A few years ago, around the time the United States Supreme Court upheld President Barack Obama’s Affordable Health Act, paving the way for a more inclusive national healthcare system in America, I was reading Wendell Potter’s Deadly Spin, an exposé on the lobby that operated from the shadows to crush its reform: the health insurance companies.
After some years in journalism, Wendell Potter joined a major health insurer to work as a public relations executive. In 2007, after a two-decade career, he abandoned his lucrative job to become a whistleblower, disgusted and disappointed, unable to cope with the lies he had to fabricate and the vulnerable people he had to destroy in order to protect the public image of his clients. His main tasks involved defending the company’s image, killing media scandals that might jeopardize its profits and affect the price of the stocks, and shaping a positive public perception of insurance companies, considered by public opinion to be motivated solely by greed. This included convincing the American public that a national health case system would run counter to its best interests. All of this manipulation was done “in such subtle ways that I could never even acknowledge to myself that I was purposely trying to mislead.” At first, Potter didn’t consider his work immoral. In fact the work he and his colleagues performed had a zing of sexiness and elegance. “I didn’t feel then that we were doing anything unethical or underhanded. We were all well read and well educated and could hold our own at any cocktail party, regardless of the subject. We were charming and articulate and sophisticated. We all wore nice clothes and ate at the best restaurants and had kids in good schools and houses in the right zip codes. We knew people in Congress and White House. We talked every day to reporters at the Wall Street Journal and the New York Times. we were powerful and influential – not nearly as much so as our CEOs, of course, but what we did and said mattered. The American dream didn’t get any better than this.” What Potter slowly realised, however, was that his American dream was being paid at the expense of the misery of millions of Americans.
Three reasons led Potter to abandon his lucrative job and start fighting the health insurance industry: Michael Moore’s documentary Sicko; witnessing the non-profit organisation Remote Area Medical (RAM) providing free medical care to thousands of citizens of Tennessee; and his part in the handling of the ‘horror story’ of Nataline Sarkisyan, a seventeen-year-old girl who died because Potter’s company, CIGNA, refused to pay for an organ transplant that could have saved her life.
Potter’s about-face started around the time Michal Moore released Sicko. When the documentary premiered in Cannes, Potter had an agent in the audience taking down notes. As soon as the session ended, he ran to a telephone to transmit to Potter the contents of the documentary: it unfavourably compared the US health care system with other countries’, and was predictably hard on insurance companies. When the documentary premiered in the USA, Potter went to see it to get a first-hand notion of what the industry was up against. One of his jobs was to show a ‘rapid response’ to crises, and Moore was a crisis for the industry. But the effect it had on him, as he watched case after case of Americans who were denied health care even though they had paid for it all their lives, was to make him question the ethics of his employers. Even so, he and the top health insurer executives got together to delineate strategies to destroy the documentary’s effect, to silence it. After a successful premiere in America that attracted political support, the PR machine initiated a fear-mongering campaign, which Potter describes in detail, that crippled the impact of the documentary on American society. However it’s a testament to Moore’s ability to raise controversial topics that he managed to terrify the industry into such a fierce response as Potter describes.
Another factor in turning Potter into a whistleblower is related to a trip he made to the Appalachians, to visit his parents. Making a stop at Wise Country, Tennessee, he had opportunity to witness the work of RAMin the town. RAM is a non-profit organisation that provides free medical care thanks to volunteers; originally it was created with the intention of operating in foreign nations, but it soon became evident that in America, especially in its poorer rural areas, there were also millions of Americans who couldn’t afford health care, either because they were so poor that they couldn’t pay for it or because companies deemed them uninsurable because they’d be “drains on profits.” On the day Potter stopped in Wise County, he saw a scene that seemed to belong to an African refugee camp: queues of dozens of thousands of men and women, old and young, waiting hours – some had slept the night there to get a good place - to be seen by volunteers who had set up their ‘offices’ in barns and tents. It seemed too amazing to be true, but there existed a whole socio-economical class that couldn’t afford health insurance in the United States, due to the greed of the companies and their draconian measures to artificially inflate prices in order to report profits that met Wall Street’s expectations. Potter asked himself if this scene of misery is something that should be happening in the allegedly most developed country in the world.
The death of Nataline Sarkisyan was the last straw. CIGNA refused to pay for a transplant operation that could have saved her life. When CIGNA refused the payment, her parents started a media campaign against it. When Potter got hold of the situation, he realized that this ‘horror story’ was better dealt with if they simply paid the operation. In this business, he explains, threatening with the media tends to work. And indeed in Natalie’s case CIGNA relented. But it was too late and she died before the operation. This only worsened things and CIGNA feared the impeding backlash. Potter had to oversee the operation to kill the scandal since her parents refused to let the story go. Ironically, the costs of restoring the company’s image after the hard blow caused by Natalie’s death were several times more than the cost of the operation itself. If a young woman hadn’t died, this irony could actually be amusing. Spending millions on anything but health, however, is one of the industry’s great crimes. In order to deal with Michael Moore, they also spent millions of dollars. And during the PR campaign against the health care reform, in 2009, it was spending as much as $700,000 a day just to defeat Obama’s reform. Money that could actually be used to pay for treatments and save lives. In face of so much venality, Potter got fed up and quit.
Deadly Spin would have been interesting enough if Potter had merely narrated his disenchantment with the job, but that’s just the skeleton holding together many other stories: like the history of PR in America (amongst other episodes, he regales us with the ironic story of Edward Bernays, the Jewish-American PR pioneer who discovered that his 1928 classic, Propaganda, was being used by Joseph Goebbels to start a campaign against Jews); or the history of healthcare – another irony: although an emblem of the Left, national health care was actually created in 1883 by Otto Von Bismarck, the father of the German empire. The reason is that at the time communism was becoming very attractive to the working masses with its promises of better living conditions; an NHS was a means conservative states saw to curtail the expansion of communism. This strategy was known by a lovely turn of phrase: “turning benevolence into power.” Although a national healthcare system has become a mainstay of just about any modern state, Potter traces the main reason why it failed in the USA for so many decades – corporate greed – and describes the PR methods and media campaigns that companies have used to shape public opinion, from the start of the 20th century to the historic debates of 2007-2009.
Potter is especially thorough when he discusses the work of public relations. I like his simple distinction between PR and advertisement: “PR people do not create ads that can be seen or heard or touched. They create perceptions without any public disclosure of who is doing the persuading and for what purposes.” This can be done in many ways: for instance, making smoking look cool, sexy and even beneficial to one’s health – for an example we have the scandal involving British philosopher Roger Scruton, who in leaked e-mails was asking Japan Tobacco incredible fees for articles he’d disseminate in high-profile newspapers promoting smoking. This method benefits from using the authority of renowned people – after all, who’d think a philosopher, such a noble figure, to be a mercenary for big tobacco? A similar technique is using the authority of scientists: for instance, companies that want to convince the public global warming doesn’t exist can always find a reliable scientist to write the right report claiming the problem doesn’t exist at all. My favourite technique is Astroturfing: “The term means creating a false grass-roots movement so that a carefully crafted campaign or event seems to be happening spontaneously.” Since companies tend to be universally despised by people, they delegate the fight to hand-picked ‘citizens’ – secretly organized, financed and directed by them – to make it look like any opposition against something that threatens their interests is just a public demonstration of civism.
Potter continues: “PR subtly convinces you to change the way you think. Advertising urges you to do something now; PR is patient. Advertisers pay for the time and space devoted to their messages. Good PR usually gets free media space because it is presented as unbiased information.” This, of course, is also the fault of journalists. “As budgets drop, especially at newspapers, there are fewer reporters and fewer resources for investigative journalism. Canned information from companies is used ‘as is’ more frequently, often without fact-checking.” So instead of doing proper investigation, journalists nowadays rely more and more on public statements issued by companies. Noam Chomsky and Edward S. Herman’s had already formulated this thesis in Manufacturing Consent (1988), but it’s nice to receive confirmation from someone who was once on the other side. Furthermore, media access to the companies is protected by people with Potter’s former job, who, through their connections – don’t forget he was a journalist – controlled who had access to the information, and how and why.
So how does PR work? “Distract people from the real problem; generate fear; split communities with rhetoric, pitting one group against another; encourage people to doubt scientific conclusions; question whether there really is a problem; and say one thing in public while working secretly to do the opposite.” And, Potter cautions, never trust a company that claims to be “part of the solution.”
Potter builds an excellent argument that health insurance companies in no way care about people. On the contrary, in their greed-driven amorality they’ll do anything to get rid of patients they consider ‘drains on profits.’ Potter describes in great detail how companies investigates their clients to know whether or not they’ll be profitable, and tells of employers who earn bonuses for doing nothing but reviewing patients’ records in search of information that may allow the companies to rescind unprofitable contracts. This is a complete distortion of the original purpose of health insurers, of course. And why do they get away with it? Because they’re big employers, Potter informs us, and so local authorities, wary of rising unemployment, don’t want to cause them trouble, and because they spend huge sums on lobbying and campaign contributions to politicians. Thanks to political protection, health insurers paradoxically continue to see their profits go up while millions of American families are declaring bankruptcy.
Change, then, Potter defends, must come from well-informed citizens and not politicians. Although these companies often succeed in manipulating public opinion, it’s a testament to the public’s ability to discern truth from lies the fact that elaborate, aggressive and expensive PR stunts are necessary to maintain the distortion. They only do so at the expense of billions of dollars. People aren’t that stupid after all. It’s important to remember that before we think nothing can be changed. The first step to change things is searching for information and raise awareness. Deadly Spin is a good place to start. It can instruct readers how to become conscious of the daily techniques used in media to shape their opinions, how to spot them, and how to develop defenses against them. Once you know what you’re fighting against, once you actually know there’s something you should be fighting against, everything becomes much easier. And his lessons about PR can be applied to just about any other company: cars, tobacco, drinks, fast food. Just for that insight Deadly Spin is well worth reading.