Health care reform

Mr Potter sees the light on the health care industry

A different view of the debate from Kristoff in the NY Times this morning…

Opponents suggest that a “government takeover” of health care will
be a milestone on the road to “socialized medicine,” and when he hears
those terms, Wendell Potter cringes. He’s embarrassed that opponents
are using a playbook that he helped devise.

“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for
nearly 20 years before his conscience got the better of him. He served
as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block
health reform, he says. He rode in limousines to confabs to concoct
messaging to scare the public about reform. But in his heart, he began
to have doubts as the business model for insurance evolved in recent
years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael
Moore’s excoriating film about the American health care system. Mr.
Potter was taking notes so that he could prepare a propaganda
counterblast — but he found himself agreeing with a great deal of the
film.

A month later, Mr. Potter was back home in Tennessee, visiting his
parents, and dropped in on a three-day charity program at a county
fairgrounds to provide medical care for patients who could not afford
doctors. Long lines of people were waiting in the rain, and patients
were being examined and treated in public in stalls intended for
livestock.

“It was a life-changing event to witness that,” he remembered.
Increasingly, he found himself despising himself for helping block
health reforms. “It sounds hokey, but I would look in the mirror and
think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his
stock options. “How can I walk away from a job that pays me so well?”
he wondered. But at the age of 56, he announced his retirement and left
Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said.
“I wouldn’t be getting any more calls from recruiters for the health
industry. It was the scariest thing I have done in my life. But it was
the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance
industry, and respected them. They are not evil. But he adds that they
are removed from the consequences of their decisions, as he was, and
are obsessed with sustaining the company’s stock price — which means
paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A
second is “rescission” — seizing upon a technicality to cancel the
policy of someone who has been paying premiums and finally gets cancer
or some other expensive disease. A Congressional investigation into
rescission found that three insurers, including Blue Cross of
California, used this technique to cancel more than 20,000 policies
over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported,
insurers encourage this approach through performance evaluations. One
Blue Cross employee earned a perfect evaluation score after dropping
thousands of policyholders who faced nearly $10 million in medical
expenses.

Mr. Potter notes that a third tactic is for insurers to raise
premiums for a small business astronomically after an employee is found
to have an illness that will be very expensive to treat. That forces
the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage
through mandates and subsidies, so as to give them more customers and
more profits. But they don’t want the reforms that will most help
patients, such as a public insurance option, enforced competition and
tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also
believes that a robust public option is an essential part of any health
reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has
been proposed for nearly a century in the United States. It was in an
early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering
industry lobbyists. That may happen this time as well — unless the
Obama administration and Congress defeat these manipulative special
interests. What’s un-American isn’t a greater government role in health
care but an existing system in which Americans without insurance get
health care, if at all, in livestock pens.

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