Wendell Potter to Congress: Go Ahead, Please Make Our Day

Submitted by Wendell Potter on

Politico is reporting that Congressional Republicans want to force their colleagues in the House and Senate who vote for a public insurance option as part of health care reform to enroll in that public plan when it becomes available.

I think Democrats ought to call their bluff and pledge to be the first to sign up. If they do, they will have to shove me out of line. I would love to have the option of enrolling in a public plan that offers a decent standard benefit package at a more affordable price. I am sick and tired of knowing that only 80 cents of every dollar I pay in premiums to my private insurer goes to pay doctors and hospitals for care they provide. (This figure is down from 95 cents in 1993 before the industry came to be dominated by a cartel of high for-profit insurance companies like the two I used to work for.) I am eager not to have to donate 20 cents of every premium dollar to cover my insurer's sales, marketing and underwriting expenses and to help make the CEO and the big institutional investors and Wall Street hedge fund managers even more obscenely rich than they already are, thanks to the inflated premiums we have to pay.

Here's what Politico reported:

Rep. John Fleming (R-La.), a family physician, kicked off the quixotic bid last week, urging House members to give up their right to participate in the much-revered Federal Employees Health Benefits Program if they support a government-run program as part of the health care reform package.

Sens. John McCain of Arizona and Tom Coburn of Oklahoma are pushing the same concept in the Senate, preparing separate amendments that would require members -- and maybe even their staffs -- to sign up for the public option. With Democrats firmly in control of Congress, the idea is not likely to gain traction. Proponents of the public plan say the resolution would do exactly what Republicans have warned against, undermining the private insurance system by moving people into a public plan.

But the effort has caught fire in the right-wing blogosphere and on talk radio, serving as a rallying point for conservatives opposed to one of the top priorities of Democrats... Newt Gingrich's Center for Health Transformation is promoting Fleming's resolution on its website and started an online petition titled "Good Enough for Congress."

After Democrats call their bluff, I would counter with this: Every member of Congress who votes against the public insurance option must enroll in one of the high-deductible plans like the one that CIGNA forced me into a few years ago, against my wishes. (I am a former CIGNA employee, so CIGNA was both my employer and my insurance company.)

Opponents of health care reform raise the specter of the government forcing us out of health care plans that we like. In reality, our employers and insurers are doing this to us already. While employed at CIGNA, I was in a PPO that I liked, until the company decided a few years ago to force all if its employees out of their HMOs and PPOs and Point of Service plans and into what the industry refers to, misleadingly and euphemistically, as "consumer-driven" plans. It was a take-it-or-leave-it deal. If I didn't want to enroll in the high-deductible plan that CIGNA offered, I could join the growing ranks of the uninsured or try to get coverage through the individual market. That wasn't really an option. I was in my 50s and could not find a decent plan that I could afford, because insurers are free to gouge us when we reach a certain age.

In a high-deductible plan, enrollees have to spend a lot more money out of their own pockets before their insurance coverage kicks in than they had to spend in their HMOs and PPOs. These plans are fine for people who are young, healthy, and not accident-prone. and wealthy. It also helps to have a better-than-average income. In other words, a high-deductible plan might be exactly what you're looking for if you don't really need decent insurance now and can afford to shell out thousands of dollars of your own money in the event you get hit by a bus. The rest of us, however, might want to steer clear of this sort of plan -- if we had the choice.

More and more companies are doing what CIGNA did -- forcing their employees out of the plans they like and into plans they don't. Another big insurer, United Healthcare, did the same thing to its employees a few years ago. If it hasn't happened to you yet, just wait. Insurers are eager to send HMOs and PPOs to the ash heap of insurance history, which is where they sent traditional indemnity plans several years ago.

On second thought, it might be good to give members of Congress who vote against a public insurance option the choice of enrolling in one of the limited-benefit plans being promoted these days by insurers -- including the huge for-profit insurance companies that now dominate the industry. The premiums for these plans are a little lower than plans that offer comprehensive coverage, but they often don't cover things most of us have grown to expect. Little things like hospitalization. Such a deal.

Now you see why the insurance industry insists on being able to charge older folks a lot more for coverage than younger folks and why it is insisting on "benefit design flexibility." They want to have the flexibility to "design" and force us into plans that cover less and less and cost us more and more. That, readers, is what your private insurance company has in store for you if Congress fails to pass meaningful health care reform legislation.

By the way, insurers including CIGNA are now also marketing these limited-benefit, high-deductible plans as "voluntary." This means that your employer would allow you to enroll in these type of plans at the workplace but make you pay the entire amount of the premium. That's right, employers in the future will not have to contribute one thin dime toward your coverage. Future, heck, many are already there. A growing number of employers are already "offering" these plans to their employees. CIGNA offers such coverage under the brand name Starbridge, which "enables companies to offer a limited-benefit plan that is affordable and does not require employer contribution." The underwriting guidelines for Starbridge make it available only to employers who have at least 70 percent annual employee turnover and who have fewer than 65 percent female employees. Also, the average age of the workforce has to be 40 or younger. You're right if you think the profit margins on these plans are high. How could they not be? Cha-ching!

I encourage every member of Congress, Republicans as well as Democrats, to do a little research into what Big Insurance has in store for us before voting on legislation this summer or fall.

This is why I left my job and why I am speaking out.

Wendell Potter is the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin.

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Comments

Anonymous replied on

Welcome to the fight for single payer health coverage. I don't believe that anyone should make an excessive profit on the illness of someone else. Yes, of course, doctors and nurses should be well paid. Drug companies should make a reasonable profit. But insurance companies are the bloodsuckers of our society. We have to unite to defeat their strangehold on our lives.

Anonymous replied on

Why doesn't the government reform insurance companies instead and let healthcare be healthcare again? Or maybe they should regulate the pharmaceutical industry? What?! No WAY!? WHY? Because they all have their hands in each other's pockets!

One small voice replied on

Mr. Potter is a very honorable man for shedding light on the truth about the insurance industry and for furthering our insight into Washington politics. Fortunately, I have insurance through my school district. Unfortunately, my husband, who is unemployed, is not insured; COBRA would require back payments plus $800 of the $1400 he receives in unemployment. Our boys are not insured. Can you imagine me telling them, "no, don't climb the tree, what if you fall? Be very careful riding your bike, if you broke your arm we could lose our house." Imagine being the child that is constantly made to be conscientious of their every move for fear of causing their family such a disaster. I have not been to a doctor in well over 8 years fearing that if I am diagnosed with something my family will descend into a financial freefall because we live on the edge. So, my question is: What Now? How do we stand up to the tactics of big insurers and make our voices heard? Mr. Potter is obviously a well-educated man well-versed in the art of PR. Is it possible for a grassroots effort to rise up against the powers that are holding us back from living a life that is free from fear?

Janice Giaco replied on

I'm not old enough to have lived when children were worked to death in factories. Perhaps this health care crisis is the equivalent in our day. I know of friends and family who have high deductable/high co-pay insurance. THey can't go for a yearly Pap smear, or Mammogram because it is way out of their reach... I am an Rn who watched a 40 something man pace the halls worrying how he was going to pay for his cardiac cath and my other patient who contentedly passed the hospital stay because he had worked for the railroad and had a "great " policy with 3 dollar prescripton co-pays. What makes the difference between these 2 persons? they are both HUMAN BEINGS that deserve care, and deserve not to have to worry themselves sick over the bills they may face....Thank you for speaking out

Randy West replied on

True in that the HC insurance companies are forcing us into some crazy plans but at the same time, Govt. healthcare is not a good idea. Governments are well known for fudging up most everything and if they are running the show on our healthplans you can't expect it to go well...I expect we'd end up like the Canadians or English with only the rich being able to afford care at all. At least with the private plans we get some decent coverage vs. what the avarage citizen in Canada or the UK gets. Reform is needed, no doubt, but the Govt. needs to set the stage and regulate and let private companies work the details. If we let them run it god help us. "Abandon All Hope Ye Who Enter Here"

Mutternich replied on

<blockquote>Govt. healthcare is not a good idea. </blockquote> How many times to you have to be told? In every other western democracy, government health care has worked well! <blockquote>Governments are well known for fudging up most everything...</blockquote> Well yes, U.S. governments, especially when the Republicans are in. Do you want to know how our government has already "fudged up" our health care? By allowing the bloodsucking for-profit HMOs to take it over, that's how. You want to know what doesn't work? That tired "socialized medicine doesn't work" mantra doesn't work. People are fed up with hearing it, and the for-profit insurers are sweating. You'd think the dittoheads would have realized that by now.

F.Lawrence replied on

Randy, correction: you wrote ,if we adopt a health care system like the British and Canadians only the rich will be able to afford health care. It's in AMERICA today that only the rich can afford health care. . RE: the government can't do anything well. Correction: the U.S. military works very well, wouldn't you agree? No one seems to be trying to ditch their medicare policies for private ones; why do you suppose that is?

Anonymous replied on

I heard Mr. Potter's story about going to his home town in Tennesee and seeing the "third world" scene as ordinary people tried to get some health care. Coincidentally, and not to pick on Tenn, I had just Googled "what if I lose my health benefits" and in the large amount of empty hits that amounted to "give us your money and we'll give you an unpredictable product" I found a column from a paper in Chatanooga where the writer was helpfully explaining that Walgreen's offered monthly (or biweekly?) blood pressure checks, etc to the unemployed. I appreciate the great job some of Congress is trying to do on health care reform. I dread the results the Senate will come up with. So many say this is a complicated issue -- it really isn't. Why should Americans have to beg around the back door to be covered for health care while our government trades with our tax money and in some cases directly aids with our tax money in countries that have better access to health care than we do? And the elected officials who carry out these policies are covered by health plans paid for by the US taxpayer, of course. The principle of risk, on which private insurance is based, is fundamentally incompatible with the uncertainties of human health, and therefore private insurance is fundamentally incompatible as the primary source of health coverage, which is why this model has been abandoned in every other country that's tried it. As a secondary source, private insurance is extremely important and is available in all countries that have national universal health coverage (that's why I hate the term "single payer" -- it sounds like there's only one choice which is both misleading to Americans and also is not consistent with the choice Americans value). The public must drive the public health system in this country. Privately driven public health doesn't work -- we're living with the results. I can't emphasize strongly enough how critical I think it is that we come up with a serious, expensive national advertising and PR campaign NOW, through the summer, that counteracts the adversaries' talking points. It's so easy! No, it isn't true that a public option would limit choice. No, it isn't true it would cost more - we already speand twice as much as the next country behind us on health spending. No it won't mean health care is "rationed" -- what are we doing now, telling Americans they can't get care? But we'll spend more on prevention and less on massively interventional procedures in the last two weeks of life. No it doesn't kill innovation -- the latest research in medical innovation out of Wales (corneal transplants) and Australia (nanotechnology for cancer treatment) prove this. Real innovation will be rewarded with profit here, as it is elsewhere. Explain exactly where our health care spending goes now -- post the names of the CEOs in Big Health Care and the profits they've made this year. Compare costs with other high-GNP countries like Canada and Britain and ourselves. Run an ad showing a woman like the President's mother, ill, trying to spend as much time as she can on the phone with an insurance company that's arguing with her about saving her life. Run an ad showing a family that finds out that saving a loved one's life is going to cost them their savings and put them into bankruptcy. Run an ad showing a young person who has a hospital bill and has to decide not to return to school in order to pay it. Yes, jobs in health care will be lost. Buildings full of billing staff (maybe me, too -- I'm a medical coder) and legions of administrators, three out of four in every American hospital are there ONLY for third-party payer issues, will learn to do something else -- these may be good jobs, but most of them don't exist anywhere else because they're built on the unique excesses and redundancies of our health system. And not to be hyperbolic, but essentially these jobs are built on the traffic in human suffering. And at least these displaced workers will have health coverage while they re-train. Let's get one of our best ad agencies on this now. Right now. It's going to be a difficult summer. Thanks, Mr. Potter.

DLG replied on

Dear Wendell - Thank you for speaking out on this issue. I have worked in managed care for over 6 years now in varied positions. What my professional experiences in managed care have taught me is that yes, it is all about the bottom line no matter if it is a for profit or a non-profit. We are in need of desperate overhaul of our current system which is so complicated to all parties involved. Consumer Driven healthcare is a complete debacle. I too once was forced into such a plan. My premiums still went up and at the end of the day, it did nothing more for promoting my health and wellbeing. I ended up not going to the doctor at all because nothing was covered. At any rate, I hope you read this e-mail. I would love to join your efforts somehow. I have so many ideas in terms of fixing healthcare but have no mechanism to do so.

Joanna Joshua replied on

This message is for Wendell Potter. I am the daughter of Jo Joshua Godfrey, a Cigna Victim, who experinced first hand the atrocities outlined in your interview with Bill Moyer. She had lung cancer for years, however Cigna failed to inform her of this, even though they documented it in her medical records. She had a lot of media attention, so I am sure you are familiar with her case. Jo has recently released the press release below and created a website: unitedpatientsofamerica.org. "They Figured It Was Cheaper to Kill Me" Stevenson Ranch, CA, June 24, 2009 -- "They figured it was cheaper to kill me than to treat me," says lung cancer survivor Jo Joshua Godfrey of California, who beat gross insurance mismanagement in the nineties -- and now lives to talk about it. She testified before the California legislature and even helped deliver caskets to key legislators in protest. Now, after seeing a daughter and a grandson suffer at the hands of insurers, she is launching a non-profit to help reform health insurance, and plans to tell her story to local, state and federal legislators and other decision makers. "The goal of United Patients of America is to give a voice to people and families who feel they have been abused by insurers. It's an organization for the people. We want to provide people with resources and, as we develop funding, help to intervene in some cases," Godfrey says. The website includes testimonials as well as news on insurance runarounds and abuse. "If Congress is going to reform healthcare, they need to understand the problem. This is not a political issue. It's an issue about people, profits and proper oversight like with the banks," says Godfrey, a controller for a group of real estate holding companies. "More government is not necessarily the answer," Godfrey says, pointing to a U.S. Supreme Court ruling1 (Aetna Health, Inc. v. Davila) that she says cleared the way for HMOs to abuse consumers. "Government can impose policy caps and indemnities that do more to protect insurers than policyholders. --What we definitely do need," she emphasizes," are clear rules and real oversight." In her well documented case, after more than a dozen visits and x-rays for "breathing difficulties" at in-network medical clinics during a two-year span in the early nineties," Ms. Godfrey fought to see a physician outside the Cigna network. A Cigna employee stuck her neck out to give Godfrey her "lost" records. The outside physician quickly diagnosed the lung cancer -- and said it was evident on even the earliest images. The insurer also revealed that Ms. Godfrey had been treated at the clinics by physician assistants rather than physicians. Ms. Godfrey underwent surgery to remove the tumor and lymph nodes, and has been cancer free ever since. "Health insurance should not be abusive," she says. Ms. Godfrey has hired a New York area PR agency and is working with HealthCareforAmerica.org to get the word out on Capitol Hill. Need for Health Reform Systemic problems with health insurance persist and can threaten people's lives and quality of life, says Godfrey -- including now two more generations of her family. During her ordeal, Ms. Godfrey's then teenager daughter, Shannon, suffered chronically from acute headaches. She was misdiagnosed and treated for sinus problems at Cigna clinics when in fact a diseased bone was pushing through the orbit of her eye, threatening her eyesight. Last summer, another insurer denied coverage for her year-old grandson, Dylan, even though his cranial defect would present long-term difficulties that early intervention could correct. California law forbids such refusals, according to Jamie Court, a consumer advocate familiar with the case. Beyond care management, local access is another issue. In the case of two adult daughters, the nearest in-network doctor was more than an hour and a half's drive from a major city. Earlier this year, Vermont fined Cigna HealthCare and Magellan Health Services which contracts with Blue Cross Blue Shield, $20,000 for operating so called "phantom" provider networks -- listing doctors not actually accepting new patients.2 Vermont law requires insurers to update their lists every six months. "It's the same old story," Godfrey says. "What we have today is a system of delays, disavowals and denials -- with little or no oversight. Instead of helping to ensure health, companies try to deny coverage, and if they must pay, they look for any reason to delay or minimize payment. They can be really heartless. They try to outlast patients with cancer and other terminal illnesses -- people who can least afford it financially or emotionally -- and hope they will just go away." A determined smile crosses her lips. "They may be able to outlast some people, but as we get the truth out and we organize, they can't outlast us all."

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