Wendell Potter on The Healthcare Crisis

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You know, for a change, Wendell Potter, former VP of Corporate Communications at Cigna Health Insurance. Well, he switched sides. He's now the president of the Center for Health and Democracy and advocates for meaningful health care reform. And so today, Wendell's with us on why health insurance costs so damn much in this country. Well, I figured out why Trump decided not to invade Greenland and slaughter thousands of NATO troops, because next year when they consider him for the Nobel Peace Prize, it would kind of count against him. Of course, what really happened was taco. Trump chickened out the bond market and the stock market had gone south. Europe was going to enact retaliatory tariffs and hurt the economy. So we got the bizarre rambling speech at Davos, among other things. It was filled with lies. Here he is talking about how the war in Ukraine never would have happened if the 2020 election hadn't been stolen from him. It's a war that should have never started. And it wouldn't have started if the 2020 U.S. presidential election weren't rigged. It was a rigged election. Everybody now knows that. They found out. people will soon be prosecuted for what they did. It's probably breaking news, but it should be. It was a rigged election. Can't have rigged elections. Now, he says that was breaking news. Hmm. Have we heard anything about it since? Let's keep an eye out for when they announce these prosecutions. I'm sure the White House press corps will follow up and ask him when these prosecutions will be announced. Mr. President, you said in Davos people will soon be prosecuted for rigging the 2020 election. You said it was breaking news. When will we know the details of who's being prosecuted and on what charges? We haven't heard any follow-up on that, and I was wondering if you could provide more about this breaking news that you announced in Davos. Well, Trump invited Putin to be on the board of peace, along with Argentina, Canada, Egypt, Hungary, India, a number of other countries, and Putin. Putin on the board of peace. If I were a Gazan, that would make me go, oh, good, things are looking up. This is a guy who's killed 70,000 Ukrainian troops, bombs civilians, kidnaps their children. No one in the White House said to Trump, Mr. President, maybe not Putin on the Board of Peace. Board of Peace. Now, Trump can veto all decisions, approve the agenda, invite members, dissolve the board entirely, and designate his own successor. This is his own personal UN, like the Trump-Kennedy Senate. And in Minnesota, thousands of ICE and Border Patrol agents continue to sow ever more chaos and terror. The FBI and DOJ have issued subpoenas to investigate Governor Tim Walz, Minneapolis Mayor Jacob Fry, St. Paul Mayor Khali Hur, Attorney General Keith Ellison Hennepin County Attorney Mary Moriarty and yet they refuse to investigate ICE agent Jonathan Ross who shot Renee Good Ross they say is at home recovering but there may be an investigation into Renee Good's widow however to determine if she's an Antifa agitator and Trump continues to threaten to invoke the Insurrection Act. All of this is so awful. We see video after video of ICE physically abusing people, dragging folks from cars, tackling them, throwing them to the ground. ICE agents are now going into hospitals and clinics, breaking into people's homes and taking them. You may have seen the video of an older Hmong man being taken out of his house in the freezing cold in just his underwear and socks in a flimsy blanket in 10-degree weather. Of course, he is a citizen. They took a five-year-old child in the custody from his school. They used him as bait to lure his other family members out of their house. The chief of police for suburban Brooklyn Park said that his officers, when they're off duty, are getting grabbed by ICE, but just the ones of color. ICE is acting like a caricature of a fascist force. But Minnesotans are still going to the streets, even when the temperature is 10 or 20 below, and they're stepping up for each other, shopping for folks who can't leave their homes, taking kids to school. It's all very Minnesotan. And you know what we aren't talking about? the Epstein files. In a Truth Social post in 2024, Trump wrote that I was never on Epstein's plane, but it turns out that he was eight times just between 1993 and 1996. I wonder what could be in the other five million pages that haven't been released. Well, today we're turning to healthcare is January when folks insurance plans reset and many are experiencing sticker shock and paying this year's higher premiums. Let's discuss with former healthcare VP Wendell Potter. It's a great one, you know, for a change. Wendell, thank you for joining us. My pleasure. Thanks for having me on. Your career has been in healthcare, right? It has been, yeah, for many years. And you're a VP at Cigna? I was a vice president at Cigna and Humana before that altogether, about 20 years working for big insurance companies. Okay. And what year did you leave? I left in 2008, just before... The ACA. Yeah, same year you were elected to the Senate. Yeah. And I became a whistleblower in 2009. During the time that Congress was debating what became the Affordable Care Act, I had left the industry a few months before that and thought I would help advocates for reform understand how the insurance industry really operates and how they would be trying to kill reform efforts after Obama was inaugurated and Congress got down to work on reform. and they ultimately told me if I wanted to make a difference, I should go public rather than stay anonymous. And I ultimately agreed to testify before Congress. I testified before the Senate Commerce Committee. What did your job entail at Cigna? When I was at Cigna, my job gave me a lot of visibility into how insurance companies really operate. I was the chief spokesman for the company. My team and I handled what we referred to his high profile cases. When a reporter called with questions about why Cigna was refusing to pay for a patient's treatment, they would call me or my staff. I also handle financial communications. My name was on every one of Cigna's financial earnings, quarterly earnings reports for 10 years. And I also handle government affairs communications. I handled talking points for our lobbyists. I I spent a lot of time in Washington working with our trade associations and the ad hoc groups that we would form to kill reform, going back to even the Clinton years. That's when I started working for the industry and played a role in killing the Clinton health care reform plan. Oh, OK. Congratulations. Now, you left for a reason. And this is a high paying job. This is a six-figure job, and you quit. Why was that? Well, I saw too much. I think the industry and my former bosses would probably regret having hired me. I was a newspaper reporter my first career, so that was one thing. I had a reporter sensibility. Sometimes I've joked that looking back over my career, I was undercover for 20 years. But I saw what motivates these companies. You know, the ones that are listed on the New York Stock Exchange like Cigna and Humana. They are beholden to shareholders and a handful of Wall Street financial analysts. And every three months, the game is to try to make sure that you meet Wall Street's profit expectations. And if you don't, if you miss the consensus estimate of how much the company should earn per share, then you can expect your stock is going to take a hit. And if you are an executive, that means your net worth is going to take a hit because most top executives are paid largely in stock options and stock grants. But I also saw how these companies spend enormous amounts of premium dollars on campaign contributions, on lobbying expenses. I'm sure you saw plenty of it, or at least the consequences of that. And I was a part of that, too. I do want to ask you about the medical loss ratio in a little bit. and whether that helped at all. Yeah. But just first, I want to ask you why you left your job. Was there an event that made you leave? Oh, there was. There actually were two major events. One was going back home to visit family in Tennessee and reading in my local newspaper about something that was called a healthcare expedition a few miles away at a county fairground. And I borrowed my dad's car. I was curious. I'd never heard of anything like that. And I drove to Wise County, Virginia, which is a small town in southwestern Virginia in the coal mining area. And I saw when I went through the fairground gates, people who were standing in long lines. It had been raining. They were soaking wet, but they weren't going to leave their places in line because they had waited in many cases for over a year to get care that was being provided. I noticed by doctors and nurses who were volunteering their time. They were being treated in barns and animal stalls on this fairground site. Now, I'm assuming these are people who don't have insurance. No, that's not exactly sure. A lot of them had insurance. Even some of them had Medicare, but many of them had private insurance that had very high deductible plans. And that was one of the things that I was responsible for in my job was to try to get people to believe that high deductible plans were the silver bullet that was going to reduce spending on health care. I knew high deductible plans, making people pay a lot of money out of their own pockets before their coverage will kick in, was going to result in a lot of Americans not getting care or going into debt. And that's exactly what I saw face to face. I saw a lot of people, people I could have grown up with, Al, because I'm from that part of the world, waiting to get care in a barn because their insurance would not cover what they needed until they paid a substantial amount of money out of their own pockets And these folks just didn have money to spend out of their own pockets for care Okay so this event was one of the reasons you left What was the other? The other was a few months later. As I mentioned, one of the things my team and I did was handle high-profile cases when Cigna would refuse to pay for some treatment that a patient needed. A 17-year-old girl in Los Angeles was scheduled to have a liver transplant, But at the last minute, just as the surgery was about to take place, a medical director from CICNA said he did not think that transplant was medically necessary. Jesus. And so he pulled the plug, essentially. He said, we're not going to pay for it. How is it possible that a girl who was lined up to get a liver transplant, that some doctor ruled that she really didn't need the liver transplant? Yeah, that's one of the reasons I left, was to tell people, this happens every day, Al, and it still does. And that's what I want to ask you about in terms of if you believe the ACA has, how it's helped and how it hasn't. It helps some. In this particular area, it did not. In fact, it's only gotten worse. What I'm referring to is something that's referred to as prior authorization when an insurance company refuses to cover something because they insist on reviewing and approving a treatment plan before they'll pay for it. And that also extends to medications and imaging. and insurance companies have realized this is a great way for them to meet those profit expectations because the more care they deny, the more money is left over for them to reward their shareholders and consequently their top executives. Well, does the medical loss ratio play here? Because there's a limit to how much profit these companies can make and that's 20%, right? Yes. And that was one of the things that I testified about was the need for some limits on the medical loss ratio because increasingly insurance companies were spending less and less of premium dollars on that was my my piece of the one of my pieces of the act was the medical loss i remember that i remember that and i'm so grateful for it because it did a lot of good as you as you know as you recall it it requires them to pay at least 80 and in some cases 85 of premium dollars on healthcare. Yeah, on a small group, 80%, on a large group policy, 85%. And what that means is they have to spend at least 80% or 85% of their premiums on actual healthcare. That's right. And not on CEO salaries or stock op, you know, not on advertising and marketing and on administration. That's right. It wasn't airtight, though. And here's part of the problem. As the regulations were being written, the industry was able to get the Department of Health and Human Services and CMS and other regulators to allow them to count various things as health care that really were more administrative in nature. So even though your intent was to make sure that they were spending 80 to 85 percent largely paying claims, they had the regulations written in ways that gave them a lot of latitude. That's one thing that they did to get around the congressional intent. The other was for them to begin to acquire pieces of the health care delivery system, doctor's offices, physician practices and clinics. That has been what these big companies have been buying up in recent years. United Health Group in particular, which is in Minnesota, as you know. Well, we know that very well. Of course, last year we had the assassination or murder of Brian Thompson, who is the CEO of United Healthcare. Yeah, United Healthcare, United Health Group, which is a parent company, owns scores and scores of physician practices. It is now the largest employer of doctors in the country. Many people realize that, but as they have been able to do that, to get more and more into healthcare delivery, and this is on the other side of their house. United Healthcare is called Optum, which is a very big division of the company. And that's a division that's bought all these physician practices and clinics and other parts of healthcare delivery. they're able to circumvent the again do a workaround medical loss ratio because health care delivery is not a part of the medical loss ratio just health insurance. So as they have gotten more and more to health care delivery they're actually paying themselves and as they're doing that they're able to reduce their medical loss ratio to meet the to stay in compliance with the medical loss ratio provision of the law. I wish I had known that before the Republicans took over Congress. I know. And Trump became president. So nothing's going to happen with that. I'm afraid it may not. It's something that I continue to write about and talk about, and I'll be spending quite a bit of time in Washington, but I fear you're right. Probably nothing's going to happen. We're going to take a quick break. We'll be right back with Wendell Potter. When your company is growing fast, order fulfillment can make or break your success. ShipStation's intelligence-driven platform brings order, management, rate shipping, inventory and returns, warehouse systems, and comprehensive analytics all in one place, saving customers 15 hours per week on fulfillment. You know, there was a time when we shipped ornaments and mugs from the Al Franken podcast website and a service like this could have saved us hours of headaches with shipping. With ShipStation, everything you need to manage getting orders to customers is in one place. 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So, we can now listen to your podcast. and start selling today at Shopify.nl. That's Shopify.nl. It's time to see what you can accomplish with Shopify by your side. So you didn't complete the story about the event that made you leave. Well, Nathleen Sarkeesian was the 17-year-old girl that I was talking about. Her family was just outraged, and they didn't know that Cigna could do this. Few people know that their insurance company can make a decision like that. So they decided to make a stink about it. They organized their family and friends. They got the media in Los Angeles interested in this story. My phone was ringing off the hook. It became a very big PR problem for Cigna that endured for days and days. Eventually, I went to the CEO and other top executives and said, look, this is a big PR nightmare for the company. We're getting a lot of bad press. Well, the company reversed that denial largely because of the bad press. So the company reversed that denial. But the problem is when you delay care, it's really like when someone needs a liver transplant. And that's what she needed, right? Yeah, needed it right then. And that liver was not available when Cigna said it would pay for the transplant. They actually said it wasn't necessary for her. It wasn't necessary. They changed the company changed its mind and said it would pay for it. But it came too late. And Nataline died just about five hours after Cigna said it would cover the transplant. She got sicker. And she was 17. And she could be with us today if it had not been for that delay. That happens again, Al, even more today than it did before. I just saw a story this week. Kaiser Family Foundation does a lot of research looking at denial rates within the health plans that people buy through the so-called Obamacare marketplaces. They have the exchanges. Right. The ACA. Exactly. About 20 percent of the requests for coverage are denied. That's on average. Some of these companies like United and this report reject one of every three requests for coverage. So it's gotten worse, and Congress really needs to address it and state legislatures. And that is why you referenced the murder of Brian Thompson. There was such an outpouring of outrage, not the murder, but at the way insurance companies operate these days. Yeah, that surprised me. Yeah, surprised me, too. Although I have known, even going back to my career, I knew that people despised their health insurance companies. Most of us go throughout the year reasonably healthy without having to test the limits of our health insurance policy. But when we get sick, we often find out it's not what we thought it was. It's not as valuable. It doesn't cover as much as we had thought. And we often are exposed to high out-of-pocket costs. That's one of the reasons I formed this organization called the Lower Out-of-Pockets Now Coalition, because people can't afford to use their insurance. And the cost of a family policy now, the average cost is $25,000. So as the cost of the coverage goes up, also the cost of what you have to pay out of pocket, that goes up too. Why is that? Other than obvious interests of the insurer, but I mean, how did that happen? How does that happen? It happened when I was in the industry. the executives and the consultants to the industry said one way that the industry, the companies can make more money is by paying fewer claims, making people pay more out of their own pockets first. And we sold it with the euphemistic term consumer driven health care. Jesus. And we were experts that getting people to believe things that just simply were not true or that were coded in language like consumer driven health care. What it was hiding, obscuring, was the fact that it made people pay more out of their pockets before their coverage would kick in. They did this. They never owned up to it. But the real reason for doing this was, again, so they would have more money to reward shareholders. So the more money we pay out of our own pockets, the more money they can reward their shareholders. And we used the term back then. My CEO and I and others would say Americans needed to have more skin in the game. I bet you heard that a time or two. when you were in the Senate. Yeah, but that wasn't the, that was the opposite of the ACA, of the intent. Oh, exactly. Exactly. But the opponents of reform and going back before you were in the Senate and Obama was president before the ACA was passed, that's when these plans began to take hold. And executives, including me, were saying patients are the problem. They need to be paying more for their health care because they not exposed enough to the real cost of health care I assuming then that the care a patient pays for out of pocket doesn count toward the MLR No. No, it doesn't. It does not. It does not. The insurance industry, the insurance company is only held accountable for, well, it does have some bearing. But as long as insurance company can say that they paid 80 again, 80 percent if it's a small group or an individual or 85 percent, if it's a large group on health care. And again, that's a very squishy definition of what health care encompasses. And they've even used it to the point of seeing how they get like it, like in the Medicare program, for example, Medicare Advantage United and other companies send nurses out to people's homes to do what's referred to as health risk assessments. And they count that as improving someone's care when actually the intent, the reason for doing that primarily is to see if they can find evidence that they can claim that the person is sicker than they actually are. Because when they do, they're able to get more money from the federal government, from the federal Medicare program through the program that's called Medicare Advantage. So they've even been able to figure out how to make a profit center from doing some of the work that is actually, in their interpretation, providing care. Wow. Now, I get Medicare. I get my health care through Medicare, but I don't do Medicare Advantage. Good. Good. It advertises too much for me. It does. If they're advertising that much, it's a profit center. Exactly. You're so right. And I wish more people were as a student as you because it is too good to be true. They advertise that you're going to get more coverage for things like dental and vision and hearing. Typically, the coverage for those things are very paltry. They're not very substantial. People never hear in these advertisements that they are going to be subject to this prior authorization we've been talking about. That doesn't happen in the traditional Medicare program. Prior authorization is almost unheard of in traditional Medicare. It's very, very prevalent in Medicare Advantage. And once again, UnitedHealthcare, one study showed that they reject about a third of requests for coverage in their Medicare Advantage plans. So people don't hear that. They sign up for these plans. I just say, whenever I can, buyer beware, because it is too good to be true. And they are not required to advertise truthfully, which is another thing that I advocate for. These companies. Advertising truthfully is something you advocated for. I do now. I do now. If drug companies have to in their TV ads at the end, have some fast talking person say, here are the side effects or potential side effects. Why shouldn't insurance companies be held to the same standard that you may not get the coverage for the care that you need because of prior authorization? You don't hear anything in those ads. So that's one thing. I talk to members of Congress. Why don't you at least address that among other things? But that's one thing that might keep people from signing up for these things unwittingly or thinking they're going to get something more than they do and wind up not getting the care that they need. Now, Americans overwhelmingly like the ACA or at least approve of it. Right. Anyway. Right. But now it's kind of at a crisis point because just it's unaffordable for so many Americans. And they're not extending the subsidies. That's it's too late now. Right. Yeah. The shutdown, of course, was in large part about the subsidies. and we're seeing premiums now skyrocket. KFF is a nonpartisan health policy research group. You must know them. Estimated the average recipient would see their premiums more than double this year. There's been quite a few different estimates for this, and none of them good. And it seems to depend on a number of things like your income, what kind of policy you have. Mm-hmm. But most Americans are going to face much higher premium. What is the main determinant of how much your policy goes up? Well, it depends on whether or not you were eligible for an enhanced subsidy that was put in place during the Biden administration during the pandemic. That's what has gone away. That means that hundreds of thousands of people who were newly insured, they were able to afford coverage as a result of that, have lost that subsidy. And so they're the ones who are losing the ability to afford insurance. I live in Philadelphia, and there was an article in the local paper that at least 70,000 people in just Pennsylvania alone have dropped their insurance because they can't afford it. Their policies have doubled in price, if not tripled in some cases. There it's been reported that a 1.4 million fewer people enroll in the ACA, which is actually, I thought might be more. I think it will be more down the road. I think that will continue to decline. I say people are healthy and feel they can risk not getting sick. Does that mean the people who do get insurance will be sicker and insurance companies will further raise their premiums. That's exactly what I think is going to happen. One of the reasons I thought it was really important to extend those subsidies because the people who are dropping their coverage are the ones that not only are having trouble affording it, but they are more than likely the youngest and the healthiest people who think they can take that risk. People who have health conditions, who are older, are probably going to be doing their best to stay covered because they will be running an even greater risk by dropping their insurance. So when that happens, that creates or could create what's referred to as a death spiral of more and more people who are in that pool of people who get their coverage through the exchanges are sicker. And then as a consequence of that, the insurance companies will increase their premiums next year, and then that will probably lead to more people dropping their coverage. So it's really destabilizing the ACA marketplace significantly by doing this. We kind of touched on this a little bit. Did Democrats miss an opportunity to address the high costs of ACA insurance when Biden was in the White House and Democrats had the majority in both houses. Did they squander their chance to address the cost of the ACA? And what could they have done that they didn't do? I think they could have. There were a number of things they could have done that I was disappointed they didn't do. And one was to address some of the problems that continued to exist even after the ACA was passed. And of course, we know that when the Republicans were running the show during the first Trump administration, there were numerous attempts to repeal it. It wasn't repealed outright. Who knew health care was complicated? That's what Trump said after McCain did the thumbs down. That's exactly right. Exactly right. But the administration could have looked to do something more to move beyond the Affordable Care Act when they had a majority, but they didn't do it. And a lot of members of Congress that I talked to, they were justifiably proud of the Affordable Care Act, but were thinking that, well, we've got that done. And of course, any kind of health care policy legislation is risky, is very polarizing, but I think they just played it too safe. But you could do that under reconciliation, right? Yes. Which means all you need are the 51 votes, the 50 plus Vice President Harris. Exactly. There was a time when we had her to be the majority of the Senate. Yeah. So what are Republicans offering? I know. I'm sorry. Yeah. That was a punchline. But what like what is Trump propose? I know he proposed something about giving tariff money to buy health insurance. Wasn't that something I heard a couple of months ago? Yeah, I think I think he probably has conflated tariffs with the with health care. Who knows? But what he what he most recently has proposed is what he he refers to as the great health care plan. And this is what we've been waiting for for, what, 10 years now that he said is on the way. But all we have so far is two or three paragraphs about what it supposedly is. And even the Republicans in the Congress are just calling it a framework. At one point, they were calling it a concept of a plan. I think the president called it that. He's proposing, and this is not fleshed out, but his idea is to spend money directly to people rather than doing the subsidies, which were in the form of tax credits that went to insurance companies to enable them to buy coverage more affordably. Trump is saying, well, let's send that money directly to individuals and families. Let them put it in a health savings account. Right. And they can spend that money as they want to for health care. But he's never said how much money that he's going to send. And health insurance is expensive. Yes. So is he going to send, you know, $20,000 or $15,000 every family of three or four or whatever? Yeah, I kind of doubt it. I don't think he knows how much it really costs. And he's saying that is a way to penalize the insurance companies because we won't be sending money directly to them. But he would put the burden on individuals to use that money to buy their coverage. So the money would still go to the same insurance company. So I hope that people will wake up to realize this is nothing more than smoke and mirrors. But the other thing he wants to do, which has been a favorite of Republicans for a long time, is put this money, give it to them so they can put it in a health savings account. Right. That exists, right? That exists. It exists. It was created years, you know, some years ago during a Republican administration. But it has to be tied to a high deductible plan. And it cannot be used to pay premiums. Currently, under current law, you can't use it to pay premiums. So they would have to change federal law to change the HSAs, the health savings accounts. But here's the thing. Most people who have HSAs are pretty wealthy folks. Not many people of modest means have them. And if they have them through work or something, there's not much money in them. So they it never has really caught on. They are a tax shelter for wealthy folks. Really? Good. So he's got something. He's got something for them. Exactly. So that's that's the plan so far. okay so there's no no plan no no there's no there's no plan okay it's not gonna happen um if you could what would you do to reform uh the insurance industry you know we talked about like them owning medical practices and pharmacy benefit management i mean is there anything to breaking them up There is. And that actually does have some bipartisan interest. There's a Republican congressman from Georgia, Buddy Carter, who's a pharmacist, by the way. He understands these PBMs pretty well. Yeah, I want to talk about PBMs or pharmacy benefit managers, because they just make a hell of a lot of money and drive up the cost of pharmaceuticals, right? Oh, they do. And that's why when we if we have to take drugs and we go to the drugstore and pick up our medicine and find out when we get there, even we think we've got good insurance. But we find out that sometimes we have to pay hundreds, sometimes thousands of dollars for our prescription medications. You can often keep your insurance card in your wallet Just go to the pharmacy counter and say I pay cash and get a better deal It that crazy for a lot of drugs And it's because these pharmacy benefit managers, the three biggest are owned by three big insurance companies. And together they control 80 percent of the PBM market. What does a PBM do just for? A PBM works very closely with an insurance company and so closely that the three biggest ones are owned by insurance companies. But they supposedly broker deals with drug makers and they negotiate with drug makers to get to arrive at a price that will be available to people who are in a certain insurance plan. OK. And then they determine how much pharmacist will be paid. They are a middleman, as you can see, in the pharmacy supply chain. But they've gotten so big and so powerful that they extract enormous amounts of money out of that pharmacy supply chain. And in many cases, these deals they strike, it's just really bogus because they sometimes capture and keep more money than the cost of the drug and certainly a lot more than what they pay the pharmacist. And we wind up often, we being patients, having to pay quite a bit of money out of our own pockets because they determine that, too. They determine how much you will have to pay out of your own pockets, even with your insurance card. So they've become incredibly powerful. And the way that they work with drug makers is that they demand rebates, which a better term for this is they demand a kickback from drug makers. This is legal. That's currently legal. But they will say to Johnson & Johnson or Pfizer or Eli Lilly or Merck or someone, we will list your drug on our formulary, but you have to give us a rebate. It's extraordinarily complicated, as everything else health care is. But they've constructed it in a way. Deliberately. And it's like a black box. No one, including lawmakers, has much visibility into exactly how they operate. I've been in those hearings and it's largely impenetrable. Yep. Let's talk more about pharmaceuticals. The U.S. makes a lot of pharmaceuticals, right? We make a high percentage or a large percentage of our pharmaceuticals. But we pay here a lot more than the rest of the world. We do. We do. Why are we paying so much more than the rest of the world? I mean, European countries or other countries, they, the government negotiates, right? That is exactly right. Almost all the other countries have some means in which the government negotiates the price of medications. We just never have. I understand that you want to listen to your podcast, so I will keep it short. Because if you think it's important to make a cost-effective choices, maybe Acer can help. I think, how then? For example, when you're paying a cost-effective money for your loved ones. Want to know more about the insurance where a cost-effective choice is? Go to acer.nl. This is Acer for you and a cost-effective community. Acer does it. So, now you can listen to your podcast. designer, marketer, logistics manager, all while bringing your vision to life. Shopify helps millions of business sell online. Build fast with templates and AI descriptions and photos, inventory and shipping. Sign up for your one euro per month trial and start selling today at shopify.nl. That's shopify.nl. It's time to see what you can accomplish with Shopify by your side. So Wendell on Capitol Hill today, I guess on the house side, There were a couple hearings on health insurance executives testified. How did that go? Yeah, two House committees testified before two big committees, the Ways and Means Committee and the Health Subcommittee of Energy and Commerce. Uh, it was really a historic hearing because I don't think even during the Obama administration, when the ACA was being debated, that, uh, you had the whole lineup of these big CEOs, uh, on the hot seat and they were on the hot seat. You know, they, they came pretty well prepared with their talking points. And now what you prepped, you used to prep insurance, uh, CEOs for, for these hearings, right? I did. Yeah. I, I worked for them for 20 years and I prepped them for every public appearance. So I knew what they would be doing. And I knew that they would be pointing the finger of blame away from them, which is exactly what they did. They're saying that it's the fault of drug companies, of hospitals, of doctors. They're the reason why we have escalating health care costs in this country. But what I am seeing is that there is bipartisan agreement among members of those committees and the Senate as well to do something about the structure of these companies, about their PBMs. You may know that Elizabeth Warren and Josh Hawley have teamed up on legislation that would address the vertical integration of these companies, the anti-competitive nature of these companies and how they do it, particularly United Health, which is the biggest and based in Minnesota. Yeah. And that, of course, owns PBMs. Exactly. Would you say make more money than the insurance side? Oh, absolutely. I worked for Cigna for 15 years, and it was a very big company when I was there. But a few years ago, Cigna bought Express Scripts, which is one of those big PBMs. And now Cigna gets far more money in revenue and profits from the PBM than it does from his health insurance business. In fact, in 2016, Cigna brought in about $47 billion in revenue. In 2024, it brought in $247 billion. Most of that additional money came from their PBM. So that just gives you an idea of how much money we're talking about here. It was a big and it still is a big health insurance company, but it gets far more money. The division that has Express Scripts is much, much bigger now than the health care division that has health insurance. Oh, my God. So that tells us a lot about why we pay so much more for our drugs. Exactly. And as you can imagine, the lobbyists for the PBM business, they're spending an enormous amount of money trying to protect that golden goose. You know, I know that you are for Medicare for all. Yes. But, you know, a lot of Americans, I think during World War II, Americans started to get their insurance from their place of work. Yes. And a lot of Americans like that. And I remember during the 2020 campaign, Democrats like Warren and Bernie and a couple others were for Medicare for all. Yes. And I think there were a lot of, you know, suburban voters who get their insurance through their employer. And we were looking at those districts and the people didn't want to give up our health care system for a government run. because something they didn't know what it would be. That's right. Yeah, it's an unknown to a lot of people. Right. So Buttigieg, as I remember, was for Medicare for all who want it. Was that what it was? That's what you're right. Yeah. And is that such a bad idea? Because other countries, right, have all different kinds of systems. Yes. I mean, the UK has, you know, national health, but not that many. And a lot of countries, you get your insurance from your employer or you get it from a private insurer. Yeah. So Medicare for all who want it. How's that? You know, it has a lot of merit. And I think it's something that we are looking at. We're doing a lot of research and polling on this. There's a great deal of support for changes. Once again, we are at this point where I think we were before when the debate on the Affordable Care Act began. People are very frustrated and concerned and upset with insurance companies in particular, more than I've ever seen it. So I think this could be an opportunity, the next window we have to push something like that forward. and maybe more successfully. I think it could happen. I think it, and you're right, in other countries like the UK, you can, everybody can be covered by the National Health Service, but you can also go to a private provider, a private hospital, private doctors, you can get private insurance. In Germany, other countries, you have that ability as well too, but you have a national program that covers everybody, but some people can opt out of it or they can get additional insurance. And I think that probably is more likely what we could have here in this country. Well, it's going to even, I mean, to get that is going to take a lot of good elections, I think. You're exactly right. And overcoming an enormous amount of opposition from my former employers because the status quo is extraordinarily profitable for those guys. Now, you said that you were kind of shocked by the reaction to Brian Thompson's murder and all the outrage that poured out. In retrospect, are you surprised by it? In retrospect, and as I've seen it, no, because a lot of it, Al, it triggered people's storytelling. Two things can be true. And I say this, the murder was horrific. And you cannot condone that. Any kind of violence is wrong. But what people decided to do was to use this as an opportunity for them to go to social media to talk about how they or someone they knew had had been denied care, in many cases, life saving care. Like the girl, like the girl who didn't get the liver transplant and died. That's the same kind of crime in a way. It is. And I've said that it is a it is a crime. It is. It's well, maybe not because it is legal. The way they operate is certainly legal. In my view, it should be criminal because people die every day. And the ACA did not address that. No, the Affordable Care Act, Obamacare, did not meaningfully address that. And in fact, Al, looking back, it has enabled these companies to act even more with impunity in certain ways. And for them to. How so? Well, there were no constraints on prior authorization, so they've expanded the use of it. And while the ACA did set a limit on how much you can charge out of pocket, those limits go up every year. And they're extraordinarily high. If you have a family plan that you get through the ACA marketplace, you can be on the hook for $19,000 out of your own pocket before your coverage kicks in. There are not a lot of families in this country who can afford that. And that's every year. That resets every year. So it was an oversight, or I think the members of Congress just were not thinking that the companies would use that as a way of using the backdoor to deny coverage or to make people who are sick pay a lot more out of their own pockets and get them off the hook for covering the care that they need. Oh, boy. Well, thank you. You're welcome. Well, I hope you enjoyed listening. That beautiful music is by Leo Kotke, the great Leo Kotke. I want to thank Peter Ogburn for producing this podcast. We'll talk again next week. Starting a business can be overwhelming. You're juggling multiple roles, designer, marketer, logistics manager, all while bringing your vision to life. Shopify helps millions of business sell online. Build fast with templates and AI descriptions and photos, inventory and shipping. Sign up for your 1 euro per month trial and start selling today at shopify.nl. That's shopify.nl. It's time to see what you can accomplish with Shopify by your side.