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I WAS A HEALTH INSURANCE EXECUTIVE. WHAT I SAW MADE ME QUIT.  
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Wendell Potter
December 18, 2024
New York Times
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_ I was forced to come to terms with the fact that I was playing a
leading role in a system that made desperate people wait months or
longer to get care, or go deep into medical debt. _

, Damon Winter/The New York Times

 

I left my job as a health insurance executive at Cigna after a crisis
of conscience. It began in 2005, during a meeting convened by the
chief executive to brief department heads on the company’s latest
strategy: “consumerism.”

Marketing consultants created the term to persuade employers and
policymakers to shift hundreds, and in many cases thousands, of
dollars in health-care costs onto consumers before insurance coverage
kicks in. At the time, most Americans had relatively modest
cost-sharing obligations — a $300 deductible, a $10 co-payment.
“Consumerism” proponents contended that if patients had more
“skin in the game” they would be more prudent consumers of health
care, and providers would lower their prices.

Leading the presentation was a newly hired executive. Onstage, he was
bombarded with questions about how plans with high deductibles could
help the millions of Americans with chronic conditions and other
serious illnesses. It was abundantly clear that insurance companies
would pay far fewer claims but many enrollees’ health care costs
would skyrocket. After about 30 minutes of nonstop questions, I
realized I’d have to drink the Kool-Aid and embrace this approach.

And I did, for a while. As head of corporate communications at Cigna
from 1999 until 2008, I was responsible for developing a public
relations and lobbying campaign to persuade reporters and politicians
that consumerism would be the long-awaited solution to ever-rising
insurance premiums. But through my own research and common sense, I
knew plans requiring significant cost sharing would be great for the
well-heeled and healthy — and insurers’ shareholders — but
potentially disastrous for others. And they have been. Of the
estimated 100 million Americans with medical debt, the great majority
have health insurance. Their plans are simply inadequate for their
medical needs, despite the continuing rise in premiums year after
year.

I grew uneasy after the company retreat. But it took an impromptu
visit to a free medical clinic, held near where I grew up in the
mountains of East Tennessee, to come face to face with the true
consequences of our consumerism strategy.

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At a county fairground in Wise, Va., I witnessed people standing in
lines that stretched out of view, waiting to see physicians who were
stationed in animal stalls. The event’s organizers, from a nonprofit
called Remote Area Medical, told me that of the thousands of people
who came to this three-day clinic every year, some had health
insurance but did not have enough money in the bank to cover their
out-of-pocket obligations.

That shook me to my core. I was forced to come to terms with the fact
that I was playing a leading role in a system that made desperate
people wait months or longer to get care in animal stalls, or go deep
into medical debt.

The tragic assassination of the UnitedHealthcare chief executive Brian
Thompson has reinvigorated a conversation that my former colleagues
have long worked to suppress about an industry that puts profits above
patients. Over 20 years working in health insurance, I saw the
unrelenting pressure investors put on insurers to spend less paying
out claims. The average amount insurers spent on medical care dropped
from 95 cents per premium dollar
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1993, the year I joined Cigna, to approximately 85 cents per dollar in
2011, after the Affordable Care Act restricted how much insurers can
profit from premiums. Since then, big insurers have bought physician
practices, clinics and pharmacy middlemen
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largely to increase their bottom line.

Meanwhile, the barriers to medical care have gotten higher and higher.
Families can be on the hook for up to $18,900 before their coverage
kicks in. Insurers require prior authorization more aggressively than
when I was an industry spokesman, which forces patients and their
doctors through a maze of approvals
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getting a procedure, sometimes denying them necessary treatment. Sure,
the insurance industry isn’t to blame for all the problems with our
health system, but it shoulders much of them. (In response to a
request for comment, Cigna told The Times that Mr. Potter’s views
don’t reflect the company’s and that Cigna is constantly working
to improve its support for patients.)

At Cigna, my P.R. team and I handled dozens of calls from reporters
wanting to know why the company refused to pay for a patient’s care.
We kept many of those stories out of the press, often by telling
reporters that federal privacy laws prohibited us from even
acknowledging the patient in question and adding that insurers do not
pay for experimental or medically unnecessary care, implying that the
treatment wasn’t warranted.

One story that we couldn’t keep out of the press, and that
contributed most to my decision to walk away from my career in 2008,
involved Nataline Sarkisyan, a 17-year-old leukemia patient in
California whose scheduled liver transplant was postponed at the last
minute when Cigna told her surgeons it wouldn’t pay. Cigna’s
medical director, located 2,500 miles away from Nataline, said she was
too sick for the procedure. Nataline’s family stirred up so much
media attention that Cigna relented, but it was too late. Nataline
died a few hours after Cigna’s change of heart.

Nataline’s death affected me personally and deeply. As a father, I
couldn’t imagine the depth of despair her parents were facing. I
turned in my notice a few weeks later. I could not in good conscience
continue being a spokesman for an industry that was making it
increasingly difficult for Americans to get often lifesaving care.

One of my last acts before resigning was helping to plan a meeting for
investors and Wall Street financial analysts — similar to the one
that UnitedHealthcare canceled after Mr. Thompson’s horrific
killing. These “annual investor days,” like the consumerism idea I
helped spread, reveal an uncomfortable truth about our health
insurance system: that shareholders, not patient outcomes, tend to
drive decisions at for-profit health insurance companies.

_Wendell Potter, a former vice president for corporate communications
at Cigna, is president of the Center for Health and Democracy and
writes the newsletter “Health Care un-Covered.”_

* health insurance
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* Healthcare for Profit
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