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.


Yeh! Congratulations on your social enlightenment, because what else could account for your awakening from the societal brainwashing. You give me hope. Thank you.

It is sad that all of this misdirection leads to confusion and doesn't allow anyone to have a real debate on the true cost of health care. I applaud you for speaking out to try to make a difference.

I am saddened whenever I hear my good, although conservative friends describe changes to the system as socialism. I'm tempted to say "if that's socialism, then bring it on!", but I know this would only feed the fire. The employer-based system we have for healthcare was once a useful benefit. Now that health insurance is essential, it needs to be something that is not tied to your employer.

thats the problem, the dumb ass sheeple scream and whine about health care (socialism) but then the ppl like the lady above is too weak or uninformed to speak up. Fcuk those idiots, your closed mouth is what is letting them get away with spending over 60% of taxes on military and war profiteering, kickbacks and free rein to energy, telecom, big pharma and insurance companies and the entitlement mentality of US Health care providers. They make more $ than anywhere in the world, prices are highly inflated compared to elsewhere (esp drugs). Corporate takeover of govt is complete bcuz u sat there and "didnt want to start anything" allowing the propagandized sheeple to spit out the soundbites they heard on FOX. Liberals suck for exactly this reason. They think govt=more laws help things and are afraid to fight back against the massive disinfo provided by MSM. The middle class who have a little, want more...actually believe Obama is not the worst tyrant we have had, worst civil and constitutional rights record by far. His healthcare program is a giveaway to the interests above. I just got Medicaid thru it, all happy...then I found that very few (elitist) doctors will take it and I am still unable to receive quality health care! The only clinic that accepts has the WORST incompetent doctors and staff that barely understand English and truthfully all the patients are illegal immigrants when i've been there (and with their six kids)All ppl deserve health care but all this does is create a third tier of so-called "health care fopr the poor and working classes that cant afford. The richest country in the world has no public health care and spends 300% more than the nearest country in on miltarism and 20% more ppl in prisons doing slave labor than the nearest country caging largely political prisoners, or economic. Make doctors- all doctors- take a certain % of Medicaid patients and not have it plastered across the file so they know who is and who isnt too.If you arent angry, you need to wake up! If you have friends like this educate them or leave them to find like minded friends, its intellectual bullying-a prime sign of fascism. They are the enemy and you are too if you continue to "not speak up." Real friends would learn from each other, and be GOOD PPL that believe we should help ppl not kill and cage them.

Thank you, Mr Potter. The medical indemnity insurers also need a big spotlight shone on them, together with tort medical malpractice tort reform legislation and the required government and the law sector complicity to make institutional corruption flourish. Medical indemnity insurers are engaging in white collar crime, racketeering and the terrorising of malpractice injured patients. They are literally running a protection racket. These include falsifying patients records and x-rays, thereby erasing prima facie evidence or replacing a patient's real evidence with manipulated evidence; secret insurance databases, blacklisting of patients and quite brazen battering of injured patients. The Medical Protection Society operates like this around the world, especially in places like South Africa and Hong Kong where governments and legislators are corrupt. In Hong Kong the MPS and medical practitioners have devised elaborate schemes to intentionally batter patients. It's brazen and then followed up by various secret processes. The Medical Protection Society has a huge Kickback Account for bribing personal injury lawyers and judges, paying Internet hackers to read your email or remove truthful content off the Internet, bribing off journalists etc etc. We know that all these indemnity insurers act as medical defence organisations and have huge devious law firms, corrupt expert witnesses, police, health boards, health depts all colluding with them. I can help anyone with this if you like as I've experienced all the above!

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.

I worked for a company for almost 30yrs and the most I have ever demanced of my insurrance is an occasional cold (visit to the doc) or dental cleaning. Today I am faced with my first real need. I have back pain and the MRI says I may need surgery. UHC has already unleashed "IGENIX SUBROGATION SERVICES" on me. I googled them and, first I don't like the tone of their questions because it is trying to blame someone for my back pain. Somthing that frankly happend so gradual I didn't noticed until just recently becoming a problem. Second I read that UHC denies claims first see if it sticks..... Please could you provide me with guidance from here on....

The subrogation inquiry is routine for any illness that may result from an injury. Just fill it out and tell them this was not the result of an accident or injury. Most times, degenerative spinal disease is just that- it comes with age... I am a patient advocate and have worked in the financial end of healthcare for 30 years. The form may seem intimidating, but really, it is routine. For example, suppose you were in a car accident and a spinal injury was sustained. Your health insurance carrier may legally go after the other driver's insurance company to pay the medical bills- Have filled them out myself-usually, you are able to do it online and once they have info that no one else is responsible for the payment, they will leave you alone. Hope this helps to alleviate your suspicions! Jillian Barclay

The idea of for profit private health insurance is basically flawed. When insurance companies insure your house, the chances are slim that your house will burn down and a claim will be filed. With automobile insurance, the odds are higher that a claim will be filed but still very small compared to the 99.9999% chance that claims for healthcare will be filed at several points in the insured’s life. If there was a 99.999% chance that houses would burn down, would we find insurance companies insuring them? I don’t think so. What were insurance companies thinking, what sustainable business model did they have in mind, what stroke of illogical drove them into insuring health care? Certainly it wasn’t efficient, affordable healthcare or if these elements were part of it they haven’t materialized and cannot materialize. What are our congress people thinking when they seek to perpetuate this absurd system? Equally illogical is the system of the insured paying exorbitant amounts of money to for profit insurance company middlemen who, unlike doctors and pharmaceutical companies, contribute absolutely nothing to healthcare. While administration will be necessary, there is no good reason for these for profit middlemen to be there. The nature of healthcare is such that for profit private insurance is not feasible. If it were, at some point in the past 80 years a reliable system would have developed. Instead we have a system for those under 65 that continues to deteriorate and fail. Healthcare should be in the province of the public domain and government where profits are not an issue. We need HR676 Medicare for all. Medicare is a uniquely American system that works. Nikki from Breckenridge Colorado