Last week, the NY Times published an op-ed by a former Cigna executive named Wendell Potter. The piece is basically a confession: as the gigantic health insurer’s vice-president for corporate communications, Potter wrote to apologize for his role in perpetuating a myth that is damaging millions of people’s health and driving millions more toward financial ruin.

The myth is this: healthcare reform threatens Americans’ choice.

Here’s the crux of his argument. 

Those of us in the insurance industry constantly hustled to prevent significant reforms because changes threatened to eat into our companies’ enormous profits. We were told by our opinion research firms and messaging consultants that when we promoted the purported benefits of the status quo that we should talk about the concept of “choice”: It polled well in focus groups of average Americans (and was encouraged by the work of Frank Luntz, the P.R. guru who literally wrote the book on how the Republican Party should communicate with Americans). As instructed, I used the word “choice” frequently when drafting talking points.

But those of us who held senior positions for the big insurers knew that one of the huge vulnerabilities of the system is its lack of choice. In the current system, Americans cannot, in fact, pick their own doctors, specialists or hospitals — at least, not without incurring huge “out of network” bills.

Potter was, like me, a communications professional working in healthcare. He worked for one of the country’s largest health insurers; I worked for one of the country’s largest emergency medicine groups. Personally, I don’t believe I ever did anything so divorced from the truth as Potter. I was not instrumental in the perpetuation of falsities which have harmed and continue to harm millions. I was not so important as that.

And yet. Potter’s transition from health insurance executive to Medicare for All activist highlights a hard truth, one that I’ve had to learn as well: sometimes it’s difficult to see the truth through the incentives, whether that’s a cushy salary, a promising career ladder we’d wish to keep climbing, or a business model that is reliant on growth at all costs.

The debate over surprise billing

My former employer is part of a coalition of physicians groups that has spent millions opposing a bill in Congress that would eliminate so-called “surprise billing.” I’ve written about surprise billing a lot in this newsletter, partly because it’s been the only healthcare-related legislation actually moving through Congress, and partly because of my close connection to the physicians groups which are involved.

For what it’s worth, I’ve written extensively about how wrong I think the physicians are here. But I also know that many of my former physician colleagues think they’re doing the right thing when they make their arguments. They are passionate that their preferred solution to surprise billing is better than the one that passed out of the Senate HELP Committee on an overwhelmingly bipartisan vote.

I happen to think they are mistaking what’s good for the profitability of their company for what’s good for patients generally, much as I feel that teacher’s unions conflate what is good for teachers with what is good for students. The two are not the same, and in fact the interests of teachers and those of students can diverge wildly. So it is with doctors and patients.

In fact, physician opposition to the HELP Committee’s bill helped torpedo a fix to surprise billing all together, at least in 2019. Congressional leaders have signaled they are going to try again this year, but I have to ask: would physicians had to choose between no bill to crack down on surprise billing and a bill that protects patients but may also eat into their profits - which would they choose?

I’m sure, if I asked most physicians what their answer to that question is, they would assure me that they are fighting to protect patients, just so long as that protection happens in the right way - the way they prefer. But the reality is that their opposition has paralyzed Congress such that nothing has gotten done. And meanwhile patients are still the ones getting hurt. It may not be the outcome physicians intended, but it’s the one that happened.

Fooling ourselves

Potter’s op-ed resonated with me because I sense deep down that almost everyone working in healthcare has a Potter-like confession buried deep within themselves that maybe they’re not willing to confront. Whether that’s perpetuating the myth that Medicare for All would threaten choice, or suggesting that a bipartisan proposal to benchmark out of network bills to area median rates would presage the wholesale destruction of healthcare as we know it.

We all accept that others are fooling themselves - but we rarely think we’re fooling ourselves.

Anyway. I may be guilty of “burying the lede,” but here it is: I’m ending healthpolity.

Over the past six months, I’ve written 40 pieces about healthcare in America. I wasn’t expecting to go in some of the directions that I did (See My boss’ boss’ boss was a drug dealer). The important thing was to write as honestly as I could, free from the incentives of my former work. I wanted to challenge assumptions and I wanted to educate policy makers and healthcare professionals about what I had learned working in healthcare for seven years.

I wanted to make sure I wasn’t fooling myself or others about the reality of America’s broken, cruel, disjointed, and downright uncivilized system of healthcare. Perhaps I just wanted to say what everyone working in healthcare knows but refuses to state plainly: ours is the worst healthcare system in the world that is pretending to be the best (actually, we’re probably the only system pretending to be the best - it all comes back to America’s stubborn insistence on its own exceptionalism).

Now, I think that project, my project, is done. The fact is, I never set out to go into healthcare. Healthcare clients fell into my orbit, and I liked working with the physicians. I started and grew with one company, which then merged with a larger company, and I liked working with them as well. But my fundamental passion was never healthcare. My fundamental passion is something larger: myth and perception, and the way those two things impact policy and politics.

What’s next

I know that many of you signed on to this newsletter expecting healthcare only. So, if this new direction feels like something you didn’t sign up for, feel free to unsubscribe. I promise you won’t hurt my feelings.

The new newsletter will come with a new name and be completely free, as its goal (at least as the start) will be to reach as wide an audience as possible. Thus, those of you who subscribed to the premium version of Healthpolity have been refunded.

All that said, I hope you will stay with me. I promise what comes next will transcend traditional left-right, liberal-conservative, Republican-Democrat politics. It will be something new entirely.

- Russell Max Simon