Podcast appearances and mentions of Wendell Potter

Former healthcare executive Wendell Potter reveals how insurance giants sacrifice patient care for profits and deploy deceptive tactics to fight reform.Full show notes and resources can be found here: jordanharbinger.com/1151What We Discuss with Wendell Potter:Wendell Potter was a healthcare insurance executive at Cigna and Humana, and became a whistleblower after witnessing Americans seeking healthcare at a fairground in animal stalls, revealing how profit motives override patient care.Insurance companies prioritize shareholder value over patient needs, with executives compensated primarily in stock, directly incentivizing them to deny claims and care to maximize profits.Companies create "front groups" with misleading names like "Healthcare America" to manipulate public opinion against healthcare reform, using fear tactics to protect industry profits.When denied coverage, patients should appeal decisions, enlist their doctors' help, and consider becoming a "squeaky wheel" through media attention, as companies often reverse denials when facing public scrutiny.There is growing bipartisan support for healthcare reform and breaking up massive healthcare conglomerates. By understanding your rights, documenting communications, and persistently appealing denials, you can better navigate the system while supporting meaningful change.And much more...And if you're still game to support us, please leave a review here — even one sentence helps! Sign up for Six-Minute Networking — our free networking and relationship development mini course — at jordanharbinger.com/course!Subscribe to our once-a-week Wee Bit Wiser newsletter today and start filling your Wednesdays with wisdom!Do you even Reddit, bro? Join us at r/JordanHarbinger!This Episode Is Brought To You By Our Fine Sponsors:The Cybersecurity Tapes: thecybersecuritytapes.comDesign.com: Free trial: design.com/jordanBetterHelp: 10% off first month: betterhelp.com/jordanShopify: 3 months @ $1/month (select plans): shopify.com/jordanHomes.com: Find your home: homes.comWant to hear a conversation with an ex-royal/ex-SEAL who fights to end human trafficking and illegal organ harvesting? Check out episode 868 with Remi Adeleke!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value. And this theme is, heads up, going to continue through a few upcoming shows as well. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We have Matt McQuide coming up, talking about patient engagement, and Christine Hale, MD, MBA, talking about high-cost claimants. And we also have an encore coming up with Kenny Cole, MD, talking about a lot of things; but patient trust is one of them. But before I get to the main theme to ponder here, let me talk about what gets selected to talk about on Relentless Health Value. I will freely admit, how topics for shows get picked, it's not exactly a linear sort of affair. And furthermore, even if it were, I can't always get the stars to align to get a specific cluster of guests to all come on like one after the other. So, for sure, it might be less than obvious at times where my head is at—and sometimes, admittedly, I don't even know. This may sound incredibly scattershot (and it probably is), but in my defense, this whole healthcare thing, in case you didn't know, it's really complicated. Every time I get a chance to chat with an expert, I learn something new. I feel like it's almost impossible to sit in a vacuum and mastermind some kind of grand insight. Very, very fortunately, I don't need to sit in a cave and do all this heavy thinking all by myself. We got ourselves a tribe here of like-minded, really smart folks between the guests and you lot, all of you in the tribe of listeners who are here every week. Yeah, you rock! And I can always count on you to start teasing out the themes and the through lines and the really key actionable points. You email me. You write great posts and comments on LinkedIn and elsewhere. Even if I am a little bit behind the eight ball translating my instinct into an actual trend line, it doesn't slow this bus down. It's you who keeps it moving, which is why I can confidently say it's you all who are to blame for this new idea I came up with the other day after the podcast with Al Lewis (EP464) triggered so much amazing and really deep insight and dot connecting back and forth that hooked together the past six, I'm gonna say, or so shows. Let's just start at the beginning. Let's start with the topics that have been discussed in the past several episodes of the pod. Here I go. Emergency room visits are now costing about 6% of total plan sponsor spend on average. That was the holy crap moment from the episode with Al Lewis (EP464). Emergency room volume is up, and also prices are up. In that show with Al Lewis, I did quote John Lee, MD, who is an emergency room doctor, by the way. I quoted him because he told a story about a patient who came into the ER, winds up getting a big workup in his ER. Dr. Lee says he sees this situation a lot where the patient comes in, they've had something going on for a while, they've tried to make an appointment with their PCP or even urgent care, they could not get in. It's also really hard to coordinate and get all the blood work or the scans and have that all looked at that's needed for the workup to even happen. I've spoken with multiple ER doctors at this point, and they all say pretty much the same thing. They see the same scenario happen often enough, maybe even multiple times a day. Patient comes in with something that may or may not be emergent, and they are now in the ER because they've been worried about it for weeks or months. And the ER is like the only place where they can get to the bottom of what is going on with their body. And then the patient, you know, they spend the whole day in the ER getting what amounts to weeks' worth of outpatient workup accomplished and scans and imaging and labs. And there's no prior authing anything down. It's also incredibly expensive. Moving on from the Al Lewis show, earlier than that I had had on Rushika Fernandopulle, MD (EP460) and then also Scott Conard, MD (EP462). Both are PCPs, both talking about primary care and what makes good primary care and what makes bad primary care and how our current “healthcare marketplace,” as Dr. Conard puts it, incentivizes either no primary care and/or primary care where volume driven throughput is the name of the game—you know, like seeing 25 patients a day. These visits or episodes of care are often pretty transactional. If relationships are formed, it's because the doctor and/or the patient are rising above the system, not the other way around. And none of that is good for primary care doctors, nurses, or other clinicians. It's also not good for patients, and it's not good for plan sponsors or any of the ultimate purchasers here (taxpayers, patients themselves) because while all of this is going on, those patients getting no or not good primary care are somebody's next high-cost claimant. Okay, so those were the shows with Rushika Fernandopulle and Scott Conard. Then this past week was the show with Vivian Ho, PhD (EP466), who discusses the incentives that hospital leadership often has. And these incentives may actually sound great on paper, but IRL, they wind up actually jacking up prices and set up some weird incentives to increase the number of beds and the heads in them. There was also two shows, one of them with Betsy Seals (EP463) and then another one with Wendell Potter (EP384), about Medicare Advantage and what payers are up to. Alright, so let's dig in. What's the big theme? What's the big through line here? Let's take it from the top. Theme 1 is largely this (and Scott Conard actually said this flat out in his show): Primary care—good primary care, I mean—is an investment. Everything else is a cost. And those skyrocketing ER costs are pure evidence of this. Again, listen to that show with Al Lewis earlier (EP464) for a lot of details about this. But total plan costs … 6% are ER visits. Tim Denman from Premise Health wrote, “That is an insane number! Anything over 2% warrants concern.” But yeah, these days we have, on average across the country, 200 plan members out of 1000 every single year dipping into their local ER. That number, by the way, will rise and fall depending on the access and availability of primary care and/or good urgent cares. Here's from a Web site entitled ER Visit Statistics, Facts & Trends: “In the United States, emergency room visits often highlight gaps in healthcare accessibility. Many individuals turn to ERs for conditions that could have been managed through preventative or primary care. … This indicates that inadequate access to healthcare often leads to increased reliance on emergency departments. … “ED visits can entail significant costs, particularly when a considerable portion of these visits is classified as non-urgent. … [Non-urgent] visits—not requiring immediate medical intervention—often lead to unnecessary expenditures that could be better allocated in primary care settings.” And by the way, if you look at the total cost across the country of ER visits, it's billions and billions and billions of dollars. In 2017, ED visits (I don't have a stat right in front of me), but in 2017, ED visits were $76.3 billion in the United States. Alright, so, the Al Lewis show comes out, I see that, and then, like a bolt of lightning, François de Brantes, MBA, enters the chat. François de Brantes was on Relentless Health Value several years ago (EP220). I should have him come back on. But François de Brantes cemented with mortar the connectivity between runaway ER costs and the lack of primary care. He started out talking actually about a new study from the Milbank Memorial Fund. Only like 5% of our spend going to primary care is way lower than any other developed country in the world—all of whom, of course, have far higher life expectancies than us. So, yeah … they might be onto something. François de Brantes wrote (with some light editing), “Setting aside the impotence of policies, the real question we should ask ourselves is whether we're looking at the right numbers. The short answer is no, with all due respect to the researchers that crunched the numbers. That's probably because the lens they're using is incredibly narrow and misses everything else.” And he's talking now about, is that 5% primary care number actually accurate? François de Brantes continues, “Consider, for example, that in commercially insured plans, the total spend on … EDs is 6% or more.” And then he says, “Check out Stacey Richter's podcast on the subject, but 6% is essentially what researchers say is spent on, you know, ‘primary care.' Except … they don't count those costs, the ER costs. They don't count many other costs that are for primary care, meaning for the treatment of routine preventative and sick care, all the things that family practices used to manage but don't anymore. They don't count them because those services are rendered by clinicians other than those in primary care practice.” François concludes (and he wrote a great article) that if you add up all the dollars that are spent on things that amount to primary care but just didn't happen in a primary care office, it's conservatively around 17% of total dollars. So, yeah … it's not like anyone is saving money by not making sure that every plan member or patient across the country has a relationship with an actual primary care team—you know, a doctor or a nurse who they can get on the phone with who knows them. Listen to the show coming up with Matt McQuide. This theme will continue. But any plan not making sure that primary care happens in primary care offices is shelling out for the most expensive primary care money can buy, you know, because it's gonna happen either in the ER or elsewhere. Jeff Charles Goldsmith, PhD, put this really well. He wrote, “As others have said, [this surge in ER dollars is a] direct consequence of [a] worsening primary care shortage.” Then Dr. John Lee turned up. He, I had quoted on the Al Lewis show, but he wrote a great post on LinkedIn; and part of it was this: “Toward a systemic solution, [we gotta do some unsqueezing of the balloon]. Stacey and Al likened our system to a squeezed balloon, with pressure forcing patients into the [emergency room]. The true solution is to ‘unsqueeze' the system by improving access to care outside the [emergency room]. Addressing these upstream issues could prevent patients from ending up in the [emergency room]. … While the necessary changes are staring us in the face, unsqueezing the balloon is far more challenging than it sounds.” And speaking of ER docs weighing in, then we had Mick Connors, MD, who left a banger of a comment with a bunch of suggestions to untangle some of these challenges that are more challenging than they may sound at first glance that Dr. Lee mentions. And as I said, he's a 30-year pediatric emergency physician, so I'm inclined to take his suggestions seriously. You can find them on LinkedIn. But yeah, I can see why some communities are paying 40 bucks a month or something for patients without access to primary care to get it just like they pay fire departments or police departments. Here's a link to Primary Care for All Americans, who are trying to help local communities get their citizens primary care. And Dr. Conard talked about this a little bit in that episode (EP462). I can also see why plan sponsors have every incentive to change the incentives such that primary care teams can be all in on doing what they do. Dr. Fernandopulle (EP460) hits on this. This is truly vital, making sure that the incentives are right, because we can't forget, as Rob Andrews has said repeatedly, organizations do what you pay them to do. And unless a plan sponsor gets into the mix, it is super rare to encounter anybody paying anybody for amazing primary care in an actual primary care setting. At that point, Alex Sommers, MD, ABEM, DipABLM, arrived on the scene; and he wrote (again with light editing—sorry, I can't read), “This one is in my wheelhouse. There is a ton that could be done here. There just has to be strategy in any given market. It's a function of access, resources, and like-minded employers willing to invest in a direct relationship with providers. But not just any providers. Providers who are willing to solve a big X in this case. You certainly don't need a trauma team on standby to remove a splinter or take off a wart. A great advanced primary care relationship is one way, but another thing is just access to care off-hours with the resources to make a difference in a cost-plus model. You can't help everybody at once. But you can help a lot of people if there is a collaborative opportunity.” And then Dr. Alex Sommers continues. He says, “We already have EKG, most procedures and supplies, X-ray, ultrasounds, and MRI in our clinics. All that's missing is a CT scanner. It just takes a feasible critical mass to invest in a given geography for that type of alternative care model to alter the course here. Six percent of plan spend going to the ER. My goodness.” So, then we have Ann Lewandowski, who just gets to the heart of the matter and the rate critical for primary care to become the investment that it could be: trust. Ann Lewandowski says, “I 100% agree with all of this, basically. I think strong primary care that promotes trust before things get so bad people think they need to go to the emergency room is the way to go.” This whole human concept of trust is a gigantic requirement for clinical and probably financial success. We need primary care to be an investment, but for it to be an investment, there's got to be relationships and there has to be trust between patients and their care teams. Now, neither relationships nor trust are super measurable constructs, so it's really easy for some finance pro to do things in the name of efficiency or optimization that undermine the entire spirit of the endeavor without even realizing it. Then we have a lot of primary care that doesn't happen in primary care offices. It happens in care settings like the ER. So, let's tug this theme along to the shows that concern carriers, meaning the shows with Wendell Potter (EP384) on how shareholders influence carrier behavior and with Betsy Seals (EP463) on Medicare Advantage plans and what they're up to. Here's where the primary care/ER through line starts to connect to carriers. Here's a LinkedIn post by the indomitable Steve Schutzer, MD. Dr. Schutzer wrote about the Betsy Seals conversation, and he said, “Stacey, you made a comment during this fabulous episode with Betsy that I really believe should be amplified from North to South, coast to coast—something that unfortunately is not top of mind for many in this industry. And that was ‘focus on the value that accrues to the patient'—period, end of story. That is the north star of the [value-based care] movement, lest we forget. Financial outcome measures are important in the value equation, but the numerator must be about the patient. As always, grateful for your insights and ongoing leadership.” Oh, thank you so much. And same to you. Grateful for yours. Betsy Seals in that podcast, though, she reminded carrier listeners about this “think about the value accruing to the patient” in that episode. And in the Wendell Potter encore that came out right before the show with Betsy, yeah, what Wendell said kind of made me realize why Betsy felt it important to remind carriers to think about the value accruing to patients. Wall Street rewards profit maximization in the short term. It does not reward value accruing to the patient. However—and here's me agreeing with Dr. Steve Schutzer, because I think this is what underlies his comment—if what we're doing gets so far removed from what is of value to the patient, then yeah, we're getting so removed from the human beings we're allegedly serving, that smart people can make smart decisions in theoretical model world. But what's being done lacks a fundamental grounding in actual reality. And that's dangerous for plan members, but it's also pretty treacherous from a business and legal perspective, as I think we're seeing here. Okay, so back to our theme of broken primary care and accelerating ER costs. Are carriers getting in there and putting a stop to it? I mean, as aforementioned about 8 to 10 times, if you have a broken primary care system, you're gonna pay for primary care, alright. It's just gonna be in really expensive care settings. You gotta figure carriers are wise to this and they're the ones that are supposed to be keeping healthcare costs under control for all America. Well, relative to keeping ER costs under control, here's a link to a study Vivian Ho, PhD, sent from Health Affairs showing how much ER prices have gone up. ER prices are way higher than they used to be. So, you'd think that carriers would have a huge incentive to get members primary care and do lots and lots of things to ensure that not only would members have access to primary care, but it'd be amazing primary care with doctors and nurses that were trusted and relationships that would be built. It'd be salad days for value. Except … they're not doing a whole lot at any scale that I could find. We have Iora and ChenMed and a few others aside. These are advanced primary care groups that are deployed by carriers, and these organizations can do great things. But I also think they serve—and this came up in the Dr. Fernandopulle show (EP460)—they serve like 1% of overall patient populations. Dr. Fernandopulle talked about this in the context of why these advanced primary care disruptors may have great impact on individual patients but they have very little overall impact at a national scale. They're just not scaled, and they're not nationwide. But why not? I mean, why aren't carriers all over this stuff? Well, first of all—and again, kind of like back to the Wendell show (EP384) now—if we're thinking short term, as a carrier, like Wall Street encourages, you know, quarter by quarter, and if only the outlier, mission-driven folks (the knights) in any given carrier organization are checking what's going on actually with plans, members, and patients like Betsy advised, keep in mind it's a whole lot cheaper and it's easier to just deny care. And you can do that at scale if you get yourself an AI engine and press Go. Or you can come up with, I don't know, exciting new ways to maximize your risk adjustment and upcoding. There's an article that was written by Sergei Polevikov, ABD, MBA, MS, MA

In this episode, Stacey Richter explores how the demands of shareholders influence the actions of publicly traded health insurance companies with guest Wendell Potter. Drawing from Milton Friedman's assertion that a business's primary responsibility is to its shareholders, we examine the implications of this philosophy in the healthcare sector. The discussion highlights concerns about fraud allegations among major insurers and the lack of open competition due to market consolidation.  We delve into the concept of the “medical loss ratio,” a key metric for investors, and how it pressures insurers to prioritize profits, often at the expense of patient care. Our guest, Wendell Potter, a former health insurance executive turned advocate for healthcare reform, provides insider insights into these dynamics. He discusses the challenges insurers face in controlling costs, the impact of rising premiums, and the broader consequences for patients and the healthcare system. This episode offers a critical look at the intersection of corporate interests and patient care, shedding light on the systemic issues that arise when profit motives drive healthcare decisions.   All mentioned links can be found in the show notes.  === LINKS ===

The murder of UnitedHealthcare's CEO on a Midtown Manhattan street “unleashed,” the New York Times reported, “a torrent of morbid glee from patients and others who say they have had negative experiences with health insurance companies at some of the hardest times of their lives.” Some comments were, “Thoughts and deductibles to the family.” Another one said, “Unfortunately, my condolences are out of network.” The dark commentary highlighted deep anger over the state of health insurance. Millions can't afford it and go without it. And many who are on some plan have inadequate coverage with high deductibles. The answer, Ralph Nader says, is single-payer: “Everybody in, nobody out.” That would bring down prices. But the handful of corporations monopolizing the health insurance industry don't want that. Why? That would cut into their profits. So, the insanity continues.

How is the Department of Veterans Affairs becoming increasingly privatized and what could this mean for those who have served and sacrificed for our country? Is corporate health insurance better than the VA healthcare system - or not? How is privatization affecting the financial viability of the VA -- and what can be done to stop it? To find out, we recently spoke to Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered where he recently penned a post entitled “Privatizing the VA: The Unseen Costs to Veterans and Taxpayers Alike.”

This time on Code WACK! How is the Department of Veterans Affairs becoming increasingly privatized and what could this mean for those who have served and sacrificed for our country? Is corporate health insurance better than the VA healthcare system - or not? How is privatization affecting the financial viability of the VA -- and what can be done to stop it? To find out, we recently spoke to Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered where he recently penned a post entitled “Privatizing the VA: The Unseen Costs to Veterans and Taxpayers Alike.”

This time on Code WACK!    How is the Department of Veterans Affairs becoming increasingly privatized and what could this mean for those who have served and sacrificed for our country? Is corporate health insurance better than the VA healthcare system - or not? How is privatization affecting the financial viability of the VA -- and what can be done to stop it? To find out, we recently spoke to Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered where he recently penned a post entitled “Privatizing the VA: The Unseen Costs to Veterans and Taxpayers Alike.”   Check out the Transcript and Show Notes for more!

Why have U.S. administrations from both sides of the aisle chosen to privatize Medicare and how has that complicated health care for patients? How do mega insurance companies benefit as a result? How much is all this costing us, anyway? And what can we do about it? To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.

This time on Code WACK!    Why have U.S. administrations from both sides of the aisle chosen to privatize Medicare and how has that complicated health care for patients? How do mega insurance companies benefit as a result? How much is all this costing us, anyway? And what can we do about it? To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.  Check out the Transcript and Show Notes for more!

This time on Code WACK! Why have U.S. administrations from both sides of the aisle chosen to privatize Medicare and how has that complicated health care for patients? How do mega insurance companies benefit as a result? How much is all this costing us, anyway? And what can we do about it? To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.

MSNBC's Ari Melber hosts "The Beat" on Thursday, January 2, and reports on the New Orleans truck attack, Congress and SCOTUS. Wendell Potter, Bill Kristol, Frank Figliuzzi and Cynthia Miller-Idriss join.

Wendell Potter, Fmr Health Insurance Exec & Healthcare Advocate, on the Medicare Advantage Fraud. Dr. Omekongo Dibinga discusses 'Lies About Black People' & and the state of our politics. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE

Join me for my next live video in the app* Humanity's Chance to Reverse Amazon's Slide Toward Tipping Point Is ‘Shrinking': The world's largest rainforest showed “ominous indicators,” including wildfires and extreme drought, in 2024. [More]* Dr. Omekongo Dibinga discusses ‘Lies About Black People' & and the state of our politics: Dr. Omekongo Dibinga, author of “Lies About Black People,” visited to discuss the election, the state of our politics, and his recent book. [More]* Wendell Potter, Fmr Health Insurance Exec & Healthcare Advocate, on the Medicare Advantage Fraud: Former Health Insurance Executive and healthcare Advocate Wendell Potter visited with us to highlight the failure of Medicare Advantage in particular and our healthcare system in general. [More] To hear more, visit egberto.substack.com

Private health insurance companies are in the spotlight, as public frustration with the American health system grows. Wendell Potter was once vice president of Cigna, until the work convinced him to quit the industry completely. In a recent op-ed, Potter highlights the pressure shareholders have placed on public health companies, and where the industry can go from here. Next, The Wall Street Journal's Joanna Stern shares her top tech gift ideas for last-minute holiday shoppers. On her list are yearly digital subscriptions and paid password managers. Plus, lawmakers avoided a government shutdown, President-elect Trump has new picks for his administration, and the Lion King prequel fell flat during its box office opening weekend. Emily Wilkins - 02:28Wendell Potter - 14:37Joanna Stern - 23:45 In this episode:Wendell Potter, @wendellpotterJoanna Stern, @JoannaSternJoe Kernen, @JoeSquawkAndrew Ross Sorkin, @andrewrsorkinCameron Costa, @CameronCostaNY

Stand Up is a daily podcast that I book,host,edit, post and promote new episodes with brilliant guests every day. Please subscribe now for as little as 5$ and gain access to a community of over 700 awesome, curious, kind, funny, brilliant, generous souls Check out StandUpwithPete.com to learn more GET TICKETS TO PODJAM II In Vegas March 27-30 Today I have 2 great guests. I was unable to produce the good stuff and news again but I think you will like both of my guests. My talk with Rothkopf begins at 32 mins Following a 20-year career as a corporate public relations executive, Wendell Potter left his position as head of communications for CIGNA, one of the nation's largest health insurers, to show the world the dark inner workings of the insurance industry. Check out his Substack  Check out his new documentary : American Hospitals: Healing a Broken System   healthcareuncovered.substack.com He has testified before Senate and House committees, briefed several members of Congress and their staffs, appeared with lawmakers at several press conferences, spoken at more than 100 public forums, and has been the subject of numerous articles in the U.S. and foreign media. His recent book – Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans – is an expose of health insurers and a stark warning that corporate spin is distorting our democracy. Currently a senior analyst at the The Center for Public Integrity, a non-partisan nonprofit that produces original, responsible investigative journalism on issues of public concern, Wendell is also the senior fellow on health care for the Center for Media and Democracy, an independent, non-partisan public interest organization. He speaks out on the need for a fundamental overhaul of the American health care system and on the dangers to American democracy and society of the decline of the media as watchdog, which has contributed to the growing and increasingly unchecked influence of corporate PR. He also serves as a consumer liaison representative for the National Association of Insurance Commissioners. Subscribe to Rothkopf's new Substack  https://davidrothkopf.substack.com/ Follow Rothkopf Listen to Deep State Radio Read Rothkopf at The Daily Beast Buy his books David Rothkopf is CEO of The Rothkopf Group, a media company that produces podcasts including Deep State Radio, hosted by Rothkopf. TRG also produces custom podcasts for clients including the United Arab Emirates. He is also the author of many books including Running the World: The Inside Story of the National Security Council and the Architects of American Power, Superclass, Power, Inc., National Insecurity, Great Questions of Tomorrow, and Traitor: A History of Betraying America from Benedict Arnold to Donald Trump. Pete on Threads Pete on Tik Tok Pete on YouTube Pete on Twitter Pete On Instagram Pete Personal FB page Stand Up with Pete FB page All things Jon Carroll Follow and Support Pete Coe Buy Ava's Art

The recent coverage around the healthcare industry from major media outlets has left me...wanting. So given this news cycle, I wanted to talk about some of the most relevant misconceptions around healthcare (and what they teach us). I'm joined by Wendell Potter, an ex-Cigna VP-turned-whistleblower and healthcare reform advocate, and he shares some eye-opening insights from his time in the space. Transcripts, show notes, production credits, and more can be found at: https://moneywithkatie.com/healthcare. Money with Katie's mission is to be the intersection where the economic, cultural, and political meet the tactical, practical, personal finance education everyone needs. Learn more about your ad choices. Visit megaphone.fm/adchoices

The murder of UnitedHealthcare CEO Brian Thompson has revealed a simmering anger with the American healthcare system in the spotlight. William Brangham discussed more with Wendell Potter. He spent decades working for the health insurance company, Cigna, before leaving and dedicating his career to reform. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Amid the shocking assassination of a health insurance executive and an upswell of anger towards the country's fragile health care safety net, the health insurance industry is suddenly facing a reckoning. Among the best experts to make sense of it all is Wendell Potter.When Wendell Potter left his job as a public relations executive for a health insurance company he was sure of one thing: his former employer was harming people every day. Potter, a former vice president of the insurance giant Cigna, became a whistleblower over a decade ago, and though he does not condone the recent murder of UnitedHealthcare CEO Brian Thompson, he understands the fury many in the country feel towards the insurance industry. Today on Lever Time, Potter shares what he learned about how insurance companies hurt patients and more than a decade as an insurance industry insider. Journalist Jonathan Cohn, a veteran health care reporter and the author of the book The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, also joins the show to unpack the decades-long political battle to reform the health care industry. 

The murder of UnitedHealthcare CEO Brian Thompson has revealed a simmering anger with the American healthcare system in the spotlight. William Brangham discussed more with Wendell Potter. He spent decades working for the health insurance company, Cigna, before leaving and dedicating his career to reform. PBS News is supported by - https://www.pbs.org/newshour/about/funders

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This time on Code WACK! Why have healthcare giants like United Health and Cigna been purging some of their commercial accounts and pivoting to government-funded programs like Medicare Advantage and Medicaid? How is this affecting patients? And what is the government doing about it? To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions. Check out the Transcript and Show Notes for more!

This time on Code WACK! Why have healthcare giants like United Health and Cigna have been purging some of their commercial accounts and pivoting to government-funded programs like Medicare Advantage and Medicaid? How is this affecting patients? And what is the government doing about it? To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.

This time on Code WACK!  Why have healthcare giants like United Health and Cigna been purging some of their commercial accounts and pivoting to government-funded programs like Medicare Advantage and Medicaid? How is this affecting patients? And what is the government doing about it?  To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He's also the author of the Substack newsletter HEALTH CARE un-covered which chronicles out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.  Check out the Transcript and Show Notes for more!

It's that time of year again... open enrollment for Medicare and just a week away for the ACA. With your life on the line, it's important to know your options. So I'm thrilled that the health insurance industry whistleblower Wendell Potter returns to the show today to answer your questions and give you actual facts.You should also be reading Wendell Potter's "Healthcare Un-Covered" newsletter by subscribing to healthcareuncovered.substack.com!

I get the dirt from WENDELL POTTER about our broken healthcare system, especially the role of insurance companies, who consistently put profit above the health and lives of patients. Potter walked away from his job at one of the country's largest health insurers to emerge as a critic of the industry and an advocate of reform. He's a best-selling author (DEADLY SPIN  and NATION ON THE TAKE), leads the Center for Health and Democracyand publishes HealthCareUncovered on Substack. You can learn more at wendellpotter.com

This is episode 113, “The Missing Criteria for Health Insurance Companies.” Do not miss this episode as host Joe Sparks explains that health  insurance companies are concerned with profits and are using AI to increase profits by denying care. Instead, insurance companies should be evaluated on how well they cover costs for treatment.  Here are the articles referenced in this podcast.  As UnitedHealth and Cigna are Sued for AI-Based Claims Denials, Documents Suggest Major AI Expansion Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need Here is Wendell Potter's news site referenced in this podcast, HEALTH CARE un-covered. I highly recommend it. Please consider subscribing to this news site.   

Health Insurance Company Whistle Blower Wendell Potter destroys Medicare Advantage for the fraud it is. Joy-Ann Reid discusses manufactured consent. Corporatized dialysis is killing people. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE

Yesterday, the HEALTH CARE un-covered Newsletter arrived in my inbox, sporting the headline "Fifteen Years Ago Today I Became a Whistleblower". It was from Wendell Potter who remains a hero to all of us in the US, whether you know it or not. I was fortunate to first interview Wendell on Air America Radio in August of 2009, just two months after he testified before the Senate Commerce, Science and Transportation Committee, pulling back the curtain from around the industry for which he carried water and covered up unethical practices. A few months later, he would testify before the House and became the most important voice for the masses, just as then president Obama was helping to push through the first health care industry reforms in decades. Fifteen years ago. And though things are better for us mere mortals who will, at some point, need medical care, we're still fighting nefarious forces in the health insurance and so-called health care industries as well as in government. And Wendell continues to fight for us. Wendell Potter has been a frequent guest on this program since that first appearance 15 years ago and I'm proud to consider him a friend. I invited him back to today to talk about the problems we're still faced with and to thank him, again, for standing up for us. --- Send in a voice message: https://podcasters.spotify.com/pod/show/nicolesandler/message

For a full transcript of this episode, click here. Here's a great musing that I read on LinkedIn: How will alternative primary care models fare when growth mode gets balanced with profitability and VC-supported burn rate is transformed to Big Retail bottom-line expectations? Mission v. margin. I'm gonna add to this: How will alternative primary care models, or even just doing good primary care, fare when it encounters the current system rife with perverse incentives of all kinds, including, yeah, for sure, Big Retail bottom-line expectations but also Big Health System and Big Payer bottom-line expectations and current business models? This show from last year was wildly popular—maybe one of our most popular shows—and relisten to it in the current context of what's going on right now in the primary care and MSO (Managed Services Only) space. Coming up, I'm gonna probably do a whole show on this if I can get my act together; but this encore is really relevant right now. One piece of podcast business before we get into the episode: Please sign up for our weekly email if you haven't already, especially if you consider yourself part of the Relentless Health Tribe. I am mentioning this not only because it's a great way to keep track of our shows because you can do an email search to remember where you heard something, since a good deal of the show intros are in the emails, but also, there's a plan afoot to hold some Zoom meetings to talk about different topics etc—and you won't be notified of such goings-on unless you're subscribed. You can unsubscribe whenever you want, by the way; and I am way too busy to send more than one email a week or spam if that was a concern. On Relentless Health Value, I don't often get into our guests' personal histories. There are a bunch of reasons for this, which, if you buy me beer, we can talk podcast philosophy and I will tell you all about my personal, very arguable opinion here. Nevertheless, in this healthcare podcast, we are going rogue; and I am talking with Scott Conard, MD, who shares his personal story. You may ask why I decided to go this route for this particular episode, and I will tell you point-blank that Dr. Conard's experience, his narrative, is like the perfect analogue (Is analogue the right word [allegory, composite example]?). His story just sums up in a nutshell what happens when a PCP (primary care provider) does the right thing, manages to improve patient care for real, and then at some point gets sucked into the intrigue and gambits and maneuvering that is, sadly, the business of healthcare in the United States today. Before we kick in, I just want to highlight a statement that Scott Conard makes toward the end of the show. He says: So, this isn't about punishing or blaming aspects of care that are being overrewarded today. It's really about what's the path forward for corporations, for middle-class Americans, and for primary care doctors who don't choose to be part of a big system. We have to figure out how to solve this problem. I hope people don't hear this and think that there are horrible people at some not-for-profit hospital systems, for example. There are some great people at not-for-profit health systems, but they have some really screwed-up incentives. A few notable notes from Dr. Scott Conard's journey and words of wisdom that I will just highlight up front here: He says that as a PCP, you actually can produce high-value care in a fee-for-service model … if you think differently and you change practice patterns. I have heard this from others as well, including most recently David Muhlestein, PhD, JD, who says this in an episode (EP393). As Dr. Scott Conard says later in this episode, healthcare organizations must embrace the art of medical leadership. So, I guess that's a spoiler alert there. Another point that Dr. Conard makes very crisply toward the end of the show is that doctors can kinda get pushed and pulled around in this mix. You have docs just trying to provide good care, and they work for one entity that gets bought and now it's some other entity … and what's happening upstairs and the prices being charged or somebody somewhere deciding not to make prices transparent, or deciding to sue low-income patients for unpaid medical bills or what charity care to offer or not to offer. These are not doctors in clinics making these calls, and we need to be careful here not to homogenize what some of these health systems are choosing to do like some kind of democratic vote was taken by everybody who works there. Health systems, hospitals, are many-celled complex entities. And a third takeaway—there are a bunch of takeaways in this show, but a third one I'll highlight here from Dr. Conard's story—is the old fiduciary responsibility code word being used by health system administrators as a euphemism for strategies that might need a euphemistic code word because the strategy has questionable community benefit. In the case study that we talk about today, the local health system managed to raise healthcare spend in North Texas by $100 million year over year. Employers and employees in North Texas communities wound up paying $100 million more year over year in healthcare one particular year. This was prices going up. It also was removing a big systemic initiative to keep heads out of hospital beds. Reiterating here, we are not talking about doctors here particularly because, of course, the vast majority of doctors are trying to prevent avoidable hospitalizations. But suddenly in North Texas, physicians did not have the population health efforts and the team really standing behind them helping to prevent avoidable hospitalizations. That sucks for everybody trying to do the right thing, and, as has been said, burnout is moral injury in a cheap Halloween costume. Moral injury happens when you have good people, clinicians, doctors, and others who realize that what is going on, at best, is not helping the patient. Also mentioned in this episode are Benjamin Schwartz, MD, MBA; David Muhlestein, PhD, JD; Brian Klepper, PhD; Al Lewis; Robert Pearl, MD; Karen Root, MBA, CCXP; and Wendell Potter.   You can learn more by emailing Dr. Conard at scott.conard@converginghealth.com.   Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment. Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk–reducing interventions. Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members' experience. Through Dr. Conard's work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients.   06:54 What triggered Scott's career journey? 07:31 What caused Scott to rethink what is good primary care? 08:11 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms? 09:25 EP335 with Brian Klepper, PhD. 09:53 How did Scott's practice change after this realization? 10:04 What is a “Whole-Person Risk Score”? 11:08 Scott's book, The Seven Numbers (That Will Save Your Life). 13:05 “You start to move from a transactional model to a relationship model.” 15:31 Did Scott have any risk-based contracts? 16:08 Why is it so important to look at total cost of care and not just primary care cost? 21:08 Scott's book, The Art of Medical Leadership. 22:13 EP381 with Karen Root. 30:43 Why did Scott move over to help corporations? 33:10 EP364 with David Muhlestein, PhD, JD. 33:51 “Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned.” 34:31 EP384 with Wendell Potter. 34:43 “It's the system that's broken; it's not bad people.”   You can learn more by emailing Dr. Conard at scott.conard@converginghealth.com.   @ScottConardMD discusses #primarycare #marginvsmission on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Jerry Durham, Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen

America Out Loud PULSE with Dr. Marilyn Singleton – The insurance industry is built on the fact that life is uncertain, and insurance will soften the blow of life's unexpected events. The insurance market in the United States is one of the largest in the world. In 2022, Insurance premiums amounted to $1.48 trillion. The health insurance industry alone had net earnings of $31 billion in profits in 2020. About 8 percent of Americans are uninsured...

America Out Loud PULSE with Dr. Marilyn Singleton – The insurance industry is built on the fact that life is uncertain, and insurance will soften the blow of life's unexpected events. The insurance market in the United States is one of the largest in the world. In 2022, Insurance premiums amounted to $1.48 trillion. The health insurance industry alone had net earnings of $31 billion in profits in 2020. About 8 percent of Americans are uninsured...

Healthcare professionals have long thought that insurance companies were lying to us. According to our next guest, we're right. Wendell Potter, former Senior VP of CIGNA, opens up about 'how health insurers make promises they have no intention of keeping, flout regulations designed to protect consumers, and skew political debate with multibillion-dollar PR campaigns to mislead the press and public.'

Why is it separate from medical insurance? And is it really insurance at all? Zachary Crockett goes in for a cleaning. SOURCES:Brad Bolman, postdoctoral member of the School of Historical Studies at the Institute for Advanced Study.Pamela Maragliano-Muniz, prosthodontist and chief editor for Dental Economics.Wendell Potter, president of the Center for Health and Democracy; former executive at Cigna. RESOURCES:"Dental Medical Loss Ratios: Understanding the Landscape in Massachusetts and Beyond," by Shaza Stevenson, Megan D'Alessandro, Sandra Wilkniss, and Nicole Evans (National Academy for State Health Policy Blog, 2023)."Health Insurance Coverage in the United States: 2021," by Katherine Keisler-Starkey and Lisa N. Bunch (U.S. Census Bureau Reports, 2022)."Medicare and Dental Coverage: A Closer Look," by Meredith Freed, Nancy Ochieng, Nolan Sroczynski, Anthony Damico, and Krutika Amin (KFF, 2021)."Dentists' Group Fights Plan to Cover Dental Benefits Under Medicare," by Julie Bykowicz (The Wall Street Journal, 2021)."Antisocial Dentistry," by Brad Bolman (Hypocrite Reader, 2021). EXTRAS:"'Insurance Is Sexy.' Discuss," by Freakonomics Radio (2023)."Does Health Insurance Make You Healthier?" by Freakonomics, M.D. (2022).

GOP Rep. Tony Gonzales' endorsement of Trump is an embarrassment for Texas. Wendell Potter explains the failure of American healthcare and Medicare Advantage. Christie's epic exit from GOP primary. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message

Rep. Jasmine Crockett exposes Trump's affinity for foreign money from China. Stephanopoulos exposed Rep. Tony Gonzales as a real Trump sycophant. Health insurance whistle-blower Wendell Potter speaks. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message

Fmr. Congresswoman & fmr. nurse Eddie Bernice Johnson killed by substandard American healthcare? Wendell Potter visits to discuss our scummy healthcare & Medicare Advantage. Great jobs report & more. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message

Former Health Insurance Executive and healthcare Advocate Wendell Potter visited with us to highlight the failure of Medicare Advantage in particular and our healthcare system in general. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message

This time on Code WACK!   Patients aren't the only people who are frustrated with our current healthcare system. So are doctors! Why?  And why doesn't free market capitalism work with health care? To find out, we spoke to award-winning filmmaker Maddy Purves, who is editor of the documentary Healing US narrated by Susan Sarandon, and Laura Fielding, founder of Red Berets for Medicare for All and associate producer of Healing US. This is the second episode in a two-part series.    

It's that time of year again and I'm not talking about Halloween. Open enrollment for Medicare began two weeks ago, and tomorrow (Nov 1), the Obamacare exchanges open for those of us still under 65. Both are like the worst haunted houses to navigate as you never know what scary monsters are hiding in those provisions and plans. So today, our old friend Wendell Potter returns to the show. Wendell is still the only former health insurance executive to become a whistleblower, so we thank him even more for his courage and dedication to informing the public about the horribly deceptive practices of the for-profit health insurance industry. Today, we'll cover exactly what Medicare "Advantage" is and isn't (hint: it's neither Medicare nor is it any advantage!) and hopefully get some advice for those of us navigating that maze. And for those of us unfortunate to not be Medicare eligible yet, we'll discuss the ACA healthcare.gov and state exchanges, and the changes that have been made to the program in the over 10 years (!) it's been up and running. Hopefully Wendell can answer your questions. If time allows, we'll open the phones!

How did UnitedHealth Group, America's largest health insurer by revenue, make billions in profit in the second quarter of 2023? How do UnitedHealth Group, CVS and Cigna control 80 percent of the drug supply market -- and why should we be concerned? To find out, we spoke to Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He is the author of the Substack newsletter HEALTH CARE un-covered which covers out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions. Check out the Transcript and Show Notes for more!

THIS TIME ON CODE WACK! How did UnitedHealth Group, America's largest health insurer by revenue, make billions in profit in the second quarter of 2023? How do UnitedHealth Group, CVS and Cigna control 80 percent of the drug supply market -- and why should we be concerned?  To find out, we spoke with Wendell Potter, a former health insurance industry executive turned whistleblower, the New York Times bestselling author of Deadly Spin and the president of the Center for Health and Democracy. He is the author of the Substack newsletter HEALTH CARE un-covered which covers out-of-control profiteering in U.S. health care, its impact on everyday Americans, and potential policy solutions.  Check out the Transcript and Show Notes for more!  

So I've assembled some shows that really are best ofs to run until I can get my studio set up in a new home…It's the end of September, so pretty soon we'll all be inundated with ads for Medicare Advantage, as Medicare open enrollment begins on Oct 15, thru Dec 7…. Then open enrollment for the ACA begins on Nov 1… To make sure you're informed about what's available and to tell you the truth about so-called Medicare Advantage (neither Medicare nor an advantage), we'll go back to Oct 15 of 2021 and an information packed conversation with health insurance industry whistleblower Wendell Potter….

On this edition of Your Call, we'll discuss the Biden administration's announcement of the first ten prescription drugs, including insulin, that will be subject to price negotiations with Medicare, as part of the 2022 Inflation Reduction Act. The White House projects that the negotiations could save older Americans around $100 billion over the next decade, and reducing the cost of these drugs will help more than 9 million Americans. Senior citizens have paid $3.4 billion in out-of-pocket costs for these 10 medications in the last year. Last year, top insurance company revenues reached $1.25 trillion, with profits reaching $69.3 billion in total, according to former Cigna executive Wendell Potter, who now advocates for healthcare reform. What will it take to counter the powerful influence of the pharmaceutical industry and bring down costs?

In this episode, we dive into our dysfunctional healthcare system with guest Wendell Potter, a former health insurance executive turned whistleblower, advocate for healthcare reform, New York Times best-seller, and documentary producer.We discuss the role of private, for-profit health plans in the U.S. and how they've drained resources from the healthcare system while leaving Americans financially vulnerable and sick. We also touch upon Medicare Advantage (which is neither Medicare, nor an advantage), Medicare for All, “non-profit” hospital systems, and if we'll ever break free from employment-based insurance.Learn more about Wendell's new documentary, American Hospitals: Healing A Broken System.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Wendell Potter, as a former executive at Cigna, has a lot to say on the state of health insurance in this country. His view, from the inside out, is part of a new must-see documentary about democracy and American healthcare. Anyone who has dealt with a health insurance company knows it's enough to make you sick all over again. Along with some shocking insights, Wendell shares two very important things ALL of us need to do to make health insurance actually work for us. All this, while Marissa prepares a blood orange polenta cake. Learn more about your ad choices. Visit megaphone.fm/adchoices

Stand Up is a daily podcast. I book,host,edit, post and promote new episodes with brilliant guests every day. Please subscribe now for as little as 5$ and gain access to a community of over 740 awesome, curious, kind, funny, brilliant, generous souls Check out StandUpwithPete.com to learn more 18 MINS Following a 20-year career as a corporate public relations executive, Wendell Potter left his position as head of communications for CIGNA, one of the nation's largest health insurers, to show the world the dark inner workings of the insurance industry. Check out his new documentary : American Hospitals: Healing a Broken System He has testified before Senate and House committees, briefed several members of Congress and their staffs, appeared with lawmakers at several press conferences, spoken at more than 100 public forums, and has been the subject of numerous articles in the U.S. and foreign media. His recent book – Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans – is an expose of health insurers and a stark warning that corporate spin is distorting our democracy. Currently a senior analyst at the The Center for Public Integrity, a non-partisan nonprofit that produces original, responsible investigative journalism on issues of public concern, Wendell is also the senior fellow on health care for the Center for Media and Democracy, an independent, non-partisan public interest organization. He speaks out on the need for a fundamental overhaul of the American health care system and on the dangers to American democracy and society of the decline of the media as watchdog, which has contributed to the growing and increasingly unchecked influence of corporate PR. He also serves as a consumer liaison representative for the National Association of Insurance Commissioners. 42 MINS Baynard Woods is a writer and journalist based in Baltimore. His work has appeared in The New York Times, The Guardian, The Washington Post, Oxford American Magazine, and many other publications. He is coauthor, with Brandon Soderberg, of I Got a Monster: The Rise and Fall of America's Most Corrupt Police Squad. He has a Ph.D. in philosophy and has worked as an educator in a variety of settings. He has written opera libretti for Rhymes with opera and writes and sings with the Barnyard Sharks. Go watch the new film "I got a monster" Check out all things Jon Carroll Follow and Support Pete Coe Pete on YouTube Pete on Twitter Pete On Instagram Pete Personal FB page

Yeah, so while the commercial payer marketplace is completely boring, the reasons it's boring are not. Let me walk you through this conversation I have in this healthcare podcast with Jacob Asher, MD. First, we establish that the relative number of each carrier's commercial members in California don't seem to change year over year … and this has been true for years. When you rank order carriers by member count, the song remains the same. It's Groundhog Day. Here's a link to the 2022 CHCF (California Health Care Foundation) enrollment almanac, which shows for the large group market, Kaiser has captured and retained just over half of enrollees. Anthem comes in next with 14%, Blue Shield gets 9%, and then bringing up the rear we have UHC, Aetna, Cigna, Centene, and all others in descending order splitting the remaining 21%. Hmmm … intriguing, the whole idea that these relative member counts remain so consistent. Then Dr. Asher and I dissect what is anybody actually doing to cut into the Kaiser market share or try to grab share from the two blues plans, if anything. Dr. Jacob Asher was a great guy to have this conversation with. He was a practicing head and neck surgeon with Kaiser Permanente, and then he also served on the Permanente Medical Group Board of Directors. Then he changed careers and became a full-time health plan chief medical officer for, first, Anthem, then Blue Cross, then Cigna, then UHC (UnitedHealthcare). Now he's “retired” and reflecting back on unsolved and unaddressed issues within healthcare. And we've covered one here: Why is the commercial payer market as boring as it appears to be in California? Now, after I had this conversation with Dr. Asher, I called up Wendell Potter, who everybody already knows (EP384), and Lauren Vela, who everybody also probably already knows, but she has spent her career at various employer coalitions and now works at a big employer transforming their health benefits (and she lives in California). I learned a few things that really helped me frame my thoughts on some of the issues that surfaced in the conversation that I had with Dr. Asher and that you'll hear today. So, let's get to it. Why doesn't the relative market share of the big payers change year over year in California in the commercial space. May I present six reasons: 1. Everybody I talked to—Dr. Asher, Wendell Potter, Lauren Vela—first thing right out of the gate that practically everybody mentioned is employer inertia. Trying to get an employer to switch carriers is like trying to pull Excalibur from its stone. And right, not so surprising, it's disruptive and obnoxious for employees and also benefit teams if carriers are switching all the time. 2. EBCs (employee benefit consultants). They have deals with carriers and others, and they also have a lot of power over employers. Listen to the show with AJ Loiacono (EP379) and Paul Holmes (EP397) for more on this. 3. As Wendell Potter put it, “The commercial market is [as a whole] stagnant. No real growth nationally. And in many states, the real money for carriers is not in the self-funded market; so they don't care much about aggressively competing for market share.” Given that chart that just came out the other day showing the insane relative gross margins that carriers are making on Medicare Advantage patients, which is over double other lines of business … yeah, totally. 4. Just keep this in mind before we barrel into reason #4 here for a stagnant and maybe not exactly competitive market. Kaiser excluded, all of the rest of the California payers have what amounts to largely the same provider network. I'm exaggerating slightly here, but largely the same hospitals, the same consolidated integrated delivery networks. And one thing that's pretty clear (not just in California but across the country): Plans who bring the most members get the best prices from these hospitals and other provider organizations. Also, as Dr. Asher mentions in the show today, he never saw an employer buy on quality. Most were far more concerned about discounts. So, right … we have some circular reasoning here or circular logic. The big plans get the best prices, and then, because they have the best prices, they maintain their market share. But wait … there's more to this one, and it's not just big gets you lower prices. Remember from episode 395 with Brennan Bilberry? He talked about the concept of the Most Favored Nation (MFN) anticompetitive clauses in hospital contracts. This concept is also super relevant here for payers as well if you think about it. This MFN Most Favored Nation anticompetitive clause, this is where a big hospital and “big carrier” have a chat … in a back room. The hospital agrees to not give any other carrier a lower price than the “big carrier.” These MFN clauses are, of course, terrible for competition and plan sponsors and any patient with cost sharing. A lot of states have started to ban, restrict, and limit these clauses. The DOJ brought a case in Michigan about this, and here's a great federal government summary of the problem: “The department and the state of Michigan alleged … that the MFN clauses in [Blue Cross Blue Shield of Michigan's (BCBSM's)] contracts with Michigan hospitals decreased competition among health plans. Some … clauses required hospitals to charge competitors more than the hospitals charged BCBSM, often by a specified percentage. Moreover, BCBSM often agreed to raise the prices that it paid hospitals, in part to obtain [the] MFN clauses.” Oh, hey … I'll let you raise your price so I can have a Most Favored Nation clause, just as long as I get a lower price, which is higher than it was originally. And this was actually back in 2013. I have no insight at all or knowledge, or I am not suggesting in any way that what was going on in Michigan is going on in California. However, this anticompetitive practice is common enough. If you're interested in how common, count the lawsuits. 5. Employers are unaware a lot of times of how they are being charged more than what might be appropriate. And they are largely unaware of options other than Blue Cross, United, Cigna, Aetna … the big payers. 6. As Dr. Asher talks about and which I never really thought about, Kaiser doesn't have Medicaid patients. [Correction: Kaiser does have some Medicaid members—just less than others.] And because their network and hospitals to a large extent are closed, they also don't have uninsured patients to a large extent. So, no charity care to speak of and, therefore (at least as it is posited), they can be cheaper because they don't have to cost offset. So, their price advantage has a structure element here that could make it even more untouchable. So, there's your six reasons. You can start to see basically all of these things solidify into the same thing. It's less about trying to get new business and more about locking in the existing business. It's not really a secret that this market is rock hard. Plans realize that. They realize that the cost of keeping an enrollee is cheaper than acquiring a new enrollee. So, carriers focus sales and marketing efforts on holding on to their existing customers, especially the coveted jumbo accounts. Interestingly (and I was talking about this with Lauren Vela), the more clinical programs a carrier has deployed for an employer, the more the carrier is locked in there. So, the more the clinical value proposition resonates, the more clinical stuff that gets integrated. Changing plans becomes even more disruptive, and employers are even more likely to remain where they are. So, there's more to clinical programs than payers catching themselves a little PMPM (per member per month) something something upcharge recurring revenue or trying to get new business. It's also locking in customer retention. Is any of this specific to California? Some of it is—like a lot of the Kaiser stuff—but most, not. Meaning a lot of the country doesn't exactly have a functioning commercial small group or large group marketplace either. To a certain extent, it's no wonder big employers don't change plans that often. Why would they bother, given probably fairly incremental differences between these big payer carriers? I realize I'm scrambling out on a limb here and making assumptions, but to achieve more than incremental improvements, a BUCA (Blue Cross, United, Cigna, Aetna) would need to invest all kinds of resources into being that shining star. And why would they do that when nobody can take down Kaiser? And for all the reasons that we just talked about, it's a hard row to hoe to grab new clients. There's a lot of ramifications to this, but this show can't be seven hours long.    You can learn more by connecting with Dr. Asher on LinkedIn.   Jacob Asher, MD, completed a residency in otolaryngology–head and neck surgery at the University of California, San Francisco, after receiving degrees from Brown University and the Boston University School of Medicine. Dr. Asher then practiced as an ENT (ear, nose, and throat) surgeon with Kaiser Permanente in Northern California and also served on the board of directors of The Permanente Medical Group, where he focused on physician compensation reform, member satisfaction initiatives, and retirement benefits. After transitioning to full-time health plan management, Dr. Asher served as a California commercial market medical director between 2008 and 2022 for Anthem Blue Cross, Cigna, and UnitedHealthcare. In those roles, he supported membership growth and retention in both fully insured and self-funded product lines and promoted value-based reimbursement, including capitation. He has led utilization management teams, collaborated with internal and external population healthcare advocates, and worked to develop clinical initiatives that sought to achieve the Triple Aim. In his role as the clinical face of the health plan to the local market, he worked with network colleagues on accountable care organization partnerships and hospital and physician contract renewals with integrated pay for performance, supported Obamacare exchange participation, engaged in quality improvement collaboratives, and supported regulatory compliance efforts. Currently, Dr. Asher is serving as a mentor for the Stanford Master in Medical Informatics program while exploring innovative solutions to healthcare delivery.   10:00 What is the competitive picture of California's health plans? 11:28 What was everyone doing in order to get market share? 15:07 EP387 with Betsy Seals. 15:22 EP379 with AJ Loiacono and EP397 with Paul Holmes. 15:26 Why is it difficult to take market share? 16:16 Who was Dr. Asher pitching to and why? 18:49 Did employers ever buy plans for quality? 22:43 What does this look like from the payer perspective? 27:01 What improvements have there been to engagement in health plans? 29:07 Have plans gotten better at communicating with employers? 30:38 Why is it hard to compare the Kaiser world to the non-Kaiser world? 33:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.   You can learn more by connecting with Dr. Asher on LinkedIn.   @JacobAsher18 discusses California's #commercialpayer marketplace on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak  

Thanks, shurx, for this review on iTunes entitled “Prepare to Learn.” Shurx wrote: “[RHV] provides key insight from experts that you won't find anywhere else. It paints the picture of how our healthcare is tangled, and who benefits because of it. Whether it's drug pricing, PBM shenanigans, hospital billing, or market trends that are challenging the status quo, this podcast is worth your time. I've shared many of the episodes with my pharmacy colleagues who have replied, ‘I didn't know that's how it worked.' Now they do thanks to Stacey and her team.” I wanted to kick off this particular show with this review because today we are again digging into the business of hospital care in this country. That's actually how Sanat Dixit, MD, MBA, FACS, put it on LinkedIn recently. He said some of the hospitals these days aren't in the healthcare business; they're in the hospital care business. And when I say some hospitals, I mean some people in decision-making roles at some hospitals. There was an opinion piece in the New York Times the other day by Eric Reinhart, and here's my highlight from his essay. He writes, “But the burnout rhetoric misses the larger issue in this case: What's burning out health care workers is less the grueling conditions we practice under, and more our dwindling faith in the systems for which we work.” Relentless Health Value is here so that our Relentless Tribe has the information that you need to influence what goes on in some of the boardrooms where some of these decisions are being made. With that, let's move on. You know why my guest, Brennan Bilberry, got into his current line of work battling hospital chain anticompetitive practices? He got into it because this behavior, which is normalized in healthcare, would never be tolerated in any other sector of the economy. No one would get away with it because these anticompetitive practices are, hey, anticompetitive. They spell the death of functioning markets. We kick off our conversation, Brennan and I, going through the typical hospital system consolidation playbook and how anticompetitive practices are kinda part of the typical gig here. It's quite clever, by the way, for hospital system executives to think this way. I mean, it's illicit and, some would say, unethical but clever if your main metric is revenue maximization. Anticompetitive contract terms are, after all, a flywheel. You consolidate to get enough market power to effectively force everyone to sign your anticompetitive contracts. And then step two: After that, you break out your anticompetitive contract terms spatula and you scrape out any remaining competition from your area. Which leads you to step three: Rub your hands together and raise prices and donate to politicians so legislation becomes even less likely. And then step four: Continue to raise your prices. Don't you love it when a plan comes together? In this healthcare podcast with Brennan Bilberry, we talk about four contract terms that any self-respecting anticompetitive hospital contract should include and how each of them restricts competition unfairly and causes higher prices for communities, taxpayers, patients, employers … basically everybody, including people who work at the health system, who wind up needing medical care. In a nutshell, here's the four anticompetitive contract terms that we dig into in this episode: All-or-nothing contracting, wherein a hospital system says if you want us in your network, you must include every single facility that we have in your network and at the monopoly-level prices we demand, even in areas that might be competitive. There is a reason why a hospital system might be all hachi machi to buy a rando not super profitable hospital in a rural area. The payer must include that hospital in their network then because of network adequacy or whatever. And then from then on, all of their care settings are now in network—even the lower-quality ones—and all of them at the highest prices. And there's no price negotiation that's possible after that. Anti-steering and anti-tiering clauses: This means that a payer/ASO (administrative services organization)/TPA (third-party administrator)/plan sponsor cannot steer members to lower-cost or higher-quality hospitals, nor can it offer benefit designs that have tiers (ie, lower co-pays if a member goes to specified high-value hospitals). So, any chance of using consumerism or navigation as a way to get members to better places is just eviscerated by this little move. Pricing gag clauses: It's when contract terms prohibit an ASO/TPA from telling its plan sponsor customers or members what the price of services are before (or sometimes even after) the service is rendered, claiming it's important to not let employers or patients know these costs because revealing actual prices will [checks notes] cause hospital prices to go up. I'm speechlessly mystified by this logic, but OK … I only have a bachelor's in economics. Contract terms that restrict other providers in the market: So, a dominant hospital uses admitting privileges or referrals or other leverage to effectively control other providers in the market, including providers who are ostensibly independent. So, while the market may look dynamic, it is really not. Some links to interesting articles and posts and other episodes related to this topic: Definitely listen to the shows with Mike Thompson (EP389) and also the one with Chris Skisak and Gloria Sachdev (EP390). We talk about market dynamics and hospital legislation in these two shows, which are, frankly, the best ways to get rid of hospital systems' ability to hold their communities and other local providers hostage with some of this strong arming. Here's a link to an article I was thinking about while recording this show about Daran Gaus's hypothesis for how mergers will impact hospital prices. And here's a link to an article about how commercial prices for outpatient visits were 26% higher for patients receiving care at a health system than those visiting non-system physicians and hospitals. Another episode I mentioned when Brennan and I discussed the consequences of some of these anticompetitive contract terms is the one with Cora Opsahl (EP373). I also reference the episode with Dale Folwell, treasurer in North Carolina (EP249). One last link is to the conversation I had with Dr. Scott Conard (EP391), where the local hospital bought a local ACO (accountable care organization) physician organization and the community paid an additional $100 million to the hospital the following year. My guest in this healthcare podcast as aforementioned is Brennan Bilberry, who is a founding partner over at Fairmark Partners, which is a law firm litigating some of these antitrust lawsuits against some of these hospital chains. You can learn more at fairmarklaw.com.  Brennan Bilberry is a founding partner of Fairmark Partners, LLP, a law firm focused on fair competition issues, especially in the healthcare industry. Fairmark has filed numerous antitrust cases against dominant hospital systems, seeking to tackle anticompetitive practices that lead to higher prices for businesses, consumers, and unions. Prior to founding Fairmark, Brennan worked as a policy consultant and political operative whose work included overseeing environmental public policy campaigns in numerous countries, providing international political intelligence for US investors, advising political campaigns around the world, and designing consumer and legal advertising. Brennan also worked on numerous US political campaigns, including serving as communications director for Terry McAuliffe's 2013 successful campaign for Virginia governor, serving as deputy executive director of the 2012 pro-Obama Super PAC Priorities USA, and developing research and policy communications for the House Democrats. Brennan is a native of Montana and South Dakota and has lived in Washington, DC, for the past 15 years.   06:16 What happens after a hospital consolidates? 07:23 What does an anticompetitive system look like when a hospital consolidates? 10:13 Tricia Schildhouse on LinkedIn. 10:35 What are some anticompetitive “tricks” that hospitals employ? 12:37 The Sutter case in northern California. 14:50 What can you do if you're forced to engage in an all-or-nothing contract with a hospital system? 18:31 The Atrium case in North Carolina. 19:36 EP373 with Cora Opsahl. 21:33 What are price gag clauses? 23:08 How are legacy gag clauses designed to prevent scrutiny in litigation? 24:04 EP249 with Dale Folwell. 26:08 How do hospital restrictions on other providers create an anticompetitive environment? 27:23 EP391 with Scott Conard, MD. 29:48 EP389 with Mike Thompson or EP390 with Gloria Sachdev and Chris Skisak.   You can learn more at fairmarklaw.com.   @brbilberry discusses #hospital #anticompetitive practices on our #healthcarepodcast. #healthcare #podcast #hospitals #hospitalsystems #anticompetitivepractices Recent past interviews: Click a guest's name for their latest RHV episode! Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki  

You would think that hospitals with the most money would offer the most charity care—trickle down and all of that. If my health system is big and I have lots of money and profitable commercial patients, I can stuff more dollar bills into the charitable donation balance sheet bucket, right? Except, in general, it's a fairly solid no on that. Let's talk about some of my takeaways from the conversation that I had with Vikas Saini, MD, and Judith Garber from the Lown Institute. During the conversation, there's also mention of a powerhouse of a New York Times article. So, let's circle up on but a few of the more interesting (according to me) reasons why some rich hospitals fail to offer the level of charity care that you might think they could or should: #1: Chasing commercial contracts because they are very profitable means building in areas where there are frankly not a whole lot of poor people. You see hospital chains doing this all of the time and saying at the 2023 JPM (J.P. Morgan) conference that they intend to do more of it, opening up in a fancy suburb with no affordable housing. When this happens, there is just less opportunity to offer charity care. The need for financial aid in that ZIP code is just less. #2: The Ambulatory Surgical Center (ASC) movement, which is weird to say because, in other respects, I'm a big fan. There are a lot of services and surgeries moving out of the hospital into ambulatory surgical centers or just the outpatient setting, and this is going on for a bunch of reasons, including Medicare and employers being very on board with this to save facility fees. But here's a consequence: Surgeons and other docs are now not in the hospital. So, indigent patient shows up in the emergency room and needs an emergency surgery or some intervention. But wait … those physicians and their teams are no longer in the hospital. And now the hospital doesn't have the “capability or the capacity” to serve that patient. I heard from a surgeon the other day, and when he's on call at his hospital, he's getting patients shipped to him on the regular from hospitals in other states. Now, about this “oh, so sorry … we can't possibly help you so we're gonna stick you in an ambulance and take you to another state” plan of action. I called up emergency room expert Al Lewis. He told me that if this “ship 'em out” is being done routinely as a pattern by hospitals who have an ER, you could call it evidence of an EMTALA (Emergency Medical Treatment and Labor Act) violation on several levels. You can't have an emergency room and then routinely not be able to handle emergencies, especially when the emergencies you can't handle always seem to be of a certain kind and for a certain kind of patient. Speaking of violations, one more that reduces the need and level of charity care is canoodling with ambulance companies to take the poor people to some other hospital and the rich people to your hospital, which was allegedly transpiring in New Jersey, based on a recent lawsuit. #3: [play some foreboding music here] This last one is the big kahuna underlying reason why some very rich hospitals may not offer the level of charity care which you'd think they would. This was superbly summed up by Tricia Schildhouse on LinkedIn the other day. She knew a physician leader who would go around saying, “Non-profit and for-profit is a tax position, not a philosophy.” Bottom line, this whole thing boils down to what has been normalized as OK behavior at some of these rich hospitals. You have people in decision-making roles taking full advantage of their so-called tax position to jack up their revenues—revenues which they have no interest in frittering away on charitable causes. Why would they do that when they can use the money to, I don't know, stand up a venture fund or make Wall Street investments? Don Berwick's latest article in JAMA is entitled “The Existential Threat of Greed in US Health Care.” And, yeah … exactly. Back to that New York Times article that we talk about in this healthcare podcast, here's what it says about a hospital in Washington State. It says: “The executives, led by [the hospital's CFO] at the time, devised … a program called Rev-Up. “Rev-Up provided [the hospital's] employees with a detailed playbook for wringing money out of patients—even those who were supposed to receive free care because of their low incomes.” All of this being said, there are hospitals out there who are, in fact, living up to their social contract and serving their communities well with very constrained resources. You also have hospitals just in general working within some really whack payment models that we have in this country, which easily could be a root cause precipitating this suboptimal-ness. Dr. Saini and Judith Garber mention three direct solves for hospital charity shortfalls and also the larger context of the issue. So, there's, of course, better reporting and better auditing, which is pretty nonexistent in any kind of standardized way right now. I also really liked one of the solutions that Dr. Saini mentions on the show: Maybe instead of all the hospitals doing their own charity care thing, they all should pool their money regionally and then put a community board in charge of distributing it. That way, if there is a hospital in an area where the charity care is really needed, even if the rich hospital nearby doesn't have a facility there, they can help fund this care that their larger community really needs—including, by the way, public health needs, which is currently a big underfunded problem. As mentioned earlier, I am speaking with Vikas Saini, MD, and Judith Garber. Dr. Saini is president of the Lown Institute. Judith Garber is a senior policy analyst there. They've studied hospitals from a number of dimensions, not just charity care.   You can learn more at lowninstitute.org and lownhospitalsindex.org.    Vikas Saini, MD, is president of the Lown Institute. He is a clinical cardiologist trained by Dr. Bernard Lown at Harvard, where he has taught and done research. Dr. Saini leads the Institute's signature project, the Lown Institute Hospitals Index, the first ranking to measure hospital social responsibility. The Index, first launched in July 2020, evaluates hospitals on equity, value, and outcomes and includes never-before-used metrics such as avoiding overuse, pay equity, and racial inclusivity. In his role at the Lown Institute since 2012, Dr. Saini led the development of the Right Care series of papers published by The Lancet in 2017, convened six national conferences featuring world-renowned leaders in healthcare, and guided other Lown Institute projects such as the “Shkreli Awards.” Dr. Saini also serves as co-chair of the Right Care Alliance, a grassroots network of clinicians, patient activists, and community leaders organizing to put patients, not profits, at the heart of healthcare. Prior to the Lown Institute, Dr. Saini was in private practice in cardiology for over 15 years on Cape Cod, where he also founded a primary care physician network participating in global payment contracts. He also co-founded Aspect Medical Systems, the pioneer in noninvasive consciousness monitoring in the operating room with the BIS device. Dr. Saini is an expert on the optimal medical management of cardiologic conditions, medical overuse, hospital performance and evaluation, and health equity. He has spoken and presented research at professional meetings around the world and has been quoted in numerous print media, on radio, and on television.  Judith Garber is a senior policy analyst at the Lown Institute. She joined the Lown team in 2016, after receiving her Master of Public Policy degree from the Heller School of Social Policy. Her research interests include hospital community benefit policy, overuse and value-based care, and racial health disparities. She has authored several white papers, journal articles, op-eds, and other publications on these topics. Judith previously worked at the Aspen Institute Financial Security Program, the Midas Collaborative, and Pearson Education. She has a bachelor's degree in American studies and political science from Rutgers University.   06:50 Why does America need socially responsible hospitals? 08:23 What standards are hospitals beholden to with their charitable spending? 08:47 “It's the honor system, essentially.”—Dr. Saini 11:38 What is fair share spending? 13:43 Which hospitals are paying their fair share? 15:05 Why do hospitals that are financially more strapped tend to give back to their communities more? 17:25 Why is it hard for hospitals with the most privately insured patients to do the most for their community? 18:56 “These outcomes … are the outcomes of the [current system].”—Dr. Saini 21:23 “A key problem here is [that] systems have gotten so big.”—Dr. Saini 22:30 What's the solution to fixing the problem with hospital charity care? 23:52 EP374 with Dave Chase. 29:21 What would be the level of acceptance with changing the system as it stands with hospitals?   You can learn more at lowninstitute.org and lownhospitalsindex.org.   @DrVikasSaini and @JudiTheGarber of @lowninstitute discuss #hospitalcharitycare on our #healthcarepodcast. #healthcare #podcast #hospitals Recent past interviews: Click a guest's name for their latest RHV episode! David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356), Dave Dierk and Stacey Richter (INBW37), Merrill Goozner, Betsy Seals (EP387), Stacey Richter (INBW36), Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Nick Stefanizzi, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari  

The "Government-sanctioned extortion" line is mine... it's what I call the for-profit health insurance industry. Think about it. You have to pay them in order to get the prices they've negotiated for medical care of every stripe. If you don't have insurance, you're charged the "list price," but if you pay your monthly extortion to cabal, then the cost for services is what those two entities negotiated.The bottom line is you'll pay, one way or the other.I used to dream of crawling across the line of 65... you know, when I'll be eligible for Medicare. I understood that the current process of insurance companies deciding what treatment you'll get instead of relying on the actual doctor to make those calls wasn't an issue when you were able to get the actual government-supplied Medicare.And it was, until the advent of so-called Medicare *Advantage*.Today, Wendell Potter returns to the show. Potter, still the only health insurance industry employee to turn whistleblower to expose these extortionists for the crooks they are, testified before NYC's Committee on Civil Service and Labor against Mayor Eric Adams' decision to move NY's public worker retirees into an Aetna Medicare Advantage Plan.He opened his testimony by repeating "Medicare Advantage is neither Medicare nor is it an advantage for millions of Americans."Be sure to subscribe to Wendell's newsletter at wendellpotter.substack.comAnd now, after a devastating report from Pro Publica, Potter is turning his sites on the unreasonable and dangerous "prior authorization" requirement that is actually killing patients...And at the end, I'll have a few words to share about the Grammys, which I didn't watch, but now wish I had....