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wendell potter
As Mexico Enacts Universal Healthcare, Advocate Says Insurers' 'Stranglehold' Is Moving US in 'Opposite Direction'
Medicare for All advocate Wendell Potter said it's "both inspiring and frustrating" to see other nations advance their public healthcare systems while the US dismantles its own.
Apr 10, 2026
As Mexican President Claudia Sheinbaum moves forward with a plan to enact universal healthcare for her country’s more than 130 million people, a longtime advocate for Medicare for All in the US called the development “both inspiring and frustrating.”
"Inspiring because it shows what is possible," Wendell Potter, a former insurance company communications director who has become a leading critic of the industry, told Common Dreams. "Frustrating because here in the US we are going in the opposite direction."
Earlier this week, Sheinbaum announced a decree that she called "a historic step" for Mexico.
Beginning in 2027, her government plans to unify Mexico's public health institutions into a single Universal Health Service, allowing patients across the country to receive care from the Mexican Social Security Institute (IMSS), the Social Security Institute and Social Services of Workers of the State (ISSSTE), and the IMSS‑Bienestar program, which provides free services to those without employer-provided insurance.
According to TeleSur, universal access would be rolled out gradually, with universal emergency care and continuity of treatment, free of financial constraints, beginning in January. Specialized services such as radiotherapy, laboratory tests, and imaging studies would be phased in later that year, and universal prescription fulfillment and hospitalization would also be added to the program in 2028.
"The goal is that when we leave the government [in 2030], any Mexican man or woman can go to any health institution for treatment for any ailment and be received," Sheinbaum said.
Mexico has expanded its annual healthcare budget in recent years, but Sheinbaum's government hopes that consolidating all of Mexico's health services into a single program will eliminate bureaucratic bloat and create a more cost-effective system that saves money over time.
Potter described the plan as “just another example of countries around the world lapping the US when it comes to healthcare policy.”
While tens of millions more previously uninsured Mexicans have become eligible for free care under the healthcare expansion efforts of Sheinbaum and her predecessor, Andrés Manuel López Obrador, the US under President Donald Trump is in the process of shredding public healthcare programs and subsidies.
Following the One Big Beautiful Bill Act, signed into law by Trump last year, 11.8 million Americans are expected to lose Medicaid and other coverage, and more than 20 million are projected to see higher premiums after insurance subsidies under the Affordable Care Act were allowed to expire.
"Due to the stranglehold Big Insurance has on too many politicians in this country, instead of expanding care and lowering costs, we are simply helping Big Insurance make more and more money," Potter said. "It is totally backwards."
"We must continue to keep Medicare for All as our north star here. But also acknowledge the reality that we need to change so much about our current political environment to make it possible," he said. "And that has to start with breaking up Big Insurance's stranglehold on Washington."
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'Gouging': US Health Insurance Giants Raked in Over $71 Billion in Profits Last Year
Meanwhile, 17% of Americans say they're using buy now, pay later services for medical or dental care.
Aug 06, 2025
The seven largest publicly traded U.S. health insurance companies made a collective $71.3 billion in profits last year, and their CEOs took home a total of $146.1 million in compensation, according to an analysis released Wednesday by an ex-industry executive.
Wendell Potter, a former vice president for corporate communications at Cigna who now leads the nonprofit Center for Health and Democracy, compiled the data ahead of his recent testimony before the Senate Committee on Health, Education, Labor, and Pensions.
As Potter detailed for his newsletter, Health Care un-covered, the companies—UnitedHealth, CVS/Aetna, Cigna, Elevance, Humana, Centene, and Molina—boosted their profits by more than half a billion dollars from 2023 to 2024.
(Image: Health Care un-covered)
Alongside a chart detailing the companies' 2023 and 2024 revenues and profits, Potter published one showing each CEO's compensation. He also pointed out that their collective take-home pay is "enough to cover annual premiums for thousands of American families."
(Image: Health Care un-covered)
"So, what's driving the revenue surge?" Potter wrote. "Gouging. Insurers continued to jack up premiums for their commercial customers and overcharge the government."
He highlighted how investigations have exposed rampant fraud and upcoding with private Medicare Advantage plans and noted that "Medicaid managed care is a gold mine, too."
Potter further noted that "to the dismay of shareholders, the big seven insurers have had to admit that so far in 2025, they've paid more medical claims than they had expected, which means their profits were down somewhat during the first months of the year."
The expert warned that the American public should "expect even more financial pain (and difficulty getting the care you need) as these companies do all they can to get their profit margins back to where Wall Street wants them."
His warning comes as new polling makes clear that Americans are already feeling the pain from healthcare bills. Results released Monday by the Associated Press-NORC Center for Public Affairs Research show that 17% of U.S. adults have used buy now, pay later services for medical or dental care.
Most Americans are also stressed by healthcare costs. According to the poll, 42% of adults identified that as a major stressor, and another 36% said it's a minor stressor. Other sources of stress include grocery prices, housing, savings, and wages.
Healthcare could become an ever bigger source of stress soon, as Republicans' recently signed budget reconciliation package starts to strip millions of people of their insurance coverage, thanks to the law's attacks on Medicaid and the Affordable Care Act (ACA).
"Cuts to the ACA will raise premiums for almost 23M Americans by hundreds of dollars each year," Congressman Ro Khanna (D-Calif.) said on social media Monday. "Working and middle-class families can't afford that. We need to pass Medicare for All and make sure health insurance stays affordable for all Americans."
While more than 100 Democratic members of the U.S. House of Representatives and over a dozen senators support the Medicare for All Act, led by Rep. Pramila Jayapal (D-Wash.) and Sen. Bernie Sanders (I-Vt.), the proposal remains opposed by not only Republicans—who control both chambers—but also some corporate Democrats.
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'We Can Get There': Medicare for All Advocates See Resurgence in National Movement
"More and more people are waking up to realize, we do not want private insurance companies to be in control of our healthcare system," said one advocate who attended the latest Sanders Institute Gathering.
Jun 05, 2024
At The Sanders Institute Gathering in Burlington, Vermont last weekend, U.S. Sen. Bernie Sanders repeated the grim facts and statistics about one of the issues he's most passionate about—healthcare—that were no doubt familiar to many of the progressive advocates at the conference.
Americans spend twice as much per capita as what people in other wealthy countries pay for healthcare, with "significantly lower" life expectancy to show for it.
Medical debt pushes more than half a million people in the U.S. into bankruptcy each year.
More than a third of healthcare expenses go not to actual medical care, but to administrative costs.
Bernie Sanders: It goes without saying that our health care system is broken. I think everybody in America knows that. pic.twitter.com/A2ZiwyoLmT
— Sanders Institute (@TheSandersInst) June 2, 2024
But despite the well-known state of the U.S. healthcare system and a current political climate in which the fight for Medicare for All has been relatively "quiet," as one advocate said, Dr. Deborah Richter believes the Gathering showed a resurgence in the movement for a government-funded healthcare system is on its way.
Growing bipartisan anger over a lack of transparency about healthcare prices, private insurers' denial of claims, and the huge profits raked in by insurance companies while an estimated 98 million American adults skip or delay medical appointments to avoid an unaffordable bill are all pushing people to demand change, according to Richter, who gave a presentation about efforts to bring government-funded healthcare to Vermont.
"Walter Cronkite once said that the U.S. healthcare system is neither healthy nor caring, nor a system," said Richter in the talk, which like the rest of the three-day conference was livestreamed. "And decades later, it's still true. But I think that's the bad news. The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
The system that costs Americans twice the amount which people in other wealthy countries pay for healthcare is spending money not on caring for people, but on administration, said Richter, showing a chart that compared Duke University Hospital Medical Center, a facility with 957 beds and 1,600 billing clerks, with a Canadian hospital with 1,200 beds and just seven billing clerks.
Since 1970, she said, the U.S. has seen more than a 4,000% increase in the number of healthcare administrators, while the number of doctors has risen just 200%.
The discrepancy has helped lead to a system in which insurers are increasingly denying claims to maximize their own profits.
"The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
"I'm hearing from people who were pretty much Republicans and more conservative in their views complaining about Medicare, complaining about the fact that Medicare doesn't cover things," Richter told Common Dreams after her talk, pointing particularly to Medicare Advantage, which is billed as an alternative to traditional Medicare that provides greater benefits, but whose participating private insurers frequently deny claims and overcharge the government, costing taxpayers $140 billion annually.
Richter, a primary care physician who chairs Vermont Health Care for All, said she frequently hears from patients "about having to jump through all kinds of hoops in order to get a procedure or a prescription or whatever. And you're hearing that from pretty much everybody now... Those are all the kindling that we need to get this movement ignited again."
"It's the silver lining to having things just crumbling before your eyes," she added.
In Vermont and across the country, the crumbling healthcare system is one in which primary care doctors are leaving their profession in droves—fed up with the bureaucracy put in place by for-profit insurance companies that force them to get approval to provide certain services.
With insurers placing more value on surgeries and other procedures than on the preventative healthcare management provided by primary care doctors, physicians are spending their days "having to deal with prior authorizations and having to deal with paperwork to justify that you deserve to be paid for the services you render," said Richter. "When you're seeing 16 to 20 patients a day, and each one of those has its own enormous bureaucracy, you can imagine how you end up taking your computer home to do your charts. Medical students are not blind to this and are not choosing [primary care], and that's become a catastrophe."
At a panel discussion on healthcare for senior citizens and the hospital system, Medicare for All advocate Wendell Potter recalled that while he was working in the for-profit health insurance industry, an executive told him the greatest threat to the business was the possibility that employers—who pay for insurance plans for roughly half of insured Americans—would begin to see that the industry does little to ensure people get the healthcare for which they pay an average of $477 per month in premiums.
"Someone asked [the executive], 'What keeps you up at night?' And he said disintermediation," said Potter, who worked in communications for health insurance giants Humana and Cigna before leaving the industry to advocate for Medicare for All. "He said that employers in particular would begin to wake up and question the value proposition of big insurance companies as the middleman. But they as middleman take more and more and more of the dollars that we spend on healthcare."
Another panel focused on price transparency in healthcare, a cause which Sanders (I-Vt.) has championed along with Medicare for All to reduce patients' costs within the current system.
Along with Sen. Mike Braun (R-Ind.) earlier this year, Sanders introduced the Healthcare Prices Revealed and Information to Consumers Explained (PRICE) Transparency Act 2.0 (S. 3548), which would require all negotiated rates and cash prices between healthcare plans and providers to be accessible to patients.
Healthcare price transparency has officially been the law of the land since 2021, explained Cynthia Fisher, founder and chair of Patient Rights Advocate, at the Gathering. But many hospitals refused to comply with the price transparency rule finalized by the Centers for Medicare and Medicaid Services under the Trump administration—even suing to block the rule and appealing when they lost the case.
More than three years later, Fisher's organization still sees medical bills "beyond the negotiated rates that are in place now today," she told Common Dreams. Only 35% of hospitals post all of their pricing data for patients to see online, she said, and "the insurance industry has made the files very difficult for anybody to read and parse through."
Under the for-profit healthcare system, Fisher said, patients become victims of the equivalent of "extortion" as they are forced to arrange medical procedures without knowing how much they'll cost out of pocket or how much another hospital might charge for the same care.
"Every time we get care we have to pay by first signing a blank check," said Fisher. "We're signing away our rights to know those prices upfront... And we're signing away our rights to say... that we are responsible to pay whatever they choose to charge us."
Fisher told the story of one patient in Colorado who was provided only with an estimate of the cost before she got a hysterectomy, with her insurer telling her she was likely to pay a $500 copay and the procedure would cost an estimated $5,000 total.
"What happened in reality was the insurance company denied the claim and the doctor charged $9,000 out-of-network and the hospital had a lien on her home," said Fisher, "because she couldn't pay the $74,000 bill."
"Everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
Patient Rights Advocate helped the patient find the hospital pricing file and found that the procedure "was indeed closer to $5,000. And indeed it should have been covered," Fisher explained. "It took us, with her, about four or five months to get that lien off of her house. But [transparent] prices empowered her, they saved her, they protected her, and it's happening across the country."
The group has started a project called Power to the Patients, partnering with famous musicians as well as artists to make sure Americans know they have the right to know how much their healthcare will cost ahead of time.
Artist Shepherd Ferry designed a mural for the group that has now been painted by local artists in nearly 50 cities across the U.S., including Seattle, Los Angeles, and New York.
With 54% of American adults delaying medical care to avoid the cost, said Kevin Morra, co-founder of Power to the Patients, millions of people across the country have come to believe that "healthcare is not for them."
"They can't afford it. They don't want to be in a critical moment where they decide, 'Do I pay my rent or do I pay this medical bill?'" Morra said at the Gathering. "People are making a decision, a deliberate decision to not seek medical care, to not take these nondiscretionary procedures. And when nondiscretionary becomes discretionary, we all have a real infrastructural issue in this country."
During the question and answer session at the panel on healthcare for senior citizens, healthcare providers and patients alike raised their hands and shared personal stories about the "demoralizing" nature of fighting to have medications and procedures covered by insurance companies, with doctors "stripped of [their] professionalism" and patients forced to prove to companies that they're required to cover certain services.
Potter agreed with Richter that Medicare for All advocates are "regrouping," particularly around the issues of improving traditional Medicare by including dental and vision coverage and protecting the program "from creeping, almost galloping, privatization by big insurance companies" through Medicare Advantage.
"More and more people are waking up to realize, we do not want private insurance companies to be in control of our healthcare system," said Potter. "Private companies have grown massively over the last several years and they control so much of their access to care."
From the audience, Ellen Oxfeld of Vermont Health Care for All rallied other attendees of the Gathering.
"The left gets very splintered," said Oxfeld. "And I think Medicare for All is one issue that can unify all of us. I know it's not happening tomorrow, but... everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
"We can get there, is what I'm going to say," she added.
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Campaigners Beat 'Greedy' Insurance Giants Exploiting Medicare Advantage
"The private insurance industry is used to getting its way, but this year we out-organized them," said one People's Action leader.
Apr 02, 2024
As insurance companies' stock fell 6-12% on Tuesday in response to the Biden administration's Medicare Advantage announcement, one healthcare campaigner celebrated that the U.S. government didn't cave to the "greedy" industry's pressure.
"The private insurance industry is used to getting its way, but this year we out-organized them," declared Aija Nemer-Aanerud, the People's Action Health Care for All campaign director.
Medicare Advantage (MA) plans are an alternative to traditional coverage under the federal health insurance program for people with disabilities and those age 65 or older. They are administered by private insurance companies known for denying patients necessary care and overcharging the government, which costs taxpayers up to $140 billion extra each year.
"We urge President Biden to do more to rein in abuse of the Medicare program by private corporations."
The Centers for Medicare & Medicaid Services (CMS) announced Monday that "payments from the government to MA plans are expected to increase on average by 3.7%, or over $16 billion, from 2024 to 2025. The federal government is projected to pay between $500 and $600 billion in Medicare Advantage payments to private health plans in 2025."
First unveiled in January, the 3.7% is higher than what campaigners wanted. Last week, Alex Lawson of Social Security Works and Brittany Shannahan of Public Citizen delivered to the White House around 28,000 petition signatures urging President Joe Biden to "reduce MA rates to a level commensurate with traditional Medicare and recoup all overpayments."
However, the rate is also far less than what insurers and industry groups were demanding—and, as Reuters noted Tuesday, the decision was a departure from the norm, as CMS "typically raises the final reimbursement from the advanced notice."
"Medicare is one of the most popular government programs because it delivers healthcare to people when and where they need it," said Nemer-Aanerud. "Private insurance companies like UnitedHealthcare spent millions in advertising and lobbying in Washington to demand more of our public money for privatized, so-called 'Medicare Advantage' plans."
The People's Action leader pointed out that "we countered their lobbying by helping people share their stories with lawmakers about how Medicare Advantage plans harmed them by denying care when they needed it most."
"We commend the Biden administration for listening to our people and refusing to cave to the insurance lobby's demands," the campaigner added. "We urge President Biden to do more to rein in abuse of the Medicare program by private corporations and reinvest public funds into expanding and strengthening traditional Medicare."
As private insurers have grown their MA businesses, "concerns about the cost of the program have been rising for years from wonkier corners of Washington," Bloomberg's John Tozzi reported Tuesday. According to his newsletter:
"We went years without the advocacy community really paying attention to it," says Wendell Potter, who left a career doing public relations for health insurers to become an outspoken critic of the industry.
That shifted over the last year or two, he said, as a loose group of advocates coalesced around the issue... Potter said advocates now get face-to-face meetings with top Biden administration officials about the issue.
Potter partnered with Congresswoman Pramila Jayapal (D-Wash.)—a leader in the fight for Medicare for All, a single-payer healthcare system that would cover everyone nationwide—for a Newsweek op-ed published just before the CMS announcement.
The pair took aim at the insurance industry's "disinformation campaign" about what they call "Medicare (Dis)Advantage."
"First off, the industry claims that Medicare Advantage plans reduce costs. But this is simply not true," Potter and Jayapal explained. "And it gets worse. While Big Insurance touts the coverage Medicare Advantage plans provide, the reality is Medicare Advantage plans often provide worse coverage than traditional Medicare."
They wrote that "another important characteristic of Medicare Advantage plans is their aggressive use of tools to delay and deny care such as prior authorization, which is seldom used in traditional Medicare, and rarely for services like physician-administered cancer treatments (no one wants chemotherapy if they don't need it)."
"Medicare Advantage plans also drive health inequalities, contrary to Big Insurance claims," they continued. "And the industry's biggest and boldest piece of disinformation is that Medicare Advantage plans will be forced to cut benefits if the government stops massive overpayments that have been padding corporate profits for decades."
"This is wholly false," they stressed. "And you want to know how we know? Because we have reduced overpayments before."
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Fueled by Stock Buybacks, Pay of Top Insurance CEOs Surged to $335 Million Last Year
"These health insurance CEOs have been so successful not because they have improved the health and well-being of Americans, but rather because they have sustained financial returns for Wall Street investors."
Jun 07, 2023
The United States' healthcare system is the worst in the developed world, delivering the highest death rates for treatable conditions, the highest infant and maternal mortality rates, and the lowest life expectancy at birth.
But a system that is failing patients, often in catastrophic ways, has been a massive boon for the executives who run the few private companies that dominate the nation's healthcare sector.
Last year, the CEOs of CVS Health, UnitedHealth Group, Cigna, Elevance Health, Centene, Humana, and Molina Healthcare—the top seven publicly traded health insurance giants in the U.S.—brought in a combined $335 million in compensation, STAT recently reported.
The outlet emphasized that "high-flying stock prices again fueled a vast majority of the gains," which mark a new record. Joseph Zubretsky, the CEO of Molina Healthcare—a company whose revenue comes entirely from taxpayer-funded programs such as Medicaid—took home a staggering $181 million in 2022.
As former Cigna executive Wendell Potter noted Tuesday, "these health insurance CEOs have been so successful not because they have improved the health and well-being of Americans, but rather because they have sustained financial returns for Wall Street investors."
"Not much has changed in how insurer CEOs are compensated since I left Cigna in 2008. Except they're making way more," wrote Potter, who is now the executive director of the Center for Health and Democracy.
In a new analysis of the latest CEO pay figures, Potter observed that "had it not been for their companies' share buybacks"—which help boost the price of their stock by reducing the number of shares outstanding—"they wouldn't have banked nearly that much money."
"My analysis of how much the companies have used our premiums and tax dollars to buy back shares of their own stock showed that combined they spent $141 billion on share repurchases between 2007 and 2022," Potter wrote. "Keep in mind that that is $141 billion that otherwise could have been used to reduce our premiums and deductibles–and keep an untold number of American families out of bankruptcy and away from GoFundMe–but was used instead to increase the wealth of their shareholders and top executives."
Potter argued that the CEOs' exorbitant pay packages are "especially alarming when you consider that they are getting more and more of it from us as taxpayers" as tens of millions of Americans go without insurance, struggle to afford their prescription medicines, and drown in medical debt.
In an analysis released earlier this year, Potter estimated that government programs are the source of around 90% of the health plan revenues of Molina, Humana, and Centene.
Centene CEO Sarah London brought in more than $13 million in total compensation last year, and Humana chief Bruce Broussard took home more than $17 million. Both companies are major providers of Medicare Advantage—a privately run, publicly funded, and fraud-ridden program that is a growing source of insurance company revenues.
"Keep all of this in mind the next time you go to the pharmacy counter and are told that even with insurance you'll have to pay a king's ransom for your meds because your insurer—through its pharmacy benefit manager (PBM)—has once again jacked up your out-of-pocket requirement," Potter wrote. "Or the next time you notice how much has been deducted from your paycheck for your health insurance–and Uncle Sam."
Fresh outrage over the pay of insurance industry CEOs, which surged during the coronavirus pandemic as millions lost health coverage and got sick, comes amid a renewed Medicare for All push in Congress.
Last month, Sen. Bernie Sanders (I-Vt.), Rep. Pramila Jayapal (D-Wash.), and others reintroduced Medicare for All legislation in both chambers, with more co-sponsors than ever before—though the bill has no chance of passing the divided Congress.
The legislation would virtually eliminate private health insurance and provide comprehensive care to all for free at the point of service, a transformative change that would likely save tens of thousands of lives and hundreds of billions of dollars each year.
"In America, your health and your longevity should not be dependent on your bank account or your stock portfolio," said Sanders. "After all the lives that we lost to this terrible pandemic, it is clearer now, perhaps more than it has ever been before, that we must act to end the international embarrassment of the United States being the only major country on earth to not guarantee healthcare to all."
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Report Shows Big Insurance Profiting Massively From Medicare Privatization
The seven largest for-profit insurance companies in the U.S. have seen their combined revenues from taxpayer-backed programs grow 500% over the past decade.
Feb 28, 2023
A new analysis released Monday shows that insurance giants are benefiting hugely from the accelerating privatization of Medicare and Medicaid, which for-profit companies have infiltrated via government programs such as Medicare Advantage.
According to the report from Wendell Potter, a former insurance executive who now advocates for systemic healthcare reform, government programs are now the source of roughly 90% of the health plan revenues of Humana, Centene, and Molina.
Over the past decade, Potter found, the seven top for-profit insurance companies in the U.S.—the three mentioned above plus UnitedHealth, Cigna, CVS/Aetna, and Elevance—have seen their combined revenues from taxpayer-backed programs soar by 500%, reaching $577 billion in 2022 compared to $116.3 billion in 2012.
"The big insurers now manage most states' Medicaid programs—and make billions of dollars for shareholders doing so—but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders," Potter wrote. "In addition to their focus on Medicare and Medicaid, the companies also profit from the generous subsidies the government pays insurers to reduce the premiums they charge individuals and families who do not qualify for either Medicare or Medicaid or who work for an employer that does not offer subsidized coverage."
Potter noted that the top insurance giants, a group he dubbed the Big Seven, now control more than 70% of the Medicare Advantage market, which has grown rapidly in recent years. According to the Kaiser Family Foundation, more than 28 million people were enrolled in a privately run Medicare Advantage plan last year—nearly half of the Medicare-eligible population.
An ardent critic of Medicare Advantage, Potter said in an interview with The American Prospect on Monday that the program "is a big contributor to the excessive spending" in Medicare.
"It needs to be ended," Potter, executive director of the Center for Health and Democracy, said of Medicare Advantage, whose major players frequently overbill the federal government and deny patients necessary care. The program is run by private insurers with government money.
"The premiums and taxes paid by Americans enabled the Big Seven to make those profits."
In his analysis, Potter observed that Medicare Advantage enrollment among the Big Seven increased 252% between 2012 and 2022.
Having deeply entrenched themselves in the Medicare program via Medicare Advantage, insurance giants are now looking to gain a foothold in traditional Medicare through a Biden administration pilot program known as ACO REACH, which has drawn mounting criticism from physicians and progressive lawmakers.
"We must fight the privatization of Medicare with every tool we have," Rep. Pramila Jayapal of Washington, chair of the Congressional Progressive Caucus, said in a statement last month.
When counting both their commercial businesses and participation in government programs, the Big Seven brought in $1.25 trillion in revenue last year and their profits rose to $69.3 billion, according to Potter, who emphasized that a growing share of insurance giants' revenues now comes from "the relatively new and little-known middleman between patients and pharmaceutical drug manufacturers" known as pharmacy benefit managers (PBMs).
"Cigna now gets far more revenue from its PBM than from its health plans," Potter noted. "CVS gets more revenue from its PBM than from either Aetna's health plans or its nearly 10,000 retail stores."
Potter lamented that "policymakers, regulators, employers, and the media have so far shown scant interest" in closely examining the taxpayer-reliant business practices of large insurance companies, which wield substantial lobbying power that they deploy against any effort to transform the United States' fragmented healthcare system.
"They've essentially been bailed out by taxpayers," Potter said of for-profit insurance giants. "And members of Congress, and various administrations, have been just standing on the sidelines, not paying attention to what's been going on."
Meanwhile, tens of millions of people in the United States are either uninsured or inadequately insured, and more than 100 million are saddled with healthcare-related debt.
A recent study by The Commonwealth Fund found that the United States spent close to twice as much as the average OECD nation on healthcare while achieving worse outcomes in critical areas such as life expectancy at birth and death rates for treatable conditions.
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Here is the Truth: Medicare Advantage Is Neither Medicare Nor an Advantage
Medicare Advantage is a money-making scam. I should know. I helped to sell it.
Jan 14, 2023
Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.
But here is the truth: Medicare Advantage is neither Medicare nor an advantage.
And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.
During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare—real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits—at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.
Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems... Congress should work to lower the cost of health care.
I regret my participation in those efforts. Over the 20 years since Congress passed the Medicare Modernization Act, the Medicare Advantage program has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits. As Kaiser Health News reported last month, the Center for Medicare and Medicaid Services estimated “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses at $11.4 billion for 2022.” That was for just one year. Imagine what the cumulative historical total would be.
The Medicare and Medicaid programs have become so lucrative and profitable for insurers that UnitedHealth Group, the nation’s largest health insurer and the biggest in terms of Medicare Advantage enrollment, got 72% of its health plan revenues in 2021 from taxpayers and seniors. In fact, all of UnitedHealth’s enrollment growth since 2012 has been in government programs. Enrollment in the company’s employer and individual health plans shrank by 370,000 between September 30, 2012, and September 30, 2022. Much of the $81 billion UnitedHealth collected in revenues in the third quarter of last year was subsidized by American tax dollars.
Members of Congress on both sides of the political aisle–and both sides of the Capitol–are at long last calling for more scrutiny of the Medicare Advantage program. Sen. Chuck Grassley has called for aggressive oversight of Medicare Advantage plans to recoup overcharges and was quoted in the Kaiser Health News story. As was Sen. Sherrod Brown, who said that fixing Medicare Advantage is not a partisan issue. And as Rep. Katie Porter commented, “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”
I know that Democrats and Republicans alike care about the financial stability of the Medicare program. Instead of joining with the corporate lobbyists in extolling the benefits of Medicare Advantage while obscuring the program’s numerous problems, and in the process helping Big Insurance make massive profits, Congress should work to lower the cost of health care.
Medicare Advantage is a money-making scam. I should know. I helped to sell it.
And I’m going to continue working alongside patients, caregivers, and elected officials to address the problems.Keep ReadingShow Less
Media Fails to Challenge Lies
Dec 31, 2010
MSNBC's Chris Matthews had a good laugh during a recent segment about the five biggest political lies of 2010. PolitiFact gave the top prize to Republicans and pundits who repeatedly lied--and got away with it--by calling the healthcare bill a "government takeover."
After showing multiple clips of Republicans repeating the same lie over and over again, Matthews could barely contain his laughter. "Are we watching a Woody Allen movie here?" he asked his guests. "Do they get all their talking points from Frank Luntz? Some guy down on the beach in Santa Monica is knocking out the terminology. The lingo in these people. Don't they know they sound like parrots?"
Former San Francisco Mayor Willie Brown replied by saying that Republicans get away with the lies because they are never challenged during interviews or asked to define the word 'takeover.' Matthews ignored the comment, but did say the healthcare bill is an insurance company takeover. He later wondered if the Heritage Foundation wrote the talking points.
They actually came from Wendell Potter and his health insurance colleagues. Potter is former head of corporate communications for CIGNA, one of the largest for-profit health insurance companies in the United States. Potter, who spent 20 years working for CIGNA and Humana, was the main media contact for top-level executives. If a journalist wanted an interview, they had to go through Potter; if he thought the interview would be "friendly," he would approve it. He always sat in on the interview and says journalists rarely challenged executives or asked difficult questions.
In 2008, his conscience got the best of him after visiting the Remote Area Medical's healthcare fair in Wise County, Virginia and saw people standing and sitting in long lines, waiting for free care. "They were treating people in animal stalls and barns. It looked like it might have been a war torn country. I could not believe this was the United States of America."
Shortly after leaving his six-figure job, he decided to expose and speak out against the very practices he once defended.
In his new book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care And Deceiving Americans, he writes, "If you are among those who believe that the U.S. has the best healthcare system in the world--despite overwhelming evidence to the contrary-- it's because my fellow spinmeisters and I succeeded brilliantly at what we were paid very well to do with your premium dollars."
"And if you were persuaded that the health care bill President Barack Obama signed into law in March 2010 was a 'government takeover of the health care system,' my former colleagues and I earned every penny of our handsome salaries."
The talking points are designed to be simple, catchy, and memorable. Think government takeover of healthcare, death panels, and socialism.
"And you have to say them over and over and over again. And if you hear them often enough, you think it's true," says Potter. "That's why people, even today, think that the legislation created death panels. Obviously it never had anything approaching that kind of provision. People think this legislation is a government takeover of the healthcare system. In reality, it props up our private healthcare system. It guarantees that these private insurance companies are going to be profitable for years and years to come. It will require us to buy their products and it doesn't include a public option, which we needed to have."
Potter says once the talking points are written, they are distributed on Capitol Hill. The process is simple, but it's done discreetly. "You don't hand them to a member of Congress, but you develop very good relationships with staff members. That's key."
He says he also cultivated relationships with television producers and reporters, who, in turn, handed them to pundits and the talking heads on cable shows. As we now know, the lies worked brilliantly.
Potter says he wrote Deadly Spin to show how a huge share of healthcare premiums bankroll relentless propaganda and lobbying efforts focused on protecting profits. The book is as much about public relations and spin as it is about healthcare.
"Without basic knowledge of PR tactics and the ability to distinguish between fact and distortion, Americans--and that includes journalists, both professional and citizen--are at the mercy of spin doctors and the public relations practitioners whose loyalty to their clients outweighs the public's right to the truth," he writes.
One of the many incidents that pushed Potter to speak out happened shortly after the March 5, 2009 White House Health Care Summit at which Karen Ignagni, president of the insurance lobby America's Health Insurance Plans (AHIP), told President Obmaa he could count on her and the insurance industry. "We want to work with the members of Congress on a bipartisan basis here. You have our commitment. We hear the American people about what's not working. We've taken that seriously," she said. "You have our commitment to play, to contribute, and to help pass health care reform this year."
Potter says it was one of her best performances to date. President Obama responded by saying, "Good. Thank you, Karen. That's good news. That's America's Health Insurance Plans." Potter said the President was played like a "Stradivarius by one of the best lobbyists to ever hit Washington."
According to Potter, Ignagni is one of Washington's most effective communicators and--with a salary and bonuses of $1.94 million in 2008--one of the highest-paid special interest advocates in Washington.
According to a recent Bloomberg report, AHIP, whose members include CIGNA and Humana, gave $86 million to the U.S. Chamber of Commerce to oppose the healthcare bill. "By funneling the money through the Chamber," says the report, "insurers were able to remain at the table negotiating with Democrats while still getting the bill criticized."
On March 9, 2009, MSNBC's Chris Matthews interviewed Mike Tuffin, AHIP's executive vice president of strategic communications. In the introduction, Matthews said, "The same people who helped kill the Clinton's efforts back in the '90s are on the other side now. Times have changed. The worm has turned. The cosmos have shifted. Some of the bad guys are becoming perhaps the good guys."
"There was no doubt about it: Tuffin was on the show as part of AHIP's charm offensive," writes Potter. "And just like Obama, Matthews seemed to be falling for it."
Potter also writes about Health Care America, a "non-partisan, non-profit healthcare" front group formed to discredit Michael Moore and his healthcare documentary Sicko. A quick search would show that there was nothing non-partisan about Health Care America. It was set up by APCO Worldwide, one of the country's largest and most powerful public relations firms.
Not only did APCO succeed in getting their talking points into most of the stories that appeared about the film, writes Potter, but "not a single reporter had done enough investigative work to find out that insurers had provided the lion's share of funding to set up Health Care America."
Potter says even though the health insurance bill has passed, the spin continues. The health insurance industry, banks, weapons manufacturers, and oil companies won't lose their power until their lies are challenged and the public understands how spin and manipulation works. "We will never be free of spin, but we can be wise to it, and we can push back against it. There is too much at stake not to try."
Listen to Your Call's interview with Wendell Potter.
Video interview with Wendell Potter, Part I
Video interview with Wendell Potter, Part II
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