Thoughts provoked by an old house in need of renovation, its garden, a marriage lived within its walls, and of a retired Thoroughbred race horse named Fibs and Flannel.
Washington, DC — We have the best medical professionals in the world, but fewer and fewer Americans can afford to pay for the care they can provide. The trends indicate that problem will get much worse.
About 17 percent of our $14 trillion dollar economy is dedicated to health care. We pay more for health care than we do for food. Too much of what we spend on our care does nothing to improve our health. We pay for our highly bureaucratic and unwieldy health care system not just with dollars, but with the lives and well-being of millions of Americans. The Affordable Health Care for America Actwill reform our health insurance industry so companies prioritize policyholders’ health instead of investors’ profits.
The insurance industry has done everything possible to make you think otherwise. This summer’s massive disinformation campaign – exposed by Tim Dickinson in Rolling Stone magazine last month – has distracted millions of honest, engaged citizens during this debate. During two town halls in my District this summer, I witnessed first hand how fear hijacked a much-needed serious conversation.
But the facts scream louder than even the angriest protester – and the data tells us the current system could literally destroy our way of life. Consider these statistics:
• The top ten health insurance companies made $8.2755 billion last year and they stand to make more when medical costs go up. • The average annual premium for employer-sponsored health insurance is $13,375 for family coverage. • Approximately 45,000 people die each year because they lack health insurance.
This is why we must ignore pressure from the health care lobby, now spending $1.4 million a day spinning its story in Capitol Hill offices (that’s chump change when you consider the top ten health insurance companies saw profits soar 426 percent between 2000 and 2007).
This is not a time to give into fear. I say this to both the general public and my Democratic colleagues. Our party lost control of Congress in 1994 after voters watched Democrats cower in the face of massive pressure from the insurance industry. We must learn history’s lessons or again face questions on whether Democrats deserve to lead.
Reform is neither easy nor cheap, but the cost of inaction is far greater – in terms of lives lost, quality of life, and dollars. Make no mistake, if we don't reduce costs we face certain economic disaster. My father was one of the first members of Congress to fight to change the private insurance system in place today. His fight began in 1943, 66 years ago. If we go another 66 years with costs continuing to rise at the same rate they have over the last three decades, estimates project health care spending to approach 100 percent of our GDP. This is simply not sustainable.
On the other hand, President Obama has said slowing the growth of health care costs by just one-tenth of one percent each year could reduce our deficit by $4 trillion over the long term.
According to the Congressional Budget Office (CBO), the House Democrats' health reform bill reduces the deficit by $30 billion over 10 years, costing less than $900 billion over that time and meeting the benchmark set by President Obama. The President asked for a deficit-neutral bill and we gave him that and then some. It is a reasonable price when you consider the Democrats’ bill will fix the current system which has left so many Americans without proper care and/or bankrupt.
And just how is the health insurance industry spending your money?
• In 2007, each American paid more than $500 to administer health insurance. The U.S. health insurance industry spends roughly 20 cents of every dollar it pays for “nonmedical costs, such as paperwork, reviewing claims and marketing,” according to T.R. Reid, author of “The Healing of America.” This figure is often referred to as “medical loss ratio” or the money spent on actual care versus the money spent on non-medical costs.
That $500 you pay funds a small army, about 463,000 people (more than the active military in Iran today), employed by the health insurance industry. Many of those employees spend their days looking for ways to slow payments or deny your claims.
• No other country has a medical loss ratio close to ours. Our administrative costs are more than double any other country, including France, where Reid points out everyone is covered by non-profit, private insurers. The French spend just 5 percent on administration, while Canada, with a single-payer, government-run system, spends only 6 percent. The McKinsey Global Institute estimates that $91 billion a year is excess insurance administrative costs due to complexity.
Look again at the previous points and replace "health insurance industry" with "government". If that was government waste there would be protests in the streets. So why is it okay when your money is wasted by corporations? As I will explain later, Democrats are prepared to fix it, despite the best efforts of the insurance industry to stop us.
So what are we getting for our money?
• Better health? No. A 2008 London School of Hygiene and Tropical Medicine study looking at deaths that could have been prevented by access to timely and effective health care placed the U.S. last among 19 countries. If the U.S. had performed as well as the top three countries (France, Japan, and Australia) 101,000 deaths per year would have been prevented.
• More care? No. In Japan, citizens average an astounding three times more visits to doctors’ offices than Americans and twice as many MRI scans and X-Rays. Even with all these visits, the Japanese still spend less than half as much per person on health care as we do. Life expectancy and recovery rates for major diseases there are much better than ours.
• Fiscal health? No. In 2006, our economy lost as much as $200 billion because of the poorer health and shorter lifespan of the uninsured.
• Premiums for small businesses are up 129 percent since 2000. And the insurance industry is quoting increases of 14-15 percent for the next year.
• The high cost of health care causes a bankruptcy every 30 seconds. In 2007, 60 percent of U.S. bankruptcies were due to medical costs. Reid points out medical bills force 700,000 Americans into bankruptcy, while there are ZERO medical bankruptcies in France, Britain, Japan and Germany.
• Security and Stability? No. The Kaiser Family Foundation reports last month “one third of Americans (33 percent) say they or someone in their household has had problems paying medical bills over the past year.” That’s up nine percentage points from August and represents the highest level in nearly a year.
• Health coverage for all Americans? Not even close, and believe me, the uninsured are costing you money. This year, every insured American family will pay the health insurance industry $1,017 -- and insured singles will pay $368 -- in premiums just to cover the medical expenses of the uninsured. This "Hidden Health Care Tax" will total $42.7 billion this year.
And there are signs the future could be worse. Employees’ premiums and out-of-pocket charges will go up 10 percent – with the average employee paying $4,023 – next year, according to the benefits consulting firm Hewitt Associates. An Aon Consulting survey of employers found 70 percent plan to increase employee contributions, while 67 percent expect to raise deductibles, co-pays, coinsurance or out-of-pocket maximums. About three out of every five Americans under 65 get their insurance through their employers.
Acclaimed Princeton economist Uwe Reinhardt says if current trends hold, total health spending by or for a typical family of four will hit $36,000 a year in 2019. In 10 years, half of all American families will have to spend more than half of their income on health care.
That’s the future for those lucky enough to keep their health care. More than four Americans lose their coverage every minute. According to the think tank Third Way, the coverage for 88 million Americans dealing with factors like pre-existing conditions, expensive premiums, or high out-of-pocket costs could be at risk without reform. New findings from the Urban Institute indicate the number of uninsured could rise as high as 65.7 million in 2019 and the cost of uncompensated care could go up as much as 128 percent - that leads to higher premiums and taxes for all of us. So it is not enough just to create new policies, they have to be better than what exists and push other insurers to do better.
Our bill will boost the nation’s economic well-being and protect the pocket of patients and doctors
Under the Democrats bill, you can keep your plan and your doctor. The House bill will also create an insurance exchange with affordable options covering 96 percent of all American citizens, including millions currently uninsured and underinsured. Perhaps PricewaterhouseCoopers, in a report that was NOT paid for by the insurance industry, summed it up the best:
“Broader coverage, particularly if paired with an individual mandate, could reduce the cost shifting that increases medical costs to private payers.”
Other measures in the bill will put money back in your pocket, including:
• Ending co-pays for preventive care;
• Implementing a year cap on your out-of-pocket expenses with no caps on what insurance companies pay;
• 50 percent discounts on brand-name prescriptions for Medicare Part D beneficiaries and shrinking out-of-pocket costs by $500;
• Elimination of the donut hole (the gap in coverage that leaves beneficiaries on the hook for the cost of prescription drugs when the cost of their prescription drugs passes $2,700 in a year) by 2019; and
• Phasing out wasteful spending for Medicare Advantage (MA) – which costs beneficiaries an extra $1,000 per enrollee. Paying for the MA subsidies costs a couple using traditional Medicare an additional $78 to $90 a year.
Steps like this will strengthen Medicare, keeping the program solvent an additional five years. Medicare is one of the most successful government programs in our nation’s history. Without reform, large numbers of doctors, who face a 21 percent cut in payments next year, would certainly drop out. Already, physicians are burdened with both outrageous malpractice insurance charges as well as meeting insurance companies’ demands, which cost them on average 142 hours – worth $68,274 - a year. We’ve simultaneously introduced a separate bill which will prevent that 21 percent cut.
Many doctors will also applaud efforts to move away from the fee-for-service system. Over the summer, we strengthened incentives for the development of “accountable care organizations (ACOs)” which have lowered costs and improved care in several communities. Doctors and administrators at providers like Geisinger Health System in Pennsylvania and the world famous Mayo Clinic haved used such systems after deciding they could do better by shrinking insurance-driven incentives. They instead make more money by keeping costs down and meeting quality-of-care indicators. ACOs are run by doctors and hospitals with no government role whatsoever. CBO scored the ACO provisions in our bill and found savings of $2.6 billion through 2019.
These doctors and hospitals have shown a real commitment to bending the cost curve. I wish I could say the same about the insurance companies.
Better Corporate Behavior = Savings for Consumers
Currently, insurance companies do not compete to offer better plans, cheaper rates, or even better customer service. "Successful" companies are those best at shedding risk. Our bill will stop discrimination against people with pre-existing conditions and rescission – the practice in which insurers search for problems with patients’ policies while they are waiting on the gurney for emergency care. Three insurance company executivesacknowledged during an Energy and Commerce subcommittee hearing this summer that rescission saved those companies $300 million by canceling about 20,000 policies over five years.
There may be no number that can state how many families have lost a loved one or were financially decimated by these practices. But it is clear that without reform, the companies will go on with these kinds of practices. It will be business as usual unless the government steps in.
But new health insurance industry regulations would only prevent the tactics the industry employs now. Americans need more choices to allow them to fight back against new forms of rascality, especially while insurers enjoy almost near monopolies in dozens of states. I believe a marketplace with increased competition, coming from a public health insurance option, will push the insurance giants to behave better than even increased government oversight could.
The public health insurance option would have leverage to force insurers, pharmaceuticals, and hospitals to bring their prices down.
As promised, back to medical loss ratio: when California state lawmakers tried to require insurers to spend at least 85 percent on medical care, hundreds of industry lobbyists worked to kill the effort. Our bill includes a two-year fix establishing the ratio at 85-15. That will deal with the immediate concern while in the long-term, the public health insurance option and other safeguards will force insurers to be more efficient and cut their administrative costs on their own. A public health insurance option would likely have administrative costs similar to those of Medicare, which operates at 3-4 percent. This kind of competition is the best way to drive insurers to spend our money wisely and more efficiently.
As for fears the public option would crowd out other healthcare providers, the Congressional Budget Office (CBO) has estimated fewer than 5 percent of Americans would sign up for it.
Without the public option, what you have is 47 million more people being added to the marketplace that the health insurance industry can charge whatever price they want. It's a wonderful way to drum up business for the insurance companies. How can we ask doctors, hospitals, drug makers and all other stakeholders to make enormous sacrifices without asking the same of the insurers?
The loyal opposition has provided no help. Neither the Republican leadership of the House nor of the Senate has offered comprehensive health care legislation for consideration. While they decry our efforts, they offer no alternative even though – as National Journal has reported – nearly half of the House Republicans (84 of 178) come from districts where the proportion of the uninsured exceeds the national average of 15 percent. Without a bill of their own, Congressional Republicans’ intractability is simply a thinly veiled defense of the status quo. Conservative think tanks cry for deregulation, but this to me is like trying to get a fox out of the hen house by letting in more foxes. The CBO said a 2005 bill allowing plans to be sold across state lines would have caused about 1 million people to lose employer-sponsored insurance. More bad plans and fewer people insured sounds like a step backwards to me.
In a recent Reuters poll, 63 percent of respondents said they’d pay higher taxes to get serious health care reform. I believe they realize this is one case where investing in reform now could put more money in their pockets later. They know the screaming should stop and reasonable discourse must rise above the rancor.
Let me close with a personal note. I make an effort to treat each class of Congressional interns to a lunch in the Member’s dinning room. During that lunch, I take questions about any topic they want to discuss. Almost every time, these interns – many of whom regard Ronald Reagan as ancient history – ask me about votes like the Gulf of Tonkin Resolution and the 1964 Civil Rights Act. In my more than 50 years here, I’ve cast ten to fifteen votes which are repeatedly revisited by the general public, both young and old, because they have such a dramatic impact on the world we live in today. And while public mood may color their sentiments or the way they ask the question, the basic premise behind the interns’ questions are always the same:
When history called, what did you do?
Without a doubt, the vote on this bill will join the list. I will tell my fellow members, when you explain a vote like this one to the generations that live with the consequences of these decisions there is no poll, not even an election result, that can justify your decision. You will be asked about this vote until the day you die. Years from now, none of these things we put so much stock in now will matter. All anyone will want to know is: did you do the right thing when history called on you? It is time for health care reform. We can’t afford to wait. We can’t afford to think small. We can’t afford to fail.
Democratic Rep. John D. Dingell has served Southeast Michigan for more than 53 years in the U.S. House of Representatives, making him the longest serving congressman in U.S. history. He has introduced and fought for legislation that would create health care coverage for all Americans since 1957.
Links to studies, stories and documents cited in Op-Ed:
“Very few things happen in Washington that are in the public's interest when corporations have huge financial stakes in the game, as they obviously do with health care — unless the public is actively involved, engaged and organized,” Reich wrote. “We won't get a public option, or anything close to it, unless people who feel strongly about it make a racket.”
The “first step is to be very loud and very vocal: Write, phone, e-mail, your congressional delegation and the White House. Second step: Get others to do the same. Third step: Get voters in Montana, North Dakota, Nebraska, and other states where Blue Dog Dems and wavering Senate Dems live, and have them make a hell of a fuss. Fourth step: March on Washington.”
And I married a doctor in France's public health system. How stu-pid could I be?
Next time, I'll be sure to marry a private health industry CEO to get a piece of that $11.9 million annual salary. Just think of all the plants that would get me, and I'd never have to look at a price on a recovered treasure of an antique door again.
I could have anything I want and the sky would be the limit, and I wouldn't have that stu-pid old conscience anymore to bother me.
Well I say "Let them have dialysis."
What?... Oh? That was "cake"? She didn't really say it you say?... Who?...
If you are against single-payer and you do not support a public option, you are working against not only your own interests -- for you, too, might become uninsured, or have a claim rejected, or a need for care denied, or watch a loved-one go down because he or she was not as fortunate as you -- you are working for their corporate interests.
The other day, I posted former Vice President for corporate communications at insurance giant Cigna Wendell Potter's interview with Bill Moyers, talking about how America's insurance and private health care interests are busy working for their own, at the expense of yours.
Is this what makes you proud to be American?
Of course, I also understand that the offer of "full debate" for single-payer and a floor vote in the house is merely a way to sweep it out of the way and be able to say, "See? We told you there just wasn't support for single-payer." We all know that, but that doesn't make it right. Meanwhile, Representative Dennis Kucinich is calling upon single-payer supporters to work to get his amendment, allowing the States to set up their own single-payer systems with ERISA protection, passed by the full House of Representatives.
Let me tell you, here, in single-payer France, everyone has the right to go the doctor and the hospital of his or her choice. Everyone. Some will pay a 30 euro co-pay for an emergency visit to their general practitioner, who might just come see them at home if it's too cold to being the baby to them in the middle of a winter's night. Yes. Ours does.
You want to see a private practice doctor? Go right ahead, the choice is yours. You might pay 50 euros, probably less, above what the health system pays for you. And, if that doctor also practices at the public hospital, he or she also sees patients on the public lists, delivering the very same care for no extra for the visit.
You worry that public hospitals are the scourge of medical delivery? Here, you have to pass additional exams to be qualified to practice in them; you are considered the medical elite. Other doctors, who haven't taken or passed those exams, will seek to practice a couple half-days a week in those public hospitals for less than you pay your cleaning lady for a morning's work. Why? Because they consider it a medical duty, and because they can associate themselves with the best in their specialties, making sure to keep abreast of the very latest in diagnostic and treatment care.
Ask me. I know. One such removed the melanoma from my toe. My husband, a public hospital practitioner these last 25 years, who only began seeing "private" patients about 5 years ago, and that only 2 half-days a week, and none in surgery (he and his colleagues all agreed that there would not be private surgery in the hospital because it compromises the system and best care for all, at a cost to them), thanks him for seeing me at a moment's notice and for my life.
Waits? No. Not if you have a problem, a need for care. I know it. I see it on a daily basis. It's the conversation at our dinner table.
Can't get pregnant? Don't worry, the government will pay for treatment for you and your partner, and you will be seen by one of a handful of accredited doctors at a fertility clinic that has had to have regular, demonstrated success rates. Leave your checkbook at home. Just be sure to bring your carte de Sécu. I know this, too, because my husband is one of them.
Worry that your doctor went to a "top tier" medical school? Here, it doesn't matter. Here, doctors are shocked by the diplomas on the walls, attesting to education at a "top" medical school. Here, all medical students pass rigorous exams to continue their training, few of the many who start out making it to the end, and even fewer making it to the prestigious "postes" in the public hospitals and the title "practicien hospitalier". All who make it through medical school receive the same quality education and training.
It's that simple. I am embarrassed when called upon to explain our American system.
If you doubt me, come live in France. Pick a smaller city, or a village outside one of the smaller cities. Now, start feeling vertigo, nausea, experiencing disorientation. You'll do what we all do at first, seek out Americans near you to ask where to go, what doctor to see. They will tell you what they have all learned, "Go to the nearest emergency room and tell them what is wrong." You will receive "top tier" treatment, wherever you are. And what's more, if you are not covered by the government health system, don't worry about your final bill. My husband operated on a friend from LA living in Paris for a year.
She had a fibroid tumor the size of a grapefruit on her uterus. In LA, she was told that she didn't qualify for surgery (they had the money, everyone, to pay for a furnished apartment near the Eiffel Tower and work from home for a school year, and they were insured). Hormone therapy was recommended, long after the tumor had exceeded the size that can hoped to be treated by hormones. She suffered bleeding, discomfort and pain during intercourse. She called a friend in Paris, who suggested she call me, since my husband is an ob/gyn. She came out to see him, he recommended surgery -- remember, it's part of his salary; he earns not a centime plus for recommending surgery, but when he does, the hospital takes it on, no questions asked --, and she and her husband opted to have her operated on by him.
The final bill, for the appointment and diagnosis, the appointment with the anesthesiologist to take her medical history (they don't do that in the US), surgery, three days hospitalization and all medications, right down to the last asprin?
1,200 euros.
She received the bill, and they called to ask if there was an error, was there not a zero missing?
They paid out of pocket. It was less than their deductible back in the States, and much less of a headache.
Still doubting the single-payer or a public option for a system like congress enjoys -- and do we hear them complaining? I didn't think so --? Ask yourself, why do you think that the USA knows better than every other industrialized country? Why is it alright for the USA to rank 37th in the world based on objective measures of medical outcomes "behind Colombia and Portugal" and 44th in infant mortality? Guy Saperstein, past president of the Sierra Club Foundation and previously one of the National Law Journal’s "100 Most Influential Lawyers in America", writes in AlterNet:
The United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. Although infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth.
Why is this alright with you?
Why are you not demanding more?
Why are you continuing to chose to collaborate with corporate America and the "prostitutes of our system" rather than demand that our representives act like The People's representatives t our federal government?
Why are you not demanding campaign finance reform to take corporate control out of our chambers of law?
You call that "socialism"? We call that democracy.
Feel free to send your questions my way, and meanwhile, thank you, Mr. Olbermann, for saying it. The list is growing of those willing to speak.
Rep. Wiener, D-NY withdraws single-payer amendment in committee for full house vote in September
Pst. Spread the word. Only YOU can make health care AVAILABLE and AFFORDABLE with FREEDOM OF CHOICE for EVERYONE.
Call your representatives in Washington, and then, write them a letter.
Oh, and there are no long lines here in France. Ask any American living here.
Former Cigna head of corporate communications Wendell Potter with Bill Moyers (see the video here. Pst! Spread the word.)
July 10, 2009
With almost 20 years inside the health insurance industry, Wendell Potter saw for-profit insurers hijack our health care system and put profits before patients. Now, he speaks with Bill Moyers about how those companies are standing in the way of health care reform.
BILL MOYERS: Wendell Potter joins us now. Welcome to the Journal.
WENDELL POTTER: Thank you very much for having me here.
BILL MOYERS: You worked for CIGNA 15 years and left last year.
WENDELL POTTER: I did.
BILL MOYERS: Were you pushed out?
WENDELL POTTER: I was not. I left-- it was my decision to leave, and my decision to leave when I did.
BILL MOYERS: Were you passed over for a promotion?
WENDELL POTTER: Absolutely not. No.
BILL MOYERS: Had you been well-paid and rewarded by the company?
WENDELL POTTER: Very well-paid. And I, over the years, had many job opportunities, many bonuses, salary increases. So no, I was not. And in fact, there was no further place for me to go in the company. I was head of corporate communications and that was the ultimate PR job.
BILL MOYERS: Did you like your boss and the people you work with?
WENDELL POTTER: I did, and still do. I still respect them.
BILL MOYERS: And they gave you a terrific party when you left?
WENDELL POTTER: They sure did, yeah.
BILL MOYERS: So why are you speaking out now?
WENDELL POTTER: I didn't intend to, until it became really clear to me that the industry is resorting to the same tactics they've used over the years, and particularly back in the early '90s, when they were leading the effort to kill the Clinton plan.
BILL MOYERS: But during this 15 years you were there, did you go to them and say, "You know, I think we're on the wrong side. I think we're fighting the wrong people here."
WENDELL POTTER: You know, I didn't, because for most of the time I was there, I felt that what we were doing was the right thing. And that I was playing on a team that was honorable. I just didn't really get it all that much until toward the end of my tenure at Cigna.
BILL MOYERS: What did you see?
WENDELL POTTER: Well, I was beginning to question what I was doing as the industry shifted from selling primarily managed care plans, to what they refer to as consumer-driven plans. And they're really plans that have very high deductibles, meaning that they're shifting a lot of the cost off health care from employers and insurers, insurance companies, to individuals. And a lot of people can't even afford to make their co-payments when they go get care, as a result of this. But it really took a trip back home to Tennessee for me to see exactly what is happening to so many Americans. I--
BILL MOYERS: When was this?
WENDELL POTTER: This was in July of 2007.
BILL MOYERS: You were still working for Cigna?
WENDELL POTTER: I was. I went home, to visit relatives. And I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued.
BILL MOYERS: So you drove there?
WENDELL POTTER: I did. I borrowed my dad's car and drove up 50 miles up the road to Wise, Virginia. It was being held at a Wise County Fairground. I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.
But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.
And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.
There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.
BILL MOYERS: What did you think?
WENDELL POTTER: It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? I just it just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me.
BILL MOYERS: People are going to say, "How can Wendell Potter sit here and say he was just finding out that there were a lot of Americans who didn't have adequate insurance and needed health care? He'd been in the industry for over 15 years."
WENDELL POTTER: And that was my problem. I had been in the industry and I'd risen up in the ranks. And I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn't put faces with that number.
Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.
And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.
BILL MOYERS: But you had, all these years, seen premiums rising. People purged from the rolls, people who couldn't afford the health care that Cigna and other companies were offering. This is the first time you came face to face with it?
WENDELL POTTER: Yeah, it was. You know, certainly, I knew people, and I talked to people who were uninsured. But when you're in the executive offices, when you're getting prepared for a call with an analyst, in the financial medium, what you think about are the numbers. You don't think about individual people. You think about the numbers, and whether or not you're going to meet Wall Street's expectations. That's what you think about, at that level. And it helps to think that way. That's why you-- that enables you to stay there, if you don't really think that you're talking about and dealing with real human beings.
BILL MOYERS: Did you go back to corporate headquarters and tell them what you had seen?
WENDELL POTTER: I went back to corporate headquarters. I was trying to process all this, and trying to figure out what I should do. I did tell many of them about the experience I had. And the trip. I showed them some pictures I took while I was down there. But I didn't know exactly what I should do.
You know, I had bills of my own. And it was hard to just figure out. How do I step away from this? What do I do? And this was one of those things that made me decide, "Okay, I can't do this. I can't keep-- I can't." One of the books I read as I was trying to make up my mind here was President Kennedy's "Profiles in Courage."
And in the forward, Robert Kennedy said that one of the president's, one of his favorite quotes was a Dante quote that, "The hottest places in hell are reserved for those who, in times of moral crisis, maintain a neutrality." And when I read that, I said, "Oh, jeez, I-- you know. I'm headed for that hottest place in hell, unless I say something."
BILL MOYERS: Your own resume says, and I'm quoting. "With the chief medical officer and his staff, Potter developed rapid response mechanisms for handling media inquiries pertaining to complaints." Direct quote. "This was highly successful in keeping most such inquiries from becoming news stories, at a time when managed care horror stories abounded." I mean, you knew there were horror stories out there.
WENDELL POTTER: I did. I did.
BILL MOYERS: You put these techniques to work, representing Cigna doing the Nataline Sarkisyan case, right?
WENDELL POTTER: That's right.
BILL MOYERS: And that was a public relations nightmare, you called it. Right?
WENDELL POTTER: It was. It was just the most difficult. We call them high profile cases, when you have a case like that — a family or a patient goes to the news media and complains about having some coverage denied that a doctor had recommended. In this case, Nataline Sarkisyan's doctors at UCLA had recommended that she have a liver transplant. But when the coverage request was reviewed at Cigna, the decision was made to deny it.
It was around that time, also, that the family had gone to the media, had sought out help from the California Nurses Association and some others to really bring pressure to bear on Cigna. And they were very successful in getting a lot of media attention, and nothing like I had ever seen before.
PROTESTERS: Shame on Cigna! Shame on Cigna!
WENDELL POTTER: It got everyone's attention. Everyone was focused on that in the corporate offices.
BILL MOYERS: You were also involved in the campaign by the industry to discredit Michael Moore and his film "Sicko" in 2007. In that film Moore went to several countries around the world, and reported that their health care system was better than our health care system, in particular, Canada and England. Take a look at this.
MICHAEL MOORE: I went across the city to a crowded hospital waiting room. How long did you have to wait here to get help?
CANADIAN WOMAN #1: 20 minutes
CANADIAN WOMAN #2: 45 minutes
CANADIAN MAN #2: I got helped right away.
CANADIAN WOMAN #3: You can see how crowded this is. They really do an amazing job.
MICHAEL MOORE: Did you have to get anyone's permission to come to this hospital?
CANADIAN MAN #2: No.
CANADIAN MAN #3: No.
CANADIAN WOMAN #1: No.
CANADIAN WOMAN #3: We can go anywhere we want.
MICHAEL MOORE: You don't have to get pre-approved?
CANADIAN WOMAN #3: No, no. You just--
MICHAEL MOORE: By your own insurance company?
CANADIAN WOMAN #3: Oh no, oh heavens no.
MICHAEL MOORE: Can you choose your own doctor?
CANADIAN WOMAN #3: Oh sure. Oh yes.
MICHAEL MOORE: What's your deductible?
CANADIAN MAN #1: Nothing.
CANADIAN WOMAN #1: I don't think we have any.
CANADIAN MAN #2: I don't know. I don't think there's any as far as I know.
CANADIAN WOMAN #3: It's really a fabulous system for making sure that the least of us and the best of us are taken care of.
BRITISH WOMAN #1: Oh, really it's not like that in the US? No. Not at all, no.
MICHAEL MOORE: So what do you pay to stay here?
BRITISH WOMAN #1: No one pays. They're asking, "How do people pay?" And I said, well there isn't, you don't, you just leave.
BRITISH MAN #1: It's just the insurance. There's no bill at the end of it, as it were.
MICHAEL MOORE: Even with insurance, there's bound to be a bill somewhere. So where's the billing department?
BRITISH WOMAN #1: There isn't really a billing department.
BRITISH WOMAN #2: There's no such thing as a billing department.
MICHAEL MOORE: What did they charge you for that baby?
BRITISH WOMAN #3: Sorry?
MICHAEL MOORE: You've got to pay before you can get out of here, right?
BRITISH WOMAN #3: No.
BRITISH MAN #1: No, no, no. Everything's on NHS.
BRITISH WOMAN #3: This is NHS.
BRITISH MAN #1: You know, it's not America.
BILL MOYERS: So what did you think when you saw that film?
WENDELL POTTER: I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned.
BILL MOYERS: What were they afraid of?
WENDELL POTTER: They were afraid that people would believe Michael Moore.
BILL MOYERS: We obtained a copy of the game plan that was adopted by the industry's trade association, AHIP. And it spells out the industry strategies in gold letters. It says, "Highlight horror stories of government-run systems." What was that about?
[Note: You can download the documents by clicking here and here (PDFs)]
WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.
BILL MOYERS: And there was a political strategy. "Position Sicko as a threat to Democrats' larger agenda." What does that mean?
WENDELL POTTER: That means that part of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, "Look, you don't want to believe this movie. You don't want to talk about it. You don't want to endorse it. And if you do, we can make things tough for you."
BILL MOYERS: How?
WENDELL POTTER: By running ads, commercials in your home district when you're running for reelection, not contributing to your campaigns again, or contributing to your competitor.
BILL MOYERS: This is fascinating. You know, "Build awareness among centrist Democratic policy organizations--"
WENDELL POTTER: Right.
BILL MOYERS: "--including the Democratic Leadership Council."
WENDELL POTTER: Absolutely.
BILL MOYERS: Then it says, "Message to Democratic insiders. Embracing Moore is one-way ticket back to minority party status."
WENDELL POTTER: Yeah.
BILL MOYERS: Now, that's exactly what they did, didn't they? They--
WENDELL POTTER: Absolutely.
BILL MOYERS: --radicalized Moore, so that his message was discredited because the messenger was seen to be radical.
WENDELL POTTER: Absolutely. In memos that would go back within the industry — he was never, by the way, mentioned by name in any memos, because we didn't want to inadvertently write something that would wind up in his hands. So the memos would usually-- the subject line would be-- the emails would be, "Hollywood." And as we would do the media training, we would always have someone refer to him as Hollywood entertainer or Hollywood moviemaker Michael Moore.
BILL MOYERS: Why?
WENDELL POTTER: Well, just to-- Hollywood, I think people think that's entertainment, that's movie-making. That's not real documentary. They don't want you to think that it was a documentary that had some truth. They would want you to see this as just some fantasy that a Hollywood filmmaker had come up with. That's part of the strategy.
BILL MOYERS: So you would actually hear politicians mouth the talking points that had been circulated by the industry to discredit Michael Moore.
WENDELL POTTER: Absolutely.
BILL MOYERS: You'd hear ordinary people talking that. And politicians as well, right?
WENDELL POTTER: Absolutely.
BILL MOYERS: So your plan worked.
WENDELL POTTER: It worked beautifully.
BILL MOYERS: The film was blunted, right?
WENDELL POTTER: The film was blunted. It--
BILL MOYERS: Was it true? Did you think it contained a great truth?
WENDELL POTTER: Absolutely did.
BILL MOYERS: What was it?
WENDELL POTTER: That we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie.
You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.
And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don't want the government to take away your choice of a health plan. It's more likely that your employer and your insurer is going to switch you from a plan that you're in now to one that you don't want. You might be in the plan you like now.
But chances are, pretty soon, you're going to be enrolled in one of these high deductible plans in which you're going to find that much more of the cost is being shifted to you than you ever imagined.
BILL MOYERS: I have a memo, from Frank Luntz. I have a memo written by Frank Luntz. He's the Republican strategist who we discovered, in the spring, has written the script for opponents of health care reform. "First," he says, "you have to pretend to support it. Then use phrases like, "government takeover," "delayed care is denied care," "consequences of rationing," "bureaucrats, not doctors prescribing medicine." That was a memo, by Frank Luntz, to the opponents of health care reform in this debate. Now watch this clip.
REP. JOHN BOEHNER: The forthcoming plan from Democratic leaders will make health care more expensive, limit treatments, ration care, and put bureaucrats in charge of medical decisions rather than patients and doctors.
SEN. MITCH MCCONNELL: Americans need to realize that when someone says "government option," what could really occur is a government takeover that soon could lead to government bureaucrats denying and delaying care, and telling Americans what kind of care they can have.
SEN. JON KYL: Washington run healthcare would diminish access to quality care, leading to denials, shortages and long delays for treatment.
REP. JOE WILSON: How will a government run health plan not lead to the same rationing of care that we have seen in other countries?
REP. TOM PRICE: We don't want to put the government, we don't want to put bureaucrats between a doctor and a patient.
BILL MOYERS: Why do politicians puppet messages like that?
WENDELL POTTER: Well, they are ideologically aligned with the industry. They want to believe that the free market system can and should work in this country, like it does in other industries. So they don't understand from an insider's perspective like I have, what that actually means, and the consequences of that to Americans.
They parrot those comments, without really realizing what the real situation is.
I was watching MSNBC one afternoon. And I saw Congressman Zach Wamp from Tennessee. He's just down the road from where I grew up, in Chattanooga. And he was talking-- he was asked a question about health care reform. I think it was just a day or two after the president's first-- health care reform summit. And he was one of the ones Republicans put on the tube.
And he was saying that, you know, the health care problem is not necessarily as bad as we think. That of the uninsured people, half of them are that way because they want to "go naked."
REP. ZACH WAMP: Half the people that are uninsured today choose to remain uninsured. Half of them don't have any choice but half of them choose to, what's called, go naked, and just take the chance of getting sick. They end up in the emergency room costing you and me a whole lot more money.
WENDELL POTTER: He used the word naked. It's an industry term for those who, presumably, choose not to buy insurance, because they don't want to. They don't want to pay the premiums. So he was saying that half... Well, first of all, it's nothing like that. It was an absolutely ridiculous comment. But it's an example of a member of Congress buying what the insurance industry is peddling.
BILL MOYERS: Back in 1993, the Republican propagandist, William Kristol, urged his party to block any health care proposal, in order to prevent the Democrats from being seen as the quote, "generous protector of the middle class." But today, you've got some Democrats who are going along with the industry.
Max Baucus, the senator from Montana, for example, the most important figure right now in this health care legislation that's being written in the Senate. He's resisted including a public insurance option in the reform bill, right?
WENDELL POTTER: That's right.
BILL MOYERS: Why is the industry so powerful on both sides of the aisle?
WENDELL POTTER: Well, money and relationships, ideology. The relationships-- an insurance company can hire and does hire many different lobbying firms. And they hire firms that are predominantly Republican and predominantly Democrat. And they do this because they know they need to reach influential members of Congress like Max Baucus. So there are people who used to work for Max Baucus who are in lobbying firms or on the staff of companies like Cigna or the association itself.
BILL MOYERS: Yeah, I just read the other day, in THE WASHINGTON POST, that Max Baucus's staff met with a group of lobbyists. Two of them had been Baucus's former chiefs of staff.
WENDELL POTTER: Right.
BILL MOYERS: I mean, they left the government. They go to work for the industry. Now they're back with an insider status. They get an access, right?
WENDELL POTTER: Oh, they do, they do. And these lobbyists' ability to raise money for these folks also is very important as well.
Lobbyists, many of the big lobbyists contributed a lot of money themselves. One of the lobbyists for one of the big health insurance company is Heather Podesta, the Podesta Group, and she's married to Tony Podesta, who's a brother of John Podesta.
BILL MOYERS: Who used to be the White House chief of staff.
WENDELL POTTER: Right. Right. And they're Democrats. And my executives wanted to meet with — and when I say my, the people I used to work for--
BILL MOYERS: At Cigna.
WENDELL POTTER: Yeah, wanted to meet with Hillary Clinton, when she was still in the Senate and still a candidate for president. Well, that's hard to do. That's hard to pull off, but she did. That just shows you that you can, through the relationships that are formed and that the insurance industry pays for, by hiring these lobbyists, you can your foot in the door. You can get your messages across to these people, in ways that the average American couldn't possibly.
BILL MOYERS: So it's money that can buy access to have their arguments heard, right?
WENDELL POTTER: That's right.
BILL MOYERS: When ordinary citizens cannot be heard.
WENDELL POTTER: Absolutely right. It's the way the American system has evolved, the political system. But it does offend me, that the vested special interests, who are so profitable and so powerful, are able to influence public policy in the way that they have, and the way that they've done over the years. And the insurance industry has been one of the most successful, in beating back any kinds of legislation that would hinder or affect the profitability of the companies.
BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?
WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.
BILL MOYERS: Compared to the industry's--
WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.
BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?
WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.
So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.
I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.
For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.
BILL MOYERS: That they're spending more money for medical claims.
WENDELL POTTER: Yeah.
BILL MOYERS: And less money on profits?
WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.
BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?
WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.
But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.
And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.
They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.
BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.
WENDELL POTTER: That's right. Exactly right.
BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?
WENDELL POTTER: Exactly right. They--
BILL MOYERS: Where does it go?
WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.
BILL MOYERS: When a member of Congress asked the three executives who appeared before the committee-- if they would end the practice of canceling policies for sick enrollees, they refused. Why did they refuse?
WENDELL POTTER: Well, they were talking to Wall Street at that moment. They were saying that because-- I guess they might have to spend some additional dollars to be more vigilant, to make sure that they were not rescinding a policy inappropriately. It makes no sense. The only reason they would have said that is to cover themselves. And to send a signal to Wall Street that you know, we're going to continue business as usual here.
You know, I've been around a long time. And I have to say, I just don't get this. I just don't understand how the corporations can oppose a plan that gives the unhealthy people a chance to be covered. And they don't want to do it themselves.
Well, keep in mind, what they want to do is enhance their profits. Enhance shareholder value. That's number one. And the way that the business that they're in is health care, certainly. But their primary motivation is to reward their shareholders.
Most of the shareholders are large, institutional investors and hedge funds. Hedge fund managers are the ones who look at the stock. And investors for large organizations. It's not mom and pop investor.
BILL MOYERS: You wrote a column with the headline, "Obama's false friends of health reform." You use as a prime example a man named Ron Williams, who is at the top of the list of insurance executives in terms of their compensation. We actually saw Ron Williams at President Obama's Town Hall meeting .
RON WILLIAMS: I would commend the president for the commitment he's made to really try to get and keep everyone covered. And I think as a health insurance company we are committed to that.
BILL MOYERS: Who is Ron Williams, and why do you use him as the example of what Wall Street expects and wants from the insurance companies?
WENDELL POTTER: He has, apparently, had a seat at the table of health care discussion. He was recruited by Aetna from WellPoint. Aetna had gone on a buying binge. There's been an enormous amount of consolidation in the health insurance industry over the last several years. Aetna bought a lot of competitors.
It reached 21 million members. And, but what it realized and what investors began to see is that a lot of the businesses that it had bought were not all that profitable. So they were in Aetna was in a pickle. And they saw their stock price starting to plummet. So they brought-- among the things they did was bring Ron Williams in. And Williams, among the first thing he did was order a revamp of the IT system, so that--
BILL MOYERS: The information technology system--
WENDELL POTTER: Exactly, so that the company could determine more about which accounts were not profitable or margining profitable. So with that new system, he was able, and the other executives to identify the accounts that they wanted to get rid of. And over the course of a very few years, they shed eight million members.
BILL MOYERS: Eight million policy holders?
WENDELL POTTER: Eight million people, men, women, and children, yes.
Some of them were shed by intention. Some, I'm sure, probably walked because the-- or left for whatever other reason, but they intentionally had this program to purge these accounts. Eight million fewer people were enrolled in Aetna's plans. Many of them undoubtedly joined the ranks of the uninsured, because their employers had been purged.
BILL MOYERS: So what happened to Aetna's stock?
WENDELL POTTER: Went up. And it has--
BILL MOYERS: And so did Ron's--
WENDELL POTTER: And--
BILL MOYERS: --compensation, right?
WENDELL POTTER: Ron's compensation and his stock on Wall Street.
RON WILLIAMS: And so I think in the context of thinking about a government plan, what we say is, let's identify the problem we're trying to solve. Let's work collaboratively with physicians, hospitals, and other health care professionals, and make certain that we solve the problem, as opposed to introduce a new competitor who has the rulemaking ability that government would have.
BILL MOYERS: You know, there's an irony, because you hear the companies and their trade groups talking about how we don't want a public option that would put a bureaucrat between a patient and his doctor. But you've just described a situation in which a CEO is actually between a doctor and the patient,
WENDELL POTTER: It's true. And that same thing happened, in the Nataline Sarkisyan case. You had a corporate bureaucrat making a decision on coverage. So, they are trying to make you worry. And fear a government bureaucrat being between you and your doctor. What you have now is a corporate bureaucrat between you and your doctor.
BILL MOYERS: Whose motive is profit. Understandably, naturally, profit.
WENDELL POTTER: Right.
BILL MOYERS: But companies, any company is in business to make a profit, right?
WENDELL POTTER: Oh, absolutely.
BILL MOYERS: So how can you object? How can we object when an insurance company wants to increase its profits? That's a serious question. I mean, it sounds like a set-up but it's a serious question.
WENDELL POTTER: It's a very serious question. And I think that people who are strong advocates of our health care system remaining as it is, very much a free market health care system, fail to realize that we're really talking about human beings here. And it doesn't work as well as they would like it to. Yeah, there's nothing wrong. And I'm a capitalist as well. I think it's a wonderful thing that companies can make a profit. But when you do it in such a way that you are creating a situation in which these companies are adding to the number of people who are uninsured and creating a problem of the underinsured then that's when we have a problem with it, or at least I do.
BILL MOYERS: This is the key question for me. Can health reform that includes a public plan actually rid our system of the financial incentive on the part of the insurance industry to provide less for more?
WENDELL POTTER: It will help. It would help. Would it rid it? No, I don't think it would, because of the for-profit structure that is now dominant in this country. But the public plan would do a lot to keep them honest, because it would have to offer a standard benefit plan. It would have to operate more efficiently, as does the Medicare program. It would be structured, I'm certain on a level playing field, so that it wouldn't be unfair advantage to the private insurance companies. But because it could be administered more efficiently, then the private insurers, they would have to operate more efficiently. And that 20 cents in that medical loss ratio we talked about earlier might get narrower. And they don't want that.
BILL MOYERS: As this debate unfolds in the next month, into the fall, what should we be watching for? Tell us as an insider what to look for that is more than meets the eye?
WENDELL POTTER: Well, what happens is they will continue this charm offensive, until there's actual legislative language. And what that means, of course, is that right now, you're not really seeing the bills before the House and the Senate that will actually be voted on. When we see the actual legislation, when there's something before Congress, and it will happen, presumably, within the next few weeks, you'll start seeing a lot more criticism of it.
And the special interests will be attacking this or that. The AMA will be upset about something. The pharmaceutical industry will be upset about something. The insurance industry will not like this or that. It's, you know, a lot of money is made in this country off sick people. And then you'll start seeing a lot more of the behind-the-scenes attacks on this legislation, in an attempt to kill it. The status quo is what would work best for these industries.
BILL MOYERS: In other words, if the industry is able to kill reform, or the Democrats and the Republicans can't agree on a proposal, that's what the industry really wants.
WENDELL POTTER: Exactly. And it happened in '93 and '94. And just about every time there has been significant legislation before Congress, the industry has been able to kill it. Yeah, the status quo works for them. They don't like to have any regulation forced on them or laws forced on them. They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not-- you know, they'll not do anything after say this plan fails.
Say nothing happens. They're saying now what they did in '93, '94. "We think preexisting conditions is a bad thing," for example. Let's watch and see if they really take the initiative to do anything constructive. I bet you won't see it. They didn't then.
BILL MOYERS: Well, on the basis of the past performance, and on the basis of your own experience in the industry, can we believe them when they say they will do these things voluntarily?
WENDELL POTTER: I don't think you can. I think that they will implement things that make them more efficient. And that enhance shareholder value. And if what they do contributes to that, maybe so. But now, they do say, they are in favor of an individual mandate. They want us all to be insured.
BILL MOYERS: For the government to require every one of us to have some policy.
WENDELL POTTER: Exactly. And that sounds great. It is an important thing that everyone be enrolled in some kind of a benefit plan. They don't want a public plan. They want all the uninsured to have to be enrolled in a private insurance plan. They want-- they see those 50 million people as potentially 50 million new customers. So they're in favor of that. They see this as a way to essentially lock them into the system, and ensure their profitability in the future. The strategy is as it was in 1993 and '94, to conduct this charm offensive on the surface. But behind the scenes, to use front groups and third-party advocates and ideological allies. And those on Capitol Hill who are aligned with them, philosophically, to do the dirty work. To demean and scare people about a government-run plan, try to make people not even remember that Medicare, their Medicare program, is a government-run plan that has operated a lot more efficiently.
And also, the people who are enrolled in our Medicare plan like it better. The satisfaction ratings are higher in our Medicare program, a government-run program, than in private insurance. But they don't want you to remember that or to know that, and they want to scare you into thinking that through the anecdotes they tell you, that any government-run system, particularly those in Canada, and UK, and France that the people are very unhappy.
And that these people will have to wait in long lines to get care, or wait a long time to get care. I'd like to take them down to Wise County. I'd like the president to come down to Wise County, and see some real lines of Americans, standing in line to get their care.
BILL MOYERS: Wendell Potter thank you very much for being with me on the Journal
AP – Rep. John Dingell, D-Mich., smiles in his office on Capitol Hill in Washington in this Dec. 13, 2005 … 
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