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At what cost care?

For nearly 20 years, Wendell Potter handled sticky public relations situations at two of the nation's largest health insurers. His assignments, first at Humana and then at Cigna, included defeating the Clinton health reform efforts in the early '90s, discrediting Michael Moore's movie Sicko and defending Cigna's denial of a liver transplant for a teenager in California. The girl died hours after Potter announced Cigna had reversed its decision.

In the later stages of his career, Potter, now 58, began having doubts about his chosen profession. After retiring from Cigna last year as head of corporate communications, he decided to speak out. Now a senior fellow on health care at the Center for Media and Democracy in Madison, Wis., Potter has become increasingly vocal about the role health insurers play in making the U.S. health care system one of the most expensive and dysfunctional in the world.

In a phone interview from Philadelphia, Potter spoke about why President Barack Obama's push for health reform must include a public plan if there's going to be real change. He also laid out health insurers' strategy for fighting that option using charm, scare tactics and millions of dollars in lobbying and political contributions.

Question: When and why did you leave Cigna?

It was entirely my idea. I told the company in January 2008 that I planned to leave and I agreed to three extensions until they had someone on board to succeed me. My last day was May 2, 2008. I'd been at Cigna about 15 years and at Humana for four years before that. I was at the pinnacle of my career, reporting to the general counsel who reported to the CEO, so there was nowhere else to go. It was a good parting and I still have friends there. But I came to see things quite differently from most of them.

When did you begin questioning your career?

It started a couple of years before I left, when insurance companies started marketing very heavily what they called consumer-directed health plans. I just became very skeptical about these plans, which have high deductibles, particularly for people with chronic illnesses or who were older or have limited means. These plans represent a significant shifting of the financial burden of health care expense from insurers to consumers.

I remember being at a meeting where an expert was giving a presentation on these plans to company executives. He was being inundated with questions about how these plans would work for people of modest means or more likely to have illnesses. Eventually the speaker got exasperated and said, "This is the model we're going to, you've just got to drink the Kool-Aid and sell this stuff."

I knew then that I did not want to drink the Kool-Aid.

You've talked about how a trip to a "health care exposition" in Wise County, Va., in the summer of 2007 also affected your thinking.

I was visiting family in Kingsport, Tenn., and had read about it in the local newspaper. I was intrigued so I borrowed my dad's car and drove up there. I had no idea what to expect — I thought maybe they'd be doing blood pressure checks. But what I saw was stunning. I walked into the fairgrounds and saw hundreds of people standing and sitting in the rain, waiting for hours to get free care donated by clinicians. People were being examined in animal stalls, in tents, on gurneys on the rainy asphalt. It was more than I could bear. I asked myself, 'What country am I in?' People had come from Ohio, South Carolina, from my hometown; they'd camped out overnight and still some had to be turned away. Walking through there was like being hit in the stomach with a bat.

A few weeks later, I was on the corporate jet, with its luxurious, spacious leather seats. The flight attendant brought me my lunch on china rimmed in gold and she gave me gold-plated flatware and it struck me. I remembered the people in Wise County. Undoubtedly my travel was being paid for by somebody's premium dollars. It became even more evident to me that what I was doing was not right.

But hadn't you been aware of the millions of uninsured ?

One of my jobs was communicating to the financial media and we dealt primarily in numbers. How many billions we had made during the previous quarter, how many millions of members. You think in abstract terms and those numbers soon lose any real meaning. I was certainly familiar with the number of uninsured, but it's a high number you don't really put flesh and blood to. So it was stunning to see.

I think a lot of that is happening in Washington today. As lawmakers are debating health care reform, they don't really have a full appreciation of what it means.

What triggered your current activism?

A couple of days after the president's summit on health care in March, when he invited the leaders of the big trade associations to come talk about reform. I was watching Chris Matthews on MSNBC and I saw them patting each other on the back and promising to really work together, just like they did back in the early '90s. Then I heard Matthews say, "The cosmos has shifted, the worm has turned." And I thought, "Oh my God, hopefully he's saying that tongue in cheek."

I was among the people who helped develop the strategy used to defeat reform under Clinton and I know the playbook. I saw the industry conducting the charm offensive.

Soon after, I heard a congressman from Tennessee, Zach Wamp, talking on MSNBC about the problem of the uninsured. One of the industry's tactics is to diminish the problem by making people think a lot of folks are uninsured, or "go naked," by choice. And here this congressman was, saying half the uninsured are "going nekked" by choice and I realized he was using a talking point I wrote!

That's when I decided I had to speak out because I knew what was going on. The wool is being pulled over people's eyes once again. Maybe if I say something it will make a difference.

What else is in insurers' playbook?

They want to be seen as wearing white hats, as advocates of reform, while behind the scenes they're working to undermine reform. They're using big PR firms to set up front groups to engage in activities that scare people away from reform. They're warning of government takeover of the health care system, though nothing like that has been proposed. They're saying a public plan is the slippery path to socialized medicine.

They raise the scare of higher taxes and warn of more burdens on small business. I know they were high-fiving each other when the CBO's (Congressional Budget Office) estimate came out on the cost of health reform. But I know how the CBO works — they have to consider additional costs without taking into consideration what the ultimate benefit might be.

There's going to have to be government subsidies if we're going to cover people who can't afford insurance. But the system we have now is constraining economic growth and vitality. I believe reform that enables people to have alternatives other than through their employer or a private plan will revitalize the economy in ways people can't imagine.

How can the industry create such fear about a public health plan when people's experience with Medicare, the government insurance for seniors, is generally pretty favorable?

Health care is complicated and the insurance industry has been using these scare tactics successfully since the Truman years. In the absence of a public plan option, expanding coverage to the uninsured creates potential customers for insurers, with the government subsidizing the premiums. It's a no-lose proposition for insurers.

If people want to ensure a public health plan is part of reform, what should they do?

Call or write a letter to your congressman and do it soon. There needs to be a movement from the people to counter the huge amount of influence special interests have in Washington. People also need to be more aware when they see TV commercials and hear politicians say stuff. They need to ask, "Where is that coming from? Who's paying for that?" The industry has its allies on Capitol Hill and they feed them the buzzwords. I hear them coming out of lawmakers' mouths.

Kris Hundley can be reached at khundley@sptimes.com or (727) 892-2996.

At what cost care? 08/01/09 [Last modified: Monday, August 3, 2009 10:13am]

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