By Wendell Potter for the Nation

Health insurance executives breathed a sigh of relief when the Supreme Court upheld their favorite part of the Affordable Care Act (the part that is one of the least popular among the rest of us)—the individual mandate. And then, I’m confident, moments after they exhaled, they were on a conference call with their army of lobbyists and PR people to approve a strategy, developed months ago, to gut the provisions that the rest of us do like. These are the parts of the law that require insurers to provide coverage to millions they have long shunned like lepers, and that make the most egregious but profitable industry practices a thing of the past, like canceling our policies when we get sick.

Part of their strategy will be a propaganda campaign to persuade us that the consumer protections in the law are not in our best interest. “The new health care reform law includes a number of provisions that will increase the cost of health care coverage,” warned America’s Health Insurance Plans (AHIP), the industry’s largest PR and lobbying group, after the ruling. The provisions in question are the ones that help finance the expansion of coverage, make premiums more affordable for older Americans and outlaw benefit plans that provide inadequate coverage. AHIP’s real concern, of course, is that such measures will negatively impact insurers’ profit margins.

The strategy will also encourage the industry’s political and media allies to keep referring to “Obamacare” as a “government takeover” of healthcare. This fabrication has been widely accepted as truth—one reason the Affordable Care Act polls so poorly.

Finally, the strategy will seek to exploit the hostility many on the left feel toward the ACA—and the deep divisions among progressives over whether it really is a step in the right direction. Insurance executives are counting on single-payer progressives to stay so disillusioned with the law and those responsible for it that they will boycott the November election, helping the industry’s Republican friends to take back Washington.

I’m sure that conference call took place because I was a regular participant in many like it while serving as head of communications for Humana and, later, Cigna, two of the country’s largest insurers. Right up until the day I walked out the door in 2008, I was working with my peers at other companies on such a strategy to influence public opinion. One of the reasons I quit—and became a vocal critic of the industry I served for two decades—was that I didn’t have the stomach to be a part of yet another deception-based effort to undermine reform. During my career I helped implement the industry’s game plan to defeat the Clinton reform proposal. A few years later I helped lead a behind-the-scenes fearmongering campaign, fronted by the National Federation of Independent Business but planned and financed by the insurance industry, to make sure Congress never passed a Patient’s Bill of Rights. Congress never did (although the Affordable Care Act does contain some of those “rights”).

One of the things that differentiates insurance company executives from many healthcare reform advocates, I’ve learned, is that the former never approach any high-stakes political game without a well-planned strategy, one that seeks to take advantage of their opponents’ weaknesses and divisions. It’s true that without reform advocates, President Obama wouldn’t have had a bill to sign into law. But in other battles, we in the industry found that advocates could almost never seem to craft a well-planned strategy or sustainable coalition. One reason we don’t have universal coverage in the United States today is the failure of these same advocates to recognize the need for a strategy—and the need to compromise.

Senator Ted Kennedy, who fought so hard for universal coverage, learned a tough lesson on compromise when Richard Nixon was president. Worried that Kennedy and other liberal Democrats might be able to get enough votes in Congress to pass a single-payer bill, Nixon proposed an alternative plan that would have required employers to provide health insurance to their workers. It also would have had the government finance coverage for low-income Americans who didn’t have a job. Kennedy refused to negotiate seriously, thinking he could get his own reform plan enacted the next time a Democrat—maybe even himself—occupied the White House. He condemned Nixon’s plan as a windfall for insurance companies. (Sound familiar?)

Kennedy said years later that his refusal to bargain with Nixon was the biggest regret of his career. He had underestimated the ability of the insurance industry, the American Medical Association and other entrenched special interests to join forces and forge a strategy to ensure that, even after the Democrats took back the White House in 1976 and solidified their control of both houses of Congress, single-payer legislation would go nowhere. This experience was one of the reasons he supported reform legislation nearly forty years later that he knew would fall short of achieving universal coverage and that would be condemned by many die-hard single-payer supporters as, yes, a windfall for insurance companies.

Among today’s die-hards (many of whom are good friends)are members of Physicians for a National Health Program and Healthcare-NOW! They are still furious at the president and the Democrats for their baffling decision not to give single-payer legislation a decent hearing and for compromising too early and too often, in their view, with the special interests. Many are no longer on speaking terms with the staff of Health Care for America Now, the umbrella organization for unions and advocacy organizations, which didn’t join their calls to kill the bill when the public option was stripped out. They believed, as Kennedy did years earlier, that more could be gained by starting over. Many still do and could be seen alongside the Tea Partiers on the steps of the Supreme Court, demanding the entire law be struck down.

These divisions are playing right into the hands of my former colleagues. Progressives must bury the hatchet and get down to the business of developing a strategy to move forward. The two factions actually see eye-to-eye on many things, including the fact that the law does much good but does not get us close enough to universal coverage, and that Obama and Congressional Democrats made strategic and tactical blunders throughout the reform debate. Now they must recognize that their true opponents are the people I used to work for—not one another.

5 Comments

  1. leftover on July 13, 2012 at 12:48 pm

    It’s funny how “a strategy to move forward” always involves poor people doing the sacrificing.

    Like with the FARM Act…in order to “move forward” the strategy is to take food out of the mouths of hundreds of thousands and deny it altogether to millions…to institutionalize more corporate handouts. With pro-corporate, neoliberal health insurance reform, poor people must either pony up 15% of their increasingly meager income for grossly inadequate healthcare, or continue to go without, dying by the tens of thousands every year.

    Screw you Wendell Potter. I’m sick and tired of “progressives” like you putting me on the chopping block for some senseless political victory. The people of this country have been demanding true healthcare reform for 50 years. Obamacare and the “public option” bait-and-switch scam was the last straw. Incrementalism and neoliberal support of for-profit commercial healthcare must end.
    The solution has to be centered on saving lives, not political victories.
    The solution is right in front of our face.
    It’s fiscally responsible, financially sustainable, Constitutionally sound, morally agreeable and even pro-business.
    It’s Single Payer.
    You want to support a strategy to move forward? Support Single Payer or go back to work for the commercial industry.



  2. Stephen Malagodi on July 13, 2012 at 5:15 pm

    Well, except for the ‘screw-you Wendell Potter’ and the ‘go back to where you came from’ spittle, I pretty much agree with leftover.

    The reason that we wound up with this mess is not because of tactical blunders, or because Obama is evil, but rather because the Democratic Party as a whole is pro-industry, and will always favor a policy that promotes industry profits. That may be ok in some industries, but not in health care. Health care and industrial-scale profit are incompatible.

    In short, we can’t get where we need to be via this road. it just doesn’t go there. It’s a clusterfuck.

    Personally, I have no hatchet to bury, though there certainly is a lot of vitriol out there.

    But on this let the pro-industry Democrats understand; this is unacceptable and it won’t work. The party needs to move toward us on this one, but I fear that institutionally it simply can’t and doesn’t want to.

    And one last thing about the Kennedy issue. Kennedy may, or may not have been correct to regret his non-compromise with Nixon. But we are not dealing with Nixon, who would not survive a month in today’s Republican party. We are dealing with the likes of Rick Scott and Jeb Bush and captains of industry who are intent on harvesting every last Earthly resource for themselves before ushering in the apocalypse.

    No, Wendell, with all due respect and admiration. It is not us who wield the hatchets, used to purge the party of all with semi-socialist sympathies. Let those with the hatchets put them down.



  3. Harriette Seiler on July 14, 2012 at 5:36 pm

    Single payer advocates thank Wendell Potter for exposing the private insurance companies as greedy profiteers. I’m sure there are many Healthcare-NOW members who, like myself, applaud the good elements in the ACA, but who are incredibly distressed at the fact that the bill retains the unnecessary and costly insurers as players in the exchanges. And players they are! HUMANA is now bragging that their Medicare Advantage plans will add to their profit stream going forward. Medicare Advantage costs the taxpayer 14 percent more than traditional Medicare! WellPoint has purchased Amerigroup so that it can get it’s fingers into federal and state Medicaid money.
    Members of Physicians for a National Health Program (pnhp.org) see patient care rationed by insurers every day; they know the impact of insurers on a doctor’s worklife–the burden of higher office costs and loss of valuable time; they see the bureaucratic boondoggle being created by the ACA’s multi-payer structure and dependence on the private health care industry.

    I recall the formation of HCAN–a coalition of groups–many of whom eagerly jumped on the health care reform bandwagon before they realized they had fallen prey to the incrementalists, even the corporatists. They had a big grant from Atlantic Philanthropies. I need to explore the rumor that certain organizations were promised money to join. Many groups who signed on had endorsed single payer. Here’s a statement from the AFL-CIO web site linked to the HCAN site: “Of course, the most cost-effective and equitable way to provide quality health care is through the social insurance model (“Medicare for All”), as other industrialized countries have shown.”

    In the days leading up to passage of the ACA, there were HCAN entities that made single payer proponents feel very unwelcome at meetings. As a result, Wendell is right–I can hardly be civil to those who touted “choice” and “American values,” but who thought it was OK to cave in to Baucus and the insurers. HCAN’s own evaluation recognizes they were co-opted: “In retrospect, there is general agreement that following the lead of the White House and not pressuring the Senate Finance Committee during its deliberations was a mistake” (Executive summary, p. 9)

    In contrast, Healthcare-NOW is a grassroots organization that depends on small donations from its members. They continue to advocate for single payer because they know the ACA–despite certain good points will not give us universal coverage , will not control costs–will prove to be overly complex and unsustainable.

    I’m not calling for repeal. Keep what’s good, but “watchdog” implementation and call out every dodge and weave by the insurers and MCOs. We must insist that the legislation be improved before we get so enmeshed in the insurers’ web–we’ll never get out.

    There’s a reason all those other advanced nations have implemented some version of single payer. It save lives and tax dollars.



    • KenS on July 17, 2012 at 7:34 pm

      Harriette – The part I lked best was “Healthcare-NOW is a grassroots organization”; I’m embracing a grassroots strategy: Healthcare is a Human Right.



  4. D. Leo Mosbrucker on July 17, 2012 at 2:40 pm

    So Mr. Potter, both sides now agree that the law “does not get us close enough to universal coverage, and that Obama and Congressional Democrats made strategic and tactical blunders throughout the reform debate.”

    That sounds to me like the “die hards” were right and the compromisers were wrong. I’m sure that all these hatchet-wielding die-hards would be more than happy to speak to any HCANer who is willing to join in the work “of developing a strategy to move forward” – forward to Medicare for all, which both sides have always agreed is the best solution. Who are these grudge-bearers you speak of, and how many are there? Why do you frame the issue as one where those who were smarter and more principled are somehow the problem?

    I wanted to kill the bill because I saw in it the further entrenchment of the leeches who are the problem. If nothing at all had passed, the issue would have had to have been revisited within a few years – the situation is too grave for it to have gone on any longer. Now we’re going to have to wait another ten years at least before people see what a mess this thing really is. That is, unless the average folk can mount an effective campaign to displace the moneyed interests (greedy people) who are responsible for the thousands of unnecessary deaths, thousands of unnecessary bankruptcies, millions of dollars in unnecessary paperwork, and immeasurable suffering this system propogates.