Wendell Potter knows what success feels like.

With a degree in journalism from the University of Tennessee, Potter was just in his 20s when he was promoted by the Memphis Press-Scimitar, a Scripps-Howard paper, to cover politics and write a column in Washington, D.C.  Eventually, Potter was lured away from daily journalism when he joined the Baptist Health System of East Tennessee as director of PR and advertising.

That’s when Potter’s stock in the healthcare industry began to climb. He jumped from Baptist to Humana and, four years later, was hired away by CIGNA.

“I joined the company to support the healthcare operations exclusively, and I worked in Connecticut where those operations are based,” Potter said. “After four years, I was asked to move to Philadelphia to work for the corporation. So I spent the rest of my career as the head of corporate communications.”

Those were heady times. Potter advocated for a managed-care insurance model in the 1990s that he believed worked to deliver efficient and quality care. “I believed in the concept of managed care, and did for many years,” he said. “It was only years later that I was able to see that the profit motive had really wrecked the idea and the promise of managed care.”

Potter described for-profit insurers’ dealings with physicians and patients as “ham-fisted” and said that, over time, he became “disillusioned.” For-profits were scrambling for a new “silver bullet” that would boost profits at the expense of providers and patients, Potter said, and eventually the former journalist had had enough. He defected.

Potter left CIGNA in 2008 and is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans, published last year by Bloomsbury Press. Today, Potter is a senior analyst at The Center for Public Integrity and the senior fellow on healthcare for the Center for Media and Democracy. He talked to the Birmingham Medical News about his crisis of conscience, his dramatic career shift and his newfound role as patient champion.

I suppose the newest silver bullet deployed by health insurers is to give patients control of their healthcare?

Well, that has been the talking point. That’s what they want you to say – “giving patients more control” – but it is essentially shifting more of the cost of care to patients. The term “consumer directed” is misleading. Yeah, consumers theoretically have to make more decisions. They certainly have more “skin in the game.” But it’s really about cost shifting, and as people have become more aware of the cost of healthcare, they’re not going to the doctor and they are not picking up their medications. That is to the great benefit of the insurance companies. 2010 was of the most profitable years ever for the big for-profits, and it’s because they have figured out how to make us pay even though we’re also paying them our premiums.

Was your decision to walk away from CIGNA a gradual realization or a gut-wrenching moment?

It was both. I was becoming increasingly uncomfortable serving as a spokesman for the industry because of this rapid movement of people from their managed-care plans that they had grown accustomed to into these high-deductible plans that require them to spend so much more out of their own pockets.

The median household income in this country is only $50,000, and the average cost of a family premium has increased to almost $14,000. Yes, for most people who are in employer-sponsored plans, the employers pay the lion’s share of that, but increasingly consumers are paying a greater share of that percentage, and more out of their own pockets for care. I was aware of all this, and I knew that you can’t keep doing that forever, and it was exacerbating the problem of the underinsured. Also, I was becoming more aware of the practices companies engage in to get rid of people they don’t want to cover through recisions and through purging small businesses from their rolls because the last thing they want to do is pay a claim.

They raise the premiums for small businesses often so high that they have no alternative but to drop coverage. It became abundantly clear to me that what I was saying, that this industry was part of the solution, was not correct. What I was seeing was that the industry and its practices were causing the most intractable problems in our healthcare system and making it worse and making it necessary for more and more people to be in the ranks of the uninsured and the underinsured.

As someone who is insured by CIGNA, I watched in horror the case in California, when in late 2007, CIGNA denied 17-year-old Nataline Sarkisyan a liver transplant that would save her life. Nataline died. Was that a time of realization for you?

It was. It was the final thing. To be a key player in that whole thing was something that made me ultimately decide, “I can’t keep doing this kind of work.” I was the main spokesman for the company, and in that role, I was the guy on the phone to most of the reporters who were calling about that case. I’m a father with a daughter a little bit older than Nataline was. I could just imagine what was going on in that family. I’m fully aware that resources are finite, that every transplant cannot be approved and that there truly are some instances in which experimental procedures are outside the boundaries of coverage. But what became clear to me, finally, was that the life-and-death decisions are being made inside big corporations by medical directors who are just as much corporate employees as I was. They know that they have their role to play to make sure the company meets profit expectations. When that finally dawned on me with this particular case, I decided, “I’m not doing what I want to do, what I’m supposed to be doing.”

How do you disentangle yourself?

It’s a process. If it had just been me, it might have been something that I could have done earlier, but I have a family. It’s hard to disentangle yourself because your ego is tied up into it, your lifestyle, your friends. You’re dependent on the income; no matter how much you make, you always want to make more. It’s the way we’re wired, I guess. You want to make sure that you’re perceived as a team player, getting the raises when they’re passed out and the bonus and your stock options. You want to keep advancing. So it’s extraordinarily hard to even think about all that coming to an end. You’re talking about something that not only pertains to your lifestyle, but also about reinventing yourself in ways that you don’t know how it’s going to turn out.

Do you consider yourself a whistle-blower?

No. I consider myself as someone who’s just telling the truth these days. I’m not trying necessarily to persuade anyone to believe a certain way. I’m pulling the curtains back to try to help people see something that I saw. In essence, what I think I’m doing is returning to my journalism days. I’m writing about things that I know to be true, and hopefully using my journalistic skills to convey that to folks.

Also, I’m not in a classic sense or even a legal sense a whistle-blower, in that I’m not a disgruntled employee of CIGNA. I don’t have a smoking gun that says CIGNA is guilty of this or that, or is defrauding the government. That’s not my point. My point is that these practices are industry-wide and beyond a single company. I know that because I was not only a spokesman for two companies, but I was very involved in doing a lot of work at the trade association level.

When you wrote the book, was it a catharsis?

It was difficult to start it. I kept procrastinating. I’d never written a book before, and I think for most people who’ve never done it, it’s very daunting to undertake. I didn’t want it to be just another health policy book. And I certainly didn’t want it to be a tell-all book. I wanted it to be something that could inform people on a lot of different fronts. I wanted to go beyond healthcare, as well, and to describe how the public relations function works, often to the disadvantage of so many people, and how I came to realize all of this.

And now our nation is at a healthcare crossroads, I suppose. Is the spin machine still working just as well as it always has?

Oh, absolutely. Probably even more so. I call the bill the president signed into law “the end of the beginning of reform.” We probably always will be reforming our healthcare system, because our country and its needs will always change, and technology and the way healthcare is delivered will always change. The vested interests that have a stake in our healthcare system, who profit from it and who get paychecks because of the way it is, resist change. They will be doing constant spinning, and they will continually use PR to persuade us to think and act in certain ways. It’s always going to be that way, I’m afraid.

It appears that as a result of the The Patient Protection and Affordable Care Act, more people than ever before will be buying health insurance?

The insurance industry comes across looking great in this bill. They helped write sections of it. They were able to accomplish their two main objectives. One, to make sure that there was a requirement that we buy their products, the individual mandate. The second objective was to make sure that there was no new competition, no public option. They got both of those.

Those were big victories for the insurance industry. Now, they not only get these new customers, but if we can’t afford their products based on our income, we’ll get subsidies from the government. So they will have these incredibly rich revenue streams for many years to come, both from us and from the government.

Is that better than where we were before?

Yes, it’s better. I’m not going to begrudge that. A lot of people do. A lot of people just can’t abide the fact that the insurance companies won any part of this, they just hate them so much. As the Senate was about to vote on this legislation, I pointed out that I don’t like a lot about this either. This legislation is built on the current system and propping it up in many ways and enriching the insurance industry in ways that I think are not good. But, it’s all Congress could do. It brings a lot of people into coverage, or it will if it’s implemented as intended. Maybe that will keep some of these statistics from getting worse and maybe improve them. We have 45,000 people dying every year because they don’t have access to care. Maybe we’ll start seeing that number go down.

Is there any good news out there for physicians, many of who have spent years in frustrating battles with insurance companies?

I think there are some things in this that are good for physicians. It tries to tackle the payment structure. I think by reining in these insurance companies a little bit, that should help not only consumers, but doctors. So, yeah, I think doctors should embrace this. In fact, the AMA came around to endorsing it eventually. One value that’s overreaching is that organized medicine came to realize that the insurance industry really controls their healthcare system, not doctors, as they probably thought they once did. So the world has changed for them. While they have historically been opposed to more government involvement in the healthcare system, they see now the consequences of a corporate takeover of the healthcare system, and they understand the importance of curbing the power of insurance companies.

www.wendellpotter.com