THE BLOG
08/24/2009 05:12 am ET Updated May 25, 2011

Healthcare Exec Turned Whistleblower Thinks America Needs Universal Coverage

To be a proponent of universal healthcare right now is only marginally more difficult than, say, being a New Jersey politician. Optimistic political newbies of the "Progressive" persuasion entered the healthcare debate with dreams of nationwide, single-payer healthcare. That was quickly downgraded by Hope's anathema, "pragmatism," to a public option, which was traded for lukewarm feelings about some kind of public-private hybrid model (with mandates).

Then, the public-private option was taken hostage by six moderate Senators, including ancillary Republicans, the "Blue Dog" Senators, who raised at least $1 million from the health and insurance sectors combined over the course of their respective careers. Meanwhile, President Obama's August deadline looms in the distance. Majority Leader Harry Reid expressed concern on Thursday that the Senate might not be able to provide for Americans' healthcare needs by the target date because the Senators have their own needs, namely the need to go on vacation where they will enjoy their government-provided universal healthcare coverage.

I interviewed Wendell Potter, the former chief PR person for CIGNA, one of the nation's largest insurers, about the kind of influence the healthcare industry wields over members of Congress, and the need for healthcare reform in America. While serving CIGNA, Potter was part of a group charged with discrediting Michael Moore's film, Sicko, which he now calls an "honest film." He is now a whistleblower for Big Health, an industry that he blames for leaving millions of Americans uninsured, underinsured, and misinformed.

Potter's change of heart began while he was visiting family in upper-east Tennessee, near the border of Virginia. It was there that Potter picked up a local newspaper and saw that a health fair was being held in Wise, Virginia by a group called Remote Area Medical (RAM). Curious, Potter got into his car and drove to Wise. He had no idea what to expect, but assumed there would be doctors and nurses conducting general health-screenings. Nothing could have braced Potter for what he saw when he reached the Wise County fairgrounds.

It was almost like being hit by lightening to see what I saw. There were long, long lines, people standing in line, sitting in a long line -- in the rain -- waiting to get free care that was being provided by volunteer doctors and nurses.

Today is RAM's tenth annual expedition in Wise, Virginia, and things have gotten worse. The volunteers are expecting 20 percent more attendees than last year, and citizens were already setting up camp outside the fairgrounds as early as Tuesday. (Click here to read my interview with RAM founder, Stan Brock.) Things are worse now, but they were still very bad back when Potter first attended a RAM expedition where he stood in the rain and watched poor people queue in animal stalls for their chance to see doctors. Something, Potter decided, was wrong.

He left CIGNA shortly after his trip to Wise, Virginia. In June, Senator Jay Rockefeller invited Potter to testify about the underhanded practices of the private healthcare industry before the Senate Commerce Committee (his full testimony can be viewed here).

But this all occurred before President Obama revealed his public-private plan. I wanted to know what a former healthcare insider thought of Obama's option, and what Potter thought of the dismissal of a universal healthcare plan. "All of us deserve access to care, so I think universal health care should be this country's goal just like other developed countries," says Potter, though he doesn't see the solution coming from the federal government. Though he fully supports a public option, Potter believes every man, woman, and child should have access to healthcare, and the only way to make that happen is with universal healthcare. However, Potter is optimistic that America might follow the Canada model for coverage.

In Canada, it began at the provincial level. I think it could possibly happen in this country at the state level. There have been a number of states that have looked at implementing a single-payer system, including California. In fact, California lawmakers have twice voted for a single-payer system that Governor Schwarzenegger has vetoed. And the state of Pennsylvania, where I live, is seriously considering a single-payer option, and it has a lot of Republican support. A lot of Republicans have signed on as sponsors. So it's something that could develop at the state level, and more than likely will be the only way it can happen in the United States.

Canadian care is delivered privately by doctors and hospitals just like we have it delivered here in America. A single-payer system in America would behave the same way. Potter emphasizes, "you would have publicly funded, privately delivered care." Not a government bureaucrat standing between a doctor and patient anywhere.

The main obstacle standing between Americans and universal healthcare is, of course, the private healthcare industry. The reason the "universal" option disappeared almost immediately from the conversation on the Hill is because Big Health flexed its muscle. Groups like "the health insurance industry, and like big PHRMA, and the pharmaceutical industry, and even the American Medical Association," Potter says are "looking out for the best interest of their membership. In other words, the health insurance trade group is looking out for the best interest of insurance companies. They're, ultimately, not looking out for the best interest of the individual residents and citizens of the United States."

The lesson was made painfully clear this week when six Senators, who are famous for sucking the teat of the private healthcare industry, successfully delayed the healthcare debate. Sadly, that's business as usual, Potter admits.

Here's how that works: The industry can pretty much rely on almost every Republican member of Congress. It seems, in my view, that they all are pretty much- if not "in-the-pocket" - certainly ideological allies of the insurance industry. So the way it's working is that the industry knows that they've got those votes, so what they're doing is devoting their resources right now to the Conservative Democrats, the so-called "Blue Dog" Democrats, any moderates who might be left in Congress - they're targeting them and trying to persuade them to see the world from their point of view.

Persuading key conservative Democrats to "see the world from their point of view" can include extremely generous campaign contributions. When the healthcare industry isn't busily buying the influence of Congress representatives, they engage in heavy public disinformation campaigns and dump sick people from their rolls in order to make more money.

Potter recently wrote an article titled "Health Care Industry Adopts Big Tobacco's PR Tactics" in which he details how the healthcare industry uses the same public relations firm that Big Tobacco has used over the years. "One of the favorite tactics of both the insurance industry and the tobacco industry is to set up front groups they fund, but that funding is not known to the public, to communicate the industry's points of view through these front groups," he says. These groups always have very altruistic names like the "Health Benefits Coalition," and their mission is to scare people away from additional government involvement in the healthcare system, say in the form of universal coverage or a public option.

Another Big Health-Big Tobacco strategy is to set up third-party advocates. "They'll look for individuals, and other groups that might have some connection either through business or ideology with the health insurance industry, and they'll feed those groups and those individuals with talking points to make sure that they have a lot of people and a lot of organizations expressing their points of view," says Potter.

This explains why the same handful of anti-public option buzzwords seemed to ubiquitously saturate the media: "Slippery slope toward Socialism." "Government bureaucrat between you and your doctor." "Rationing." These are not grassroots words adopted by citizens who fear universal healthcare. These are PR-molded buzzwords that are disseminated to satellite groups whose sole purpose is to kill a public option.

Recently, it was reported that President Obama has hosted at least 27 meetings with some of the most influential private health-industry executives in the country including representatives from the American Hospital Association, PHARMA, the AMA, UnitedHealth, Kaiser Foundation, Merck, HealthNet, and Pfizer. That kind of access is normal for Big Health, Potter stresses, which helps to illustrate the kind of daunting force Americans are battling in their fight to get affordable healthcare. "The industry is so rich, so resourceful, so powerful...They have hired lobbyists, who used to be members of the Congress, or the Senate, or staff members on Capitol Hill, they have tremendous access, and they have made contributions to members of Congress over many years, so they've got a cumulative records of making contributions - essentially buying influence on Capitol Hill. It's enormous," Potter says. Max Baucus is a perfect example of this. Famous for accepting vast donations from Big Health, Baucus also has former staff members who now work in the health insurance industry as lobbyists. Surely, one perk of being a former staffer to Max Baucus is that they now have the ear of their old boss when Big Health needs something from Congress.

The problem can't fix itself when Big Health remains a beast without compassion, concerned only with its bottom line. Things are so dire now that the healthcare companies have resorted to "dumping the sick," and screwing small businesses. If you buy your insurance, meaning an employer doesn't provide the insurance for you, the industry refers to that as purchasing insurance from the "individual market." When the insurance company starts to see "individual market" claims coming in, they go through them and look for any kind of "preexisting condition" that could possibly disqualify you, so they don't have to pay the claim. A preexisting condition can literally mean anything: high blood pressure, high cholesterol, or even acne, Potter tells me.

This kind of "purging" of the sick has gotten so widespread that many small businesses can no longer afford to provide insurance for their employees. "In 1993, 61 percent of small businesses were offering coverage to their employees. By 2008, it had dropped down to 38 percent," he says.

Even the temporarily healthy are paying a hefty price for their coverage. A worrying trend that Potter observed while working at CIGNA was the move toward "consumer-driven plans," a euphemistic term for shifting the financial burden from insurance company to consumer. These plans feature high deductibles and are really just another way for the insurance companies to make money from the suffering of their consumers.

Potter is unequivocal about who is to blame for the disinformation and governmental bribery behind the killing of universal coverage and the slow suffocation of the public option: "I saw that the insurance companies were directly contributing through their behavior, through their practices, to the growing number of the uninsured, and also to the growing number of people who are underinsured."

Unfortunately, it's difficult to get government representatives to care in the same way, particularly when their hands are shoved in the Big Health cookie jar. The universal option is dead in the water. The public option may be next, at least if Big Health has any say in the matter.

Wendell Potter's blog can be read here.

Cross-posted from Allison Kilkenny's blog. Also available on Facebook and Twitter.