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 practiced medicine for 31 years in the 2nd poorest of 67 Florida counties. It was quite common to see someone die because of no access to healthcare in a timely manner. Half my patients had no insurance. And, no they were not “mostly illegal immigrants”.The rare non-English speaking patient(who may or may not have been illegal) always brought cash. If an imaging study was needed, such as an MRI, it would be a terrible uphill battle and arguing and fighting with a Wall Street owned hospital...etc. I never heard of a Medicare patient complain about access. What other rich country on earth has such a crude, heartless, despicable and morally reprehensible state of affairs? Is the whole world wrong and only Americans are right? It would be very naive to believe such nonsense? Our healthcare delivery system is the laughing stock of the world. One hears this in between-the-lines comments from visiting foreign colleagues at national medical conventions. As a prominent Princeton economist said; “Advanced countries don’t do that to their citizens”. Something has to change where the insurance companies will stop cherry-picking by refusing to give insurance to anyone except the perfectly healthy. From a moral and ethical standpoint, insurance executives, big pharma executives and big finance executives have a lot in common.

Nice, but where's the beef?

What's everyone so excited about? All he's offers are general comments that most of us already know. The bad guys are the bad guys. Where's specific details? Where's the expose'? Where's the "hand in the cookie jar" specific examples of wrong doing? We all watch TV court room dramas. There's not a shred of evidence to what he says. How will he "bring them all down" with general, vague statements.?

Please talk about how profit-taking has "reformed" health care

Thanks for stepping forward. As a marketing consultant in health care for over 20 years, I've also witnessed the transition of much of the health insurance industry from non-profit Blues to for-profit, publicly-traded companies. This transition was driven by Wall Street, which stepped forward with billions to "buy" the Blues from the public, all for the sake of fees. They earned more fees from consolidating the companies into firms like WellPoint and Anthem (who then merged). Former non-profit managers, like Leonard D. Schaeffer (head of HCFA in the Carter administration and of Blue Cross of California) sold out to Wall Street and walked away with 10s, even 100s of millions of dollars. This is a largely-untold story that most Americans have no idea about. The increasing need to earn profits has, in fact, already reformed health care over the last 20 years, but not in a direction most people like. Please tell this story and help people understand that their for-profit insurer hires and trains staff to deny claims in order to boost profits.

Mr. Potter, God bless you.

Mr. Potter,

God bless you. Thank you , thank you, thank you. We need more men like you and women as well to speak up. I fear that I may be falling through the cracks. I would like to know that I can get a hand up and continue to work and contribute to society for a few more years. No other democracy forces people to choose between staying in their homes and getting the care they need - and I DO have insurance. Its just that the premiums and deductibles themselves are becoming unmanageable. It doesn't help that the medications I need are so outrageously overpriced - even after being on the market for nearly thirty years! (I'm waiting for an exec from big pharma to spill the beans on how much of their profit really goes into r&d). Thank you for your voice!

health care crisis

i saw a special last night on TV about Wendell Potter and today had to find a way to give my two cents worth. I have been in health care for twenty five years with a multi-specialty medical group who contracts with commercial and medicare advantage plans. ALL the plans waste money everyday!! Their focus is not for the patient or the doctor it is for how much money they can make by "reviewing the doctor's recomendations" and saying "sorry it is not medically indicated" or sorry your patient does not meet criteria".

I am so happy that there are people like Wendell who are now willing to speak out! We need to fix this problem NOW.

Wendell, please share all your experiences with President Obama and with anyone else who will listen. Your same experiences are still happening everyday at every insurance carrier. I have contacts inside every insurance company that our medical group contracts with who say the same thing you are saying. BUT they can't speak out because they have families to feed and a morgage to pay.

'reform' won't make everything okay

More and more money is being wasted every year in Canada, too, reviewing the doctors' recommendations and creating paper hurdles for direct treatment. Gathering statistics (usually specious) and designing mostly redundant information systems has become the medical imperative because they are the only things remotely connected to health that the types in the government appointed health authorities can understand. Yes, the Canadian system is still better than the American but our taxes are very high and the true cost is masked.
The U.S. should not consult with people in the Canadian bureaucracies unless the consultations are very objective and cynical.

healthcare reform

My comment is: Don't copy the Canadian system, at least as it exists today. 'Reform' (strange how the word is always presumed to have a positive outcome) up here has become somewhat like Castro's continuing 'revolution', essentially meaningless, a catchword for empowering a self serving cadre. Like all of the other Canadian bureaucracies, the healthcare systems have been overrun by corporate raiders--CEOs etc.--complete with all the trappings and perks that brought GM down. Bureaucratic imperatives have become the driving force; the medical people, who are the only ones who know what's really going on, try to ignore the declining efficiency--the misdirecting of funding-- as much as possible. Steps have been taken to make sure their input is muted. Healthcare's mission is to take off in strange new directions where no doctor has gone before but where fiscal scandal often lies. For example, the present priority is the endless collection of medical 'information' (there's never enouigh) at a cost of hundreds of millions. Meanwhile--damn those pesky patients!--the waiting lists themselves are becoming the subject of studies.

Rights of ordinary people

For decent and respectful health care is modeled in Canada, but is under stress here also by people who are living a lifestyle modeled on excess food, excess luxury where cars replace exercise and a leisurely, unstressed life style. Wendell Potter has become part of the 'awake and conscious' new world consciousness who understand that greed is no longer acceptable. He knows that the elite have siphoned off funds intended for the good of everyone. This is important for all of us to learn his inside story as he can best tell it.

There is an emerging story of a new world teacher who will appear on our television screens soon to speak about sharing all of the resources to all of the world's peoples to enable all of the world to have a decent way of life. Sharing in this manner will create peace and justice for us all.

Wendell, and those insider's turning away from their former lives supporting greed, they are the leaders of a new wave of understanding we will all be learning from this new world teacher --very soon.

? teacher

Doyou have a name, religion or any other information about this teacher to baes this article on? All seems a bit too good to be true!


Cut the crappola above about 'gomnt' being 'full of ignoramuses. It took me six months about two years ago to simply get my BILLING ADDRESS CHANGED as re: CIGNA Government Services which administers Medicare in: TN; ID; NC.

I called, submitted forms, called, submitted forms. I spent hours and hours when I could have been caring for clients as a psychologist.

CIGNA's 'Medicare Claims Express', the way a private provider submits electronic payment requests is so antiquated that it uses a DIAL UP MODEM. I had to farm out my billing to a person who spent two years in school to simply learn how to manipulate the CIGNA Medicare and private insurance company systems.

Contrarily, NC Medicaid, administered by EDS, is a wonderful, user-friendly, efficient machine.

BCBSNC which insures 75% of people who have insurance in NC-----AND WHO IS DEFENDED BY DEMOCRATIC SENATOR KAY HAGAN-----is using its stockpile of money to crash the single payer option. The former Democratic Party Chairman, Ken Eudy, created a company, CAPSTRAT, which creates the PR for BCBSNC; he was best man at BCBSNC CEO recent wedding (yes, I am a registered Democrat and proud of that).

More details here (NC Mental Health Reform which has decimated NC's mental health care system, here:

Details on BCBSNC, which for my 3 member healthy family, offers no preventive health care, and charges me premiums of $750/ month :

Marsha V. Hammond, PhD