Frustration with a broken health care system has many Americans blaming insurance companies. In the first episode of New York Times Opinion’s new show “Divided,” a doctor and a former insurance executive confront a central question: Do insurance companies prioritize profit over patient care?
Dr. Elisabeth Potter, a plastic surgeon specializing in breast reconstruction, has seen firsthand how insurance decisions can interfere with treatment. Dr. Troyen Brennan, a former chief medical officer at CVS Health, which owns Aetna insurance, believes those decisions are part of a system intended to keep care affordable.
Since the 2024 killing of UnitedHealthcare’s chief executive in broad daylight, most insurance executives have wanted to avoid the spotlight; this conversation is a rare chance to hear directly from one engaging with a critic.
Can they find common ground, or will they remain divided?
Below is a transcript of an episode of “Divided.” We recommend watching it in its original form for the full effect. You can do so using the video player above. The subjects read prompts from cards which guided their discussion. The following transcript has been edited for length and clarity.
Dr. Elisabeth Potter: OK, here we go.
[Reading from a card] Do insurance companies prioritize profit over patient care?
Clip of Senator Bernie Sanders: Insurance companies are making tens of billions of dollars every year denying you coverage.
Clip of person holding an insurance denial letter: It was like the insurance company telling me my life didn’t matter.
News clip: Breaking news, the C.E.O. of UnitedHealthcare was shot and killed.
News clip: Forty-one percent of people age 18 to 29 think the killing was either somewhat or completely acceptable.
News clip: Sorry, my sympathy is out of network.
News clip: This incident and the reaction to it ought to be a wake-up call to this industry.
Dr. Troyen Brennan: Do insurance companies prioritize profit over patient care? I would say no. I think most insurance companies would believe that patient care is very important and optimal patient care is what they’re trying to help deliver.
There are not going to be any profits if they don’t take care of the patient. So I would say no, they do not.
Potter: I would say that, yes, they do prioritize profit over patient care. I don’t think there’s anything wrong with making money in health care.
When I think about finding the right point of balance, there’s been a shift toward profit and away from this autonomous decision-making for patients. I can think of some specific examples where I know what’s right for my patient — and I don’t even think it’s more expensive, but an insurance company has told me: “No, you can’t do that thing. You can’t do that type of breast reconstruction.”
And in most of those situations, it really felt like that was about profit. When I look at what’s happened over the last 13 years that I’ve been in practice, insurance companies are making more and more money, doctors are making less and less, and I see patients experiencing difficulties in getting care.
Brennan: Well, a lot of responses to that. One is that there is a huge increase in health care costs.
News clip: American health care costs are by far the highest in the world.
News clip: We spend two or three times what other countries do.
News clip: The number one reason why most Americans file for bankruptcy is because of medical debt.
Brennan: The insurance companies are basically hired to try to reduce those costs or try to keep those costs somewhat under control. Insofar as they do that, they’re trying to make sure that the people who are insured are getting all the care that they need, but no unnecessary care.
Most of the drivers in the health care system, from an economic point of view, are drivers in a direction of doing more, spending more — that’s the way people make money.
You earn your living by basically doing procedures, so you’re going to plan to do more procedures. That’s not to say that the procedures that you’re doing are inappropriate, but at the margin, there’s a lot of inappropriate care that goes on.
So, that’s what insurers are trying to basically regulate. But nobody really likes to talk about that much. Insurance companies don’t like to talk about it because they don’t want to be seen as the people who are denying care.
Potter: I don’t think that insurance companies should be in the position of policing bad doctors. I don’t actually believe that there’s that many bad actors out there in medicine.
If insurance is there to control costs, when you look at it, one of the biggest waste sectors is the administrative burden in insurance.
Clip of Health Secretary Robert F. Kennedy Jr.: The cost of administration is enormous to our health care system.
News clip: More than $260 billion are wasted on administrative complexity every year.
Potter: Insurance companies aren’t making health care any cheaper. They say that they’re protecting the public from fraud and abuse. I just don’t know that the majority of fraud and abuse in health care is on the side of doctors.
Brennan: [Reading from a card] The biggest problem with our health care system is?
Potter: Oh, the biggest problem? Lack of transparency. If we could only just really see the cost in real time, if we were able to budget our health care dollar with transparency like Americans budget their dollar when they buy groceries, I feel like that would be a huge step forward.
The fact that things are so obscured, that it’s not clear how to get an insurance plan, how to get a contract if you’re a physician, how much the procedure is going to cost, what the rebate is going to be on that medication — if we just had real-time market dynamics with transparency, I think we would have a healthier system.
Potter: I wish that I could explain to you how health care pricing is set, but the truth is that it’s all obscured.
News clip: The price for the same procedure at the same hospital, it varies enormously.
News clip: The same simple blood test, $19 over here, $522 just a few blocks away.
Potter: There just isn’t transparency.
News clip: Doctors don’t even know what’s happening with our billing processes.
Clip of Kennedy: You go out to eat at a restaurant, the price of food is right there on the menu. Why is it that when it comes to many medical procedures, we only find out the price afterward?
Potter: I have started my own ambulatory surgery center, and I can see the costs there. Now, I also see — because I can see the pricing — that the hospital has been overcharging four or five times what it’s costing me to do these surgeries in an outpatient setting.
Brennan: I think that’s a very good point. Certainly, we have a nontransparent system, and there are steps being taken to try to make that more transparent.
Clip of President Trump: We will have maximum price transparency and costs will come down incredibly.
Clip of Kennedy: When you can see the cost of care before you receive it, you can shop for the lowest-cost, highest-quality treatments, which will drive down the cost of care by promoting market competition and the price.
Brennan: Laws have been passed and further proposals in Congress are bringing that about slowly — and I agree that transparency is a real issue.
From my point of view, the big problem with our health care system is access. There are just too many people who don’t have access to good health care, and we continue to have a system that’s very expensive and getting more expensive. Access, in many ways, was improving over the course of the last 15 years, and now it’s taking a reverse turn and there’s going to be more people who are uninsured.
News clip: Lawmakers made deep cuts to safety net programs, including Medicaid.
News clip: Twelve million Americans are expected to lose health insurance.
Potter: Access to care is — we’re at a crisis point in America when patients are paying 10 percent of their take-home paycheck for an insurance premium, and then being diagnosed with breast cancer and coming to see me and finding that you don’t have an insurance product that has adequate facilities or doctors in network and that the premiums are so high or your co-pays are so high that you can’t afford that care.
It’s getting harder and harder to get care through insurance.
[Reading from a card] Agree or disagree: Insurance companies should have a say in what treatments patients receive.
Brennan: I think that most doctors would disagree with that, but let me try to make the case why they should have a say. If you think about it, there’s a big group of people — maybe it’s a group of employees, maybe it’s us as citizens, maybe it’s us as the entire country — and we’ve all thrown in together to provide a certain amount of money that’s being put aside to cover the care for those of us who get sick.
Since we’ve all put our money off together for this insurance policy, that community really wants that money to be spent wisely. Research over the course of many years has outlined that there’s unnecessary care that occurs. We as a community wouldn’t want to have the money go to them.
So, the insurance company gets the responsibility of policing that, of taking the steps to make sure that the care is appropriate. Things like prior authorization ——
Clip: Prior authorization.
Clip of Kennedy: Prior authorization.
Clip: You and your doctor have selected a new medicine to treat your condition. But before you can fill your prescription, you may need your health plan’s approval. It’s a process known as prior authorization.
Brennan: That’s interfering with the relationship between the doctor and the patient, because they’ve already decided that they want to proceed with this particular procedure. But the insurance company’s coming in from the outside to say, “Does that fit the evidence?”
It feels like the insurance companies are doing that, but it’s basically not the insurance companies — it’s the community of people who put in all this money together to provide care for people who are sick and who want to make sure that the care is being rendered appropriately and with the best medical evidence. That’s the way the insurance company would see it.
Potter: I hear you. I think they would see it that way. I see it very differently.
I think insurance is so important, first of all. As someone who does breast reconstruction, everything that I do is provided for under the Women’s Health and Cancer Rights Act, which says that insurance covers your breast reconstruction if you have a mastectomy that’s covered by insurance. So, that has been life-changing for women affected by breast cancer.
I agree, I think that insurance can be a really great thing. I think insurance is initially thought of as communities of farmers who put their money in a bucket and say: If one of us gets harmed, if one of us needs help, we’re all there for each other, we’re going to draw out of that bucket.
That is a beautiful ideal. It’s not what we have in American insurance today. Every time an insurance company calls me about a patient, they’re telling me not to do something that I know is best for my patient. I wish that when I, for instance, had a peer-to-peer call ——
Clip of Potter working: Hello, this is Dr. Elisabeth Potter. Who is this? So, you’re calling to ask me for reasons why she stayed in the hospital beyond the first day?
Potter: I wish that that call was with somebody who was qualified to talk to me about breast reconstruction. But it’s so often someone who’s never done that type of surgery.
Clip of a doctor recording an on-camera statement: I did a peer-to-peer. That means I call the insurance company, then they transfer me to a physician. Now, this is supposed to be a peer — someone that can understand sports medicine. Well, they put me in touch with a physician who’s an internal medicine physician.
Clip of Potter recording herself: The doctor who called me was not a surgeon, and I actually asked the doctor, “Do you know what a deep flap is?” And the doctor said, “No.”
Clip of a doctor recording an on-camera statement: This is called a peer-to-peer, but you’re not a surgeon. You’ve never done a shoulder replacement. How are you the designated peer from the insurance company who literally has the decision to dictate whether this patient’s care is going to be approved or not?
Potter: The ideal, I agree with. But in practice, I think that that trust needs to be built back by the insurance company.
Brennan: Yeah, difficult to do. There are going to be these conflicts.
That person who you’re talking to on that peer-to-peer call when there’s a prior authorization for a procedure you’re doing, they should have consulted the literature pretty carefully and they should be ready and able to talk with you about what your planned course is.
There are rules and there are laws that oversee much of what goes on in prior authorization, and they have to adhere to those things. So, it’s unfortunate that your experience is that you’re not seeing a lot of that.
But from the other side, I can tell you that most of the people who are doing those peer-to-peer discussions feel like they’re productive, and it’s just somebody who’s basically dug in on what they want to do — as opposed to what the medical literature might say is the appropriate thing to do.
I don’t see how to ameliorate that situation well. I can take it to an empirical level and say to somebody who’s buying the insurance, like a big company, that we’re willing to take away prior authorization — but it’ll cost 5 to 8 percent more in terms of what your total costs for insuring your employees are. They usually are going to say: Let’s keep prior authorization in place.
In some ways, you can break it down into a set of marketplace decisions, and most people are opting — in fact, universally opting — to keep prior authorization in place.
Potter: It keeps coming back to money. As a physician, I just land on the side of: OK, it may cost too much. You’re the insurance company. That’s your business to sort that out.
I just have to go to sleep at night knowing that I try to do the very best thing for my patient. If it costs that much, maybe you need a system that costs less.
Brennan: Well, you hit the crux of the matter, which is really that there is a business and it’s a very costly business, and it is a business that more and more people are finding that they can’t afford, and that’s not a good thing. You would agree with that.
That comes up hard against your desire to do what you think is right for your patient and sometimes coming into conflict with those who are trying to police what the costs are.
Brennan: I’m a physician. I was a professor of medicine and law and public health at the Harvard School of Public Health and the Harvard Medical School for about half my career.
I was convinced that the health care system was not doing well simply because it cost too much.
News Clip: What is really going on with health care costs?
News Clip: Insurance companies are asking for big premium increases.
News Clip: In my particular case, our premiums went up over 30 percent this year. How is that justifiable?
Brennan: And I felt like the only entities in health care that had responsibility for oversight of costs were the insurance companies. And so I made a big career switch in the middle of my career to go over and work on the insurance side, simply to attempt to address this problem surrounding the cost of health care.
I loved being in the hospital and I loved taking care of patients. So it was a big decision to decide to move over to the insurance side. And many people who I work with saw it as going over to the dark side, but I had great hopes for the good that we might be able to do.
[Reading from a card] A moment in my career when I had to make a decision that challenged my morals and ethics was ——
Potter: Oh, heavens. Well, I have one from this year that sticks out in my mind quite a lot. I was called while I was in the operating room performing breast reconstruction by an insurance company.
They didn’t know the patient’s diagnosis. They didn’t know she had breast cancer. They wanted me to justify her overnight stay. This has become absurd. I chose to speak out. I posted a video that I didn’t think would be widely viewed.
Clip of Potter recording herself: I got a phone call into the operating room saying that UnitedHealthcare wanted me to call them about one of the patients who was having surgery today, who was actually asleep having surgery. It’s 2025 and insurance just keeps getting worse.
News clip: Dr. Elisabeth Potter made national news for publicly calling out a health insurance company.
News clip: That video has now been viewed over 13 million times.
News clip: Millions of people got a front-row seat to the bureaucratic madness doctors wrestle with every day.
News clip: This is exactly what is wrong with insurance companies.
Potter: And the insurance company kind of came after me for that.
Clip of Representative Lloyd Doggett: United sought to discredit her and is denying coverage for her surgery center.
News clip: UnitedHealthcare demanded she remove the video from her social media channels, accusing her of making false claims.
News clip: And that it informed Dr. Potter that it wasn’t accepting new surgery centers well before she posted any videos.
Potter: That was one of those moments in my career as a physician when I thought: To take care of these women; I can’t just be silent. And it almost cost me my business — being honest about the problems that I see for my patients and being outspoken about that. That was a difficult decision this year, but also a rewarding one, like the hard things usually are.
Brennan: I would say that in the area of the insurance company stepping in to stop care, the really hard cases over the years — I worked at CVS Health — I would see those. But in most of the circumstances, the really hard cases, we would end up erring on the side of the patient and the doctor and going forward with them.
I would say, from a moral point of view, the biggest issue for me over the years was when I went to work for CVS, we had a big retail pharmacy and it was all supposed to be part of health care. But we sold a lot of cigarettes. How can you continue to sell cigarettes and consider yourself a health care company?
I thought I’d be able to insist that we get rid of the cigarettes when I first joined the company and, of course, that didn’t turn out to be the case. So, my dilemma over the years was: Am I really going to eventually accomplish anything here, and how much longer do I struggle with it? So, over the years, we continued to build the case for getting rid of cigarettes — and eventually we were able to remove them.
News clip: CVS will stop selling all tobacco products.
News clip: It will lose about $2 billion annually. But in making the decision, the company said, “We’ve come to the conclusion that cigarettes have no place in a setting where health care is being delivered.”
Brennan: It does give a nice contrast to the perspectives that we have. When I’m working in an insurance company, I’m thinking of a big group of people. When you’re taking care of patients, you’re thinking about that patient right in front of you.
Potter: When I’m taking care of the patient in front of me, I’m thinking about all of the patients who are in that same situation. I’m speaking here for all of the doctors who’ve reached out and who want to be heard.
[Reading from a card] Agree or disagree: Doctors perform unnecessary procedures because there is a financial incentive to do so.
Brennan: I don’t think that there’s any doctors who tell patients they should have a procedure who are thinking to themselves: I know this is inappropriate, but I really would like to earn $500, $1,000, $1,500 by doing it, so I’m going to go ahead and recommend it.
On the other hand, I know you’ve been in practice for a long time, but I’ve been around this health care system for 40 or 50 years now. All the literature, including research that we’ve done ourselves, would suggest that there are multiple motivations why people do things — but there’s always an economic motivation as part of that.
At the margin, you can usually predict what’s going to happen by looking at what the economic incentives are. I hate to bring harsh capitalist market-based concepts into a discussion about patient care, but nonetheless, they’re there. Our system is a fee-for-service system.
News clip: Fee-for-service.
News clip: Fee-for-service.
Video clip: Doctor says, “I did the following things to the patient” and the doctor then sends that bill to the insurer and the insurer pays it. There’s an incentive for the doctor to do more things to a patient than necessary.
News clip: The more patients you can get through the hospital in and out of the operating rooms with efficiency, the profit is higher.
Brennan: People make more money by doing more things, so more things happen. I don’t want to say that doctors do things inappropriately just to earn money, but I do want to say that there are financial incentives that are driving behavior. So, I hope that that’s a reasonable distinction.
Potter: Yeah, I think it is. We don’t have nationalized health care. We don’t have socialized medicine. We have a business of health care in America. So, of course, incentives can influence anyone to do things. But do I think that physicians on the whole make treatment decisions based on finances? No, I do not.
I think my medical license is on the line there. I will say that if you’re going to trust an entity, I would rather put the treatment decision in the hands of the doctor who has taken the oath to care for the patient rather than the company who has a fiduciary responsibility to shareholders to maximize profits.
Brennan: I agree with you completely, and that’s why for years I’ve preferred an approach where we use value-based or managed care.
News clip: Value-based care.
News clip: Value-based payments.
News clip: Instead of reimbursing physicians for each individual service they render, value-based care ties reimbursement to the quality and effectiveness of the care provided.
Brennan: We basically take a certain amount of money for each patient and assign that to a primary care doctor and a patient. Then the primary care doctors are responsible for making sure the patient gets all the care that’s necessary. When that patient needs breast surgery, for example, that’s a discussion between you and the primary care doctor.
Now, that’s a fabulous world that we’re never really going to have, but I would much rather leave those kinds of decisions about what’s necessary in the hands of the doctors, and I think a value-based approach as opposed to a fee-for-service approach brings the appropriate incentives to do that.
[Reading from a card] Hypothetical scenario: There are two options available for surgery. One option costs 10,000 and is adequate. Option 2 costs 30,000 and is far superior. Which one should an insurance company cover?
Potter: I love this. Immediately, my mind goes to: What’s our time horizon? Who’s thinking about the lifetime of the patient?
For instance, implant-based reconstruction in the setting of radiation for women who have breast cancer has a super-high complication rate, super-high failure rate. In fact, Medicare spends more money on implant rework than they do on natural tissue reconstruction.
Natural tissue reconstruction is a really high upfront cost but has very high satisfaction and longevity and fewer complications long term. It costs less long term. So, which thing should the patient have? No. 1, I think it should be the patient’s choice. I think that if a patient wants, in consultation with their physician, to have a certain type of surgery, that it should be not about the money, but about the outcome that they decide is best.
But if there are two truly similar options, but one is more expensive and has a better outcome, I think that what we’re seeing is sometimes insurance companies seem to be making decisions that are kind of shortsighted, that think of the patient only in the term of their policy.
As a physician, when I’m talking to a patient, I’m thinking about how they are going to live with this surgery for the rest of their life. So, I would invest in the surgery that has the better outcome long term.
Brennan: That’s interesting that you say that. I think the question was put like you’ve got something that’s adequate, and then you’ve got something that’s far superior that’s more expensive. The history of the American health care system is that if it’s far superior, we redefine the standard of care and then that standard of care is what has to be adhered to.
So, the insurance company’s really not stepping in to define the standard of care. The standard care is really defined by the physicians themselves and by the medical establishment.
In many ways, I think that the harder question is really the one you raised at the end, which is how long does the insurance company really care about these things? That’s one bad thing about our system of insurance in this country — a lot of it’s based on employment. That might have been appropriate when that first began to occur back in the 1940s and 1950s, when people stayed with the same employer for 15 years.
But now, people your age, for example, they spend a little less than two years with any one employer. So, no one has this long game in hand.
[Ed. note: There is debate over whether employees remain in their jobs for less time today than in the past.]
But having said that, the insurance companies, nonetheless, are basically structured upon the standard of care. And if the standard of care is that this particular procedure is superior, that’s one that they’re going to have to pay for.
Potter: Yeah, I think in practice, though, I see insurance companies telling me to do inferior surgeries. For instance, a patient had breast cancer on one breast and had advice from her breast surgeon to have bilateral mastectomies, and that was well supported in the literature as a risk-reducing surgery. Her policy did not support having a contralateral mastectomy.
We really had to fight to get this insurance company to live up to the standard. But the insurance company said, “We simply don’t cover contralateral mastectomies.” I do see insurance companies, in practicality, telling me what surgeries I can and can’t do.
Brennan: That’s unfortunate. I hope it’s not an insurance company I worked for. But be that as it may, most of the major insurance companies have very clearly stated clinical practice bulletins about what’s acceptable care and what’s not going to be paid for. That’s meant to be very adherent to what is the existing standard of care.
So, if you went to the American Society of Plastic Surgeons and asked them what the standard of care is, that standard of care should be part of what you find when you read the clinical policy bulletins that the insurers have.
That’s a bad case that you’re talking about, but I would say for most insurance companies, it’s not going to pay for them to have a clinical policy that’s outside of the standard of care because those cases will all be overturned and you have just wasted administrative costs.
Potter: They’re not always overturned, though, because so many denials aren’t appealed. Applying resistance to the patient and the physician often does result in that treatment not happening.
You’re talking about women who are at their lowest moment. They have no energy. I’m the only person. I’m meeting them and I’m saying, “They’ve denied it, but I’m going to do my best. I’m going to spend literally a year trying to get this done.”
There’s so much wrong with that. I don’t want to work in a system that requires heroic effort to get to the appropriate outcome. I want to work in a system that is so well designed and so intent on doing the right thing for the patient that it’s easy to do the right thing, not hard.
So, this process of iterative appeals and conversations, it’s just so cumbersome. And it’s one of the things that’s driving physicians out of medicine.
News clip: Growing problem of doctor burnout.
News clip: Many contributing factors to doctor burnout but a big one is the prior authorization requirement of many insurance plans.
Potter: It highlights a real point of pain in the system now.
Brennan: Yeah, I agree with you about that. There’s tremendous pain in the system.
But I wanted to go back to what you said with your patients. I’m presuming that if you feel like it’s necessary, you do go ahead and make every effort to try to get that done. You actually go ahead and appeal and go through the prior authorization process.
Potter: We do all of it, and I employ two people full time doing that.
Brennan: Generally, I’m here to support what it is insurance companies do, but they don’t take into account the costs on your side of putting together the materials that are necessary to get the prior authorization done.
At least in this day and age, one would hope that much more of that could be done through a digital electronic process rather than for you to have two people who are basically pulling records and going back and forth.
Potter: [Reading from a card] The best way to get health care costs under control is ——
Brennan: At least from my point of view, the only real way to get health care costs under control is for the government to basically name what the rates of payment are going to be. I don’t see much of a future for what’s called commercial insurance, simply because I think the costs are rising fast and are going to continue to rise.
To put it in perspective, in most hospitals today, a commercial insurance company will pay three times as much as Medicare pays and maybe four to five times as much as Medicaid pays for the same procedure. So, I believe that eventually the government will have to name what those prices are going to be in order to get the costs under control.
Potter: I think that the best way to control costs in health care right now would be more competition. We have seen the near decimation of the independent provider.
Previously, 75 percent of physicians were independent — and now, 75 percent are employed. It’s becoming so difficult for the small practices to exist and to compete with larger consolidated practices.
News clip: It has been difficult for private practice to compete against these big consolidated systems.
News clip: Well, the insurance industry is consolidated, so the health care industry has to consolidate so they can sort of compete with them. Basically, this ends up driving up prices.
News clip: When there’s less competition in a marketplace, prices go up.
Potter: We need to create a culture of healthy competition and health care. That’s very American of me, right? Competition brings out the very best in me. I think that doctors know best what their patients need, and if you simply allow for doctors to do things like I’ve tried to do — to build a surgery center, to have a small business that thrives on their main street.
Right now we have what looks like a monopoly. And I would love, instead of the government being in control — Medicare has lots of problems with that system — I would rather see more independent providers so that the consumer, the patient, can shop more.
Brennan: I think those are both good and appropriate sentiments, but just to take a different point of view: The reason why there aren’t as many independent practitioners anymore is because if you join a hospital, you can get paid more.
The hospital has a certain amount of market power, and as a result, it negotiates for better rates for the physicians. The hospitals realized that as they got bigger, they were able to exert leverage vis-à-vis the insurers.
Today, in most metropolitan areas, you have a lot of concentration of the insurers, but you have much more concentration of the large hospitals. That’s why the hospital rates have increased so much more dramatically than have the rates that are paid by government. Those market incentives are basically what’s sweeping up the individual private practitioner.
There is something that’s very attractive about the situation you have, where you’re an independent person, you’ve got consumers choosing to come to you and you’re providing good service for them, and you don’t want to have a boss on the outside telling you what to do. That’s admirable, and in many ways, it’s very American.
But the sweeping forces of the market in health care over the course of the last 30 or 40 years are just blowing that away. I don’t see it going back to an era where we’ve got a lot of private practitioners and choice by consumers. But I could be wrong.
Potter: I hope you’re wrong. I think it has to go back.
Brennan: [Reading from a card] Agree or disagree: The Affordable Care Act was beneficial to the health of Americans.
Potter: Absolutely, no doubt about it.
Clip of President Barack Obama: We are done.
Potter: Pre-existing conditions. I mean, yeah, definitely beneficial.
Clip of Obama: Tens of thousands of uninsured Americans with pre-existing conditions will finally be able to purchase the coverage they need.
Potter: I mean, more access for more people. I’m a huge fan.
Clip of Obama: Today, almost 50 million people have gotten quality, affordable health care through the A.C.A. And the percentage of people without insurance has been nearly cut in half.
Potter: I’m not a huge fan of some very specific things about the Affordable Care Act — and the No. 1 would be the limitations on expansion of physician-owned hospitals.
Clip: Did you know physicians aren’t allowed to own hospitals? This was part of the Affordable Care Act.
Clip: If you’re going to let UnitedHealthcare own hospitals, if you’re going to let private equity own hospitals, why don’t you let physicians own hospitals?
Potter: I’m not all about making money. I’m literally the least wealthy plastic surgeon you will ever meet. I take everything — Medicare, Medicaid, I do surgery for free. I am in this for the karma. My karma bank is full.
I am a huge fan of expanding access, but I also want to be free to be my best. And I don’t like it when the government tells a physician: You can’t own a hospital. That’s like telling a baker they can’t own a bakery. You think that I’m going to cherry-pick patients? No, I’m a doctor. Trust me to doctor well.
Brennan: Well, the physician-owned hospital issue is obviously one that’s very important to you, but a relatively small issue in health policy.
But I would just say I think that much of the reasoning underlying that — and I’m not sure it was good, and it looks like the new administration wants to change things in that regard — but they were worried about physicians taking the cases that make a lot of money out to those centers and leaving the hospitals basically impoverished.
Putting that aside, I was very impressed by what you said. The Affordable Care Act is usually associated with expansion of Medicaid —
Clip of President Joe Biden: The Affordable Health Care Act expanded Medicaid to cover an additional 20 million people.
Brennan: And creation of the exchange insurance markets.
Clip of Representative Maxine Waters: These exchanges will be a marketplace where individuals, families and small businesses can purchase health insurance.
Brennan: Both of which greatly expanded access to health care, and that, I think we can agree, is a wonderful thing.
But what you said about pre-existing conditions — that was a critical change, and it crystallized what I thought was an enduring change in the way in which Americans looked at things — that you shouldn’t be able to deny care, and insurance companies could for many, many years. You could deny an insurance policy for somebody who had a pre-existing condition.
The A.C.A. wiped all of that out. I thought that was evidence that our health care system was finally becoming a really humane thing. So, I’m greatly saddened to see the changes that are occurring right now with regard to the reductions in the number of people who are going to be in the exchanges and the restrictions that are being put on people to be able to qualify for Medicaid.
News clip: President Donald Trump officially signed the controversial One Big, Beautiful Bill Act.
News clip: More than five million Americans could lose Medicaid because of newly passed work requirements.
News clip: Tens of millions in the United States will see their health insurance costs soar, pricing many out of health care coverage entirely.
Brennan: We were improving access and it was crystallized by this: Let’s get rid of the pre-existing condition clause. And now I see it turning backward.
[Reading from a card] One easy fix to improve the health care system would be ——
Potter: Point-of-care pricing. Again, with the market, I want us to know what we’re spending and what on. When you go to the doctor, I want to know exactly what this costs, what I’m paying, period, so that I can shop.
Brennan: I was going to say transparency, because you had raised that before. It should be an easy fix, right? It should be the kind of thing where the government can insist, as they have, that everyone make their prices known, and that’s going to inform individuals.
Most people have no good idea about how much health care costs. I do some writing about cancer and cancer drugs, and the administration is now talking about: We’ll give everybody $1,500 in an H.S.A.
Clip of Trump: Put extra money straight into the health care savings account when you go out and buy your own health care.
Clip of Trump: Let the money go directly to the people where they can buy their own health care.
Brennan: You know, an average person who has multiple myeloma is on two or three drugs, each of which costs over $200,000 a year. So, they just have no sense about what the costs are associated with our health care system. I think transparency, like you said, point-of-care pricing, would be a great thing. I think that most people in the insurance industry would agree with you on that one.
Potter: Awesome.
[Reading from a card] Over the course of this conversation, I have changed my mind about ——
Brennan: I always struggle with physician complaints about what insurance companies do, simply because, in a lot of circumstances, I think the physicians are used to doing these things and they want to do these things, and they’re not willing to listen to the insurance company’s outline that this is not part of the standard of care and this is an unnecessary cost.
I tend to think, because my last 15 years of work were in insurance companies, that the insurance companies are trying to be reasonable, but the doctors just aren’t.
But then to meet somebody like you, who’s obviously a very reasonable person and someone who’s clearly and transparently committed to her patients, it makes me reconsider some of the policy issues surrounding these kinds of things that insurance companies do — like prior authorization. So, I really appreciate that.
Potter: Thank you. I think, likewise, sitting across the table from someone on the insurance side, if you will, to hear that there are humans on the other side trying to reach the same goal — that gives me hope.
I’d say if there was a part of me walking into this conversation that was feeling very tired and wondering: Are we going to get somewhere positive? Are we going to change health care? — then that part of me is a bit changed.
So, I appreciate that very much. I needed this conversation, and I hope that there are more to come.
Brennan: Thank you. So did I.
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