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.


Well said by Activist. If private insurance for under 65 people is so good, why don't members of Congress not cancel their special government insurance coverage and go to private health care plans like the rest of us? If "government ran" health care is so bad, why aren't these congressmen complaining about it? Ah ha! Ask yourself, of those you know on Medicaid, how many are complaining about the service? With Medicare, there are deductibles and people usually get a Medical Supplement policy to cover what Medicare won't pay. There are various Standardized plans to choose from at different rates. I say expand the coverage members of congress have to all citizens! We're going to pay for our health care one way or another, whether we pay insurance company premiums plus most of our health care, or whether we pay in taxes. We pay, period. What is everyone so afraid of? Right now, well-compensated CEO's are the ones who determine our health care and what kinds of treatments we receive - not our doctors! Doctors can only recommend - these companies decide, based on the profits shareholders are demanding. We ought to be the drivers here - instead we allow ourselves to be the driven and we don't get to tell the driver where to go. You can only control your congressional representative if he/she knows your vote counts, but individually we are weak. We each individually can't afford a lobbyist to threaten a representative with not being re-elected. But in the next few weeks, it will be vitally important to get the word out there. Maybe if everyone sent pink envelopes to their Congressmen with just the same simple message: vote YES to public health care (or if opposite, send whatever letter you want) maybe they would get the message while lobbyists are threatening to damage their re-election campaigns if they vote for the bill.

Sorry, but the statistics you're quoting are not true. Medicare and Medicaid have a 3% overhead, as opposed to the bloated health insurance corporations who spend a fortune paying executives, denying claims, marketing etc. Additionally, hospitals must have entire departments dedicated solely to billing varying amounts to the many insurance companies and their many plans: a tremendous waste of money and energy. One needs look no farther than the insurance/medical complex to see a huge wasteful bureaucracy. I don't know about the other social service plans that you are referencing with your large, indistinct useless statistic, but medical insurance is done extremely efficiently by the government, and would be even more efficient if they were allowed to negotiate the price of pharmaceuticals.

Thanks for standing up for patients. It's time that everyone should have the opportunity to be covered by health insurance. I have a preexisting condition and had to pay over $800 a month for Cobra insurance while I was between jobs. Explain how this is fair to those of us who do our best to be productive citizens. I just watched Wendell Potter on MSNBC's Ed Show and was very glad to hear someone speaking the truth about why Health Care Reform must pass.

Mr. Potter: Thank you for so clearly laying out the connection between Wall Street and the insurance industry on "Bill Moyers' Journal" and "Democracy Now". We have seen so many instances of the short-term mentality leading to disastrous public policy decisions. There is too much at stake to allow financiers to warp this initiative. Our health care system is our international shame. The rest of the civilized world has recognized the fundamental right of the individual to decent health care-- it's time the United States got on board. Your courage in speaking out is an invaluable contribution to this process. Thank you again.

Dear Mr. "My Hero" Potter, I was becoming faint with the onslaught of Snakes and Jellyfish in the Menagerie swarming slitherily around putative health care reform. Then I saw you on Bill Moyers & The Ed Show and feel awash with joy. I only wish you could be chained to your blog & tv until folks <i>get</i> the degree of catastrophe of our medical-industrial-complex insurance corporation-dominated ATM-for-Them 'system.' The medical-industrial-complex insurance corporation, MICIC (mick-ick), 'system' has slid from gruesomely sad-&-bad into evil. They have put rapacious Wall Street and medical-loss-ratios between any of us and our doctor. I paraphrase you saying that their stock price depends acutely on <i>how many people they can rescind, purge, or force into fake insurance.</i> They win by their customers losing. It is revolting. It is capitalism gone odiously amuck. The equivalent of every child, woman, and man in the whole states of Georgia, Indiana, New Jersey, North Carolina, and Virginia have <i>zero</i> health coverage in our USofA. This. is. shamefull. <i>Wendell Rocks</i> is on my teeshirt. Keep your heart bright and keep talking & blogging, I implore you.

You go sister! I just saw Wendell on The Rachel Maddow Show last night, and I said my hero!

Mr. Potter, I just watched your interview on Democracy Now and was fascinated. Mr. Potter you may be our single best hope for real healthcare reform. Please, please, please continue - with haste - your education of the American public as we are truly lost in the woods, and of course, the for-profit insurance companies don’t want us informed. At the moment I’m very fortunate as I have a good policy through my employer. Unfortunately, as a result, my co-workers tend to fall for the insurance industries scare tactics. What they don’t understand is that it is just a matter of time before our employer will no longer be able to offer us a choice of comprehensive plans or that they might be let go during an economic downturn losing any possibility of affordable coverage. God forbid they have a pre-existing condition. Even with my “good" plan (which is costly, not portable, and is rationed by the insurance company) I’m only one serious illness away from financial ruin due to denied coverage. Why there even needs to be a debate over our current system that is riddled with health care bankruptcies and the under / uninsured is proof to the strength of healthcare lobbyists. Why Americans wouldn’t take their chances with a “Washington Bureaucrat” (which we can throw out of office) over a for-profit corporacrat is testament to our collective confusion created by the Healthcare Industrial Complex. God bless you Mr. Potter.

Thanks Mr. Potter for saying what everyone was thinking! Our government has given license to the insurance companies at large to rape and pilfer the American People for a long time now. The insurance industry is the only business I know of that wants your premiums paid in a timely manner, but is really in the business of screwing people out of the very service they sell them. We need to return to a time when we are sincere in the way we treat and relate to one another. Capitalism has sucked the life out of doing what's right in exchange for profits.

Wendell, you are a hero. Might I suggest you take some of all that cash you made and support the effort. Wow, what a day that would be. Perchance, you may have done this already and I don't know. If so, I'm sorry for suggesting it.

Please speak louder. Bill Moyers,The Ed Show,Amy Goodman--not enough people are seeing your story. Your interview with Bill Moyers,especially the health expo pictures and the discrediting of Michael Moore ,along with seeing the movie Sicko, should move anyone to the side of reform. I hope you are not being shutout by design.