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OpEdNews Op Eds    H3'ed 5/25/19

More Die From Medical Insurance 'Aggressive Prior Authorization' Than Before ACA

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More Die From Medical Insurance 'Prior Authorization' Than Before ACA - Wendell Potter (6/7) Wall Street demands medical insurance companies maintain their profits under the Affordable Care Act, which means they get even more aggressive in denying ...
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PAUL JAY Welcome back to Reality Asserts Itself on The Real News Network. I'm Paul Jay. And we're continuing our discussion with Wendell Potter about the health care system, and his own life, and how he came to decide he couldn't work in the health insurance industry anymore.

Now joining us again in the studio is Wendell Potter. Thanks for joining us again.

WENDELL POTTER Thank you, Paul.

PAUL JAY Wendell is the author of Deadly Spin: An Insurance Company Insider Speaks Out on how Corporate PR Is Killing Healthcare and Deceiving Americans.

In an earlier segment we talked about your road to Damascus, your coming to understand you just couldn't stomach the kind of stuff you had to do for the private insurance company you were working for. You talked about the death of a young woman. And we're going to play a little clip from that part of the interview.

WENDELL POTTER [CLIP] The family began to get a lot of support from activists. The California Nurses Association took up the fight, and they were beginning to stage a protest in front of Cigna's regional offices in Glendale, California. CNN was there. And when I learned that, that's when the decision was made, very quickly after that. After I told the CEO and others that this was happening on live TV, they very quickly reversed that denial. And one of the jobs I had was to try, then, to make sure that the family, as they were on TV, got the word that Cigna had changed that, and it was reversing that denial, and was going to allow the transplant to go forward.

And I saw that happening. I got someone to go and tell Mrs. Sarkisyanthe family name was Sarkisyan. And I could see someone whispering in Mrs. Sarkisyan's ear something that clearly made her happy. So I knew I'd gotten word to the family. And I felt pretty good about that. I thought, well, maybe this girl is going to get that transplant. She'll probably live. She died five hours after that.

PAUL JAY So, Wendell, since that happened, the Affordable Care Act has been passed. Would that woman still die under the ACA? Could insurance companies still make a decision like that now?

WENDELL POTTER Oh, absolutely. And probably more people are dying now than even then.


WENDELL POTTER Because one of the things that I knew was that when the Affordable Care Act was passed, the insurance industry, they could no longer engage in some practices, like refusing to sell coverage to people with preexisting conditions. But they had this obligation to meet Wall Street's financial expectations. So there is a profit expectation that they have to meet, that they're under the gun to meet. So there would be other things that they will do to avoid paying claims. One is, as we've talked before, shifting more and more people into high deductible plans. But another is more aggressive prior authorization, which means that doctors and patients have to essentially beg, in many cases, to get the coverage that they're entitled to. In the Nataline Sarkisyan case, her father's policy covered transplants, but the medical director said no, we're not going to pay for it, because he felt it, in his opinion, was medically unnecessary or inappropriate. That happens day in and day out. That was one case that got a lot of attention.

PAUL JAY Because a lot of the critique of Medicare for All is government bureaucrats are going to decide these questions of life or death.

WENDELL POTTER Yeah. Which iswhich is not true at all. And in the current Medicare program, the traditional Medicare program, this doesn't exist. It only exists inside private insurance companies when they set up this mechanism. And that is what, when I talk about insurance companies coming between doctors and their patients, that's exactly what I mean. Insurance companies have hired tens of thousands of nurses that are often referred to as denial nurses and doctors to serve as medical directors. These are people who've decided they don't want to practice medicine or treat patients anymore. So they're working for these big corporations, and their main responsibility, in many cases, is to say no. And that goes on day in and day out.

PAUL JAY I should say in Canada, where I grew up, doctors decide. There is no government bureaucrat that can decide whether you get a particular care. Once the classification of care is considered legitimate, then it's up to the doctors to decide whether you get it or not.

WENDELL POTTER And that's what we should have here. And it's what an expanded and improved Medicare program would be like in this country. In fact, as I said, the traditional Medicare program is like the Canadian system, the Canadian Medicare program. There is no government bureaucrat who calls those shots, who makes those decisions.

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