This interview has been lightly edited for grammar and clarity. 

This interview originally aired on the Current Affairs podcast. Wendell Potter’s investigative journalism site, Tarbell.org, investigates and reports on corporate corruption. Follow him on Twitter @WendellPotter.

Nathan J. Robinson

Wendell Potter is the former vice president of Cigna, but don’t let that fool you. He is no longer part of the evil empire of the private insurance industry.  For ten years now he has been an activist exposing the PR spin and lies of the insurance industry and [pushing] for single-payer healthcare in America, and I’m very excited to talk to him. He’s also the author of the book Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Healthcare and Deceiving Americans, which was released in 2010 but hasn’t aged at all in ten years. 

So I want to start with something funny that happened the other day. You’re a very active Twitter user… 

Wendell Potter:

Yes, I am.

NJR:

And you have a tendency to say things like, “as a former insurance industry executive, I can tell you X, Y, and Z,” and someone saw one of these and was just shocked at the level of honesty and said something like, “This asshole just admitted everything.”

WP:

Yes, that was a very notable one.  I, uh, there are a lot of people out there who don’t cut me any slack, or people who are just now catching on to what I’ve, what I’ve been doing over the last really almost 11 years now, but it comes with the territory.  

NJR:

You were quite quite gracious about it, but the interesting thing about it is that I think that person had the kind of shock that a lot of people have when first encountering your writing and your work, which is that we hear so often from journalists, outsiders, activists, people who have not been part of the industry, but to hear someone who was in it for so long say so frankly some of the things you say about the private insurance industry comes as quite a shock to people.

WP:

It does. I’m a rare breed. There aren’t many people who’ve done what I’ve done and I’m just grateful to have that platform even with the critics that come with it, but, I think it’s the most important work that I’ve ever done, what I’m doing now.

NJR:

[Today on Twitter] you were talking about how you worked in communications for Cigna and PR for many years and what actually started to change your mind, the things that turned your perspective. You talked about one particular case, the case of Nataline Sarkisyan, I wonder if you could tell us what that case was and why it changed your perspective.

WP:

That was, as I said that Twitter thread, the last straw. I had over the course of my career handled a lot of what we referred to as high-profile cases and my team and I were the place where reporters would call, or others [at Cigna] would refer callers to me and my team. If someone was complaining about some service being denied, if they went to the media, if they were complaining to a Congressperson or a member of the legislature, we were the people in the company that had to try to make it go away, and that’s what we did. I can’t tell you how many cases, over the years like this that I handled, and they became rather routine. 

This one was different and probably because by this time I was already beginning to question what I was doing for a living. There was that, but also it involved a 17-year-old girl who needed a liver transplant and her doctors were confident that she would get through the surgery and live for years afterwards. But a medical director at my company decided to deny coverage for that procedure and so I was on the front lines trying to defend the company. It became a very big PR problem for Cigna and I was the person who was having to defend the company’s decision to deny that procedure.  

NJR:

Can I ask you: as you say, you obviously felt conflicted at the time and now looking back on it, it seems horrible to have to defend the denial of coverage to a sick teenage girl who, who then died. But from the inside, how do people in the insurance industry think about what they do? Is that kind of conflictedness common?  Do people think of themselves as helping? Do they rationalize what they do?

WP:

They do. It’s a lot of rationalization and people compartmentalize what they do at work, and I know, I’m sure that many are like me. You look for things that you do that you can point to to make yourself think, and maybe make others think, that what you’re doing is worthy and socially responsible. 

But the other thing is that most employees have a limited view of what their companies actually do. I was unique in that I had a pretty high-level position. I worked very closely with the CEO and others, in the executive suite, the chief financial officer, the general counsel, and others, so I knew what motivated those people. I also had to handle financial communications for the company. I knew how the company made money and what it did with it; most people who work for these companies don’t have a clue. I also worked with my counterparts at other companies, with our trade association, to develop propaganda campaigns to push back against any kind of healthcare reform ideas we didn’t like. Most people in the company had no clue that we were doing that, or how that happened.

 So what I did for a living was quite different from what most people do, and I had some visibility into how the company really operates and how the decisions are made that most people don’t.

NJR

Yeah, I want to ask you about that, because reading your book and your articles and your tweets, your perspective on the insurance industry really does seem to be that the kind of cynical take is correct: a profit-maximizing insurance company does what you think it does, which is that because of its mandate as a for-profit company, it has to think about healthcare as something financial and think about the people it serves in terms of how much money it can wring out of each person.

WP:

That’s exactly right. In fact, one of my, I guess it was the top job objective for a long time, was for me to do my part to enhance shareholder value. That is the most important thing that the company does, from the point of view of the executive suite and the board of directors, it is to maximize shareholder return. You lose sight of what it is you actually do, or what you were supposed to be doing. I can’t recall, Nathan, a time during the ten years that I handled financial communications for the company, ever hearing or having a discussion with anyone in the executive suite about how we could make sure that we were meeting the needs and expectations of our people enrolled in our health plans. It was all about Wall Street and the shareholders.

NJR:

I’m reminded of the phrase “the banality of evil,” because you talk in the book about how all the people you worked with were well-read, well-educated, could hold their own at a cocktail party. You said they’re charming, articulate, but the patients, the people you were serving, were just numbers. They were people on spreadsheets. They weren’t real. Their lives just had no reality to you.

WP:

That’s exactly right. It was all about the numbers in every different way.  We would disclose numbers of how many millions of members were enrolled in Cigna health plans. But it was all about the numbers, whether we’re talking about earnings per share or the medical loss ratio, quarterly earnings, in terms of revenue or profits. It was all about the numbers. 

NJR:

I think one of the shocking things—and this is why I think everyone should read Deadly Spin—about the book is, well, it’s easy to grasp the basic fact that the health insurance industry has a perverse incentive to deny care. People have dealt with their own insurance companies. They know how difficult it can be to get things paid for. But I think what you exposed that book and in your congressional testimony and subsequently is that it goes much, much further than that. You’re talking about the fact that the mandate to make money not only applies to how the industry deals with its customers, but spreads to large-scale disinformation and manipulation of public opinion.

WP:

Exactly. And that was the main reason that I had a job and kept it for so long. I was pretty good at spreading misinformation and obscuring important truths about the health insurance business and the health care system in this country. I became a really pretty good propagandist, so I know how it’s done. I know how much money is spent to hire PR firms to work with linguists, to work with a lot of different people to come up with just the right words and phrases to manipulate public opinion and to come up with campaigns that are designed to scare people away from any kinds of proposals to create a system that’s not like ours.

NJR:

Can you give me an example of some kind of talking point that is misleading, or some way in which the truth can be massaged in order to deceive people?

WP:

I will. And it often involves some element of truth, or being partly true, so there is some credibility to these talking points. One in particular is that, over many years, we were successful in getting people to believe things that just simply are not true about the Canadian healthcare system. Systems in other countries, too, but certainly and in particular the Canadian healthcare system. And there’s one part of the Canadian system that does need improvement, and that is waiting for some care, in particular elective procedures, sometimes imaging procedures. So we wanted to take that and make people believe that people in Canada wait months and months and months for medically necessary care, which is just not true. But by very carefully cherry-picking the data and telling anecdotes that cannot be verified, you can get people to believe things that just are simply not true about the broader system that Canada has.

NJR:

“Cherry-picking” is such an interesting and pernicious thing, because oftentimes the, the thing you’re saying is not strictly factually false. Oftentimes the stories that are told, sometimes they’re not verified. But, well, I am originally from England, and we have the NHS, and of course oftentimes things conservatives find anecdotes about the NHS, and they say, “Well, you can’t disprove this, this is true, this is a fact.” And it’s true that the thing, whatever it is that they describe, actually happened. But it leaves out the fact that on the whole, British people of course would never give up their free-at-the-point-of-use healthcare.

WP:

Exactly. And I’ve seen this on stage. There is a woman who is the president of an organization called the Pacific Research Institute, [Sally Pipes]. She’s a Canadian but she’s lived in the U.S. for many years. She had worked at a right-wing organization called the Fraser Institute in Vancouver and she’s especially adept at this. She’s very prolific in her writing and she’s written books to try, as I did (and I quoted her often) to misinform people about the Canadian healthcare system. On stage she can use this cherry-picked data and tell stories that you have no idea if they’re true or not, but she tells them in such a persuasive way that you begin to believe that what she’s saying is actually the way the Canadian healthcare system really is. 

When I was in college a long time ago, one of the books that I remember, a very slim volume, was called How to Lie with Statistics and I still have that book. It never occurred to me when I was taking that class that I would one day use statistics in a way to lie. But you do it by, again, cherry-picking, not using context, and obscuring other important data. That’s very important. Obscuring information is a big part of what you do.

NJR:

You talk in your book about how Cigna would produce in-house studies and presumably, again, the things stated in them are not necessarily provably false, but they’re just so well-crafted that they give a misleading impression.

WP:

It’s true. I was working on a white paper during the summer of 2007—this was during the time that I was beginning to have what became a crisis of conscience for me and it was one of the contributing factors to my decision to leave. I was asked to write a white paper on the uninsured in the United States. There were lots of media reports, a lot of discussion in Congress about the rising number of people who were uninsured. And, in fact, by the time the Affordable Care Act was passed, there were about 50 million people in this country who didn’t have health insurance. We wanted to divert attention away from the uninsured and to make people think that it wasn’t such a big deal after all. And you can slice and dice data from the Census Bureau and other sources and persuade people that a high percentage of people who don’t have insurance are uninsured by choice. You can find families with incomes of $75,000 or more and then draw the conclusion that those people could afford health insurance, they’re just not buying it.

What we would obscure at that point was that in many cases people could not buy insurance in this country at any price because of their ability to deny coverage to anyone because of a pre-existing condition, or to charge people a lot more for coverage if they’d been sick in the past, or to charge people a whole lot more as they got older. So the reality was that many, many—probably the great majority—of people who were uninsured, they were not uninsured by choice, they were uninsured because they simply could not afford to get the coverage or, in many cases, couldn’t buy it at any price.  They’d been black-balled by the insurance industry.

NJR:

And fortunately the Affordable Care Act managed to take care of, to some degree, the pre-existing condition problem, but you talk a lot about the insurance industry’s role in shaping actual government policy and what gets passed and what doesn’t. In the fight around the Affordable Care Act, we actually have an example of how American healthcare policy is shaped in some ways by choices made by for-profit companies, and you’ve really documented exactly how the sausage is made.

WP:

Yeah, it’s true, and I think few people realize just how much lobbyists for health insurance companies, or the pharmaceutical companies, or big hospital systems, are able to essentially write big chunks of important legislation. That certainly happened with the Affordable Care Act.

Not only that, the work that my colleagues and I did was to really make the term “single-payer,” for example, very toxic so that Democrats in Congress would shy away from it. And in fact, during that time, 2009, when the debate on that legislation began, Congress, the Democrats decided they would hold no hearings on Medicare-for-all, no hearings on single-payer healthcare. And it even gets worse. There was one hearing in which some single-payer advocates showed up during a hearing. They were not part of the panel, but they were there supporting single-payer healthcare, and Max Baucus, the chairman, was not happy with their presence there. They’re trying to disrupt the hearing, he had them ejected from the meeting room, handcuffed and jailed. So there was this hostility toward anything that the insurance industry was hostile to itself.

NJR:

I think we often think about the influence of corporate America on Washington as direct lobbying and campaign contributions, but one thing you really add in your book is the way that there can be an intermediate kind of variable which is public opinion. It sounds kind of conspiratorial to talk about manipulating the minds of the public, but if you can get a talking point that really sticks in people’s heads, then you could almost wield the public and voters as a weapon and have them almost do the lobbying for you, without the industry, without it being just purely lobbying firms.

WP:

Oh, it’s very true, and their terms, their talking points that politicians who are friendly to the insurance industry use. There are many who would willingly say them over and over and over again. As an example, when the House was voting on the Affordable Care Act, just about every Republican went up to the well of the House and called it the government takeover of healthcare, or something to that effect. Using words like that had been crafted by my former colleagues to make people think that this was legislation which would allow the government to take over our whole healthcare system.  Nothing remotely true about it. 

I was invited by a member of Congress from New Jersey to join him at a town hall, during the height of this debate, and it was just as the Tea Party was really getting its voice and at this town hall at Montclair State University there were many, many Tea Party supporters. They all sat on one side, supporters of reform on the other side, they were shouting at each other. There was no tolerance for what I had to say or anybody else on the program for that matter, but afterwards a woman came up to me who was on the Tea Party side and she said, “No one paid me to come here.” And I told her, I said, “No, you’re exactly right. No one paid you, but a whole lot of money was paid to somebody to get you to show up here.” And that’s how it happens. People are just unwitting foot soldiers and just have no idea how it happens to them.

NJR:

You talk about how there was this terror in the industry when Michael Moore’s Sicko came out because there was this fear that Sicko would be this incredible sort of counter-weapon to change public opinion. You say there were even people going, like, “How can we push Michael Moore off a cliff?” And they don’t mean a real cliff, but like, how can we discredit Michael Moore forever? And there’s people actually sitting in rooms trying to find ways to do that, and you said they didn’t want to say or mention Michael Moore, but, but really behind the scenes were strategizing: “what can we do about Michael Moore”?

WP:

Well, yeah, that obsession was months long. When we first heard that Michael Moore was going to be doing a movie on the U.S. healthcare system, we were concerned. We didn’t know if he was going to be coming after us, us being the insurance industry. We were hopeful it might be the pharmaceutical industry, but our worst fears were confirmed when the movie finally did premiere  But we spent, and when I say “we” I mean my peers at other companies and our trade association and the big PR firm that we hired, APCO Worldwide, we spent I can’t tell you how many hours developing a PR strategy. We were determined as best we could that we would be so discreet that none of this would be leaked to Michael Moore, or anybody for that matter, but we didn’t want him to know that we were paying the least bit of attention to what he was doing. His codename was “Hollywood” and a big strategy was developed. A lot of money was put into an effort to try to scare people away from Michael Moore, from a movie.

NJR:

You know, it sounds like the stuff of conspiracy, it really does. But as you point out, it’s not crazy, it’s what you would do if the survival of your industry depends on making sure that the United States government doesn’t pass policies that essentially eliminate your industry. Because, being honest, Medicare-for-all does eliminate much of private for-profit insurance, that’s the point.

WP:

Right. That’s right. And that’s why a big part of my job was to protect profits, to protect the status quo. That was what we’ve been talking about, the way I contributed to protecting the status quo. We talked a moment ago about Nataline Sarkisyan, that 17-year-old girl who died. The medical director who denied coverage for that transplant was every bit as much of a corporate employee as I was and he knew, too, just as I did, that if you didn’t do your part to help the company meet Wall Street’s profit expectations, you’d be evaluated on that. You’re always held accountable. You don’t have to have a memo that comes from your boss saying that you’ve got to deny X number of transplants or do that, it’s just you know that if you want to get a bonus, if you want to get stock options, if you want to get a raise, you have to impress your superiors, you have to do your part to help the company achieve its ultimate objective, which is to meet Wall Street’s profit expectations.

NJR:

You spent a lot of time thinking about how to change public minds in one direction, but when we think now about these talking points—if we take, for example, “government takeover,” if you meet someone like that Tea Party person you met and they say to you, “Well, I don’t want a government takeover of my insurance,” how do you think about how to persuade in the other direction? How do you dismantle a talking point? Where do you start? A lot of money has been spent trying to worm these ideas into people’s brains. Where do we begin to unravel them?

WP:

You know, you have to honestly use some of the tools and techniques that I used. You have to use storytelling. You have to connect with people emotionally.  When I was telling you about Sally Pipes on stage, much of what she did was tell stories, and you’ve got to be able to make an emotional connection with someone if you’re talking to them. You can use some data, but you have to kind of wrap those into the story you’re telling. 

But do know this: there are some people who are just so convinced that the free market can work in healthcare, as it does presumably in other sectors of the economy, they are not persuadable. So you can make a decision pretty quickly that it’s just not worth your time to try to persuade someone. Others are so wed to ideology that it’s almost a fool’s errand to try to persuade them, but there are probably enough people who are persuadable, and we’re seeing this certainly over time, who are beginning to catch on. I think the work that I and other advocates are doing is beginning, slowly, to pay off. 

We also are at a time when there is such abundant evidence that the healthcare system we have is failing so many. One reason that it’s been able to go on as long as it has, at least our way of insuring people, is that in a given year most people are pretty healthy. You don’t have any need to test the limits of your health insurance policy. Now we’re seeing that tens of millions of Americans are finding, as I’ve said many times, that so many of us in this country are a layoff away from not only losing our jobs but our health insurance. People are becoming increasingly aware of just how much they have to pay out of their own pockets before their coverage kicks in, because of the strategy of moving everyone into high-deductible plans. So we’re able to find people now who are much more receptive to an argument against our current healthcare system than we had ten years ago.

NJR:

It was so frustrating during the Democratic primary because you had a lot of the candidates, members of the Democratic party, many of whom call themselves “progressives,” often repeating the idea “Well, a single-payer healthcare system would mean hundreds of millions of people kicked off their health insurance, they would lose their health insurance.” And that does legitimately terrify people. When they see Democrats telling them Medicare-for-all would take away their health insurance, they’re genuinely frightened. But now we’re seeing that the thing that takes away your health insurance is losing your job. We don’t have a system in which you get to keep your health insurance. That’s an illusion.

WP:

You’re exactly right. And if the pandemic had begun just a few months earlier, you would not have heard Amy Klobuchar or Pete Buttigieg or even Joe Biden, talk about the employer-based system—all three of them, and others, would frequently say 150 million Americans get their coverage through their employers, they like it, they don’t want to lose it. Well, of course they don’t want to lose it, but just a matter of weeks after some of those debates, people began to lose their jobs by the hundreds of thousands and by the millions. So that would not work right now. But it was a talking point that was working then, and people did buy into it and as I tweeted and wrote about, it was so dismaying to see those candidates just mouthing the talking points that my colleagues and I used to write.

NJR:

And the other thing was “it’ll raise your taxes,” right?  When they talk about single-payer healthcare they show one side of the balance sheet. They show how much it costs you but they don’t show how much it saves you. 

WP:

Right. And what we’re talking about here is absolute outright deception on the part of politicians. And even those that are running for the Democratic nomination for President! It’s the same kind of thing we’ve talking about. You can talk about these things by taking taxes and purposely obscuring the other important element of that, which is that you would no longer have to pay premiums that you and your employers are paying to an insurance company. That’s never mentioned. So people have this notion that somehow they’re going to be paying a lot more overall and that’s purposeful, and that comes absolutely from the insurance industry. And when you hear a Democrat using that kind of language, that’s a real tipoff that that candidate has taken a lot of money from the insurance industry in campaign contributions, or is inordinately receptive to the talking points that an insurance company lobbyist gives to him or her.

NJR:

I think what’s important about that it shouldn’t be classified as a policy disagreement. Because when you’re concealing information that is crucial to helping people understand what would happen if this thing were passed, that is, as you say, it is just deception. We can have a discussion about what the proper way to finance healthcare spending is. There are lots of different models around the world, and healthcare economists disagree. But if you just tell people “you’re going to lose your coverage” … In fact, often you heard people say “Oh, yes, Medicare-for-all is very popular in polls, but if you tell people ‘you’re going to lose your insurance,’ and then it becomes much less popular.” And you think, “well, of course, if you tell them that then it becomes less popular.” 

WP:

Yes, again, this is what we’re doing. This is exactly how it works. When you fail to disclose certain information, you can really persuade people, and that was exactly what was happening. However, one of the things that we were observing, those of us in the advocacy community, during every one of the primaries and caucuses that were held, even including in the southern states like Tennessee where I grew up and South Carolina, a majority of those who voted in the Democratic primary said, in exit and entrance polls, that they supported Medicare-for-all, knowing that it would mean, that it would replace private insurance. So, that dog don’t hunt as much as it used to. People are not as enamored with private insurance companies as some politicians would like us to think that Americans are.

NJR:

Yes, they say, “Oh, well, people love their plans, though, they love their employer-based health insurance.”  

WP:

They do not.

NJR:

And you say, what was your last experience with your insurance company?  

WP:

Right, yeah, yeah.

NJR:

One disturbing thing that you’ve mentioned is the way that this coronavirus crisis is not necessarily going to be bad for the insurance industry. Because the first question in any situation is “how can we still make money out of this?” and there are going to be ways. 

WP:

It’s true. Among the horrible things that is happening as a result of this pandemic is that some healthcare providers, those who actually provide care, whether we’re talking about some hospitals and many doctors, they’re losing revenue. You know, they’re trying to save lives and, but they’re getting hurt financially. The insurance industry, on the other hand, they’re making money hand over fist, and the reason for that is that people are still having to pay their premiums but a lot of procedures that otherwise would have taken place have been canceled. Hospitals, in many cases, have just been canceling all elective procedures and so you’ve got this situation in which insurance companies are taking in as much revenue as they otherwise would in premiums, for the most part, but paying out far, far less in claims. 

And when you look at who has really been most affected by the pandemic, they’re older folks, and a high percentage of them are on Medicare, so in other words, private insurance companies are not on the hook to pay for their testing and care, it’s the government through the Medicare program. There are others who are in the Medicaid program, once again a public program. And because we have multiple insurance companies, no one company is having to provide coverage for a lot of their COVID-19 testing and treatment. So they’re going quite well.

NJR:

I just want to finish up by asking you if you could tell me what you think the best response is to a couple of anti-single-payer talking points. So if I came to you and I’m a skeptic of Medicare-for-all and I go, “I’ve heard something about this Medicare-for-all, but what about choice? What about this “one size fits all” plan? This idea that everyone’s going to be in a single plan. What about the custom tailoring of plans,individual choice?”

WP:

That is one of the current talking points from the other side, that Americans don’t want one size fits all. And they want to make you think that we have abundant choice. But what I would tell people is: just step back and take a look at this.  What choice is most important to you?  And I would wager that they would say it is more important for them to have a choice of doctors and hospitals and other facilities, not so much the health insurance companies. That’s the choice that’s important to them, and increasingly and systematically, insurance companies have been taking that choice away by their ability to create these limited networks that exclude a lot of doctors and hospitals, so our choice of doctors and hospitals is diminishing. 

But when you look at the choice of insurance companies, again most people who have private insurance get it through their employer. Regular folks don’t make the decision about which health insurance company they’ll have access to, it’s the employer that makes that decision. So we have very, very limited choice when it comes to picking health insurance companies; that’s just an illusion, it’s not true. What has been happening to us is insurance companies have been taking away the choice that we value most.

NJR:

You’ve persuaded me on that one. But I’ve heard that doctors are going to have their pay cut under single-payer healthcare and that they’re going to have to work for Medicare rates and that rural hospitals are going to shut down and I’m very worried that Medicare-for-all is going to reduce the quality of care that we get.

WP:

Well, I’ll start with rural hospitals first. Again, I’m from Tennessee.  Over the past three or four years, about 15 rural hospitals in that state have closed. And it’s not a big state, it’s a middle-sized state. And they’ve closed because there are not enough big employers in those communities for people to have rich benefits, that just doesn’t happen, so in our current system we are seeing rural hospitals close all over the country, by the score. So that is happening and we need to have a Medicare-for-all system that like the bill that Bernie Sanders has introduced and like the one that Pramila Jayapal has introduced, that would provide a means of budgeting so that these hospitals can keep their doors open. That’s one of the reasons why Medicare-for-all would be really good for people who live in rural communities, it would be a way of protecting their rural hospitals from closure.  

As for doctors, doctors are experiencing something in this country that doctors in other countries are not, and it’s called moral injury, because of all of the things that insurance companies are making them do now that interferes with the way that they treat their patients. One in particular that I wrote about in my tweet, is called prior authorization. Doctors increasingly have to beg for approval from insurance companies before they can proceed with the treatment for their patients, and they have to spend on average $100,000 a year just because of the need to deal with the multiplicity of insurance companies we have and to have someone on staff to do that begging day in and day out. So you’ve got all that money that is being spent by doctors all over this country because we have this situation we have now. Let’s free that money up and pay doctors rather than making them have to spend hours and hours and hours on a phone begging for being able to treat their patients as a way they know they should treat them.

NJR:

But what about innovation? I’ve heard that America is one of the leading—we have bad healthcare outcomes in some respects and are very unequal—but we’re one of the leaders in medical innovation. Won’t that be slowed down and stalled by a single-payer system?

WP:

The word you’re looking for there is “stifled” because one of the big talking points is that if we move to Medicare-for-all, or any kind of reform, quite frankly, it’ll, it’ll stifle innovation.

NJR:

Oh, yes, “stifled.”

WP:

You watch for that one. Stifle. It’s a big talking point. Well, let’s look at the insurance industry. What are the innovations that the insurance industry has brought to this country? I was in a leadership meeting with my CEO before I left and someone asked him what kept him up at night, and he said what kept him up was worrying that at some point the company’s customers would begin to question the company’s value proposition. Well, that day has arrived. What value do insurance companies really bring to our healthcare system? I bet you can’t find many. 

But what you can do is you can tick off the barriers that they have brought, the innovations in making sure that people do not get the care that they need through prior authorization, making it more and more difficult for doctors to treat their patients as they know they should be treated, high-deductible plans that mean that Americans have to spend thousands of dollars out of their own pockets every year before their coverage kicks in, and these limited networks, this stealing of choice away from Americans. Those are the innovations that private insurance companies have brought to the American people that folks in the U.K. and Canada just haven’t been able to realize yet.  

NJR:

I find that an illuminating comparison is to ask people to think about how health financing would work if you imagine it with the fire department. If you imagine that we structured fire prevention the way we do healthcare and we had not only private fire services instead of a fire department, but then on top of that it was all funded through privatized fire insurance, and you think “what contribution would the addition of this create,” it sounds like a much simpler thing. Why not just have a fire department?

WP:

I’m in Philadelphia, I’ve lived here for several years. You can go wander some of these small cobblestone streets of Philadelphia, and you’ll see on some of these really old houses a shield, and those shields are from the time before there was a publicly-funded fire department, and people who were able to pay for fire protection would put a shield on their house, and if you didn’t have that shield and your house caught on fire, you were up the creek. But that’s what it was like back then. And finally the community decided, well, this doesn’t make a lot of sense because if my neighbor’s house burns down and we’re in a row house, as many people are in Philadelphia, my house is going to go, too.

NJR:

Right. Which brings up the fact that in health, people’s fates are tied together in ways that we don’t see, too, and the coronavirus pandemic is showing that very clearly. My health affects yours.

WP:

Exactly right. People are beginning, I think, to realize that. This is another reason why we’ve struggled to move forward, that a lot of people think “Well, I pulled myself up by the bootstraps, I can afford health insurance. Why do I want to pay for some unworthy person who’s a slacker?” That’s been the mentality. But this is waking people up to realize that we’re all in this together.

NJR:

And the final talking point I wanted to run by you was: “Okay, but government can’t get anything right. Obamacare shows that the government getting involved in healthcare makes it worse, and we just need a truly free market in healthcare. Look at the VA, government is always a failure.”

WP:

The VA is—unfortunately, because it did get some bad publicity—but in the VA one thing in particular, they are able to at least negotiate prices for prescription drugs in ways that regular Americans cannot. But here’s the thing. Let’s look at the fact that we pay twice as much for healthcare in this country as any other country on the planet, twice as much as the Canadians do on a per capita basis, but our outcomes are so much worse. We’re spending a lot of money out of our own pockets until our coverage kicks in. That’s what the free market has really brought to us. Now some people say, okay, just let, get rid of regulations. Well, that will actually take us back to days before the Affordable Care Act, when insurance companies could, and did, refuse to sell people coverage because of their age or their health status or charge them a lot more. If that’s what you want, then we could go back to that, but hopefully, if you are someone who hopes to live a few years, you will have a pre-existing condition, you will get older. That’s why having a system that is more like one-size-fits-all really fits all of us a lot more than most people will stop to think about.

NJR:

I met a military veteran recently who said he wished that people talked about Tricare in these conversations as much as they talk about the VA, because he thought the care on the base was absolutely fantastic.

WP:

Yeah. It is, exactly. The government care that’s provided to people in the armed services, they love that government-run healthcare.

NJR

Can I just ask you, do your old colleagues think you’re nuts  Do you just not talk to them? 

WP:

You know, when I started doing this, I got e-mails from a lot of them, and calls, thanking me for doing this because many of them knew what I was doing, I was telling the truth. And they just have not had the ability, they just haven’t been moved to do what I’ve done, and I understand why. A lot of them have certainly not spoken to me. I was worried about that initially, then I’ve come to realize that most of the people I would have called my friends in the industry, they were just acquaintances, they were not close friends. There are many who don’t speak to me now, but I really don’t miss them.

NJR:

Yeah, I’m sure there are certain social events you’re not invited to, but they probably weren’t the ones worth going to.

WP:

That’s exactly right, I’ve met a lot of people since then that I much prefer hanging out with.