AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, as we continue with Part 2 at our look at the outrage over the state of healthcare in the United States, this after the murder of the CEO of UnitedHealth, Brian Thompson. Police have just arrested 26-year-old Luigi Mangione in Altoona, Pennsylvania.

While many offered condolences to Thompson’s loved ones, his killing sparked outrage over the state of healthcare here. Some turned to social media to share their experiences with health insurance companies.

DR. ABOUM: I started my day with another denial letter from UnitedHealthcare from one of our patients who deserved… Hello. My name is Yazan, and I am a board-certified internal medicine doctor, and I’m here to share our stories, trying to bridge the gap between us and the public as much as I can. One of the suckiest part of our jobs is getting all these denial letters from insurance companies. A lot of times, these denial letters are completely baseless. Unfortunately, we don’t have even the evidence or the reason for why they deny such letters.

AMY GOODMAN: That’s a doctor posting online his experience with denials for healthcare for his patients.

For more, we continue with our two guests. In Washington, D.C., Derrick Crowe is with us, with the nonprofit People’s Action Institute, which has a Care Over Cost campaign, focused on the health insurance companies’, quote, “systemic practice of refusing to approve care through prior authorization denials or pay for care through claim denials.” And in Philadelphia, Wendell Potter is with us, former executive for the health insurance companies Cigna and Humana, executive editor of HEALTH CARE un-covered. He’s the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans and also the book Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It.

Thank you so much for staying for Part 2 of our conversation. Now, Wendell Potter, you’ve been raising this issue for decades. I think it’ll be instructive if you go back in time. I remember when we first interviewed you, when you first really became a whistleblower, describing flying over and looking down on an area of the United States where you had just come from — well, explain what you had come from and where you think — how it has taken so long for the corporate media to recognize people’s rage.

WENDELL POTTER: Yeah. Yeah, what you were referencing was an experience that occurred to me when I went to, just prior to what you were describing, an outdoor clinic near where I grew up in the Appalachian Mountains of northeast Tennessee. It was at this county fairground where a nonprofit organization was treating people. They had brought in doctors and nurses, who had volunteered their time, and dentists, because these people were largely uninsured, or they were working, but they worked for companies that couldn’t afford to offer benefits.

But I found out that many of those people, in what were long lines that stretched out of view — and this was a county fairground — and I realized that a lot of those lines were leading to animal stalls and barns on this county fair site. They were there to get care in this undignified way in the richest country on the planet, largely because of the practices of the insurance industry. At that time, they could refuse to sell you coverage because of a preexisting condition, or they could drop you from coverage if they didn’t want to pay your claims.

The Affordable Care Act, which was ultimately passed, addressed those issues, but it has not addressed the problems that continue to plague Americans with insurance, and these are high out-of-pocket costs. A lot of those people, even them in those long lines, had insurance, but they couldn’t afford to pay out of their own pockets what the insurance company demanded they pay before their coverage would kick in — in other words, before their insurance company would pay a dime. And in many cases, they had been denied coverage for medically necessary care. And that is going on, on and on, every single day.

The violence against Brian Thompson is nothing to be condoned. It was a horrible crime. But it’s important to point out that violent crime is perpetrated by these companies in an anonymous way every single day. An untold number of Americans are told they are not going to get the care that they need, because an insurance company bureaucrat somewhere says, “We’re not going to pay for it,” or you’re going to have to pay so much out of your own pocket, money that you do not have. And it is why we have 100 million Americans without — who are in medical debt.

What we have seen here is just, finally, like a dam bursting of resentment that’s been building over many, many years against this industry. And I think that, as sad as the circumstances are, this might be an opportunity for us to really move forward with really far-reaching reforms that can take these companies out of the middle between us and our doctors. Doctors increasingly are using the term “moral injury” to describe what it’s like to practice medicine in this country. And it’s largely because of their having to jump through so many hoops, spend so much time on the phone with an insurance company bureaucrat to try to either get paid appropriately or to get approval to treat a patient the way the patient needs to be treated.

AMY GOODMAN: I wanted to go back to one of the cases that prompted you to quit your job as Cigna’s chief spokesperson, Wendell. In 2007, Cigna denied a California teenager, 17-year-old Nataline Sarkisyan, coverage for a liver transplant. Amidst mounting public pressure, Cigna eventually reversed its position, but by then, it was too late, and Nataline had died. Her mother Hilda became an outspoken critic of Cigna and the health insurance industry. We interviewed Hilda, Natalie’s mother, on our program back in 2009.

HILDA SARKISYAN: Well, we miss her. We don’t have our beautiful daughter with us anymore. And Cigna is doing this every day, every day. And that’s why I’m out there to help other families to stop them. It’s not only Cigna; it’s all the insurance industry, that they are placing profit before patient, and it’s not right. And they are enforcing the care of people, not their — you know, they should not enforce the care of the people to their deep pockets. It’s all about their pocket, all about the CEO, how much he makes. I miss my daughter. I had a beautiful, perfect daughter. I don’t have her anymore. I don’t.

AMY GOODMAN: Hilda, describe what happened to your daughter.

HILDA SARKISYAN: Well, we had insurance. We were covered. We thought we had insurance. So it’s like having insurance and not having insurance is the same thing. People who have insurance and don’t have it, they get the same care. But having insurance and knowing that you do have it, and you are recommended to a certain hospital, because the insurance company only pays if you go to that hospital, you go to that hospital, which in our case was UCLA. We were transferred there. By the way, that’s our fourth hospital within, I would say, three years, because they were jumping us around. And finally, you go there. My son gave her the perfect bone marrow transplant, perfect match. And my daughter needed a liver transplant. And so many requests, so many requests, and they were — the doctors were denied. We were denied, until the California Nurses Association stepped in, helped us out.

We had to get out and go to their headquarters in Glendale, make a scene with our family, the Armenian Youth Federation, our church. Why do we have to do that? I’m a mother who should have been next to my daughter. Only if I knew she was going to die that same day, you think I would have that energy to go out there and do that? I could have been holding my daughter’s hand and praying with her. This is not right.

AMY GOODMAN: So, that was Hilda Sarkisyan talking about her 17-year-old daughter Nataline, who died because she couldn’t get coverage for a liver transplant in time. Wendell Potter, talk about this moment for you. This was 15 years ago. Do you think we’ve made progress in this country? And what do you feel needs to happen?

WENDELL POTTER: You know, sadly, we have not made the progress we need to make.

I’m so grateful, by the way, that you found and played that interview with Hilda. I’ve gotten to know her over the years. She has become a remarkable advocate for reform, because she’s a mother who lost a daughter, a 17-year-old girl, a perfect, young girl, because Cigna, the company I worked for, refused to pay for a liver transplant. I remember that so, so well. A perfect liver had been found for transplantation. But just before the surgery was to start, a Cigna doctor 2,500 miles away said he didn’t think it was medically necessary, medically appropriate for Nataline. So the surgery was canceled.

And Hilda and her family were able to get such attention focused on this case. It became a huge PR problem for Cigna, and Cigna eventually caved and agreed to pay for it. But delays of care are lethal, or can be lethal. She got — Nataline got sicker, and she died just a few hours after Cigna reversed course and said it would pay for the transplant.

That was an example of a case that really attracted media attention. But day in and day out, these denials happen, the use of prior authorization. That’s what was — we didn’t use that term all that much back then, but that’s what’s going on. It’s a term that is — that encompasses all these ways that insurance companies refuse to pay for care, and usually by some distant bureaucrat saying that, in his or her view, they don’t think something is medically necessary. When these are successfully appealed, these denials, in most cases, the appeals are successful, which means that these companies absolutely are refusing to pay for medically necessary care.

Fifteen years later, we’re finally having, I think, the conversation we must have about this. It’s sad that it’s taken that long. But more and more people are now enrolled in these gigantic corporations, like UnitedHealth and Cigna and Aetna, which is now owned by CVS, are part of these gigantic conglomerates that worship at the altar of Wall Street. And more and more people are beginning to realize the consequences of having a system that is run by Wall Street like we do.

So, we’re seeing, I think, the beginning of a kind of organized rage, of outrage, that those of us in the advocacy community have been wanting to know when this might happen. I used to have this bumper sticker called “if you’re not outraged, you’re not paying attention.” People are paying attention now, and they are experiencing, in large numbers, these denials, denials of care and denials of claims, and they’re just not going to take it anymore.

AMY GOODMAN: Derrick Crowe, I wanted to ask you about the scope, more about the scope and the scale of the problem, private health insurance companies denying or delaying over 248 million healthcare claims or preauthorization claims. You have what? Some insurance companies denying up to four out of five claims. And then you have what’s coming up next. You have, of course, President Trump, basically, you could say, part two. If you can talk about what we can expect from Project 2025’s vision for healthcare in this country and where you think Trump might be headed?

DERRICK CROWE: Sure. Well, let me start by saying what we should be able to expect from our healthcare system in the richest country in the world: Every person should get care when they need it, no matter the cost and no matter whether they are of any race, gender or type of community.

Unfortunately, you’re asking about what Project 2025’s plans are for Medicare and other public programs like that. Trump plans to hand over more of Medicare to companies just like UnitedHealthcare. He plans to, according to Project 2025, make Medicare Advantage the default option under Medicare coverage. And what that means is people are going to have more experiences just like Carly’s. Carly’s provider was a UnitedHealthcare Medicare Advantage plan. And that is the kind of difficulty that the folks that are behind this want to impose on other people so they can make more profits.

AMY GOODMAN: Talking about Carly Morton.

DERRICK CROWE: Yes, that’s right.

AMY GOODMAN: One of the people you represented. You also — if you could tell us about the EMT, the former Republican state legislator —

DERRICK CROWE: Right.

AMY GOODMAN: — Jenn Coffey from New Hampshire? What happened to her?

DERRICK CROWE: Right. As you say, Jenn Coffey is a former Republican state legislator. She was also an EMT. She had a battle with cancer. And as a result of her battle with cancer, she developed complex regional pain syndrome, and the more common name for that is “the suicide disease.” It’s such a painful condition that many people, rather than face the lifelong pain of that, choose to end their own lives.

There’s a well-known treatment for it that involves ketamine infusions. UnitedHealthcare stands in the way whenever she needs to get those infusions. She was initially denied her treatments, and then, after a public pressure campaign with us, United started to authorize these infusions. But they’re periodic; they don’t just happen once. And frequently, UnitedHealthcare will offer a prior authorization and then deny paying the claim, only — and forcing her to go back to fight with them to get payment for that claim. And as a result of the financial difficulty that’s imposed on Jenn, at one point Jenn had to sell most of her possessions. It’s ruined her life. She’s had to rack up medical debt, as Wendell was referencing earlier.

This happens to people 248 million times a year in this country. Wendell was just mentioning the claims appeal process. It is true that a large number of those can be overturned, and especially if they’re reviewed by an outside body, but the simple fact is that process is run by the corporations themselves, and as a result, it is so complicated and so stressful, and sometimes so expensive to run all the way through that process, that fewer than 1% of people who are denied a claim will end up taking it all the way to the point of having it appealed.

AMY GOODMAN: Derrick, we just have a minute, but if you can talk more about Medicare Advantage and efforts to further privatize it, what Project 2025 is pushing?

DERRICK CROWE: Right. Project 2025 is simply a plan, as we pointed out during the election, to divide working people against each other so they can be profited off of by corporations. Medicare Advantage is currently a thing that exists in our current system. It’s the privatization of Medicare. And it’s run through these companies that often are more expensive than public Medicare. And people are going to have to fight more if more of their healthcare from these public programs is turned over to companies like UnitedHealthcare. And they’re going to have more experiences just like we saw with Carly, just like we saw with Jenn, and you’re going to see more of the rage that we saw online building up throughout the people of this country.

AMY GOODMAN: Derrick Crowe, we want to thank you for being with us, with People’s Action Institute, and Wendell Potter, former executive for the health insurance companies Cigna and Humana, executive editor of HEALTH CARE un-covered, author of the book Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans and Nation on the Take.

To see Part 1 of our conversation, go to democracynow.org. I’m Amy Goodman. Thanks for joining us.