Wendell Potter was formerly in charge of public relations for Humana and then Cigna. Potter's intent in "Deadly Spin" is to expose the deceptive techniques of public relations in the insurance segment of health care. He does this quite well, and also provides readers with insight into the two events (the large turnout, including many with illusionary health insurance, for a free Pennsylvania dental and medical clinic; the death of a young girl after his employer dithered and delayed approving a necessary transplant) that turned him against continuing to defend the industry he had been part of for some 25 years. Potter begins by introducing readers to a sampling of tested phrases that have served the industry quite well, such as 'socialized medicine,' 'government-run' medicine, and 'government takeover' of medicine. Readers also gain exposure to other P.R. favorites, such as identifying with patriotism and the American way of life, testimonials, name-calling, smearing opponents (eg. Michael Moore and his "Sicko"), identification with plain folks, fake grassroot campaigns, junk science and statistical analyses, and euphemisms. A brief tour of the darker side of health insurance practice likewise is given - rescissions (retroactively canceling policies of those with large medical bills, using whatever pretext possible), and purging less than profitable accounts via large rate increases. Missing, however, is any comment on the fact that if the uninsured paid the same rates as insurance companies, much of the need for health insurance would go away, and a large proportion of medical bankruptcies avoided.
Universal health coverage began under Germany's Otto Von Bismarck in 1883, with Social Security following in 1889. The motivation was neither altruism or socialism, but to provide leverage against the labor and socialist movements of the day. Health insurance quickly spread - Austria (1888), Hungary (1891), Norway (1909), England (1911), Russia (1912), and the Netherlands (1913). Unfortunately, the momentum took almost 100 years to get to the U.S.
Some of the most disturbing revelations in "Deadly Spin" are that 'ObamaCare' is not a 'cure-all.' For example, it will not stop employers from only offering high-deductible plans such as the $30,000 for some families in Maine. Nor does it remove the ERISA liability protection for employer-sponsored plans. However, it will sharply reduce medical bankruptcies, the key reason for 62% of personal bankruptcies in 2007. Hopefully, it will also reduce the amounts paid for executive salaries and retreats - WellPoint spent over $27 million on staff retreats in 2007-08, while William McGuire, United Health CEO for 12 years, was paid almost $2 billion for his leadership ($620 million was 'clawed-back' because of fraudulent option back-dating). (Comparison: Dr. Donald Berwick, an extremely well-regarded expert in charge of care for the 103 million receiving Medicare or Medicaid, receives only $176,000/year.) Hopefully, the $52.4 billion spent on stock buybacks instead of medical care by the 7 largest insurers from 2003-08 will also either cease or be drastically diminished.
An important side effect of our market-based health-care system is the very high administrative overhead - about 31%, per some estimates, compared to 3% for Medicare. Duplicity and high lobbying costs are two more - America's health insurance plans donated $86.2 million to the U.S. Chamber's lobbying against 'ObamaCare' in 2009, while promising President Obama on tape that they were in support.
Mr. Potter is unquestionably qualified and sincere in his effort. Unfortunately, limiting the scope to his personal expertise both enormously understates the size of America's health care problem, and unfairly skews the focus towards insurance firms. The U.S. spends 17.3%+ of GDP on health care, despite not covering some 40-50 million. Compare that to competitors Japan (about 7.2%), Taiwan (about 6%), and China (4%). Reducing our expenditures to Taiwan's level would save about $1.7 trillion/year, and also reduce unfunded Medicare and other health care liabilities for retirees by close to $30 trillion. Most of the problem is due to excessive service charges (about 2X those of other nations), and excessive utilization by profit-maximizing physicians. Solutions require not just Potter's recommendations for limiting monopolistic practices by health care insurers (providers are also guilty) and mandating higher MLRs, but also restructuring health care to combine insurance and care provision in the manner of Kaiser Permanente (California), the V.A., the Cleveland Clinic, Mayo Clinic, Bassett Health Care, and Geisinger Health System. Physicians must be predominantly paid by salary, to discourage excess care. It will also require that the U.S. emulate every other developed nation that I'm aware of by mandating strict price-controls for medical services, and limiting the ability of drug makers to mislead patients and providers with overly expensive 'new' products that are no better than existing ones.
