Meeting in the aisle

I have a lot of ways to save or share web pages of interest. There's Evernote, ReadItLater, and good old bookmarks. Plus, bookmarklets make Twittering a page easy, and Note in Reader lets you now star, share or 'like' any page.

With so many ways of highlighting good content, it's kind of sad that I rarely go back to look at the material I select, tag, and archive.

But there was a page I kept coming back to, after I saw it online over the weekend. It's a transcript of an interview between an ex-health insurance exec and Bill Moyers.

I've excerpted just a tiny bit and rearranged it a little here, but it's really excellent and deserves a full read (or watching) if you have the time. via Metafilter.

WENDELL POTTER: ... I went home, to visit relatives. And I picked up the local newspaper and I saw that a health care expedition was being held a few miles up the road, in Wise, Virginia. And I was intrigued.

BILL MOYERS: So you drove there?

WENDELL POTTER: I did. I borrowed my dad's car and drove up 50 miles up the road to Wise, Virginia. It was being held at a Wise County Fairground. I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.

BILL MOYERS: What did you think?

WENDELL POTTER: It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? I just it just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me.

BILL MOYERS: People are going to say, "How can Wendell Potter sit here and say he was just finding out that there were a lot of Americans who didn't have adequate insurance and needed health care? He'd been in the industry for over 15 years."

WENDELL POTTER: And that was my problem. I had been in the industry and I'd risen up in the ranks. And I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn't put faces with that number.

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.


WENDELL POTTER: ...there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

BILL MOYERS: That they're spending more money for medical claims.


BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.


WENDELL POTTER: Right. Right. And they're Democrats. And my executives wanted to meet with — and when I say my, the people I used to work for--


WENDELL POTTER: Yeah, wanted to meet with Hillary Clinton, when she was still in the Senate and still a candidate for president. Well, that's hard to do. That's hard to pull off, but she did. That just shows you that you can, through the relationships that are formed and that the insurance industry pays for, by hiring these lobbyists, you can your foot in the door. You can get your messages across to these people, in ways that the average American couldn't possibly.

BILL MOYERS: So it's money that can buy access to have their arguments heard, right?

WENDELL POTTER: That's right.

BILL MOYERS: When ordinary citizens cannot be heard.

WENDELL POTTER: Absolutely right. It's the way the American system has evolved, the political system. But it does offend me, that the vested special interests, who are so profitable and so powerful, are able to influence public policy in the way that they have, and the way that they've done over the years. And the insurance industry has been one of the most successful, in beating back any kinds of legislation that would hinder or affect the profitability of the companies.

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit...

So, yeah. I don't usually share or post much on healthcare reform. There's a lot of stakeholders in US healthcare, they make a lot of good points, and it's difficult for me to reconcile the proposals and theory with the forces at work in the emergency department. Plus, the risk of alienating some prospective employer with my forever-googlable opinions always seemed to outweigh the benefit of trying to persuade some anonymous readers.

But I was interested in what Wendell Potter had to say. I know, he's got a new job and a blog and therefore, undoubtedly, an agenda of his own. Maybe it's just his skill in PR but he seemed like an honest guy, and that's something I've been looking for in this debate for a long time.

Today, some other bloggers head to DC to discuss healthcare reform -- Dr. Val, Dr. Rob, Dr. Wes, Kevin MD, Emergiblog, Kerri and others.

I've read these people's words for years. Interviewed them all for Medscape. Some, I've met in person. One, I almost met, but my hospital caught fire, and then I recovered his iPod and earned a llama.

Yes, many of them have forged ties to industry and agencies. And many of them are advancing an agenda of their own, or at the very least, a podcast. But unlike the Potters and Moores and Becks of the world, well, I know these folks, and they seem like honest and good people. Even the guy giving out the llamas. So I recommend you all listen to them, and bookmark Better Health, and retweet, and Note in Reader, and save to Evernote, and whatever else you do with thoughtful material.

Update: The #patientsfirst hash will get you the twitterfeed of the event. A helpful blogger has generated this pdf transcript of the conversation.