“I’ve spent the better part of three decades dissecting the American health insurance racket from every angle — as an attorney, as strategist, and as someone paid to clean up the mess insurers leave behind. I’ve seen it all.” – Craig Gottwals
By Craig Gottwals – Minimizing the Damage Insurers Do To Your Bottom Line | Insurance Consultant | Attorney
April 5, 2025
Champagne, Denial, and Hostages: Inside the Health Insurance Cartel
By Craig Gottwals, 25-year healthcare attorney and employee benefits consultant
I’ve spent the better part of three decades dissecting the American health insurance racket from every angle — as an attorney, as strategist, and as someone paid to clean up the mess insurers leave behind. I’ve seen it all. So when New York Magazine dropped a scorched-earth exposé on insurance executives spilling their guts about the rot at the core of the industry, I wasn’t shocked. I was nodding along like an oncologist at a Marlboro convention.
The piece profiles four former health insurance execs who decided — either by conscience or exhaustion — to stop selling the party line. These aren’t low-level malcontents. They’re ex-Cigna and Express Scripts brass, former Blues officers, and one anonymous insider who helped run a major nonprofit insurer. And every single one of them arrived at the same soul-curdling conclusion: the American health insurance model is not broken. It’s working exactly as designed — to avoid care, preserve profit, and keep Wall Street and private equity happy. Patients? They rank somewhere below shareholders, Champagne, and “brand integrity.”
The story opens with Wendell Potter, the original whistleblower who famously torched his Cigna career in a 2009 Senate hearing. Today, he’s watching a new generation of disillusioned insiders stagger out of the burning wreckage. And in the wake of UnitedHealthcare’s CEO being murdered by a disgruntled patient, Potter is back on TV explaining how an industry built on denial, deflection, and delay has finally inflamed the wrong person.
Potter’s own moral detour began in 2007 when he witnessed insured Americans waiting in livestock stalls for free medical care at a Virginia fairground. That same year, Cigna denied a liver transplant for a 17-year-old leukemia patient, a decision that came just hours before her death. He couldn’t spin it anymore. So he left, testified, and began shouting the truth from rooftops that too many policymakers were paid not to hear.
Then there’s Ron Howrigon, another Cigna alum. He remembers his boss — future Aetna CEO Mark Bertolini — coolly suggesting they “execute a few hostages” by kicking vital specialists like cardiologists out of the network. Not because they were unnecessary, but to send a message: we are in charge. When Howrigon’s conscience caught up, he fled too, trading corporate Stockholm Syndrome for the small joy of now helping doctors renegotiate their rates. But Cigna hasn’t forgotten. They still refuse to talk to him — a 20-year grudge, because he stopped licking their boots.
Dr. Ed Weisbart had hoped to help people. First as a physician, then as a CMO at an HMO in Chicago. But it wasn’t long before he found himself mentally gaming out how to make a costly hemophiliac just stop showing up. Not because he wanted to — but because the business rewarded exactly that kind of quiet cruelty. Later, at Express Scripts, he was ordered to make a PowerPoint arguing against health reform. He refused and resigned. Now he volunteers full-time in patient advocacy. Once the curtain drops, you can’t walk past the bodies and still call it healthcare.
And then there’s “John,” the anonymous doc turned nonprofit insurer exec who quit after just 17 months. His crime? Suggesting prior authorization might be overused. His punishment? Watching leadership panic when their own family member got cancer and had to navigate their “product.” The kicker? While the country was drowning in a pandemic, John was supping on four-course French meals and sipping vintage bubbly courtesy of his employer. He had to buy a wine fridge just to hold it all. Nothing says “value-based care” like foie gras and Dom Pérignon as you deny claims.
The core rot is simple: insurance companies make money by delaying care, inflating loss ratios and issuing astronomical renewals. The more layers they add — prior-auth gatekeepers, PBM middlemen, opaque reimbursement algorithms — the more opportunities they have to skim. And as they vertically integrate, acquiring everything from hospice chains to pharmacy networks, the conflicts of interest erupt.
But what’s the solution? Politicians mumble about prior auth reform, but let’s not kid ourselves — the only real power employers have is to exit the cartel altogether. Self-fund your health plan. Get out of the network. Strip these middlemen of the leverage they use to fleece you, your employees and their families.
Because when you carve out the networks, the contracts, and the opacity, you expose the real costs. You pay doctors directly. You stop incentivizing denial. You stop hosting claim appeals for chemotherapy like it’s a parole hearing. And, maybe most importantly, you stop buying Champagne for the folks who think your sick employees are actuarial rounding errors.
I’ve spent my career helping employers navigate this minefield, and I can tell you this: there’s no such thing as an ethical bureaucracy. The only way out is through. That’s not just poetic flair — it’s the hard truth for any employer serious about fixing their health plan. You can’t coupon-clip your way out of this mess. Swapping one big-box carrier for another, layering on another glossy vendor, or negotiating for another 2% discount off an inflated chargemaster is just theater. These are tweaks inside a system that was engineered — meticulously and maliciously — to extract value from employers and patients alike. You’re still playing their game, on their field, with their refs. And they own the scoreboard.
Want to take control? Fire the gatekeepers. Cut the network. And start treating your employees like patients, not pawns.
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