Obama's False Friends of Health Reform

I'm hoping President Obama realizes that some of the folks who've been currying favor with him are not, as they claim, bringing "solutions" to the health care reform table. Most Americans -- especially those who voted for him -- want nothing to do with the kind of "reforms" they are peddling.

If you watched the president's televised Q&A on ABC last Wednesday night, you probably noticed that one of the people in the audience was Ron Williams, the chairman and CEO of Aetna, Inc., the nation's third largest health insurer, and currently one of the most profitable. But there are a few things that you should know about Williams.

Back in the '90s, Aetna set out on an acquisition binge in its quest to become the biggest health insurer in the country. It got there by the end of the decade after spending billion of dollars for several competitors. By 1999 it had 21 million health plan members, the most any insurer had ever had at the time.

But, as often happens after buying sprees, Aetna soon came down with a bad case of buyers' remorse. As it turned out, some of the customers it had paid top price for were not as profitable as Wall Street analysts and the big institutional investors who owned most of Aetna's stock expected. When they took a closer look at what Aetna had bought, investors started deserting the company in droves. As a result, the company found its stock price in a free fall.

As the Wall Street Journal reported on August 13, 2004, Aetna's pretax profits as a percentage of revenues began falling dramatically after peaking at about 12 percent in 1998. By 2001 the company was a basket case as far as Wall Street was concerned. It had to do something, and fast.

Probably the most important thing it did to turn itself around was recruit Williams from rival WellPoint, the ambitious for-profit company that was gobbling up Blue Cross and Blue Shield plans from coast to coast.

As the Journal reported, Williams promptly ordered a $20 million revamp of Aetna's data systems. Health care analyst Joshua Raskin told the Journal that the new system that emerged from that investment, which Aetna dubbed the Executive Management Information System (EMIS for short), was "the single largest driver of the Aetna turnaround." Why? Because it helped Aetna "identify and dump unprofitable corporate accounts." How did it do the dumping? By jacking up premiums to unaffordable levels.

By the time the dumping -- or purging, as it is frequently called in the industry -- was done, Aetna had shed eight million of its 21 million members. It shrank so much that by the time it emerged from the Ron Williams-led turnaround, it had fewer members than when the company started out on its multi-billion dollar buying binge.

While Aetna was shedding those eight million men, women and children, by the way, it also reportedly shed 15,000 of its employees. Wall Street likes it when insurers dump employees, too, because the workers who don't get the ax have to assume the responsibilities of their laid-off colleagues. That theoretically boosts productivity, which Wall Street likes. And reducing the payroll leaves more money for profits.

The health insurance industry and its allies are working hard right now to convince you that the creation of a public insurance option would put a government bureaucrat between you and your doctor. As the 2004 Wall Street Journal article makes it clear, however, EMIS was at its heart a system that put corporate bureaucrats between people and their doctors. Here's what it saId:

Mr. Williams says EMIS helps him ferret out creeping costs so Aetna can react quickly. Sitting in his first-floor office in Hartford overlooking the Aetna parking lot, he taps on his keyboard to see whether some of the health insurer's members are visiting emergency rooms too much for nonemergency reasons, such as for the flu or a sprained ankle.

Did that send a chill up your spine like it did mine? And know this, if Aetna's CEO can keep an eye on your trips to the doctor, so can the CEOs of all the other big insurers.

The insurance industry claims that this time it really and truly supports legislation to reduce the number of people without insurance, that they've changed so much since 1994 -- when they said the same thing but did everything they could behind the scenes to kill reform -- that you can and should believe them now.

The next time you hear someone from the industry talking about how much they are committed to reform, remember that just a few years ago, the CEO of one of the biggest health insurers was the mastermind behind a business strategy that cost thousands of workers their jobs and millions of other people their insurance coverage. That's the real "solution" the industry is bringing to the table -- and the kind of reform Wall Street can really get behind.

Ron Williams has been richly rewarded by Aetna's board of directors for leading the company back to a level of profitability suitable to Wall Street. They tapped him to succeed Jack Rowe as CEO when Rowe retired in 2006. And they rewarded him with compensation totaling nearly $65 million over the past two years.

(Rowe, by the way, was paid $22.2 million in 2005, his last full year as CEO. He played a big role in hawking the high-deductible plans that Aetna and the other big insurers are now trying to push us all into. He claimed that Americans enrolled in managed care plans have been too sheltered from the real costs of health care and that we need to have more "skin in the game," by which he meant that we should have to pay a lot more out of our own pockets when we go to the doctor and pick up our prescriptions, even if we have health insurance. The median family income in the United States is just $50,000, which means that most of us already have a lot more skin in the game than Dr. Rowe and Ron Williams will ever need to.)

The insurance industry's two biggest lobbying groups -- America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association of America -- warned members of Congress in a joint letter a few days ago that the creation of a public insurance option would unravel the country's employer-based system.

As they say where I come from, that dog won't hunt.

It is the insurance company executives -- in their never-ending quest to meet Wall Street's profit expectations -- who are doing the unraveling by purging employers whose workers have the audacity to file claims when they get sick or injured.

A final point about Ron Williams: Not only are he and his fellow CEOs trying to kill the idea of a public health insurance option -- a central part of candidate Obama's health care proposal -- but he is the leading advocate of an idea Obama rejected and which differentiated his proposal from Hillary Clinton's -- the imposition on all of us of an "individual mandate." Many insurance executives were wary of such a mandate because they don't like the government mandating anything, especially those pesky state mandates that force them to include certain benefits in the policies they sell. Advocates of an individual mandate eventually brought the skeptics, including many of AHIP's board members, around to their way thinking by persuading them that insurers could make billions more in profits if every American had to buy an insurance policy from them. Now you know the real reason behind AHIP's shift from neutrality on the issue to full-fledged support. It's all about the money.

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


You seem to be one of the key individuals who realizes that companies who are raking in profits on health care aren't going to be interested in reducing everyone's health care cost at the expense of their profits. No one in Congress or the Administration seems to think that will be an obstacle, as a result we get all these absurdly detailed health care plan proposals when what we really need is a health care strategy for winning what will be a war with the profiteers. My strategy: Fight FUD with facts. Before we try to make a plan, we ought to find out where all the dollars actually go. Everyone has a pet political dogma driven theory about it, but no one has any facts. The first thing we need is the legislation and research required to track all the health care dollars. Then put 'em on a big chart with direct patient benefit on one axis and cost on the other. Now you can form a plan to attack the items high on cost and low on patient benefit - keep repeating the process forever. Details of strategy can be found at http://home.att.net/~Tom.Horsley/health.html

is the lining on the pockets of these misanthropes. Thanks for posting numbers like these, Wendell. Sooner or later, the "$2T savings" over ten years among the insurers will dawn on people as the kind of figure that indicates a complete overhaul is in order for this institutionalized theft from the American public.

Dear Wendell, I just wanted to say thank you. I am a graduate student (attending on scholarships, loans and part-time jobs) who has been unable to afford insurance since I was dropped form my father's policy several years ago. I have suffered greatly for this, from just 'dealing' with cavities and ear-infections to an accident where I broke my right thumb and was never able to receive any medical care for it. It feels terrible, having one's own body at the mercy of these ruthless, profit-motivated CEOs; Everyday that goes by when my thumb aches, I can't help but feel that the only reason I could not obtain treatment was because someone had to find a way to make money off my bad luck, and since I had no money to give, I got no treatment. If I lived in Canada or Britain, no problem, but in the greatest nation in the world so many of us are left to suffer for the sake of nothing other than greed. Health insurance in America today is, at best, no different than extortion: you pay the guys in charge or you pay the price. Not enough dough? Too bad. At worst, it is not far removed from someone putting a gun to your head and demanding money; sooner or later than debilitating accident or that terminal disease is coming, and if you haven't paid your dues, America is going to sit by and watch you die. Anyway, what I meant to get at was a thank you. Thank you for fighting for me. Thank you from all in my situation. We need you. In some cases, our lives depend upon you. You're a strong man for following your heart on this and doing the right thing. Keep fighting the good fight.

we can no longer trust board members and CEO'S of the health care giants. once again we are forced to rebuild a part of life which we enjoy. we shall use federal law to be a vehicle for this transition of power. to regulate health. the hand off of the money that funds insurance companies to pay for doctors,hospital, etc... must be swift in transaction as so that it the transaction doesnt effect or disturb the nature of its existence. ( the wellness of American people ) . the employer based system is a large asset for funding Americas largest health care system. personal accounts will follow the employer based accounts. first in regard too medical, vision, dental, long and short term disability, life, etc... the American people the average mid class tax payer shall have the final say in who regulates health care. it is vital to begin this new division of the federal government as soon a possible ( know ). Mr. Ron Williams should re-think the direction he is taking his investor. the American public will reach a point in a deep recession that they will drop health coverage all together. we cant wait for the big collapse. as this will threaten millions of lives.

Thank you for all you're doing. About high deductible health plans tied to HSAs: We have one, and deposited $5606 last year; $6000 this year, and pay $660/mo to Humana for health insurance. It is a fantasy to expect mothers like myself to spend that money on ourselves. That money is an asset of my family, which includes my husband and three children, and I would no more spend that money on myself than the man in the moon. "America's Health Insurers" should think again about whether HDHPs encourage me to better manage my health care dollars to keep myself healthier. In my case, is encourages the opposite--a highly conservative use of those funds which I would never voluntarily use on myself when I have three children who may need braces or who may fall and need urgent care for a broken bone.

What you are doing is great and courageous. Our whole business financial system has become not a capitalist system of supply and demand, but a system of manipulation and greed. Our health care system is right at the top of that system. From a consumers aspect, one of the most obvious ways that the health care providers do that is to limit ones knowledge of costs. Let's say I go to the doctor and he wants to perform a needed procedure. My doctor will tell me how much he will bill the insurance company or how much how much he will bill me without insurance. If I then call my insurance company to ask how much their negotiated rate is with the doctor for that procedure, they will not tell me. They say I must have it done first then they will tell me the cost. They take away my ability to make an informed choice of whether or not to use my insurance for that procedure. That is NOT free market, that is manipulation and deception. BTW, I am 43, and VERY healthy, and have barely ever used my insurance. Anthem raised my rates 40% this year. When I called to ask why, they said that management wasn't telling them why. Then the customer service rep said, "I think it's because we need to buy doctors new equipment." She REALLY said that. I laughed out loud. One more unrelated point. Being married to a European and having many friends abroad, the only people I hear complaining about a single payer system are people who have never had it. EVERY person I know who has had government sponsored health care has nothing but fine things to say about it. The ONLY complaints I hear from them are minor things about waiting for an appointment... JUST LIKE HERE! People, stop being manipulated, like a bunch of sheep, by these companies' agendas. WE MUST NOT SIT DOWN AND LET THIS OPPORTUNITY PASS WITH A WATERED DOWN HEALTH CARE REFORM BILL. The compromise IS a public option.

Dear Mr. Potter, Thank you for your honesty. I used to be a life and health insurance agent and worked for three different companies at different times. When I discovered the dishonesty and outright lies (not to mention rampant forgery by agents and the "churning and burning" of agents by companies) I could not continue working in the insurance business. I was raised to be an honest person and to try to treat others the way I'd want them to treat me. I was ridiculed by other agents and demeaned by company managers for being naive and even irresponsible. "There's no room for honesty in a commission driven business" I was told. "You'll never make it," they said. I wish that you'd also confirm the truth to people about the life insurance industry in your blog. It seems that the general public is, tragically, still in the dark about it too. One of the people who responded to your blog, "Obama's False Friends of Health Reform," clearly applauded the industries' deceptive ways and strongly implied that you were the one being deceitful by not telling all of the truth as he saw it. The surest way for evil to continue and succeed is for good people to do nothing. Finally, you are doing something.

I can't help but be suspicious of some of the above comments. Reading through some of them made me think that they were posted by people employed as public relations people by the insurance companies themselves. PR Watch ought to see if their IP addresses actually have origins from the offices of insurance companies.

It is noteworthy that the first comment in these messages was from "Anonymous", on the attack immediately. This suggests Health "Care" Incorporated already has legions of minions patrolling the web for the purpose of preemptive strikes and damage control. Counterstrike: http://www.youtube.com/watch?v=7QwX_soZ1GI From PBS, July 10.