An industry defector warns of outside influence in the single-payer debate
Maybe you’ve seen the commercial. It debuted on Vermont airwaves last month, and the message goes something like this:
“Governor Peter Shumlin and the Democratic majorities in Montpelier want to completely uproot our health care system and spend more than $5 billion on a single-payer health care scheme,” says a middle-aged woman sitting down to tea in her kitchen. She looks exasperated and extremely skeptical. She tells viewers that no one knows where the money will come from or what the benefits will look like, and that elected officials won’t have any answers until after the next election.
“It’s not fair and it’s not right,” she says, then adds, “They’re hiding something. They’re not giving us any reason to trust them.”
The ad was paid for by a group called Vermonters for Health Care Freedom — and Wendell Potter predicted exactly this kind of publicity. It’s indicative, he says, of the kind of tactics the insurance industry will roll out in the coming months and years to counteract the forward march of single-payer health care in Vermont.
Potter knows those tactics well: He’s a longtime insider who defected from a high-ranking, high-paying public relations job to draw back the curtain on the health insurance industry. Based in Philadelphia, he is closely watching Vermont and testified last year before its legislators. Now Potter warns that the state will be a frontline battleground for single-payer health care in the U.S., and that the insurance industry — with its profits at stake — is sure to have a hand in the debate.
“The insurance industry is very afraid that [if Vermont succeeds] … other states will pay attention,” Potter says. That includes much larger states, such as California, where a single-payer bill stalled out in the state senate last month.
Vermont led the nation last year when it passed legislation to establish the country’s first single-payer health care plan. Proponents say it will cut care costs while providing universal insurance, but opponents such as Vermonters for Health Care Freedom say the system could raise taxes, chase off employers and limit health care choices.
Under current federal rules, the state can’t enact that plan until 2017. Potter and local single-payer advocates say the delay gives opponents time to mobilize.
“What I’m seeing right now is that they’re having their shills, the people they’re influencing, try to raise doubts about how the state will pay for universal coverage and what will happen to taxes,” Potter says. “They’ll try to … get Vermonters to second-guess themselves.”
Potter would know: Not long ago, he was on the inside. He began his career as a newspaper reporter, then, like many journalists, made the switch to public-relations work. He spent the bulk of his PR days at Cigna, where he climbed the corporate ladder and eventually ended up about as close to the top as a public-relations executive can be, he says.
“I spent a lot of time trying to mislead people,” says Potter, though in the early days, he notes, he himself was a believer. He joined Cigna in the early 1990s at the advent of “managed care,” an approach the industry hoped would bring down costs while providing coverage to more people. During the heyday of managed-care plans, Potter says, that worked relatively well.
But slowly the industry changed. Companies began focusing on what they called “consumer-driven care” and shifting more and more customers to high-deductible plans. Potter calls these customers the “underinsured”: They’re technically covered, but their deductibles are so high — often thousands of dollars each year — that they can’t afford much care, or must go into debt to obtain it. Part of Potter’s job was making people think these plans were a good solution to the problems of providing health care in America, yet he grew increasingly doubtful.
“I was trying to sell people snake oil, to tell you the truth,” he says.
Potter is soft spoken, and the twang in his voice reflects his Southern upbringing. It was during a trip back to the South, in 2007, that he had what he now calls his “epiphany.” Potter tagged along to watch a Knoxville, Tenn.-based nonprofit dole out medical care at county fairgrounds in Virginia. That nonprofit, Remote Area Medical, has tended to patients in developing countries, but its leaders found that people closer to home desperately needed attention, too.
With RAM, Potter drove the 50-odd miles from Tennessee to the Wise County, Va., fairgrounds, where he watched thousands of patients queue up to see doctors and nurses ensconced in animal stalls-turned-makeshift clinics. Though he’d been having doubts about his career for some time, he says that experience opened his eyes.
“What I was doing for a living was in some way making it necessary for people to get care that way, in an undignified, dehumanizing way,” Potter says.
Potter quit his job in 2008, a few months after he worked on a white paper to persuade legislators that the problem of uninsured citizens in the United States wasn’t a problem at all. By the time he left Cigna, he was convinced of exactly the opposite. These days, Potter supports single-payer health care as a way to provide quality care while cutting costs.
Surprisingly, Potter hasn’t experienced any backlash from the insurance industry, which he says he’s seen effectively silence or discredit critics in the past. What he has experienced, though, is a flood of emails from former coworkers and others still in the insurance world — often writing from private accounts — thanking him for the work he does. Potter has returned to his roots as a reporter and now writes news-analysis columns for the Center for Public Integrity. He’s also published a book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.
While Potter says the insurance industry itself may never be especially visible in Vermont, he predicts it will funnel in money through groups such as the National Federation of Independent Business and the U.S. Chamber of Commerce. He expects a “fear-mongering” campaign to unfold over time.
“It will be the attempt to kill [single payer] by a thousand cuts over the months to come,” Potter says.
He warns Vermont residents to be skeptical of the talking points they’ll hear on the topic of single-payer health care, to question motives and to look at the sources of the information provided.
“I encourage Vermonters to seek out the truth and keep their eyes on really transforming the health care system here,” Potter says. “Vermont can lead the country toward a more rational and equitable health care system.”
Local proponents of a single-payer system are well aware that the fight isn’t over. Ellen Oxfeld is a longtime advocate, one of the leaders of Vermont Health Care for All. She says she’s particularly concerned about the influence of outside money on the health care debate in the state. She points out that Vermont is a small market where ad time isn’t that expensive.
“They have more money, and they have time,” Oxfeld says of her opponents. “But I think what’s on our side is that the present system is unsustainable, and people’s own experiences are showing them that.”
Peggy Carey agrees. Carey is a doctor and chair of the Vermont chapter of Physicians for a National Health Program. She says the tactics of which Potter warns are already in play in the state, and it’s going to take a continuous response from activists to counter those attacks. But she also thinks Vermont is fortunate enough to have residents who want to hear both sides of the argument and make informed decisions.
“I think they’re pretty good about overlooking special-interest folks and the spin-meisters that are out there,” Carey says.
But who is doing the spinning? Potter says it’s likely organizations funded or in some other way backed by for-profit insurers, though tracking the funding behind voices in the unfolding health care debate may be impossible.
Vermonters for Health Care Freedom, for example, is a 501(c)(4) — in other words, a nonprofit devoted primarily to social welfare. That means the group doesn’t have to disclose its donors or sources of funding. Groups with that tax designation include major nonprofits, such as the National Rifle Association and AARP, some of which are also major political spenders. Tax law says these groups can’t promote individual candidates but can promote causes, and they may do unlimited lobbying on issues related to a cause.
Darcie Johnston, a Burlington consultant, founded VHCF, which aired some radio ads last year before unveiling its first television spot last month. Johnston headed the group until VHCF hired its executive director, Jeffery Wennberg. Johnston says her motivation is to educate Vermonters about the possible economic and health care impacts of Green Mountain Care, the state’s proposed single-payer system.
Though she’s squarely at odds with activists Oxfeld, Carey and Potter, Johnston does agree with them on one count: She predicts Vermont will soon be the focus of attention from individuals, companies and interest groups around the country.
“We’re lab rats,” she says.