A Crisis of Conscience
A Crisis of Conscience | Wendell Potter, Deadly Spin, CIGNA, for-profit health insurance, health reform

Wendell Potter

Wendell Potter’s Examination of For-Profit Insurance and Health Reform

Wendell Potter knows what success feels like.

With a degree in journalism from the University of Tennessee, Potter was just in his 20s when he was promoted by the Memphis Press-Scimitar, a Scripps-Howard paper, to cover politics and write a column in Washington, D.C.  Yet, as many reporters are, Potter was lured away from daily journalism into public relations and joined the Baptist Health System of East Tennessee as director of PR and advertising.

That’s when Potter’s stock in the healthcare industry began to climb. He jumped from Baptist to Humana and, four years later, was hired away by CIGNA.

“I joined the company to support the healthcare operations exclusively, and I worked in Connecticut where those operations are based,” Potter recalled. “After four years, I was asked to move to Philadelphia to work for the corporation. So I spent the rest of my career as the head of corporate communications.”

Those were heady times, Potter acknowledged, when he served as the insurance giant’s national spokesman. He was an advocate for a managed-care insurance model in the late 1990s that he believed worked – especially the HMO staff model popular in the western states – to deliver efficient and quality care. “I believed in the concept of managed care, and did for many years. It was only years later that I was able to see that the profit motive had really wrecked the idea and the promise of managed care,” Potter said. He described for-profit insurers’ dealings with physicians and patients as “ham-fisted” and said that, over time, he became “disillusioned.”

For-profits were scrambling for a new “silver bullet” that would boost profits at the expense of providers and patients, Potter said, and eventually the former journalist had had enough. He defected. Potter left CIGNA in 2008 and is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans,” published last November by Bloomsbury Press. Today, Potter is a senior analyst at The Center for Public Integrity and the senior fellow on healthcare for the Center for Media and Democracy. He talked to Medical News about his crisis of conscience, his dramatic career shift and his newfound role as patient champion and truth teller.

 

I suppose the newest “silver bullet” deployed by health insurers is to give patients “control” of their healthcare, right?

Well, that has been the talking point. That’s what they want you to say – “giving patients more control” – but it is essentially shifting more of the cost of care to patients. The term “consumer directed” is misleading. Yeah, consumers theoretically have to make more decisions. They certainly have more “skin in the game,” which is a term executives in the insurance industry used for a while until they figured it wasn’t a good thing for them to say. It’s really about cost shifting, and as people have become more aware of the cost of healthcare, they’re not going to the doctor and they are not picking up their medications. That is to the great benefit of the insurance companies. 2010 will be one of the most profitable years ever for the big for-profits, and it’s because they have figured out how to make us pay even though we’re also paying them our premiums.

 

Was your decision to walk away from CIGNA a gradual realization or a gut-wrenching moment?

It was both. I was becoming increasingly uncomfortable serving as a spokesman for the industry because of this rapid movement of people from their managed-care plans that they had grown accustomed to into these high-deductible plans that require them to spend so much more out of their own pockets. I know the median household income in this country is only $50,000, and the average cost of a family premium has increased to almost $14,000. Yes, for most people who are in employer-sponsored plans, the employers pay the lion’s share of that, but increasingly consumers are paying more and more of that percentage, more and more out of their own pockets for care.

I was aware of all this, and I knew that you can’t keep doing that forever, and it was exacerbating the problem of the underinsured. Also, I was aware of the practices more and more that the companies engage in to get rid of people they don’t want to cover through recisions and through purging small businesses from their rolls because the last thing they want to do is pay a claim.

They raise the premiums for small businesses often so high that they have no alternative but to drop coverage. It became abundantly clear to me that what I was saying, that this industry was part of the solution, was not correct. What I was seeing was that the industry and its practices were causing the most intractable problems in our healthcare system and making it worse and making it necessary for more and more people to be in the ranks of the uninsured and the underinsured.

 

As someone who is insured by CIGNA, I watched in horror the case in California, when in late 2007, CIGNA denied 17-year-old Nataline Sarkisyan a liver transplant that would save her life. Nataline died. Was that a time of realization for you?

It was. It was the final moment, the final thing. To be a key player in that whole thing was something that made me ultimately decide, “I can’t keep doing this kind of work.” I was the main spokesman for the company, and having that role, I was the guy on the phone to most of the reporters who were calling about that case. I’m a father with a daughter a little bit older than Nataline was, but not much.

I could just imagine what was going on in that family, and I could just envision my daughter being Nataline. I’m fully aware that resources are finite, that every transplant cannot be approved and that there truly are some instances in which experimental procedures are outside the boundaries of coverage. But what became so clear to me, finally, was that the life-and-death decisions are being made inside big corporations by medical directors who are just as much corporate employees as I was. They know that they have their role to play to make sure the company meets profit expectations every three months. When that finally dawned on me with this particular case, I decided, “I’m not doing what I want to do, what I’m supposed to be doing.”

 

That’s a scary moment, isn’t it?

Yes, it really is.

 

How do you disentangle yourself?

It’s a process. If it had just been me, it might have been something that I could have done earlier, but I have a family. It’s hard to disentangle yourself – and that’s a good word – because your ego is tied up into it, your lifestyle, your friends. You’re dependent on the income; no matter how much you make, you always want to make more. It’s the way we’re wired, I guess, the way we are in this country.

You want to make sure that you’re perceived as a team player, getting the raises when they’re passed out and the bonus and your stock options. You want to keep advancing. So it’s extraordinarily hard to even think about the idea of not being a part of all that and all that coming to an end. You’re talking about something that not only pertains to your lifestyle and your ability to earn a living for your family, but you’re also talking about simply reinventing yourself in ways that you don’t know how it’s going to turn out.

 

Do you consider yourself a whistle-blower?

No, I don’t. I don’t mind if people call me that, because I think it’s a worthy thing. I consider myself as someone who’s just telling the truth, the unvarnished truth these days. I’m not trying necessarily to persuade anyone to believe a certain way. I’m pulling the curtains back, as I wrote in the book, to try to help people see something that I saw. In essence, what I think I’m doing is returning to my journalism days. I’m writing about things that I know and I know to be true, and hopefully using my journalistic skills to convey that and talk to folks.

The other thing is I’m not in a classic sense or even a legal sense a whistle-blower, in that I’m not a disgruntled employee of  CIGNA. I don’t have a smoking gun that says CIGNA is guilty of this or that or is defrauding the government this way or that way. That’s not my point. My point is that these practices are industry-wide and beyond a single company. I know that because I was not only a spokesman for two companies, but I was very much involved in doing a lot of work at the trade association level. I’m talking about things that are industry-wide and that pertain to for-profits as well as nonprofits.

 

When you wrote the book, was it a catharsis?

It was very difficult to start it. I kept procrastinating. I’d never written a book before, and I think for most people who’ve never done it, it’s very daunting to undertake. … I didn’t want it to be just another health policy book. And I certainly didn’t want it to be a tell-all book. That wasn’t my intention at all. It wanted it to be something that could inform people on a lot of different fronts. I wanted to go beyond healthcare, as well, and to describe how the public relations function works, often to the disadvantage of so many people…and how I came to realize all of this and why.

 

 

And now we as a nation are at some sort of a healthcare crossroads, I suppose. Is the spin machine still working just as well as it always has?

Oh, absolutely. Probably even more so. I call the bill the president signed into law “the end of the beginning of reform.” We probably always will be reforming our healthcare system, because our country and its needs will always change, and technology and the way healthcare is delivered will always change. The vested interests that have a stake in our healthcare system, who profit from it and who get paychecks because of the way it is, resist change. They will be doing constant spinning, and they will be continually using the dark arts of PR to persuade us to think and act in certain ways. It’s always going to be that way, I’m afraid.

 

The U.S. House recently voted along party lines to repeal healthcare reform, yet it seemed rather disingenuous to me. Republicans aren’t going to repeal healthcare reform, are they? You recently wrote in Newsweek that for-profit health insurance gave three times the contributions to Republicans as Democrats. Thus, aren’t those lawmakers’ strings being pulled by the health insurance companies?

That’s right, they are. I don’t suggest that every Republican politician is being disingenuous by believing that this is bad legislation and should be repealed. Many of us are really wed to our ideology and want to believe what we’ve been led to believe. A lot of folks, especially in this country, really want to believe and firmly do believe that the free market system should work in every area of our lives. They continue to hold out this belief that it can work in healthcare as much as it works in other sectors of the economy. It just simply does not, but they haven’t seen that yet.

One of the things I learned when I began testifying before Congress and meeting with members of Congress is that there’s a huge lack of understanding, a great ignorance about how the private health insurance industry operates. The reason I wrote the book was to try to enlighten people, including lawmakers. They just don’t understand, because they’ve never had any reason to really study it or get to know it.

Suddenly they’re lawmakers, and they’re making important decisions based on incomplete and often completely wrong information. A lot of information that lawmakers get comes from the insurance industry, and you can imagine the perspective they’re getting there. I’m not suggesting that they’re disingenuous, but just are acting in ways based on a very inadequate understanding of how the system operates.

 

On top of that, now more people than ever before will be buying health insurance, right?

The insurance industry comes across looking great in this bill. They helped write sections of it. They were able to accomplish their two main objectives. One, to make sure that there was a requirement that we buy their products, the individual mandate. The second objective was to make sure that there was no new competition, no public option. So, they got both of those. Those were big victories for the insurance industry. Now, they not only will get these new customers and their premium revenues that we will all have to pay to them, but if we can’t afford their products based on our income, we’ll get subsidies from the government. So they will have these incredibly rich revenue streams for many years to come, both from us and from the government.

 

But isn’t that better than where we were before?

Yes, it’s better. I’m not going to begrudge that. A lot of people do. A lot of people just can’t abide the fact that the insurance companies won any part of this, they just hate them so much. What I pointed out as the Senate was about to vote on this legislation was that I don’t like a lot about this either. This legislation is built on the current system and propping it up in many ways and enriching the insurance industry in ways that I think are not good. But, it’s as far as Congress could go, it’s all Congress could do. It brings a lot of people into coverage, or it will if it’s implemented as intended. Maybe that will keep some of these statistics from getting worse and maybe improve them. We have 45,000 people dying every year because they don’t have access to care. Maybe we’ll start seeing that number go down – and hopefully drastically.

 

Is there any good news out there for physicians, those people who actually care for their patients and have spent years in frustrating battles with insurance companies?

I think there are some things in this that are good for physicians. It tries to tackle the payment structure. I think by reining in these insurance companies a little bit, that should help not only consumers, but doctors. So, yeah, I think doctors should – and many do – embrace this. In fact, the AMA came around to endorsing it eventually. One value that’s overreaching is that organized medicine came to realize that the insurance industry really controls their healthcare system, not doctors, as they probably thought they once did. So the world has changed for them. While they have historically been opposed to more government involvement in the healthcare system, they see now the consequences of a corporate takeover of the healthcare system, and they understand the importance of curbing the power of insurance companies.