The day I believe in any religion is when God writes the book

...himself




ASC..

I don't necessarily think its about race as much as it is about

keeping people poor thus making one more subservient It is said

that one day the meek shall inherit the world and maybe we have no

further to look than the meek little mouse we have laying beneath

our hand for in knowledge lies power..ASC..

To me success is happiness,it doesn't have to be about money

it's just if you are truly happy deep down inside your soul.Some

people chase it all their lives and never find it. Yet it's right

there in front of them they just need to change their perspective

in order to see it...

rice..that cooks in minutes...

I hope I still have some coffee in the cupboard so I don't have to

run to the dang store.. <--- didn't have to run to the store

Personally I think until the people unite and decide to take back

what is rightfully theirs then the government will continue to be

owned by large corporations like the banks the oil companies and

the insurance companies. After all they are the ones lining the

pockets of politicians with campaign contributions (legalized

bribes) and

lobbying for laws that benefit their cause and profits. Until

people are willing to step out of the norm as they have known for

so long these companies will continue to milk the system for all

it is worth..to me education and leadership are both key

School curriculum needs to be revamped so that after twelve years

one comes out with more knowledge than what it takes to work at

McDonald's

As far as the housing market I have to say that what was done to

countless of people was one of the biggest scams since Bernie Madoff

and showed people that there are those who indeed are above the

law... This whole ripoff might have been orchestrated

because of

credit default swaps..of course this is my theory but the timing is

quite suspicious


I have often said that the government never freed the slaves they

just found a way to enslave us all...ASC...

If ya can't dazzle'em with brilliance then baffle them with

bullshyt..

The Year of the Cat.. Al Stewart

I have dreamt many a dreams from ending world hunger to ending

all wars to finding a more sustainable food source so that the

animals we feed on can live a life in peace rather than fear of

winding up on someone's dinner table.I have dreamt of meeting God

and having a one on one conversation with him so that I might be

able to enlighten the world,..but most of these dreams I fear will

never happen so I will settle for going to the Cannabis Cup

instead...

As long as she can make a mean ham sammich it's all good..

I know how ya feel cuz people with pictures are my pet peeve they

could be like wanting me to see them,so that I might be attracted

to them and like email them or something and then have to come up

with something to talk about so I get to know them and possibly

get into some kind of relationship and then talk to them all hours

of the night when I would rather be doing something else.

and to think

it never would of happened if she hadn't posted the picture of

herself..good grief...

throw them to the lions or have them beheaded... jk

I like all kinds of oriental foods..its because there is such an

array of different flavors ..

What better way to show their own hypocrisy.each one believing

theirs is the "right" religion and none knowing any better or any

more Yet all believing in a book written by man and we know about

man whether he wears the cloth..they all have their own agenda.

The day I believe in any book written about religion is when God

himself writes it...

Whoever said life was suppose to have a meaning...

If you have been in an accident and are injured it is even worse

than the VA and the government is culpable in allowing the

insurance companies to deny delay and defend the cases until the

victims go bankrupt or wind up homeless..

o.k like is no one curious as to how it got there..or is it just me..

Romeo and Juliet ..they died didn't they.. ..and the point

is what..love and die ..fk that I vote for having money and partying

...like a rock star..now of course unless your love has money and then ya both can

party like rock stars...

rather lengthy I know but very interesting in understanding the companies we pay our premiums to...a very interesting read








Wendell Potter (born July 16, 1951) is an American expert on, plus outspoken insider-turned-critic of, the U.S. private health insurance industry -- particularly HMOs, and the sometimes-hidden tactics insurers can use to increase their profits by creatively denying policyholders their healthcare benefits when needed the most. Potter is also an advocate for major reforms of the industry, and even single payer insurance, in some instances. Until his 2008 resignation, he was vice president of corporate communications for CIGNA,[1] one of the United States' largest health insurance companies. In June 2009, he testified against the HMO industry in the U.S. Senate as a whistleblower


















This is a transcript of an interview with Wendell Potter, a former Health Insurance Exec who has turned whistleblower. The week before this interview, he testified before congress. This interview was for the Rob Kall Bottom-Up Radio show, broadcasted Wednesday, July 1, 2009 to the Philly Metro area and South NJ on WNJC 1360 AM.
Thanks to my transcription team, Paula Sayles, Janet Loughrey, Janet Mills andLori Stefano
crossposted from OpEdNews.com


Rob Kall: This is Rob Kall, Bottom-Up Radio Show. I'm interviewing Wendell Potter, who last week testified before Congress about a duplicitous health insurance industry, who tells us shouldn't be trusted. Wendell, again, could you give us the name of the organization you're now with?

Wendell Potter: Yes, thank you. It's the Center for Media and Democracy, and I'm the senior fellow in health care at the Center for Media and Democracy.

Rob Kall: And is there a website for that?

Wendell Potter: There is, and I'm blogging there, so if you'd like to see and keep up with what I'm writing, go to prwatch.org. It's a great organization, and I'm certainly not the only one there by any means, of course, as you'll see. They do great work. One of their missions is to try to make sure people are aware...people like I used to be, how public relations professionals and firms manipulate public opinion.

Rob Kall: Ok, so that's Wendell Potter at the Center for Media and Democracy, prwatch.org, and you're listening to Rob Kall Bottom-Up Radio Show WNJC 1360. Welcome to the Rob Kall Bottom Up Radio Show.

Wendell Potter: Thank you very much for inviting me.

Rob Kall: Oh, it's a pleasure. I just finished reading your testimony that you gave in Congress on the twenty-fourth. Did they transcribe it or did you supply a statement that they published, or both?

Wendell Potter: It was both. I provided a written statement and I gave an oral version of that which was abbreviated. So I think that what you have seen may be one or both. It could be the longer version or the abbreviated oral version that I gave.

Rob Kall: Okay. Well, let's get started on this conversation. Can you tell me a little bit about yourself and your background?

Wendell Potter: I'll be glad to. I am a former journalist; that was my first career. I was a newspaper reporter in Tennessee and then in Washington for a few years and I covered Congress and the White House. But my longer career was in public relations and my most recent job was Head of Corporate Communications at Cigna, which is the large insurance company. I have been there for fifteen years and I was at another insurer, Humana, for four years before that. So, I've spent almost two decades in the health insurance industry.

Rob Kall: In the belly of the beast.

Wendell Potter: In the belly of the beast. And I left last year after deciding I just didn't want to do that anymore and I couldn't live with myself to continue doing that kind of work. Now I am a Senior Fellow on Healthcare for the Center for Media and Democracy.

Rob Kall: You had a message to give to Congress. What was the overall message that you wanted to leave them with?

Wendell Potter: As they are looking at and writing legislation to reform the healthcare system and determine the appropriate role for private insurers, I think it's very important to understand how the private insurance industry has behaved over the last several years and to know that they are not trustworthy partners for individuals, for businesses or for the government. They've got a long track record to show that they're untrustworthy.

Rob Kall: So, are you suggesting that when they say that they're going to try to change their ways as part of Obama's plan to fix the healthcare system, we shouldn't expect a good faith effort from them?

Wendell Potter: No. No, you should not expect that. And if you look at what they were saying and doing in 1993 and 1994, the last time we had a big debate on healthcare reform, they were saying absolutely, almost verbatim the same things that they're saying right now. So, while their trying to make us believe that they've changed and that they're saying some new things now, you can't believe that. You can look, in fact, at Congressional testimony from 1993 and 1994 and see that what I am saying is true. They will tell you what they think you want to hear and make promises they have no intention of keeping.

Rob Kall: Yet Obama is treating them with trust and respect. What advice would you give to Obama?

Wendell Potter: That he's abiding by the old adage of "Keep your friends close, keep your enemies closer." And I'm hoping that maybe that's what he's doing. That he realizes that these folks are not his friends. They're trading favor with him, and promising that they're coming to the table with solutions. I just hope that he realizes that they cannot be trusted and that the solutions that they have in mind would make matters worse, not make matters better for the American people.

Rob Kall: Now, you start off here in your testimony, talking about how what we have now, instead of a government-run system, is a Wall Street-run system. Could you go into that a little bit?

Wendell Potter: I will. The companies that I worked for grew very rapidly over the years that I worked for them. They both are for-profit health insurance companies. In the early '90's, most people who had insurance were enrolled in plans that were not for profit, but over the last fifteen years there's been a consolidation in the industry and now the industry is dominated by seven very large, for-profit health insurance companies. One out of every three Americans is now enrolled in some kind of a health plan managed by one of those seven health insurance companies.

Rob Kall: What are they?

Wendell Potter: Those companies are WellPoint, United, Aetna, Cigna, Humana, HealthNet and Coventry. Those are the seven largest. There are some that are smaller than that that have a fair number of enrollees, as well. But those seven are very big and they're all investor-owned and their first allegiance is to the shareholders who own them. And it's not just you and me. As someone who owns stock, we might own stock in these companies, but by and large, the largest shareholders for these companies are huge institutional investors and hedge funds--hedge fund managers. So, they're the ones who are calling the shots at these companies and, indirectly, how we get our insurance and what benefits we have available to us and how much the premiums cost.

Rob Kall: Now, you said they take up about thirty percent of the market?

Wendell Potter: They do. If you consider that we have about three hundred million or so many Americans, of those seven the total enrollment is about a hundred million. And some of those enrollees are in government-funded plans already--Medicare Advantage is the program that has been created over the last several years in which these companies offer Medicare care to senior citizens. And also, a lot of states have turned over their Medicaid programs to these companies. So a lot of people who are enrolled in the public programs like Medicaid are actually being managed by for-profit managed care companies.

Rob Kall: Interesting. I interviewed John Conyers a couple of months ago, talking about his single-payer [HR676] health plan, and he told me that it would be possible within a single-payer plan to have private insurers involved in the management and providing specific services. So, it's already happening.

Wendell Potter: It's already happening. Yeah, the for-profit companies are very entrenched into the government programs and have been for several years.

Rob Kall: Okay. But that leaves, if they say there are forty-seven million uninsured, that leaves a hundred and fifty some million more people who are insured, by, what? The Blues or what? What is the percentage that these "non-profit" insurers are covering?

Wendell Potter: Well, you have to ___________________ the population. A fair number of people are enrolled in Medicare and some Medicaid plans that are not managed by these companies. I don't know the exact number right off the top of my head, but you've got some senior citizens and some fair number who are enrolled in just straight Medicare and you get a lot of children who are now enrolled in the state children's health insurance plans. Several million children are enrolled in those plans. Again, some of those, however, are managed by for-profit managed care companies. But, your point is correct. Some of the BlueCross/BlueShield plans do cover the remainder.

But one thing you need to keep in mind is that a lot of the BlueCross/BlueShield plans are now for-profit. They're not the same kind of plans that they were several years ago, certainly not when I was growing up. One of the biggest companies that I mentioned a little while ago, WellPoint, has grown to be as big as it is, in fact it is the largest now in the Country in terms of enrollment with well over thirty million members. They have bought a lot of these BlueCross plans and have turned them into for-profit companies. So, it's a huge for-profit organization made up of BlueCross/BlueShield plans from coast-to-coast.

Rob Kall: How can you tell whether it's a BlueCross/BlueShield plan that's for-profit or not?

Wendell Potter: Well, it's hard to find out. You can probably find out something on their website as to whether they continue to have a non-profit status and who owns them. For example, BlueCross of California, one of the biggest in the Country is owned by WellPoint. So is BlueCross of Georgia.

Rob Kall: How about here in Pennsylvania?

Wendell Potter: Pennsylvania, I don't know. The two biggest ones in Pennsylvania are still non-profit. Or I think there are more than two; I think there are three--Independence, BlueCross and Highmark tried to merge and become a very huge company in Pennsylvania. That did not happen, it did not go through, which I think is a good thing because they would certainly have been much more of a monopoly than they are now. But they have not yet converted to a for-profit status.

Rob Kall: Yet, even these non-profits operate in many ways like for-profits, or they have for-profit elements or components or ways to make money and keep it aside. That's what I understand. Is that correct?

Wendell Potter: That is correct. Even if their main business entity has non-profit status legally, almost all of them operate some for-profit businesses that are separate from the other parts of the business. But, yeah, they have many for-profit components.

Rob Kall: And I understand that some of them have huge bank accounts with billions of dollars that they claim to be in case there's some kind of a catastrophic illness or something.

Wendell Potter: That's true. They call it a "surplus." The for-profit companies call it profit. So we're talking about a matter of semantics here, regardless of whether you're for-profit or non-profit, if you have billions of dollars over what you need to operate and to pay out in claims, that's a profit or a surplus, but we're talking about the same thing.

Rob Kall: And I understand, for example, Pennsylvania has somewhere around fifteen or eighteen billion dollars?

Wendell Potter: That's right. It's a huge amount of money and more than one would think that they would need to keep in reserve. And certainly more than they are legally required to keep.

Rob Kall: Okay. You talked in your testimony about a number of different problems with the health insurance industry. One of them is purging. What's that about?

Wendell Potter: Purging is something that the executives of the for-profit insurance companies talk to investors and the financial analysts who cover them, they talk to them fairly freely about this practice, but you'll certainly not see it in a press release or hear them talk about it very freely to newspaper reporters for that matter.

What that means, is that when a business customer of an insurance company...when the employees of that business file claims that are above what the insurance company's underwriters expected, then that will trigger a review, and very often and very likely when that business comes up for renewal, the underwriters will jack the premiums up so much, so high, that the business has no alternative but to drop the insurance for their employees. And it can sometimes take just one claim from one employee for this to happen.

Rob Kall: So, if one employee needs surgery or some ongoing chronic care that's going to get expensive, it could affect all of the employees for that business? Or do they force that business to drop that employee? Or, what?

Wendell Potter: No, everybody who's employed is affected, not just the person who is sick. Yeah...it could be any one of us who might come down with an illness or be in an accident that would require continuing care or some expensive care, and that's what they do, they drop people and they purge accounts when people get sick and need the insurance most.

Rob Kall: Now, the other thing that you describe is a little different than purging. You described how the insurance companies will accept premiums from people for a long time, whether from a company or an individual, and then if they start to get expensive, they'll look for an excuse to dump the insured and reject the claims.

Wendell Potter: That's right, and the term for that is "rescission." And what they do, and this is primarily in what's referred to in the individual market, when people buy their insurance outside of their employer...if they get sick, if they get injured and file a claim, then the insurer will take a real close look at the application that the person filed to see if there might be some possibility that some previous illness wasn't disclosed. And often people don't even know they have a pre-existing condition, which is what this is called; sometimes it could be something in a doctor's note and the doctor might not have mentioned it, or he might have forgotten. Someone who's my age, I'm in my 50's; I can't remember everything I went to the doctor for many years ago. So many people just simply forget or inadvertently leave out information.

Rob Kall: That could...destroy a person.

Wendell Potter: Oh, absolutely. And it does. Many, many, many times, you may have seen a statistic that well over half of the bankruptcies in this country are related in one way or another to high medical debt. And when you incur medical debt, or have a lot of extensive care, and you expect the insurance company to cover it because you've made a good faith effort, you've paid your premiums on time, sometimes for years and years and years, and when you need it most, they'll kick you out because they don't want to have sick people on the rolls.

Rob Kall: So, would you say then that it's part of the business model of the health insurance industry to do a sloppy job of accepting insurance money from people for years even...if there's a problem, they can get out of their expected responsibility to cover an illness, because they didn't do their job in the beginning of informing the patient that there was a question or a problem with the way they registered with them.

Wendell Potter: Oh, that's exactly right, it's done retroactively, and it happens many, many times. And it's done consciously, as some of the insurers were even paying bonuses to employees to scour applications and find things that would enable them to deny a policy.

Rob Kall: Would they use that information immediately, or would they save it and wait until the patient got sick?

Wendell Potter: Usually, it would be when a person got sick, and more than likely, they would continue to let you pay your premiums. Most people, remember, don't use their insurance all that much. Fortunately, most people are healthy and don't get in accidents, so you keep paying the premiums hoping the insurance will be there if you need it. So that's typically what happens, is after you do need it and you file a claim, that you're often subjecting yourself to the possibility of being purged, or not purged in this case, but your policy being rescinded and you would be left with the responsibility of paying all of your medical costs.

Rob Kall: Rescinded...?

Wendell Potter: Rescinded...

Rob Kall: The faith that you had insurance, that your life would go on smoothly because you were insured, has been rescinded.

Wendell Potter: Correct.

Rob Kall: Now, you also testified that there's a lot of secrecy and a lack of transparency, intentional, with these insurance companies. Could you talk about that a bit?

Wendell Potter: Well, that's true. The first priority, as I said earlier, is to make a profit and to extend as much money as possible to shareholders. Developing materials that are clear and understandable is not a priority. In fact, it often benefits an insurance company if they can obscure the terms of the policy and either mislead or just not even tell people what the coverage limits are on certain policies, for example. And often, when you do get some coverage information from an insurance company, it's so hard to understand.

Like I said, I was in the insurance industry for twenty years, and I have a pretty good education and a lot of understanding of how the insurance companies operate, and was actually the head of corporate communications. I myself had a heck of a time understanding something called the "Explanation of Benefits" statement that they'll send you when you get care and to explain, try to explain how much they paid and how much is your responsibility to pay. It's very, very...very confusing, very complex.

Rob Kall: They make it something you don't want to look at, and...I run a small business, and we have health insurance. And so I get these documents, the "Explanation of Benefits." I'm not sure if it's every subscriber or every person who's insured that gets them, or if it just comes to the head of the company. How does that work?

Wendell Potter: Well, it usually goes to the individual policyholder. For example, if you are the head of the household, you probably would get it mailed to you, but if some member of your family had gotten care, you would get the information about your family member. But you're right, it's very hard to understand, and I think most people when they see these, and from the point of view when I thought about it, was so baffling, you just file them away, or throw them away.

Rob Kall: When I see them, I usually see really obscure treatments and illnesses on the front page. I think, "That doesn't apply to me," and I kind of flip through, and there's a lot of gobbledy-**** and boiler-plate legalese, and I'm guessing that maybe if there's anything important, they embed it somewhere in the middle so you don't even notice it.

Wendell Potter: Well, that's true; there are a lot of codes on these things. And you're right; it's kind of a mix of medical jargon and codes and legalese, and just plain bad writing. It's almost impossible to figure those things out.

Rob Kall: So I can think of two simple rules that Congress could pass regardless of the kind of insurance they have. One, insurance companies should have thirty or sixty or ninety days, or something like that, to reject somebody because they didn't provide all of their information. And then they can't reject them later on after they've taken all their money when they've been healthy. That ought to be a simple thing that could be passed, that would protect a lot of people. And the other is, that notification should be in plain, simple English, and issues related to the patient should be up front, in the beginning. I know enough about databases, so that's an easy thing to do.

Wendell Potter: It's an easy thing to do, and certainly something that the industry could afford. These big for-profits make billions of dollars in profits a year, and you know, they could spend a few million dollars on trying to make their communications clearer, without missing it.

Rob Kall: Well, let's be clear; the non-profits make billions in profits, too. They just label it differently; it's framing.

Wendell Potter: Rob, you're correct, and a very good point that you make.

Rob Kall: Ok, so we talked about the secrecy. But there's also a kind of a problem in transparency as well, and dealing with the companies that they provide the insurance to. That's another issue as well, isn't it?

You talked about how they don't...they resist or refuse to provide information on what it's actually costing them to provide the insurance. You mentioned in one case, a company was paying an amount and it only cost the insurance company twenty percent of that for the year to insure. Yet they raised their rate twenty-two percent, I think.

Wendell Potter: Exactly. And there's some irony there. (In) that particular case...the employer was the Harris County, Texas Medical Society and Harris County is (in) the Houston area. And it took a state law...Texas finally passed a state law that made insurance companies provide the information that would tell employers how much of their premium dollars was actually being paid out in claims. And they found out that, even though their insurance company was demanding that their rates increase 20 percent for the next year, they had only paid out 9 percent - 9 percent - of the premium dollars the year before for medical claims. So, in other words -

Rob Kall: Is there any regulation of these nonprofits or for-profits? Or is there any kind of a guideline on what percentage paid out should be - how they should base how much the rates are or the increases or what have you?

Wendell Potter: No. There really isn't. You know...there are...regulations on the books but not one that particularly addresses that in the way that I think it should. In California, for example, last year, when there was an effort to try to reform the system at the state level in California, one of the things that was advocated, even by the governor and a lot of state legislators, was setting - or requiring that insurers pay at least 85 percent of every premium dollar for medical care - or to pay claims. The legislation ultimately failed for a variety of reasons but mainly politics. But almost no state has been able to pass a bill like that because the insurance lobbies are so powerful at the federal and state levels.

Rob Kall: Well, we're going to talk about this, insurance lobbies, in a couple minutes.

Is there anything that so far we've talked about that you want to kind of wrap up a bit in terms of where we need to be going and heading with health insurance for Pennsylvanians, for Philadelphia, in terms of our legislators or for our senators?

Wendell Potter: Yeah. I think...there's a - it's before the Pennsylvania legislature; it's certainly before Congress. I think people need to get themselves as informed as they can and be active and write or call their state representatives or senators and members of Congress. This is vitally important. Health care can be complex. But there are a few things that I think are very important.

At the federal level, President Obama, when he was a candidate, campaigned on - a part of his platform was creating a public insurance option that would be available for people to enroll in as an alternative to a private plan. And the health insurance industry is adamantly opposed to that. They're trying to kill it. It's very important legislation that needs to be passed. And the President needs to hold firm on that, and he needs support.

Rob Kall: Okay. So what we need to do...is...to contact (our) state legislator in the state Senate and the state House, (our) member of Congress in Washington, and (our) two state - two U.S. Senators. And you tell them that you want the public option.

Now, I think we should be going all the way and going for single payer health care like all the other major nations in the world have. That's the only civilized thing to do. And anything less than that is shameful. And it allows for and will continue to allow for people to be uninsured and people to go bankrupt.

Now, another thing that you mentioned, when you spoke to Congress last week, was the increase in the uninsured.

Wendell Potter: Correct.

Rob Kall: Can you talk about that.

Wendell Potter: I made the point that one reason why the uninsured - the number of uninsured has been going up is a direct - there's a direct correlation to the behavior of private insurance companies when they are rescinding policies and kicking people off their - or, you know, making their policies no longer valid. Those people can rarely get coverage anywhere else. So they join the ranks of the uninsured. And the employees of the companies that are purged often are winding up there as well. So I wanted to make sure that the members of Congress understood that it is - many of the people who are uninsured are working people that cannot afford to get insurance. And, you know, they'd love to have coverage. But they can't afford it.

Rob Kall: You mentioned, in your testimony, that some families were given short notice that their rates went up to $44,000 a year?

Wendell Potter: Exactly right. That happened a few years ago. It was a CIGNA group insurance plan. It was - there were people who had families - they were in two states, California and New Jersey, primarily. And CIGNA reviewed the business and decided that it needed to increase the premiums dramatically. And as a consequence, some members - some employees would have to pay $44,000 a year for their premiums. And that was much more than a lot of them made in a year.

Rob Kall: And how many employees were affected by this particular decision? Do you know?

Wendell Potter: There were a few hundred. I don't recall now the exact number. But, again, there were people in California and New Jersey and, I think, maybe some other states. But those states in particular were affected.

Rob Kall: So, in other words, one or two individuals in this plan might have a problem, some kind of a heart problem or cancer or something like that that could cost hundreds of thousands or even millions of dollars, or maybe a head injury, something like that, or a spinal cord injury that gets very expensive -

Wendell Potter: Yeah.

Rob Kall: -- and the company could basically, to protect itself from the expense, just cut off all the people?

Wendell Potter: Yeah. In this case, what they did - they said that - I think they sent the company or this organization a letter that was the group, saying that they were going to increase -

Rob Kall: You mentioned the group, didn't you? Didn't you, in your testimony -

Wendell Potter: Yeah.

Rob Kall: -- mention the group?

Wendell Potter: Yeah. It's an entertainment group. It's kind of like an association in which people who are in one way or another involved in the entertainment industry - they were getting their insurance through this group. And the - what happened is they were given three months to either agree to pay the additional amount or get - you know, say goodbye. And good luck to you finding insurance anywhere else.

Rob Kall: And what happened?

Wendell Potter: Well, they - you know, if you were facing premiums of $44,000 a year, that's not an option for most people. So they - you know, the group had no - no alternative but to try to find coverage somewhere else. I assume they got some kind of policy somewhere. But I don't know exactly what their insurance coverage looks like now. But I can guarantee you that it would be probably something with very limited benefits.

Rob Kall: And so one or two people being ill, out of hundreds, could affect the insurance coverage of a whole workforce?

Wendell Potter: It could. And this points up a big problem that has developed with the way that we have our insurance structured in this - in this country. The insurers try to cherry-pick the healthiest people to cover. That's what they want, which means that people who are sick and needing it, needing coverage, are often the ones who are excluded from getting it and can't afford it or kicked out. It makes no sense in the world. But it's the way our system operates.

Rob Kall: Has there been any effort to establish anti-cherry-picking laws, so to speak?

Wendell Potter: Well, going back to something you said at the top of the show, health insurers have said and were saying back in 1993 that, "Oh, yeah, we - we agree that cherry-picking and not covering people because of preexisting conditions is wrong. But we'll change. We won't do that anymore." So that was something they promised then. They never fulfilled that. And it was never anything that they intended to make good on. And they're saying the same things now.

When you have a debate on health care reform, it's something that has some energy behind it for a while. And something will either pass or fail. And then Congress or the state legislature will move on to something else. And it usually takes years and years before the problem becomes so critical once again that there's another big effort for reform.

Rob Kall: You know, in my conversation with John Conyers, I learned that it was not really just one bill that he had, HR676, there were five bills that would have to be passed to cover all the different issues involving health care. It would seem to me that some of these horribly inappropriate policies, like the cherry-picking, or the rescission, where insurance companies go back and review application information years later after they take in all the money while the people have been healthy, seems like those are simple things that are so obvious that I cannot imagine any member of congress arguing against; why can't they just do that first? Is it that the lobbyists are so strong that they cannot even move against such unfair practices?

Wendell Potter: Yes, it is the strength of the lobbyists, and members of congress, who are so influenced by the lobbyists of special interests, just turn a blind eye to what needs to be done. They get big campaign contributions from these companies, and often the lobbyists themselves make significant contributions. A lot of the lobbyists are former members of the house or the senate, or staff members, who have developed good relationships with current members, so the insurance industry looks for people who are ideologically aligned with their political and ideological points of view; you have money, that makes a big difference, and you have people who are also being able to make persuasive arguments just because of relationships they have developed over the years.

Rob Kall: Are there certain members of congress who have reputations among the insurers as being the most helpful, the most in bed with them?

Wendell Potter: There are; I will not necessarily name names right now, but there are many; and I would not think it would be an overstatement to say that many of them are shills for the industry.

Rob Kall: Why won't you name names?

Wendell Potter: Maybe I will do that as time goes by, in my blog, because I think it is important for people to be aware and right now I am not at my desk and I don't have a list of members of congress who have received a lot of contributions; but one in particular I think that you need to be mindful of is Senator Max Baucus, who is chairman of the senate finance committee. He has received more contributions from the insurance industry and from the pharmaceutical companies, from the health industry combined, than any other member of congress.

Rob Kall: Is this a guy, Baucus, who they talk about? Behind the corporate doors, or the "non profit" doors of the Blues, do they talk about any of these guys, with a "hey, we've got him covering us" or anything like that? Have you ever heard any conversations along those lines?

Wendell Potter: Well typically yes; I mean, the health insurance industry knows which members of congress it can count on and keeps a list of those, and they know which members of congress are never going to see eye-to-eye with them, so what you typically have when you have a debate like this, they have the votes that they can almost always count on, and there are some members who have not really declared, or who might be persuaded one way or the other, so those are the ones they really go after to try to really pressure into seeing things from their point of view. That is the way things are done in Washington.

Rob Kall: So you are talking about the ones that are not completely bought yet?

Wendell Potter: That's right.

Rob Kall: So when they have these conversations, are there any words to describe them, or characterize them, that are used within the doors of the health insurance industry?

Wendell Potter: It is just known that there are people that can be counted on; and one of the things, too, to keep in mind that the insurers have done a lot of, and it is not just insurers who have done this, but they will put ads on in the districts where they are from to pressure them, and they will bring pressure in a grass roots way on the members of congress. They will threaten them with giving contributions to competitors and things like that, so there is a lot that they can do to pressure and persuade lawmakers to do the things they want them to do.

Rob Kall: So, I kind of get the feeling there are some words they use that you are not willing to say, or...?

Wendell Potter: You know, you don't really need to vet any of this; it is just an understanding of which members of congress you can pretty much count on; you can look at their voting records. In fact, when a company's political action committee makes a decision on where to send money, you look at their voting record to determine what they have done, how much they have supported you in the past, and how important they are to you in the future, and that is where you make you contribution.

Rob Kall: So, basically, if we see (using different websites), ...(such as) LittleSis (http://littlesis.org/), is a new site funded by the Sunlight Foundation (http://sunlightfoundation.com/) LittleSis.org, that lists the influential people, the contributors, the board of directors and what-have-you, so you can see the nexus of connections between them and the members of congress.

Wendell Potter: Yes, and I will close with this; that is a very important point. There are a lot of intricate relationships and connections that really make a difference. It is not just when you can try to trace the money but that is just one part of it; there are a lot of other ways that influence is peddled in Washington and elsewhere.

Rob Kall: You mentioned deceptive marketing and fake insurance in your testimony; would you talk a little bit about that?

Wendell Potter: The insurance companies, particularly now, are marketing limited benefit plans and another one is the high deductible plan. They are not very forthcoming on what your obligation is in terms of how much your out-of-pocket expenses might be if you get ill or injured, or what might not be covered. They spend a lot of money on glossy brochures about the coverage but not very much of any words are wasted on what actually is covered and what will happen if you really need care, and that is by design. They want to attract you into the plan, particularly they will try to segment the population to target those who are healthy, but spend very little in terms of words to language to tell you what the limitations are and what you are actually getting yourself into.

Rob Kall: We are not just talking about small operations. The biggest insurance companies do this, don't they?

Wendell Potter: Well they do. And I think that is a surprise. I was talking to the New York Times reporter, who expressed the same surprise. You might think that these are obscure insurance companies that are fly-by-nights; but no, they are the very biggest in the country that are doing this...

Rob Kall: The biggest in the country are doing deceptive marketing and offering fake insurance?

Wendell Potter: Oh yes! Fake insurance, as I call it, or very inadequate insurance; these very, very limited policies that often have no hospital coverage, for example, have very low caps on how much they will pay out totally, do not cover a lot of things. Yes, the very biggest companies in this country are doing that and that is their vision for this country; that is what they know, they can make money on this, and when they say they want to maintain flexibility in designing their benefit plans, this is what they have in mind for us. It is a real hellish scenario that they have in mind for us.

Rob Kall: There is an article in the New York Times about that, either today or yesterday, where a man who had insurance thought he was covered. He went in and he found out that the hospital insurance only covered the BED, it did not cover the medicine, did not cover the diagnostics or treatments, or the tests. He ended up owing hundreds of thousands of dollars and having to go bankrupt. He said he had insurance.

Wendell Potter: And that is a good example, a very good example, of what happens to people, and that was a plan that was offered through Aetna, which is the third largest insurer in the country.

Rob Kall: I wanted to talk a little bit about single-payer health care. What are your impressions about it?

Wendell Potter: I think a single payer appears (to be) the kind of plan that the Canadians have; and the Canadians, by the way, are very happy with their plan, and the Conyers bill that you mentioned, HR676, would establish a single payer plan. The insurance companies are certainly opposed to that because it would essentially put them out of business as they currently offer policies now. But, the other countries around the world who have coverage like this, the citizens are very happy with it.

Rob Kall: That is my thinking. You know, I think you have spoken with Chuck Pennacchio, who was spearheading an effort to get single payer at the state level in Pennsylvania, have you?

Wendell Potter: Yes. I know Chuck. I have talked with him.

Rob Kall: Yes, he mentioned to me the other day. Pennacchio is working on - Health Care 4 All PA (http://www.healthcare4allpa.org/) is the name of their organization, and they are trying to get the state to pass it; and California has made efforts to pass it, which Schwarzenegger blocked, right?

Wendell Potter: Yes. He did. In fact, the California legislature has passed a single-payer bill a couple of times and it has been vetoed by the governor.

Well, I am going to have to go because I need to go on to my next appointment; but I have really enjoyed this, it has been a terrific conversation.

Follow Rob Kall on Twitter: www.twitter.com/robkall

..or maybe it just has all to do with controlling one's emotions and

putting them in check when they are faced with adversity..rather

than looking for someone to blame..