Wendell Potter to Congress: Go Ahead, Please Make Our Day
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.
Comments
Wendell, I just wanted to
Wendell, I just wanted to thank you for your courage on speaking out. You have so many people backing you. Keep up the good job.
Insurance Plans
I am currently with a staffing company as my employer. The only plan available to me, if I am working, is a limited benefit plan. I don't even bother. Partly because my work is so sporadic, and partly because it really doesn't cover anything.
I have spent most of my adult life without insurance and most likely will continue to do so until I qualify for Medicare, assuming it is still there when I retire. I have not seen a dentist since I fell off my father's insurance as an 18 year old. I pay for my vision care out of my pocket. Thank God I am healthy and have decent genetics and have not yet run into a major problem. If I were to be diagnosed with cancer or a severe chronic health condition, most likely I would die; since I refuse to go run up medical bills that I would never be able to pay.
Some clarifications for you, Mr. Potter
Mr. Potter,
You, as a former member of CIGNA's communications team, should know that the case of the 17 year-old girl in California was an ASO. This means that CIGNA denied her coverage because her parents' employer did not choose to cover it with their self-funded insurance plan.
As for the voluntary plans, you should also know, that the employers that choose to offer them when they have not offered insurance, in any form, to their employees. They tend to be very low-wage workers, but not low enough to qualify for Medicaid. These plans are a huge benefit to the workers who are able to enroll in them.
Finally, high-deductible, HSA eligible plans are only "bad" if you are a person who wants every test for every little thing that goes wrong. I'm sorry that someone tried to get you to take control of your own health. I'm guessing you're a 50 year old man who has high-cholesterol, high blood pressure, and hasn't seen a gym in years.
I'm sick and tired - of rationalizations
A sporadic employer who makes glorified-temps pay for their own bare-bones insurance isn't doing anyone any favors, good intentions aside. That temp could end up in a commuter accident while rushing from one to the second job probably required to survive, or heading to/from a gym for that matter.
That low-wage temp will never be able to save for a catastrophic accident or illness. You, my dear gym-subscriber, will pay for that accident or illness eventually. The insurance magnates will get rich covering pretty much nothing.
A gym will not protect you from cancer, from accidents, from genetic predisposition to heart attacks, or from an aneurism. As I recall, the father of the jogging movement died of a heart attack - while jogging. If he'd survived, he'd have needed full coverage.
The best solution right now is to make low-wage workers eligible for Medicaid, which covers everything regardless of preexisting conditions - which, btw, the man who spent 15 yrs in Cigna knows full well insurers always manage to find. Latest one I heard of: a woman's adult daughter got denied insurance for seeing a doctor twice for "knee problems" as a teen. No surgeries, no chronic problems. Her knees probably hurt from playing basketball or soccer or jogging - nice, healthy pastime. Good grief.
To Anonymous
First of all I have the courage to state my name. I have CIGNA as my health insurance and my 4 year old daughter has a tracking problem with her eyes. Tracking as in they don't track at the same time or what other children tease and say "monster eyes". We've had surgery when she was 2 to help fix them, however, she goes to a specialist every 3 months to see if they are improving and if she needs another surgery. CIGNA will NOT pay for most of the bill because they say it's refraction and they only pay for refractions one time of the year, you know like when you have your yearly eye exam. CIGNA doesn't call it MEDICAL because it's a refraction examination even though her condition is MEDICAL and the REFRACTION is NEEDED for this medical condition. They are by far the worse insurance company I've ever had. So before you get too righteous, my daughter has done NOTHING WRONG other than be born with an eye defect, and if I knew who to contact to spread this all across America I would do just that. Does anyone have any information so I could help get the word out about what these insurance companies are doing to people?
Thank you,
reply to clarification to Mr. Potter
In response to the person (no name) who tried to blame an employer for killing a 17 year old girl by refusing to cover a liver transplant...My sister is an HR person. She has a bachelor degree in Human Resources and several years experience. When complaining to her about my own experience with Humana--my cholesterol tests were being denied as interchangebly medically unnecessary and experimental, she advised me that my HR department should have selected the test for coverage. What? She explained that she picks out what is covered under her company's health plan offered to their employees. She decides. My sister's medical degree, well, she doesn't have one. My sister's experience in the medical field, a doctor's office, any medical institution at all? None. It's shameful to put people in situations where they have to choose based on cost to cover medical services-it's an impossible choice. And yet this choice is being made everyday by insurance companies. A public option would hurt only the CEO paychecks, and stockholder portfolios. But the up side, people could have liver transplants covered, oh, and cholesterol tests too. Mr. Potter, please find a way to get President Obama's attention. Thank you so much for shining the light-I'll be standing right behind you in line to sign up for a public option.
"I am sick and tired of
"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 hugh for-profit insurance companies like the two I used to work for.)"
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It is estimated that social services dollars spent by the government, 25% of the spending reaches the intended recipient. This will end well!
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Government is paying for 50 percent of the health care right now in our country. We will make it better by government paying for 90% of health care. I like this logic!
Claims Without Sources
You have sources for these figures Mr. Stewart?
If you don't get the logic,
If you don't get the logic, let me give you a little help here. "Government" is your money, taxpayers money. It's all your money, whether it comes from your taxes or your individual pocket. So it's your money that pays for health care, however you look at it.
The difference is that if you demand that "government" (you, directly) pay for health care, as the Brits, Canadians, Taiwanese, French, Japanese, etc. etc. etc., do, you won't be paying 20 cents (actually, Wendell, I am sure you know that it is often up to 50) out of each dollar to push paper around to divide people up into pools, plans, marketing, etc. to make sure that they never enroll those annoying and unprofitable sick people. And the high CEO salaries that Wendell used to have. Ah! And also those extraordinary prices we pay to Big Pharma because we lack the collective purchasing power that patients in other countries have.
And that is for starters some of the things that you get when you "pool risks" through a fully publicly financed system (for medically necessary services, I have no problem allowing insurers to make money from somebody's unhappiness with their nose that leads them to a cosmetic surgeon).
That much better use of your money is what you get once you give up on the myth that comparative shopping for health care policies is no different from comparative shopping for laptops, or designer shoes.
Okay, okay, not that simple. I agree that to make a full case you need more details. So here they go:
http://blogs.kqed.org/healthyideas/2009/05/20/the-elephant-in-the-room/
But believe me, the last thing we need is yet another garden variety of a "uniquely American solution". So I must disagree with Wendell that a public option will get us anywhere.
After all the horrible things we've always suspected or known about for profit insurers (and that Wendell so courageously has confirmed), why would anybody want them to be in charge of our health care at all? Why not just have Medicare for All?
I'm sick and tired - of irrelevant comparisons
Jimmy, "social services" includes sheltering abused or neglected kids, qualifying for and disbursing childcare and housing and transportation vouchers and food stamps, vocational training, tracking deadbeat parents usually dads, etc. The valid comparison is one you either haven't heard about or choose to ignore: Medicare vs. private insurance, 95-97% of cost directly paid for actual medical services and products under Medicare, vs. 80% and the other 20% to profit and/or mismanagement under private insurance.
There's also the issue of accountability. If your govt leaders run Medicare badly, raising your costs and reducing your access or worsening your outcomes, you can vote out the leaders. Can you honestly fire your private insurer and find competitors of equal price/access when you wish?
Percent spent on services
Well said by Activist.
If private insurance for under 65 people is so good, why don't members of Congress not cancel their special government insurance coverage and go to private health care plans like the rest of us? If "government ran" health care is so bad, why aren't these congressmen complaining about it? Ah ha!
Ask yourself, of those you know on Medicaid, how many are complaining about the service? With Medicare, there are deductibles and people usually get a Medical Supplement policy to cover what Medicare won't pay. There are various Standardized plans to choose from at different rates.
I say expand the coverage members of congress have to all citizens! We're going to pay for our health care one way or another, whether we pay insurance company premiums plus most of our health care, or whether we pay in taxes. We pay, period.
What is everyone so afraid of? Right now, well-compensated CEO's are the ones who determine our health care and what kinds of treatments we receive - not our doctors! Doctors can only recommend - these companies decide, based on the profits shareholders are demanding.
We ought to be the drivers here - instead we allow ourselves to be the driven and we don't get to tell the driver where to go. You can only control your congressional representative if he/she knows your vote counts, but individually we are weak. We each individually can't afford a lobbyist to threaten a representative with not being re-elected. But in the next few weeks, it will be vitally important to get the word out there. Maybe if everyone sent pink envelopes to their Congressmen with just the same simple message: vote YES to public health care (or if opposite, send whatever letter you want) maybe they would get the message while lobbyists are threatening to damage their re-election campaigns if they vote for the bill.
Not true
Sorry, but the statistics you're quoting are not true. Medicare and Medicaid have a 3% overhead, as opposed to the bloated health insurance corporations who spend a fortune paying executives, denying claims, marketing etc. Additionally, hospitals must have entire departments dedicated solely to billing varying amounts to the many insurance companies and their many plans: a tremendous waste of money and energy.
One needs look no farther than the insurance/medical complex to see a huge wasteful bureaucracy. I don't know about the other social service plans that you are referencing with your large, indistinct useless statistic, but medical insurance is done extremely efficiently by the government, and would be even more efficient if they were allowed to negotiate the price of pharmaceuticals.
Health Care Reform
Thanks for standing up for patients. It's time that everyone should have the opportunity to be covered by health insurance. I have a preexisting condition and had to pay over $800 a month for Cobra insurance while I was between jobs. Explain how this is fair to those of us who do our best to be productive citizens. I just watched Wendell Potter on MSNBC's Ed Show and was very glad to hear someone speaking the truth about why Health Care Reform must pass.
Short-term profits for insurers, long-term misery for us
Mr. Potter:
Thank you for so clearly laying out the connection between Wall Street and the insurance industry on "Bill Moyers' Journal" and "Democracy Now". We have seen so many instances of the short-term mentality leading to disastrous public policy decisions. There is too much at stake to allow financiers to warp this initiative. Our health care system is our international shame. The rest of the civilized world has recognized the fundamental right of the individual to decent health care-- it's time the United States got on board. Your courage in speaking out is an invaluable contribution to this process. Thank you again.
Profile in Courage
Dear Mr. "My Hero" Potter,
I was becoming faint with the onslaught of Snakes and Jellyfish in the Menagerie swarming slitherily around putative health care reform. Then I saw you on Bill Moyers & The Ed Show and feel awash with joy. I only wish you could be chained to your blog & tv until folks get the degree of catastrophe of our medical-industrial-complex insurance corporation-dominated ATM-for-Them 'system.'
The medical-industrial-complex insurance corporation, MICIC (mick-ick), 'system' has slid from gruesomely sad-&-bad into evil.
They have put rapacious Wall Street and medical-loss-ratios between any of us and our doctor. I paraphrase you saying that their stock price depends acutely on how many people they can rescind, purge, or force into fake insurance. They win by their customers losing. It is revolting. It is capitalism gone odiously amuck.
The equivalent of every child, woman, and man in the whole states of Georgia, Indiana, New Jersey, North Carolina, and Virginia have zero health coverage in our USofA. This. is. shamefull.
Wendell Rocks is on my teeshirt. Keep your heart bright and keep talking & blogging, I implore you.
Wendell Rocks
You go sister! I just saw Wendell on The Rachel Maddow Show last night, and I said my hero!
Mr. Potter, I just watched
Mr. Potter,
I just watched your interview on Democracy Now and was fascinated. Mr. Potter you may be our single best hope for real healthcare reform.
Please, please, please continue - with haste - your education of the American public as we are truly lost in the woods, and of course, the for-profit insurance companies don’t want us informed.
At the moment I’m very fortunate as I have a good policy through my employer. Unfortunately, as a result, my co-workers tend to fall for the insurance industries scare tactics. What they don’t understand is that it is just a matter of time before our employer will no longer be able to offer us a choice of comprehensive plans or that they might be let go during an economic downturn losing any possibility of affordable coverage. God forbid they have a pre-existing condition.
Even with my “good" plan (which is costly, not portable, and is rationed by the insurance company) I’m only one serious illness away from financial ruin due to denied coverage. Why there even needs to be a debate over our current system that is riddled with health care bankruptcies and the under / uninsured is proof to the strength of healthcare lobbyists.
Why Americans wouldn’t take their chances with a “Washington Bureaucrat” (which we can throw out of office) over a for-profit corporacrat is testament to our collective confusion created by the Healthcare Industrial Complex.
God bless you Mr. Potter.
Thanks!
Thanks Mr. Potter for saying what everyone was thinking!
Our government has given license to the insurance companies at large to rape and pilfer the American People for a long time now. The insurance industry is the only business I know of that wants your premiums paid in a timely manner, but is really in the business of screwing people out of the very service they sell them. We need to return to a time when we are sincere in the way we treat and relate to one another. Capitalism has sucked the life out of doing what's right in exchange for profits.
Wendell, my hero
Wendell, you are a hero. Might I suggest you take some of all that cash you made and support the effort.
Wow, what a day that would be.
Perchance, you may have done this already and I don't know. If so, I'm sorry for suggesting it.
Please speak louder. Bill
Please speak louder. Bill Moyers,The Ed Show,Amy Goodman--not enough people are seeing your story. Your interview with Bill Moyers,especially the health expo pictures and the discrediting of Michael Moore ,along with seeing the movie Sicko, should move anyone to the side of reform. I hope you are not being shutout by design.
Welcome to the fight for
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.
Why doesn't the government
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!
So what now?
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?
health care in america
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
HC Reform
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"
Govt. healthcare is not a
How many times to you have to be told? In every other western democracy, government health care has worked well!
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.
HC Reform
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?
Health care adversaries
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.
Thank you for taking a stand
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.
Cigna Victim
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."
Utility model
Wendell and Co.
Glad to have come across your blog today for the first time.
I've often wondered: Why not implement the "public utility" model for health insurance?
That means private insurance companies continue to exist, but are regulated by an "insurance utility board" in each state. The board is charged with making sure insurance companies are providing sufficient service to all customers, have enough in reserves to pay all claims and cannot make more than a 15 percent net profit each year. I have not run any numbers on this kind of model, but would that likely bring down premium costs?
Make them put their money where their mouths are.
A bit of a turn of the tables, I suppose but:
I propose that all members of congress and the executive be given a choice: Endorse single-payer universal health care or give up the coverage you receive as part of your compensation and shop in public (with the CBO's allowance for your coverage) for coverage in the marketplace. A written and televised (c-span, under oath) report of your findings will be a requirement. Written portion in your hand if you are able. Other wise notarized and not by an attorney.
So there. If you think this system is so #$@%*&! great, YOU try it. Put your health where your mouth is.
Can we take it away from them since we pay for it?
Thank you - for Standing for Humanity and Conscience
TO mister Potter, i was just reading an article in Commondreams.org about yourself: from being a very powerful individual, in the clearly "profiteering upon human suffering and need" insurance industry, to one that is doing what he can to reclaim his own conscience and humanity. In all history , we know that the poor, defenseless, powerless always have to eke out a living and while losing to the powerful and wealthy..and one loses hope almost that it can ALSO be from among those that had been in your own position that SOME sense of justice and humanity can come from within such a cruel system towards so many others in this world, rather than always having to come from the longing and suffering majority of people anywhere..
Your "new" work towards economic and humane justice regarding health care reminds one of the saying that applies NOBLY to yourself in this capacity: "to those to whom much is given, much is expected" - and you STEPPED UP to this sense of humanity, imo, in no less moving a way , and hopefully as effectively as you would now dream of, as the great humanitarians of history , such as Mahatma Gandhi and others.
Thank you for your sense of humanity. All good health and long, truly fruitful and meaningful life to you and your family and all you love.
You are who we must call - a citizen of the world.
Health Care "Reform"
I am former executive with a national group insurance company (same as Mr. Potter's last employer) who has held positions in Underwriting, Marketing and Product Management. I have firsthand knowledge of Commercial HMO, Medicare HMO, small group (50-200 employees) and large group (200+), including multi-site national accounts. Here’s what I believe is needed in any “reform” legislation.
1. Tax health insurance premiums paid by employers as any other compensation. The current exemption was a reaction to Federal Government wage and price controls and did not evolve in a free market. The current tax treatment masks the true cost health insurance leading to distorted behavior at the consumer level.
2. Mandate that every resident of the US be covered by a health insurance plan whether employer provided, through a union or individually purchased. The controversies over “pre-existing conditions” and individual underwriting are resolved if everyone, from birth, has coverage. There are no “free riders.” The political process can decide at what level of poverty premiums should be subsidized by taxpayers.
3. Establish a minimum benefits plan. The Devil will truly be in these details, but without a minimum plan the issue of the underinsured will remain. Except for the poorest among us the plan should call for cost sharing for all but preventive care and the treatment of chronic disease. The focus should be on protection against catastrophic expenses, the kind that bankrupt families, rather than day to day expenses. The degree of personal responsibility (that is, how much you must pay yourself) could be established as a function of family income much as today’s medical expense deduction is.
4. Establish premiums using a “community rating by class” methodology (CRC). This provides for some recognition that medical expenses, in fact, vary by age, sex and geographic local. In addition, at the individual insured level, allow for “good health” discounts from the CRC premiums for those who meet certain standards shown to be consistent with lowered medical costs such as not smoking, maintaining an appropriate weight and following preventive care regimens.
5. Provide for risk adjustment pools among participating insurers. This protects any single insurer from attracting more than the “normal” number of catastrophic cases. Participating insurance companies would pay into this “re-insurance” pool which would be required to be self supporting (no government subsidy).
6. Abolish all State mandated benefits. There must be a single, national plan available to all. With the other provisions listed this will ensure that insurance is portable, freeing American labor to move to better opportunities without fear of losing insurance.
7. There is no need for a “Public Option” if these rules are implemented, but if we must have one it must be self supporting (no government subsidy) and adhere to the same rules as private plans. Furthermore, any fee schedule “negotiated” by a Federal plan must be available to any participating insurance company as well.
In other words,
you want your for-profit industry's stranglehold on health care for all Americans enshrined in law forever.
So nice of you to allow the American people to seek a public option from their government which exists, among other reasons, to "promote the general welfare," provided it doesn't actually compete with the for-profits. I don't think you need to worry too much -- I'm sure the industry lobby will see to it that any public option is so crappy most people will opt for not-much-better private offerings.
The for-profit industry is responsible for the disgraceful condition of U.S. health care today. Why should anyone listen to you at all?
Get involved
Mutternich, thanks for being involved enough to respond to my comments on healthcare "reform." However, you didn't say what you believe the solution to be (other than the implication that a government plan is better than a private one). If you have thought this through, write about it; on forums like this and to your elected representatives. See how your ideas stand up, and, just think, maybe your idea is the best and will get enacted.
You're so welcome.
Single payer universal coverage. Take health care financing completely out of the for-profit sector and give it to democratically accountable government. Make the lobbyists find other interests to lobby for. Otherwise the imperative to maximize profits will always trump patient care.
Thank you so much for your advice. I'd never have thought of it.
Do some further research?
Examine the systems in Canada, the UK, France and The Netherlands. Two have what you think is most desirable; two combine public and private plans. You may change your mind.
When you say "democratically accountable" why do I think of the Post Office, Fannie and Freddie, Amtrak, Medicare and Medicaid? The USA sure doesn't have much of a track record in the accountability department. Maybe Mark Twain was correct that the US Congress is our only natural criminal class.
...[W]hy do I think of the
I dunno, you're the one thinking of them. Why would I think of Enron and Arthur Andersen if you mentioned corporate responsibility?
When I say "democratically accountable" that has to start with our elected representatives and our representatives in Congress are mostly accountable to the moneyed interests who fund their campaigns. Like the health insurance industry, for instance.
Freddie and Fannie? The worst sort of "public-private partnership" -- profits privatized, liabilities socialized, i.e. stuck to the taxpayers.
The Post Office? Worth subsidizing for the service it provides everyone, not just the most profitable customers. Make junk mailers pay more if you want less subsidy.
Medicare? It's worked pretty well for me, I think everyone should have it. One thing -- my statements from Medicare tell me I "may be billed" for my co-pay several weeks after I've received and paid the bill. Damned inefficient government -- oh, wait: that's handled by a private contractor. You know, "private" as in "for profit."
Amtrak: You mean to tell me America, the self-styled greatest country in the world, couldn't equal or beat anything those socialistic Europeans can do, if the political will existed?
Actually,.political will does exist for all sorts of reforms you consider "socialistic" -- it's just that in this country "political will" has come to be identified as corporate will, not that of the majority of everyday Americans. Congress isn't a "natural criminal class," it's a nurtured criminal class, and your industry is one of the most attentive nurturers..
Thanks for speaking out
Caught you on Coundown tonight w/ Howard Dean. I am so encouraged to know someone with your experience of the industry is speaking out. And thank you for the information above re/ limited-benefit plans. Having recently exhausted COBRA, I encountered these plans when family friends kept insisting that "of course you can get coverage for less than $1K/mo for an individual policy. AND it will cover pre-existing conditions!" Yeah, right.
The limited benefit plan being heavily advertised here -- FOR LESS THAN THE COST OF ONE GOURMET CUP OF COFFEE PER DAY -- is from Cinergy. I was astounded by the limited benefits. Why not cover pre-existing conditions? They don't pay for much of anything anyway! I live in an area dominated by the military and military retirees who are clueless about the private insurance market. These advertisements are seriously skewing the public's perception of the need for reform. Knowing the industry term for them will let me do more research for a letter to the editor I hope to write.
Many thanks - keep it up and I hope we see more of you on the news shows.
Valerie Sellers
Niceville, FL
drug advertising and specialty hospital "blue-chipping"
In almost every category, US consumers use more prescription drugs than other countries. The end result is that we die younger, anyway. It's time to take prescription drugs advertising off of the air and out of print media (please check askapatient.com)
By now, we have all manner of specialty hospitals, who take only the adequately and fully insured, leaving the others to eventually show up at some ER, somewhere.
All in all, we have the most dreadful system--THANKS FOR YOUR HELP IN BLOWING ALL THE WHISTLES.
(BTW, I have employer paid "insurance" and am fully aware that this is a very real $1,000 per month net money out of my employer's pocket that IS NOT IN MY PAYCHECK....and there are many who are illegitimately getting fat from this so called system!)
I'll be one of the first to sign up for the public-plan option
And I've written Mr. Obama to say as much. I pray that this option won't be scrapped from the bill. What the insurance industry obviously wants is to eliminate the public option BUT keep the mandate requiring all Americans to subscribe to some health insurance plan.
Should that happen, the government will have provided the insurance industry a captive customer pool. Then they can do with us what they like, and our health and well being will be a marginal concern, if that.
I am watching Mr. Moyers' program as I type this. Mr. Potter, you are the kind of American who maintains my faith in America. Thank you for your bravery and decency, and for reminding us of the power that one honest person can wield.
PLEASE TRAVEL WITH BODYGUARDS. The Devil will stop at nothing.
Blessings and strength to you, and thanks, thanks, thanks.
Nancy McLaughlin
I agree with you totally,
I agree with you totally, Mr. Potter. I too worked for a huge insurance company and you portrayed their tactics accurately. Also, it happened to me with my employer changing over to a consumer driven health plan and after having simple wrist surgery I am left with high bills due to high deductible.
Good 4 you speaking out. thank you
Republicans want Dems to enroll in public plan if passed
Tell the Republicans if they vote against it they can't enroll in any publicly funded plan, including Medicare.
A Brief Journey into the Maw of the US Health Care System
So, for the first time since I was born 55 years ago, in March 2009 I found myself in a hospital and in the emergency room no less. I am what one might refer to as a “light user” of medical services choosing more holistic approaches to health – vitamins, exercise and such - than the heavy handedness of doctors and their prescriptions though I always have maintained health insurance. My diagnosis was one many women of a certain age hear these days – I had a gallbladder in need of being removed soon. Thus began my brief and recent journey into the wide maw of the health care system.
Luckily, and I do mean luckily, I have health insurance through COBRA from a previous employer with a monthly premium of $350. As a self-employed business writer, I am forced back into the employer/employee work world about once every 12-18 months remaining long enough to access health insurance and fulfill contractual obligations. It makes for a spotty resume but there are many of us out there who are primarily self-employed that find this to be the best method of accessing reasonably priced health insurance with adequate if not great benefit terms. I will not go into the gyrations a COBRA participant who is self-employed must go through to deduct monthly COBRA payments as business expenses (current rules award this deduction to our previous employers) – suffice it to say it may be possible to get this deduction but IRS rules governing this are unfair by my estimation.
I know at my ripe age of 55 the option to duck in and out of employment is becoming increasingly limited – and I see looming before me a serious decision to buy individual prepaid health (that’s what insurance really is now days) or risk going without coverage. While working as an administrator for my previous employer, a moderately sized non-profit organization, I was flat out told it would not be hiring anyone over 50 ever again and employees over 50 were going to be released as business allowed. This was because older employees caused the overall group rate for health insurance to be higher than it would be if only younger folks were employed. Prejudicial – yes, illegal – maybe, reality – absolutely.
It might be interesting to find out just how many highly skilled persons over age 50 are routinely dumped from the traditional workplace because of the burden their ages place upon the business reality of their employers. What a racket: the insurance companies manage to remove through their aggressive group rating tactics the very people who have “banked” health care premiums over the years at the very time they need coverage the most (ages 50 through 65). Then, because of the “politics” of attaining private policies, these same insurance companies wash their hands of this same age cohort through denials, pre-existing condition clauses, and pricing far and above what a “newly self-employed” person can afford. The unfortunate reality is to pay huge monthly premiums ($500/month for high deductible insurance if you can get it) or go bare and potentially risk your retirement savings, your home or even bankruptcy.
Back to my gallbladder …
As I recall, here’s the progress of what happened to me, an otherwise completely healthy individual, during the six week process to get my gallbladder successfully removed: emergency room visit, CT scan, sonogram, blood work, visit with primary care physician, more blood work, visit with surgeon, another visit with surgeon, more blood work, more blood work, chest x-ray, consult with hospital physician assistant, laparoscopic removal of my gallbladder, overnight stay in the hospital with good care and drugs, and finally a follow-up visit with the surgeon. Mind you – gallbladder surgery is considered now a routine outpatient surgery though I was waylaid for over a day in the hospital so I could have intravenous antibiotics administered. Want to know the charges?
How much was billed: $44,716.80
How much insurance paid: 17,540.99
How much I paid: 3,249.97
Funny money billed that no one pays: 29,092.91
First – what’s with that $29,092.91 in funny money charges? I have no reasonable answer to this question; however, a neighbor who works in health insurance says it inflates hospital, doctors, and other providers “losses” and works as an income tax write-off against what otherwise would be enormous profits. So why do not-for-profit hospitals such as the one where I received care need such tax write-offs? I can’t answer that either. Also, you will see that I paid over $3,000 out of pocket for this ordeal in addition to insurance that costs $350 per month - I am (barely) able to afford this but what an extreme burden this must be for others. By my former employer’s estimation – my current health insurance plan is considered a “rich” one covering more than other comparably priced plans.
During the exact same six week time period when I was going through my gallbladder ordeal, a family friend without health insurance (but more income than mine) had a health crisis resulting in surgery and a three day hospital stay. He walked out of the hospital with a medical bill of $34,000. Within the week, the hospital called and offered to cut his bill in half to $17,000 if he was willing to place this charge on a credit card or pay in cash that day. He declined this option. Next a hospital social worker called to help my friend find another way of getting this bill paid. Believe it or not, this family friend with a household income of over $100,000 per year was granted temporary Medicaid benefits dating back to the week prior to his surgery and hospital stay. All said, his financial responsibility ended up being about $7,000 – just about what mine was if you take into account a year’s worth of insurance premiums plus my out of pocket expenses.
Now, here’s a kicker – I could have had gallbladder surgery with all of its moving parts done at a highly reputable private clinic in Mexico just south of the border for a maximum of $6,000 including transportation and hotel!
I finish with a story of the miracle of socialized medicine in the US – Medicare. My husband reached the magic age of 65 a couple of years ago. Last year, he underwent heart catheterization that resulted in three stents being placed in arteries near his heart. This life saving, minimally invasive procedure saves multiple lives each year and helps many avoid heart by-pass surgery. I was astounded when we received a simple bill – the cost of the procedure and overnight stay in ICU was $102,000, Medicare was billed $12,500, and we were responsible for $250. We carry no Medicare supplemental insurance – $250 was the true charge to us through a Medicare advantage plan that costs $90 per month deducted from my husband’s social security check. But again we have funny money totaling $89,250 – what’s with that?
My conclusions? The current US health care system is grossly unfair to those of us who pony up premiums on a monthly basis. In the end, if you are sick access to care as well as the expense (if you're a good negotiator) is about the same for those who have health insurance as for those who don’t. Health insurance needs to become just that again rather than pre-paid plans that try to take your money and push you out the door before any claims are made. I also am rather glad my gallbladder ordeal happened while I still am covered by my previous employer’s group plan – I really hope its cost of business is increased just a little by my illness as devilish as that may sound.
Medicare is a miracle of how socialized medicine can work in the US. Senior citizens who protest health care system reform – are, well, stupid and hypocritical. They readily accept the largess of Medicare (and Social Security for that matter) and work to deny similar access for the balance of the US population. I for one believe the US would be better off with a single payer system with the large insurance companies working as administrators similar to how they work with Medicare in delivering its successful advantage plans. Large insurers can offer supplemental insurance plans for those wanting greater benefits.
Without clear reform to the health care system that reduce monthly insurance premiums while increasing access for all, I believe the US will see extreme consequence as the baby boom enters its retirement years. Many will have limited their health care because of under insurance or no insurance reaching Medicare age in poor health. Others, who have been denied insurance for pre-existing conditions, will be forced to spend retirement savings accessing health care that will increase substantially the need for other social services in coming years.
As for me if there is no reform, I have concluded I will not spend more than $350 per month for health insurance – I am at my limit now. My COBRA runs out next April and I look to face difficult options that may force me for the first time in my responsible adult life to not have health insurance. I don’t particularly like the idea of not being able to “pay my way.” As a result, I am exploring moving to Mexico, which offers expatriated Americans a lower cost of living inclusive of access to affordable out-of-pocket health care as well as low-cost access to its government health care system ($300 per year) if you're a resident. As a freelance writer, I can work remotely from Mexico. If we’re close enough to the border, we can border jump for my husband to access Medicare.
However, it would be better if our leaders just do the right thing and approve health care reform NOW.
Healthcare Reform
There is an anonymous document circulating the web called Common Sense on Health Care. It takes on even greater significance given the GOP's new plan.
http://commonsenseonhealthcare.blogspot.com/2009/10/common-sense.html
nervous
I have to be honest--I'm a bit nervous about health care reform. I know some changes need to be made, but I'm very skeptical about anything that is run by the government. I wish we could have found some middle ground between the current system and a government-run health care plan.