🔱 The myths that drive our thinking about healthcare

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.