Wendell Potter to Congress: Go Ahead, Please Make Our Day

Politico is reporting that Congressional Republicans want to force their colleagues in the House and Senate who vote for a public insurance option as part of health care reform to enroll in that public plan when it becomes available.

I think Democrats ought to call their bluff and pledge to be the first to sign up. If they do, they will have to shove me out of line. I would love to have the option of enrolling in a public plan that offers a decent standard benefit package at a more affordable price. I am sick and tired of knowing that only 80 cents of every dollar I pay in premiums to my private insurer goes to pay doctors and hospitals for care they provide. (This figure is down from 95 cents in 1993 before the industry came to be dominated by a cartel of high for-profit insurance companies like the two I used to work for.) I am eager not to have to donate 20 cents of every premium dollar to cover my insurer's sales, marketing and underwriting expenses and to help make the CEO and the big institutional investors and Wall Street hedge fund managers even more obscenely rich than they already are, thanks to the inflated premiums we have to pay.

Here's what Politico reported:

Rep. John Fleming (R-La.), a family physician, kicked off the quixotic bid last week, urging House members to give up their right to participate in the much-revered Federal Employees Health Benefits Program if they support a government-run program as part of the health care reform package.

Sens. John McCain of Arizona and Tom Coburn of Oklahoma are pushing the same concept in the Senate, preparing separate amendments that would require members -- and maybe even their staffs -- to sign up for the public option. With Democrats firmly in control of Congress, the idea is not likely to gain traction. Proponents of the public plan say the resolution would do exactly what Republicans have warned against, undermining the private insurance system by moving people into a public plan.

But the effort has caught fire in the right-wing blogosphere and on talk radio, serving as a rallying point for conservatives opposed to one of the top priorities of Democrats... Newt Gingrich's Center for Health Transformation is promoting Fleming's resolution on its website and started an online petition titled "Good Enough for Congress."

After Democrats call their bluff, I would counter with this: Every member of Congress who votes against the public insurance option must enroll in one of the high-deductible plans like the one that CIGNA forced me into a few years ago, against my wishes. (I am a former CIGNA employee, so CIGNA was both my employer and my insurance company.)

Opponents of health care reform raise the specter of the government forcing us out of health care plans that we like. In reality, our employers and insurers are doing this to us already. While employed at CIGNA, I was in a PPO that I liked, until the company decided a few years ago to force all if its employees out of their HMOs and PPOs and Point of Service plans and into what the industry refers to, misleadingly and euphemistically, as "consumer-driven" plans. It was a take-it-or-leave-it deal. If I didn't want to enroll in the high-deductible plan that CIGNA offered, I could join the growing ranks of the uninsured or try to get coverage through the individual market. That wasn't really an option. I was in my 50s and could not find a decent plan that I could afford, because insurers are free to gouge us when we reach a certain age.

In a high-deductible plan, enrollees have to spend a lot more money out of their own pockets before their insurance coverage kicks in than they had to spend in their HMOs and PPOs. These plans are fine for people who are young, healthy, and not accident-prone. and wealthy. It also helps to have a better-than-average income. In other words, a high-deductible plan might be exactly what you're looking for if you don't really need decent insurance now and can afford to shell out thousands of dollars of your own money in the event you get hit by a bus. The rest of us, however, might want to steer clear of this sort of plan -- if we had the choice.

More and more companies are doing what CIGNA did -- forcing their employees out of the plans they like and into plans they don't. Another big insurer, United Healthcare, did the same thing to its employees a few years ago. If it hasn't happened to you yet, just wait. Insurers are eager to send HMOs and PPOs to the ash heap of insurance history, which is where they sent traditional indemnity plans several years ago.

On second thought, it might be good to give members of Congress who vote against a public insurance option the choice of enrolling in one of the limited-benefit plans being promoted these days by insurers -- including the huge for-profit insurance companies that now dominate the industry. The premiums for these plans are a little lower than plans that offer comprehensive coverage, but they often don't cover things most of us have grown to expect. Little things like hospitalization. Such a deal.

Now you see why the insurance industry insists on being able to charge older folks a lot more for coverage than younger folks and why it is insisting on "benefit design flexibility." They want to have the flexibility to "design" and force us into plans that cover less and less and cost us more and more. That, readers, is what your private insurance company has in store for you if Congress fails to pass meaningful health care reform legislation.

By the way, insurers including CIGNA are now also marketing these limited-benefit, high-deductible plans as "voluntary." This means that your employer would allow you to enroll in these type of plans at the workplace but make you pay the entire amount of the premium. That's right, employers in the future will not have to contribute one thin dime toward your coverage. Future, heck, many are already there. A growing number of employers are already "offering" these plans to their employees. CIGNA offers such coverage under the brand name Starbridge, which "enables companies to offer a limited-benefit plan that is affordable and does not require employer contribution." The underwriting guidelines for Starbridge make it available only to employers who have at least 70 percent annual employee turnover and who have fewer than 65 percent female employees. Also, the average age of the workforce has to be 40 or younger. You're right if you think the profit margins on these plans are high. How could they not be? Cha-ching!

I encourage every member of Congress, Republicans as well as Democrats, to do a little research into what Big Insurance has in store for us before voting on legislation this summer or fall.

This is why I left my job and why I am speaking out.

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


Wendell, I just wanted to thank you for your courage on speaking out. You have so many people backing you. Keep up the good job.

I am currently with a staffing company as my employer. The only plan available to me, if I am working, is a limited benefit plan. I don't even bother. Partly because my work is so sporadic, and partly because it really doesn't cover anything. I have spent most of my adult life without insurance and most likely will continue to do so until I qualify for Medicare, assuming it is still there when I retire. I have not seen a dentist since I fell off my father's insurance as an 18 year old. I pay for my vision care out of my pocket. Thank God I am healthy and have decent genetics and have not yet run into a major problem. If I were to be diagnosed with cancer or a severe chronic health condition, most likely I would die; since I refuse to go run up medical bills that I would never be able to pay.

Mr. Potter, You, as a former member of CIGNA's communications team, should know that the case of the 17 year-old girl in California was an ASO. This means that CIGNA denied her coverage because her parents' employer did not choose to cover it with their self-funded insurance plan. As for the voluntary plans, you should also know, that the employers that choose to offer them when they have not offered insurance, in any form, to their employees. They tend to be very low-wage workers, but not low enough to qualify for Medicaid. These plans are a huge benefit to the workers who are able to enroll in them. Finally, high-deductible, HSA eligible plans are only "bad" if you are a person who wants every test for every little thing that goes wrong. I'm sorry that someone tried to get you to take control of your own health. I'm guessing you're a 50 year old man who has high-cholesterol, high blood pressure, and hasn't seen a gym in years.

A sporadic employer who makes glorified-temps pay for their own bare-bones insurance isn't doing anyone any favors, good intentions aside. That temp could end up in a commuter accident while rushing from one to the second job probably required to survive, or heading to/from a gym for that matter. That low-wage temp will never be able to save for a catastrophic accident or illness. You, my dear gym-subscriber, will pay for that accident or illness eventually. The insurance magnates will get rich covering pretty much nothing. A gym will not protect you from cancer, from accidents, from genetic predisposition to heart attacks, or from an aneurism. As I recall, the father of the jogging movement died of a heart attack - while jogging. If he'd survived, he'd have needed full coverage. The best solution right now is to make low-wage workers eligible for Medicaid, which covers everything regardless of preexisting conditions - which, btw, the man who spent 15 yrs in Cigna knows full well insurers always manage to find. Latest one I heard of: a woman's adult daughter got denied insurance for seeing a doctor twice for "knee problems" as a teen. No surgeries, no chronic problems. Her knees probably hurt from playing basketball or soccer or jogging - nice, healthy pastime. Good grief.

First of all I have the courage to state my name. I have CIGNA as my health insurance and my 4 year old daughter has a tracking problem with her eyes. Tracking as in they don't track at the same time or what other children tease and say "monster eyes". We've had surgery when she was 2 to help fix them, however, she goes to a specialist every 3 months to see if they are improving and if she needs another surgery. CIGNA will NOT pay for most of the bill because they say it's refraction and they only pay for refractions one time of the year, you know like when you have your yearly eye exam. CIGNA doesn't call it MEDICAL because it's a refraction examination even though her condition is MEDICAL and the REFRACTION is NEEDED for this medical condition. They are by far the worse insurance company I've ever had. So before you get too righteous, my daughter has done NOTHING WRONG other than be born with an eye defect, and if I knew who to contact to spread this all across America I would do just that. Does anyone have any information so I could help get the word out about what these insurance companies are doing to people? Thank you,

In response to the person (no name) who tried to blame an employer for killing a 17 year old girl by refusing to cover a liver transplant...My sister is an HR person. She has a bachelor degree in Human Resources and several years experience. When complaining to her about my own experience with Humana--my cholesterol tests were being denied as interchangebly medically unnecessary and experimental, she advised me that my HR department should have selected the test for coverage. What? She explained that she picks out what is covered under her company's health plan offered to their employees. She decides. My sister's medical degree, well, she doesn't have one. My sister's experience in the medical field, a doctor's office, any medical institution at all? None. It's shameful to put people in situations where they have to choose based on cost to cover medical services-it's an impossible choice. And yet this choice is being made everyday by insurance companies. A public option would hurt only the CEO paychecks, and stockholder portfolios. But the up side, people could have liver transplants covered, oh, and cholesterol tests too. Mr. Potter, please find a way to get President Obama's attention. Thank you so much for shining the light-I'll be standing right behind you in line to sign up for a public option.

"I am sick and tired of knowing that only 80 cents of every dollar I pay in premiums to my private insurer goes to pay doctors and hospitals for care they provide. (This figure is down from 95 cents in 1993 before the industry came to be dominated by a cartel of hugh for-profit insurance companies like the two I used to work for.)" -------------------- It is estimated that social services dollars spent by the government, 25% of the spending reaches the intended recipient. This will end well! -------------------- Government is paying for 50 percent of the health care right now in our country. We will make it better by government paying for 90% of health care. I like this logic!

If you don't get the logic, let me give you a little help here. "Government" is your money, taxpayers money. It's all your money, whether it comes from your taxes or your individual pocket. So it's your money that pays for health care, however you look at it. The difference is that if you demand that "government" (you, directly) pay for health care, as the Brits, Canadians, Taiwanese, French, Japanese, etc. etc. etc., do, you won't be paying 20 cents (actually, Wendell, I am sure you know that it is often up to 50) out of each dollar to push paper around to divide people up into pools, plans, marketing, etc. to make sure that they never enroll those annoying and unprofitable sick people. And the high CEO salaries that Wendell used to have. Ah! And also those extraordinary prices we pay to Big Pharma because we lack the collective purchasing power that patients in other countries have. And that is for starters some of the things that you get when you "pool risks" through a fully publicly financed system (for medically necessary services, I have no problem allowing insurers to make money from somebody's unhappiness with their nose that leads them to a cosmetic surgeon). That much better use of your money is what you get once you give up on the myth that comparative shopping for health care policies is no different from comparative shopping for laptops, or designer shoes. Okay, okay, not that simple. I agree that to make a full case you need more details. So here they go: http://blogs.kqed.org/healthyideas/2009/05/20/the-elephant-in-the-room/ But believe me, the last thing we need is yet another garden variety of a "uniquely American solution". So I must disagree with Wendell that a public option will get us anywhere. After all the horrible things we've always suspected or known about for profit insurers (and that Wendell so courageously has confirmed), why would anybody want them to be in charge of our health care at all? Why not just have Medicare for All?

Jimmy, "social services" includes sheltering abused or neglected kids, qualifying for and disbursing childcare and housing and transportation vouchers and food stamps, vocational training, tracking deadbeat parents usually dads, etc. The valid comparison is one you either haven't heard about or choose to ignore: Medicare vs. private insurance, 95-97% of cost directly paid for actual medical services and products under Medicare, vs. 80% and the other 20% to profit and/or mismanagement under private insurance. There's also the issue of accountability. If your govt leaders run Medicare badly, raising your costs and reducing your access or worsening your outcomes, you can vote out the leaders. Can you honestly fire your private insurer and find competitors of equal price/access when you wish?