Too long to post here, but it was a good read. Highlights:

http://www.guernicamag.com/interviews/1207/the_last_temptation_of_wendell/

Just a few weeks later, Potter, who is from Tennessee, read in a local paper about a free healthcare expedition being held in Wise County, Virginia. He decided to check it out. Walking through the fairground gates, Potter saw hundreds of people waiting in the rain while physicians attended to patients in animal stalls or on gurneys lying on the rain-soaked pavement. Tents had been pitched across the fairground lawns, creating a scene “like something that could’ve been happening on a battlefield or in a war-torn country.” Tears mixed with the rain to cloud Potter’s vision. “What I thought was: ‘Is this the United States?’ It was so remote from my reality. It just seemed impossible.”

PR firms help create the front groups and serve as the back offices to get the work done. The insurance industry contributes advice and counsel and feedback, but the real work gets done by the PR firms that the insurance industry hires.

Guernica: You worked in the industry for twenty years. It doesn’t seem like it should have taken so long.

Wendell Potter: You don’t really focus on it or understand the significance of it. I’ll admit I knew that Wall Street looked at the medical-loss ratio. I knew it was an important measure. I didn’t know until, frankly, very recently how important it was. As recently as fifteen years ago, the medical-loss ratio in this country was 95 percent. Since then, there’s been great industry consolidation to the point that now there are seven companies that dominate. They’re all for-profit. During the time that this consolidation, this shift to for-profit occurred, the medical-loss ratio has continued to drop. Now it’s around 80 percent. That means twenty cents of every dollar goes to something other than paying medical claims. Just fifteen years ago, ninety-five cents of every dollar went to paying medical claims. This trend is due to pressure from Wall Street. If a company misses Wall Street’s expectations—if the medical-loss ratio starts to inch up—the company will suffer. I’ve seen companies lose 20 percent of their stock value in one day by disappointing Wall Street with their medical-loss ratio.

Guernica: Why is a corporate bureaucrat scarier?

Wendell Potter: Because every person who works for a for-profit company knows that the company has to meet Wall Street’s expectations. Every manager of the company has to pull his or her weight to make sure he and his team are doing all that they can to help the company meet that objective. That includes medical directors. Same with the nurses. They know what the company has to do to meet Wall Street’s expectations and to stay in the good graces of investors.

Guernica: So in other words, corporate bureaucrats have a profit incentive to deny care to people who are enrolled in their plans.

Wendell Potter: Absolutely. It doesn’t have to be stated directly to them that you will be paid a particular bonus if you deny X number of claims; it’s known, and it’s part of the culture.

Guernica: But we’ve heard this exact same talk of socialism decades ago during the battles over Medicare, Social Security, Medicaid, etc. And I don’t think very many people want to lose these programs now.

Wendell Potter: Conservatives are so bound to ideology they refuse to take a serious, open-minded look at how for-profit insurance companies have wrecked our healthcare. They don’t want to take the blinders off. What gives me hope is that despite all the lies and all the disinformation that opponents of reform have spread over the years, real reform has nevertheless been enacted. Like the Medicare program during the Johnson years; like the Medicaid program that is such an essential safety net for so many of our people; the Veteran’s program you mentioned. We have plenty of examples of government programs that work great and have done so much for so many billions of people over many years.

(My Bold)

Guernica: Did you ever express your concerns with colleagues at Cigna?

Wendell Potter: I talked to friends, but I didn’t muster the courage to [talk to co-workers]. When I decided to quit, I thought I’d just kind of go quietly. I announced it as a retirement, but I could have made a lot more money had I stayed. But I was okay with that. I wasn’t ready to go fishing, but I was ready to take a break. At one point, I thought I might have a chance to change things inside the company and the industry. But I realized very quickly that that was just wishful thinking. The industry is controlled by Wall Street investors. These companies are for-profit. Their first rule is to enhance shareholder value. That is what’s important. If what I said hindered a company’s profitability, I was not going to be listened to, plain and simple.