BILL MOYERS: Welcome to the Journal.
The biggest medical drama on our TV screens this summer is not reruns of "House" or "Grey's Anatomy." It's a high stakes, life and death spectacle inside and outside the halls of Congress, as lawmakers attempt open heart surgery on that most fragile and stubborn of patients health care reform.
On a bright summer day, these thousands of people have traveled to Washington from all around the country. They're here in good spirits, on a serious mission.
CROWD: Senators and Congress people around this land, it's time you listened to our demands. Hear our voice, we want choice, we've come here today to make lots of noise! We want...we want health care! We want...we want health care! We want it now!
BILL MOYERS: They represent some 72% of all Americans who have told pollsters they want health care reform to include a public insurance option that competes with private plans. Many here are from the front lines.
Nurses like Anita Kuennen.
ANITA KUENNEN: Well, everything is at stake from the perspective of providing healthcare. When people can't afford insurance, when they can't provide or afford, you know, to get care for themselves, it's a continuous loop. From a public health perspective, the fact that we have such poor outcomes in this country, it's abominable.
BILL MOYERS: There were doctors on the march.
DR. ALICE CHEN: A lot of people say America has the best healthcare system. And in many ways we do. We have the best hospitals, we have good training. We have so much good equipment. We have all the medicines. We do all of the good research. And the fact there's so many people in this country-- this is America. It's not okay for so many people in this country not to be able to get healthcare.
DR. RAB RAZZAK: This is our best chance. We haven't had a chance like this in decades. And so we're hoping that legislators put in a reform bill that does look at quality of care. That does look at cost and cost containment. And basically what's best for our patients.
CROWD: What do you want? Health care! When do you want it? Now!
BILL MOYERS: Reform's high on the agenda of organized labor, too...
JOE MAYHEW: The problem is the skyrocketing costs of healthcare is making it-- the ability for our employers to provide it to us is becoming more and more difficult.
It was only about 10 years ago when I was representing groups in Connecticut, the costs they were asking us to pay were two percent. Maybe $10 a week. Didn't seem like a big deal. But here we are 10 years later and they're asking for 15 percent, 20 percent. We just can't afford it. It's time for health care reform. It has to happen now.
BILL MOYERS: Even people content with their current coverage but concerned about the future were demanding reform.
DICK MANOUKIAN: I have a very good plan right now. But with one whipstitch I could lose it all through bankruptcy, through a job loss, through a medical injury or some tragedy. And I could be denied coverage.
We need a public option where-- that'll bring true competition and bring these people in line. Do you think big pharmacy and big insurance is going to put anything on the table unless they are afraid? Because they've had a lock on it forever? No, they're not going to give it up. We've got to take it from them.
BILL MOYERS: This is where protestors hoped their voices would penetrate the inner sanctum of the capitol. Here, a congressional subcommittee investigated the twisted tactics used by health insurance companies to dump customers and stick them with their bills. It's a practice known as recission.
ROBIN BEATON: In May 2008, I went to a dermatologist for acne, pimples. A word was written down on my chart, which was considered to mean precancerous. In June 2008, I was diagnosed with invasive HER-2 genetic breast cancer, a very aggressive form of this cancer.
I needed a double mastectomy immediately. Blue Cross and Blue Shield pre-certified me for my surgery and for a hospital stay. The Friday before I was to have my double mastectomy, Blue Cross and Blue Shield called me by telephone and told me that my chart was red flagged.
BILL MOYERS: Red flagged. The insurer used inadvertent omissions on her original application data that had nothing to do with her current condition as an excuse to cancel her health policy. Without that insurance she couldn't have the cancer surgery that she needed.
ROBIN BEATON: I was frantic I did not know what to do. I didn't know how to pay for my surgery, the hospital wanted a $30 thousand deposit. I was by myself. I didn't have that kind of money.
BILL MOYERS: In despair, Robin Beaton turned to her Texas Congressman, Joe Barton. His staff tried and got nowhere... until Barton picked up the phone and called the president of Texas Blue Cross directly. But months were lost.
ROBIN BEATON: My tumor grew from two to three centimeters all the way to seven. I had to have all my lymph nodes removed in my arm, everything. Delay in cancer treatment, it only worsens the condition, costing more to treat, and treatment is much more intensive. Also the outcome is not as good.
REP. JOE BARTON: I think a company does have the right to make sure that there's no fraudulent information, but it's obvious to me [...] if a citizen acts in good faith, we should expect the insurance companies that take their money to act in good faith also.
BILL MOYERS: Unfortunately it's not that easy.
The committee found other insurers pulling the same tricks. Over the past five years the companies Assurant, Golden Rule and Wellpoint had cancelled 20 thousand individual policies.
Michigan Congressman Bart Stupak asked their executives if they would change their ways.
REP. BART STUPAK: Let me ask of our CEOs this question, starting with you Mr. Hamm, would you commit today that your company will never rescind another policy unless there was intentional fraud - fraudulent misrepresentation in the application?
DON HAMM: I would not commit to that.
REP. BART STUPAK: How about you Mr. Collins, would you commit to not to rescind any policy unless there is an intentional fraudulent misrepresentation?
RICHARD COLLINS: No, sir. We follow the state laws and regulations. And we would not stipulate to that. That's not consistent with each state's laws.
REP. BART STUPAK: How about you, Mr. Sassi, would you commit that your company will never rescind another policy unless there was an intentional fraud, misrepresentation?
BRIAN A. SASSI: No, I can't commit to that. The intentional standard is not the law of the land in the majority of states.
REP. JOE BARTON: Doesn't it bother you that people are going to die, because you insist on reviewing a policy that somebody took out in good faith and forgot to tell you that they were being treated for acne? Doesn't that bother you?
DON HAMM: Yes sir, it does. And we regret the necessity that that has to occur even a single time and we've made suggestions that would reform the system such that that would no longer be needed.
BILL MOYERS: With the new push for reform, health industry corporations are now pledging to clean up their act without government intervention.
They'd stop charging women higher premiums than men. And, don't worry, a coalition of the pharmaceutical, medical, hospital, and health insurance industries told President Obama in May, they'll bring those soaring costs down voluntarily. Trust us...
PRESIDENT BARACK OBAMA:These groups are voluntarily coming together to make an unprecedented commitment. Over the next 10 years, from 2010 to 2019, they are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year an amount that's equal to over $2 trillion dollars.`
BILL MOYERS: But before the week was out, those health care CEO's were backpedaling, suggesting that perhaps in his enthusiasm the president had overstated. They hadn't agreed to hit the $2 trillion dollar target. But over time ... they might aim at it.
In the meantime, they are working relentlessly to kill off efforts to include a public insurance plan in the health care bill. Although three quarters of Americans polled support a public option, the industry is spending more than 1.4 million dollars a day to make sure it doesn't happen.
AD #1: What will happen to your family's health care?
AD #2: This government run plan could crush all your other choices.
AD #3: It could put a bureaucrat in charge of your medical decisions.
BILL MOYERS: For extra fire power, the industry has hired more than 350 former members of Congress and government staffers, who are up on Capitol Hill, back-slapping and glad-handing their old pals, hoping to preserve the huge profits in health care.
But business as usual is being challenged by this man who knows the business all too well, from the inside out.
SEN. JAY ROCKEFELLER: I'm pleased to welcome Mr. Wendell Potter to the committee today. He is a former insurance executive who is going to tell us about some of the tactics insurance companies use to keep insurance in the dark. I have a special respect for him, simply because he's doing something I think very courageous and very brave.
WENDELL POTTER: Mr. Chairman, thank you for the opportunity to be here this afternoon...
BILL MOYERS: Until last year, Wendell Potter was head of corporate communications for Cigna the country's fourth largest health insurance company.
Altogether Potter spent nearly 2 decades playing for the side that has opposed health care reform from the Clintons forward... he sat on policy committees, crafted executive messages, cajoled the press and witnessed firsthand the promises made... and broken... Take the case of Nataline Sarkisyan...
HILDA SARKISYAN: The insurance company is denying our case. She needs a liver transplant...
BILL MOYERS: At the end of 2007, Potter defended Cigna when it refused to pay for the 17-year-old's transplant surgery, claiming the procedure was experimental. Protests at a regional headquarters created a public relations nightmare.
CROWD: Health care for all! Health care for all!
BILL MOYERS: Cigna reversed its decision, but by then, it was too late. Nataline died just two hours after her surgery was approved. Early last year Potter left Cigna. This summer, before the Senate Commerce Committee, he went public for the first time.
WENDELL POTTER: Recently it became abundantly clear to me that the industry's charm offensive, which is the most visible part of a duplicitous and well-financed PR and lobbying campaign, may well shape reform in a way that benefits Wall Street far more than average Americans.
The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable, publicly accountable health care option as, quote, "government-run health care." What we have today, Mr. Chairman, is Wall Street-run health care that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care and to the state and federal governments that attempt to regulate it.