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.


Wendell my simple thanks, for your grounded stand. If you would be so kind, I would appreciate if you would contact me and give me permission to email you my private newsletter to the community of practice I have launched called WeCare. I hope someday as you get to know me we can have a live conversation. http://aboutworkecology/ We travel in a similar trajectory woven by numerous of my mentors. I left health care as a leader very young, only to open my eyes to what care has become in this country as a mother, daughter, patient, neighbor, medical advisor, ecologist who was inspired most of my life by a father who was a community leader, spinal injured Veteran of WWII, who understood and taught me the meaning of sustainability as it relates to health and the economy. I need to have direct contact with more people like you ready and able to lead the change I see possible that is practical and not off the wall.

I am a health insurance agent in Utah. I sit on the board of the Utah health underwriters as webmaster for and I was heavily involved in designed a web connector to help Utah residents by pulling private and state sponsored insurance mechanisms together. It had a low budget of around $150k that virtually guaranteed health insurance coverage through either the private or state programs. Better yet all the local carriers agreed to split the costs. Our state insurance task force committee rejected the idea. They elected to go for a Massachusetts type connector program that isn't working well when you actually dig deep and check facts of where they are now. Our state approved H.B. 188 with a zero fiscal note attachment! My point is, I have been a fly on the wall in countless legislative meetings, insurance board meetings, hospital board meetings, the list goes on. The problem is conflict with the market demanding profit in all sectors of the system. Tough order to fill and keep costs down? You are absolutely right when you claim that healthcare is now unsustainable. I have been crying that a long time. Nobody listens.

I worked for Wendell for seven years as a regional PR director. He was a great boss and I want to echo many of his comments. In California, where I worked, the industry spent millions of dollars in 1994 to defeat two single-payer health initiatives. One of the campaign directors who ran the HMOs campaign was Frank Shubert, who later went on to run the "Yes on Proposition 8" campaign in November 2008. If those same single-payer propositions were on the ballot today, I bet they would pass overwhelmingly.

It takes courage to do what Mr. Potter is doing. Not magic, not wizardry, but courage. We should all share and learn in the lesson he is bringing all of us! The corruption in this industry should not shock us. It should not make us recoil in horror. This is us, this is America, and the lubricant that makes it all work is money. Enormous, enormous amounts of it. It makes the healthcare world go round, and it brings the healthcare world crashing down! Let us shine all the light on this industry. It is our money, after all! The money for the healthcare industry is perhaps mainly spent in the private sector, but the clients, the millions and millions of healthcare clients in America, constitute a very large part of the mainstream American public. The mainstream American public, widely known as the middle class, is being royally screwed. And as goes the American middle class, so goes America. Screwed. As Melissa sings so well, "I need to wake up!" Wake up, America, it is time to wake up! They are here! They want it all, and they will take no prisoners! As the famous French revolutionary song, La Marseilleise, so eloquently calls out to its citizens, "Allons enfants de la patrie!" (Children of the nation, march!). We must stand against these thieves, these corruptors! We must stand together, and rebuild our torn and embattled nation! Since the time of Franklin Delano Roosevelt, the private sector corporate interests have toiled tirelessly to regain and maintain their supremacy in society through profit. They have sought to crush the power of the people. The power of the people was warned by the founding fathers against the large monied interests of privilege and power. Wherever people came together against these interests to form cooperatives, community and union halls from which they would take power over and for themselves, the corporate interests were ruthless and tireless in attacking and destroying these institutions of the people. The corporate interests have never slept in their incessant quest for more. More profits, more power, more influence, leading to more profits, more power... Insatiable power and greed lust. Heady stuff. Mr. Potter's liberation from that should be a celebration. We should wish that all Americans will one day be liberated from the clutches of these insatiable profit-seeking, destructive corporate interests, which are not truly interested in healthcare, as much as they are driven by the incessant demand for more and greater profits. It is no longer any fun to work in the healthcare field. The whole things has become monstrous! We need Universal Medicare. Now.

As a former employee of CIGNA, though far from an executive level capacity, I always felt that insurance companies have been ripping us off for years. It may have paid my bills for 6-1/2 years, but the basic principals under which they operated just seemed wrong. The talking-heads are telling us that having "choices" of which insurance company we're going to buy our mandatory coverage from will bring prices down because of "competition", but car insurance never went down when states passed mandatory coverage. Why should we ever believe that the cost of health care will come down as long as insurance companies have control? Maybe after they fix health insurance, Congress could pass a similar national car insurance system.

A couple of decades ago, the Michigan originators of the true "no fault" insurance proposed pay at the pump system. It would be a splendid way of encouraging fuel frugality without the impact that taxing would have. Since insurance has to be paid for, the use of pay at the pump would provide incentive for minimizing wasteful fuel consumption. Moreover, pay at the pump would see to it that unlicensed drivers and illegal immigrants were paying towards insurance.

So health insurers are terrible people. This is new? And how does this justify national healthcare? You noted that lawmakers will do everything they can to discredit you, the same lawmakers that work for the government you want to take care of our health. So the government is corrupt but not when it comes to health care? Further, crying socialism isn't a scare tactic just because some suits have caught onto the socialism scare and are trying to exploit it. There is nothing wrong with wanting to provide health care for all. But forcing everyone to pay for it is criminal and it is socialism--spreading the wealth when it's not yours to spend. If you want to spread the wealth, fine. Leave me out of it. Please, don't tell me I ought to support something I fundamentally disagree with because you feel bad. Respectfully sir, that seems to be your problem. Instead of thinking, you feel. You felt good about taking that money until you felt bad. I appreciate your insight and think it is valuable, but I don't wish it to be used to dismantle the system we currently have. The government can't take care of anything, speaking as a military wife who had this so-called great government health care that everyone raves about. They screwed up our paychecks, screwed up all our moves (because the government only cares about the lowest bidder and hence low quality ), messed up reimbursements and just about anything you can think of.