Deadly Spin

Health insurance companies are generally held in low esteem, and many of us would love to see them disappear, replaced by the same type of government-funded universal health care that other civilized nations enjoy. Wendell Potter, formerly with one of the nation's biggest insurers, CIGNA, gives us an insider's look at how for-profit insurance companies operate in THEIR interests (as in, making lots of money off our premium dollars) rather than in the public interest.

A Background Promoting Health Insurance Ccompanies

Potter is not a medical expert; rather, he was Public Relations (PR) chief, first for Humana and later for CIGNA. Starting his career as a journalist, he moved into PR because of the better pay, and soon moved up the ladder. As he got to the top job in his profession, he was more privy to the thinking and actions of the CEO and his executive suite advisors. Perhaps because of his own humble beginnings in a small rural town, Potter began to have some doubts about how his company operated. He stresses that what these top executives really cared about was the company stock price, which affected the value of their stock options. What kept the stock price high was having the right "Medical Loss Ratio" which measures how much the company spends on medical care. In Wall Street thinking, the less they spend on YOUR medical care, the more valuable the company stock. So the main incentive of health insurers is to spend as little as possible on actual health care.

"Consumer-Driven" Health Plans?

Potter walks the reader through various trends in health insurance, including HMOs, which ultimately failed and have been replaced by "consumer-driven health plans" in which more costs are passed on to patients. Some plans offer such skimpy coverage that Potter refers to them as the "illusion of insurance." High-deductible plans coupled with Health Savings Accounts have been sold as a way to hold down costs, but they are a disaster for low-income people who cannot afford the deductibles, which typically are never reached, so health services are always paid-for out-of-pocket.

The Former Advocate Becomes a Vocal Critic

Potter's qualms about his job reached a crescendo with the Nataline Sarkisyan case, his last "spin" assignment before quitting his high-paying, stock-option executive job at CIGNA. The Sarkisyan family was insured through CIGNA and relied on the insurance to treat Nataline's leukemia. The treatment worked for some time before the disease returned, and Nataline received a bone marrow transplant. But there were complications that affected her liver. She needed a liver transplant, which her doctor was preparing for (a match liver had been found) when CIGNA refused to authorize it. They wanted more tests and opinions, and the well-matched donated liver had to be given to someone else. The family mobilized the Armenian community to protest publicly; the case received a great deal of media coverage, which sparked outrage across the nation. Once CIGNA capitulated and approved the transplant, it was too late to save Nataline, who died.

Potter was also deeply affected by the work of Remote Area Medical (RAM), an organization founded by Stan Brock, which formerly flew an older airplane full of medical people and supplies into remote area of the world to provide medical assistance to people who did not normally have access to care. But Brock, seeing the need in America, now visits rural unserved parts of the US, bringing services to the poor (and more recently, the underinsured middle-class) who have been doing without care. Attending one of their "expeditions" near his own home town in Tennessee, Potter was deeply moved by the long lines of people, some waiting overnight for a place in line, who came to get the care they could not otherwise afford. It caused him to question how well health insurance - his industry - was serving the public. He had to conclude that it wasn't.

After leaving his job at CIGNA, Potter searched for ways to let the public know how PR executives and large PR firms "spin" health insurance products to look like they serve the public when they really serve shareholders. He finally connected with someone who arranged for him to testify before Congress. That brought him into the public eye, and he has appeared on TV and radio talking about the health insurance industry. He now works with several public think tanks that support real health care reform.

What is the Future of Healthcare in America?

Many books (good books!) are out there detailing how the US health care "system" (if you can call it that) fails the American people. This book is a bit different from any of them since it is the story of an insider, someone with a conscience, who could no longer do what he was doing. My only disappointment with the book is that I wish he had said more about Obamacare and how he thinks it will play out. It leaves these same insurance companies (which have been consolidating into a smaller number of huge for-profit giants) in charge of our health care. He does say that passing health care reform was the right thing to do, but does not make any predictions of whether it will ultimately be viewed as a success, a waypoint on the road to real universal health care, or a failure that may produce a backlash that ensures our nation will continue to suffer, alone among civilized nations allowing profit to drive the health care we all need.

You may be interested in my reviews of these books:

Overdiagnosed: Making People Sick in the Pursuit of Health by Dr. H. Gilbert Welch

Overhauling America's Healthcare Machine by Douglas Perednia

The Cancer Conspiracy by Barry Lynes

Critical by Tom Daschle

Do Not Resuscitate by Dr. John Geyman

Vibrational Medicine by Richard Gerber, MD

The Body Electric by Robert O. Becker

And read my personal Healthcare Rant
What's Wrong With American Health Care?