There’s a Way to Fix Healthcare, but Is There a Will?
“We’ve been sold a bill of goods.”
In this episode, we dive into our dysfunctional healthcare system with guest Wendell Potter, a former health insurance executive turned whistleblower, advocate for healthcare reform, New York Times best-seller, and documentary producer.
We discuss the role of private, for-profit health plans in the U.S. and how they’ve drained resources from the healthcare system while leaving Americans financially vulnerable and sick. We also touch upon Medicare Advantage (which is neither Medicare, nor an advantage), Medicare for All, “non-profit” hospital systems, and if we’ll ever break free from employment-based insurance.
Topics covered:
The role of private, for-profit health plans in the United States
If insurance will ever be decoupled from employment
The tactics employed by health insurance companies to deny coverage or limit benefits for policyholders
Medicare Advantage, and how it’s not medicare nor an advantage
Lessons he’s learned as a whistleblower and advocate
About Wendell Potter
Wendell Potter is a former health insurance company executive who became that industry’s worst nightmare. Time Magazine called Wendell “the ideal whistleblower.” Bill Moyers called him a straight shooter. Michael Moore called him “the Daniel Ellsberg of corporate America.”
Wendell walked away from his job at Cigna, the big health insurance corporation, in 2008 after what he has described as a crisis of conscience. Now, Wendell is President of two organizations -- Business for Medicare for All and Medicare for All NOW -- working to end the employer-based health insurance system and guarantee health care for all Americans.
In June of 2009, Wendell went public with what he knew, and in a very big way. In riveting Congressional testimony, Wendell described how insurance company executives, in their quest to meet Wall Street’s profit expectations, routinely canceled the coverage of policyholders who got sick. He went on to disclose a common but little-known practice that industry executives, behind closed doors, called “purging.” Under purging, insurance companies used big price increases to force small businesses with sick workers to drop their policies.
Wendell also explained how insurance companies flouted regulations designed to protect consumers, and how they intentionally made it nearly impossible for consumers to get information they needed about their policies in language they could understand.
Wendell went on to become a bestselling author. The New York Times called his first book – Deadly Spin – “a tour de force.” Pulitzer Prize-winning author and historian Doris Kearns Goodwin called his most recent book – Nation on the Take —“a stirring guide for how we can work together to reclaim our democracy and reunify our country.”
Wendell has also written numerous articles for publications in the U.S. and abroad, including the New York Times, the Washington Post, USA Today, the Los Angeles Times, the Chicago Tribune, Newsweek and the Guardian, and has been a frequent guest on TV and radio. He is president of the Center for Health and Democracy and Business Leaders for Health Care Transformation and founder of Tarbell.org, a journalism nonprofit.
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Transcript:
Halle: Hello Heart of Healthcare listeners. This is the last week to apply to the Heart of Healthcare Grant Challenge. Semi-finalists will get $2,500 plus a spot on the podcast, and our grand prize winner will walk away with $50,000 and a full episode. Featuring your organization. Learn more at the heart of healthcare podcast.com.
Today's episode is going to be a good one. I'm talking to whistleblower Wendell Potter. Following a 20 year career in corporate public relations, Wendell left his executive position at Cigna, one of the nation's largest health insurers, to show the world the dark inner workings of the insurance industry.
He has testified before Senate and House committees. Briefed several members of Congress and their staffs has become a New York Times bestselling author on the topic, and recently helped produce a documentary titled American Hospitals Healing a Broken System.
Wendell, welcome to the show.
Wendell: Oh, thanks so much for having me on.
Halle: Let's start by talking about the industry you started your career in health insurance. We've been talking about this a lot on the podcast, and I wanna know, are we the only nation with private for-profit health plans, or are we just the only nation that doesn't mind that they generate billions of dollars of profit while Americans go bankrupt trying to pay for lifesaving care?
Wendell: You know, we are the only country on the planet that I know of. Uh, certainly the only developed country, uh, a rich country that has, uh, handed over our healthcare system to for-profit health insurance companies. There are some countries in Europe that rely on private health insurers, but they operate on a nonprofit basis.
They're much more regulated than they are in the US and much more standardized. So we're alone out there in the way that we pay for healthcare and, we're certainly suffering the consequences in so many different ways.
Halle: Yeah, you recently wrote about executive compensation at health insurance companies, and one stat that stood out to me is the Health Plan, Molina Health, where more than 80% of the revenues come from Medicaid. So our tax dollars and the CEO last year made I, I literally had to read this a few times, 181 million. Sometimes it feels like health insurance companies are a black hole sucking money right out of our system, while America remains very, very sick. What do you make of this?
Wendell: Well, I make out of this that, uh, as I've said before, uh, these companies know one thing and they care about one thing, and that is making money, making money for their top executives and their shareholders.
And we have most people in this country, even in our public plans now, the Medicare and Medicaid enrolled in a private plan, mostly operated by for-profit companies. So, uh, when you have that situation, you're just set up to have, increasing healthcare costs, premiums that continue to go up, taxes that go up to pay these companies.
And they're voracious. They have no intention of doing anything but grow if they possibly can. And we've seen the emergence of seven large for-profit companies. Many of them that just deal with public programs. Now, Humana recently where I used to work, announced as even getting out of the commercial insurance business and focusing exclusively on the public programs Medicare Advantage in particular.
So that's where, that's where we are. And, we are paying well more than twice as much on a per capita basis for healthcare and getting far less for it than any other country in the world.
Halle: Yeah, far less one. Um, one of our followers on Twitter, Jamie Stockton, wanted me to ask you if you think insurance will always be tied to employment or if there's a way to migrate away from that system.
Wendell: There is a way, whether there's will is in different matter entirely, and, uh, the insurance industry would resist that even those, uh, that uh, are are not even strongly in that business would resist it. But, uh, The, uh, majority of people who get their coverage through their employer, their carrier, their insurance carrier, is one of these big for-profit insurance companies.
It's not a business by the way that's growing for them. Uh, even when I was at Cigna, the way that the companies really gained membership in employer sponsored health insurance, Is by stealing market share from each other. Uh, we just simply are not growing there because insurance companies have priced their products out of the reach of so many employers, to the point that the majority of small businesses with 50 or fewer workers now offer, insurance to their workers.
So we've got that situation, but as broken as that system is, it's still profitable for the big, for-profit insurance companies, so they will resist it. I do think that employers are beginning to wake up and realize they've been sold a bill of goods over many years. Not all of them. Uh, many of them have very tight relationships with their broker or consultant, uh, and their insurance carrier.
Personal relationships mm-hmm. Uh, that have, uh, been in the way of, uh, of moving beyond, uh, the employer sponsored system. I do think that it's possible, but it's gonna take a lot of effort on the part of advocates and policymakers to make a shift. Yeah,
Halle: I recall the Starbucks, c e o Howard Schultz saying that Starbucks spends more on healthcare for employees than coffee beans.
Yeah.
Wendell: And you, you, you've, you, you hear that over time, uh, years ago, uh, GM said the same thing, uh, and probably I'm sure it's the case today, that at General Motors and most big employers, or many big employers, they're spending more on health benefits for their workers, uh, than they are for their core business.
Uh, it's just incredible. What, uh, those employers have been willing to put up with now. Mm-hmm. Uh, the thing is, because of the way federal law is structured, these companies get tax breaks for offering benefits. So, uh, they don't wanna lose that. And that's another reason why we've, uh, we've still got this, uh, this system in place.
Halle: Yeah. So it's, they're pre-tax dollars that can be used towards the health plan, and you don't have that same benefit if you are someone who is buying insurance independently.
Wendell: Exactly. Yeah. You don't have the same setup. Uh, now a lot of people who do buy their coverage independently because of the Affordable Care Act, uh, they are in many cases eligible for subsidies.
Those subsidies go straight to the insurance companies. They don't go to the to the member or the, the patient. But, that's the only way that that market can work is with these subsidies, because once again, these companies, these insurance companies have jacked up premiums so much that people just simply can't afford to pay their premiums much lesser out pocket expenses without significant support from the federal government.
And that means taxpayers.
Halle: Yeah. Isn't this regressive allowing health insurance premiums to be excluded from income? Resulting in these tax expenditures that are inequitably concentrated in higher income individuals, employees.
Wendell: Yeah, it's extremely regressive. Yeah. Uh, what you have is a situation in which, uh, the biggest companies, uh, benefit they're able to do this year after year.
Small businesses, not so much. Uh, even those small businesses that offer insurance, they're typically facing even higher premium increases year after year. And they find themselves having to shift more of the cost of care, uh, before their coverage kicks in, in the form of deductibles. Co-insurance and co-payments.
Uh, so, uh, uh, yeah, it's very regressive and very unfair for most employers. But, uh, you know, the big employers have the loudest voice and the most, uh, impact and the most influence in Washington. Yeah,
Halle: it's actually surprising given our nation's obsession and pride in entrepreneurship. That we would dis put, put a disadvantage on small businesses.
Wendell: You know, we have that pride. We have the belief that America is a place where, uh, we really care about entrepreneurship and small businesses. But the fact is, the United States is no longer the country that is most conducive, most able, in which small businesses and would be entrepreneurs were able to make it primarily because of, health insurance.
Now, a lot of people obviously work for companies that don't have, don't offer health insurance. So their resort, you know, they can get coverage because of the Affordable Care Act through marketplaces. But, um, it's, it's an extraordinarily expensive and regressive system that we have overall.
Halle: On the positive side, since the ACA, we've had had a decrease in uninsured individuals. That's a win.
Wendell: Right? It's been a significant win. Yeah. And that was what, uh, was the main benefit, frankly? Well, not the, I I would say it's the main benefit, but there are almost, uh, as important benefits, uh, to that for one, insurance companies can no longer engage in some of the practices that were very routine, very common before the ACA was passed, like refusing to sell coverage to people with preexisting conditions.
Just blackball people because they'd been sick in the past or dropping them once they got sick. That was a very prevalent practice as well too. Uh, they can't do that now, but, uh, I knew when the, the, the law was passed, which I supported by the way, but I knew that these companies would try to figure out other ways to make sure that their profit margins didn't take a hit.
Mm-hmm. And they've been able to do that.
Halle: Yeah, I assume they do benefit by having more, more folks on plans and also you don't have that adverse selection of who is opting into health insurance.
Wendell: Exactly. They, they benefit and so do, uh, individuals and families because they are at long last, able to get coverage.
Uh, and affordable coverage, thanks again to the subsidies from taxpayers. Mm-hmm. And so that's been a, a huge, huge win. The problem, uh, and I think almost as bad as a problem of people not having insurance. And keep in mind we still have about 30 million people in this country who don't have health insurance.
And, um, uh, many of them would like to be covered, but they just don't have the money or even know that they have subsidies that could be available to them.
Halle: You had mentioned some of the tactics that were used before the ACA to help the health plans make more money by denying care. Are there tactics employed today by health insurance companies that are still allowing them to deny coverage or limit benefits for policy holders?
Wendell: Oh, absolutely. There are different ways and they fall under the umbrella of benefit buy down. That's a term you, you don't hear very often, maybe ever. It's a term that's used frequently behind closed doors that insurance companies and, and conversations that executives have with Wall Street financial analysts and shareholders.
That is a term that covers a lot of sins. What it means is that year after year, the value of our health insurance plans, it diminishes. In one way or another, and insurance companies have become very adept in reducing the value of insurance companies. One is by making people pay a lot more outta their own pockets for coverage that they used, you know, for, for claims that they used to cover.
And, um, also prior authorization, which is increasingly in the news. It's become a tactic that insurance companies have made aggressive use of. Mm, uh, which inserts them, uh, rice macab between, uh, Patients and their doctors.
Halle: their, can you explain? Yeah. Can you explain what prior authorization means?
Yeah.
Wendell: And, and I appreciate the opportunity because most people just simply do not know that it even exists, or that's a, it's a thing. Some people, uh, clearly many people have gotten, uh, notices from their insurance company. Or through their doctor, uh, or the hospital that what the doctor is recommending, the insurance company has decided they will not cover.
And they have many different reasons for doing that. Often it is just to, uh, see if they can get away with it. They know that most people. Don't, again, know about prior authorization or even know that they have the right to appeal a denial or, you know, something that's, that's been refused. And, um, so, uh, people just leave money on the table.
Uh, if pe but on the other hand, keep in mind that. A lot of people are just sick when they, uh, when, when they're, uh, getting these notices of something being denied and are not able to be champions for themselves, and often don't have a family member or friend who can advocate for them. Uh, so it really works for the insurance company, uh, and sadly, uh, so many people.
Go without getting the care that they need because of this practice. Uh, and uh, in many cases when they do, they'll have to pay a lot outta their own pockets, and many people wind up deep in debt. Uh, we have a hundred million people in this country who have medical debt. And, uh, most, the vast majority of those people have health insurance.
It just shows you how the, how, how coverage has changed even since the Affordable Care Act was passed. It's one of those examples of, of how these companies have protected their profit margins by shifting more and more of the cost of care to us.
Halle: Yeah, we had the c e o of r i p medical debt on the show a few weeks ago and, um, we're an incredible organization.. But wish it didn't have to exist.
Wendell: It shouldn't have to exist. Yeah. There are a number of organizations that exist that, uh, in a real world, in a good world in this country, they would not exist. Yeah. Uh, another organization that shouldn't exist but does and had a big impact on, on my decision to leave the industry is, uh, Uh, uh, a non nonprofit called Remote Area Medical, which, uh, operates free clinics around the country.
It started out just off operating, operating clinics in, uh, third world countries, uh, flying doctors to Haiti and other places. And then they started getting requests to have these, they call them expeditions, but they're just really pop-up clinics around the country in which people co can come and get care.
That's doesn't cost them anything. But it, we shouldn't have that. No, either. I mean, it's absurd. Yeah. Uh, the, the first time I encountered them, uh, the remote area medical was at a county fairgrounds and people were getting, and they still do to this day, get, uh, care that's being provided in Barnes and animal stalls on county fairgrounds.
Oh. Uh, that's, that's the United States for you and Yeah. Uh, r i p medical debt is, Uh, really keeping a lot of people out of bankruptcy, uh, paying off debts that, uh, they just simply can't do that. But you can, you know, it's, it's the way it's structured and it's no fault of their own, but they, you cannot apply to R F P medical debt to have your debt, uh, erased.
Uh, they work with hospitals to buy debt. And pay it off. Mm-hmm. It's just a bizarre system. Really, really important for the people who benefit from it. But, um, it's, uh, it's not an ideal situation by any means. Yeah.
Halle: I have one more question on the payer side, and then I do wanna talk about the documentary and more on the provider side.
But when it comes to private for-profit health plans and the problem that they have created, uh, for our health system, do you think that. The industry can fix itself. Do you think it needs to be re like regulated in a new way, or do you think private health plans should be eliminated altogether?
Wendell: I. Well, they, the, the industry will not fix itself.
These companies, uh, uh, are, you said that very quickly. Wall Street. Yeah. And I've, for 10 years I handle financial communications for Cigna. Uh, my name was on every one of the companies quarterly earnings reports for 10 years. So I know how these companies make money and, and what's important to them and the links they go to to make sure that they don't disappoint Wall Street's financial analysts who cover these companies or their shareholders.
Those are the stakeholders that they care most about. It's not employers. It's not us as individuals or our families. So when you've got that dynamic, there's just simply no way that, uh, these companies will police themselves. No one company in this system can venture very far. A field from the way their competitors operate or they would risk getting more people who are sick and uh, uh, would cost them more money.
So yeah, because of the way the current system's structured, we're going to have to have some disruption. And I think disruption can't occur actually in the private sector, but we're also gonna need some attention from policy makers at both the state and federal levels to try to move us toward the, the, the place we need to be.
Halle: Do you think there's a chance we would have a, a option a, a government option for everyone? A me, a Medicare for All, and so. Perhaps people would choose that option because it could be better, lower cost, less scammy.
Wendell: You know, I, I think it, I think if we did open up Medicare, we first have to improve it. Uh, but I think, uh, I think more people would indeed sign up for Medicare.
I can't tell you how many people I've talked to over the years who've counted the days. Months and years un uh, until they're eligible for Medicare. Uh, so it's a very popular program and most of them are, are wanting to enroll in the traditional program, which we can talk about more if you want to, about how that is different from the so-called Medicare Advantage plans.
Yeah. Uh, I think, uh, it is possible that we could have more public plans available to people. Some states have actually passed, uh, laws that enable people to. Enroll at the state level in a state-based public option. Uh, mm-hmm. Three states that I know of, Washington, Colorado, and Nevada have, uh, established public options.
They, they vary in detail, but, uh, it is, it is something that's available to folks in those states, and more and more states are looking at that. It's not. It's not the same as expanding the Medicare program, but it is expanding and policing these companies or making, giving people an option that they otherwise wouldn't have.
Sure. Which I think is very important.
Halle: And presumably whoever's running it isn't making $181 million a year.
Wendell: Well, that's, that's, that's exactly right. Exactly. When you have someone making that kind of money, Uh, you know, um, you know where their priorities are. Yeah. And, and you know that that's costing taxpayers Yeah.
A lot more money than it should. Yeah. That's
Halle: a lot of primary care visits for a lot of people. It absolutely
Wendell: is. Yeah. Yeah. Yeah. And, and just imagine that even that much money would help alleviate so many out out-of-pocket expenses that people, people face.
Halle: We'll be right back after the break.
I really wanna talk about your new documentary. I watched it last night. I saw Elizabeth Rosenthal in it. She was a guest on the podcast last year. Tell us about. What kind of started this whole project and just give us the pitch for it.
Wendell: This is the fourth documentary that I've, uh, been a co-producer of.
And, uh, the, uh, my, my partner in this, and there are several people we worked with, but the, uh, executive producer is a businessman in the Lehigh Valley of Pennsylvania. His name is Richard Master, and Richard has a very successful business in Eastern Pennsylvania. Uh, but he began to notice that he was just paying so much money, both for insurance premiums or his, what he contributed to premiums for his employees.
Uh, but he was also seeing that drug prices were really, really high, even with insurance. Uh, his employees were having to pay a lot of money out of pocket, so he just began to spend more time investigating what other countries have done. Uh, what could and should be done to fix our healthcare system. And he's been a champion for reform for a long time.
Uh, the first in a series, this is, as I said, the fourth in a series of of documentaries. The others have looked at pharmaceutical prices. And just the system as a whole. The first one was called Fix It Healthcare. And frankly, it did advocate for a medicare for all type of healthcare system. Now, I think you would say that, uh, our approach is saying that's not the only way to get, uh, to a system that we need.
What our ultimate objective is in this country is universal coverage and a system. That is better able to control healthcare costs and make sure people have access to quality care. We don't have that in the current healthcare system by any means. Uh, so, um, and I, and Medicare for all or a single payer of healthcare is a, is an important way and has a support of many, many people.
But I would argue that there, there are some other approaches that can get us closer to that, uh, that overall objective.
Halle: Yeah. One of the things that has been, Discussed recently is within the hospital provider network, nonprofit hospitals have been found to have actually worse ratios of charity care to total expenses than even for-profit hospitals.
And so they've, they perhaps, and Elizabeth Rosenthal has talked about this, is perhaps they've gotten a pass, like it's easy to point fingers at the health plans who have CEOs making hundreds of millions of dollars, but. Should we take a look at the hospitals and while, while providers themselves, doctors and nurses have sacrificed a ton over the past, especially over the past three years, you know, if 86% of nonprofit hospitals aren't providing as much charity care as the value of their tax exemption, are they really for-profit?
Wendell: It's a good point. Um, they, they maintain their nonprofit tax exempt status, but you're exactly right. Um, a lot of the, the so-called nonprofit hospitals, and I think a better term really is to call them tax exempt, uh, are not fulfilling their community benefit. These entities, these hospitals are supposed to, by law, Uh, set aside a certain amount of money to improve the health and wellbeing of people who live in, in their communities.
And we're seeing that they're, in many cases, not getting anywhere close to fulfilling that obligation. So, um, uh, and it's absurd when you have for-profit hospitals in a community providing more care, doing a better job of taking care of the health of people in the communities than the, their, the nonprofit, uh, versions of hospitals.
Uh, it's, it's, it's really messed up and, uh, Uh, we hope that this, this documentary will help wake policymakers up and Employers Hospital Care is the main, is the chief, uh, driver of healthcare costs in this country. About a third of what we spend on healthcare goes to cover hospital care, and, uh, drug prices are high.
But comprise drugs comprise a relatively small percentage, much less than 30%. I think it's already more than 10% or 10 to 15%. Yeah. Uh, but as Elizabeth Rosenthal's, uh, Rosenthal said, uh, hospitals have largely gotten off scot-free. She uses that, that phrase in the movie. Yeah. And in many cases it's, it's true.
We've had a situation, which drug companies have been, I call it drug companies, have been in the barrel on Capitol Hill. Yeah. In Washington for now several years. And it seems like it, we, the, in, in Congress, they can only focus on one part of the healthcare system at one time. Mm-hmm. And as a consequence, we've had, uh, and we have had movement, uh, on, on, on drug prices.
We finally got legislation that enables Medicare to begin to negotiate for lower prices for prescription drugs. Uh, we've not had anywhere close to that kind of scrutiny. Of hospitals, uh, when the Affordable Care Act was being debated, there was a lot of scrutiny on insurance companies that too diminished by, by comparison.
Uh, so drug companies, they replaced insurance companies in that barrel. Uh, and they too have not had very much attention focused on them over the past several years. But hospitals really have, in many cases, gotten off scot free. And among the reasons for that is that. Uh, hospitals are, are everywhere. They are, uh, big, uh, components.
Big employers in most communities. They are well connected with, uh, people that represent us in Congress and the state legislature or locally. So they've got immense power and, uh, yeah. Uh, and, and, and most people don't really understand that. Uh, hospital care is, you know, the principle driver of healthcare costs.
Halle: But not just hospital care, it's, it's the administrative costs as well. I'm trying, trying to remember the stats. Someone said that within hospitals, there are some hospitals where there's a person in billing, one person in working in billing for every bed. Was that what, do you remember that stat that
Wendell: was Yeah, that's, that's, that's right.
And sometimes it can be even more. And, uh, and, and their defense. Okay. You, you have that situation because we have multiple private insurance companies in any given market. Many of them are for-profits like we've been talking about. Some, uh, insurance companies still operate also on a nonprofit basis. All of those companies have multiple variations of health benefit plans.
So yeah, hospitals and doctor office, doctor's, offices and clinics have to staff up considerably. So, To do nothing more day in and day out, but to deal with all of this and try to make sure that they're paid appropriately, that they're, that the patients are, are getting the care that they need and not having to be saddled with, with, with too much debt.
So, uh, that's, that's one of the reasons I don't, I don't think hospitals, uh, in the absence of that kind of a situation would need, I know they wouldn't, they wouldn't need to have that kind of administrative staff. Yeah.
Halle: So why don't we just say, I. You know you have your charge master and everybody pays that, and no one pays less.
No one pays more.
Wendell: Well, you can get there. Uh, and as we note in the movie, at least one state has been able to demonstrate that that can happen. You, uh, what we need, uh, I think universally in this country is a situation which everybody knows how much procedure's gonna cost in a given hospital. Yeah. Uh, and that cost, uh, applies whether you're uninsured or get your coverage through the.
So-called Obamacare marketplaces or through Medicare, Medicaid, or an employer. Uh, we don't have that. Everybody, all those entities, all those payers, if you will pay a different price. And it's based on, uh, at least when it comes to private insurers, how the. Successful they are, or you know, the outcome of their negotiations with individual hospitals.
And it varies and you don't have any transparency into that. Significant and transparency that is beginning to change. There is, uh, laws have been passed just recently that require hospitals to be more transparent when it comes to their. Uh, how much they, they charge and yeah. You know, how they negotiate with, with, uh, insurance companies, but we still will.
That didn't fix a problem with having these big variations in prices. Yeah.
Halle: And the transparency around chargemasters is a relatively new policy, right? That was, it is. It's very new. Just in the last, yeah. But its still new. It's still not easy to find. It's still, it's not
Wendell: easy to find. And even, no, uh, even when the data began, began to be available, Even researchers couldn't make heads or tails of it.
And, uh, I mean, we're doing better, but, uh, it's extraordinarily complicated and that kind of information rarely reaches the patient. Uh, I would say that there are very few people listening who, uh, would know that information is available, where to go look for it, and if they found it, how to make sense of it.
Yeah.
Halle: Your career has been in healthcare, but it's been so different, right? Yeah. You were on the inside and now you're really one of the most vocal advocates working on healthcare reform and transformation. Tell us about what happened to you when you spoke out against, we initially left your job and spoke out against, The system, uh, what was going on in your head?
How afraid were you, and then how has that journey kind of transformed as you've now settled into your job as a whistleblower and advocate?
Wendell: You know, when I decided to do what I did, which was to become a whistleblower, and by the way, it was against the entire industry. It was not necessarily. It wasn't against, uh, signal or Humana where I'd worked because I became very much aware that, uh, these practices were industry-wide.
So my whistle blowing was on the entire industry. Mm-hmm. Uh, and as I said earlier, no one company can really vary all that much from, from, from, uh, its competitors. I began to see things that most employees of insurance companies don't see. Very few people anywhere. See, uh, with the, the responsibilities I was given, I had visibility.
Into the finances of of my company. I had to understand 'em, as I said, to be able to, uh, explain them to reporters who might call. But I also had an orientation to Washington. Uh, my team and I wrote the talking points for our lobbyist. I spent a lot of time in New York and Washington, uh, during my career.
So I was in this unique position to be able to see how these companies operate, but also how they spend a lot of our money on PR campaigns and lobbying campaigns and campaign contributions to protect their profits. And then I saw, as I mentioned earlier, This event in near, I grew up in Tennessee, this remote area, medical expedition at a county fairground.
I went there, I went to Tennessee to visit my family. I live in Philadelphia. Uh, but this was several years ago, back in 2007 actually, and I went down there to visit. My parents who were still alive at the time, and I read about this expedition being held pretty close by Nabar Dad's car and, and drove up there just completely outta curiosity.
And I saw something I couldn't have imagined seeing in this country. I had been insulated and isolated from. Uh, the way so many people experience our healthcare system. Uh, and, uh, I realized when I walked through the, when I walked through the fairground gates that day, I saw people who were lined up by the hundreds in the, in the rain, waiting to get care.
That was being provided literally in animal stalls, and it just, um, it changed me and I made a, a decision that day that I would, I would have to find another word, earn a living. I had to accept wow, that I had to take some responsibility for that because I was a propagandist. I, uh, in various ways, uh, was.
Uh, trying to make people believe that we have the best healthcare system in the world and the way that we pay for it is superior. And, uh, defending my company and the industry, I couldn't do that anymore. And I realized if, if, you know, if my parents hadn't been able to save some money, they were, this is, I grew up in a working class family.
I was just really fortunate to be able to go to college and get a. A good job. I never imagined, uh, having a career in the insurance business. That just kind of happened over time. But, uh, I knew that if it hadn't been for them, my parents, I could have been one of those people standing in, in those lines.
I'm sure there were people there that day that, uh, were neighbors of my parents, uh, people I could have gone to school with. So I, I, I just felt I, that was a, uh, that was a. Crisis of conscience that I, that I'm telling you about, that I've often used that term. And a few months later I did, did leave my, my job.
There were two or three other things that happened during that time. I've sometimes said my, my decision was, but was both gradual and. And sudden, uh, the gradual part of it was what I was referring to. I was able to see how these companies really operate and I ultimately felt that Congress needed to know this.
The only thing that members of Congress really know about health insurance companies, for the most part, many of them is what they hear from health insurance company lobbyist. And insurance companies have legions, legions of lobbyists. Just Cigna alone has a robust government affairs staff in Washington, but keeps many companies on retainer.
Uh, some that are close to Democrats, some that are close to Republicans. I knew all this and so part of the work that I do now, I call making amends or trying to, for all the work that I did to try to help people understand this is how, what's really going on. This is why your premiums are so high. Uh, and this is why it's so hard to get meaningful change, uh, through Congress.
Yeah.
Halle: What advice do you have for others working in healthcare and getting disillusioned by what they're seeing?
Wendell: My advice is to save some money if you possibly can. Don't spend it all. Don't go into debt so that you don't, as long as you don't have the healthcare
Halle: issue
Wendell: come up. That's exactly right. It, it's important if you're looking to do what I did to, yeah.
Feel that you can pull it off. In other words, I knew when I did this that there was no chance I was gonna get a job offer working in the insurance industry. There's no going back. No going back. No. I was, I was torching a lot of bridges, but not only that, I didn't think, and I'm sure it's probably the case, that when you're a whistleblower, you're not likely to be hired by any, uh, corporation.
So that door kind of closes. So people need to know going into something like this. Now, I'm not suggesting that, uh, uh, a lot of people become whistleblowers. That's, that's really going, uh, an extra step. But I do hope people will listen to their conscience and to, uh, if, if, if they think that what they're doing is not right, if the company that they're working for is, uh, cheating people, uh, is in one way or another, making it more difficult for people to get the care that they need and can afford.
Then you've got a problem. You've got a a problem. You should have a crisis of conscious, I think as well. And, uh, Uh, I, I hope more people will, will begin to speak out and they are. I, uh, write a, i, I founded an edit, a newsletter called Healthcare Uncovered. And, um, a number of people have stepped up who are insiders or former insiders to either publicly or anonymously tell their stories about what they do, uh, and did when they were in the industry.
So there is, there are more people who are feeling bolder and are willing to step out, but most people are just too fearful. And, and I get that because you do worry that you're just not gonna be able to, uh, make a living to continue your lifestyle as you've, as you want it to be. Uh, I would say, and I've, maybe I'm an anomaly, but I'm much happier.
And I've figured out a way to, you know, to do meaningful work. At least I think my work is meaningful and I'm. Much happier. I work harder, but I, it's hardly worked to me. It's just, uh, it's, it's what I feel that I'm on this earth to do now. Yeah. I think, uh, I, I had to spend those 20 years in the industry. I was a, I was a reporter in my first career.
I was a newspaper reporter and in Tennessee, and then later in, in Washington. One of the other things I realized when I was at that expedition and, and that I, I mentioned, uh, was that, What I was doing for a living was the exact opposite of what I tried to do as a journalist. I never tried to mislead people or to leave out important details.
That's exactly what I was doing, and paid quite well to do, uh, during my 20 years in the industry. So sometimes I say that I've spent 20 years inside the insurance industry, un uh, undercover to, uh, uh, now go back into journalism and, and, uh, report on what I, what I did and what I learned. Yeah.
Halle: Well, how can people follow you on, you know, social media online, and how can they watch the
Wendell: film?
Uh, thank you. The, I would hope people would try to find my newsletter. It's on the CK platform. You can find me at wendell potter dot sub stack.com. I'm on Twitter at Wendell Potter. And, um, go to fix it healthcare.com because you can see information about the hospital, movie, and the other movies that I mentioned earlier.
And please reach out if you would like to have a screening of the movie or. Just share information with us. Please do that. The movie premiered, uh, several weeks ago, but we're still having screenings of it around the country. It will soon be available, uh, uh, to stream, uh, on and also video on demand. So we will, uh, uh, it will be able to make sure that more people can see it, uh, in the, in the weeks ahead.
We also wanna have a screening. On Capitol Hill that's in the works. Uh, we've, we've had a, a, actually the movie Premier in Washington, but it was downtown, and we're working with members of Congress to host a screening on Capitol Hill.
Halle: Great. Awesome. Well, Wendell, thank you so much for your time
Wendell: today. My pleasure.
Thanks for having me on.