Health care reform: New ad, old tricks

By WENDELL POTTER

After watching Vermonters for Health Care Freedom’s new commercial, I was reminded of what my former colleagues in the health insurance industry and I used to do to influence public opinion, often using deceptive tactics. I was also reminded of why I left my job as an industry executive and began speaking out about how the use of those tactics helped perpetuate a system that fails more and more Americans, including Vermonters, every year.

The 30-second commercial is a classic example of misdirection, a form of deception frequently used in political advertising (and by magicians) to get people to focus on one thing in order to distract them from something else, to worry about some imagined future rather than the reality of today.

The point of the commercial is to make viewers believe that under a single-payer system, health care decisions would no longer be made by patients and their doctors but by “unaccountable” government bureaucrats.

The misdirection here is that the ad’s sponsor wants us to forget that under our current system, “unaccountable bureaucrats” already exercise the kind of control Vermonters for Health Care Freedom wants us to fear. But the “unaccountable bureaucrats” don’t work for the government. They work for private insurance companies—both the nonprofits like Blue Cross and Blue Shield and the for-profits, like Cigna, where I used to work. And it is those bureaucrats who have the ultimate power to limit—and in many cases deny—access to often life-saving care recommended by a doctor.

Nataline Sarkisyan might still be alive today had a medical director colleague of mine—who was just as much of a corporate bureaucrat as I was—decided to approve, rather than deny, a liver transplant her doctors believed would save her life.

This medical director had never laid eyes on the 17-year-old girl, but, just like me, he was expected to do his part to ensure that the company met its financial goals. It was only after Nataline’s family was able to generate publicity about her plight that Cigna agreed to pay for the transplant. But so much time had passed since her doctor had first requested coverage that Nataline became gravely ill. She died a few hours after Cigna reversed the denial.

The only thing that made Nataline’s case unique was the media attention it attracted. Every year, medical directors at both nonprofit and for-profit insurers issue thousands of denials—which for all but the wealthiest of patients are often the equivalent of a death sentence—but most of those denials never attract media attention. And consequently we simply don’t think of the people who make those life-and-death decisions as “unaccountable bureaucrats” because they work for a big company instead of the government.

Vermonters for Health Care Freedom’s executive director said the commercial uses humor to illustrate his concern about single payer reforms. There is nothing funny about either the misdirection of the commercial or the horror many patients in Vermont and elsewhere face every day when an insurance company bureaucrat decides whether doctor-ordered care is appropriate.

Wendell Potter, who wrote this guest blog, consults with Public Assets Institute on health care issues. He was formerly head of national corporate communications and chief corporate spokesperson for Cigna. Prior to joining Cigna, Potter headed communications at Humana Inc., another large for-profit health insurer. He lives in Philadelphia.