Wendell Potter's News Articles

The Obama Administration will be making some important decisions over the coming weeks that will determine to a large extent whether consumers or health insurers will be the biggest beneficiaries of health care reform.

When Congress passed the Affordable Care Act last year, it included a controversial provision that insurers insisted on, but which is undoubtedly the most unpopular part of the law: a requirement that all Americans not eligible for a public program like Medicare or Medicaid must buy coverage from a private insurance company.

To make that mandate fairer and more palatable, Congress also included provisions that eventually will make several of the insurance industry's most egregious practices illegal, such as refusing to sell coverage to people just because they have a pre-existing condition. The law also prohibits insurers from selling "junk" insurance and from cancelling policyholders' coverage at the time they need it most -- when they get sick.

One of the reasons why Congress has been largely unable to make the American health care system more efficient and equitable is because of the stranglehold lobbyists for special interests have on the institution.

Whenever lawmakers consider any kind of meaningful reform, the proposed remedies inevitably create winners and losers. Physicians' incomes most likely will be affected in some way, as will the profits of all the other major players: the hospitals, the drug companies, the medical device manufacturers, and the insurers, just to name a few. The list is long, and the platoons of highly paid and well-connected lobbyists who represent their interests comprise a large private army that conquered Capitol Hill years ago.

If there is one organization that insurers despise and fear more than any other, it surely must be Consumer Watchdog.

Since its founding in 1985, Los Angeles-based Consumer Watchdog has dogged insurers relentlessly and played a key role numerous times in forcing them to change business practices and price their policies more fairly. I first heard of the organization in 1996, when I was still an insurance industry spokesman. Consumer Watchdog seemingly came out of nowhere to take the lead in trying to put a halt to a new practice in the insurance industry: requiring women to be discharged from the hospital within a day after delivering a baby or undergoing a mastectomy. Largely because of Consumer Watchdog's efforts, insurers had to rewrite their discharge policies.

If you have no idea what you're paying good money for when you enroll in a health insurance plan, there's a good reason for that: insurers profit from your ignorance. And they're waging an intense, behind-the-scenes campaign to keep you in the dark.

In my first appearance before Congress after leaving the insurance industry, I told members of the Senate Commerce Committee that insurers intentionally make it all but impossible for consumers to find out in advance of buying a policy exactly what is covered and what isn't, and how much they'll be on the hook for if they get sick or injured. Insurers are quite willing to provide you with slick marketing materials about their policies, but those materials are notoriously skimpy when it comes to useful information. And the documents they provide after you enroll are so dense that few of us can understand them.