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

R D Harmony replied on

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!)

Ms. McLaughlin replied on

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

Anonymous replied on

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

Anonymous replied on

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.

Anonymous replied on

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

Kevin of Streng... replied on

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.

MR at AZ fitnes... replied on

I also have a bit nervous-nus considering health care reform. Some changes need to be made, these changes are to protect us. We need to provide for ourselves through work, and a no quit attitude. Upon further pursuit, is our current reform going to protect the United States of America?

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