Bill Moyers talks to Wendell Potter

[M. (hristine]

Former insider calls the health insurance industry's campaign against a public health care option "a duplicitous and well financed pr and lobbying campaign."

 

My disdain for the health insurance and pharmaceutical industry is well documented in these pages, but regardless how you feel, this interview may open some eyes.

 

I hope one day the lid gets blown clean off.

 

http://video.pbs.org/video/1178899944

 

Thanks for posting this on teh fb, solace.

[ih8music]

Thanks. This should be required viewing for all - but especially for those who are opposed to a public healthcare option.

[ikol]

Why? Does it portray those in government as selfless and benevolent?

[ih8music]

Why? Does it portray those in government as selfless and benevolent?

No, quite the contrary as it shows how both parties are more interested in keeping the healthcare industry happy rather than protecting it's citizens. Despite the fact that 72% of Americans say they want a public healthcare option, there's still a good chance it'll never happen. Infuriating.

 

 

 

But the following passage highlights the emphasis of the story - the implications of having for-profit corporations in control of medical decisions, as told by someone who was a senior exec at Cigna for some 15 yrs.

 

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

 

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

 

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

 

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

 

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

 

BILL MOYERS: That they're spending more money for medical claims.

 

WENDELL POTTER: Yeah.

 

BILL MOYERS: And less money on profits?

 

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.

 

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

 

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

 

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

 

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

 

They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

 

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

 

WENDELL POTTER: That's right. Exactly right.

 

There's a lot of talk out there are how a public healthcare system would put "Washington bureaucrats" in between you & your doctor. But what we have right now is much, much more sinister IMO - a system driven by profit motive alone, and not the patient's right to access the healthcare they thought they had.

[ikol]

You'll get no argument from me that insurance companies are in it for profit and not to provide healthcare. But part of the problem is that health insurance is expected to cover routine costs which is the antithesis of what insurance is about. People should be paying for that stuff out of pocket and using insurance for catastrophic costs. Another problem is government mandates on what insurance has to cover, including stuff like in vitro fertilization and viagra. And if putting control of healthcare reduces costs, it will do so by reducing compensation to providers rather than by reducing unnecessary tests. If you don't believe that, I suggest working in a VA hospital.

[M. (hristine]

Willy, would you kindly quit med school and write policy for this reform instead?

 

I'm not interested in seeing government run hospitals a la the VA. I did find surprising the disparity in administrative costs between the private sector estimated at 20%, and 3% for Medicaid.

 

OpenSecrets.org, has some illuminating numbers concerning lobby dollars: "Obama, who made health care reform a large part of his presidential election platform, brought in $18.8 million from the health care sector in the 2008 election cycle--far more than any other presidential hopeful. Money follows power as the industries ride the tides of Obama-styled change."

[Good Old Neon]

You'll get no argument from me that insurance companies are in it for profit and not to provide healthcare. But part of the problem is that health insurance is expected to cover routine costs which is the antithesis of what insurance is about. People should be paying for that stuff out of pocket and using insurance for catastrophic costs. Another problem is government mandates on what insurance has to cover, including stuff like in vitro fertilization and viagra. And if putting control of healthcare reduces costs, it will do so by reducing compensation to providers rather than by reducing unnecessary tests. If you don't believe that, I suggest working in a VA hospital.

 

Out of curiosity, what sort of magic has prevented the Canadian health care system (to take but one example) from devolving into a US-VA-system-like hell, and what is preventing it from being replicated here?

 

I would kindly post the $120 cost associated with a routine, 15 minute doctor visit, if the insurance company would kindly stop taking $308 out of my check every month.

[ikol]

Out of curiosity, what sort of magic has prevented the Canadian health care system (to take but one example) from devolving into a US-VA-system-like hell, and what is preventing it from being replicated here?

 

Not having any experience with the Canadian healthcare system, I won't accept your premise that it hasn't. However, I do know that there are many problems with Canada's system, including wait times and doctor/nurse shortages. In fact, many Canadian patients go the US for treatment, and many physicians trained in Canada end up practicing in the US. And it's not just the amount of money being spent that's the problems but the restrictions that come with government payments. Doctors in Canada cannot set their own prices; instead, they have to accept the previously negotiated fees (much in the same way Medicare pays whatever it wants to in the US). In the US Medicare does not fund treatment for complications it deems as "preventable" even if they occur regardless of preventative measures.

 

I would kindly post the $120 cost associated with a routine, 15 minute doctor visit, if the insurance company would kindly stop taking $308 out of my check every month.

 

One of the reasons your insurance premiums are so expensive (in addition to corporate greed, Republicans, etc.) is that your insurance provider is mandated by law to pay for certain things whether or not you want them to. If more people were paying for routine visits out of pocket, competition would drive the prices down, similar to what has occurred with LASIK surgery.

[Good Old Neon]

Not having any experience with the Canadian healthcare system, I won't accept your premise that it hasn't. However, I do know that there are many problems with Canada's system, including wait times and doctor/nurse shortages. In fact, many Canadian patients go the US for treatment, and many physicians trained in Canada end up practicing in the US. And it's not just the amount of money being spent that's the problems but the restrictions that come with government payments. Doctors in Canada cannot set their own prices; instead, they have to accept the previously negotiated fees (much in the same way Medicare pays whatever it wants to in the US). In the US Medicare does not fund treatment for complications it deems as "preventable" even if they occur regardless of preventative measures.

 

My knowledge of Canada’s health care system is also very limited, but based on their standard of living, life expectancy, and an overall health care approval rating in the neighborhood of 90%, I’m going to have to assume it shares very little in common with the VA. From what I’ve read, their system, like all systems, could use some improvement, but the very same thing could be said of ours.

 

Wikipedia provides a pretty good overview of both.

 

Excerpt:

 

In 2007, Gordon H. Guyatt et al. conducted a meta-analysis, or systematic review, of all studies that compared health outcomes for similar conditions in Canada and the U.S., in Open Medicine, an open-access peer-reviewed Canadian medical journal. They concluded, "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Guyatt identified 38 studies addressing conditions including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies with the strongest statistical validity, 5 favoured Canada, 2 favoured the United States, and 3 were equivalent or mixed. Of 28 weaker studies, 9 favoured Canada, 3 favoured the United States, and 16 were equivalent or mixed. Overall, results for mortality favoured Canada with a 5% advantage, but the results were weak and varied. The only consistent pattern was that Canadian patients fared better in kidney failure.

 

link - http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

[ikol]

So basically despite the fact that Canada has universal healthcare there's no dramatic difference in outcomes from the U.S.

[Good Old Neon]

So basically despite the fact that Canada has universal healthcare there's no dramatic difference in outcomes from the U.S.

 

 

For many people, I would think not – for the uninsured, I suspect there is quite a disparity.

 

Peter Singer recently wrote an article in which he defends health care rationing – it’s an interesting read, regardless of your feelings on the matter.

 

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=2&ref=magazine&pagewanted=all

 

Excerpt:

 

When a Washington Post journalist asked Daniel Zemel, a Washington rabbi, what he thought about federal agencies putting a dollar value on human life, the rabbi cited a Jewish teaching explaining that if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally. Perhaps that is how those who resist health care rationing think. But we already put a dollar value on human life. If the Department of Transportation, for example, followed rabbinical teachings it would exhaust its entire budget on road safety. Fortunately the department sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million. Other government agencies do the same. Last year the Consumer Product Safety Commission considered a proposal to make mattresses less likely to catch fire. Information from the industry suggested that the new standard would cost $343 million to implement, but the Consumer Product Safety Commission calculated that it would save 270 lives a year — and since it valued a human life at around $5 million, that made the new standard a good value. If we are going to have consumer-safety regulation at all, we need some idea of how much safety is worth buying. Like health care bureaucrats, consumer-safety bureaucrats sometimes decide that saving a human life is not worth the expense. Twenty years ago, the National Research Council, an arm of the National Academy of Sciences, examined a proposal for installing seat belts in all school buses. It estimated that doing so would save, on average, one life per year, at a cost of $40 million. After that, support for the proposal faded away. So why is it that those who accept that we put a price on life when it comes to consumer safety refuse to accept it when it comes to health care?

 

It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

[ikol]

For many people, I would think not – for the uninsured, I suspect there is quite a disparity.

 

The table comparing the incidence and mortality of various forms of cancer showed the U.S. and Canada to be pretty similar, and it doesn't give any indication that the uninsured were excluded from the numbers. So either the outcomes in both countries are about the same or the care in the U.S. is so much better that it cures enough people to make up for the uninsured that would have otherwise made outcomes worse in comparison to Canada.

 

Peter Singer recently wrote an article in which he defends health care rationing – it’s an interesting read, regardless of your feelings on the matter.

 

I say it depends on who the individual on the scale is. If it's someone I know and love, they're going to count more than some anonymous individual. But that's probably why I'm not a utilitarian like Singer.

[MattZ]

ikol, you keep saying that folks should pay for checkups, etc. out of pocket, and that insurance should be insuring against big health events. But from a purely economic perspective, isn't it in the insurance companies' interests to be paying less up front to treati illness before it becomes a catastrophe down the road? Wouldn't the insurance companies be better off (financially) if my chronic illness is caught early instead of treated late? And isn't that why insurance companies cover checkups, etc.? I realize I am simplifying the issue to a large degree.

[Duck-Billed Catechist]

So basically despite the fact that Canada has universal healthcare there's no dramatic difference in outcomes from the U.S.

They're paying less, though.

[ikol]

ikol, you keep saying that folks should pay for checkups, etc. out of pocket, and that insurance should be insuring against big health events. But from a purely economic perspective, isn't it in the insurance companies' interests to be paying less up front to treati illness before it becomes a catastrophe down the road? Wouldn't the insurance companies be better off (financially) if my chronic illness is caught early instead of treated late? And isn't that why insurance companies cover checkups, etc.? I realize I am simplifying the issue to a large degree.

 

Maybe, so. I'm not sure whether insurance companies cover that stuff for purely economic reasons or if it's just because most people demand coverage for routine stuff. Either way, premiums are much higher as a result. Insurance isn't really meant to cover routine stuff. You're paying premiums so that in the unlikely event that you require really expensive treatment, you'll be covered. Why pay premiums to someone to pay for a routine visit? All adding the middle man does is takes price out of the equation for the patient, so doctors don't have to compete with low prices. I'm not advocating against preventative medicine, I'm just saying it would be better to pay for it out of pocket and have lower premiums.

 

They're paying less, though.

 

True, but there are a lot of factors at play and it's not clear that it's because they have more government subsidization than us. You can send your kid to a private school for less than per student spending on public schools, so it's not a universal principle that government subsidization equals lower costs.

[bjorn_skurj]

Is every other First World country wrong and we right by not having socialized medicine? And if people should pay for routine health care out of their pockets, will that lead to the price of routine health care coming down to a point where people can afford it?

[ikol]

Yes. Yes.

[caliber66]

Maybe, so. I'm not sure whether insurance companies cover that stuff for purely economic reasons or if it's just because most people demand coverage for routine stuff. Either way, premiums are much higher as a result. Insurance isn't really meant to cover routine stuff. You're paying premiums so that in the unlikely event that you require really expensive treatment, you'll be covered. Why pay premiums to someone to pay for a routine visit? All adding the middle man does is takes price out of the equation for the patient, so doctors don't have to compete with low prices. I'm not advocating against preventative medicine, I'm just saying it would be better to pay for it out of pocket and have lower premiums.

You're also assuming that people would pay for preventive checkups/routine visits out of pocket if they were not covered. I did not have dental insurance for five years and paid for exactly zero routine visits out of pocket. As soon as I got insurance again, I started going to the dentist again. If people don't go to the doctor for routine stuff, which then develops into something more serious as a result, and only visit the doctor once it gets bad enough to be covered, the covered treatment can cost as much as a bunch of those routine visits which aren't covered under your plan, and then where will premiums go?

[ikol]

That falls under the mantle of personal responsibility. The government does not exist to change our diapers (at least in my opinion; others may differ on this point).

 

Also, did I mention that my proposed plan comes with a tax-free health savings account which can be used for routine stuff?

[caliber66]

That falls under the mantle of personal responsibility. The government does not exist to change our diapers (at least in my opinion; others may differ on this point).

But if people do not do routine medical care, causing easily and cheaply preventable conditions to become much more expensive covered conditions/events, what happens to premiums then?

[Tweedling]

That falls under the mantle of personal responsibility. The government does not exist to change our diapers (at least in my opinion; others may differ on this point).

 

Also, did I mention that my proposed plan comes with a tax-free health savings account which can be used for routine stuff?

What if their "green" eco-frienly washable reusable diapers?

[ih8music]

You're paying premiums so that in the unlikely event that you require really expensive treatment, your claim can be rejected due to a technicality and you're stuck with the option of either going bankrupt paying for it yourself, or not getting the treatment and dealing with deteriorating health and/or death.

fixed it for you.

[Good Old Neon]

That falls under the mantle of personal responsibility. The government does not exist to change our diapers (at least in my opinion; others may differ on this point).

 

The government would not be acting as your mommy, no more so than when it provides for your defense. It’s not as if it, the government, is offering or supplying you with something you haven’t earned and/or paid for - the insurance would be provided using OUR tax dollars. The government is simply administering the plan. Now, you could claim that the private sector always does a better job with such things, but I would counter that they’ve done a pretty good job of fucking it up. And, as far as I’m concerned, the very near collapse of our economic system has done little to bolster my confidence in that sector, the private corporate one.

 

The one we were coerced into bailing out.

[M. (hristine]

But part of the problem is that health insurance is expected to cover routine costs which is the antithesis of what insurance is about. People should be paying for that stuff out of pocket and using insurance for catastrophic costs.

The premise here is correct. AAA doesn't pay for oil changes in my car or to clean the leaves from my gutters.

 

The problem arises in that there is a choice involved with owning the things we normally insure. One's body is not optional.

 

Out of pocket prices for routine care is expensive. $80 for an office visit. $200 for a mammogram. That's almost a week's take home for minimum wage folks. In 1974 my husband and I, as college students, paid for prenatal care and birth of our daughter out of pocket within a year after she was born. Try doing that today.

 

And has been pointed out, insurance companies can deny catastrophic care for myriad spurious reasons.

 

Neither model; government run or for profit insurance health care seems entirely suited for this.

[ikol]

But if people do not do routine medical care, causing easily and cheaply preventable conditions to become much more expensive covered conditions/events, what happens to premiums then?

 

They go up, as they should. Just like your car insurance premiums go up if you get multiple speeding tickets. If your behavior increases your risk, it's going to cause more to insure against an adverse event.

 

It’s not as if it, the government, is offering or supplying you with something you haven’t earned and/or paid for - the insurance would be provided using OUR tax dollars.

 

Except it would be using some people's tax dollars more so than others. Like half of our populations pays no federal income taxes. Are we going to add a tax so that they too would be paying for their healthcare?

 

Now, you could claim that the private sector always does a better job with such things, but I would counter that they’ve done a pretty good job of fucking it up. And, as far as I’m concerned, the very near collapse of our economic system has done little to bolster my confidence in that sector, the private corporate one.

 

But the government certainly contributed a great deal to that fuck up by coercing banks into making risky loans. True, the private sector bears a lot of the responsibility too, but the government shielded them from the consequences of their actions and then bailed them out when they failed. I won't claim that the private sector always does better than the government, just that it's easier to change insurance than it is to change governments. I can't speak for everyone in the medical profession, but if our entire system ends up like medicare or the VA system, then I will probably leave the profession, and I know a lot of classmates who feel the same way.

 

The one we were coerced into bailing out.

 

Which was another mistake the government made. They should've been left to face the consequences of their irresponsible business practices. Refusing to bail them out probably would not have prevented a recession, and it may have even been worse temporarily, but at least those businesses would fail and be replaced by better ones which is better in the long run.

 

The problem arises in that there is a choice involved with owning the things we normally insure. One's body is not optional.

 

Sure it is. The consequences of losing it are just a bit more permanent than losing a car.

 

Out of pocket prices for routine care is expensive. $80 for an office visit. $200 for a mammogram. That's almost a week's take home for minimum wage folks. In 1974 my husband and I, as college students, paid for the prenatal and birth of our daughter out of pocket within a year after she was born. Try doing that today.

 

Two things: 1. That's partially because people used to pay out of pocket for routine care so they had to compete on prices. 2. That routine care has gotten better. Compare what you got with prenatal and birth care in 1974 to what you would get now.