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.


Why? what's wrong with Sicko? I love that documentary and really opened my eyes on the current state of America. The part about the people who helped with the world trade center incident.. That almost made me cry.

"Reacting to the surprise announcement that congressional budget referees now predict healthcare reform could top $1 trillion, the Obama administration threatened Wednesday to veto parts of its own healthcare bill. The politically explosive revelation, which is likely to give new impetus to the GOP?s repeal movement, came after the Congressional Budget Office (CBO) said the law potentially could add at least $115 billion to government healthcare spending over the next 10 years." That is how an ill conceived idea ends up.

"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." I agree with you here. It does seem like every time we have a new proposal from Obama, we get everyone screaming socialism. Well, to me its all just word labelling. What we should look are is how the proposals affect the future and as long we could see a benefit I don't see why it should not be implemented. Using socialism as fear mongering is just hindering change.

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I have not seen any mention of the public health system aims to make customers out of insurance companies, reducing their spending due to unnecessary layoffs and reduced bonuses paid to executives due to decreased benefits. My point is, nothing works, unless insurance companies to be part of the solution. The debate has been all about the government, the uninsured, and cost savings from suppliers, including <a href="">recados para orkut</a> pharmecuticals. When insurance companies have been in this debate? strangely silent, I would keep. In my opinion, their piece of the market must be significantly eroded achieve real savings. Have to make significant cuts to the structures of their earnings, or anything else of this work.

Great to have you aboard the train leaving the station en route to universal health-care free at the point of delivery. That is your ultimate destination, isn't it? It's what I'm used to. My healthcare system allows me to see my doctor free of charge, and because I'm over 60 all my medicines are also free. If I have a prolonged episode of paroxysmal atrial fibrillation I can dial for an emergency ambulance (also free) which will have a paramedic and a defibrillator on board. Heart attack victims get taken straight to state of the art cardiac catheter labs at major Accident and Emergency Centres. My sister in law was diagnosed with age-related macular degeneration - she's had a course of treatment that has stabilised her condition, ensuring she doesn't lose her sight - each injection was worth about £14000 but they were free of charge to her. I live in England and my health service is the National Health Service. For all of its faults and inadequacies, I wouldn't swap what I've got for a health insurance model like that of the USA. You may have some of the best medical centres in the world, but the inequalities of provision that deprive the 'have-nots' of anything more than the very basic levels of healthcare provision is a situation that shames your country. I wish you well in your endeavours.

As a US citizen who has had treatment by the UK's NH system, I can double underline all the good Reg has to say about the NHS. I was in a clinic in Oxford to have a boil lanced and I was three days in the Radcliff Infirmary for what turned out to be a non-viral meningitis. The facilities were spartan, but the staff were people highly motivated to do medical work. I was also a month in an British organized hospital in Singapore following a near fatal accident in the offshore oil-fields, and I shall never tire of telling people how much it helped me to cope that the doctors considered me an active participant in my own treatment. I was consulted each time a medical decision was in the offing, and could ask questions, or be part of the decision making. At one point, when it was still a question whether my lower leg could be saved, I asked my doctor if there was a chance it would have to be amputated. He responded with an honest frankness that still takes my breath away: he said to me that sometimes it could be the wiser choice to loose the leg, get a prosthesis, and get back on my feet again rather than spend a long time on crutches and seeing my general body musculature weaken, not to mention being unable to reinsert myself in normal adult occupations. And, if there was a choice to be made, it would be made with my participation. I do think the health system in the UK works (some complain) because the British are unusually civic minded, and do not abuse the system. If the US changed to the same system overnight, I fear the masses of people heretofore left out of the health-care circuit would storm the system. All I want is the assurance of good basic care and a medical system committed to prevention and education about good personal hygiene. The private sector can offer luxury services to people with money to burn, and I'll be the first to wish them all the best. The American Hospital in Paris serves the rich and famous, and the kings and queens from all over the planet, for unbelievable prices, and that's just fine by me; I can live with an " not all but something" choice.

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It takes courage to switch sides and put the public interest first over one's own personal success working for the private health insurance industry. You did a great service today for America in exposing the problems with private insurance and you should be commended for such courage. Forcing Americans to purchase a defective product is a huge mistake and cannot be morally or politically justified. We need a single payer, national health insurance plan for this country. Let's hope your testimony as an insider brings courage to other insiders who can shed light on the state of private insurance, their motives, and why they should not be allowed to control our health care system. Please speak up. Bravo!

Welcome to you, Wendell Potter! We need you and more like you. Some years ago after having lingering health issues after an auto accident I made a decision to change careers, moving to the insurance and securities industry. How naive I was, but the education was quick. After struggling with all the required insurance and securities education and exams I foolishly thought I would be actually helping clients. When I started on the job I could not help but feel the SCORN for everyday people and their efforts to protect their families with insurance packages, establish retirement programs - potential clients were literally ignored. We were required to research obituaries, find out who owned substantial businesses, examine trust information in public records and find out who we could CONVINCE TO ROLL OVER THEIR WEALTH into our programs. When my first client came to me with $10,000 to establish a retirement account I was scoffed at by my manager and was told that wasn't the kind of client we would be dealing with. I can't tell you how devasted I was when I actually became aware how the insurance and securities industry really operates and what their true philosophy is. Within 6 months I left to go back to my business that I had started a few years earlier and worked very hard at re-establishing it. After that hard lesson and returning to my own business for 5 years I was diagnosed with breast cancer. Fortunately I had had a solid - or so I thought - health insurance program for almost 10 years. During my treatment I was treated so badly I could not believe what they were doing to me - refusing to pay for my radiation after having sent me home in less than 24 hours with drain tubes and no one to help me since I live alone. Then they tried to cancel everything in the middle of the treatment by giving back all my premiums which certainly would not have covered all my treatment. I pleaded my case with out state insurance commission to no avail. I cashed in my retirement to pay my bills because the medical center harassed me causing me emotional distress. Ultimately I filed for bankruptcy and started from scratch in my life. Some years later when I was dating a gentleman who was an independent insurance actuary I shared my experience with him. It was amazing! He knew exactly which insurance company that I was talking about even though I never mentioned who it was . He explained that they were only in this venture for the short term profits, made a lot of policyholders angry by refusing to pay claims, were sued successfully by all the states where they did business but not the one where I lived because that is where this investor group lived and were close friends of our governor. See why the insurance commission also gets involved? The fraud and extortion in this industry is unbelieveable. Currently I have a $450/mo premium and a $2,500 deductible for just myself. Of course there are many more details but surely you get the picture. The irony of this all is that they continue to tell us that we need to 'take responsibility' - so why are we continueing to pay them our premiums? Mutual Insurance or some other NON-PROFIT SYSTEM is the way to go.