The Center for Public Integrity

As I was reading former Wall Street executive Greg Smith’s bombshell of an Op-Ed in the New York Times last week, I mentally inserted the names of the big for-profit health insurers — two of which I worked for — in place of Goldman Sachs, where Smith worked until resigning on the day his column was published.

Smith wrote that he decided to leave Goldman-Sachs because it had veered so far from the company he had joined straight out of college that he could no longer say in good conscience “that I identify with what it stands for.”

He put the blame squarely on Goldman’s current CEO and president. It was during their watch, he wrote, that “the firm changed the very way it thought about leadership.

“Leadership used to be about ideas, setting an example and doing the right thing. Today, if you make enough money for the firm (and are not currently an ax murderer) you will be promoted into a position of influence.”

Had Smith been an executive at any one of the big investor-owned insurers that have come to control the U.S. health care system, he could have written the same thing.

Like Smith, I came to realize toward the end of my career that the companies I had worked for had changed so much during my two decades with them that I could not in good conscience continue to serve as an industry cheerleader and spokesman.

If I were trying to persuade the Supreme Court later this month that Obamacare should not be declared unconstitutional, I would tell the story of the woman who was the original named plaintiff in the lawsuit filed by the National Federation of Independent Business, one of the fiercest critics of the health care reform law.

The NFIB thought it had found the perfect person when one of its members, Mary Brown, a 56-year-old owner of an automobile repair shop in Panama City, Florida, volunteered to lend her name to the lawsuit.

Brown was outspoken in her belief that Congress had gone beyond what the U.S. Constitution allows when it included in the reform law a requirement that, beginning in 2014, most Americans will have to obtain health insurance or pay a fine to the IRS. She said she was uninsured and was that way by choice.

“She firmly believes that no one should have the right to tell her she has to use her own money to pay for health insurance,” Karen Harned, executive director of the NFIB legal center, said when the NFIB filed its lawsuit in 2010.

She turned out not to be such a perfect choice after all.

Last year Brown shuttered her business and filed for personal bankruptcy. Among her debts: nearly $4,500 in medical bills. More than $2,000 of that was owed to the Bay Medical Center in Panama City. The rest was to doctors in Florida, Alabama and Mississippi.

The NFIB had to scramble to find another small business owner to replace Brown’s name at the top of the lawsuit. It settled on Kaj Ahlburg, a retired New York investment banker who now lives in Port Angeles, Washington.

Aetna CEO Mark Bertolini caused quite a stir when he said at a Las Vegas conference a few days ago that the insurance industry as we know it is, for all practical purposes, a dinosaur on the verge of extinction.

Time to sing, “Ding dong the witch is dead”? Not quite, but the day when most Americans get their coverage from what we think of as an insurance company is close at hand.  It won’t be long before most of us get coverage through either a state or federal government-run plan or a local nonprofit company. The big investor-owned corporations like Aetna and the companies I used to work for, Cigna and Humana, know that the days of making a killing off of basic medical insurance policies are over. And the companies have no one to blame but themselves and a fatally flawed, uniquely American system of providing access to care.

While Bertolini was by no means predicting that Aetna and its competitors were about to close their doors and get the hell out of our lives, he most certainly sounded the death knell for the standard business model insurers have followed for many years — actually insuring people.

“The system doesn’t work. It’s broke today,” he said. “The end of insurance companies, the way we’ve run the business in the past, is here.”

Bertolini ticked off a number of reasons why providing basic health insurance to Americans was no longer viable — changes in demographics and the economy and, of course, health care reform at both the state and federal levels. What he did not say was that the standard operating practices of the industry were simply not sustainable and actually contributed more to the demise of the business model than any external factors.

Recent news releases from two very different organizations paint entirely separate pictures of what can happen to people once they sign up for a high-deductible health plan. 

One release from Cigna, the giant for-profit insurance firm I used to work for, would lead us to believe that human resource managers who haven’t moved all of their company’s employees into a high-deductible plan should be canned for fiscal ineptness.

The other, from GiveForward, a Web site where people can create personal fundraising pages, tells of the real-world consequences when people in high-deductible plans become seriously ill or get hurt.

One of the reasons I left my job in the health insurance industry was because I could not in good conscience continue to promote high-deductible plans, often marketed as “consumer-driven” plans, as wise choices for most Americans. These plans, which are often coupled with a health savings account, have become a favorite of insurance company executives and an increasing number of employers. That’s because they enable insurers and employers to shift more and more of the cost of care from them to health plan enrollees.  

Insurers regularly trot out studies, which they themselves conduct, as part of their ongoing campaign to persuade employers that haven’t yet joined in, to get with the program. Earlier this month, for example, my former employer released the results of the “Sixth Annual Cigna Choice Fund Experience Study.” A press release crowed that, “When American workers engage in health-smart habits offered in consumer-driven health plans, they reduced their health risks and lowered their total medical costs an average of $9,700 per employee over a five-year period.”

The biggest applause line Senator Diane Feinstein (D-Calif.) got at a gathering of Democratic Party activists last week came when she endorsed a ballot initiative to give the California Insurance Commissioner power to reject excessive health insurance rate increases.

Consumer advocates there decided to go the ballot initiative route after the insurance industry’s friends in the legislature blocked a bill last year that would do the same thing. Feinstein became the first Californian to sign a petition. Insurance Commissioner Dave Jones became the second. To get the measure before voters in November, the advocates, led by Santa Monica-based Consumer Watchdog, must collect half a million more signatures.

In her San Diego speech before the party faithful, Feinstein pointed out that in the first quarter of this year, the five largest health insurers — UnitedHealth, WellPoint, Aetna, CIGNA and Humana — posted profits of $3.6 billion, 16 percent more than the same period a year earlier. One of the ways those companies were able to achieve such Wall Street-pleasing success was by jacking up the rates on policies bought by individuals and small businesses. While most of these policyholders dug deeper into their pockets to avoid joining the 50 million Americans who are uninsured, many others had no choice but to let their coverage lapse.

As Feinstein noted, thousands of Californians have been forced into the ranks of the uninsured in recent years because of policies being priced beyond the ability of individuals to pay. She said many people in the state had received rate increase notices twice over the past year alone.

All the attention paid to the debacle about coverage for contraceptives over the past several days obscured a broader, undisputed win for all consumers, including those who are pregnant or about to be pregnant.

While the media was obsessing about the contraceptives controversy, the Department of Health and Human Services unveiled a final rule that even the Catholic bishops should support. Starting this fall, insurers and employers that offer health care benefits must provide us with more clearly written information about what their benefit plans cover and how much of our own money we’ll have to pay if we get sick, injured or, yes, pregnant.

This is no small matter. Rumors had been circulating in Washington over the past several months that the administration would cave to the demands of the insurance industry’s trade organization that this requirement be gutted to the point of being meaningless for most Americans. The rule requiring that this information be written in plain English was part of the health care reform law.    

The powerful insurers’ group, America’s Health Insurance Plans (AHIP), reportedly was hard at work early last week trying to persuade its friends in Congress, including some Democrats, to flood the White House with calls urging that the new requirement be postponed indefinitely and apply only to benefit plans sold outside of the workplace. That would mean that the requirement, if ever implemented, would be of value to only a small percentage of Americans.

MONTPELIER, Vermont — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.