The Health Care Industry vs. Health Reform

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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.


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I am saddened whenever I hear

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.

Afraid to speak up

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.

Health care cost and waste

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.


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

How much money did the insurance company pay the politicians to

How much money did the insurance company pay the politicians to defeat health care reform?
I suppose it must be billions.
Those politicians want their Mega Yachts.
I guess that explains the big increase in premiums.

Health Care vs. The Dollor vs. The People

The How to;

President Obama, asked for the help, of a way to cover the sick. And it is a simple concept that is presented before all to see. Health Care Insurance Companies will not cover the sick, {This will not make dollars for them.} Our tax failure within our system will not be able to carry the load because of cost.
Within this United Forum, as Health Care Insurance Companies do join and earn money by helping the pay in form and the Health Care Tax Forum within our Medicare Tax system all ready in place, the concept of the dollar is like this in a low ball figure, { $10.00 x 250 million people, per week x 1 month} as stated before you do the math.
Now this is the part that Government Officials do not like, because of the constant failures before 9/11/2001 to 2/15/2010, all government Officials should be penalized
10% off of their pay. And that money should go to the Health Care Account. It is a recorded fact of history that our Officials we elected / hired to do a job have failed to do their jobs. The lives of the people have become in dangered and lives lost. They fight over this Health Care Dollar as if it is to be split up between 52 States. Our goal is to Unite The 52 States Of the United States Of America, as it should be.
Health Care Companies have also failed, and it is also a part of documented history, of their failures. This concept of profit under a Health Care Responsibility is the biggest lie before the people and we offer one last chance to theses Insurance Companies to Unite with the Peoples Government and earn money. Fact; 0ne Insurance Company can not maintain the dollar cost of a few people, so what happens when a Nation Wide Out Break takes Place ?
Some how Government Officials failed to understand that the American People have a common sense about them to see that around 173 Million people still jobs out of 373 million legal American People and there are around 125 million Illegal People in the U.S.A. It would only confirm the failure of Government Officials if they admitted this information.
Some have asked how I know that this is a $100 Trillion Dollar Health Care Package that Officials fight over, I called and asked Insurance Companies. And to my surprise 70% of those I talked to stated that this concept of a United Health Care Forum Built By The People in our Government System hold a honest approach of how to cover the sick that cant be covered. And Laws built to protect this money from miss use.
I wanted to Save this for page 100 but I will only show part of the building block of a Health Care Reform Stimulus Package. It is of a interest to many people to see the ideas that will come forward.
So again I ask all to Help President Obama to get this Job concept under way, and at the same time build this Health Care reform. Do not set it into action and not keep track of it, I am talking about a 10 year month to month data read out to see if scams are in the works.
And I will state this one more time just to humor Government Officials, as you fight over this Health Care Issue, it looks like a bunch of chickens fighting over a scared little bug, as I reached down and took this little scared little Health care Bug from you, I now have it safe in my hand, and this health care belongs to the people.
Henry Massingale
FASC Concepts in and for Pay It Forward

Health reform NOW

the only people that oppose to it, it's people that never needed any care... but they eventually will... sorry to inform....

I been paying my individual health insurance since I was young (more than 20 years) and I been feeling the heavy changes.... co-pays became outrageous, deductibles (when we pay for a premium policy), medicines and several exams and procedures are not fully covered anymore.... I suppose to go to a cardiologist now but after pay almost 600 $ for my premium, I just can't afford, another $ 50 for co-pay/visit, plus $100.00 for a stress test, plus ANOTHER $ 50 for RETURN (within 30 days, going back to a doctor used/should be a return).... plus the cost of the possible prescription... so... I'm going to sit in here and wait for things to get worse because, going to the emergency room, might be cheaper then to prevent any possible problem. Enough is enough.... I pay my insurance to be FULLY covered. No brainer.

UHC and Aetna Unproven Status on Hip surgery

Dear Mr. Potter,

I am a member of a very large patient support group that provides support to patients worldwide. The diagnosis that each patient has in common is Femoroacetabular Impingement (FAI). Basically, in layman’s terms, there are large bone spurs in the hip that contribute to torn cartilage. The medical profession, fortunately, is able to fix this with minimally invasive surgery (arthroscopy) such as what A-Rod just recently had. That is the good news!

The unfortunate part is that there are two main insurers that are discriminatory in their coverage. Blue Cross/Blue Shield, Cigna and Kaiser all pay for this surgery. Aetna and United Healthcare do not. In fact, United Healthcare just wrote a policy that would deny all coverage for ANY surgery that would fix this (open or arthroscopic). Both United Healthcare and Aetna both have adopted the opinion that this surgery is “experimental” in direct contrast to their peers (BCBS, Cigna, Kaiser) who have recently adopted coverage policies based on scientific evidence and peer reviewed studies. United Healthcare and Aetna would prefer that young active patients become disabled enough to require a more expensive and potentially riskier hip replacement.

As you also may be aware there have been multiple million dollar fines against United Healthcare specifically as well as a pretty recent class action lawsuit against UHC brought by Cuomo of New York.

My experience with UHC is that the external reviewer that reviewed my claim for coverage indicated that UHC was being arbitrary and unethical in their decisions and UHC was ordered to pay it. It was shortly after this that UHC came up with a formal policy that indicated that the surgery was unproven.

Our group is reaching out to your organization to be able to get UHC and Aetna to see the peer reviewed literature that does support this procedure and to also make contact with the media.

UHC Refusing To Pay For Hip Arthroscopy

Mr. Potter,
Thank you for bringing these issues to light. Like a previous commenter, Maria C., I am having issues with UHC, I also had a hip arthroscopy to address bone spurs and some other issues with my hip, and UHC is refusing to pay. What is most distressing is that they have paid for this procedure in the past, but now are stating that it is experimental and unproven. Despite the fact that an external reviewer deemed the procedure NOT experimental in Maria's case, and ordered UHC to pay, UHC refuses to pay for my procedure. I currently author a blog about my experience with this procedure and have had countless emails from other UHC members telling me about their experiences, and UHC refusing to cover the surgery. Most patients with this condition are young and active, but suffering from hip pain. Hip arthroscopy is a minimally invasive procedure that can correct the anatomical deformity in the hip. Since UHC is denying coverage for this procedure, as well as the more invasive open procedure to correct the abnormality, young patients are left with no choice but to continue to suffer hip pain, until the joint has degenerated enough to need a total hip replacement.
I am reaching out to your organization to help get UHC and other carriers who do not cover this procedure, to realize that this is a highly beneficial procedure, that it is not experimental, and that there is plenty of peer reviewed literature to prove this.

FAI repair

I support the above comment about how FAI surgery can help and that a few insurance companies are arbritrarily denying coverage. The surgery worked so well on Alex Rodriguez that potential subsequent surgery proved unncessary. Apparently athletes can get covered to repair a labral tear, but anyone with United HealthCare or Aetna have to live their lives in constant pain if FAI caused their labral tear.

If only those at the insurance company could walk around in the shoes of those who suffer FAI, they would do what they could to resolve the pain.

Their are enough success stories to prove that the surgery is not experimental.