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Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans

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Wendell Potter is the insurance industry's worst nightmare. In June 2009, Wendell Potter made national headlines with his scorching testimony before the Senate panel on health care reform. This former senior VP of CIGNA explained how health insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers, and how they skew Wendell Potter is the insurance industry's worst nightmare. In June 2009, Wendell Potter made national headlines with his scorching testimony before the Senate panel on health care reform. This former senior VP of CIGNA explained how health insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers, and how they skew political debate with multibillion-dollar PR campaigns designed to spread disinformation. Potter had walked away from a six-figure salary and two decades as an insurance executive because he could no longer abide the routine practices of an industry where the needs of sick and suffering Americans take a backseat to the bottom line. The last straw: when he visited a rural health clinic and saw hundreds of people standing in line in the rain to receive treatment in stalls built for livestock. In Deadly Spin, Potter takes readers behind the scenes to show how a huge chunk of our absurd healthcare spending actually bankrolls a propaganda campaign and lobbying effort focused on protecting one thing: profits. Whatever the fate of the current health care legislation, it makes no attempt to change that fundamental problem. Potter shows how relentless PR assaults play an insidious role in our political process anywhere that corporate profits are at stake-from climate change to defense policy. Deadly Spin tells us why-and how-we must fight back.


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Wendell Potter is the insurance industry's worst nightmare. In June 2009, Wendell Potter made national headlines with his scorching testimony before the Senate panel on health care reform. This former senior VP of CIGNA explained how health insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers, and how they skew Wendell Potter is the insurance industry's worst nightmare. In June 2009, Wendell Potter made national headlines with his scorching testimony before the Senate panel on health care reform. This former senior VP of CIGNA explained how health insurers make promises they have no intention of keeping, how they flout regulations designed to protect consumers, and how they skew political debate with multibillion-dollar PR campaigns designed to spread disinformation. Potter had walked away from a six-figure salary and two decades as an insurance executive because he could no longer abide the routine practices of an industry where the needs of sick and suffering Americans take a backseat to the bottom line. The last straw: when he visited a rural health clinic and saw hundreds of people standing in line in the rain to receive treatment in stalls built for livestock. In Deadly Spin, Potter takes readers behind the scenes to show how a huge chunk of our absurd healthcare spending actually bankrolls a propaganda campaign and lobbying effort focused on protecting one thing: profits. Whatever the fate of the current health care legislation, it makes no attempt to change that fundamental problem. Potter shows how relentless PR assaults play an insidious role in our political process anywhere that corporate profits are at stake-from climate change to defense policy. Deadly Spin tells us why-and how-we must fight back.

30 review for Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans

  1. 5 out of 5

    Lobstergirl

    I received this as an ARC in 2010 and, yes, just now I'm reviewing it. I'll ignore the ARC-related issues, such as misnumbered footnotes, which presumably were corrected for the first proper edition, and move right on to the real flaws: 1) a lack of tight focus on healthcare/health insurance, while spending too much time on the public relations industry and what it does in lots of areas, not just health insurance; relatedly, a narrative that was not linear, but bobbing all over the place in I received this as an ARC in 2010 and, yes, just now I'm reviewing it. I'll ignore the ARC-related issues, such as misnumbered footnotes, which presumably were corrected for the first proper edition, and move right on to the real flaws: 1) a lack of tight focus on healthcare/health insurance, while spending too much time on the public relations industry and what it does in lots of areas, not just health insurance; relatedly, a narrative that was not linear, but bobbing all over the place in terms of chronology and subject matter; 2) an overly simplistic writing style that read like YA in many chapters; 3) the author's fudging on his motivations for staying so long in this industry when it must have been clear to him fairly early on how much damage the industry was doing to ordinary people. Potter was a PR exec at Cigna. His job entailed crafting messaging for the CEO and other top executives, interacting with and feeding company propaganda to reporters, and doing damage control when a film like Michael Moore's "Sicko" came out, or a teenage girl died because she hadn't received a new liver in time after Cigna had prolonged the organ transplant approval process. In 2007 he was sent to surreptitiously watch the "Sicko" premiere, and he claims there were things in the film that made him want to cry because it showed the human costs of rapacious insurance company practices, yet the next day he got to work on more pro-industry talking points. Less than two months later he went to a Remote Access Medical event in rural Virginia and saw hundreds or thousands of Americans lined up to get teeth pulled or mammograms in tents and horse stalls. 40% of these people already had health insurance, but it was such poor quality that they had no access to or couldn't afford to get these things done, so they were having them done gratis by a charity that had originally been established to distribute free health services in the Third World. At some point late in the book Potter writes that he was so torn by his job he was drinking a six-pack of beer a night. But it's not as if the healthcare crisis only emerged in the mid-aughts. There were ugly festering problems back in the 90s too. After all, that's why the Clintons had attempted healthcare reform. Potter went to work for Cigna in 1993. Why didn't the ethical problems bother him back then? He never says. In writing this book, he was claiming some kind of mantle of virtuous whistleblower. The scales had fallen from his eyes....recently. If a person is both intelligent and curious, the scales fall much more quickly, if the scales are even there to begin with. In a few sparse areas, the book is a worthwhile read. The sausagemaking involved in the Affordable Care Act is somewhat enlightening, covered in chapter 10, "A Victory, of Sorts." The chapters most worth reading are 6, "Consumer-Driven Care" - an industry euphemism - and 7, "It's All About the Money." Read Chapter 7 to find out how obscenely profitable the industry has been while moaning and groaning that they need to raise premiums in order to cope with rising medical costs. (It's a load of B.S.) Chapter 6 has a subchapter, "Managed Care: What Was That All About?" Was? Managed care is still very much a thing. (It refers to the insurance practice of restricting plans and their patients to a limited number of doctors and hospitals in order to keep costs down.) Consumers should know about the MLR, or medical-loss ratio. It expresses a percentage which is the amount an insurer spends on medical claims, with the balance going to overhead. Insurers tried extremely hard to lower their MLRs, which made investors and Wall Street analysts happy. If MLRs crept up, an insurer's stock price would usually drop. If MLRs crept down, stock prices went up, and along with them, CEO compensation. "Since 1993," says Potter, "MLR in America has dropped from 95% to around 80%." The ACA demands that a company have a MLR of no lower than 80%. As a comparison, Medicare "has consistently had a MLR ratio greater than 97% since 1993." Gosh, why don't we ever read about this in the press, or hear it on the nightly news? All you hear about is Medicare fraud. Someone please tell the people that Medicare is a radically better managed company than any other insurance company out there! "Within days of President Obama's signing the [ACA], WellPoint told Wall Street analysts that it had decided to "reclassify" certain categories of costs that it had previously counted as administrative expenses and move them to the medical-spending side of the equation, effectively raising its ratios - without making any actual changes in behavior." In the subchapter "Selling the Illusion of Coverage" Potter describes a Cigna plan called Starbridge Select. This was a plan designed to have extremely limited benefits. It was marketed to "midsized employers with high employee turnover, such as chain restaurants." The coverage was so skimpy that "some insurance brokers refused to sell them." (I suspect that this type of plan is not legal under the ACA, although I can't swear to that.) The "underwriting criteria...appear to guarantee an impressive profit margin. Under the plan, the average age of an employer's workers cannot be higher than 40, and no more than 65 percent of employees can be female." (Before the ACA, women could be charged more than men for any particular plan because they are susceptible to maternity expenses and breast cancer.) "To qualify, employers must have a 70 percent or higher annual employee-turnover rate - which means that most employees won't stay on the job long enough to use their benefits. Employees also get no coverage for care related to any preexisting conditions they might need during their first six months of enrollment. Plus employees have to pay the entire premium - employers are not allowed to provide any subsidies. While a relatively small number of employers meet all these criteria, there are enough to make it very worthwhile to market the Starbridge Select plan." Why am I bothering to describe this plan which is most likely not legal under the ACA? Because the next Congress has vowed to repeal the ACA. If that happens, get ready for plans like this to reappear. Get ready for things to get really ugly all over again.

  2. 5 out of 5

    Linda

    I have been following Wendell Potter with fascination since he first surfaced on Countdown and then in the long interview with Bill Moyers. It is rare indeed to find a top-level executive who will set aside his career in order to follow his conscience. Potter is such a man. I was delighted to receive an advance copy of the book through Goodreads and am pleased to review it. It is not fun to read. I say this because of the content. The style is altogether excellent, the work of a trained I have been following Wendell Potter with fascination since he first surfaced on Countdown and then in the long interview with Bill Moyers. It is rare indeed to find a top-level executive who will set aside his career in order to follow his conscience. Potter is such a man. I was delighted to receive an advance copy of the book through Goodreads and am pleased to review it. It is not fun to read. I say this because of the content. The style is altogether excellent, the work of a trained journalist who moved into PR only after learning the meaning of journalism and journalistic ethics. What smarts so much in the telling is the dulling of the consciences of so many "spinners" who ignore the code of ethics of the public relstiond profession -- yes, there is one! -- for the sake of gain. Lack of conscience in the health insurance business is all the more deadly in that this is not something any of us can, ultimately, choose. We may decide to use or not to use the products of the tobacco and beverage industries, but nearly all of us will need and receive medical care and have to pay for it. The saga of how Wendell Potter learned to believe his own spin, and then unlearned it through encounters with a free health clinic and the case of Nataline Sarkisyan forms a thread through the book and links the drier material on the history of health insurance and the grim story of attempts to reform the insurance system, only partially fulfillled in the Obama administration's legislation. Readers who are confronted with the inside story of the sleazy practices of the health insurqnce giants are likely to be more, not less, incensed at being mandated to purchase insurance from these unscrupulous sharks. With every page, I felt more and more fortunate to have made it to Medicare without disaster -- although it nearly happened to me, just before I reached Medicare age, when I suffered a ruptured appendix in a city many hundreds of miles from my company's home base and the "network" of its HMO. It took me over a year of argument to convince the administrators of the plan that mine was a medical emergency and had to be treated as "in network," as thr plan's handbook provided. The public hospital where I had received such excellent care had to wait all that time to be paid for its services. In some ways the most riveting chapter was Potter's explanation of ERISA, the Employee Retirement Security Act of 1974. Enacted to prevent the looting of pension funds by unscrupulous owners, the act has served as shelter for insurers, giving them incentive to gamble with people's lives. The Sarkisyan case is a bitter example: if Nataline Sarkisyan had lived, her insurer would have been responsible for her care and could even have been sued for damage caused by delay in treatment. But once she was dead, the insurer -- in this case Mercedes Benz, her fathe's employer, which ran a plan administered by CIGNA, was off the hook. Cases governed by ERISA can only be adjudicated in federal court, and the remedy is limited to the provision of treatment; thus, once the patient is dead there is no remedy at all. One can only hope that readers of this book will be moved to address their senators and representatives about altering ERISA to change this situation. I know I will. As soon as our Vermont legislature convenes in January, many of us will be at the State House to lobby for universal, single-payer healthcare, or public-option steps in that direction, asking the state to seek a waiver from the federal government to allow such an experiment. I hope Wendell Potterr's book will be required reading in Montpelier, and in state capitols throughout the country.

  3. 4 out of 5

    Steve

    This was a very interesting but puzzling book from my Canadian perspective. It was also disquieting in that our conservative politicians seem intent on pushing us towards an American model in regards to public services. From our point of view, how can the American people be so fearful of "big government" controlling healthcare? At least governments can be voted out, or pressured to work for the people. If you are in a democracy (And you are, right America?) then you government ostensibly works This was a very interesting but puzzling book from my Canadian perspective. It was also disquieting in that our conservative politicians seem intent on pushing us towards an American model in regards to public services. From our point of view, how can the American people be so fearful of "big government" controlling healthcare? At least governments can be voted out, or pressured to work for the people. If you are in a democracy (And you are, right America?) then you government ostensibly works for your collective benefit. A business on the other hand wants to give out the least amount of services while collecting the most money. They are by definition profit-driven above all else. Even their own self-preservation (see the recent Wall Street and automotive industry meltdowns). Imagine if your government operated under the same principles. There would be collapse potentially followed by dictators seizing power on a regular basis. I don't know how democracy could survive under those conditions. Wendell Potter certainly is a good spokesman against the healthcare insurers. He walks us through examples and case studies of the dodgy practices of the business. No easy answers here but there is a road map to a better system. This is a big issue and I welcome the insights offered here. It seems imperative that we become better informed. So, who would you put the greatest trust in?

  4. 4 out of 5

    Ericka Clouther

    Every American should read this as soon as possible. It's a tell-all by a health care insurance insider. Reading this book is critical to understanding, and not just the health care debate taking place in this country right now, but many of the political debates we're all wallowing in.

  5. 5 out of 5

    Gayle

    I read this book because it is mentioned in Nader's Getting Steamed Over Corporatism. I also read it because I am one of the more than 50 million Americans without health insurance in a country where the corporate interest always takes precedence over individuals. Mr. Potter knows of what he speaks. He worked in public relations for 25 years, 15 of those years for CIGNA, one of America's beloved "It's not our fault!" corporate insurers. Yes, Mr. Nader and Mr. Potter, I'm steamed! Just a few of I read this book because it is mentioned in Nader's Getting Steamed Over Corporatism. I also read it because I am one of the more than 50 million Americans without health insurance in a country where the corporate interest always takes precedence over individuals. Mr. Potter knows of what he speaks. He worked in public relations for 25 years, 15 of those years for CIGNA, one of America's beloved "It's not our fault!" corporate insurers. Yes, Mr. Nader and Mr. Potter, I'm steamed! Just a few of Wendell Potter's statements: "From 2007 to mid-2009, insurance and HMO political contributions and lobbying expenses totaled a jaw-dropping $586 million, according to Public Campaign. At the height of the battle, the industries were spending nearly $700,000 a day to influence the political process," (p. 193). [This in the effort to stop any health reform proposed by the Obama administration.] Quoting from National Health Expenditure Historicals for 1960-2007, "The most prominent public plan, Medicare, had recorded annual spending growth significantly lower than private insurers' over the previous decade, with per capita costs growing by 4.4 percent a year under Medicare versus 7.4 percent under private health insurance," (p. 194). [This in direct contrast with what the American people were repeatedly fed about the inefficiency of government run health programs.] This goes on and on, but the most important thing to take away from this, other than internalizing the tactics of PR so that you can become immune (see "Spotting Spin" pp. 245-247), is to remember that these insurance corporations--CIGNA, UnitedHealth Group, WellPoint, etc.--are corporations and the CEOs duty is to "increase shareholder value." This duty is paramount to anything else, including the well-being of the insured. This is why health care as we have it in the U.S. will never be affordable and equitable for all. These corporations, and not just in health care, have perfected the art of deception and swaying public opinion to the point that Americans will willingly accept, even fight for, what hurts them! And this is why, unless we push back hard, it will always be so in this country. As a side note, I especially enjoyed the fact that the insurance corps were so afraid of Michael Moore's Sicko movie and Mr. Moore himself that the subject warranted a whole chapter in the book. Way to go Michael!

  6. 5 out of 5

    Book

    Deadly Spin: An Insurance Company Insider Speaks Out On How Corporate PR Is Killing Health Care and Deceiving Americans by Wendell Potter Deadly Spin is the excellent, insightful book about Public Relations spin. The focus of this book is on health-care spin. Former public-relations executive Wendell Potter provides an expose of corporate greed and human indifference that will make you sick. This 304-page book is composed of the following twelve chapters: I. The Beginning, II. The Campaign Deadly Spin: An Insurance Company Insider Speaks Out On How Corporate PR Is Killing Health Care and Deceiving Americans by Wendell Potter “Deadly Spin” is the excellent, insightful book about Public Relations spin. The focus of this book is on health-care spin. Former public-relations executive Wendell Potter provides an expose of corporate greed and human indifference that will make you sick. This 304-page book is composed of the following twelve chapters: I. The Beginning, II. The Campaign Against Sicko, III. Perception Is Reality, IV. Remote Area Medical in Wise County, Virginia, V. Health Care History, Reform, and Failure, VI. Consumer-Driven Care, VII. It’s All About the Money, VIII. An End Too Soon, IX. ERISA Stymies the Sarkisyans, and Us, X. A Victory, of Sorts, XI. The Playbook, and XII. Spinning Out of Control. Positives: 1. Well written, engaging prose. A page-turner of a book. 2. Fascinating and the timely topic of health care in the hands of a true insider. Mr. Potter was a 20-year executive for two, for profit health-insurance companies. 3. A truly human story. A coming of age for an executive. 4. Enlightening, educational and one of the most insightful books I’ve ever read. 5. The inside scoop of a for profit health insurance company. Some of it will make you ill. 6. Provides the deceptive tactics of health insurance companies. 7. The art of spin with a luxury of practical examples. Public relations. 8. The key to spin, running and setting up front groups who help “reframe the debate”. 9. Great classic examples of viral phrases and buzzwords that mold public opinion, “government takeover”. 10. The eight “Rhetorical Tricks” used by propagandists. 11. Great executive wisdom, “Good PR leaves little to chance. Good PR is about control”. 12. The health care industry’s spin in full details. 13. The evil rescission practices of the health care industry. If this doesn’t leave you ill, nothing will. 14. The practice of purging. 15. The fact that universal health care is available today in EVERY industrialized nation except ours! 16. The reform bill that Congress passed in 2010 is far reaching, but what happened to the public option? Find out. 17. A look at the history of health care. 18. The outrageous retirement packages of Health Care CEOs. 19. What is an MLR and why reducing it drives the health care industry. 20. Why did previous attempts to get health care legislation failed? 21. Follow the money…”Wall Street-driven financial imperatives trump the needs of millions of Americans”. 22. The heart-breaking story of Nataline Sarkisyan. 23. ERISA, a “ridiculous perversion of the law”. 24. President Obama’s health care reform bill. What it will accomplish and what it will not and why. 25. One of the most powerful lobbyists in America, meet the soft-spoken Karen Ignagni. 26. The insidious rumors, “death panels”. 27. How the health care reform bill got approved. A fascinating look back. 28. “The Playbook on How to Influence Lawmakers and Regulators Through the Manipulation of Public Opinion”. 29. How the tobacco industry applied the playbook. 30. How did BP apply the playbook? 31. Understanding how PR firms campaigned to control the climate change discussion. 32. The tried-and-true tactic of trying to kill parts of any reform legislation not liked by an industry by: saying one thing and working behind the scenes to do just the opposite. It had to be said. 33. The future of investigative journalism. 34. How to uncover the true nature of a front group. 35. A great notes section that linked. Negatives: 1. I have very little to criticize this book. Some may consider it one-sided but that’s what exposes emphasize. The most important issue that anyone should care about is whether or not you believe Mr. Potter to be truthful, and I do. 2. Charts or illustrations would have added value. 3. If you are familiar with PR tactics then some of the book may be a refresher of sorts. In summary, what a satisfying and an eye-opener of a book this was. I truly enjoyed it and learned so much about not only the art of public relations but about health care. I highly recommend this book a real treat.

  7. 5 out of 5

    Richard Etzel

    If you ever wondered how the state of health care got into the current mess with millions of Americans without insurance, then you must read this book. The second title tells it all. Wendell Potter, a "spin doctor" for Cigna insurance left the company when it became impossible for him to live with his conscience. Decisions to refuse service to Cigna customers, even if it involved imminent death or death itself, finally caused him to say "enough". He had to do something to alert the public so he If you ever wondered how the state of health care got into the current mess with millions of Americans without insurance, then you must read this book. The second title tells it all. Wendell Potter, a "spin doctor" for Cigna insurance left the company when it became impossible for him to live with his conscience. Decisions to refuse service to Cigna customers, even if it involved imminent death or death itself, finally caused him to say "enough". He had to do something to alert the public so he wrote this book. It's a must read that not only explains the history of the current health insurance companies but also gives understanding how the big corporations with unlimited money can influence political decisions that work against mainstream Americans. Every time lawmakers get close to reforming the laws governing the health insurance agency the spin gets rolling convincing the public that such changes would destroy health coverage in the country. You see ordinary people criticizing and turning against the very plans that would benefit them, because of the "spin". And so the laws keep getting changed and watered down, always in favor the the companies who make sure it goes that way with lobbying and use of premium money to influence voting in congress. I highly recommend the book!

  8. 5 out of 5

    Oldroses

    The title of this book, "Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans" is a bit off-putting. Reading it, I mentally prepared myself for a diatribe written by a disgruntled low-level employee out to get his pound of flesh. We all know that health insurance companies are in the habit of denying coverage and raising premiums, occasionally exorbitantly, but they arent all that bad, right? Surely not as bad as the Wall Street The title of this book, "Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans" is a bit off-putting. Reading it, I mentally prepared myself for a diatribe written by a disgruntled low-level employee out to get his pound of flesh. We all know that health insurance companies are in the habit of denying coverage and raising premiums, occasionally exorbitantly, but they aren’t all that bad, right? Surely not as bad as the Wall Street firms that first took away our retirement savings and then our jobs. I worked in the financial industry for 25 years. Nothing I saw there was as heinous as what is revealed in this book. Put simply, Wall Street may take away people’s money, but health insurance companies take away people’s lives. Author Wendell Potter was an insurance company executive, heading up a PR department. For years, he participated in the shameless pursuit of profits over lives until he finally came face to face with the effects on real people of what he was doing. Visiting a clinic set up on a fair ground offering free health care to those who had no insurance and no means to pay for health care, he saw ordinary hardworking people reduced to being treated in animal stalls. He has written about his experience in the health insurance industry, as well as his epiphany, in a straightforward manner, making it more powerful than if he had penned an hysterical screed. He takes us, step by step through the changes in the health insurance industry from a privately held companies offering true health insurance to the modern publicly owned companies whose focus is on profits rather than health. The lengths to which health insurers go and the collusions in which they participate are extraordinary. They routinely deny coverage to people who need it and drop coverage of people who become ill. They hire outside PR firms who form bogus grassroots groups who lobby in favor of health insurers. They provide statistics to back up all of their false claims that any kind of healthcare reform is bad. Potter devotes an entire chapter to revealing how health insurers torpedoed Healthcare Reform using all of the dirty tricks he had discussed in previous chapters. The reason we have no public option is because it would put the health insurance industry out of business prompting them to wage all-out war against it. It took the death of a child who was denied a liver transplant to convince Potter to leave his job with CIGNA. He devotes his time now to healthcare reform advocacy and as a health insurance critic. He testified during the healthcare reform debates, but obviously not enough people listened to him. In my opinion, this book should be required reading for every member of Congress. They need to know how they have been bribed and manipulated by the health insurers to do what’s best for the health insurance industry instead of what is best for the people who elected them to office.

  9. 5 out of 5

    Clif

    Deadly Spin is a plainly written account by a man who rose to the top in the health insurance PR field, became unable to continue pushing out disinformation and quit to sound the alarm. This book describes something that we are inundated with in America: carefully crafted, heavily funded BS. Americans are cynical because they are trained to be by everyday experience in marketing. I first became aware of Wendell Potter when I saw a video news clip where he was apologizing to Michael Moore for all Deadly Spin is a plainly written account by a man who rose to the top in the health insurance PR field, became unable to continue pushing out disinformation and quit to sound the alarm. This book describes something that we are inundated with in America: carefully crafted, heavily funded BS. Americans are cynical because they are trained to be by everyday experience in marketing. I first became aware of Wendell Potter when I saw a video news clip where he was apologizing to Michael Moore for all of the work he had done to undermine Moore's film "Sicko". The details are in this book. Though the health insurance industry was almost in a panic over the movie (since it told the truth) "Sicko" had little impact and was seen by relatively few people. The book not only tells Potter's personal story, it also gives an interesting history of the techniques of corporate PR that were first established by the tobacco industry, the primary one being turning the situation upside-down to make it appear that the guilty party, the industry, is innocent and being attacked with unfair accusations. My favorite example of this is the the laughable claim that the environmental movement has created the global warming issue because it makes money from it. There's a good historical account of the effort to provide a single-payer plan, repeatedly shot down by the insurance industry. Single-payer is the obvious best choice for insurance of any kind, where the pool of those covered needs to be as large as possible to provide the lowest cost. There is no useless variety of procedure and paperwork, nor an industry whose profits are determined by how many claims they can deny, not by any "service" they offer. My similie for the health insurance industry is the tapeworm, a creature that lives in the human gut extracting nourishment from the food a person eats while giving nothing in return. A quick read, you should be able to finish the book in an evening. There's little in it that will be a surprise to anyone who realizes that profit making always defends itself no matter how that profit is made, in proportion to the amount made, and with little or no connection to the facts. What was new to me (and what altered the author's life) is the the Remote Area Medical (RAM) operation that puts on events where people (by the thousands) get medical care immediately if they are able to reach the site. Check it out at http://ramusa.org/

  10. 4 out of 5

    Ray

    I wish I could say that this book was full of lies and exaggerations, because that would make reflections on the Health Care debate much more palatable. Much of what Potter says are things I'd prefer not to acknowledge, and hearing it from an industry insider only makes everything sound worse. It was especially revealing to see how the spin authored by Insurance PR staffs to protect the industry and not the public became sound bites for political activits supposedly acting on the behalf of the I wish I could say that this book was full of lies and exaggerations, because that would make reflections on the Health Care debate much more palatable. Much of what Potter says are things I'd prefer not to acknowledge, and hearing it from an industry insider only makes everything sound worse. It was especially revealing to see how the spin authored by Insurance PR staffs to protect the industry and not the public became sound bites for political activits supposedly acting on the behalf of the public. But too much of makes sense, and too much of it is verifiable to dismiss what he states. The book is something we all should be aware of as the health care debate and the future adjustments continue. Valuable insights and lessons.

  11. 5 out of 5

    Asha

    Best... midlife... crisis.. ever. I agree with those reviewers who say that the book is a little unfocused (PR + healthcare + journalism), and I also agree with those who assert that it could be split into multiple books (and may well be in the future). My only other gripe is that Potter avoids thorough explanations of some complex and confusing subjects to avoid losing his reader (e.g. ERISA - I still don't really get what happens when the insurers are tried on a federal level). Finally, Best... midlife... crisis.. ever. I agree with those reviewers who say that the book is a little unfocused (PR + healthcare + journalism), and I also agree with those who assert that it could be split into multiple books (and may well be in the future). My only other gripe is that Potter avoids thorough explanations of some complex and confusing subjects to avoid losing his reader (e.g. ERISA - I still don't really get what happens when the insurers are tried on a federal level). Finally, though, books are being published about the history and current state of healthcare in America that are accessible to the "rest of us". Bravo!! Wendell Potter and TR Reid (The Healing of America) do an admirable job. I disagree with those who think that Potter is just trying to "spin" us the other way, in part because I don't really see what his motive would be besides increasing access to healthcare (without impossible premiums and deductibles). It was fascinating to read about how the PR industry works, and I appreciated the examples from global warming, big oil, banking, tobacco, etc. Truly eye-opening. I'm inspired by Potter's courage. It is extremely rare. I hope iron core journalism isn't doomed. And I hope that we continue to progress in the quest to deliver good healthcare to more people. For profit insurance as it exists today simply doesn't make sense, and simply will never deliver optimal healthcare delivery due to the insurance industry's inherent conflict of interest. It needs to go away.

  12. 5 out of 5

    Barb McCarthy

    This book does more than give you an insider's perspective on what the health insurance industry is doing to destroy the public health option. It gives a historical perspective of why health costs have increased astronomically and how all the players share responsibility. Our government representatives are not educated well enough in the spin industry and the ability for these companies to use our premium dollars to sell us short is disgusting. I think we are all aware how PR firms manipulate This book does more than give you an insider's perspective on what the health insurance industry is doing to destroy the public health option. It gives a historical perspective of why health costs have increased astronomically and how all the players share responsibility. Our government representatives are not educated well enough in the spin industry and the ability for these companies to use our premium dollars to sell us short is disgusting. I think we are all aware how PR firms manipulate information to a particular group's advantage. I don't think most of us can imagine the lengths to which many of America's Corporations will go and the amount of money they are willing to spend (millions!!) to enrich themselves and their investors. This book recounts those details, no only for the health insurance industry,but the tobacco corporations, and soda companies to name a few. The one disturbing fact that he brings to light is the demise of news reporting, that previously would have uncovered these "deals". "If there is one message-and one that is actually true-it is this: Always look behind any public argument to see how your emotions are being manipulated" (WP) That won't be so easy any more as spin begets spin....... At any rate, if you have been anti Obamacare, read this first. You will see how you were manipulated.

  13. 5 out of 5

    Jo

    I get so frustrated when people get their "facts" from websites, email, and sponsored newscasts. We all need to carefully research the facts before we speak out for or against partisan action. Read and discern. I make a point of reading books written by those on the right and the left and those who have real experience with the issues. That said, this is a great look at how the insurance industry deceives us and how public relation experts are able to manipulate (spin) us. This is not a slur on I get so frustrated when people get their "facts" from websites, email, and sponsored newscasts. We all need to carefully research the facts before we speak out for or against partisan action. Read and discern. I make a point of reading books written by those on the right and the left and those who have real experience with the issues. That said, this is a great look at how the insurance industry deceives us and how public relation experts are able to manipulate (spin) us. This is not a slur on PR although it acknowledges the power of PR and shows how the insurance industry has used PR, media, and lobbyists to make big bucks at the expense and sometimes even lives of the insured. Unfortunately, too often, perception is reality.

  14. 4 out of 5

    Kelly

    A brilliant take down of the health insurance industry in the USA. This was an eye-opening education in how health insurance functions, who profits, and who suffers. A must read.

  15. 4 out of 5

    Clif Hostetler

    I've long been puzzled why many Americans seem to be more frightened by government provided health insurance than they are of private health insurance companies. Even many of those who are currently covered by Medicare are alarmed at the prospect of "socialized medicine" that may result from implementation of a public option of health insurance. Do people really trust their insurance companies that much? This book partly explains why many people have unrealistic fears that cause them to support I've long been puzzled why many Americans seem to be more frightened by government provided health insurance than they are of private health insurance companies. Even many of those who are currently covered by Medicare are alarmed at the prospect of "socialized medicine" that may result from implementation of a public option of health insurance. Do people really trust their insurance companies that much? This book partly explains why many people have unrealistic fears that cause them to support political positions that are contrary to their own best interests. This book reveals "... the techniques employed by practitioners of the dark arts of PR--from the use of 'third-party advocates' to the creation of front groups, from the staging of PR 'charm offensives' to the selective disclosure of information and misinformation--which influence people's thoughts and actions in ways that advertising cannot." The millions of dollars spent on public relations and spin controls over many years by the private insurers have created a reality distortion field that continues to pervade the American political scene. The author of this book, Wendell Potter, worked many years as a former VP of corporate communications at CIGNA and thus writes from a unique perspective as one who has a working knowledge of the tactics used by the masters of spin. These credentials make him the perfect mightmare for the health insurers. Mr. Potter describes his personal journey that led to an epiphany that he could no longer in good conscience continue to work for CIGNA. Quotation from page 2: "Had it not been for a series of events that occurred in 2007--events that, as someone raised as a Southern Baptist, I can't help believing were part of some kind of divine intervention--I would probably still be spinning for health insurers." Quotation from page 70: "Quite unexpectedly, this spur-of-the-moment outing was starting to feel personal and even spiritual--and I didn't consider myself to be much of a spiritual kind of guy. It was clear to me at that moment that I was having an epiphany. .... Quotation from page 72: SCALES BEGAN FALLING FROM MY EYES Among the many reasons I finally left my job at CIGNA was that with each promotion, I got a better understanding of how insurers get rid of enrollees they don't want--the very people who need insurance--when they become a drain on profits. I could no longer in good conscience continue serving as a spokesman for an industry whose practices ... were swelling the ranks of the uninsured." The book provides a rundown on how the health insurance business has consolidated into fewer large nationwide companies and how their profit margins have increased along with their premium rates. It goes on to describe the ways in which the balance sheets are made to look good and the resulting inflation of executive bonuses. One statistic I found of special interest was the change that has occurred in the medical-loss ratio (MLR) which is the percentage of income that is actually paid to policy holders. In 1993 the average MLR was 95% and by 2007 it had dropped to 81%. Meanwhile the MLR for Medicare stayed at 97% over the same time period. So what's wrong with a public option? The author tells what it was like to write press releases in the face of insurance "horror stories" that he knew were pure spin and simply not the truth. After he quite his job the author describes the relief of being able to tell the truth. "Telling the truth is very cathartic. I highly recommend it." (pg.210) His play-by-play write ups of the Clinton and Obama attempts to pass meaningful health care legislation enable the reader to see what was occurring behind the scenes in the halls of corporate power and perhaps understand those events for the first time. The author was working against insurance reform during the Clinton administration and was working for reform during the Obama administration. He is thus able to tells of experiences on both sides of the issue. Toward the end of the book the author reviews the "fundamental tools of the spin business." The tobacco companies were early practitioners of the art of spin and manipulation of public opinion, and other types of business such as health insurance, petroleum, and coal mining have since learned the tricks of the trade. Regarding the future the book notes that with the decline in the number of newspapers, there are now more and better-paying jobs available in public relations than in journalism. We are thus facing a future where there will be more paid spinmeisters than professional news reporters.

  16. 5 out of 5

    Giselle

    I won this book through goodreads first-reads! Wendell Potter is a courageous person, and he is genuinely penitent about any possible harm his career in the Medical Industrial Complex has done to individuals, groups or classes of individuals, and to the Nation at large. He is awash with a desire to make amends. Cool. The best amends consist of revealing his insider knowledge of the Medical Industrial Complex, the healthcare insurance industry, and the history of legal and illegal activities and I won this book through goodreads first-reads! Wendell Potter is a courageous person, and he is genuinely penitent about any possible harm his career in the Medical Industrial Complex has done to individuals, groups or classes of individuals, and to the Nation at large. He is awash with a desire to make amends. Cool. The best amends consist of revealing his insider knowledge of the Medical Industrial Complex, the healthcare insurance industry, and the history of legal and illegal activities and machinations to prevent the populist call for Universal Health Care in this country (which began in the late 1940s). Potter has been open about the serious efforts to neutralize both Michael Moore and the movie SICKO, whether or not the threat to =push him off a cliff= was more than hyperbole. In short, Mr. Potter is expert in his personal experience as a participant in these Machiavellian schemes and maneuvers. So far as I know, however, Wendell Potter has no direct experience receiving health care from any nation with universal coverage for its people. He has not lived in such a country, and I will say here that I lived in Canada for 30 years, and 20 of those years I worked in hospitals. I volunteered my expertise to Michal Moore as he was starting to make SICKO. My offer was either lost or rejected, with no feedback to me. In my opinion, the best possible action when reading Deadly Spin is to borrow from your library a copy of this book: The Healing of America: A global quest for better, cheaper, and fairer health care. The author is T.R. Reid and the book was published in 2009. After reading this comment, please examine reviews of Mr. Reid's excellent book. Between these two references you will have most of what you need to know. A word of warning: books written about health care by economists and lawyers are like a goose that has been meticulously trained to QUACK. You think that, as ducks, they know what they are talking about. Health care is not a commodity, nor whereas and heretofore by the consent of the party of the second part. Health care is the socially contracted response, by trained medical professionals, to the biological situation and the existential fear of a society member. AXIOM: The manner in which any nation distributes health care to its members is that nation's answer to the basic question: "Why have a society in the first place?"

  17. 4 out of 5

    Ashley

    It took me a week or so to devote enough time to this one, and I'm glad I waited until I had time to really focus on what Potter had to say. After just a few pages, I had to break out the highlighter. Post-it notes and bent page corners just weren't cutting it - Potter packs so much info into this 250-pager. It was not, like I had initially feared, incredibly dense, but was written in a way that made all Potter's points and explanations easily understandable and relatable. Like many people, I've It took me a week or so to devote enough time to this one, and I'm glad I waited until I had time to really focus on what Potter had to say. After just a few pages, I had to break out the highlighter. Post-it notes and bent page corners just weren't cutting it - Potter packs so much info into this 250-pager. It was not, like I had initially feared, incredibly dense, but was written in a way that made all Potter's points and explanations easily understandable and relatable. Like many people, I've been a little confused and overwhelmed by all the healthcare reform bills flying around. I have so much to say about this book, but it's hard to explain and convey everything as succintly as Potter has done in Deadly Spin. I feel like the scales have fallen from my eyes and I want to put a copy of this book into everyone's hands I pass. This is a must read! A few fascinating facts are listed below to pique your interest... suffice it say, the need for healthcare reform is real. Take some time - and Potter's knowledge - to consider why they're fighting so hard against this. Bottom line - "an absence of competition in health care insurance markets is clearly not in the best economic interest of patients." - About 45,000 people die in America every year because they have no health insurance. - In 2009, the average cost of a family health insurance policy was $13,375. The average income for a minimum-wage employee, though was just $11,500 in the same year. - WellPoint, the parent company of Anthem Blue Cross has profited by more than $128 million from cancelling policies retroactively. - The average employee contribution to company-provided health insurance increased by more than 143% between 2000 and 2005, while average out-of-pocket costs increased by 115%. - Wall Street judges insurance company's harshly by their MLR, or Medical Loss Rate; the amount of money they pay out on medical claims. A) Interesting that they consider this a loss, B) since 1993, the average MLR in the US has dropped from 95% to 80%

  18. 5 out of 5

    Ross

    I read this at the same time as Michael Lewis's The Big Short, and found Deadly Spin both more interesting and more important - despite its much lower profile and promotional budget. This is despite my initial hesitancy, totally unfounded, that its contents might be somehow obsolete or stale in light of the recent health care legislation. While Potter focuses on the PR tricks of for-profit health insurers (who can increase their profits by decreasing their payouts to policyholders), he also shows I read this at the same time as Michael Lewis's The Big Short, and found Deadly Spin both more interesting and more important - despite its much lower profile and promotional budget. This is despite my initial hesitancy, totally unfounded, that its contents might be somehow obsolete or stale in light of the recent health care legislation. While Potter focuses on the PR tricks of for-profit health insurers (who can increase their profits by decreasing their payouts to policyholders), he also shows how PR is abused by a number of other industries that, for one reason or another, seem to be unpopular with voters and taxpayers. Big tobacco, big oil, big coal, Wall Street, misunderstood groups like that. Potter says that these industries are continuing to learn better PR tricks, and continuing to exercise ever-more influence over the media and public debates. Which puts the onus on voters and taxpayers to cultivate an ability to identify, see through, and reject these PR tricks. Reading this book is a good start. Tantalizing quote from the later chapters of Deadly Spin (can you take credit for your own apathy?): "Goran Therborn, the renowned social theorist, author, and professor of sociology at Cambridge University, contends that there are three arguments most likely to sustain popular apathy toward any issue or problem: (1) denying that the issue exists; (2) insisting that its a good thing rather than a bad thing; or (3) conceding that it's a problem but claiming that it can't possibly be solved. All three have been used, with varying degrees of success, in the attempt to discredit the reality of [manmade] global warming."

  19. 5 out of 5

    Carolyn

    This book might be called "The Trials and Tribulations of a Whistleblower." An executive with PR responsibilities at large health insurance firms, after 20 years or so his conscience woke him up, he got out, and joined the other side. While I don't think health insurers are any more honest or ethical than tobacco companies, big oil companies, I wish the author were equally skeptical of Obama, Pelosi, Reid, et al. The bits of history I *know* he gets wrong make me suspicious of his relating of This book might be called "The Trials and Tribulations of a Whistleblower." An executive with PR responsibilities at large health insurance firms, after 20 years or so his conscience woke him up, he got out, and joined the other side. While I don't think health insurers are any more honest or ethical than tobacco companies, big oil companies, I wish the author were equally skeptical of Obama, Pelosi, Reid, et al. The bits of history I *know* he gets wrong make me suspicious of his relating of other bits of which my knowledge is limited. The details of creating spin are interesting, (e.g. "astroturfing," paying third parties to form phony grassroots groups) and its dangers clear, but this book could have told its story better in half the length.

  20. 5 out of 5

    Scarlet

    Good overview of the history of health care reform attempts in the US, but I was hoping for something with a little more insider info on the health insurance industry. Yes, I know they are motivated by profit, and I understand the concept of astroturf lobbying. Maybe this book would be a little more groundbreaking for someone who wasn't familiar with the skanky side of PR, but I've been watching corporate PR scum tactics for nearly 20 years, so it wasn't as interesting as I expected. And the Good overview of the history of health care reform attempts in the US, but I was hoping for something with a little more insider info on the health insurance industry. Yes, I know they are motivated by profit, and I understand the concept of astroturf lobbying. Maybe this book would be a little more groundbreaking for someone who wasn't familiar with the skanky side of PR, but I've been watching corporate PR scum tactics for nearly 20 years, so it wasn't as interesting as I expected. And the biggest mystery--why people are so scared of a public option--remains unanswered by this book. We already have Medicare and Medicaid, so what's the big deal about creating a public option for everyone?

  21. 4 out of 5

    Nick

    Potter's book is part autobiography and wholly expose from within of how the medical insurance industry corporations have repeatedly derailed efforts at health care reform. He also details the industry's duplicitous campaign, partly successful, to defeat the health care reform legislation which President Obama sought. Potter moves on from there to summarize the "playbook" industries use to defeat reform efforts and outlines exactly how tobacco, BP and big banks have used the playbook to deflect Potter's book is part autobiography and wholly expose from within of how the medical insurance industry corporations have repeatedly derailed efforts at health care reform. He also details the industry's duplicitous campaign, partly successful, to defeat the health care reform legislation which President Obama sought. Potter moves on from there to summarize the "playbook" industries use to defeat reform efforts and outlines exactly how tobacco, BP and big banks have used the playbook to deflect reform. That's a lot of useful, and action-inspiring, information in 250 pages.

  22. 4 out of 5

    Karin

    This has got to be one of the most interesting books I've read in a while. It's extremely relevant despite the 2010 pub date.... he essentially calls out the fake news scandals going on now, seven years before it happened. You'll learn lots about health care and PR and the media and how Washington works. Read this!!

  23. 5 out of 5

    Rita Arens

    Horribly depressing but necessary. As my dad says, "Always consider the source." And always question your medical bills.

  24. 5 out of 5

    Joe Bliven

    This book is a great explanation of how the insurance industry and other industries influence public opinion and lawmakers to favor their exploitative business practices. Written by an ex public relations executive from CIGNA (a large insurance provider) who became dissatisfied with his role in helping his industry suck every last penny out of the market at the price of everyday Americans. The book does more than offer this whistle-blower's accounts of his involvement by giving a real crash This book is a great explanation of how the insurance industry and other industries influence public opinion and lawmakers to favor their exploitative business practices. Written by an ex public relations executive from CIGNA (a large insurance provider) who became dissatisfied with his role in helping his industry suck every last penny out of the market at the price of everyday Americans. The book does more than offer this whistle-blower's accounts of his involvement by giving a real crash course in the role of public relations and media in the current era. He starts by explaining what his job was as a PR worker, how he got into his role, and the events that led him to question his role and eventually give up his career. Wendell Potter gives us a brief, yet deep, summary of the current health insurance climate in the U.S. and how we got here. He also gives an excellent summary of the history of PR and common tactics. Potter gives specific examples of cases where insurance companies consciously do the wrong thing time and time again and then launch massive PR campaigns to quell public backlash and government intervention. He gives thorough accounts of how the insurance industry uses PR to fight against certain insurance "horror stories" including a widely reported case of a 17 year old girl who was denied coverage for a life saving treatment that resulted in her death. Potter also gives summaries of how the industry has combated unfavorable regulations including the Clintons' efforts to reform health care in the 90s. He also details how politicians, the news media and the public were so easily duped by insurance companies during the drafting and passing of the ACA. He also ends the book by explaining how other industries have exploited PR tactics and the current state of the media. This book is an excellent comprehensive introduction to the healthcare reform climate in the U.S. right now and should be read by any American who wants a better understanding of the healthcare debate. The author holds your hand from beginning to end and will leave anyone who hasn't lived his life with a great deal more knowledge on an important issue facing our country.

  25. 4 out of 5

    emily Ying

    This book is certainly engaging(the author probably read the book himself) and probably also professional(he worked in the industry for quite some time and is part of the system, and probably the very beneficiary of such corporate health care system). The author grows up in Tennesee and talks about his working class background in order to express his alignment with the average American against the "big evil insurance companies" that he is part of. lol. then the author talks about his experience This book is certainly engaging(the author probably read the book himself) and probably also professional(he worked in the industry for quite some time and is part of the system, and probably the very beneficiary of such corporate health care system). The author grows up in Tennesee and talks about his working class background in order to express his alignment with the average American against the "big evil insurance companies" that he is part of. lol. then the author talks about his experience working at a big insurance corporation whose name I forgot(no longer exist in Philly) and his life in Philly that I find to be interesting and somewhat relatable. Most of the book is the author's rambling and criticism of the industry. Like how the insurance companies will use various calculation against employee benefits and consumer rights and benefits like deliberately raise premiums in the next year if the expense for the insurance company increased for a certain object or group. Basically how the insurance corporation outsmarts the consumers and consumer corporations and avoid risks as much as possible to shun potential responsibilities that its functions as insurance is no longer obvious, blah blah blah. The author read with emotion and it would certainly least be a boring read.

  26. 4 out of 5

    Adrian Mora

    What the F! What is the problem???? If this is as accurate as I would like to be I don't see why we don't try the single payer option. My theory is --> If the Big Insurance Companies in charge if our "Healthcare" (but at the same time have a fiduciary responsibility to create profit?? Obviously a direct conflict of interest!) are ready to drop millions upon millions of dollars to create smear campaigns and disinformation content then without a doubt, they are fully aware of how corrupt things What the F! What is the problem???? If this is as accurate as I would like to be I don't see why we don't try the single payer option. My theory is --> If the Big Insurance Companies in charge if our "Healthcare" (but at the same time have a fiduciary responsibility to create profit?? Obviously a direct conflict of interest!) are ready to drop millions upon millions of dollars to create smear campaigns and disinformation content then without a doubt, they are fully aware of how corrupt things have gotten. They don't want to have their golden goose taken from them. I'm not saying I have the answer but it is so obvious For-Profit Publicly-Traded companies should not be the ones in charge of health care. These enterprises actually do have "Death Panels"! Anyways, if you want to get some insight about the corruption and real collusion in Health Care then read this book and find out what drove Wendell Potter (ex PR Exec for Cigna) to give up his lucrative high-status career. It's good to hear about good people with high morals!

  27. 4 out of 5

    Amelia

    Potter's summary of how universal healthcare or any kind of true reform has been shot down again and again is concise and readable. Having already read the nitty gritty details of the Affordable Care Act in Bryson's America's Bitter Pill, I really appreciated Potter's overarching narrative on US healthcare legislation. His perspective and past experience is useful as a lens. Focusing on the PR spin from the health insurance industry is crucial in understanding the lack of progress the US has Potter's summary of how universal healthcare or any kind of true reform has been shot down again and again is concise and readable. Having already read the nitty gritty details of the Affordable Care Act in Bryson's America's Bitter Pill, I really appreciated Potter's overarching narrative on US healthcare legislation. His perspective and past experience is useful as a lens. Focusing on the PR spin from the health insurance industry is crucial in understanding the lack of progress the US has made in this area. The "horror stories" he brought up were good enough to move the narrative along. He brings up how insurance companies have adopted the same spin tactics from other companies and their PR firms. Toward the end, Potter also specifically brings his concerns for the future of reporting and consumers being able to sort out fact from fiction due to the rising amount of spin compared to honest investigative journalism.

  28. 4 out of 5

    Eve

    i'm not finished yet, but i'll need to return it to the library soon. i'm around page 50. i should watch michael moore's "sicko" in the meantime. this is one of those books where if you read any 10-20 pages you're going to learn stuff. however, it also brings out how controlled our overton window is & makes me wonder whether this is counter-revolutionary. also the fact the whistleblower worked for the scammers, it does bring in an interesting level of unreliable narration. I'm not saying the i'm not finished yet, but i'll need to return it to the library soon. i'm around page 50. i should watch michael moore's "sicko" in the meantime. this is one of those books where if you read any 10-20 pages you're going to learn stuff. however, it also brings out how controlled our overton window is & makes me wonder whether this is counter-revolutionary. also the fact the whistleblower worked for the scammers, it does bring in an interesting level of unreliable narration. I'm not saying the whistleblowing is false, what i am saying is that question of how controlled is the overton window here. it's a similar question of hinting & self-censorship involved in suzanne collins's hunger games trilogy. so given that, this is an enjoyable read if you put aside how much work we have left to do.

  29. 4 out of 5

    Michael Treiman

    Whenever he talks about his own experiences it is engaging, but the historical background is super boring. Still, it's a good review of the subject. News flash - we're all screwed! I also am more interested in the PR techniques - I wanted to read this to learn "defense against the dark arts." Unfortunately not enough of that. Almost finished- I am glad I read it but the last bit melted my face off with boredom. I am glad I read it though (Audiobook)

  30. 5 out of 5

    Pontaeus

    Very interesting book, well written. Learned a lot about the inner workings of the industry, and while much have happened since, with the effect of the ACA well known by know, it's a very worthwhile read to understand what happened and why we are where we are today.

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