This story is told in this 30 minute podcast. A transcript of the interview is also at that link. It is a story about corporate business tactics and attendant "public relations" (company propaganda) that CIGNA, a big health care company, routinely employed to keep profit margins high while maintaining a caring public image. Presumably, CIGNA, and all other for profit health care companies still use these tactics to keep costs as low as possible.
By now, it should be clear to everyone that for-profit health care companies operate with an intractable conflict of interest. Specifically, they make more money when insured people do not get health care services. Therefore, in capitalism like with any other company, CIGNA did its best to deny paying for health care services as best it could. The podcast interviews a former senior public relations executive, Wendell Potter[1], who worked for CIGNA. Once Potter accidentally came to realize what he was involved in helping CIGNA do to its customers, his conscience kicked in and he had to get out.
According to Potter, everything he did was legal, but often misleading. The corporate deceit he helped instill in people led to some bad health care choices by patients and to some preventable patient deaths. His job was to make CIGNA look caring and honest to the public, while maximizing profit by being uncaring and dishonest.
One episode involved CIGNA dragging its feet about deciding to pay for a teenage girl's liver transplant after she developed leukemia. The company did not want to pay for the transplant so it delayed making a decision. The company delayed so long that the girl's liver had deteriorated to the point that the transplant was considered experimental and therefore not covered by the insurance policy. Bad publicity arose from this case, so CIGNA decided to pay for the transplant even though it was no longer covered. The girl died before she could get her new liver.
Other parts of the interview discuss other sleaze tactics that health care insurance companies routinely employ to avoid paying for health care services. Most civilized industrialized countries have had the common sense to take profit out of their mainstream health care systems. The inherent conflict of interest simply cannot be made to go away any other way.
Ruthless public relations
Unlike those countries, the US is not civilized. We operate with a capitalist for-profit system. Americans are told they get the best health care in the world. We are not told that we do not necessarily get the best health care in the world. We are also not told that we pay more for health care than any other country in the world. And, we are also not told by the American health care insurance industry that tens of millions of Americans either have no insurance coverage or, they have coverage in theory but cannot actually afford to pay for the deductibles from their "cheap," minimal coverage insurance policies to get payment. Many of them rely on free medical services when, where and if they can get it. Thus, even though Americans pay more than any other country with universal health care systems, we still have tens of millions who are not in the system and get little or no care unless they can afford it on their own.
If memory serves, estimates of deaths from lack of health care in the US before Obamacare ranged from ~20,000/year to ~45,000/year. Not sure what it is these days. That's another fact that the health care insurance industry prefers to not talk about. In capitalism, uninsured people need to pull themselves up by their bootstraps and either get over whatever it is that ails them or drop dead. There's no room in capitalism for any profit-impairing sentiment.
Profit and opacity
This insurance industry loves opacity. For example, people cannot do cost comparisons. Also, when people sign up for Part C of Medicare (Medicare "Advantage" plans -- the advantage is to the insurance companies, not the taxpayers), the insurance industry is brought into the picture and the government moves out. The government pays the companies to handle Medicare and we all know what that means, i.e., the conflict of interest is baaaack! Part of the deal with Part C is that the insurance company negotiated and/or bribed our corrupt federal government into keeping the profits from Part C that the companies make. One estimate is that Part C is worth tens of billions/year, which is why we are constantly bombarded with TV ads trying to coax people out of regular Medicare and into private sector Part C.
Questions: Would it be better to leave US health care as a mostly for-profit system, or do what other countries with universal health care systems do and socialize it to mostly or completely get rid of the conflict of interest? Is it even politically possible to socialize medicine in the US? Do you like being deceived and lied to about health care, or does that not happen in the US? Is the US health care system corrupt and opaque, or merely just doing what for-profit companies do, e.g., maximizing profits while minimizing transparency?
Footnote:
1. Potter used to run a cute little website called the Potter Report. It looks to have been abandoned. There he reported on the fun and games of the industry he used to work for. For example, this is part of the last post of March 14, 2019:
Months after advising the Democratic Party to abandon the idea of “Medicare for All,” a former U.S. senator has been hired by a lobbying firm whose clients are leading the fight against changes to the nation’s health care system. Akin Gump Strauss Hauer & Feld LLP, a Washington, D.C.-based law and lobbying firm, announced on Wednesday that former Sen. Joe Donnelly is joining the firm as a partner and will be counseling clients in the health care and financial industries.
In August 2020 at a different site, Potter wrote this:
In my prior life as an insurance executive, it was my job to deceive Americans about their health care. I misled people to protect profits. In fact, one of my major objectives, as a corporate propagandist, was to do my part to “enhance shareholder value.” That work contributed directly to a climate in which fewer people are insured, which has shaped our nation’s struggle against the coronavirus, a condition that we can fight only if everyone is willing and able to get medical treatment. Had spokesmen like me not been paid to obscure important truths about the differences between the U.S. and Canadian health-care systems, tens of thousands of Americans who have died during the pandemic might still be alive.On a task force for the industry’s biggest trade association, America’s Health Insurance Plans (AHIP), we talked about how we might make health-care systems in Canada, France, Britain and even Cuba look just as bad as ours. We enlisted APCO Worldwide, a giant PR firm. Agents there worked with AHIP to put together a binder of laminated talking points for company flacks like me to use in news releases and statements to reporters.
I spent much of that year as an industry spokesman, my last after 20 years in the business, spreading AHIP’s “information” to journalists and lawmakers to create the impression that our health-care system was far superior to Canada’s, which we wanted people to believe was on the verge of collapse. The campaign worked. Stories began to appear in the press that cast the Canadian system in a negative light. And when Democrats began writing what would become the Affordable Care Act in early 2009, they gave no serious consideration to a publicly financed system like Canada’s. We succeeded so wildly at defining that idea as radical that Sen. Max Baucus (D-Mont.), then chair of the Senate Finance Committee, had single-payer supporters ejected from a hearing.
While it’s true that Canadians sometimes have to wait weeks or months for elective procedures (knee replacements are often cited), the truth is that they do not have to wait at all for the vast majority of medical services. And, contrary to another myth I used to peddle — that Canadian doctors are flocking to the United States — there are more doctors per 1,000 people in Canada than here. Canadians see their doctors an average of 6.8 times a year, compared with just four times a year in this country.
Then there’s quality of care. By numerous measures, it is better in Canada. Some examples: Canada has far lower rates than the United States of hospitalizations from preventable causes like diabetes (almost twice as common here) and hypertension (more than eight times as common). And even though Canada spends less than half what we do per capita on health care, life expectancy there is 82 years, compared with 78.6 years in the United States.
The insurance industry loved Obamacare --
if it didn't there would have been no Obamacare
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