Local Warning: Corporate Rationing Purging the Sick

[FayeforCure]

July 2, 2009
Health insurance “insider” speaks out: "They Are Dropping the Sick"
Posted: 06:49 AM ET
Jim Acosta - Correspondent, CNN's American Morning
Filed under: Health

Wendell Potter is the former chief spokesman for health insurance giant Cigna.
By CNN’s Jim Acosta & Bonney Kapp

Last year, Wendell Potter stepped down from his post as the chief spokesman for the health insurance giant, Cigna. Potter tells CNN he is finished with defending an industry he calls “beholden to Wall Street.”

At a hearing last week before the Senate Commerce Committee, the former vice president of corporate communications at Cigna testified, “I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry.”

The committee’s chairman, West Virginia’s democratic Senator Jay Rockefeller told Potter, “you are better than Russell Crowe on ‘The Insider,’” referring to the award-winning 1999 film about cigarette company executive Jeffrey Wigand who blew the lid on the tobacco industry’s practices.

In his testimony and in an interview with CNN, Potter described how underwriters at his former company would drive small businesses with expensive insurance claims to dump their Cigna policies. Industry executives refer to the practice as “purging,” Potter said.

“When that business comes up for renewal the underwriters jack the rates up so much the employer has no choice but to drop insurance,” Potter said.

CNN obtained a transcript of a 2008 Cigna conference call with investors in which company executives use the term “purge.”

But in an email to CNN, Cigna spokesman Chris Curran denied the company engages in “purging.”


“We do not practice that. We will offer rates that are reflective of the competitive group health insurance market. We always encourage our clients to compare our proposed rates to those available from other carriers,” Curran said.

Potter started thinking about leaving Cigna in 2007 after he visited a medical charity event held at a Virginia fairground.

“It was almost like an electrical jolt,” Potter said.

At the event, Potter took pictures of doctors offering free health care to the uninsured.

“The volunteer doctors were seeing patients in barns, people in animal stalls,” Potter said. “It changed it for me.”

He says he finally decided to quit after Cigna’s controversial handling of an insurance claim made by the family of California teenager, Nataline Sarkysian.

In 2007, the Sarkysian family made repeated public appeals at news conferences for Cigna to approve a liver transplant for the 17-year-old, who was suffering from leukemia. Cigna initially declined to cover the treatment, then reversed its decision.

Sarkysian died shortly after the company’s reversal.

As Cigna’s spokesman during the controversy, Potter had no role in the decision to deny coverage. But he was inundated with angry phone calls from the public.

“After she died my voice mail and my email inbox were just filled with messages from people who were just outraged, ” Potter said.

Now a senior fellow on health care for the public watchdog group, “Center for Media and Democracy,” Potter is speaking out on efforts to reform his former industry.

He supports legislation that would give Americans the option of joining a government health care plan.

Potter is also taking aim at some of the TV commercials aired by groups opposed to reform.

One such ad caught Potter’s eye. Run by the conservative organization, Patients United Now, the ad claims “now Washington wants to bring Canadian-style health care to the U.S.”

“Sometimes you’ll see misleading information. And sometimes you’ll see outright lies, like that (ad) is,” Potter said referring to the spot.

Patients United Now spokeswoman Amy Menefee disagrees.

“We’re not saying there’s a Canada health care act of 2009,” Menefee said. “It is a trend. It’s trending in that direction.”

Potter notes that the leading proposals for health care in Congress do not seek to set up Canadian-style health care in the U.S. He says claims that reform would lead to “rationing” of care are missing his point.

“What we have is rationing by corporate executives who are beholden to Wall Street. And it happens all the time,” Potter said.

http://amfix.blogs.cnn.com/2009/07/02/health-insurance-%e2%80%9cinsider%e2%80%9d-speaks-out/#more-4196

[BridgeTroll]

This is an example of a reform that I would be receptive to.  It should be fairly simple to tighten the rules to stop this behaivior... and it would not cost taxpayers billions.

[BridgeTroll]

Prosecution for what??  Did someone break the law?  If anyone should be prosecuted it is congress for creating the laws and guidelines that govern the industry.  Your anger is misdirected.

[BridgeTroll]

If this is true I would surely like to see them prosecuted.  I do not think the article accused anyone of fraud nor suggested a prosecution for this offense.  Again... if these things are occuring shouldnt the government prosecute?  Again... if what you say is true then you should be angry with government as well.  If government is derelict in its duty in this case why would you be in favor of any government healthcare system.  If they cannot monitor and prosecute the evil insurance companies how can you expect them to monitor themselves??

[BridgeTroll]

Not sure about evil... would you settle for incompetent?

[second_pancake]

I think both of you are missing the point.  Before any blame can be placed, you have to look at the cause.  WHY are the healthcare companies resorting to these practices to save money??  Why are healthcare costs increasing at a rate that small-businesses and families unable to afford the premiums??  News for everyone, if healthcare companies continued this "purging" practice on everyone all the time, they would no longer be in business.  They wouldn't have any policy holders demanding payment of claims because there would be no claims.

The fact of the matter is, healthcare in our nation is suffering for a number of reasons, the main being CONSUMER fraud.  Yes, you read that right. 

The increase in premiums comes from inreased claims.  Increased claims come from increased 'need' or injury.  The increased 'need' comes from the consumer. The consumer claims funnelling in nowadays are mostly for PREVENTABLE illness...issues from smoking, and from obesity.  We have choices in the country.  We can make choices how we want to live our lives.  If we decide to live sedentary lives and eat junk all day, contract type 2 diabetes, obesity-related heart-disease, blot-clots, etc, then our insurance companies should be able to increase our premiums or deny claims altogether.  And IF our lovely government supported them in these decisions instead of mandating more payments, more healthcare coverage for less premium, and overall healthcare for everyone in our nation, those of us who truely NEED it (organ transplants, birth-related illness, etc.) would not have to suffer.

I have been an advocate for years in incenting healthy individuals with lower premiums and increased coverage.  If you are an active, healthy, non-smoker, ideal weight, regularly work-out, you eat-out less than twice a week, the I should not be paying increased premiums on account of the person who made the concious decision to destroy his or her life.

It's sad what happened in this article, but it's not surprising and personally, I can't place blame on Cigna.  They were only doing what they needed to do to stay a viable company.  If this were a mom-and-pop insurance company I doubt many people would be pointing fingers and calling them "evil."

[BridgeTroll]

Why do you give this group of people any standing at all in this problem?

Because most people are satisfied with their care.  Sure they want lower costs and and realize as I do that reform is needed.

But you seem unwilling to look at the empirical facts.

I look at them all the time.  When you use terms like "evil" it diminishes the "factual" discussion and turns it into an emotional one.  I prefer the factual...  How about you?

[BridgeTroll]

Yes... most polls show that up to 70% or so are.  As I and many have said before... the system needs reform, costs need to be lowered and we need a method for treating the 20 mil or so who do not have coverage.

[second_pancake]

most people are satisfied with their care?

Doesnt that kind of blow the whole 'government cant run health care' argument off the table?

Yes.  Most honest, hard-working, healthy, active individuals.  The exceptions are:  the healthy group that is dissastified with the cost (not the coverage, just cost which I proposed the solution to in my previous post), those with long-term illness, issues, non-lifestyle related (which again, I proposed a solution to), and the I-deserve-more-for-less-even-though-i-chose-my-condition, group. 

Drop coverage or significantly increase premiums and reduce coverage for that last group and you solve the problems for everyone else.

[hooplady]

but the largest health care provider in the country is already uncle sam, bridgetroll.

Why don't all those people above mentioned demand to use the private carriers?

Health CARE or health INSURANCE provider?  Let's not confuse the two.  Did you mean doctors, hospitals, etc.?

Anyhoo, a lot of those being served by the government are disenfranchised and can't push for much of anything, Stephen.  Besides, the government itself recognizes that private companies can often do it better - which is probably why Florida Medicaid has its clients enrolled in one of several private HMO's.

[JeffreyS]

The system has been as private as private can get for a long time.  Free market won't work here because not many people can shop the innsurance well enough to be the corporations at their own game of making as much money as possible.
The insurance companies make money now why would they want to reform. If the goal of these companies was to provide the best health care for the most affordable price they could do it.  The goal as it turns out is to make money. I am not saying that to vilify just to point out the truth.  Why would they want to cover the poor, sick and old if they are a for profit business.  I own a for profit business and I do not take accounts I view as less profitable than my current model.  If we just try to put more regulations on them they become less profitable and will look to cut costs or raise prices though whatever channels they can lobby for.  I know both conservative and liberal alike do not think health care should be tied to employment.  Think of it for moment for the insurers point of view healthy enough to work and can pay these are the only people they want.  Again I ask why would private insurers want to change? If just reform in the way of regulations come wouldn't they just pay lawyers to get around the regulations and lobbyists to have the regulations changed?  The conflict of interests is a fundamental problem here.

[Dog Walker]

"The system has been as private as private can get for a long time.  Free market won't work here....."

Sorry, Jeffery, we haven't had a free market medical care system since the AMA persuaded the states to limit the provision of health care to doctors in the '30's.  There has been a constant fight since for midwives, chiropractors, acupuncturists, etc. to be able to provide some kind of care ever since.  Like most "licensing" laws that are ostensibly passed for public safety, they are actually used to limit competition.  In a free market you could chose who to go to for healthcare.

Our healthcare system is an impenetrable morass of overlapping regulations that limit the number of doctors and hospital beds.  All of the attempts to "fix the problem" are simply to try to patch the problems caused by a distorted system.

Only the sheer increase in the population and medical needs has begun to change this system.  You now will see your doctor for only a minute or two, if at all, for routine care and instead will be examined by a nurse-practitioner or physicians assistant. But these people cannot practice on their own, only under the "supervision" of a physician which vastly increases the cost.

It's like the government requiring all of us to drive a Mercedes-Benz when we just need a Kia to get to and from work and then trying to come up with a scheme of cost sharing so that we all get a Mercedes.

[JeffreyS]

Dog walker I agree that the free market has been hampered by regulations.  Some regulations good some terrible. I just do not believe more regulations in the name of reform to save the private sector is the answer.  The private companies and employer based insurance have been given a fair amount of time to work under the "morass of overlapping regulations". I do not think they(the AMA or Private Insurance) want the system to change and why should they?

[johnsantangelo]

I don't get why everyone is so freaked out about government running healthcare. They just outsource it to privacy companies anyway, just like Medicare. You think the government runs the day to day administration of Medicare - provider enrollment, claims, etc? Nope, its 13 companies (mostly BCBS subsidiaries) across the country. The one for Florida, the US Virgin Islands, and Puerto Rico (Jurisdiction 9) is based here in Jacksonville.  Sure the government comes up with the rules, but the private companies carry out the majority of the work. Would a public healthcare plan really operate that much differently? I doubt it.

[jaxtrader]

Just when  I thought we were done with this socialist drivel it strikes again. Health care is not a right. Nothing that someone else must be compelled to provide you is a 'right'.