Health Insurance Whistle-Blower Knows Where the Bodies Are Buried

Wendell Potter is the health insurance industry's worst nightmare. He's a whistle-blower. Potter, the former chief spokesperson for insurance giant CIGNA, recently testified before Congress, "I saw how they confuse their customers and dump the sick--all so they can satisfy their Wall Street investors."

Potter was deeply involved in CIGNA and industrywide strategies for maintaining their profitable grip on U.S. health care. He told me: "The thing they fear most is a single-payer plan. They fear even the public insurance option being proposed; they'll pull out all the stops they can to defeat that to try to scare people into thinking that embracing a public health insurance option would lead down the slippery slope toward socialism ... putting a government bureaucrat between you and your doctor. They've used those talking points for years, and they've always worked."

In 2007, CIGNA denied a California teenager, Nataline Sarkisyan, coverage for a liver transplant. Her family went to the media. The California Nurses Association joined in. Under mounting pressure, CIGNA finally granted coverage for the procedure. But it was too late. Two hours later, Nataline died.

While visiting family in Tennessee, Potter stopped at a "medical expedition" in Wise, Va. People drove hours for free care from temporary clinics set up in animal stalls at the local fairground. Potter told me that weeks later, flying on a CIGNA corporate jet with the CEO: "I realized that someone's premiums were helping me to travel that way ... paying for my lunch on gold-trimmed china. I thought about those men and women I had seen in Wise County ... not having any idea [how] insurance executives lived." He decided he couldn't be an industry PR hack anymore.

Insurance executives and their Wall Street investors are addicted to massive profits and double-digit annual rate increases. To squeeze more profit, Potter says, if a person makes a major claim for coverage, the insurer will often scrutinize the person's original application, looking for any error that would allow it to cancel the policy. Likewise, if a small company's employees make too many claims, the insurer, Potter says, "very likely will jack up the rates so much that your employer has no alternative but to leave you and your co-workers without insurance."

This week, as the House and Senate introduce their health care bills, Potter warns, "One thing to remember is that the health insurance industry has been anticipating this debate on health care for many years ... they've been positioning themselves to get very close to influential members of Congress in both parties." Montana Sen. Max Baucus chairs the Senate Finance Committee, key for health care reform. Potter went on, "[T]he insurance industry, the pharmaceutical industry and others in health care have donated ... millions of dollars to his campaigns over the past few years. But aside from money, it's relationships that count ... the insurance industry has hired scores and scores of lobbyists, many of whom have worked for members of Congress, and some who are former members of Congress."

The insurance industry and other health care interests are lobbying hard against a government-sponsored, nonprofit, public health insurance option, and are spending, according to The Washington Post, up to $1.4 million per day to sway Congress and public opinion.

Don't be fooled. Profit-driven insurance claim denials actually kill people, and Wendell Potter knows where the bodies are buried. His whistle-blowing may be just what's needed to dump what's sick in our health care system.

Denis Moynihan contributed research to this column.