Former Health Insurance Executive Debunks Trump Attacks on Single Payer

Yves here. This Real News Network interview with former Cigna executive Wendell Potter, who among other things now heads Tarbell.org, a site that investigates money in politics, provided a point-by-point takedown of the factually-challenged criticisms Trump has made of single payer. The fact that this rebuttal comes from a former health industry insider may make it more persuasive to skeptics in your circle.

And let us not forget that polls shortly before the election showed that health care was the most important issue to voters, but as we know, the Vichy Dems are much more willing to give lip service to the idea of addressing this inefficient and too often predatory industry than doing something about it.

GREG WILPERT: It’s The Real News Network, and I’m Greg Wilpert coming to you from Baltimore.

For the midterm elections this year, Republicans have been blasting Democrats on two main issues: immigration and health care. While Trump’s remarks on immigration have been receiving a lot of attention, what he has been saying about healthcare has not received so much attention. In general, Trump is accusing Democrats of wanting to impose socialism, and he uses single-payer healthcare, also known as Medicare for All, as one of his main examples. Here’s what he said recently in one of his rallies.

DONALD TRUMP: A majority of House Democrats have already signed up for socialist healthcare. By the way, it doesn’t work anywhere in the world. Just so you understand. It doesn’t work. It’s good if you don’t mind waiting, like, five weeks to see your doctor. They come from socialist countries. Frankly, they come from Canada because they want to use our doctors. They come from all over the world. And we’re making it now better. And they want to destroy everything that’s been built. All of that great foundation.

GREG WILPERT: Meanwhile, the White House, under the direction of the Council of Economic Advisers, released a pamphlet last month titled The Opportunity Costs of Socialism. This pamphlet develops a detailed critique of state socialism as it was practiced in the Soviet Union, as well as a social democratic government of Scandinavia. One of the main areas of focus of the document is the healthcare system in single-payer countries, system-payer countries, as well as Medicare for All, a bill that Senator Bernie Sanders introduced earlier this year.

Joining me now to take a look at some of the criticisms of single-payer healthcare is Wendell Potter. He’s a former health insurance executive and author of several books, including Deadly Spin, Obamacare: What’s In It for Me? and his latest is Nation on the Take. He’s also the founder of Tarbell.org, an investigative site that examines the role of money in politics. Thanks for joining us today, Wendell.

WENDELL POTTER: My pleasure, Greg.

GREG WILPERT: So there are many criticisms that Republicans have leveled against single-payer healthcare systems; both the proposals for the U.S. healthcare and also the ones that have been implemented in countries such as Canada and various countries of Europe. We can’t go over all of these criticisms, but some of the main ones include increased costs, worse health outcomes, loss of medical innovation, and longer wait times. Let’s take these one by one.

So first, regarding costs, proponents of single-payer healthcare say that increases in taxes will be offset by not having to pay insurance premiums of private insurance companies. Critics, though, say that higher taxes distort the economy, which reduces economic activity, and thus makes the overall cost of healthcare greater. What’s your response to this argument? I mean, what is the balance in terms of the costs? Which would be cheaper, according to your analysis?

WENDELL POTTER: According to my analysis and that of many others, the proponents of Medicare for All have it right. We would be paying ultimately far less than we will be, that we are paying now or will be paying in the future, if we maintain the status quo. The problem is in a multipayer system like we have in the United States, the payers being the insurance companies, the multiple insurance companies that we have supposedly competing with each other, they just don’t have the clout to negotiate good deals with their customers, with big hospital systems and big physician groups, and certainly with the pharmaceutical industry.

So what we have in this country in the US is a classic example of market failure, because the system does not work to control costs, nor does it work to bring everyone into coverage. We still have almost 30 million Americans who do not have insurance. But under a Medicare for All-type plan you can bring everyone into coverage, and you can cover everyone and have better outcomes than you have under our current system.

And when you look at- what people need to do is kind of have a paradigm shift in their thinking. You would no longer have to pay the ever-increasing premiums to your health insurance company, or the ever-increasing deductibles, which means that your insurance doesn’t even kick in until you’ve spent several thousand dollars out of your own pocket, even though you’re making payments for your insurance.

So that would go away. You instead would be making the equivalent of your premium payments in taxes, and the system will be structured so that everyone could be brought into coverage. And studies have shown even in this country that- not only that, but a single-payer system in this country would do much more to control healthcare costs than our multipayer system does now.

GREG WILPERT: Now, a related argument in this regard is that single-payer healthcare costs save money in terms of administrative costs, but those savings are lost then again through fraud. In other words, that there are people who would try to cheat the system. And they claim that there’s a lot of fraud in the Medicare system in the United States, and that doesn’t happen so much in the private system. What’s your response to that?

WENDELL POTTER: I would say that’s absolute nonsense. And having worked in the private system for more than 20 years, I can tell you that fraud is just as prevalent, and probably more so, in the system that we have, the private system of insurance. The company that I worked for most recently, Cigna, instituted a system several years ago to try to detect fraudulent billing. So I can tell you it’s just as rampant, probably more so, in the private system. For one reason, because private companies just don’t have the resources to combat fraud and abuse as much as a single system with combined resources would have.

So it’s a completely bogus argument. In fact, we see, when you look at statistics for other countries that have a single payer or a similar system, there’s far, far less fraud and abuse in those countries and their healthcare system than in the U.S. system.

GREG WILPERT: So now the other main argument that the White House critique of single-payer brings up is that health outcomes would be worse. They cite a fairly specific study of life expectancy in the U.S. and in Europe which claims to show that once cancer is diagnosed, U.S. patients tend to live longer. And the argument is basically that under single-payer healthcare, cancer treatment would be rationed, especially for seniors. And they give examples in Europe, basically, while in the U.S. cancer patients tend to receive better care. What’s the response to this claim in terms of outcomes, health outcomes?

WENDELL POTTER: Well, what you’re seeing here, and as in many of their arguments, they being the opponents of moving to a single-payer system, is the selective use of data and the confusing and misleading use of data.

The reality is that most of the developed countries around the world- and many of them have a single-payer system- all do a better job, broadly, in healthcare outcomes than we do. The Commonwealth Fund in the United States has annually done an analysis of the performance of healthcare systems around the world. They look at 11 countries, developed countries, including the U.S. And the United States consistently, even after the Affordable Care Act was passed, brings up the rear. It’s always number 11 in the composite score. So outcomes are typically better across the board, or in many, by many measurements in other systems.

And as far as cancer treatment is concerned, or life expectancy in particular, the United States is alone in the developed world over the last two years in which life expectancy has been declining. And those are statistics from the government. And we’re seeing that in the other countries, in both the developing and developed world, life expectancy is going up. And we’re pretty much alone in the world going in the opposite, in the wrong direction.

Now, with regards to cancer, you have a lot of people in this country who do not have insurance and who cannot afford to get the care that they need. Period. So we have a lot of people in this country who just simply- and also, even if they have insurance, as I mentioned earlier, people have very high deductibles in most of their plans, if they have a private insurance company. And a lot of those people just don’t have the money to pay out of pocket for the care that they need to spend money for before their their coverage kicks in. So again, it’s the selective use of data and trying to scare people, when in reality the outcomes across the board in other countries are generally far better than they are in the U.S.

GREG WILPERT: Actually, related to this issue of health care outcomes is also the question of innovation. The White House paper argues that single-payer healthcare would reduce innovation; that is, more expensive treatments in the U.S. result in more innovation because there’s more money available for such innovation, whereas price controls, which are usual in single-payer systems, would reduce innovation because there’s less money available for them. What’s your response to this argument?

WENDELL POTTER: The question we often used in the industry- and they still do, obviously- is that any kind of reforms that would move us away from the status quo would have a “chilling effect” on innovation. But that’s not, it’s not true at all. In fact, most of the innovation, actually, in the health insurance industry has been innovation that has been detrimental to the needs of patients in this country. The most prevalent innovation in this country has been shifting more and more of the cost of care from insurance companies and employers to regular folks. So that is a kind of example that I think we could move away from and everyone would benefit from it.

But there’s no, there’s no evidence that suggests that moving to a single-payer system would mean that there would be less innovation on the provider side. In fact, we’re seeing quite a bit of innovation in the UK and Canada that this country should adopt. In the UK, for example, hospitals have a way of treating people. They can admit them, but there’s kind of a blend of inpatient and outpatient that saves the system a lot of money and allows the patient to get much of their care outside of an inpatient setting. So there’s a lot of innovation that you’re saying in single-payer systems that we have not adopted yet in this country. So there’s no reason why if we move to a system like that we would have less innovation than we have now, and probably would have innovation that benefits patients more than we have now.

GREG WILPERT: So finally, the White House paper that I cited earlier argues that wait times in the U.S. are shorter mainly because in single payer systems there are no market signals about what type of care is needed, and that the lack of deductibles and all that would cause an overuse of certain treatments. And so as a result, single-payer systems have much longer wait times. And they specifically cite the example of Canada actually having one of the longest wait times, whereas the U.S. in an international comparison supposedly has the shortest. What’s your response to that argument?

WENDELL POTTER: Well, once again, when you’re looking at the U.S. compared to other countries, keep in mind that many millions of us wait forever for the care that we need because we don’t have the money, and we have don’t have insurance. And 30 million of us don’t have insurance. The wait is indefinite. And so that’s something that needs to be factored in, as well, too. There are people in this country who just simply cannot access care at any point. So the wait lines, or the waiting period, is endless for a lot of people.

But even in Canada, the waits have been dramatized in the U.S. by opponents. There is a very short wait for essential care in Canada. Now, it is true that for elective procedures like joint replacement, a knee replacement, for example, the wait time can be fairly long; possibly longer than it would be for some patients to get the same procedure done in the U.S. But the majority, the vast majority of people in Canada, get knee and hip replacements and cataract surgery within the recommended period of time. So again, for essential care, for life-threatening events and for other kinds of care and to see a physician it’s not a significant problem in Canada or other single-payer systems. But in the U.S. for many people it’s an indefinite wait.

GREG WILPERT: OK. Well, we’re going to leave it there for now, but I’m sure we’re going to get back to this topic again very soon. I was speaking to Wendell Potter, former health insurance executive and founder of the website Tarbell.org. Thanks again, Wendell, for having joined us today.

WENDELL POTTER: My pleasure. Thank you, Greg.

GREG WILPERT: And thank you for joining The Real News Network.

Print Friendly, PDF & Email

22 comments

  1. pricklyone

    Morning, Yves.
    Shouldn’t all this be obvious, even to those “taxpayers”? You hear grumbling from the right about Dems being tools of the “giant insurance companies”, but no indications that they understand what the consequence of “giant insurance companies” would be.
    Somehow “private companies” can pay the cost of treatment, and make huge profits, for less than the cost of treatment alone, if provided by a government entity.
    A strange, and magical equation, that…

    Reply
    1. Yves Smith Post author

      The problem is that a lot of those taxpayers have grown up with demonization of government. They’v been told again and again that it’s less efficient and more costly than private businesses. And they also believe the lies that they’ve been told about countries with single payer or significant government-provided healthcare. For instance, the woman who colors my hair (hair colorists can do quite well financially; she has a house in NJ and a condo in Florida), got rabidly upset when I mentioned Canada’s government provided health care: “They take half the income of people who make $50,000 a year!” Which of course is not true but I didn’t have the facts at hand. They also believe that single payer = restricted choice and queuing.

      Reply
      1. Inode_buddha

        My standard reply in that conversation is “Would you rather have a private, for-profit company rationing your healthcare?” Then I usually go on to point out that a gov’t workers salary is far, far less than the executive compensation at xyz insurance/pharma, (50 mil/yr at blue cross for the ceo alone, the list goes on…) and *that* is where the money comes from to pay for single payer.

        Reply
        1. HotFlash

          I have found this works pretty well replying to people who complain about ‘the gummint’. I pick a company they know and hate (cable and internet providers are a good bet) and ask, “You want Comcast running your life?”

          Reply
        2. Knute Rife

          You need to put a finer point on it: Would you rather have your access to healthcare decided by someone who makes more money the more he restricts your access to healthcare?

          Reply
      2. Kurtismayfield

        They also believe that single payer = restricted choice and queuing.

        We already have this in abundance in our health insurance market. Try to get an appointment with a specialist in network, or get billed by a hospital out of network. How do people not see this?

        Reply
        1. Tom Stone

          Kurtis, I see it real clearly having spent a week in a cardiac ward earlier this year, before Medicare kicked in for me.
          One drug ran $700 per 30 15 MG tablets…
          Not cheap.
          Once medicare kicked in the price dropped to $1.75.
          When I became covered by Medicare I also had some tests done that I simply could not previously afford under my Obamacare plan.
          One referral was to a Neurosurgeon, a seven week wait for an initial look at the damage caused to my cervical spine when I was hit head on by a drunk driver two decades ago, Four weeks to see someone at a pain management clinic for my chronic severe pain.
          My best bet is to get the treatment I need and then go Bankrupt next year.
          Single payer sounds like a better alternative to me.

          Reply
    2. Edward

      I’m glad this seems so “obvious” to you. However, I have never known the government to do anything efficiently. That does not mean the system we have works well either. So, where and how to go forward. What I miss in the conversation is “what is the true cost of health CARE, not insurance”. Here in Mass. we passed the precusor to Obamacare, my premiums tripled, nearing $1000.00/mth for a single policy $2000.00/deductible, plus copays. So, excuse me when I hear how much better off we would be with Medicare. Again I ask, let’s do the math please. Forget the hyperboly, and misquoting wait lines, death rates etc. How are the costs calculated, and how much in taxes would need to be levied. ? I’m not an expert in Canadian tax law, so I don’t know what they pay. Yes, it probably isn’t 50% but what is the true cost? Our tax laws are so convoluted, many don’t pay any tax. So where do the funds come from? Remember, we are talking 330 million people. So, let’s have a math class please. “What a fine mess you got us in”

      Reply
      1. Ian Olllmann

        A problem government faces is that there is an entire political party devoted to destroying it. One wonders if that party was less interested in proving the government doesn’t work than fixing it so it works for less, whether the government would be in better shape.

        It should be pretty clear to anyone that the cost of healthcare has outstripped inflation for decades now and is a much larger part of the economy than it should be for most of us. Yet somehow, we seem to treat the most expensive patients (by far!) over all that time without breaking the bank using single payer. It is not like we are talking about a hard left switch to socialism. We already doing it for millions at less cost — nothing new. Can you point to a Republican that is outraged at having gotten old enough to qualify for medicare? Probably not. They usually take their free medical care and social security checks and rail on about the evils of socialism.

        What we would really be doing is turning off the siphon that has been redirecting all meaningful wage increases to workers over the last 30 years to the medical industry and allowing the money to stay with those that earned it. That is, The tax is going to be there either way. Whether the money goes to the government or insurance premiums is the choice, and it is pretty clear that the government does it for less.

        Reply
      2. False Solace

        You got Romneycare and need to ask why it was terrible? Medicare is single payer. It is not Romneycare or Obamacare.

        The US pays far more than any other developed country for health care and its parasitic infestation of insurers. “How can we afford health care that’s cheaper?” What a mystery. Start by removing the paper pushers who deny claims and pay themselves huge bonuses instead of delivering care.

        Reply
  2. disillusionized

    A fact omitted, but worth pointing out that the US spends around 15% of its GDP in healthcare, where the western average is 7-8%.

    Reply
      1. Off The Street

        The NC focus on health care has been very informative. I have often felt that the health care debate in the larger media gets mired (by omission or commission?) in paragraphs of verbiage and talking points of whichever side is available. There may be some charts, graphics or other way to cut through to basic facts to help the average healthcare consumer. Here is one wish list/example based on some defined standard care. Variations would show cancer, cardio and similar.

        Country Cost for equivalent service ….US cost ………..Difference
        1
        2

        11 (USofA) …………….$ …………….$$$ …………….$$

        Reply
  3. Knifecatcher

    The entire US employer based system is just so perverse. Right now we’re dealing with Cigna trying to run out the clock on my wife’s shoulder problem – she’s been trying to get an MRI for months after the therapy she was prescribed only exacerbated her pain. Even though the doctor has repeatedly requested approval for the MRI they keep coming up with reasons to deny the test.

    Could this have anything to do with the fact that we’ve hit our deductible AND out of pocket max for the year? Heaven forfend! And if they drag the process into the new year, ripping another $XXXX out of our pocket before they have to pay a dime, well, that’s just the way the cookie crumbles.

    Also fun – our HR department is now referring to the High Deductible Health Plan as a CDHP instead of an HDHP. The new acronym, I kid you not, stands for “Consumer Driven Health Plan”. Gag me.

    Reply
  4. Unna

    2015 Canada per capita Health care expenditures were $5,782 CAD. US per capita expenditures were $11,916 CAD. Canada 10.4 % of GDP. US 16.9% of GDP.

    https://www.cihi.ca/en/how-does-canadas-health-spending-compare-internationally

    Also see Wikipedia https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_cap

    You can look absolutely anywhere on the web and the numbers are always rather similar: The US spends twice as much per capita as Canada on health care. If you use the percent of GDP spent by the US compared to Canada based on a $19 Trillion economy, adopting the Canadian system would save over $1.3 Trillion dollars US per year – at least in theory (and assuming my calculator is giving me the correct numbers.) Suffice it to say that the US would save a heck of a lot of money.

    And remember, the whole idea of comparing Canadian per capita spending to America’s is itself flawed in that Canada provides health care to each Canadian person, per capita or “per head” (caput) while the US does not with tens of millions of Americans not covered at all and tens of millions more who may be “covered” but can’t access actual health care because of co-pays, deductibles, etc.

    So to get a true comparison of per capita expenditures you’d have to divide the total national health care expenditures in the US, not by the total number of Americans, but by the total number of Americans who actually get medical treatment which is much less than the total number of American persons.

    Therefore, the true per capita health care expenditure in America is considerably higher than the usual figures cited like those above, which are embarrassing enough. How much higher the real per capita American expenditure is for people who actually get treatment is a number that should be determined by researchers who have access to the numbers and have the skills to do this.

    Reply
  5. RickInTheWest

    As someone just now signing up for Medicare, I don’t think “Medicare for all” is such a great goal.

    Medicare is a multi-part, confusing, inadequate, infested with for-profit insurance corporations, mess.

    Universal single payer with minimal cost at the doctor’s office is the way to go.

    Reply
    1. False Solace

      HR 676 Expanded & Improved Medicare For All eliminates all copays and deductibles for everyone. It adds coverage for vision, dental, and long term care. And it covers everyone.

      Medicare has been fighting off neoliberal attacks and market-based “innovation” for 60 years. There’s no mystery why it sucks. It’s still far better than the vast majority of private insurance.

      Reply
  6. Jean

    Maybe ‘health care’ CEOs, need to be identified, pictured and treated the same way that Ted Cruz and McConnell and wife were greeted in public; crowds of people surrounding them and letting them know their activities are repugnant and deadly.

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *