THIS TIME ON CODE WACK!
Why have healthcare giants like United Health and Cigna been purging some of their commercial accounts and pivoting to government-funded programs like Medicare Advantage and Medicaid? How is this affecting patients? And what is the government doing about it?
To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He’s also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.
SHOW NOTES
WE DISCUSS
Talk to us about how companies like United Healthcare and Cigna are evolving their business model.
“…they’ve been running off a lot of their commercial accounts and they purge a lot of the customers … and that encompasses employers and individuals.
“What these companies have realized in recent years is that there’s a lot more money to be made from the public programs like Medicare and Medicaid. So that’s why we’ve seen this rapid growth of Medicare Advantage.
“[They] advertise aggressively to lure people into their Medicare Advantage plans, because Uncle Sam pays them quite generously, and they’ve been able to figure out how to rig the system to get more money by claiming that the people that enroll in their plans are sicker than they really are.” – Wendell Potter
So there’s no way to oversee their business practices? Why isn’t the government onto this?
“… these companies are incredibly powerful. They push back against any kind of deregulation or oversight…
“You’ve got a situation that’s referred to as regulatory capture … industries are able to influence regulators and bureaucracies like the Center for Medicare and Medicaid Services…
“… big companies have realized that you don’t limit your lobbying to Congress, you also have to influence the regulatory bodies. And in many cases, you’ve got this revolving door in which people who work in the industry take jobs at CMS, for example, or all the regulatory agencies in Washington.” – Wendell Potter
What do you think it’s going to take to stop the insurance companies from getting away with rigging the system for profit?
“An act of Congress, to be honest with you, and there is interest and I’ve talked to members of Congress on a regular basis … and I’ve written op-eds with members of Congress about this.
“… California Congressman Ro Khanna has been very much involved and aware of this. I wrote an Op-Ed with him and Congressman Mark Pocan of Wisconsin … about Medicare Advantage, and they have a bill that would prohibit big insurance companies from even using the name Medicare. I wish that would happen but the industry has so many friends in Congress, that that’s not a bill that’s really gonna go anywhere.” – Wendell Potter
Helpful Links
Health Care, un-covered, Wendell Potter’s Substack
Humana to leave commercial insurance in favor of government programs, Health Exec
In a shifting market, it is “advantage” Medicare for health plans, Deloitte Insights
Feds killed plan to curb Medicare Advantage overbilling after industry opposition, NBC News
Health Care Costs and Affordability, KFF
How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost, Commonwealth Fund
The Revolving Door In Health Care Regulation, Health Affairs
Episode Transcript
Read the full episode transcript.
Biography: Wendell Potter
Wendell Potter is a former health insurance company executive who became that industry’s worst nightmare. Time Magazine called Wendell “the ideal whistleblower.” Bill Moyers called him a straight shooter. Michael Moore called him “the Daniel Ellsberg of corporate America.”
Wendell walked away from his job at Cigna, the giant health insurance corporation, in 2008 after what he has described as a crisis of conscience. Now, Wendell is President of two organizations — the Center for Health & Democracy; which publishes HEALTHCARE un-covered and houses the Lower Out-of-Pockets NOW Coalition and Business Leaders for Health Care Transformation.
Wendell has explained how insurance companies flout regulations designed to protect consumers, and how they intentionally make it nearly impossible for consumers to get information they needed about their policies in language they could understand.
Wendell went on to become a bestselling author. The New York Times called his first book – Deadly Spin – “a tour de force.” Pulitzer Prize-winning author and historian Doris Kearns Goodwin called his most recent book – Nation on the Take —“a stirring guide for how we can work together to reclaim our democracy and reunify our country.”
Wendell has also written numerous articles for publications in the U.S. and abroad, including the New York Times, the Washington Post, USA Today, the Los Angeles Times, the Chicago Tribune, Newsweek and the Guardian, and has been a frequent guest on TV and radio.
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