Clinton-era PR campaign misled Americans about single-payer health care : Planet Money For years, Wendell Potter ran a campaign to terrify Americans... about health care in Canada. Now he explains how he did it, and why. | Subscribe to our weekly newsletter here.
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UNIDENTIFIED PERSON #1, BYLINE: This is PLANET MONEY from NPR.

AMANDA ARONCZYK, HOST:

When I first moved to New York from Canada back in 2000, I went to visit a park, and I made the mistake of sitting down in the grass. And something bit me.

ROBERT SMITH, HOST:

You know, in New York, that's probably the best thing that could happen to you sitting on the grass.

ARONCZYK: (Laughter). So the bite got worse, and I didn't have any health insurance, but I had to go see a doctor.

SMITH: Ooh.

ARONCZYK: So I went to a clinic in my neighborhood, and they were going to charge me, like, a lot of money.

SMITH: Yeah, welcome to America.

ARONCZYK: They were going to charge me a lot of money. And I was not used to paying money to go see a doctor. So the whole thing was, like, super-foreign. They would try to explain to me what was happening, and I did not understand. And I would talk to my friends and people about what was going on. And I was, like, trying to figure it out. And they're like, yeah, but isn't this better than what you had in Canada? And they would say things like, you know, I thought Canadians waited forever to go see a doctor, and I thought Canadians couldn't, you know, get the treatments that they needed. And I will always remember this detail. They would say Canadians die in hallways. They die lying on gurneys in the hallways of hospitals waiting for treatment. And the people that said this to me were not conspiracy-minded types. These were people who I knew and I respected. And I just was like, where are you guys getting these stories from? So flash-forward to this past summer. And I'm scrolling through Twitter, and I see this article by someone who used to work in the health insurance industry. And the headline - I'm quoting here - is "I sold Americans a lie about Canadian medicine."

SMITH: A big old lie.

ARONCZYK: This was the guy who had made up all of those lies.

WENDELL POTTER: I'm at fault here. And I'm - the work I'm doing now is to make amends for all of the work that I did to perpetuate those beliefs, those myths about the Canadian system.

ARONCZYK: This is Wendell Potter. He ran the PR department of Cigna Health Insurance for a long time. Now he's a whistleblower. When I talked to him, he told me that part of his job was to run campaigns to specifically badmouth Canadian health care because for decades, one of the biggest fears of the insurance industry in the United States was that Americans would discover that just to the north was a place that had essentially no health insurance companies...

(SOUNDBITE OF MUSIC)

ARONCZYK: ...A place where the government ran health care systems, a place where people live longer than Americans and have lower infant mortality rates.

SMITH: A place called Canada.

ARONCZYK: Hello, and welcome to PLANET MONEY. I'm Amanda Aronczyk.

SMITH: And I'm Robert Smith. And we should say that we are both Canadians who walk among you. I'm from London, Ontario.

ARONCZYK: And I'm from Toronto.

SMITH: If more Americans truly understood how Canadian health care worked, if they could imagine a world without insurance companies, Americans might demand the same thing. And that would be disastrous for American health insurance companies.

ARONCZYK: Today on the show, Wendell the whistleblower takes us inside this decades-long fight to make sure that Americans have no alternative.

SMITH: The story of how the health insurance industry launched a secret Cold War - Cold War - to convince you that Canadians are total losers.

ARONCZYK: (Laughter) When it comes to health care. Like, not, you know (laughter) - I just feel like it's mean, but it's OK.

In 1992, Wendell Potter is just starting out his journey as a hit man for health care. He's working on the PR team for Humana hospitals, and he's just learning how to twist statistics and say no comment in, like, 100 different ways.

SMITH: His playbook at the time was this old book that he had read in college. No joke, it is called "How To Lie With Statistics."

POTTER: That was one of the books that we used, a little slim volume. It is not really a primer on how to lie, but it is a book on how statistics can be used to mislead.

ARONCZYK: "How To Lie With Statistics" is hilarious, by the way. It's got chapter titles like Much Ado About Practically Nothing, The Gee Whiz Graph and The Well-Chosen Average.

SMITH: It was useful, but Wendell was going to need a whole new playbook for what was about to become a major health care debate in America. He was going to need How to Lie About our Gentle Snow-Dwelling Cousins to the North.

ARONCZYK: The Canada problem first comes up during the presidential race that year. George Bush, the father, was president at that time, and he's running for reelection against young Bill Clinton. And Bush was not happy about the Democrats' suggestions on how they wanted to fix health care.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT GEORGE H W BUSH: And then there's another favorite Democratic plan. It's to make the federal government the monopoly provider of national health insurance. And if you think socialized medicine is a good idea, ask a Canadian for a second opinion.

SMITH: No one actually asked me at the time.

ARONCZYK: They didn't ask me either.

SMITH: But I totally could have answered. In Canada, health care is just a normal thing that the government runs, like schools. If you get sick, you call your doctor, you get an appointment. But here's the big difference. Instead of charging the patient or an insurance company, the doctor essentially bills the government. And by government, I mean the province or the territory where the patient lives. It's basically like a state. And that government pays the bill. It's called single-payer.

ARONCZYK: In Canada, you never pull out a credit card. You never pay a deductible or get a bill. Now, it is not perfect. And this isn't a show about which kind of health care system is best. But the Canadian system is certainly very simple.

SMITH: What the Clintons were proposing wasn't actually a Canadian-style system. But the Democrats did borrow some ideas from the Canucks. Regardless, the health care industry was not pleased.

POTTER: We all had something we didn't like about it. The hospitals didn't like this part. The drug companies didn't like this part. And the insurance companies didn't like this part. So they said, well, let's just all get together, throw a lot of money into this one place. And that place back then was the Health Care Leadership Council.

SMITH: The council was the first chapter in the new playbook. Bring together all the heads of the health care families. You know, set aside all grievances and unite against this common enemy.

POTTER: That was the hub of our propaganda efforts, our communications efforts collectively to push back against the Clinton reform plan.

SMITH: This hub would execute the next chapter of the playbook - define the terms of the debate. Whatever the Clinton's pitch, call it government-run health care, even worse, bureaucratic-run health care. Oh, even better - socialism.

POTTER: We used those terms specifically. And we would usually cite Canada as a country that had government-run health care and that you don't want a system like Canada's.

ARONCZYK: They made this plan a reality with a series of ads about a fictional couple named Harry and Louise. Harry and Louise are middle-aged. He's got glasses and a plaid shirt on. Her hair is gently feathered because it's the early '90s. That's what people did. And they're sitting at their kitchen table. They've got a stack of bills and a calculator, and they're really stressing about, you know, the potential upheaval of the health care industry.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED PERSON #2: Things are changing, and not all for the better. The government may force us to pick from a few health care plans designed by government bureaucrats.

UNIDENTIFIED ACTOR #1: (As Louise) Having choices we don't like is no choice at all.

UNIDENTIFIED ACTOR #2: (As Harry) If they choose...

UNIDENTIFIED ACTOR #1: (As Louise) Then we lose.

ARONCZYK: Wendell says the Harry and Louise ads were part of what insiders call a FUD campaign.

POTTER: Fear, uncertainty and doubt. You know, the acronym is FUD. So these were FUD campaigns.

SMITH: This is an actual term in marketing. Fear, uncertainty, doubt - FUD. They don't have to prove anything. They just have to make someone else's idea seem dangerous.

ARONCZYK: This is why everyone I met when I came to the U.S. thought that Canadian hospitals were a place where Canadians go to die in the hallways. Wendell and his friends had searched around, and they'd found a photo of a patient lying on a gurney in a hallway in a hospital in Canada, presumably.

SMITH: Which sometimes happens in Canada, as everywhere when there are not enough rooms.

ARONCZYK: And they use this photo as the symbol of the failures of government-run health care.

POTTER: We sent that image or images like that far and wide.

SMITH: Wendell was amazed at how effective it was. Suddenly he started to hear his words, his propaganda, coming out of the mouths of senators and representatives as they debated health care.

ARONCZYK: And it worked. The Clinton plan was put on a gurney, rolled out to the hallway, never to be seen again.

SMITH: But the PR playbook, the unified front, the language, the FUD campaign got tucked away in an insurance company file cabinet, waiting for the next time they would need it.

(SOUNDBITE OF ARCHIVED RECORDING)

BARACK OBAMA: Thank you.

(APPLAUSE)

OBAMA: Thank you.

SMITH: Thirteen years later, Barack Obama decides to run for president. And there he is, starting the same fight as the Clintons tried.

(SOUNDBITE OF ARCHIVED RECORDING)

OBAMA: I will finally keep the promise of affordable, accessible health care for every single American.

(APPLAUSE)

ARONCZYK: At that point in time, Wendell is working for an insurance company. He's working for Cigna.

POTTER: Our internal polls showed us that a majority of Americans were favorable to the idea of a Canadian-style health care system. And that scared us to death.

ARONCZYK: They were going to need a bigger playbook.

SMITH: The fake Harry and Louise ad wouldn't cut it this time. The health care industry wanted a real person with real anecdotes. They needed an anti-Canadian Canadian. They needed Sally Pipes.

(SOUNDBITE OF TV SHOW, "LIFE, LIBERTY AND LEVIN")

MARK LEVIN: Hello, America. I'm Mark Levin. This is "Life, Liberty & Levin." We have a great guest. Sally Pipes, how are you?

SALLY PIPES: Fine, thank you. Nice to be on with you.

ARONCZYK: Sally Pipes is also a Canadian who walks among us. She's lived in the U.S. for a few decades.

(SOUNDBITE OF TV SHOW, "LIFE, LIBERTY AND LEVIN")

LEVIN: Sally Pipes, you're president, chief executive officer of the Pacific Research Institute, a San Francisco-based...

ARONCZYK: And she's in the media all the time.

(SOUNDBITE OF TV SHOW, "LIFE, LIBERTY AND LEVIN")

LEVIN: We have no idea what they're talking about, do we?

PIPES: Well, I think I do because I'm a former Canadian who grew up under single-payer.

POTTER: She's the go-to person because she - by mentioning that she's from Canada, she will often talk about her mother.

(SOUNDBITE OF TV SHOW, "LIFE, LIBERTY AND LEVIN")

PIPES: I'll just tell you a quick story about my mom who passed away in December 2005.

POTTER: And how can you dispute that? If she's talking about her mother or sister, it's - you know, you can't counter something like that.

SMITH: Sally Pipes was deployed to the front lines of the debate over Obama's plan. She was advising Republicans. She was doing cable TV hits all the time. She was debating Paul Krugman. She was everywhere.

POTTER: The anecdote has a huge effect. And you don't need a lot of them. You can just tell these stories very effectively, and people will go, I don't want a situation like that. And when you get that kind of reaction from people, they are willing to forget just how unfair and expensive and inequitable our health care system is. It's incredibly effective.

ARONCZYK: Now, Democrats, liberals, health care reformers - they're not stupid. They knew what went wrong during the Clinton era. And they had some PR tricks of their own.

SMITH: The health care industry had Sally Pipes. Liberals had their own slinger of anecdotes.

(SOUNDBITE OF FILM, "ROGER AND ME")

MICHAEL MOORE: Can you hear me?

UNIDENTIFIED PERSON #3: We're rolling.

MOORE: Hi, I'm Michael Moore.

SMITH: Michael Moore - that's from the film "Roger & Me." Now, a lot of people have very strong opinions about Michael Moore today. But back then, he had just made the most successful U.S. documentary of all time, "Fahrenheit 9/11." His shtick was to confront the rich and powerful on camera.

POTTER: Everybody in health care knew that Michael Moore's next movie was going to be about health care. We didn't know exactly who was going to be the target. We clearly were fearful that it would be insurance companies. We didn't know.

ARONCZYK: Wendell is convinced that health insurers, like his company, Cigna, are going to be the target. And Big Pharma is like, I don't know. Everybody hates us so much. We're pretty sure it's us. And the hospitals are like, no, no, no, no. This could be ours. They just don't know.

POTTER: So we spent months and months trying to get intelligence, trying to find out what was going on.

SMITH: Wendell and his buddies go full CIA. They avoid printing documents. They speak in code. Michael Moore - they don't say his name. They just call him Hollywood, as in, we got to do opposition research on Hollywood.

POTTER: I watched every one of his movies to understand how he did what he did. I watched every episode of his TV shows just to get to know how he operated.

SMITH: People may not remember this, but Michael Moore was an innovator of the documentary form. Rather than just go through the PR department to talk to an executive, Michael Moore would just show up at corporate headquarters.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #4: Where are you guys going?

MOORE: We're going up to the 14th floor.

UNIDENTIFIED PERSON #4: Do you have an appointment?

MOORE: No, we're going to try and see Roger Smith.

UNIDENTIFIED PERSON #4: No, you're not. You're not going to get on one of those elevators.

MOORE: Why is that?

POTTER: I just was constantly fearful that I would come to work someday, and Michael Moore would be waiting with his camera or ambush me or, even worse, my CEO. It was enormous stress.

SMITH: While Wendell is stressing out, Michael Moore finishes his film. It was called "Sicko," and it premiered at the Cannes Film Festival in 2007.

POTTER: America's Health Insurance Plans actually sent a guy to view the movie at the film festival. And he called back to the States with his report on what he saw and what was in the movie.

SMITH: I imagine Wendell grilling this guy who had seen the movie. OK, do they mention the insurance company Cigna in the film? Yes. Yes, they do. Does it look bad for Cigna? Oh, yeah, it looks bad. Do they have some sympathetic figure who is denied treatment? Oh, yeah.

(SOUNDBITE OF DOCUMENTARY, "SICKO")

UNIDENTIFIED PERSON #5: La, la, la, la, la.

UNIDENTIFIED NARRATOR: His daughter Annette (ph) was 9 months old when they discovered she was going deaf. His health insurance company, Cigna, said they'd pay for an implant in only one of her ears. According to the letter they sent, it's experimental for her to hear in two ears.

SMITH: This is pretty much the worst-case scenario for Cigna.

ARONCZYK: But, of course, Michael Moore is not done. He then goes after the whole American system. He takes his camera north and goes to talk to Canadians.

(SOUNDBITE OF DOCUMENTARY, "SICKO")

MOORE: So if you'd stayed in the United States, this would've cost you $24,000.

UNIDENTIFIED PERSON #6: Twenty-four thousand dollars, yes.

MOORE: Instead, you went back to Canada.

UNIDENTIFIED PERSON #6: Yeah.

MOORE: And Canada paid your total expenses...

UNIDENTIFIED PERSON #6: Everything.

MOORE: ...Paid for the operation.

UNIDENTIFIED PERSON #6: Yes.

MOORE: And it cost you...

UNIDENTIFIED PERSON #6: Nothing.

MOORE: Zero.

UNIDENTIFIED PERSON #6: Zero.

ARONCZYK: Now, Wendell and his colleagues have just a few weeks before the movie's going to open in the U.S., and they know that this could bring together support for a single-payer system like they have in Canada. They need to get their strategy in place.

SMITH: A few days later, the strategy arrives in the mail.

POTTER: My assistant brought in a package that was wrapped in brown paper.

SMITH: Big, thick package with no return address.

POTTER: And then I open it up, and then it became pretty clear what this was. It was a binder that was put together by America's Health Insurance Plans to make sure that we were all singing from the same hymn.

ARONCZYK: This lobby group worked with this big PR firm, and they filled the secret binder that Wendell is holding with all of these cherry-picked statistics and talking points.

What were the talking points? What were the nasty things you could say about Canada?

POTTER: We always would hone in on elective procedures. You want to make people believe that because Canadians might wait several weeks or a few months to get a knee replacement, that's indicative of everything in Canada. People are having to wait for everything.

SMITH: Inside the binder, there are also statistics about X-ray machines. Apparently, a lot of them are out of date in Canada. There's a stat about the number of doctors per capita actually going down. The cumulative picture is that the Canadian system is lousy, expensive and even dangerous.

ARONCZYK: As the country is debating Obama's health care plan, it is full-on PR versus PR, Sally Pipes versus Michael Moore. And for Wendell, it's all going according to plan.

POTTER: Just about every Republican who went to the well of the House to say something about it used some of our talking points. They almost all used the term government-run health care. We don't want a Canadian-style health care system. So that's how it happens. You can get politicians to say what you want them to say if you give them enough money.

SMITH: In the end, Obama wins. Congress passes the Affordable Care Act, aka Obamacare, as opponents have dubbed it. And the insurance companies - they get a win, too, from all their stats and anecdotes. The final law is very much not a single-payer plan. It is not a Canadian-style system. The insurance companies live to fight another claim.

(SOUNDBITE OF CALVIN K. SAMUEL AND JOSH KESSLER'S "STAND-UP")

ARONCZYK: After the break, Wendell, the PR pro, grows a heart and a spine and finally says sorry.

(SOUNDBITE OF CALVIN K. SAMUEL AND JOSH KESSLER'S "STAND-UP")

SMITH: Wendell did his job, and he did his job well. He spent his time massaging statistics, anecdotes and saying no comment over and over again. It was easy to forget that there were real people involved.

ARONCZYK: Then Wendell gets a call about a patient. The patient is a 17-year-old girl. Her name is Nataline Sarkisyan. She's covered by Cigna. And she'd had leukemia, but after the aggressive treatment, her doctor said that she needed a liver transplant. It was probably going to cost around $250,000.

POTTER: When something is expensive, a procedure is expensive, doctors have to run it past insurance companies. It's called a prior authorization.

ARONCZYK: So in this case, they have to run it by one of Cigna's medical directors.

POTTER: And this medical director, just based on what had been faxed to him, said, no, I don't think that that procedure is medically appropriate or medically necessary for Nataline.

SMITH: So Cigna says, no, they are not going to cover the cost of the transplant.

POTTER: I mean, this happens day in and day out. But the family was very resourceful. It's a 17-year-old girl, and it was just a good story. And my phone was ringing off the hook from reporters in LA and then around California - then started getting calls from national media.

ARONCZYK: Wendell's PR team writes up an email - polite, generic, essentially, no comment. But this is not going away. Reporters keep calling.

POTTER: I advised executive management that, look. This is a real PR problem for the company. When I was reporting to the CEO what was going on, the family was actually involved in a protest in front of Cigna's regional offices in Glendale, Calif., which is part of LA. And CNN was covering it live. And during that protest, the company decided, OK, we're going to pay for this. We need to make this go away. Just go ahead and cover it. And so the company reversed course. And part of my job was to figure out how to get word to the family. I knew some folks in Glendale, so I had someone come outside of the building and tell the family that Cigna was going to be covering the transplant. And I could - I was watching my own TV in my office what was happening when they got that word. Mrs. Sarkisyan, her mother, Hilda Sarkisyan, just start jumping up and hugging people and say, Cigna is going to cover the transplant. Cigna is going to pay for it. And I was relieved. I thought, well, this is the PR problem that is now over. Nataline will get that transplant, and this story will go away.

SMITH: Wendell's job at this point is to write a media statement and spin the story so it doesn't seem like Cigna really gave in to the pressure, which, of course, they did. Of course, they gave in to the pressure. But mostly, Wendell's just relieved that it was all over. But it was not all over.

POTTER: So just a few hours after what I thought was going to be a happy ending, Nataline died. And I got a phone call, you know, late at night that she had passed away. And it was one of those stories that I obviously will always, always think about this. It's - I just did not have it in me to handle another high-profile story or horror story, as we call them. I could not keep justifying the practices of the industry that I work for and turned in my notice a few days after that.

ARONCZYK: We called Cigna for comment on the story, but whoever has Wendell's job now so far has not responded to our requests.

SMITH: Wendell Potter became a whistleblower, revealing what he knew about the health insurance industry. And I guess to atone for all his years of no comment, he started to comment. He wrote a book. He went on a speaking tour.

ARONCZYK: He wrote that article in The Washington Post that made me want to do this episode.

SMITH: He even went to Canada to try and make amends.

POTTER: I sometimes called it my apology tour to apologize to the Canadians for all that I had done in my career to discredit their health care system.

ARONCZYK: An apology tour is the most Canadian thing ever.

POTTER: Sorry, Halifax. Sorry, Moosonee. Sorry, Mississauga. Saskatoon, I'm so sorry. Sorry, Chilliwack.

ARONCZYK: But, you know, really, what he needs to do is to apologize to the American people. Yeah, sure - he lied about Canadians, but he lied to Americans. And while Wendell is no longer in the game, there is some young PR exec out there who still has this playbook.

POTTER: When you do a campaign like that that goes on and on and on, decade after decade, the anecdotes might change a little bit. And you might update some stats, but you can use them in 1991 or '94 or 2004 or 2020. But that's how it works.

SMITH: Oh, it is coming. Debates over the Affordable Care Act, "Medicare for All," single-payer.

ARONCZYK: I just hope that this time, they pick a different country to blame.

(SOUNDBITE OF STUART ROSLYN'S "AMBER LIGHTS")

SMITH: Are you experiencing the symptoms of FUD - fear, uncertainty, doubt? Email us at planetmoney@npr.org or...

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: Ask a Canadian for a second opinion.

ARONCZYK: You can also find PLANET MONEY on Twitter, Facebook, Instagram and TikTok. We're everywhere at @planetmoney. Thanks to Dr. Cal MacDonald (ph) and to the George H.W. Bush Presidential Library and Museum for their help.

SMITH: Also, we're looking for an intern. If you like the show, want to help us make it and learn how it's made, consider applying. It is a paid internship. You can work from anywhere, but it does not get you NPR health insurance, which is provided in part by Cigna. Find out more about the internship at npr.org/internships.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: It's the last statement I'm going to have on broccoli.

(LAUGHTER)

ARONCZYK: Today's show was produced by Nick Fountain...

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: I do not like broccoli.

(LAUGHTER)

ARONCZYK: ...Edited by Bryant Urstadt.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: And I haven't liked it since I was a little kid.

ARONCZYK: Alex Goldmark is our supervising producer.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: And my mother made me eat it.

SMITH: I'm Robert Smith.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: And I'm president of the United States.

ARONCZYK: I'm Amanda Aronczyk.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: And I'm not going to eat any more broccoli.

ARONCZYK: This is NPR. Thanks for listening.

(SOUNDBITE OF ARCHIVED RECORDING)

BUSH: But - wait a minute. For the broccoli vote out there, Barbara loves broccoli. She's tried to make me eat it. She eats it all the time herself, so she can go out and meet the caravan of broccoli that's coming in from Washington outside. Thank you.

UNIDENTIFIED PERSON #7: What about cauliflower?

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