Former executive at two major health insurance companies, Wendell Potter, became a whistleblower who is working now for health care reform. He is senior fellow for health care at the Center for Media and Democracy. He is interviewed here by Marty Moss-Coane on WHYY's "Radio Times" and by callers to the program.
From Radio Times, 7/21/09: "As Congress and the President grapple with the complicated issues surrounding health care legislation insurers have launched an aggressive ad campaign conjuring up "Harry and Louise" to share their concerns about the Obama campaign with the public. Our guest Wendell Potter is a former corporate executive with one of the nation's largest insurers who has concerns about the health insurance industry and how they do business."
Radio Times: Wendell Potter was an executive for Cigna Corporation, one of the largest insurance companies in the country. He was a go-to guy for reporters covering health care and was part of a well-funded PR machine as its chief spokesman. A life-changing event led to his retirement from the company last year. Potter testified before a Congressional committee last month [pdf] because he was concerned about the campaign to manipulate opinion about health care legislation. He told the Senate Committee that for 20 years as a health insurance executive, "I saw how they confused their customers and dumped the sick, all to satisfy their Wall Street investors." ... Wendell Potter, you were the chief spokesman for Cigna?
Wendell Potter: I was.
RT: And your job was to...?
WP: ... was to make sure that the messages we wanted to convey to the media were conveyed. It was my job to make that happen, to defend the company's reputation, and also to work within the industry. Often I wasn't speaking for just the company but for the industry as well.
RT: I'm interested in the kinds of questions reporters would have for you -- reporters perhaps covering healthcare, maybe even covering the insurance industry.
WP: Having been a reporter in my first career, I love working with reporters but I was always expecting to be challenged more than I was by reporters. I think what has happened to the media over the last several years has made a big difference in how reporters do their jobs and the information that we get as Americans. I think many reporters are overworked and don't have time to really get to know the companies they're covering. So I think oftentimes I got away with a lot!
RT: By that you mean that a reporter would call you, get a comment or a statement from you and then it would show up in their report?
WP: Exactly. And so I was able to do my job, I think, a lot better than maybe I would have several years ago. Most reporters will take the statement that you spoonfeed them and then just go with it.
RT: You also had to handle some crises for the company as well?
WP: Oh, I did. Many times. Over the years crisis communications was a big part of my responsibilities.
RT: What was one of the more memorable crises you had to handle?
WP: The last one, I guess, toward the end of 2007 right around the holidays. The doctors at UCLA -- for a patient there, a 17-year-old girl -- the doctors said that she needed a liver transplant. It was the only thing that could possibly save her life. She was covered by a plan that was administered by Cigna. The request was denied. The family was so distraught that they took to the media in California where she lived and enlisted the support of the California Nurses' Association to bring a lot of public pressure to bear on the case. It was a remarkable thing to live through because I was, at that time, the spokesman for the company.
RT: She died.
WP: She died. The company did agree to cover the procedure and pay for it after the family had gotten so much media attention. Regrettably it came too late. She died just a few hours after the family learned that the procedure would be covered.
RT: What did you say in defense of Cigna at that time?
WP: Well, that in any system there has to be some means of determining whether a procedure should be paid for. The fact that the patient's doctors had recommended this didn't mean that the procedure couldn't go forward, it just meant that Cigna's decision was that it wasn't going to be paid for by her insurer.
RT: Do you think there was anything wrong that you were doing as a spokesperson for this insurance company?
WP: I tried not to lie or mislead. I don't recall ever having lied to the media. Looking back, I think there are times -- one of the reasons I ultimately decided to leave was that having been a journalist I felt that much of the time what I was doing was just the opposite of what I'd tried to do as a reporter. I was often, I think, while not lying, I was not disclosing a lot of information that I think would have made a difference in a reporter's story if the reporter had had more information.
RT: Withholding information vs. misleading or lying to a reporter.
WP: That's correct.
RT: You also have described -- I don't know whether "life-changing event" is making it more dramatic than it is -- but nevertheless you were actually visiting family in the South where you're from.
WP: That's right. I grew up in Tennessee -- was born in North Carolina but grew up in eastern Tennessee. I was there and picked up a local newspaper, the Kingsport Times-News -- in fact I had an internship there early on! And there's a story about this exposition or health fair that was being held a few miles up the road in Wise, Virginia. I borrowed my dad's car because I was intrigued. I'd never heard of this organization. It had been held for several years and I'd never heard about it because I hadn't lived there in a long time. I wasn't prepared for what I saw. When I drove up to the parking lot of the Wise County fairgrounds, it was jam-packed. I don't think even the county fair would have attracted as many people as this expedition [exposition?] did. I didn't see people until I actually walked inside the fairground gate. When I did, it was absolute overwhelming. I saw people by the hundreds -- probably thousands -- who were lined up, standing in the rain or sitting in the rain... They were waiting to get care that was being provided by doctors and nurses and dentists who were volunteering their time in animal stalls! Volunteers -- in fact, they're doing it right now because it's going to be held again this coming Friday through Sunday in the same community -- volunteers come early to disinfect the animal stalls.
RT: So the human patients can come in and get care.
WP: Exactly. And that's where many of them get the only care they can get because they either are uninsured or many are under-insured and can't afford to make the payments to get care.
RT: You have been part of the insurance industry as an executive for many years: 15 years with Cigna and about 5 years with Humana. You didn't know about the millions of people that were uninsured or underinsured in this country and the desperate straits they were in?
WP: Not so much the latter. Yes, I knew -- I knew the numbers. I think most of us hear the numbers and think, "Well, that's bad. We've got 46 million or more and now it's probably closer to 50 million who are uninsured." That's not a good thing. But there are a variety of reasons why people are uninsured. When you're in the executive offices, you think in terms of numbers rather than human beings. One of my responsibilities was to communicate the financial condition of the company to the media. So I dealt a lot in numbers -- in the billions of dollars, in the millions of members. As I was talking to the media about public policy, I would obviously reference or be asked about the number of people who are uninsured. But you don't really see it in the executive offices. Sure, I probably knew people who were uninsured but you don't really think about it that much. It's probably a good thing or -- it's not a good thing, it's not, and ultimately I realized that you can't just think in terms of numbers. You have to realize that real flesh and blood is attached to those numbers, and we're talking about men, women and children.
RT: You saw this and you said, "I've got to change my life. I've got to get out of this business that I've been in"?
WP: I did. I knew, although I didn't know exactly how I would do it or when I would do it, I knew at that moment. It was really life-altering. It was an experience I've never had before or since. Almost like being struck by lightning. I was affected very emotionally and that was important as well. If you think about these things just intellectually, it doesn't have as much power or impact until you can actually see it and witness it.
RT: I notice that you resist being called a whistleblower. And I don't want to get bogged down in language here But nonetheless I find that interesting.
WP: Well, I don't mind being called that. I don't care what people call me as long as they listen to what I have to say and maybe open their minds to my point of view. As a former journalist, I tried to provide information, tried to educate or enlighten people on whatever I was writing about and I see myself returning to that kind of role -- maybe more advocacy journalism now than what I did before. I do write a blog and I do speak out and I appreciate opportunity to do interviews. But I see myself more as a journalist I guess because of my journalistic career.
RT: How about people still at Cigna? What do they... do they talk to you? Do you hear from them? Do they criticize you? What do they think about what you're doing?
WP: Well, they're very careful in what they say about me. I think I understand why. I would probably have taken the same tack had I been there and someone else had done this. They've been very careful not to be critical of me. They've acknowledged that I worked there, the work that I did. They've noted, when they've been asked, that they have a disagreement with my point of view. They haven't argued with the facts -- with one exception to that. But I think that one of the reasons they haven't said anything more about me is that they don't want to perpetuate the story or keep it going. I think they think -- and rightfully so -- that if they do begin to talk about it, it will fuel the fire.
RT: What is your message?
WP: My message is that this is an opportunity for us to have meaningful health care reform. We can't blow it this time. And I want to make sure that people understand the tactics that the special interests -- especially the large health insurers -- are using to kill health care reform as they have done in the past. And that we, as Americans who know the importance of reform, need to be aware of that and get involved if we really think reform is what this country needs.
RT: When you talk about tactics, I'm thinking about some of the words that have been used to criticize healthcare legislation: "socialism," "rationing"... Is that what you're talking about?
WP: It is. The industry has what I refer to as "evergreen" messages. You'll see and hear many of the same tactics used and many of the same things being said this year as you did in 1993 and 1994 -- the last time we had a big debate on health care reform. In fact I went back and looked at some of the Senate testimony and I saw that the leaders of the industry back then were making some of the same promises and assurances and commitments. On the surface they'd say, "We for reform." But what happens behind the scenes is really what's going on. That's just window-dressing. The PR charm offensive, as I call it. Behind the scenes they are working through their allies to use the same language and the same scare tactics that they did back in the early '90's any time reform has come up.
RT: ... So what are insurance companies afraid of?
WP: They're afraid of more competition. They're certainly afraid of competition from the government and that's why you're hearing so much criticism of the so-called public insurance option that was a big part of President Obama's campaign. It was something he proposed -- so did Hillary Clinton in her campaign -- and it's a part of legislation that's working its way through Congress in both the House and Senate. We haven't seen final legislation that will be voted on. But the insurance industry is adamantly opposed to this and this is the main thing they're targetting right now.
RT: Because they think it will put them out of business? Is that their fear?
WP: That's what they're saying. It would not put them out of business but it would be some additional competition and significant competition. They don't want to have anything forced upon them. They're very adaptable companies and if there is -- and I believe there can be -- a public option passed as part of reform legislation, they can adapt. One thing these companies are very good at is being adaptable and making money. I've seen over the course of 20 years how they've changed their business models many times in the face of changes in the economy and in the insurance industry. So they're very adaptable.
RT: Is there anything wrong, from your perspective, of an insurance company making money, being profitable?
WP: When I first started my job, I didn't think so. I thought there were good things about being a for-profit company. But in more recent years I've come to think not. I was able to see in the last few years of my tenure in the insurance industry how these companies make money, and because of the pressure from Wall Street investors on these companies less and less money is being spent of the premium dollar on actually paying claims.
RT: In fact, in your testimony before Congress -- before a Senate committee last month -- you quoted a study conducted by Price Waterhouse Coopers looking at, I guess, the profitability of some of these insurance companies. Can you talk about that?
WP: Right. These companies have become very profitable. Two or three things that I think people have not been made very aware of is that since the '90's there's been an enormous amount of consolidation in the insurance industry. There are not nearly as many insurance companies as there had been. And now the industry is dominated by for-profit companies. The seven largest for-profit companies combined had revenues last year of over $250 billion and many billions of dollars in earnings or profits as well.
RT: And this is during an economic downturn!
WP: That's right! Much better than the rest of the economy. In fact, these companies are often places where investors go during a recession because people do need to have coverage. So even if their enrollment declines, these companies know how to continue to make money.
RT: You also detailed before the Congressional committee the ways that these companies maximize their profits -- including denying benefits, canceling policies, increasing rates -- and again I wonder if you could describe what some of these companies' strategies are.
WP: Right. One that I'll start with is how it affects people who buy their insurance in the so-called "individual market," who can't buy it or for whatever reason don't get it through their employers. When someone who has insurance through the individual market has an illness or an accident, or has fairly high medical claims, back at the insurance company someone will review not only those claims but will go back and look at the application that the person filled out. If there is any reason to think that someone might have withheld information or didn't include something that was pertinent and that might have indicated a pre-existing condition (as it's referred to in the industry), then the insurance company will use that as rationale to cancel the policy. So if a person has been paying premiums on time for months or years but at the time they really need the insurance most, they may find themselves not having insurance and being left with a lot of medical bills and no insurance coverage at all.
RT: How common is that practice?
WP: It's quite common. It was investigated in California -- where this investigation originated. And when Congress looked at it, they found evidence in this particular investigation 20,000 people whose policies had been canceled. That is significant when you look not only at the numbers of those individuals who were affected, but that meant that the insurance companies did not have to pay out more than $300 million dollars in claims! So just a few of these makes a big difference in the profitability of the company. And there are other ways that they do the same thing. People who are enrolled in employer-sponsored plans are also vulnerable to being dumped by the insurance company.
RT: For the same kinds of reasons?
WP: The same kinds of reasons. This is a particular problem for small employers and people who work for small employers. Because they're small, one person's illness within the small group can make a significant difference. Insurance companies look at the claim experience of these small businesses as well, and if one employee or one dependent of an employee has unusually high claims that also will trigger a review of the business. And when that business account comes up for renewal -- annually, usually -- then the underwriters will determine what they can do to make this company either more profitable or make it go away. The evidence shows that they often will jack their premiums up so high that the small business has no alternative but to walk away.
RT: But I would say that for most people who work for a company that has health insurance, thei premiums have gone up -- maybe not exploded like that, but certainly have gone up. Co-pays have gone up as well. And I think most people are told, "Well, it's an expensive business and this is what we need in order to be a profitable company.
WP: That's what people are being told. You're exactly right. But the premiums have increased significantly more than regular inflation. Much, much more. The insurance companies have always figured out a way to make sure that they're pricing their health plans at more than what they expect medical inflation to be. So they've got that figured out. But you've mentioned something that's also going on that insures their continued profitability. They've been shifting more of the financial burden -- even if you have insurance -- onto the people who hold policies, who are insured. It's a cost-shifting that I think people are experiencing -- in the form of high co-pays and larger co-insurance responsibilities.
RT: Do you think, though, that the insurance industry -- what are there, say 45 to 50 million people who don't have insurance in this country? -- isn't that an opportunity for insurance companies? Wouldn't they want a lot of those people to be insured?
WP: They've now come around to accept that. They have embraced, as an industry, what they refer to as an individual mandate. That's inside-the-beltway talk for a requirement that everybody be forced to have some kind of insurance coverage whether in a public plan like Medicare or Medicaid or the Children's Health Insurance Plan -- "S-CHIP." Or a private insurance plan. And they certainly would prefer that all these 50 million people who don't have insurance be required to buy insurance from the private insurance industry. If they have any trouble affording it, the federal government will send tax dollars to these insurance companies to subsidize those payments.
RT: How many people do you think in this country are under-insured? I guess paying they're paying for the basic insurance but it doesn't cover a lot of conditions.
WP: There is a study by the Commonwealth Fund that indicated at least 25 million people are underinsured. This is a problem that is not as well known as the uninsured. It's a problem that's gotten increasingly worse as insurers have been pushing and marketing these so-called "consumer-driven" or "consumer-directed" plans which really are the high-deductible plans that we've just been talking about -- that shift a lot more of the financial burder onto consumers.
RT: You also say that there's been another shift in the health insurance industry from shared responsibility -- I guess the idea is that you have a big pool of people and it's shared risk -- to individual responsibility. Why is that significant?
WP: That's significant because it reflects a philosophical change from the whole concept of insurance as we used to know it -- or when we grew up knowing or thinking that we had insurance in this country. It's part of an ideological shift by the executives of these companies. It's very much aligned with the thinking of the Bush administration, for example, which enabled a lot of these consumer-directed plans to really gain strength. It's a belief that individuals have far more of the responsibility to not only take care of their own health but to pay for their own insurance and out-of-pocket expenses.
RT: One more thing -- because there's so much talk in the past couple of days about health care legislation -- and one of the critiques of this "public plan" is that it puts the government between you, the consumer, and the doctor. What do you say to that?
WP: It's a specious argument. It's not true. Many people are enrolled in Medicare, which is a very popular public plan. I hope people will remember that. There's no government bureaucrat between a Medicare beneficiary and his or her doctor. More like, and what is really true, is that there really is now a corporate bureaucrat between a person enrolled in a private plan and his or her doctor.
RT: Let's get some callers in on the conversation.
Chuck: ... Thank you, Mr. Potter, for your courage and for speaking out as a former industry official. Just for purposes of full disclosure, I'm the executive director of Health Care For All (Pennsylvania). We're an advocacy group working on a couple of bills in Harrisburg: Senate bill 400, House bill 1660. They would provide publicly funded, privately delivered, health care for all. Single-payer is the shorthand name. At the national level, the readership has said that single-payer is "off the table." Mr. Potter, what do you think about moving up the single-payer solution to state level?
WP: I think that's especially where it's important. You're right. Regrettably, all options are not on the table in Washington, and single-payer is one that is not on the table because the leadership of both the House and the Senate have kept it off the table.
RT: And why do you think that is?
WP: Because of the power and influence of the insurance industry. That is the ultimate thing that would put them out of business as we know it. Canada has a single-payer system and there are no private insurance companies that compete with the government program. ... So they're fighting. They don't want a public option but they certainly don't want a single-payer. I think that it's more likely.... I think single-payer efforts could succeed at the state level much more than they could at the national level. And in fact, in California, bills have passed twice in the legislature that would create a single-payer system. Both bills have been vetoed by the governor. And, as Chuck mentioned, in Pennsylvania there's strong bi-partisan support for single-payer in the legislature. So I think it should be enabled. There should not be passed anything at federal level that precludes adoption of a single-payer system.
Ruthanne: Wendell, thank you so much. My question has to do with whether there's been any survey or do we have numbers on how many people are well-insured but cannot pay their co-pay? I've been well-insured for a long time but because of certain personal economic situation, was not able to pay my co-pay after a breast lump was removed. I could not go back for the follow-up, could note even get a mammogram to see that everything was fine, and that caused a lot of stress. I then couldn't pay for stress-related medication like asthma medication and I just went downhill. Recently I took in a tenant in return for work around the house. He is a vet, a Gulf War vet, who has had radiation illness ... [inaudible] ... and cannot prove that it was because of the Gulf War. So he gets no coverage and his new job will not cover a pre-existing condition. ... There really are a lot of people who can't pay their co-pay.
RT: It's a poignant story. Let me give our guest a chance to respond to that.
WP: It is. And there are at least 25 million people who have insurance but who are considered under-insured and partly because they cannot afford to make the co-payments. It's going to be more and more of a problem. That, frankly, is one of the reasons I decided to leave my job. I saw that the insurance industry was moving more in this direction, shifting more and more of the financial burden. That is pretty much the last card they had up their sleeves to manage medical expenses for employers and for themselves. It's a shifting of the cost of the financial burden to individuals. It's not sustainable in the long run. But they're going to try to do it as long as they can because these are very profitable plans for them to market and to administer. But ultimately, if we don't have reform, more and more of us are going to be in that same predicament.
RT: You mentioned that the Clinton attempt to change the health care system. But you also said that the insurance companies are richer, more powerful and more connected than they were 15 years ago.
WP: Absolutely. There's been consolidation in the industry as I mentioned before. There are far fewer and the surviving companies are much, much bigger. Wellpoint and United are the biggest and they both have well over 3o million people enrolled in their health plans. If you take the seven largest plans -- just the seven largest for-profit plans -- it's over 100 million people. So one out of every three Americans is enrolled in one of the plans sponsored by one of these big seven for-profit companies. So it's changed a lot. And also at the trade association level, there's been a merger of the trade groups into one very powerful lobby group in Washington.
RT: So how many lobbyists do you think working today on healthcare legislation? Or against healthcare legislation!
WP: You can bet there are hundreds. I've heard at least three hundred and I'm suspecting it could be even more. Every one of the big companies has several lobbyists at work for them. Some are in-house that they employ, but they hire lobbying firms. They each have both Republican and Democratic firms. They want to do that because many of these lobbying groups have or are headed by former members of Congress on their payrolls. It's important for them to do that.
RT: We're talking about the revolving door here?
WP: We sure are. Absolutely are. A revolving door in Congress and also in the administration. There are a lot of people, for example, who went from private insurance or some of the PR firms or lobbying firms that supported them into the White House. It's a giant revolving door in Washington.
RT: I wonder if you could talk a bit about Montana senator Max Baucus. He heads the Senate Finance Committee, one of several committees looking at health care legislation. Is he tainted?
WP: Well, Senator Baucus probably is the most influential member of Congress because he is chairman of the Senate Finance Committee. Any health reform legislation would have to come through his committee -- it's the committee that figures out how it's going to be paid for. He is the recipient of more money from the health insurance industry than any other member of Congress. He's a Democrat and obviously a very influential one which is one of the reasons why he's been a recipient of so many contributions from all sectors of the health insurance industry. Is he tainted? I know he says he's not. And the other thing, as we talk about the revolving door, is that many people who used to work for him are now in lobbying firms and representing the special interest in this debate. I think he bristles at the suggestion that influences him unduly. But, uh, all the evidence is that he is listening more to the insurance industry than to average Americans. He's been very slow to warm up to the idea of a public option. He's not entertaining the idea of a single payer. So many of the things I've seen him say and do indicate that he really is someone who's paying a lot of attention to what the insurance industry wants.
RT: Do you think it's a fair fight because there are lobbyists and interest groups on the other side -- the other side that might be for a single-payer or a public plan? Do you see this as a kind of David and Goliath situation? Is one side richer and more connected than the other?
WP: Absolutely! There's no doubt about it. The insurance industry is much more powerful and richer and influential than it ever has been. It's able to spend millions and millions of dollars not only in lobbying and public relations but they'll be gearing up advertising. So we're seeing the evidence of their spending and influence there. The only way -- and I've thought this for a long time -- that we can achieve meaningful reform in this country is if individual Americans -- the same people who voted for Barack Obama and voted for him because they thought that health care reform was so important... People just can't say they voted and be done with it. They really have to make their point of view known to these members of Congress and more than once.
RT: President Obama has invited members of the health insurance industry to the White House to try to fashion some kind of bi-partisan or inclusive health care plan. Was that naive on his part?
WP: I don't think it was naive. I think it was important for him to do that. I tend to think that he's abiding by the adage, "Keep your friends close and your enemies closer," and just making sure he understands where they're coming from. I think he knows that having them to the White House was something important. I think he probably benefited from it from a public relations point of view and certainly the industry representatives did who went there. He's very smart. I don't that he really thinks these people are really his friends.
George: I really appreciate the conversation, particularly about the for-profit cost centers that impact the cost of our health care. Obviously the insurance industry is a part of that problem. Another problem that I'd like you to address is the legal cost to our health care. We look at malpractice insurance as an issue, but the driver of malpractice insurance is the settlement. I don't think that our health care practitioners have gotten more careless and our health care itself less capable. What I believe is that the legal process is a highly for-profit process. ...
RT: Let me take your question. It's a good one. We haven't talked about it.
WP: It is a contributor, I think. Not as much as some people might have been led to believe. But there is such a thing as "defensive medicine" to a certain extent. The doctors are concerned about being sued for malpractice -- maybe more than is necessary. One of the things I think people need to keep in mind is that most people don't have the ability to sue their health plans, for example. You can bring a suit against your doctors. And I think that reform has to encompass a lot of different things and this is an area that should be looked at as well.
RT: If insurance executives had the perks reduced and their benefits reduced and their pay reduced, would that make a dent in our trillions and trillions of dollars-worth of health care?
WP: I've always thought that it would make a dent. Some of the salaries in my view are exorbitant. One of the things that I dreaded most during the year was the time the company released its proxy statement -- which is the document which has to be filed with the Securities and Exchange Commission. It discloses the total compensation of the five top executives. I was always expecting that I was going to be asked a lot of questions by reporters about that. But I was not!
RT: You weren't?
WP: I was not. Only one reporter that I can recall called me consistently. It was something that reporters just didn't seem to think was all that significant. The executive salaries are really quite significant and could pay a lot of premiums for people.
RT: What kind of money are we talking about if you aggregate them, put them all together?
WP: Oh, hundreds of millions of dollars a year. The CEO of Aetna alone over the last two years pulled in a total of $65 million. A few years ago the CEO of United Healthcare was in the news a lot with his really outsized compensation in the hundreds of millions of dollars.
Dan: I'd like to thank Mr. Potter for doing some myth-busting. People have to speak out. One of the myths which becomes prevalent is that a single-payer system will imply a limit on choice of doctors. In fact on this show, years ago, when John Fox was a Congressman, he said, "Well, it would be like Canada. You wouldn't have a choice." I called his office and said, "That's not true. You can pick any doctor you want in the province." He was actually receptive to hearing this but people perpetuate these myths. The second thing is: I think if a company pays a claim or pays for care at any point, then that's a waiver of recision. They've admitted they've done their due diligence. They only come back when it becomes expensive. My question for Mr. Potter is about the public option. Why won't this be a gift to the insurance industry? Won't they do cherry-picking, take the best cases and the worst ones will have to go into the public option? I'm skeptical that anything in the law will require them to take all comers.
RT: I've seen that criticism or even concerns about the public option, just as Dan says. The private companies take the healthy people and leave the unhealthy people for the government.
WP: Yes, and the legislative language will have to address it or that situation could arise. Whoever drafts the ultimate legislation that goes to the president, that will have to be addressed. The public option cannot be something that's just made available for those who are not potential customers of the private sector. The insurance industry will have to be prohibited from doing the cherry-picking that it's been doing for years and years and years.
RT: Let me put another criticism of the public option and also of efforts to change the healthcare system. "We're talking about one sixth or one seventh of the total US economy. We have to take our time. We're rushing this. There are going to be unintended consequences." Do you think there's any legitimacy to those concerns?
WP: I don't. Those concerns are coming from people who want to kill reform. They know that if they slow it down, that gives them more time to use scare tactics and move people away from reform as they have every time it's come up before. So it is just a tactic of theirs. It's been 15 years since we last did this. That's a long time. The Congress has held many, many hearings and has an enormous amount of information about our healthcare system and what needs to be done. So delaying it is not the way to go.
Cathy: I would like you to address something which happens with insurance nowadays. There's an increasing reliance on families to supply medical care. They let you out and the families are expected to do this. I have a friend who had no family around here. We had to rally a whole slew of people to take care of her. They don't complete the process. They expect family and friends to pick up the remainder of the services for people nowadays.
WP: That is a concern. It's very real. These problems developed during the height of the managed care era when insurers and employers were moving people more into managed care plans and very successfully moving them. A lot of the insurers did to control medical costs proved to be very onerous. Some are still in existence and things like this -- discharging patients from hospitals earlier than probably their doctors would really like -- that continues. Not having the skilled nursing or whatever in place and covered by insurance is an issue too. I'm facing it as a son. My father actually had a stroke a couple of years ago. He fell a couple of weeks ago and broke his arm -- he's in the hospital now. We're trying to figure out what next. Will he be able to go to a skilled nursing facility? Will there be some skilled services available to him? You're left wondering and it's not the kind of a system we should have when families are worried about that.
RT: Before we went on the air, we were talking about our healthcare system, the fact that it is the most expensive in the world and yes, some people get very good care from the system. A lot of people don't get very good care and millions of people don't get care at all. And yet it seems so difficult to try to change the system that doesn't really work very well and is extraordinarily expensive.
WP: It is. Americans like to think that we have the best of everything. Nobody else could have anything that any better than ours! That's a myth -- that we have the best system. We do have some of the best facilities, there's no doubt about that. The tragedy is that so many millions of us don't have any access or ability to get treatment at some of these great facilities. What has happened over the years is that a system has developed -- I think it's a dysfunctional or non-system for most of us Americans -- that has been a big profit machine for many, many companies that have developed. And not just insurance companies. It's a vast, vast system that generates profits. No wonder we spend so many of our dollars on healthcare because there are so many people who want to make money off of us!
Dr. Noller: I'm a family practice physician in Reading. I deal pretty much mostly with Medicaid. In Pennsylvania, Medicaid is actually handled by private insurance companies because it's a very profitable business. Very few journalists seem to have the answer. My question is what do you believe the profit margin is if a Medicaid insurance company receives $700 from the state, what is the cost of medical care that is provided?
RT: I'm not sure I understand the question, but perhaps you do?
WP: I don't have the data that would answer that as directly as maybe you'd like. But your point is correct, though, that many states have turned over administration of the Medicaid program to private insurance companies and some of those companies are extremely profitable! Very profitable!
RT: You were part of the industry campaign that criticizen Michael Moore's documentary a couple of years ago -- "Sicko". What was your message against "Sicko"? How would you describe that movie today?
WP: I would describe the movie today as a movie that really contained a lot of truth. I hope that Americans will have a chance to see it and take another look at it. I think it's being shown on TV now. It does give Americans a realistic view of how other systems operate. The industry was attacking it pretty much the same way that it's attack healthcare reform -- by pointing to the deficiencies of a single-payer system and saying, "If we want to adopt something like another country has, we are almost assuredly moving down the path towards socialism." They used scare tactics then, and they're using the same tactics now.