, of course.) Welcome, Wendell. :-)

Sorry, bad analogy - President Johnson was one of our greatest - Medicare, Medicaid, Civil Rights Act - all under his watch. President Obama should be so fortunate to match Johnson's record!

Bad analogy perhaps to civil rights, Medicare and Medicaid, but you've overlooked imperialism, militarism and war. Terrible enough in themselves, and in the long run they undermine everything good, as we're seeing played out right now.

Didn't it occur to you over the twenty years you spent raking in the big bucks that your message was corruption? Just because you didn't break any laws didn't it cross your mind that elderly, children and others were at risk because of your snake oil routine. You were that clueless? It's no wonder we are where we are. You have trained hundreds of others to take your place as health insurance lackeys. Somehow I have a hard time wondering if you are really on our side.

Hi Wendell, New (corporate) “officers” in CIGNA were flown in for a three day orientation at headquarters in Connecticut. We were given a short presentation on your work. CIGNA thought most highly of you and apologized for your being away lobbying and thus unable to address our class yourself. What I remember of that module was being told that we were expected to “tithe” 3-10% of our salary to the CIGNA lobbying group. The trainer explained it like a friendly grand-parent to a young child. This is how I remember it. You see if we can influence legislation to benefit our business then we make more money, and you do too - through our generous profit sharing program. Our lobbyists are skilled at providing and presenting reasons for our duly elected representatives to support legislation that we sometimes write ourselves. Last year we had $3,000,000 in the lobbying budget. There are only a handful of senators and congressmen that we have to get on our side to get our legislation passed. We had one representative who was against one of the pieces of legislation we wanted to pass. We asked some questions and with only a $10,000 check, written in a completely legal way, he changed his vote. Currently, we are working on influencing the legislature in Quebec, Canada to change the rules to open them up to the American style of health care. Our analysts have determined that once 15% of a population buys their own private health insurance the voters can be influenced to legislate the socialized system away. The reason the percentage is only fifteen percent is that those are the richest and most influential citizens. If you get that 15% to lead, then the herd will follow. Quebec is not that lucrative but once Quebec falls then Ontario will be open and that market is the size of Michigan! After I flew home, I realized that I felt like I was working for Darth Vader. Something else occurred that concerned me. Our Customer Service Representatives (CSRs) got bonuses (about 20% of their pay) for having better performance statistics in the current year as compared to the prior year. They were expected to deny more people the benefits that our subscribers expected year over year. The first year you may expect to deny benefits that our subscribers did not deserve. However, to have that same program year after year inevitably causes our CSRs to deny legitimate claims. When I raised this question it was suggested that I needed to pay more attention to being a “team player.” After only eight months I left CIGNA. Self respect is worth more than a big paycheck.

Well, sorry to disillusion you, guy, but I can tell you that up here in Canada the same type of sharks that are raiding your private insurance companies are a growing infection within the Canadian bureaucracies, giving themselves ludicrous bonuses and all. Because they control the system, no one can do anything about it, Like they say: It's virtually impossible to give sharks that sort of money and expect them to use it ethically.

I retired this month from a sales position with one of your former employers. I couldn't continue to do it anymore and sleep at night. You are brave - I thank you for your article and will send it to everyone I know.