I left my job as a health insurance executive at Cigna after a crisis of conscience. It began in 2005ps88, during a meeting convened by the chief executive to brief department heads on the company’s latest strategy: “consumerism.”

Marketing consultants created the term to persuade employers and policymakers to shift hundreds and, in many cases, thousands of dollars in health care costs onto consumers before insurance coverage kicks in. At the time, most Americans had relatively modest cost-sharing obligations — a $300 deductible, a $10 co-payment. “Consumerism” proponents contended that if patients had more skin in the game, they would be more prudent consumers of health care, and providers would lower their prices.

Leading the presentation was a newly hired executive. Onstage, he was bombarded with questions about how plans with high deductibles could help the millions of Americans with chronic conditions and other serious illnesses. It was abundantly clear that insurance companies would pay far fewer claims but that many enrollees’ health care costs would skyrocket. After about 30 minutes of nonstop questions, I realized I’d have to drink the Kool-Aid and embrace this approach.

And I did, for a while. As head of corporate communications at Cigna from 1999 to 2008, I was responsible for developing a public relations and lobbying campaign to persuade reporters and politicians that consumerism would be the long-awaited solution to ever-rising insurance premiums. But through my own research and common sense, I knew plans requiring significant cost sharing would be great for the well-heeled and healthy — and insurers’ shareholders — but potentially disastrous for others. And they have been. Of the estimated 100 million Americans with medical debt, a great majority have health insurance. Their plans are simply inadequate for their medical needs, despite the continuing rise in premiums year after year.

I grew uneasy after the company meeting. But it took an impromptu visit to a free medical clinic, held near where I grew up in the mountains of East Tennessee, to come face to face with the true consequences of our consumerism strategy.

Overall, violent crime fell 3 percent and property crime fell 2.6 percent in 2023, with burglaries down 7.6 percent and larceny down 4.4 percent. Car thefts, though, continue to be an exception, rising more than 12 percent from the year before.

But the move backfired in a way that few supporters expected. Californians in 2021 actually tossed nearly 50 percent more plastic bags, by weight, than when the law first passed in 2014, according to data from CalRecycle, California’s recycling agency.

At a county fairground in Wise, Va., I witnessed people standing in lines that stretched out of view, waiting to see physicians who were stationed in animal stalls. The event’s organizers, from a nonprofit called Remote Area Medical, told me that of the thousands of people who came to this three-day clinic every year, some had health insurance but did not have enough money in the bank to cover their out-of-pocket obligations.

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