Wendell Potter: Health insurance whistleblower

09/28/11 Janelle Irwin
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Wendell Potter made a career of covering for health insurance companies who wouldn’t cover their patients. He got tired of being a tool for one of the nation’s top healthcare providers used to ensure their bottom line. After resigning from the company in 2008, Potter became insurance providers’ worst nightmare.

At a touring free clinic in rural Virginia, Potter saw thousands of uninsured people being treated on the ground, in parking lots and even in barns. Some had driven hundreds of miles to be seen. But it was a little girl whose family had insurance that made him decide to quit.

”I had the unenviable job of being the PR guy to try to explain to the world why CIGNA didn’t pay for her transplant. There was a lot of bad publicity and CIGNA eventually did agree to pay for it. Unfortunately, the news came just a little too late. On December the 20th CIGNA did agree to pay for the transplant, but just a few hours later, Nataline died.”

Before seeing healthcare practices through the eyes of the uninsured, Potter rationalized the rising number of people without access to basic healthcare.

“I wrote that many if not most of the uninsured had chosen to shirk their responsibility to themselves and their families. It was their problem, not society’s. I’m sure you’re familiar with this point of view, if you’re uninsured chances are you’re a deadbeat.”

But he now realizes even those in high paying positions with great health benefits are just one layoff away from the same woes he saw in Virginia. Now transformed, this whistleblower recognizes the healthcare industry as a corporate giant only interested in turning a profit.

”United health care CEO Steven J. Hemsley is ranked number one on Forbes magazines list of America’s highest paid chief executives. He hauled in more than $100 million last year alone. That’s just one man. Collectively, top executives of US health insurance companies make billions of dollars. Now folks, I don’t begrudge anyone a good pay check, but I ask you, do those folks really deserve to make that amount of money when an estimated 45,000 of our neighbors die each year because they don’t have health insurance.”

Potter isn’t the only healthcare professional to find fault in the profiteering of insurance companies. Susan Coffey has been a nurse for 30 years. She said she has seen people denied procedures and shuffled from hospitals before they were fully healed all because the insurance companies said so. The system, she said, is not working and people are suffering.

”To me, what we need right now is socialized medicine. And I’m going to say it loud and clear, we need socialized medicine. We don’t need the middleman, they’re just money makers. And people just cringe when they hear socialized medicine. Like Wendell Potter said, Oh my God, we’re going to turn into a communist country. That’s not it. If we had socialized medicine, yes it will be probably be taken out of our taxes, but everyone would be privy to having insurance. It wouldn’t be because, oh you have a job and then you get insurance through the job. This way everybody would have it.”

Gail Gradel had to bury her son. He was born with a congenital heart defect that left him an easy target for healthcare providers to deny coverage.

”He would never have it because he was born with it. My ex-husband had insurance for him until he turned of age and of course, that was the end of that. But, it’s pre-existing condition, there’s no coverage, for any of the health problems.”

”So, had he had that care during that period of time, do you think it would have made a difference?”

”If he had a catheterization every year or two, they would have done a valve replacement.”

Potter said the Affordable Care Act will keep other mothers from sharing in her tragedy though. Under its provisions, children can no longer be denied coverage as a result of a pre-existing condition. That will soon be expanded to include adults. But Gradel isn’t the only one to suffer by the hands of insurance companies. Potter said these healthcare providers have been able to get away with too much.

”We’ve allowed them to get so big and so powerful that they get to decided who gets affordable access to care and who doesn’t. We’ve allowed them to charge more and more every year for fewer and fewer benefits. We’ve allowed them to cancel people’s coverage when they need it most and we’ve allowed them to deny benefits to millions of others just because they don’t want to pay for it. And guess what. They’ve been laughing all the way to the bank as they’ve been doing this.”

Not only do groups like CIGNA deny coverage and drop clients, they also charge high prices that are constantly rising. Kurt, an industry professional in Tampa who didn’t want his full name disclosed, said people need to urge elected officials to apply a law that would encourage competition among insurance companies.

”So, basically what’s happening is the health insurance companies are fixing prices. And the way they do that is they outsource the adjudication and the price setting to a single company. So, thousands of claims go to multiple insurance companies that supposedly compete when in fact they’re fixing prices by having one outsourced company set prices. And so, they tell the doctors what to charge. We do not have free market healthcare. We do not have free market healthcare in the United States. The best thing we can do is to write to Congress to tell them to apply the Sherman Antitrust Act. And the health insurance companies have been exempt from that.”

Potter also squashed myths regarding the Affordable Care Act, including claims that it will put government in charge of health care. He spoke last night about his book called Deadly Spin: An Insurance Company Insider speaks Out on How Corporate PR Is Killing Health Care and Deceiving America.

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