 people like I used to be and others like me at big corporations spent a lot of money over the years trying to get Americans to not trust their government or to think the government is just taking our money and and not making very good use of it and politicians not behaving as we would want them to behave and I hate to admit I was unwittingly a part of that to get Americans to distrust the government and it is why in in many of the anti-healthcare reform campaigns almost all of them to be honest with you regardless of what is being proposed my old industry and its allies will say that what is being proposed is a government-run health care system or is a proposed government takeover of our health care system this is rob johnson president institute for new economic thinking I'm here today with an extraordinary gentleman Wendell Potter in this crisis of health care which has been boiling in the united states I have not read or heard anybody more sensible and so I'm very glad to have you here today when we have a health care system which the OECD says is more than double what most advanced economies pay per capita and the world health organization ranks at something around 38th best in performance we got work to do I'm not is how you say there's some things wrong I don't want to just growl I want to see the light at the end of the tunnel and that's why I asked you to join me today but where are me where are we starting my dad was a doctor let's start with diagnosis then we'll get to remedies where are we now well we're we're very much in a crisis mode we all know obviously that we're in a pandemic but we are also in a health care crisis that I don't think many people are aware of and it shows up in many different ways the companies that I used to work for are enormous companies now far bigger than they were when when I was there they've grown so big largely because of public resources that in a sense the government is bailing them out and making them the monsters that they are now and paying very little attention to what they're doing one of the ramifications of of the growth of these companies and frankly some of the work that I was doing before I left the industry people are functionally uninsured in this country people who think they have health insurance but millions and millions and millions are are finding out when it's frankly too late that their health insurance that they and their employers in many cases have been paying a lot of money for is just completely inadequate and they in many cases wind up in bankruptcy or in debt for the rest of their lives even with insurance so it's a lot worse than it was when I left in many regards I think there is some hope possibly even in the private sector that some things can change that will disintermediate if you will the big companies that I work for they are big middlemen companies that extract enormous sums of money in recent years the big health insurers and I use that word insurers deliberately but it's not really accurate anymore they've they've joined up they've bought or been bought by other big parts of the health care system primarily pharmacy benefit management companies which is itself a big middle man so you've got these enormous companies that are even more in charge of our health care system than ever before two of those big companies are now in the fortune five in this country so it just goes to show you how big these companies have grown how enormous they are and how well they are rewarding their shareholders while the rest of us are having a hard time getting the care that we need even a harder time than ever before in my in in many cases I saw recently you have a sub-stack column that I find very nourishing and you've written about Anthem and you've written about United Health Care recently and what proportion of their growth in profits seems to come from from government from Medicaid like institutions and so it's it's not what you might call willy-nilly in the private sector and I imagine they're paying real close attention to the regulators who are appointed to fundraisers for senators and congressmen and the kind of money in politics that you've written about in your books seems how do you say quite potent quite dangerous and then I guess I'll add an extra dimension that haunted me as I was preparing for this they can charge you insurance premiums but they can in a kind of power discretionary way cancel your coverage if you have a serious affliction on a kind of discretionary basis they don't even have to honor ex post what ex ante you paid a lot of money for it is true it's not quite as blatant as it was before or but it it happens because of the way that insurance companies have structured health benefit plans over the past several years the affordable care act sought to make illegal and it did make illegal some of the most egregious practices of health insurance companies but I knew when the bill was passed that it was going to set up a situation which these big companies would would find other ways that they can make the profit margins and the earnings per share that investors expect them to make and we've seen that play out you're mentioning money and politics is is is especially appropriate because it is at the heart of why we can't make much progress beyond the affordable care act and some would would say that that didn't represent a lot of progress it represents some in my opinion but it also created or set up some unintended consequences one of which is enabling these big companies to have even a tighter grip on our health care system than ever before and they do it largely because they spend so much money on campaign contributions and lobbying at both the federal and state levels and even the local levels they spend a chunk of every dollar that we pay them that it goes into a pot that then goes to lobbying and campaign contributions and propaganda campaigns like the ones that I used to help develop and carry out yeah I remember when I was younger I started my career in the Republican Senate Budget Committee working for Pete Domenici and one day I was sitting on the floor with Bob Dole who at the time was the majority leader and he was quite an affable man he came over and we were waiting about a half an hour before things started and he said well what's on your mind being a senior economist and everything I said I don't understand why because you're all concerned about budget discipline these were during the Reagan years and they done all the tax cuts and what have you I said you guys are all concerned why don't you stop fundraising and make a public allocation for people to run for president and penalize the people who own the radio stations and so forth because you grant them their license they should have to contribute some bandwidth as a public service for the elections and if you take all the money out of politics then people aren't going to do so much pork and you can run a more balanced budget because you guys are having to run deficits to survive and he started laughing and then he looked at me and he said Devin I just don't think it's feasible and uh but it but it was kind of he was playful about it he wasn't offended and but there it just felt like the pork was running wild you know this is 84 85 86 and and it continues to run wild I mean there have been some uh uh some some things that have been done that uh in that might limit the pork a little bit but not not very much I was a reporter in Washington for a few years just prior to that time I was uh covering Congress and the White House for Scripps Howard newspapers back in the in the mid to the late 70s and Howard Baker was the minority leader and then majority leader at that time and I got to know him very well because he was from Tennessee and where I'm from and at one point this issue came up in a campaign of his and he said and his opponent said that it it would be great if if we had a system in which no one could give me money unless they could vote for me and if we had a system like that in which no one other than the people who could vote for you as a member of Congress or Senate it would it would it would it would do a world of good we wouldn't see this rush of money that flows into every campaign from out of state to buy these elections I'll uh I have to protect his name but there was a former senator who was a friend of mine and when he retired I went out to lunch with him and I said okay you know why are you doing this and he said because I can't look in the mirror when I spent 70% of my time raising money all around the country and the world to do things that harm my constituents that elected me and he said I it's it's obvious that for me to survive and god of who thinks that damage my constituents I don't want to live like that wow you know that that's that's very interesting I I had I had sometimes said that well I finally decided I couldn't keep doing what I was doing uh in the insurance business it was big when I looked in the mirror and said who are you how did this happen to you uh do this was not a career that you could ever have imagined and certainly when I was a reporter couldn't even comprehend doing what I ultimately wound up doing as someone is leading the big PR shops within enormous insurance companies so that that's interesting just going to your which you might call your life trajectory my name is Robert Johnson so they talk about the crossroads uh in the blues music with my namesake so that's that's what I'm getting at you have uh this experience in a republican family in Tennessee your father I believe had fought in the war and then you go to college in that 60s era you become a journalist your the product is illumination for the population of what's going on which would interest them I would I would say in an idealistic way and then you you make the shift for public relations for I think it was Humana and then SIGNA and then you after you do that you live inside you understand that you break away so I I would say there are two crossroads I'm interested in when you chose to go in to the insurance private sector what was on your mind what was the magnet and when you chose to break out what were the forces in play at that crossroad you know that I've never been asked that quite that way and I will have to admit that for the first question it was money an advancement in a career uh maybe attaining a lifestyle that I uh aspired to attain that was more than my parents could ever have imagined I mean I think that was probably more of what was on my mind than anything else ultimately later though the reason I left that was I it was a crisis of conscience it was a realization that I was chasing something that was would have embarrassed my parents would have they would have been so ashamed to a certain extent of knowing what I was doing for a living and how I had changed from the you know the the boy who had grown up in their household and I think that my coming from from that family from that part of the country played a huge role in my ultimate decision to to walk away I I found myself in a situation which I had to face people who could have been people I grew up with who were waiting to get care in in barns and animal stalls and I probably wouldn't have had that reaction had I not grown up in a quite frankly a low-income working class family a farming family and a small rural area of Tennessee so at some level at this the second crossroads which I think is very tender in it I think it has a lot to do with what you've done since you reached a place of conflictedness between what you were being asked to do on behalf of the company and what the company and in the context of our political economy was doing to people that's exactly right I I had this realization that what I was being paid quite well to do in my corporate career at these insurance companies was the exact opposite of what I tried to do in my career as a journalist and I was always proud of that career even though I left it at a fairly young age I never wanted to and never did intentionally mislead anyone with anything that I wrote as a journalist never to my knowledge left anything out to obscure anything that was important or relevant just to make a point in any story that I wrote or even any commentaries that I wrote but I realized that's what I was being paid precisely to do in my job at at Humana and then Sigma was to mislead people was to present some facts and figures and purposely leaving some other facts and figures out that that were very important for people to know and doing this to enhance shareholder value that was exactly what it was that is the one thing that is most important for these companies and it's not certainly unique to the health insurance business but if you are a if you are an executive of a company whose stock is is on the New York stock if your New York stock exchange company or publicly owned company that's for most of these companies that's what drives them and I saw that up close I think that the position I had gave me visibility into corners of the business that most people don't get for that there is there is that and I just could not continue doing it and looking myself in the mirror and and and and remembering who I was how I was raised and what I tried to do in my first career that's beautiful I I think there is there's a very interesting dilemma which I once heard you explore with Paul Jay on the real news network and that was when you had this consciousness that things were off course in terms of a moral purpose you said you realized that you couldn't stay and reform from within that you would be distanced as opposed to going outside writing books shedding light carrying the expertise from your experience which gives you credibility but that was the only way to make the difference that's true I I came to realize there is is not possible to change things from within these big companies and I would go so far as to say even the CEO and the executives we really can't do that if you're in a company that is large and has shareholders that essentially are large institutional investors there is no way that you can change a company in this in a way that is significantly different from what your your few competitors are doing and we've seen that play out in just recent days I've also written a piece about Cygnus recent earnings report or the report of earnings for 2021 Etna more recently announced and if you look at all of both Etna and Cygnus announcements you'll see that they did very very well in 2021 but Wall Street wasn't happy with what they were saying that they thought they would be earning in 2022 so both of those companies got big hits on their stock prices on the day that they announced earnings significant loss of market capitalization just because they were signaling or saying that they expected to earn X in 2022 and that was a bit less than what Wall Street's financial analysts were expecting those companies to do so it's all about the expectations of these big investors investors it's not so much about well thank you for making us so rich last year how rich are you going to make us this year that's what really controls these companies and and I was in a position to observe that to see that play out day in and day out my name was on every earnings release at Cygnus for 10 years so I I know what motivates the CEOs and the CFOs the investor relations people because those are their bosses and the other thing is they have a vested interest in pleasing Wall Street because certainly the CEO his or her compensation is so tied to the financial performance of the company I was one of my talking points when I was having to try to justify the CEO's salary was that 90% of his compensation was as we call it at risk which meant that yeah he made his salary was like one or two million dollars a year but he made a lot more than that through stock grants and stock options that the company gave him and that was depending on how well he led the company to meet Wall Street's expectations and if if you had a day like Cygnus and had and and had recently their compensation took a big big hit because their shareholders as well too so that's that's that's something I don't think people realize that people who run these companies they have financial interest their net worth fluctuates depending on how well they are leading those companies to meet the needs and expectations of of one stakeholder and that stakeholder is the shareholder yeah I always tell people and I used to work in the I was in the hedge fund industry for a number of years that the song that I thought companies should sing to themselves was an old soul song by the charelles called will you still love me tomorrow yesterday never mattered anymore will you still love me tomorrow perfect it's it's absolutely the truth and and it changes in a minute I mean it's not been so long ago that we were looking at 2021 and how how well investors did but yeah what have you done for me what are you gonna do for me now yeah the dilemmas that you raise about not being able to repair inside so you leave you wrote deadly spin an insurance company insider speaks out on how corporate pr is killing healthcare and deceiving americans I think it was 2010 2011 around that time it was 20 it was uh uh toward the end of 2010 uh yeah I bought that book from my dad by the way at the time okay but the uh but I guess where I want to go with this the the dilemma is okay you can't repair on the inside now you come outside when you're outside something has to change the contours in which the company performs to get it to change your book in 2016 is called nation on the take how big money corrupts our democracy and what we can do about it so I want to say you're now outside from inside you can't reform them how can you get government which is on the take from big donations to enact the reforms this society needs and where I'm gonna take this is if they can't do it that despair that frustration that unfairness will destroy the credibility of government the credibility of expertise and I would say fans the flames of the attraction of authoritarian demagoguery and I think we are in the midst of that right now so how do how do you take from coming out how do I say bearing witness with expertise but then seeing the systemic problems what kind of recipe can you and I concoct to put us on a healthier trajectory well first of all I share your your concern and and and I think it is be well another reason why is that people like I used to be and others like me at big corporations spent a lot of money over the years trying to get Americans to not trust their government or to think of the government as just taking our money and and not making very good use of it and politicians not behaving as we would want them to behave and and there was a purpose for that and that was to get people to think that any kind of government regulations for example would be a bad thing and that taxes are a bad thing because big companies try to avoid both as much as possible so they've done a very very good job and I hate to admit I was unwittingly a part of that to get Americans to distrust the government and it is why in in many of the anti-healthcare reform campaigns almost all of them to be honest with you regardless of what is being proposed my old industry and its allies will say that what is being proposed is a government run healthcare system or is a proposed government takeover of our healthcare system those those terms were used and are continued still used because of just what that dynamic that I described big corporations have really over decades got us to think the way we do about our government and it's getting worse as you said because the way that our political system has evolved some to a certain extent because the Supreme Court decisions that have made it even more likely that big corporations will call the shots because of that people are frustrated and they're seeing that are the people that we elect to represent our interest are not able to deliver on on their promises and we are so easily I think confused about what is in our best interest and so gullible because it changes in in the way we get our news and information it's almost setting up a perfect storm that can make it much more likely I think that we would will be drifting into an authoritarian kind of regime for for who knows how long it worries me a great deal because it is at the heart of what's what problem is is all the money that is a watch in our political system that keeps change for happening and to protect a status quo that is extraordinarily profitable for a few of the incumbent industries and companies yeah I recommend a book there's a scholar at Columbia University had come out of University of Chicago named Bernard Harcourt and the name of his book is the illusion of free markets and what in essence kind of the meta perspective is that capitalism gets its moral license from being embedded in a democracy but when the institutions have to be managed and the servant becomes the master the contortions and the distortions don't look anything like that free market competitive model that's used in academic world to justify this system simplest answers or simplest window in is when you don't in you don't enforce any trust then you're not dealing with a competitive market any longer but there are many many dimensions in which you might call contradictions to those underlying simplistic assumptions that makes it very very important that something be there which we will call government to shape things one of the things that haunts me and some of our friends through Guy Saperstein have been able to explore is the notion that the left has lost confidence in government it used to be there was a team that worshiped free markets and there was a team that kind of what I'll call had FDR nostalgia Lyndon Johnson nostalgia and said we believe in the government a mixed economy the Pagliani's great transformation about creating balance then there's the free market people there was a man named Stuart Zekman who was a musical writer and Carol Avedon I think shared with us that he had done a podcast years ago where an Obama official who was unnamed was on Politico and this Obama official said you can't pretend we're in an environment anymore like Franklin Roosevelt people don't believe in government and Zekman who was I believe a musician went and looked at the Gallup surveys from which this anonymous individual was quoting his evidence and found that the people on the left didn't believe in the free market because they believed that the government was captured by the corporate sector and I remember just feeling like how do you say understanding the disparagement of government or the notion of inefficiency that came from watching the Soviet Union or part windows of Maoist history in China got transformed into disparaging unnecessary condition for a healthy political economy in the United States and I think we got a lot of work to do now we really do and I think there's there's reason to have that concern if you are on the left of seeing just how big corporations and large special interests have have captured government captured the the the regulatory apparatus and certainly control the electoral process to a certain extent to a large extent more than I think most people realize because of the way that they can just pretty much call the shots when someone's running for camp for a for elected office and and certainly through the enormous sums of money that are spent to influence public policy when the affordable characters being debated the pharmaceutical industry spent more during that time lobbying Congress and the White House than any industry had ever spent on any prior legislation but we're seeing that now as you know those records are being challenged just about every year as members of Congress try to look at where do we go from here and I think progressives are seeing that even at the state level where there has been hope that maybe progress could be made there those those hopes are dashed but and again it is because of money that is controlling the the actions of the people that we vote for well then your recent work I know you're starting I would say activism on a number of fronts that you had shared with me in an earlier conversation center for health and democracy business leaders for health care transformation and one I think you called it loops or lupin what was it lower out of pocket now lower out of pockets now yeah yeah loop and and so I can see how would I say you're not giving up the fight we talked a little bit from a kind of what I might say mildly despondent perspective of capture in the discouragement that zekman uncovered what are you what are you doing in these organizations to to carry on well they are distinct one I'll start with the business group first business leaders for health care transformation seeks to bring the the voice of of business leaders particularly those that are concerned about the cost of health insurance or providing coverage to their workers and and also many employers that just have long ago been priced out of the health insurance market they can't they can't afford to offer coverage to their workers so that is an organization that tries to make sure that policymakers and the public broadly understands that that there is a large swath of our business community that that is not in league with us chamber of commerce and outfits like the national federation have been dependent business which report to represent the interest of of businesses in this country they don't and I know that because in my old job I used to work very closely with those organizations to get them to carry out our propaganda campaigns and they'll do it for a dollar you know for now more than a dollar it costs quite a bit to get those organizations to carry water for you but that's what happens so with that organization we are looking to bring the business voice to helping to find some solutions to make our health care system more rational center for health and democracy the word democracy is very important for the reasons we've we've been talking about what can we do for that organization to help people understand just how our political system has been taken over by the special interest the big corporations the big industries and that's why we have this health care system that we have and why it is so hard for those that we vote for to make any improvements in it we as part of that work this year we'll be looking at campaign contributions at both the state and federal level to show for example which democrats are taking money from the political action committee so the big companies like the ones I used to work for just within recent days we saw that my old industry the health insurance business through one of its front groups called a better medicare alliance crow about getting 340 members of congress to sign a bill sign a letter to the secretary of hhs and the administrator for the the center for medicare and medicaid services to protect medicare advantage to make sure that that is funded because americans love it so much that's an example of how they are able to get politicians in their pockets they gave money to these members of congress democrats and republicans alike gives them the opportunity in the industry to say this is bipartisan support for medicare advantage when what's really going on here is keeping a cash cow being fed the medicare advantage program in particular is the new cash cow for these big companies and that is where in many cases we as taxpayers are bailing out these big insurance companies they are no longer growing on the private side on the commercial side in fact their their membership in the employer sponsored plans and other plans that people buy on their own has been diminishing for years now most of their money is coming from us as taxpayers so we we we we we try to expose all that to educate the public to put pressure on policy makers but also to one of the things i want to do going forward is also to shine a light on some things that that's going on in the private sector that might might make some things better for us in certain regards it because it is so hard to change policy and and to influence policy makers i think it's it's it's important to look at what can be done in the private sector to to disintermediate the big companies that i used to work for and i think that's a possibility i think we need to focus attention on both the public and the private sectors to to change our health care system if we just look to try to influence legislation i'm just afraid that we're not going to be able to make much progress we haven't seen much progress over the past several years because of again all the money that the incumbents are able to throw into the system to protect their profits let me ask you a question we have a lot of young people still in school i look at universities today let's i'll speak about california public school system university of michigan university of virginia the public support for education is down lots of pharmaceutical and health care companies are doing laboratories at major universities as a source of revenue there's a lot of uh how would i say wealthy donors and alumni who've worked in the health care industry are we illuminating these dilemmas in university curriculum to the degree that we need to so that people are preparing to become citizens people are preparing to address these challenges in lockstep with your efforts or is this is this a one of those silences that anthropologists tell you study the silences because the silences reveal where the truth is and where the power is and they're not in the same place they're not in the same place oh they're not i think that's uh that's really an important question also worries me a great deal i i i i even um at the level before college i think that we long ago have have stopped teaching civics uh top stop uh providing uh training and information about how to be a good corporates that are not a good civic uh participant uh and a good citizen uh and i don't think you're seeing that's that that at the college level as much as as is needed and what we might want to might have seen in years past i think the the whole idea of a liberal education is is one that probably is not as attainable as it once might have been i think there is too much of an emphasis on training people to go into the workforce to do x job and not nearly enough focus on um making sure that someone has critical thinking skills for example um so and i think that has been a significant change in our educational system over the years that is a really dangerous dangerous change in our in our system i i i think it is it is why so many people or a reason why so many people are so gullible so why they are so easily persuaded to believe things that are not true they are not equipped to think critically and understand how they're being taken advantage of it's hard to to understand that in the first place but in the absence of any kind of training about how to do it um i think we're maybe suck yeah the late uh and very famous canadian author jane jacob's last book was published in 2004 it was called dark age ahead and the third chapter was called credentializing versus educating and i remember reading that feeling quite uh unsettled but i think there's another dimension now which is when people are at that place between learning curiosity on one side and credentials on the other part of what drives them towards the credentials is the fear of economic insecurity if they aren't conformist and so we're we're not in a uh which am i call a free environment and this anxiety will i have health care can i afford a car all these kind of things in this advanced nation often relates to the kind of data that the economic policy institute in washington puts out which is productivity has been going up and more than a hundred percent of the gains have gone to essentially about eight percent of the population the median income in america is lower than it was in the mid 1980s according to those studies and so something's happening in terms of distribution inside that's heightening fear and i remember uh there's a wonderful psychologist named howard gardener who i've never met at harvard and he wrote a story once in the washington post about why cheating is so rampant at his university called harvard he said you think these people are already on the conveyor belt to success but he said the stakes between being in the one-tenth of one percent and even in the 10 to 20th percent were so high that many people took the risk of cheating and being caught in order to which might call propel their their credentials and record to a higher level and i thought that was that was really an interesting symptom of the anxiety which young people face in the world today i think you're right i think that one thing that might seem and hopefully could counter that is from what i am hearing and reading maybe more of a sense of social justice among millennials and people who are younger and maybe less a feeling of being driven to have a house that's bigger than our parents or the the you know the the biggest most expensive car model uh maybe maybe that can help counter that but i think you i think it is is is absolutely right the economic insecurity is is a very big thing and a very real thing at all levels of our society unless you are pretty well assured of of being left a lot of money by your your parents and it also is leading leading i think to something called diseases of despair in this country in which people are almost hopeless they they can't see how they can get ahead and they they work in many cases two or three jobs and it's just not working out for them they're not and and and they're seeing things on social media and on tv and other other traditional media about things that others may have or that they should have but they don't and i think it just really leads to these diseases of despair and contributes to the fact that our our lifespan of this country is actually shortening rather than than then increasing