Wendell Potter can remember exactly when he took the first steps on his journey to becoming a whistleblower and turning against one of the most powerful industries in the US.
It was July 2007 and Potter, a senior executive at giant US healthcare firm Cigna, was visiting relatives in the poverty-ridden mountain districts of northeast Tennessee. He saw an advert in a local paper for a touring free medical clinic at a fairground just across the state border in Wise County, Virginia.
Potter, who had worked at Cigna for 15 years, decided to check it out. What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 300km from Georgia.
Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements.
For Potter it was a dreadful realization that healthcare in the US had failed millions of poor, sick people and that he, and the industry he worked for, did not care about the human cost of their relentless search for profits.
“It was overpowering. It was just more than I could possibly have imagined could be happening in America,” he said.
Potter resigned shortly afterwards. Last month he testified in US Congress, becoming one of the few industry executives to admit that what its critics say is true: Healthcare insurance firms push up costs, buy politicians and refuse to pay out when many patients actually get sick.
In chilling words he told a Senate committee: “I worked as a senior executive at health insurance companies and I saw how they confuse their customers and dump the sick: all so they can satisfy their Wall Street investors.”
Comprehensive healthcare reform in the US has been an ambition of many presidents since the early part of the 20th century. None has succeeded in creating a system that gives all Americans the right to coverage. Barack Obama is desperate to avoid the same fate.
WHAT IS THE CURRENT SYSTEM?
It is a complex mish-mash of systems. Millions of Americans have their own private healthcare plans, either individually or through their employer. About 47 million Americans have none. However, systems do exist to cover the very poor and the old. The system is fiendishly complex and full of loopholes, so even those with coverage can have it withdrawn.
HOW BAD IS IT?
US hospitals are the best in the world if you can afford them. Many cannot, and an accident or sudden illness can bankrupt someone.
HOW DOES IT COMPARE WITH OTHER COUNTRIES?
It depends how you measure things. The US spends about 16 percent of GNP on healthcare, far more than France and Germany, which spend between 11 percent and 12 percent. Yet those countries provide universal care.
WHAT IS THE BIGGEST PROBLEM?
Critics say the biggest issue is the profit motive that drives US healthcare. This ensures that costs are always rising as the incentive is there to provide expensive treatment. It also gives health insurers the incentive to refuse treatment to claimants, by seeking to withdraw their cover.
WHAT IS OBAMA’S SOLUTION?
Obama has asked Congress to draw up a government option, allowing all Americans to get some sort of cover. The sheer size of the state plan should theoretically allow it to drive down costs by economies of scale.
WHAT’S HAPPENING NOW?
Obama has put his reputation on the line to persuade wavering Democrats and moderate Republicans to vote on legislation by next month. The Senate has said this will not happen. That’s a major blow, as it puts off the debate until September and could see the political momentum stall.
Potter’s claims are at the center of the biggest political crisis of US Barack Obama’s young presidency. Obama, faced with 47 million Americans without health insurance, has put reforming the system at the top of his agenda. If he succeeds, he will have pushed through one of the greatest changes to domestic policy of any president. If he fails, his presidency could be broken before it is even a year old. Last week, in a sign of how high the stakes are, he addressed the nation in a live TV news conference. It is the sort of event usually reserved for a moment of deep national crisis, such as a terrorist attack. But Obama wanted to talk about healthcare.
“This is about every family, every business and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades,” he told the country.
Obama’s plans are now mired and the opponents of reform are winning. The Republican attack machine has cranked into gear, labeling reform as “socialist” and warning ordinary Americans that government bureaucrats, not doctors, will choose their medicines. The bill’s opponents say the huge cost can only be paid by massive tax increases on ordinary Americans and that others will have their current healthcare plans taken away.
Many centrist Democratic congressmen, wary of their conservative voters, are wavering. The legislation has failed to meet Obama’s deadline next month and is now delayed until after the summer recess. Many fear that this loss of momentum could kill it altogether.