A liar for the insurance industry

CAN YOU talk about how insurance companies make profits?

THEY MAKE profits in ways that other companies don't. It's a unique way of doing business.

McDonald's, when it sells hamburgers or French fries, doesn't care whether you are old or young, whether you are sick or not, whether you are male or female. They don't care about that, but insurance companies care a lot about that. And they don't want to sell you their product if you have been sick in the past, they don't want to sell you the product if you are older. If they do, they want to charge you a lot more.

McDonald's doesn't charge an older person three times as much for a hamburger as they charge a teenager. Insurance companies can do that. So it's an entirely different kind of business that way, in order to make Wall Street happy. And I say Wall Street because the industry is controlled by big for-profit corporations these days, and they're all listed on the New York Stock Exchange, so they have to meet Wall Street's expectations.

To do that, they have to do things that are often not in the best interest of the people in this country. Their practices result directly in people going without insurance, not being able to buy it at any price. We have too many people in this country who don't have insurance, largely because of the practices of the insurance companies.

These companies want to avoid risk. They want to avoid paying out medical claims. They try to avoid insuring people who need insurance.

WHAT ARE some of the "tricks of the trade" that you witnessed?

CANCELING INSURANCE when people get sick, a practice called recission. The companies will cancel someone's policy when they're in the midst of cancer treatment. They'll have someone look at the application the person filled out, looking for some justification to cancel the policy.

Often, they'll find something--some omission that's usually inadvertent, like one woman who testified before Congress. She was in the midst of treatment for breast cancer, and her policy was cancelled because she forgot to disclose that she had been treated for acne.

Purging small businesses from the rolls is another industry practice that is prevalent. It's the reason why half of small businesses can't offer health care to their employees. When one employee gets sick and has high medical claims, the insurance company will raise the rates so much that the employer will have to drop coverage for everyone. Refusing to pay for treatment that a doctor has recommended is another example.

DENIAL OF care.

THE INDUSTRY calls it "denial of coverage." They use that term because the lawyers insisted. We would always say "denial of coverage." It's semantics, because when you deny coverage to someone, you essentially deny care.

Most people in this country don't have the financial resources to pay for a liver transplant, for example, or for cancer care. They don't have the financial means to do it, and it's why a lot of people go bankrupt. They think their insurance will cover them, they have to have the treatments but they find they can't afford it. Others forego treatment and die. Many die.

YOU WERE the public relations person for Cigna. What was your job, in terms of the overall picture?

MY JOB description said my responsibility was to protect and enhance the company's reputation. It's very broad, and it encompasses a lot of things--handling crisis communications, situations.

In that category, I was the person who handled what we called "high-profile" cases, when someone was denied coverage for care, and it became a media event. I would be the person, along with my staff, who would deal with the reporters. We tried to explain the company's point of view.

I dealt with financial matters, particularly with litigation. I dealt with reporters from the Wall Street Journal and other financial media when they announced earnings. So I had to know how these companies make money and how they met or didn't meet Wall Street's expectations.

I represented the company at the industry level. I worked with my peers at other insurance companies to plan PR strategy to defeat health care reform. Or try to shape reform to benefit industry.

DID YOU ever think in the course of your work that you were hurting people?

I DIDN'T. I wouldn't let myself think that. On the contrary, I thought some of the things I was doing might actually benefit people.

For example, I would explain the p.r. consequences to the CEO of not overturning a denial when the media was involved. I would say, "If you don't reconsider this, then this will become a significant p.r. problem." From time to time, the company would say they'd reconsider, and agreed to pay. I would pat myself on the back and say I played some role in this person getting a life-saving procedure.

That's rationalization. I think all of us rationalize, and I know I certainly did, and a lot of my fellow employees did. You look at what you do individually, and you think that maybe you contribute to someone getting the care they need, and acknowledge that your company does provide insurance benefits to a lot people, and hopefully those people who are insured get the coverage they need when they need it.

You don't really think about the other practices of the industry. I didn't think about it until I rose up the corporate ladder and was able to see things that these companies do to satisfy Wall Street's expectations. It became abundantly clear to me that what I was doing was contributing to the number of people who don't have insurance. It was only in the latter part of my career that I came to terms with that.

ONE OF the most interesting parts of your book was your reaction to Michael Moore's movie Sicko. Can you talk about what you had to do to spin that? It must have been a huge task.

IT WAS. When I finally saw the movie I was affected by it. I think he did an exceptionally good job of knowing how to handle people who were wronged by insurance companies in a way that connected with us emotionally.

It really was a movie that explained in an effective way the problems we have with our health care system in this country--and also, the benefits of other systems. Other countries have been able to achieve universal coverage for their citizens.

Moore knows how to elicit emotional responses, and that happened to me. He was depicting something that few people really understood. I knew from my own personal experience that what he was writing about was true--from my own handling of a lot of these high-profile cases. And they're not just occasional cases. These things happen all the time. It's just the fact that most of them aren't known.

WHEN I saw Sicko, people in the audience were crying.

IT WAS as if you were sitting across from some of those people and hearing their stories. I've heard these stories face-to-face from people as I've traveled around, and you want to do something for them. I know that by making Sicko, Moore hoped to change the system so people don't suffer like that anymore.

SO HOW did you handle the p.r. for Sicko?

I HAD an obligation to understand the situations that he had in the movie that pertained to Cigna. There were two or three people who were covered by Cigna in the film. I had to figure out a way to explain why we did what we did to those folks in a very general way. I would always say, "I can't talk about a particular individual or case because of federal privacy laws."

My role was to say that we provide care for millions of people, and we have an effective way for people to appeal denials. So I more or less talked about process--about how we had a process to keep these things from happening.

CAN YOU discuss the influence of America's Health Insurance Plans (AHIP) on the new health care legislation passed last year? How much influence did they have on the crafting of the law?

AN ENORMOUS amount of influence. AHIP made sure one of their CEOs was visiting the White House on a regular basis. Ron Willams of Aetna was there at least half a dozen times during the debate, meeting with the president.

BEHIND CLOSED doors?

YES, ABSOLUTELY behind closed doors--at least, not public meetings. They weren't all necessarily private meetings with the president, but they were with him and/or staff out of public view. They also have lobbyists who were responsible for crafting the legislation and making sure the industry's points of view were in the bill.

Karen Ignagni, the head of AHIP, testified before Congress many times. They spent a lot of time on Capitol Hill, both testifying and lobbying.

IS THERE any concern among AHIP members about the suffering their industry causes?

IF THERE is, it's never discussed. I'll speak for myself. I was in a lot of meetings. I never heard any acknowledgement that the industry played a role in the suffering.

There is a great deal of denial. The finger was pointed elsewhere. We'd say, "We're not the reason why health care costs are so high."

Also, we'd try to find other reasons why the number of uninsured was so high, other than the practices of the insurance industry. You spend an enormous amount of time looking at other potential reasons for people's suffering.

LIKE THE pharmaceutical industry and the prices they charge for medication?

OH YES. Consolidation among providers was another one. As my former CEO would call it, "the real drivers of health care costs."

AND THE real drivers of health care costs are?

DRIVEN BY other parts of the health care system. And by us.

If you believe the health care executives, all Americans are largely responsible for high health care costs, because we demand the best. We demand drugs we see advertised, we demand the latest technology, so we demand all these things without having any understanding of how much they cost. Or we don't care how much they cost.

WHAT DO you think about PPACA? Will it solve the health care crisis?

IT WILL not solve the health care crisis. It will begin to make a dent in it.

I've said the legislation is worth passing. There are a lot of flaws. Much of it was written by the health insurance industry to benefit health insurance companies--like the individual mandate, the requirement that we buy their product.

But it also makes some of their practices illegal. It does have consumer protections in there. It begins to close the "donut hole" for Medicare Part D. Parents can keep their kids on their policies until the age of 26. It will prohibit the industry from using pre-existing conditions [to bar people from insurance].

It does a lot of good things--but it doesn't bring all of us into coverage and it does not do enough to end these egregious practices. It doesn't do enough to reduce or control costs. In my view, the enactment of this reform is the "end of the beginning "of health care reform.

THEY'LL STILL be able to deny coverage for medical treatment.

YES, THEY will. This legislation doesn't affect that. For most people, it's a "benefit decision." The law doesn't require these companies to cover everything the doctor recommends.

ARE YOU a supporter of single payer as proposed by Physicians for a National Health Program (PNHP)?

I DON'T talk about that too much. I try to stick to what I know. And I know a lot about what the insurance industry has done. I don't pretend to know the ideal solution for the health care crisis. What I have said is it's outrageous that Congress didn't give single-payer a fair hearing. It never was debated. And it seems to work quite well for Canadians. They like it a lot.

Why don't we look at how France has been able to achieve universal coverage? Why did we have a debate just looking at what we've got? Why don't we look at something that's more far reaching--I hate to use the word "radical"--but something that is different from system that is broken right now?

IT WOULD mean the abolition of the insurance industry as we know it. Can you see that happening?

I CAN see that happening. I can say I'd be in favor of that happening.

WHAT DO you hope your book will do?

I HOPE it will make people think. I hope it will open eyes. I hope people will see that it pulls the curtains back on how corporations behave, what they do to win, and why frankly it's so hard to get meaningful reform. Why has it taken 100 years to get this far?