Illustration: Tim Bouckley
They call him an opportunist and a vulture who’s capitalizing on a tragedy to promote his dangerous Medicare for All agenda. Over and over, they invoke his name alongside those of left-wingers the likes of Bernie Sanders. For the target of these attacks, Wendell Potter, it’s a familiar playbook — after all, he helped write it.
“I guess I should be flattered,” he jokes.
Potter is the nation’s most prominent health-care whistleblower, a former Cigna executive who dramatically called out his old employer in front of a Senate committee almost two decades ago. Since the December killing of UnitedHealthcare CEO Brian Thompson, Potter has also been the go-to expert mainstream media outlets have relied upon to help explain how insurance companies screw over patients. (Ammunition used to kill Thompson was pointedly inscribed with the words deny, defend, and depose, terms insurers use to deny prior authorization for treatments.) The attacks against Potter started just as soon — and bear all the hallmarks, he says, of remarkably similar spin operations he facilitated as a communications executive when hiring PR firms to place op-eds parroting industry talking points in outlets nationwide.
Since walking away from the industry, Potter has waged a relentless, sometimes lonely campaign against for-profit insurance companies through media appearances, books, a newsletter, and Capitol Hill lobbying. Now 73, he’s something of a guiding figure for a loose network of former health-insurance executives trying to atone. United by their desire to rein in the behemoth insurers, all are fighting their own overlapping battles — whether helping doctors wrangle with the companies or advocating for single-payer health care. Even as chaos reigns in Washington, D.C., they’re hopeful the current outrage toward insurers just might provide momentum for a few crucial changes.
In their collective decades of work across the health-care sector, each of the four former executives I spoke to for this story, including Potter, arrived at the same conclusion: Patients’ needs are fundamentally at odds with insurers’ financial incentives and the ever-growing demands of Wall Street. “Health care is a weird thing where you don’t want the customer to use your product,” as one put it. All described stomach-churning encounters with greed that prompted them not only to leave the country’s for-profit health-insurance industry but to question its premise.
Patients are “the least important stakeholders”
In 2007, Potter had never been more powerful as an executive, or more conflicted. Having spent the previous two decades climbing the industry ranks at Humana, then Cigna, he had grown uneasy with insurers’ offsetting more and more costs onto patients. A series of events that year sent him over the edge. His mission involved undermining director Michael Moore, who was about to release his documentary Sicko criticizing the U.S. health-care system. Potter took his son along to an early screening in Michigan; his son was so taken with the film that he asked Moore to sign a poster, but Potter himself was preparing to smear the documentary as socialist propaganda. “The objective,” he says, “was to get people to think Moore was outside the mainstream of American politics and was trying to sell us on a government-controlled health-care system.”
Potter soon decided on a whim to visit a free medical clinic at a fairground in Wise, Virginia, after seeing an ad for it in the newspaper. When he arrived, he saw hundreds of people waiting on line to get free medical care from doctors working out of animal stalls. Some of the patients had health insurance but simply lacked the money to cover the out-of-pocket costs.
At the end of that year, he reached his breaking point when Cigna denied prior authorization to pay for a liver transplant for Nataline Sarkisyan, a 17-year-old girl with leukemia. As with any crisis the company faced, Potter found himself fielding calls 24/7, trying to keep Cigna’s reputation and stock price intact even as the standoff intensified into a national news story. The insurer eventually caved to the pressure, but the reversal came too late — Sarkisyan died within hours. Rattled, Potter later wrote, “I simply didn’t have it in me to handle the PR around another case like Nataline’s.”
A few months later, Potter resigned and took some time off to gather his thoughts, reemerging in 2009 amid the Affordable Care Act debate to testify about how Wall Street’s influence dictated insurers’ coverage decisions. A professional communicator, Potter was uniquely qualified to handle the attention that comes with whistleblowing, deftly leaning into the role of a guilt-ridden executive who made it to the top only to realize in a fit of conscience that the whole system had to go.
Nine days after the UnitedHealthcare shooting, while suspected killer Luigi Mangione was being memed to folk-hero status, I asked Potter, “If you were running comms at UnitedHealthcare right now, what would you do?” He proceeded to describe the steps the insurer’s parent company, UnitedHealth Group, has since taken: No interviews with reporters except in the friendliest of circumstances. Write an op-ed for CEO Andrew Witty in the New York Times acknowledging that this is a difficult business but that the company will work to do right by Americans. Give lobbyists talking points to assuage Congress, and give account representatives separate talking points to placate employer customers who may be facing calls from their workers to switch providers. And of course, send out Witty to comfort anxious shareholders. “I’ll assure you,” Potter says, “that the least important stakeholders are the people who are enrolled in their health plans. They’re at the bottom of the pile.”
“Execute a few hostages”
After graduating from college in 1987, Ron Howrigon answered a help-wanted ad in the Sunday paper for a job at Kaiser Permanente, figuring a career in health care would make him a force for good in the world. Later, he made the leap to Cigna, where his specialty was negotiating payment rates with doctors and other providers, aiming to pay them as little as possible. In the early aughts, an order came down from his boss, Mark Bertolini, a major insurance-world figure who later became CEO of Aetna. According to Howrigon, Bertolini had decided Cigna was seen as too physician friendly, so Howrigon and his colleagues would need to drop 10 percent of the providers they contracted with from the insurer’s network. After some debate, they talked Bertolini down to one percent, and Howrigon cracked a dark joke: Why not cut costs by specifically targeting cardiologists and other vital but expensive specialists? He says Bertolini responded with a straight face and said he was onto something.
“I got this feeling in the pit of my stomach,” Howrigon says. “Like, My God, we’re going to terminate doctors out of network just to show ’em who’s boss, and we’re going to pick the doctors whose patients need them most.” According to Howrigon, Bertolini said they needed to “execute a few hostages.” He went through with it and kicked 150 doctors out of network without cause. (Bertolini, who now runs the insurance provider Oscar Health and has cast himself as an advocate for health-care reform and a progressive, yoga-doing figure in the industry, did not respond to a request for comment.)
It was clear to Howrigon that the profit motive meant the only way these insurance companies could satisfy shareholders was to “screw the people who need your product.” Hoping it would be different in the nonprofit sector, he took a job with a Blue Cross Blue Shield plan in Pennsylvania — only to find that it prioritized generating revenue as much as the for-profit plans did. Shortly after his employer cut payment rates to obstetricians, Howrigon’s wife had a successful C-section. Before he was even out of the operating room, his wife’s obstetrician told him, “Next time you take money out of a doctor’s pocket, remember today because I’m the one who was here.” That, Howrigon says, was his rock bottom.
He secretly used his paternity leave to devise an exit strategy. “I’d be much richer,” he says, if he had simply stayed put. “But it was making me into a person I didn’t like.” Howrigon now calls himself a “recovering managed-care executive” and works on the opposite side of the table, helping doctors negotiate higher reimbursement rates from insurers. In the process, he has run up against a hardball form of retribution from Cigna. After his business started having success in securing higher rates for doctors, Cigna gave some of his clients an ultimatum: Drop Howrigon or we’re kicking you out of network. In response, two clients said they would sooner terminate their contracts with Cigna than with Howrigon. The insurer backed off but still refuses to communicate with him directly. Now, when he negotiates contracts with Cigna, Howrigon says he has to play a “childish game” in which he emails messages to his clients, who then forward them to the insurance giant. “They won’t talk to me,” he says. “They’re holding a 20-year grudge that I left.” (Cigna did not respond to a request for comment.)
Even now, Howrigon says one of his friends, a medical director at a big insurer, won’t be seen with him in public. “What’s that old saying?” he asks. “It’s not ‘Am I paranoid?’ It’s ‘Am I paranoid enough?’”
“What can we do to make him not want to come in?”
Several of the former executives I spoke with expressed fear of being corrupted on a personal level by working in a business that juices its profits partly by withholding care from its customers. Ed Weisbart went into medicine in the 1970s because he believed in the then-nascent idea of HMOs — self-contained insurance networks intended to keep patients’ costs down by incentivizing doctors to keep them healthy with preventative care rather than saving the payouts for when patients got sick. He began to lose faith in that model after serving as the chief medical officer of an HMO outfit in Chicago in the ’90s. One of its medical offices was humming along, he says, getting good outcomes for patients and earning a tidy profit, when a policyholder got in a car crash and discovered he had hemophilia. The infusions needed to treat the blood-clotting disorder would cost about $1 million a year, enough to flip the entire operation into the red. Weisbart began to have disturbing thoughts.
“I was thinking, What can we do to make him not want to come in? We could not answer the phone if we know it’s him. We could make him wait an hour or two to be seen,” he says, imagining he could declare victory once the patient gave up and found a new provider. Though the patient ultimately did receive treatment, Weisbart says, that is the kind of thinking the for-profit health-insurance business rewards: “That’s exactly what happens in managed care all over the place.”
In 2003, Weisbart took a job with Express Scripts, the massive pharmaceutical-benefits manager, and quickly ran into similarly warped financial incentives. At the time, statins were a popular treatment for preventing heart attacks, but Weisbart couldn’t sell insurance companies on the idea of paying for the drugs because the preventative benefits worked on too long a timeframe — why should insurers pay for a treatment when their policyholders were likely to switch providers by the time they started seeing any benefits? Why pass those savings along to a competitor? Rather than producing the best results through competition, Weisbart says, the country’s fragmented insurance system just creates perverse business incentives: “A robust public-health solution would be counterproductive for most insurance companies. That got me very disturbed, and it made me think, What am I doing here?”
A few years later, as the industry was working to undermine public support for the Affordable Care Act, he says the Express Scripts CEO asked him to put together a PowerPoint presentation on why health-care reform was unnecessary. Weisbart said “no” — not something he was in the habit of saying to the C-suite. “I thought, Well, shoot, I am really on the wrong side of this dance card, and I can’t keep putting my skills, such as they are, into supporting this really wrong industry,” says Weisbart, who now volunteers full time for Physicians for a National Health Program, a group advocating for universal single-payer health care. “So I left.”
“Sitting in our living room drinking Champagne”
The fourth former executive I spoke with requested anonymity because he thinks his former employer would bury him in expensive lawsuits if he were to go on the record for this story. Unlike the other three, the person we’ll call John left the industry just recently. As a veteran physician and longtime health-policy wonk who has held executive roles in a hospital system, John took a job with a major nonprofit insurer primarily because it was the one side of the industry he hadn’t yet worked on and he wanted to observe it up close. He was optimistic that he could at least push for marginal improvements to mechanisms like prior authorization. He lasted 17 months.
One day, John received a call from a spine surgeon who asked him, doctor to doctor, why his office had to deal with multiple prior-authorization denials per week when almost every single surgery ended up being approved in the end. John took that feedback to his higher-ups, along with a bold idea: Why not turn this whole thing upside down? Instead of using prior authorization for “everything” and denying treatments that would likely be approved in the appeals process anyway, why not prior-authorize nothing and see if any greedy doctors prescribing unnecessary treatments emerged?
His bosses deemed it too difficult to implement, and John began to realize insurance executives are often too insulated from their own policies to understand them. At one point, a senior executive he had barely interacted with came to him when their spouse was diagnosed with cancer, “petrified” that they wouldn’t receive timely care through one of the insurer’s own plans. “All of a sudden, when their loved one was sick,” John says, “they decided it was time to get to know the chief medical officer.”
That lack of concern about patients stood in contrast to the perks for executives like John. In late 2020, in the depths of the pandemic, he was attending a virtual board meeting when a delivery person showed up at his front door with his company-provided lunch. Already irked by the self-congratulatory tone of the meeting, which focused on how well the company was doing financially since so few people were getting nonurgent health care at the time, John was surprised to find a four-course French meal complete with an expensive bottle of Champagne at his doorstep. “It felt callous,” he says. “My colleagues were on the front line risking their lives, and we’re sitting in our living room drinking Champagne, talking about how good we’re doing.”
The Champagne wasn’t a one-off, either — by the time John left the company, he had to buy a small wine fridge, partly just to store all the expensive bottles he’d been sent. After leaving the insurance industry behind, John had some friends over on his birthday to clean out the collection. “We put it to good use,” he says, “but I couldn’t bring myself to open it or do anything with it while I was actually working there.”
The financial incentive to deny care is at the core of the industry’s rot, all four former executives argue, and it only seems to be getting worse as big insurers like UnitedHealth Group expand into more areas, including hospice care. It isn’t hard, John says, to imagine the potential conflicts of interest when your insurance company also makes money from your hospice stay. “These companies are even bigger — far bigger — than they were when I was in the industry,” Potter says. “They use a lot of their money on campaign contributions, on lobbying, on propaganda campaigns to protect the status quo.”
As deeply entrenched as their business practices may seem, Potter says the big insurers haven’t been this way for that long — only over the past 30 years or so has a majority of Americans’ health care been consolidated under a few massive for-profit corporations. In that same period, the companies have perfected the art of what John calls “self-dealing,” buying out major players in other areas of the health-care sector to create more stopping points at which they get paid. Those points are often middleman businesses that arguably do little to improve the patient experience yet drive up the costs. Most of Cigna’s $232 billion in revenue last year, for instance, came from Evernorth Health Services, a subsidiary that contains Express Scripts and the prior-authorization shop EviCore. Pharmaceutical-benefits managers, including Express Scripts, have been accused by the Federal Trade Commission of inflating drug prices, while one insider at a large, unidentified prior-authorization shop says the company sells its services to insurers by bragging about how many denials it issues for care it deems unnecessary.
A broad consensus has formed that these companies are too big. Politicians in both parties have introduced prior-authorization bills in the past few years, and even President Trump has criticized PBMs, saying he plans to “knock out the middleman.” On a recent lobbying trip to D.C., Potter says he spoke with more Republicans than Democrats about cracking down on Medicare Advantage plans, which insurers have used to wildly overcharge the federal government.
Even as the former executives and others attempt to channel revived public rage toward insurers into reform, they admit systemic overhaul remains a long way off. “Things are going to have to get much worse before we can approach something like this,” Howrigon says of his preferred model for a universal-coverage health-care system, before offering an analogy: “Some people don’t get serious about diet and exercise until after they have a heart attack. That’s where we are now. I just hope we survive the heart attack.”
For now, the health-care defectors’ club remains small, though several of the ones I spoke with say former colleagues still working in the industry frequently reach out to secretly agree with them. In a frustrated email recently, Howrigon summed up a sentiment expressed by each of the former executives: “I’m tired of the stuff they get away with.”
While Potter acknowledges the risks of defection, he’s made clear that he’s willing to help any current insiders who might want to take a step toward becoming vocal critics of the industry, and is working with a whistleblower nonprofit, the Signals Network, to encourage more to come forward. “I hope there will be more,” he says, adding that the big insurers now find themselves in a more precarious situation than they’ve seen “in many years.”
“I think they have long felt, or at least have felt in recent years, that they could operate with impunity,” Potter says. “They have to be thinking now that they may not be doing something they can do indefinitely.”
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