Last Week Tonight With John Oliver (2014) s12e27 Episode Script
Medicare Advantage
Welcome to "Last Week Tonight"!
I'm John Oliver, thank you so much for
joining us. It has been a busy week.
The government shutdown continued,
there was a jewel heist at the Louvre
and Bravo wet dream George Santos
celebrated his release from prison,
after Trump commuted his sentence,
with a 28-second video
that took some wild turns.
Hey, everybody,
George Santos here.
I'm just sitting here
with some friends
at a good old American establishment,
IHOP! Shoutout to IHOP!
anything is good after prison.
But anyway, Jesus is good,
God is king,
but I do want to say this:
I heard that Zionists are getting
paid 7.000 dollars for a post.
Where is my fucking check?
I didn't get it!
Excellent. Now, generally,
IHOP will give you
way too loud theater kids,
someone screaming about
Zionism, and the words,
"Where is my fucking check?"
but you so rarely
get all three from one body.
Though, maybe don't compliment
their coffee by saying,
"Anything's good
after prison."
Most brands want a better
endorsement than that,
it's why Waffle House's slogan
is "good food fast"
and not "legally edible".
Trump commuting
of Santos's sentence
was just one of many bold
decisions he's made recently,
with the most visible being this.
This morning,
with these new images
showing demolition work
at the White House,
the Washington Post reports
more than just the East Wing
facade is being replaced
to make way for President Trump's
250 million dollar ballroom.
The Post, citing a White House
official, now says
the "entirety" of the East Wing
is being rebuilt.
You probably hear the beautiful
sound of construction to the back.
You hear that sound?
That's music to my ears.
I love that sound.
Yeah, of course, you do. Now, look,
obviously, those images are distressing.
Especially when you know
it's all to build a giant ballroom
in a style best described
as "med spa Versailles".
And yet, the demolition
of the White House,
a metaphor that, if anything,
is too on the nose,
was just the tip
of Trump's iceberg this week.
President Trump is pushing
for a personal 230 million payout
from the Justice Department
as compensation
for the federal investigations
he's faced.
That money would ultimately
come from American taxpayers.
The Justice Department officials
who would likely sign off on the payment
were once President Trump's
own personal lawyers.
All of it raising
new ethics concerns.
One ethics professor
telling the New York Times,
"The ethical conflict is so basic
and fundamental,"
"you don't need
a law professor to explain it."
Yeah, you sure don't!
And I do love that professor
giving The Times a comment
amounting to,
"Do I think the president giving
himself a payout is unethical?"
"Ya doy!"
Now, I should say,
Trump has said he'd donate
any settlement to, in his words,
"charity or something."
But as his former White House counsel
told CNN, there is still a problem.
Well, keep in mind, he gave
a lot of money to, you know,
or took a lot of money out of the
Trump University charity that he had.
He's familiar with charities
and he knows how to loot them.
Yeah, he does. And I probably
shouldn't have shown you that
without warning you there was an
aggressive mustache headed your way.
It is hard to focus on the message
when that is the medium.
He looks like Steampunk
Doc Brown.
He looks like Santa post-divorce
but pre-allegations.
He looks like someone you'd find
on the groom's side of the aisle
at the Monopoly man's wedding.
And by the way, credit to Erin Burnett
for keeping a straight face there
while interviewing a man
who has styled his facial hair
into a biologically accurate recreation
of the female reproductive system.
But incredibly,
we're still not done.
Because Trump also posted an AI video
of himself dumping shit
on No Kings protestors,
abandoned trade negotiations
with Canada
after seeing a TV ad
he didn't like,
and authorized a 20 billion bailout
to Argentina
to ensure their experiment
with libertarianism works out.
And perhaps most shockingly
of all, there was this.
Tonight, this video showing another
deadly U.S. military strike
against a boat allegedly smuggling
drugs to the U.S.,
killing two narco-terrorists on board,
according
to Defense Secretary Pete Hegseth.
This is the eighth strike the Trump
administration has announced
against alleged drug boats
since early September,
killing at least 36 people.
Yeah, we've actually now killed
over 40 so-called "narco-terrorists",
even though the administration's
not provided evidence for its claims.
But even if they had some,
I've watched enough "JAG" to know
the typical approach to drug boats
is to intercept them
and arrest the suspects, not murder
them with no due process.
And all of this is bad enough
before you learn this.
President Trump tonight suggesting
he'll soon order strikes
on cartels smuggling drugs
by land, too.
Something very serious
is gonna happen.
The equivalent
of what's happening by sea,
and we're going to Congress
just to tell them what we're doing.
Yeah, he apparently plans
to launch strikes
on "suspected drug traffickers"
in Venezuela
without congressional approval,
saying,
"We're just gonna kill people.
They're going to be, like, dead."
You know, the kind of chilling
statement you expect to hear
from a serial killer or the mastermind
behind Panera Bread's Lemonade,
but not, ideally, the president
of the United States.
And look,
we're taping this on Saturday.
Who knows what's happened
in the last 24 hours?
But this has already been a lot.
Because between tearing down
the White House,
trying to use the Justice Department
to pay himself,
and proudly sharing AI footage of him
literally shitting on Americans,
the president now also
appointed himself
judge, jury, and executioner
of foreign citizens.
And it is infuriating that neither
Congress nor the courts
seem to be interested
in putting a stop to any of this,
because we're supposed to live
in a country of checks and balances,
and if I may quote IHOP's most
chaotic new spokesdiva,
"Where is my fucking check?"
And now, this.
And Now: People On TV Try
to Understand Six Seven.
Do you understand this six
seven phenomenon that you hear?
Or do you get it or don't get it?
I don't really get it, but I know
it's like a thing. Six seven.
They love it!
I was at Kentucky Kingdom
and kids were screaming it
from the rides. Six seven!
Why?
Chances are you've heard this phrase,
you've Googled this phrase.
You've asked Alexa, "What is
six seven?" We don't know.
It's annoying. No one knows
what it means,
but anyway. So, it's like, why are
you doing it? So, whatever.
It's what the cool kids are saying,
have you heard of it?
I did and I Googled it 'cause
I'm trying to keep up.
It means nothing.
I know your grandkids know
what it means.
I want you to go home today and be
like, "Six seven, six seven."
My 12-year-old granddaughter's
going to be so impressed!
You love it, don't you?
Say, "six seven".
- Six seven.
- There it is. Sound just like my boys.
Good job.
Moving on. Our main story
tonight concerns healthcare,
ostensibly the subject matter
of "The Pitt",
which is slightly
about healthcare,
but much more about the gentle
head tilt of Noah Wyle.
On behalf of several members
of my staff:
engulf me in that hoodie,
you casual Friday hero.
Specifically, we're gonna talk
about Medicare,
the federal program for those 65 or
older, or with qualifying disabilities.
Now, open enrollment for it
began on October 15th,
and will run through December 7th,
and it's why this time of year
sees tons of ads like these.
Hi, I'm Joe Namath.
If you're on Medicare,
this is important information.
Hi, William Shatner here with a new
message about Medicare benefits.
Hi, I'm Jimmie "JJ" Walker. If you're
on Medicare, listen to this.
I'm Meredith Viera.
What's complicated and confusing
that many people over 65
deal with each year? Medicare.
Okay, this isn't the point,
but the question,
"What's complicated and confusing that
people over 65 deal with each year?"
is just too broad, given that
the answer is: everything.
Everything confuses them.
Have you ever seen a 70-year-old
try to work an Apple TV remote?
It's actually the reason Biden
dropped out of the race last year.
Apparently, his team handed him
an Amazon Fire Stick
right before that debate, and
we all know what happened next.
These ads are ubiquitous.
One analysis found
that in Medicare's open enrollment
period a few years ago,
over half a million ads
like those aired on TV.
That's over 8.000 a day! Normally,
for an ad to be that overplayed,
it needs to feature a child band
singing a song that makes you
want to commit mass murder.
But while they're often framed
as being about Medicare,
they're actually promoting something
called Medicare Advantage.
And that is different.
Because while Medicare Advantage
has the word "Medicare" in it,
it is not what you may think,
it's not health insurance
provided directly to you
by the government.
Instead, it's a different system where
the government pays private insurers,
typically owned by companies
like these,
to administer your benefits for you.
Honestly, it probably shouldn't have
the word "Medicare" anywhere near it.
Because it's misleading. It's kind of
like the mountain chicken.
Picture what a mountain chicken
looks like in your head right now.
Do you have it?
You're wrong, 'cause it's this.
It's a fucking frog!
Which is just wrong.
"Mountain chicken" sounds like,
at minimum,
a chicken that lives
in the mountains,
or what a starving, stranded
hiker would call human flesh.
"It's just mountain chicken,
it's definitely not Jeff!"
What it does not sound like, though,
is this. That is a misuse of words.
Anyway, the point is,
thanks to blanket advertising,
and the fact some employee retirement
packages offer these plans exclusively,
more than half of eligible Medicare
beneficiaries are now enrolled
in a Medicare Advantage plan,
a percentage expected to grow
to nearly two-thirds by 2034.
Which is concerning, because
these plans can have real issues.
One expert has said,
"The best candidate for Medicare
Advantage is someone who's healthy."
"We see trouble when someone
gets sick." But that is a problem!
Because statistically,
most people will get sick.
It's just a fact of life,
like "all hamsters die",
"most cats hate you",
and "if Jeremy Allen White
is on screen, he is sweating."
Acting is sweating,
we all know that.
And that's by no means
the only flaw here,
because as you all see,
while these plans can be great
for companies' bottom lines,
they can be woefully insufficient
for those who signed up for them
and the providers
who have to deal with them.
Medicare Advantage basically has
all the problems of private insurance,
but applied
to a more vulnerable population.
So given that, tonight, let's talk
about Medicare Advantage:
what it is,
what the coverage can be like,
and whether you or someone
you know should sign up.
And to understand it,
you first need to understand
how Medicare works,
which already isn't easy.
Because as you'll know if you've
ever enrolled in it yourself
or had to help someone else do it,
it is fucking confusing.
On a scale of one to "Inception",
it is basically a "Tenet".
And I don't say that lightly.
To put it very simply:
Medicare currently has four
components, Part A, B, C and D.
Part A covers hospital
and other inpatient care,
that's what you've paid
into your whole life,
and for most, you can enroll
at 65 with no additional premium due.
Part B covers doctors' visits
and outpatient services.
Now, you do have to pay
a monthly premium for that
that's typically taken out
of your Social Security check.
And even then, it only
covers 80% of your costs,
so the remaining 20%
you have to pay for out of pocket.
But you can buy a separate
"Medigap plan" to cover that,
which typically costs
200 dollars or more a month.
And that gap is something ads pushing
Medicare Advantage like to highlight,
like this one
featuring Kelsey Grammer.
Doesn't look good. He's missing 20%.
He should have got better insurance.
Fingers crossed.
Are you missing 20% too?
That's what your Medicare
insurance might not pay for.
That 20% is critical to your
healthcare and your wallet.
See, original Medicare only covers
about 80% of your Part B medical cost.
The rest is up to you.
Can be thousands of dollars,
right when you least expect it.
So, let Coverance help find
a Medicare insurance plan
that doesn't leave you so exposed.
Stop it!
You stop it right now, Frasier!
Though, to be fair,
that is not the creepiest thing he's
ever said about the medical profession,
given his memoir
features the quote,
"Nice girls made me really nervous,
claustrophobic."
"But broken women, women in pain,
women looking to be fixed,"
"for these women
the doctor was in."
That is on the back cover!
And it is wild to publish a book
where you essentially argue,
"If you fuck me, you might
need professional help."
Anyway, that is Part B.
Now, if you want prescription drugs,
and if you're a senior citizen,
you definitely do,
you need to pay for a separate
Part D premium,
which helps cover those.
And that leaves us with Part C,
which is Medicare Advantage.
It functions as an alternative
to all the other parts,
in that it helps cover hospitals,
doctor visits, and usually drugs,
while offering often extra benefits
like some dental,
vision and hearing coverage,
or even debit cards to help
pay grocery bills.
And it does all of that
for a relatively low upfront cost,
as, other than that standard premium
taken out of your Social Security check,
over three-quarters of enrollees
pay no additional premium at all.
So, it is pretty appealing
on the surface.
And while I don't have to show you
one more ad for it,
especially as it basically recaps
everything I just said,
I'm gonna do it anyway,
because it is magnificent.
Al, did you make that call?
Honey, we already have Medicare.
Why do I need to call?
Alan, the Feldmans said we may be
able to get additional benefits
with a Medicare Advantage plan
right here in our ZIP Code
with 0 dollars
monthly premiums.
Honey, what do you mean
"additional benefits?"
We turned 65, we got Medicare.
That's all there is to it, right?
I'm talking about Medicare Part C,
commonly called Medicare Advantage.
We have traditional Medicare,
which is only Medicare
parts A and B, but not Part C.
Wait, so not everyone
on Medicare has a Part C plan?
No, that's why we need to call,
because there may be plans available
with additional benefits that aren't
covered under Medicare parts A and B.
We don't have a Medicare Part C plan,
which covers everything
in Part A and Part B,
plus extra benefits
in Medicare Part C.
What kind of extra benefits?
There are great plans that may be
available with extra benefits
like dental, vision and hearing.
Did you say dental?
That is, and this is true, only
the first half of that commercial.
It has it all! Amateur-porn-level
acting, wild physical gestures,
the totally unnecessary
undercurrent of a broken marriage,
and the phrase,
"Right here in our ZIP Code."
It is perfect. I love the disclaimer
saying, "Paid actor portrayal."
As if we'd be so sucked in
by the natural delivery
of concussed Rob Reiner
and overcaffeinated Amy Sedaris here
that we might need
to be reminded.
But there are a lot of drawbacks
to Medicare Advantage plans.
For a start, they come
at an inflated cost to taxpayers.
Which is a bit weird,
given that a big part of the argument
for creating this system
over two decades ago
was that bringing in private
insurers would help control costs.
In fact,
here is Orrin Hatch back then,
one of its biggest cheerleaders,
making his pitch.
Choice. The right to pick
the coverage you want.
That's what Medicare Advantage
actually gives you.
Now, there are those who believe that
socialism is the answer to everything.
Let government do it.
Government can do it more efficiently.
Well, if you believe that, you
haven't watched the last 50 years.
Yeah, the whole argument was
that this would expand choice,
and companies would do a better job
at controlling costs
than the government.
And look, some things are better
when the private sector's involved.
Take novelty slippers. Only through
competition in the free market
do you get innovations
like hairy feet slippers,
creepy Marge Simpson slippers,
Sigmund Freud slippers,
"Danny Defeeto" slippers
and golden penis slippers.
And if you're wondering,
"Who the fuck would buy those?"
you are looking at him right here.
Now, why did I buy these?
I don't know, probably because
of something deep-rooted in my psyche
stemming from my childhood,
at least according
to my Sigmund Freud slipper
right here.
But sadly, the private sector
hasn't done as well with Medicare
as it has with slippers.
Because these plans have
never saved the government money.
In fact, a report last year estimated
Medicare Advantage
had cost the government,
over the previous 18 years,
an extra 591 billion.
And this is partly down to the fact
the major companies involved
need to make profits for investors
and they have found ways to do that.
One concerns how they get paid.
Because in traditional Medicare,
a provider treats you, and
the government pays a fee for it.
But in Medicare Advantage,
plans get a fixed payment
from the government
for each member they take on,
regardless of whether
you get treatment or not.
And crucially, that payment's
based in large part
on what illness
you're listed as having,
because insurers are entitled
to extra money
when their patients are diagnosed with
conditions that are costly to treat.
Here is a report
from several years ago,
explaining
how it basically works.
The insurance company uses
what are known as diagnosis codes
to report that person's level
of sickness to the government.
Well, and they pay one rate
for plain old diabetes,
and then they pay another rate
for diabetes with complications.
If you write down in the file
that the patient has diabetes
and has complications
with eyesight or other things,
they'll get paid a higher rate.
Right. And in theory,
that makes sense,
you want insurers
to take care of sicker patients.
Unfortunately, a lot of things
that sound good
turn out to be
terrible in practice.
Like overalls on adults,
or drinking a beer-rita,
or buying a flight that leaves
at 6:00 AM to save money.
Sure, seems like a good idea
until you're at the airport
at 4:00 in the fucking morning,
but at least you got
to your destination by 10:00 AM
and can't check in to your hotel
for another five hours.
Aren't you glad you saved
35 dollars on that ticket?
The same is true here.
Because the government paying
more for sicker patients
has given insurers an incentive
to identify as many health conditions
as possible for each enrollee,
and potentially
to then game the system.
They can find lots of ways to add big
money diagnoses to patients' charts,
through a practice
known as "upcoding".
This happens a lot,
one investigation found
that Medicare paid insurers
about 50 billion over three years
for diagnoses
added just by insurers.
Not only that,
many diagnoses were added for which
patients then received no treatment,
and "often, neither the patients
nor their doctors had any idea."
Which isn't great, is it?
The whole point of a doctor
is for them to diagnose you.
Or, in my case, for them to look
at me, down at the chart,
look at me again, back at the chart,
and then say,
"48 years old?
Are we sure about that?"
And while insurers will claim
they're just being thorough,
they've been repeatedly accused
of essentially pulling
a Munchausen by paperwork.
In 2022, the Times found eight of the
10 biggest Medicare Advantage insurers
had submitted inflated bills
according to federal audits,
and that four of the five largest
players had faced federal lawsuits
alleging that efforts
to overdiagnose their customers
had crossed the line into fraud.
And some have been accused of getting
very sneaky to add patient codes.
For instance,
many tout "home visits",
with ads featuring happy seniors
excitedly greeting healthcare workers
at their door.
Here is how UnitedHealthcare
advertises theirs.
Remember the good old days when
doctors made house calls?
UnitedHealthcare offers their
Medicare Advantage members
an annual visit from a licensed
clinician in their own home,
at no extra cost.
Home visits may include a review
of your medical history,
a check of your vital signs,
and a chance to talk
about your health concerns.
With HouseCalls,
being healthy starts at home.
Yeah, and you can see
how attractive that is.
Not least because
the senior gets a visitor!
And you know how happy
that makes them.
The elderly love exactly
three things: having guests,
talking to guests,
and then freaking out
when that guest
sits in their fucking chair!
But an investigation found that,
in programs like that one,
companies pushed
nurses to run screening tests
and add unusual diagnoses,
turning the roughly hour-long
stops in patients' homes
into an extra 1.800 dollars
per visit, on average.
And while United will insist
most of the conditions it's coded
for in its "HouseCalls" program
haven't raised payments,
some very much have.
For instance, documents show
its software would suggest
the diagnosis
of "secondary hyperaldosteronism,"
"a condition in which levels of
the hormone aldosterone rise",
without requiring it
be confirmed by a lab test.
UnitedHealthcare
apparently diagnosed that
nearly a quarter million times
after home visits,
leading to 450 million in government
payments over just three years,
even though a former
HouseCalls nurse said,
"In a million years,
I wouldn't have come up"
"with a diagnosis of
secondary hyperaldosteronism."
And of course not!
I didn't even know
what hyperaldosteronism was
before working on this piece,
and to be honest, I still
don't really know much about it,
aside from the fact that you can
rearrange the letters to spell
"modernist horseplay".
Which isn't nothing!
But it does feel close to it.
Now, I have to tell you:
UnitedHealthcare claims that
report misrepresents HouseCalls,
which is just about
supplementing doctors' visits
and identifying gaps
in patient care.
I presume that they're currently
making that same argument
to the DOJ's criminal healthcare
fraud unit,
which is investigating
its Medicare billing practices.
And I wish them
the very best of luck with that.
They are not the only company who've
faced these sorts of accusations.
An insurer called Independent Health
faced similar claims,
including that a woman
in one of their Advantage plans
was apparently coded
for prostate cancer
because, according
to an internal email,
"When a married couple
has any disease,"
"both were assigned to that disease."
Which is both ridiculous
and also kind of romantic.
"Do you, Tracy, promise to take
Doug's diseases from tip to taint,"
"as long as you both shall live?"
"I do! I really do!"
Now, again, I have to tell you:
Independent Health
did not admit liability,
but they did pay 98 million dollars
to settle that lawsuit.
The exact kind of thing you do
when you're not liable for something.
So, at this point,
I think it's pretty clear,
these plans aren't a particularly
good use of taxpayer money.
But are they good for patients?
Well, on the surface, "cheaper
premiums" sounds appealing.
And if you're relatively healthy,
these plans can seem like
the more attractive option.
Just listen to this woman explaining
why she and her husband picked one.
We are very active. I play pickleball
twice a week. We have a big garden.
We have animals
that we take care of.
And so,
we're always doing something.
And we wanted to retire while we
were still able to do things together.
We like the Advantage plan because
it seemed to fit our needs for that.
Right, and I get that that
makes sense for her right now.
Because, from the minute I saw that
woman, I knew she played pickleball.
She didn't need to tell me that.
Everything about her screams,
"I'll dink your kitchen, then
cross-court lob until we bagel,"
"because je suis le pickle bitch."
Medicare Advantage plans go out
of their way to recruit people like her.
Many even offer perks like gym
memberships, which can be
disproportionately attractive
to relatively healthy beneficiaries.
But, once you get sick,
you can find out your plan
has a lot of limitations.
For example, under regular Medicare,
you can go to any doctor or hospital
that takes it,
which is most of them.
But with Medicare Advantage,
as with most private insurance,
you can typically only use doctors
in the plan's network and service area.
And as those can change
at any time,
a doctor who is in-network
when you sign up,
can quickly fall out of it.
And that can be a big problem.
Consider this woman
who had cancer,
and who qualified
for Medicare due to disability,
but signed up
for a Medicare Advantage plan,
thinking
that it would save her money.
I went for my routine checkup.
I'd been a Dana-Farber patient
since 2013, and I got a bill.
They're saying the provider's
in-network in the building,
but the building of Dana-Farber
is out-of-network,
and I'm not allowed
to go there anymore,
even though I'd been going there
and have the same insurance.
So, after all of these years,
I have now moved my care
to a different hospital
because I can't go there anymore.
That is absurd.
Her doctor was in-network,
but the building wasn't.
It's one of those things
that makes your brain hurt
if you think about it for too long,
like how gravity works,
or why some people's bodies
shit when they're scared,
or how Bill Belichick's daughter
was 17 years old
the year his girlfriend was born.
Some things are just too difficult
for you to comprehend!
It can be hard to find someone
in-network on an Advantage plan.
And even if its list of providers
looks good on paper,
it can quickly collapse under
the slightest inspection,
as this man discovered.
I'm diabetic, so I looked
under "endocrinology".
There were four listed,
and the first two
were at Schnucks grocery stores,
and they weren't endocrinologists.
They were just pharmacies.
So, apparently, that means
that they offer two endocrinologists
in this 25-mile radius,
and that has me
hugely concerned.
- Enough for the senior population?
- No.
Yeah, of course it isn't.
And finding out half your list
is just grocery store pharmacies
would be frustrating.
Everybody knows you don't go there
for an endocrinology appointment.
You go there to check your
blood pressure in the machine
that makes your arm feel like it's
squeezed by Paul Mescal's thighs.
That is a thing that we all do.
And that is not a one-off either.
One review found the majority
of Medicare Advantage organizations
had between 30 to 60% inaccurate
locations in their directories.
But even if you can find a provider,
you may then have to deal
with something called
"prior authorizations".
You're probably familiar with them
from employer-sponsored plans.
While traditional Medicare
almost always pays for the care
your doctor says you qualify for,
virtually all enrollees
in Medicare Advantage are required
to obtain prior authorization
for some services.
While these plans are supposed to
cover all medically necessary services
that original Medicare does,
actually getting approval
can be a grueling process,
as this doctor explains.
We have
to call for a prior authorization.
We can't do it electronically,
we have to call on the phone,
the old-fashioned telephone.
We have to call an 800-number.
And then we have to give them
all the data,
we have to give them
the insurance information,
we have to give them the patient's
date of birth, and things like that.
And then what they do
is they give us then an authorization
to fax them the information.
So, I've called them to get permission
to fax them a request.
Once they've got it, I've got to
call them while they discuss the fax.
That's another barrier
and obstacle to care
that's incredibly time-consuming,
has no value added,
and it seems antithetical
to trying to get prior authorization.
I am getting a prior authorization
to get a prior authorization.
Yeah, and everything about that
sounds like a nightmare,
including the presence of
the words "fax machine".
I thought we stopped making them
around the same time we stopped
making good romantic comedies.
In fact, I think the last time
I saw a fax machine,
a frazzled Michelle Pfeiffer was getting
horned up for George Clooney.
Remember that? Remember
good romantic comedies?
The kind of films that feel
like a blanket
and make you leak
from all your holes?
What happened to this country?
Anyway, as you might guess,
Medicare Advantage providers
partly or fully deny
millions of prior authorizations
each year,
and that can be maddening
for those who need care.
Take what happened to Gary Bent.
He had significant complications
from brain surgery,
including being unable
to stand or walk on his own.
His doctors said he needed a lengthy
stay at a highly skilled rehab center.
Now, under traditional Medicare,
that would've been covered.
But he had a Medicare Advantage
plan from UnitedHealthcare,
which only approved him for a few
weeks at a short-term rehab facility.
And Gary's wife and daughter
remember the advice that they got
from his care team about trying
to appeal United's decisions.
They told me I would probably win
one or two, maybe even three.
But then the speed with which
these denials came would increase.
They would be fewer
and fewer days apart,
and eventually I was going to lose.
We felt like this process
was designed to wear us out
and I would say it did wear us out.
Yeah.
And that's exactly what happened.
They won two appeals,
then lost a third,
after an external reviewer
sided with the company.
And while UnitedHealthcare insists it
was just following Medicare guidelines,
Gary was sent home before his family
felt he was ready,
with, by the way,
a fever and neck pain.
And within 11 hours
of being discharged,
he was rushed to the ER where
he was diagnosed with meningitis.
And that was just one step
in a quick decline towards him
dying the following winter,
a decline that his wife says was made
worse by "the added trauma"
"of having to fight for the care
he needed and was entitled to."
And there are some things so awful,
it's almost impressive
to be able to make them worse.
It's like seeing a Cybertruck
with Diddy's face painted on it.
I don't know how you managed to do it,
but I like this even less.
And the thing is, delaying,
underpaying, or denying care
doesn't just hurt patients,
it hurts hospitals too,
particularly those in rural areas.
Because they don't have the time
or resources to sink
into constantly appealing decisions,
which has had real consequences.
This was once
the geriatric psychiatry unit
at Alliance Healthcare
in Holly Springs, Mississippi.
Now, the hallways hollow,
and beds sitting empty.
This operating room,
only a few years ago,
was doing five or six procedures
a day. Now? Zero.
Dr. Kenneth Williams is the CEO.
He says the hospital
can no longer afford the unit, or
any inpatient care, for that matter.
All of this used to service people
that really needed help,
and now it's just totally empty.
It's empty, it's gone,
and it died the last few years
with Medicare Advantage.
That is terrible.
Thanks to Medicare Advantage,
that whole wing is now abandoned,
and by the looks of it,
already haunted.
Because at any moment, it feels
like Jigsaw is about to pop out
with a realtor
to "just check out the space".
And even hospitals
which haven't had to close wings
have stopped taking these plans,
with a 2023 survey finding
nearly 20% of health systems
had stopped accepting
at least one Medicare Advantage
plan that year alone.
And if you're thinking,
"Well, you know what, that's okay."
"If I get sick and I need a specialist,
I'll switch back to regular Medicare",
you may not be able to.
Because remember, it has
that 20% gap you need to cover.
Now, when you first enroll, it's easy
to buy a Medigap plan to do that,
because they can't hold
preexisting conditions against you.
But, in most states,
once you've enrolled
in a Medicare Advantage plan,
Medigap insurers are allowed
to reject you based on them.
So, as a practical matter,
once a patient enters
the Medicare Advantage system,
they typically can't afford to leave.
Think of it like Scientology,
or a bean bag chair,
easy to get in,
very difficult to get out.
And when you take
this all together,
you get a system where the incentives
are clearly set up
for insurance companies to make you
look as sick as possible on paper,
while doing as little as possible
to help you when you actually need it.
Now,
the industry is gonna dispute that.
They've even funded their own studies
suggesting their plans
actually save the government money
and deliver consistently better health
outcomes than traditional Medicare.
When Stat News asked more than
a dozen leading health policy experts
to review a bunch of those studies,
they found they had "fundamental flaws"
and "obvious biases," and on
the whole were so skewed,
they basically constituted
an "alternate reality".
And look, if these companies are living
in such a dangerous fantasy world,
they clearly need professional help.
Luckily, I happen to know
a board-certified therapist
who can see them.
But bad luck, he's out-of-network,
so fuck you!
So, what can we do here?
Well, as I've said before,
so many of these problems would go
away if we had single-payer healthcare.
And we could get closer to that
by making regular Medicare more
expansive and easier to navigate,
and getting rid
of that 20% gap in coverage.
But until then,
we should, at the very least,
be calling Medicare Advantage
by a different name,
and ideally one without the term
"Medicare" anywhere near it.
Because as you've seen,
they're just not the same.
It's like the difference between
a flashlight and a Fleshlight.
Sure, they might sound similar, but
they do drastically different things.
Unfortunately, though, it is tough
to talk about potential reforms now,
given who is in charge
of Medicare currently.
Because in case you've forgotten,
it is this fucking guy.
22 across, eight letters,
starts with M.
A government entity dedicated
to the health of seniors.
Mehmet Oz!
It's Medicare.
Mehmet Oz fits.
It's Medicare.
Guess what, I work for you now.
Yup, they put me in charge of Medicare.
Now, how cool is that?
Not cool! Not cool at all!
And it is just wild to see someone
who's been on TV for two decades
give the single worst line
reading I have ever seen.
And remember,
we just watched these two go to town.
But one of the many reasons
it's not cool
is that Dr. Oz not only promoted
Medicare Advantage
in sponsored segments
on his TV show,
he once co-wrote an op-ed titled
"Medicare Advantage for All
Can Save Our Healthcare System",
basically suggesting
we roll it out for everyone.
While he's recently acknowledged
some of the problems I've mentioned,
he's also said the administration
wants to give insurers
an opportunity
to "voluntarily fix" them.
Which I would say is the most
ridiculous thing that he has ever said,
except he did once do this.
- So, that's what you call a camel toe.
- Yes.
Can I actually show you what
camel toes look like?
Of course!
So here's a picture of what
a real camel toe looks like.
Television was a bad idea!
So, look, at the policy level,
for now, we are kind of fucked.
But in the meantime,
if you or someone you know
is considering one of these plans:
first, if you can afford to buy
a Medigap plan
and enroll in traditional Medicare,
you should do that.
But if you can't,
you should at least understand
the potential drawbacks
of Medicare Advantage.
And whatever you do, do not call
those broker numbers on TV.
Because they won't give you
unbiased advice.
They get much higher commissions if
they funnel you to Advantage plans.
So, if you want independent advice,
you can call your state health
insurance assistance programs.
You can find your state's number
at this website.
And while I know it is basically
impossible to escape these ads now,
we thought the least we could do
is provide one for you
that is technically accurate.
- Al, did you make the call?
- What call?
The Feldmans said we may be able
to get additional benefits
with Medicare Advantage,
right here in our own ZIP Code!
- Our ZIP Code?
- Yeah, the ZIP Code we live in?
It covers the 8.6 square miles
of our neighborhood.
Yeah, I know what a ZIP Code is.
But, honey, we already have Medicare,
so we don't need to call anyone.
Al, do you listen?
I said, Medicare Advantage!
It has all the letters
of the word "Medicare"
but none of the actual Medicare.
Wait a minute,
it's not regular Medicare?
No, that's why we need to call.
The Feldmans said
their Medicare Advantage plan
has dirt cheap premiums.
- Did you say dirt cheap?
- Yes, Al, of course I did!
What is wrong with you today?
With Medicare Advantage,
you'll get free gym memberships,
a grocery allowance
and a nurse will come
to our house.
- For a threesome?
- You'd love that, wouldn't you, Al?
No, not for a threesome!
The nurse will come to our house
so that she, or he, can diagnose us
with a bunch of diseases
that we don't have and our doctors
don't even know anything about!
But what about conditions I actually
have, like my diabetes?
Not only will they cover it,
but I will suddenly
have diabetes too.
- Why?
- Because it's romantic, Al. Kiss me!
- Hold on!
- What?
Do we at least get
to keep our doctors?
Well, we get to choose from
a list of doctors,
but they're mostly just grocery stores,
local middle schools,
a JCPenney
and an abandoned Chuck E. Cheese.
Did you say Chuck E. Cheese?
And,
if you find a doctor that's covered,
you'd better hope that the building
that he, or she, works in is too.
Otherwise, you might be getting
your prostate checked out
in the parking lot,
and not in the fun way!
This is starting
to sound like a bad idea.
No! No, it isn't! I want
a Medicare Advantage plan, Al!
Plus, the premiums are so low,
think of all the money we could save!
Sure, the care might be worse,
but that's okay,
because we're not sick right now
in this very moment!
- But, what if we get sick later?
- Well, then we're fucked, Al.
But that's a later problem.
Right now, we're active.
You golf and I play pickleball
with Paul Feldman twice a week.
I didn't know you played
pickleball with Paul Feldman.
Yeah, I've been playing
with Paul for years. He is great.
In fact,
I think I'm in love with him.
Did you say you're in love
with him?
Yes, Al, he fucks like a Toyota
and loves like a Subaru.
Now please, call the number
and get us a doctor
so that he can treat our herpes.
Herpes?
Is that one of these fake diagnoses?
No, Al, we both have herpes now.
Don't call this or any other
number on your screen.
Medicare Advantage
is not traditional Medicare.
It's administered
by private insurance.
Your doctor
may or may not be covered.
And if you or your wife is playing
pickleball with Paul Feldman,
seek medical attention immediately
because you have herpes now.
Paul Feldman
gave you both herpes.
That's our show,
thanks so much for watching.
We'll see you next week, good night!
Dirt cheap premiums.
Dirt cheap premiums.
Dirt cheap premiums.
I'm John Oliver, thank you so much for
joining us. It has been a busy week.
The government shutdown continued,
there was a jewel heist at the Louvre
and Bravo wet dream George Santos
celebrated his release from prison,
after Trump commuted his sentence,
with a 28-second video
that took some wild turns.
Hey, everybody,
George Santos here.
I'm just sitting here
with some friends
at a good old American establishment,
IHOP! Shoutout to IHOP!
anything is good after prison.
But anyway, Jesus is good,
God is king,
but I do want to say this:
I heard that Zionists are getting
paid 7.000 dollars for a post.
Where is my fucking check?
I didn't get it!
Excellent. Now, generally,
IHOP will give you
way too loud theater kids,
someone screaming about
Zionism, and the words,
"Where is my fucking check?"
but you so rarely
get all three from one body.
Though, maybe don't compliment
their coffee by saying,
"Anything's good
after prison."
Most brands want a better
endorsement than that,
it's why Waffle House's slogan
is "good food fast"
and not "legally edible".
Trump commuting
of Santos's sentence
was just one of many bold
decisions he's made recently,
with the most visible being this.
This morning,
with these new images
showing demolition work
at the White House,
the Washington Post reports
more than just the East Wing
facade is being replaced
to make way for President Trump's
250 million dollar ballroom.
The Post, citing a White House
official, now says
the "entirety" of the East Wing
is being rebuilt.
You probably hear the beautiful
sound of construction to the back.
You hear that sound?
That's music to my ears.
I love that sound.
Yeah, of course, you do. Now, look,
obviously, those images are distressing.
Especially when you know
it's all to build a giant ballroom
in a style best described
as "med spa Versailles".
And yet, the demolition
of the White House,
a metaphor that, if anything,
is too on the nose,
was just the tip
of Trump's iceberg this week.
President Trump is pushing
for a personal 230 million payout
from the Justice Department
as compensation
for the federal investigations
he's faced.
That money would ultimately
come from American taxpayers.
The Justice Department officials
who would likely sign off on the payment
were once President Trump's
own personal lawyers.
All of it raising
new ethics concerns.
One ethics professor
telling the New York Times,
"The ethical conflict is so basic
and fundamental,"
"you don't need
a law professor to explain it."
Yeah, you sure don't!
And I do love that professor
giving The Times a comment
amounting to,
"Do I think the president giving
himself a payout is unethical?"
"Ya doy!"
Now, I should say,
Trump has said he'd donate
any settlement to, in his words,
"charity or something."
But as his former White House counsel
told CNN, there is still a problem.
Well, keep in mind, he gave
a lot of money to, you know,
or took a lot of money out of the
Trump University charity that he had.
He's familiar with charities
and he knows how to loot them.
Yeah, he does. And I probably
shouldn't have shown you that
without warning you there was an
aggressive mustache headed your way.
It is hard to focus on the message
when that is the medium.
He looks like Steampunk
Doc Brown.
He looks like Santa post-divorce
but pre-allegations.
He looks like someone you'd find
on the groom's side of the aisle
at the Monopoly man's wedding.
And by the way, credit to Erin Burnett
for keeping a straight face there
while interviewing a man
who has styled his facial hair
into a biologically accurate recreation
of the female reproductive system.
But incredibly,
we're still not done.
Because Trump also posted an AI video
of himself dumping shit
on No Kings protestors,
abandoned trade negotiations
with Canada
after seeing a TV ad
he didn't like,
and authorized a 20 billion bailout
to Argentina
to ensure their experiment
with libertarianism works out.
And perhaps most shockingly
of all, there was this.
Tonight, this video showing another
deadly U.S. military strike
against a boat allegedly smuggling
drugs to the U.S.,
killing two narco-terrorists on board,
according
to Defense Secretary Pete Hegseth.
This is the eighth strike the Trump
administration has announced
against alleged drug boats
since early September,
killing at least 36 people.
Yeah, we've actually now killed
over 40 so-called "narco-terrorists",
even though the administration's
not provided evidence for its claims.
But even if they had some,
I've watched enough "JAG" to know
the typical approach to drug boats
is to intercept them
and arrest the suspects, not murder
them with no due process.
And all of this is bad enough
before you learn this.
President Trump tonight suggesting
he'll soon order strikes
on cartels smuggling drugs
by land, too.
Something very serious
is gonna happen.
The equivalent
of what's happening by sea,
and we're going to Congress
just to tell them what we're doing.
Yeah, he apparently plans
to launch strikes
on "suspected drug traffickers"
in Venezuela
without congressional approval,
saying,
"We're just gonna kill people.
They're going to be, like, dead."
You know, the kind of chilling
statement you expect to hear
from a serial killer or the mastermind
behind Panera Bread's Lemonade,
but not, ideally, the president
of the United States.
And look,
we're taping this on Saturday.
Who knows what's happened
in the last 24 hours?
But this has already been a lot.
Because between tearing down
the White House,
trying to use the Justice Department
to pay himself,
and proudly sharing AI footage of him
literally shitting on Americans,
the president now also
appointed himself
judge, jury, and executioner
of foreign citizens.
And it is infuriating that neither
Congress nor the courts
seem to be interested
in putting a stop to any of this,
because we're supposed to live
in a country of checks and balances,
and if I may quote IHOP's most
chaotic new spokesdiva,
"Where is my fucking check?"
And now, this.
And Now: People On TV Try
to Understand Six Seven.
Do you understand this six
seven phenomenon that you hear?
Or do you get it or don't get it?
I don't really get it, but I know
it's like a thing. Six seven.
They love it!
I was at Kentucky Kingdom
and kids were screaming it
from the rides. Six seven!
Why?
Chances are you've heard this phrase,
you've Googled this phrase.
You've asked Alexa, "What is
six seven?" We don't know.
It's annoying. No one knows
what it means,
but anyway. So, it's like, why are
you doing it? So, whatever.
It's what the cool kids are saying,
have you heard of it?
I did and I Googled it 'cause
I'm trying to keep up.
It means nothing.
I know your grandkids know
what it means.
I want you to go home today and be
like, "Six seven, six seven."
My 12-year-old granddaughter's
going to be so impressed!
You love it, don't you?
Say, "six seven".
- Six seven.
- There it is. Sound just like my boys.
Good job.
Moving on. Our main story
tonight concerns healthcare,
ostensibly the subject matter
of "The Pitt",
which is slightly
about healthcare,
but much more about the gentle
head tilt of Noah Wyle.
On behalf of several members
of my staff:
engulf me in that hoodie,
you casual Friday hero.
Specifically, we're gonna talk
about Medicare,
the federal program for those 65 or
older, or with qualifying disabilities.
Now, open enrollment for it
began on October 15th,
and will run through December 7th,
and it's why this time of year
sees tons of ads like these.
Hi, I'm Joe Namath.
If you're on Medicare,
this is important information.
Hi, William Shatner here with a new
message about Medicare benefits.
Hi, I'm Jimmie "JJ" Walker. If you're
on Medicare, listen to this.
I'm Meredith Viera.
What's complicated and confusing
that many people over 65
deal with each year? Medicare.
Okay, this isn't the point,
but the question,
"What's complicated and confusing that
people over 65 deal with each year?"
is just too broad, given that
the answer is: everything.
Everything confuses them.
Have you ever seen a 70-year-old
try to work an Apple TV remote?
It's actually the reason Biden
dropped out of the race last year.
Apparently, his team handed him
an Amazon Fire Stick
right before that debate, and
we all know what happened next.
These ads are ubiquitous.
One analysis found
that in Medicare's open enrollment
period a few years ago,
over half a million ads
like those aired on TV.
That's over 8.000 a day! Normally,
for an ad to be that overplayed,
it needs to feature a child band
singing a song that makes you
want to commit mass murder.
But while they're often framed
as being about Medicare,
they're actually promoting something
called Medicare Advantage.
And that is different.
Because while Medicare Advantage
has the word "Medicare" in it,
it is not what you may think,
it's not health insurance
provided directly to you
by the government.
Instead, it's a different system where
the government pays private insurers,
typically owned by companies
like these,
to administer your benefits for you.
Honestly, it probably shouldn't have
the word "Medicare" anywhere near it.
Because it's misleading. It's kind of
like the mountain chicken.
Picture what a mountain chicken
looks like in your head right now.
Do you have it?
You're wrong, 'cause it's this.
It's a fucking frog!
Which is just wrong.
"Mountain chicken" sounds like,
at minimum,
a chicken that lives
in the mountains,
or what a starving, stranded
hiker would call human flesh.
"It's just mountain chicken,
it's definitely not Jeff!"
What it does not sound like, though,
is this. That is a misuse of words.
Anyway, the point is,
thanks to blanket advertising,
and the fact some employee retirement
packages offer these plans exclusively,
more than half of eligible Medicare
beneficiaries are now enrolled
in a Medicare Advantage plan,
a percentage expected to grow
to nearly two-thirds by 2034.
Which is concerning, because
these plans can have real issues.
One expert has said,
"The best candidate for Medicare
Advantage is someone who's healthy."
"We see trouble when someone
gets sick." But that is a problem!
Because statistically,
most people will get sick.
It's just a fact of life,
like "all hamsters die",
"most cats hate you",
and "if Jeremy Allen White
is on screen, he is sweating."
Acting is sweating,
we all know that.
And that's by no means
the only flaw here,
because as you all see,
while these plans can be great
for companies' bottom lines,
they can be woefully insufficient
for those who signed up for them
and the providers
who have to deal with them.
Medicare Advantage basically has
all the problems of private insurance,
but applied
to a more vulnerable population.
So given that, tonight, let's talk
about Medicare Advantage:
what it is,
what the coverage can be like,
and whether you or someone
you know should sign up.
And to understand it,
you first need to understand
how Medicare works,
which already isn't easy.
Because as you'll know if you've
ever enrolled in it yourself
or had to help someone else do it,
it is fucking confusing.
On a scale of one to "Inception",
it is basically a "Tenet".
And I don't say that lightly.
To put it very simply:
Medicare currently has four
components, Part A, B, C and D.
Part A covers hospital
and other inpatient care,
that's what you've paid
into your whole life,
and for most, you can enroll
at 65 with no additional premium due.
Part B covers doctors' visits
and outpatient services.
Now, you do have to pay
a monthly premium for that
that's typically taken out
of your Social Security check.
And even then, it only
covers 80% of your costs,
so the remaining 20%
you have to pay for out of pocket.
But you can buy a separate
"Medigap plan" to cover that,
which typically costs
200 dollars or more a month.
And that gap is something ads pushing
Medicare Advantage like to highlight,
like this one
featuring Kelsey Grammer.
Doesn't look good. He's missing 20%.
He should have got better insurance.
Fingers crossed.
Are you missing 20% too?
That's what your Medicare
insurance might not pay for.
That 20% is critical to your
healthcare and your wallet.
See, original Medicare only covers
about 80% of your Part B medical cost.
The rest is up to you.
Can be thousands of dollars,
right when you least expect it.
So, let Coverance help find
a Medicare insurance plan
that doesn't leave you so exposed.
Stop it!
You stop it right now, Frasier!
Though, to be fair,
that is not the creepiest thing he's
ever said about the medical profession,
given his memoir
features the quote,
"Nice girls made me really nervous,
claustrophobic."
"But broken women, women in pain,
women looking to be fixed,"
"for these women
the doctor was in."
That is on the back cover!
And it is wild to publish a book
where you essentially argue,
"If you fuck me, you might
need professional help."
Anyway, that is Part B.
Now, if you want prescription drugs,
and if you're a senior citizen,
you definitely do,
you need to pay for a separate
Part D premium,
which helps cover those.
And that leaves us with Part C,
which is Medicare Advantage.
It functions as an alternative
to all the other parts,
in that it helps cover hospitals,
doctor visits, and usually drugs,
while offering often extra benefits
like some dental,
vision and hearing coverage,
or even debit cards to help
pay grocery bills.
And it does all of that
for a relatively low upfront cost,
as, other than that standard premium
taken out of your Social Security check,
over three-quarters of enrollees
pay no additional premium at all.
So, it is pretty appealing
on the surface.
And while I don't have to show you
one more ad for it,
especially as it basically recaps
everything I just said,
I'm gonna do it anyway,
because it is magnificent.
Al, did you make that call?
Honey, we already have Medicare.
Why do I need to call?
Alan, the Feldmans said we may be
able to get additional benefits
with a Medicare Advantage plan
right here in our ZIP Code
with 0 dollars
monthly premiums.
Honey, what do you mean
"additional benefits?"
We turned 65, we got Medicare.
That's all there is to it, right?
I'm talking about Medicare Part C,
commonly called Medicare Advantage.
We have traditional Medicare,
which is only Medicare
parts A and B, but not Part C.
Wait, so not everyone
on Medicare has a Part C plan?
No, that's why we need to call,
because there may be plans available
with additional benefits that aren't
covered under Medicare parts A and B.
We don't have a Medicare Part C plan,
which covers everything
in Part A and Part B,
plus extra benefits
in Medicare Part C.
What kind of extra benefits?
There are great plans that may be
available with extra benefits
like dental, vision and hearing.
Did you say dental?
That is, and this is true, only
the first half of that commercial.
It has it all! Amateur-porn-level
acting, wild physical gestures,
the totally unnecessary
undercurrent of a broken marriage,
and the phrase,
"Right here in our ZIP Code."
It is perfect. I love the disclaimer
saying, "Paid actor portrayal."
As if we'd be so sucked in
by the natural delivery
of concussed Rob Reiner
and overcaffeinated Amy Sedaris here
that we might need
to be reminded.
But there are a lot of drawbacks
to Medicare Advantage plans.
For a start, they come
at an inflated cost to taxpayers.
Which is a bit weird,
given that a big part of the argument
for creating this system
over two decades ago
was that bringing in private
insurers would help control costs.
In fact,
here is Orrin Hatch back then,
one of its biggest cheerleaders,
making his pitch.
Choice. The right to pick
the coverage you want.
That's what Medicare Advantage
actually gives you.
Now, there are those who believe that
socialism is the answer to everything.
Let government do it.
Government can do it more efficiently.
Well, if you believe that, you
haven't watched the last 50 years.
Yeah, the whole argument was
that this would expand choice,
and companies would do a better job
at controlling costs
than the government.
And look, some things are better
when the private sector's involved.
Take novelty slippers. Only through
competition in the free market
do you get innovations
like hairy feet slippers,
creepy Marge Simpson slippers,
Sigmund Freud slippers,
"Danny Defeeto" slippers
and golden penis slippers.
And if you're wondering,
"Who the fuck would buy those?"
you are looking at him right here.
Now, why did I buy these?
I don't know, probably because
of something deep-rooted in my psyche
stemming from my childhood,
at least according
to my Sigmund Freud slipper
right here.
But sadly, the private sector
hasn't done as well with Medicare
as it has with slippers.
Because these plans have
never saved the government money.
In fact, a report last year estimated
Medicare Advantage
had cost the government,
over the previous 18 years,
an extra 591 billion.
And this is partly down to the fact
the major companies involved
need to make profits for investors
and they have found ways to do that.
One concerns how they get paid.
Because in traditional Medicare,
a provider treats you, and
the government pays a fee for it.
But in Medicare Advantage,
plans get a fixed payment
from the government
for each member they take on,
regardless of whether
you get treatment or not.
And crucially, that payment's
based in large part
on what illness
you're listed as having,
because insurers are entitled
to extra money
when their patients are diagnosed with
conditions that are costly to treat.
Here is a report
from several years ago,
explaining
how it basically works.
The insurance company uses
what are known as diagnosis codes
to report that person's level
of sickness to the government.
Well, and they pay one rate
for plain old diabetes,
and then they pay another rate
for diabetes with complications.
If you write down in the file
that the patient has diabetes
and has complications
with eyesight or other things,
they'll get paid a higher rate.
Right. And in theory,
that makes sense,
you want insurers
to take care of sicker patients.
Unfortunately, a lot of things
that sound good
turn out to be
terrible in practice.
Like overalls on adults,
or drinking a beer-rita,
or buying a flight that leaves
at 6:00 AM to save money.
Sure, seems like a good idea
until you're at the airport
at 4:00 in the fucking morning,
but at least you got
to your destination by 10:00 AM
and can't check in to your hotel
for another five hours.
Aren't you glad you saved
35 dollars on that ticket?
The same is true here.
Because the government paying
more for sicker patients
has given insurers an incentive
to identify as many health conditions
as possible for each enrollee,
and potentially
to then game the system.
They can find lots of ways to add big
money diagnoses to patients' charts,
through a practice
known as "upcoding".
This happens a lot,
one investigation found
that Medicare paid insurers
about 50 billion over three years
for diagnoses
added just by insurers.
Not only that,
many diagnoses were added for which
patients then received no treatment,
and "often, neither the patients
nor their doctors had any idea."
Which isn't great, is it?
The whole point of a doctor
is for them to diagnose you.
Or, in my case, for them to look
at me, down at the chart,
look at me again, back at the chart,
and then say,
"48 years old?
Are we sure about that?"
And while insurers will claim
they're just being thorough,
they've been repeatedly accused
of essentially pulling
a Munchausen by paperwork.
In 2022, the Times found eight of the
10 biggest Medicare Advantage insurers
had submitted inflated bills
according to federal audits,
and that four of the five largest
players had faced federal lawsuits
alleging that efforts
to overdiagnose their customers
had crossed the line into fraud.
And some have been accused of getting
very sneaky to add patient codes.
For instance,
many tout "home visits",
with ads featuring happy seniors
excitedly greeting healthcare workers
at their door.
Here is how UnitedHealthcare
advertises theirs.
Remember the good old days when
doctors made house calls?
UnitedHealthcare offers their
Medicare Advantage members
an annual visit from a licensed
clinician in their own home,
at no extra cost.
Home visits may include a review
of your medical history,
a check of your vital signs,
and a chance to talk
about your health concerns.
With HouseCalls,
being healthy starts at home.
Yeah, and you can see
how attractive that is.
Not least because
the senior gets a visitor!
And you know how happy
that makes them.
The elderly love exactly
three things: having guests,
talking to guests,
and then freaking out
when that guest
sits in their fucking chair!
But an investigation found that,
in programs like that one,
companies pushed
nurses to run screening tests
and add unusual diagnoses,
turning the roughly hour-long
stops in patients' homes
into an extra 1.800 dollars
per visit, on average.
And while United will insist
most of the conditions it's coded
for in its "HouseCalls" program
haven't raised payments,
some very much have.
For instance, documents show
its software would suggest
the diagnosis
of "secondary hyperaldosteronism,"
"a condition in which levels of
the hormone aldosterone rise",
without requiring it
be confirmed by a lab test.
UnitedHealthcare
apparently diagnosed that
nearly a quarter million times
after home visits,
leading to 450 million in government
payments over just three years,
even though a former
HouseCalls nurse said,
"In a million years,
I wouldn't have come up"
"with a diagnosis of
secondary hyperaldosteronism."
And of course not!
I didn't even know
what hyperaldosteronism was
before working on this piece,
and to be honest, I still
don't really know much about it,
aside from the fact that you can
rearrange the letters to spell
"modernist horseplay".
Which isn't nothing!
But it does feel close to it.
Now, I have to tell you:
UnitedHealthcare claims that
report misrepresents HouseCalls,
which is just about
supplementing doctors' visits
and identifying gaps
in patient care.
I presume that they're currently
making that same argument
to the DOJ's criminal healthcare
fraud unit,
which is investigating
its Medicare billing practices.
And I wish them
the very best of luck with that.
They are not the only company who've
faced these sorts of accusations.
An insurer called Independent Health
faced similar claims,
including that a woman
in one of their Advantage plans
was apparently coded
for prostate cancer
because, according
to an internal email,
"When a married couple
has any disease,"
"both were assigned to that disease."
Which is both ridiculous
and also kind of romantic.
"Do you, Tracy, promise to take
Doug's diseases from tip to taint,"
"as long as you both shall live?"
"I do! I really do!"
Now, again, I have to tell you:
Independent Health
did not admit liability,
but they did pay 98 million dollars
to settle that lawsuit.
The exact kind of thing you do
when you're not liable for something.
So, at this point,
I think it's pretty clear,
these plans aren't a particularly
good use of taxpayer money.
But are they good for patients?
Well, on the surface, "cheaper
premiums" sounds appealing.
And if you're relatively healthy,
these plans can seem like
the more attractive option.
Just listen to this woman explaining
why she and her husband picked one.
We are very active. I play pickleball
twice a week. We have a big garden.
We have animals
that we take care of.
And so,
we're always doing something.
And we wanted to retire while we
were still able to do things together.
We like the Advantage plan because
it seemed to fit our needs for that.
Right, and I get that that
makes sense for her right now.
Because, from the minute I saw that
woman, I knew she played pickleball.
She didn't need to tell me that.
Everything about her screams,
"I'll dink your kitchen, then
cross-court lob until we bagel,"
"because je suis le pickle bitch."
Medicare Advantage plans go out
of their way to recruit people like her.
Many even offer perks like gym
memberships, which can be
disproportionately attractive
to relatively healthy beneficiaries.
But, once you get sick,
you can find out your plan
has a lot of limitations.
For example, under regular Medicare,
you can go to any doctor or hospital
that takes it,
which is most of them.
But with Medicare Advantage,
as with most private insurance,
you can typically only use doctors
in the plan's network and service area.
And as those can change
at any time,
a doctor who is in-network
when you sign up,
can quickly fall out of it.
And that can be a big problem.
Consider this woman
who had cancer,
and who qualified
for Medicare due to disability,
but signed up
for a Medicare Advantage plan,
thinking
that it would save her money.
I went for my routine checkup.
I'd been a Dana-Farber patient
since 2013, and I got a bill.
They're saying the provider's
in-network in the building,
but the building of Dana-Farber
is out-of-network,
and I'm not allowed
to go there anymore,
even though I'd been going there
and have the same insurance.
So, after all of these years,
I have now moved my care
to a different hospital
because I can't go there anymore.
That is absurd.
Her doctor was in-network,
but the building wasn't.
It's one of those things
that makes your brain hurt
if you think about it for too long,
like how gravity works,
or why some people's bodies
shit when they're scared,
or how Bill Belichick's daughter
was 17 years old
the year his girlfriend was born.
Some things are just too difficult
for you to comprehend!
It can be hard to find someone
in-network on an Advantage plan.
And even if its list of providers
looks good on paper,
it can quickly collapse under
the slightest inspection,
as this man discovered.
I'm diabetic, so I looked
under "endocrinology".
There were four listed,
and the first two
were at Schnucks grocery stores,
and they weren't endocrinologists.
They were just pharmacies.
So, apparently, that means
that they offer two endocrinologists
in this 25-mile radius,
and that has me
hugely concerned.
- Enough for the senior population?
- No.
Yeah, of course it isn't.
And finding out half your list
is just grocery store pharmacies
would be frustrating.
Everybody knows you don't go there
for an endocrinology appointment.
You go there to check your
blood pressure in the machine
that makes your arm feel like it's
squeezed by Paul Mescal's thighs.
That is a thing that we all do.
And that is not a one-off either.
One review found the majority
of Medicare Advantage organizations
had between 30 to 60% inaccurate
locations in their directories.
But even if you can find a provider,
you may then have to deal
with something called
"prior authorizations".
You're probably familiar with them
from employer-sponsored plans.
While traditional Medicare
almost always pays for the care
your doctor says you qualify for,
virtually all enrollees
in Medicare Advantage are required
to obtain prior authorization
for some services.
While these plans are supposed to
cover all medically necessary services
that original Medicare does,
actually getting approval
can be a grueling process,
as this doctor explains.
We have
to call for a prior authorization.
We can't do it electronically,
we have to call on the phone,
the old-fashioned telephone.
We have to call an 800-number.
And then we have to give them
all the data,
we have to give them
the insurance information,
we have to give them the patient's
date of birth, and things like that.
And then what they do
is they give us then an authorization
to fax them the information.
So, I've called them to get permission
to fax them a request.
Once they've got it, I've got to
call them while they discuss the fax.
That's another barrier
and obstacle to care
that's incredibly time-consuming,
has no value added,
and it seems antithetical
to trying to get prior authorization.
I am getting a prior authorization
to get a prior authorization.
Yeah, and everything about that
sounds like a nightmare,
including the presence of
the words "fax machine".
I thought we stopped making them
around the same time we stopped
making good romantic comedies.
In fact, I think the last time
I saw a fax machine,
a frazzled Michelle Pfeiffer was getting
horned up for George Clooney.
Remember that? Remember
good romantic comedies?
The kind of films that feel
like a blanket
and make you leak
from all your holes?
What happened to this country?
Anyway, as you might guess,
Medicare Advantage providers
partly or fully deny
millions of prior authorizations
each year,
and that can be maddening
for those who need care.
Take what happened to Gary Bent.
He had significant complications
from brain surgery,
including being unable
to stand or walk on his own.
His doctors said he needed a lengthy
stay at a highly skilled rehab center.
Now, under traditional Medicare,
that would've been covered.
But he had a Medicare Advantage
plan from UnitedHealthcare,
which only approved him for a few
weeks at a short-term rehab facility.
And Gary's wife and daughter
remember the advice that they got
from his care team about trying
to appeal United's decisions.
They told me I would probably win
one or two, maybe even three.
But then the speed with which
these denials came would increase.
They would be fewer
and fewer days apart,
and eventually I was going to lose.
We felt like this process
was designed to wear us out
and I would say it did wear us out.
Yeah.
And that's exactly what happened.
They won two appeals,
then lost a third,
after an external reviewer
sided with the company.
And while UnitedHealthcare insists it
was just following Medicare guidelines,
Gary was sent home before his family
felt he was ready,
with, by the way,
a fever and neck pain.
And within 11 hours
of being discharged,
he was rushed to the ER where
he was diagnosed with meningitis.
And that was just one step
in a quick decline towards him
dying the following winter,
a decline that his wife says was made
worse by "the added trauma"
"of having to fight for the care
he needed and was entitled to."
And there are some things so awful,
it's almost impressive
to be able to make them worse.
It's like seeing a Cybertruck
with Diddy's face painted on it.
I don't know how you managed to do it,
but I like this even less.
And the thing is, delaying,
underpaying, or denying care
doesn't just hurt patients,
it hurts hospitals too,
particularly those in rural areas.
Because they don't have the time
or resources to sink
into constantly appealing decisions,
which has had real consequences.
This was once
the geriatric psychiatry unit
at Alliance Healthcare
in Holly Springs, Mississippi.
Now, the hallways hollow,
and beds sitting empty.
This operating room,
only a few years ago,
was doing five or six procedures
a day. Now? Zero.
Dr. Kenneth Williams is the CEO.
He says the hospital
can no longer afford the unit, or
any inpatient care, for that matter.
All of this used to service people
that really needed help,
and now it's just totally empty.
It's empty, it's gone,
and it died the last few years
with Medicare Advantage.
That is terrible.
Thanks to Medicare Advantage,
that whole wing is now abandoned,
and by the looks of it,
already haunted.
Because at any moment, it feels
like Jigsaw is about to pop out
with a realtor
to "just check out the space".
And even hospitals
which haven't had to close wings
have stopped taking these plans,
with a 2023 survey finding
nearly 20% of health systems
had stopped accepting
at least one Medicare Advantage
plan that year alone.
And if you're thinking,
"Well, you know what, that's okay."
"If I get sick and I need a specialist,
I'll switch back to regular Medicare",
you may not be able to.
Because remember, it has
that 20% gap you need to cover.
Now, when you first enroll, it's easy
to buy a Medigap plan to do that,
because they can't hold
preexisting conditions against you.
But, in most states,
once you've enrolled
in a Medicare Advantage plan,
Medigap insurers are allowed
to reject you based on them.
So, as a practical matter,
once a patient enters
the Medicare Advantage system,
they typically can't afford to leave.
Think of it like Scientology,
or a bean bag chair,
easy to get in,
very difficult to get out.
And when you take
this all together,
you get a system where the incentives
are clearly set up
for insurance companies to make you
look as sick as possible on paper,
while doing as little as possible
to help you when you actually need it.
Now,
the industry is gonna dispute that.
They've even funded their own studies
suggesting their plans
actually save the government money
and deliver consistently better health
outcomes than traditional Medicare.
When Stat News asked more than
a dozen leading health policy experts
to review a bunch of those studies,
they found they had "fundamental flaws"
and "obvious biases," and on
the whole were so skewed,
they basically constituted
an "alternate reality".
And look, if these companies are living
in such a dangerous fantasy world,
they clearly need professional help.
Luckily, I happen to know
a board-certified therapist
who can see them.
But bad luck, he's out-of-network,
so fuck you!
So, what can we do here?
Well, as I've said before,
so many of these problems would go
away if we had single-payer healthcare.
And we could get closer to that
by making regular Medicare more
expansive and easier to navigate,
and getting rid
of that 20% gap in coverage.
But until then,
we should, at the very least,
be calling Medicare Advantage
by a different name,
and ideally one without the term
"Medicare" anywhere near it.
Because as you've seen,
they're just not the same.
It's like the difference between
a flashlight and a Fleshlight.
Sure, they might sound similar, but
they do drastically different things.
Unfortunately, though, it is tough
to talk about potential reforms now,
given who is in charge
of Medicare currently.
Because in case you've forgotten,
it is this fucking guy.
22 across, eight letters,
starts with M.
A government entity dedicated
to the health of seniors.
Mehmet Oz!
It's Medicare.
Mehmet Oz fits.
It's Medicare.
Guess what, I work for you now.
Yup, they put me in charge of Medicare.
Now, how cool is that?
Not cool! Not cool at all!
And it is just wild to see someone
who's been on TV for two decades
give the single worst line
reading I have ever seen.
And remember,
we just watched these two go to town.
But one of the many reasons
it's not cool
is that Dr. Oz not only promoted
Medicare Advantage
in sponsored segments
on his TV show,
he once co-wrote an op-ed titled
"Medicare Advantage for All
Can Save Our Healthcare System",
basically suggesting
we roll it out for everyone.
While he's recently acknowledged
some of the problems I've mentioned,
he's also said the administration
wants to give insurers
an opportunity
to "voluntarily fix" them.
Which I would say is the most
ridiculous thing that he has ever said,
except he did once do this.
- So, that's what you call a camel toe.
- Yes.
Can I actually show you what
camel toes look like?
Of course!
So here's a picture of what
a real camel toe looks like.
Television was a bad idea!
So, look, at the policy level,
for now, we are kind of fucked.
But in the meantime,
if you or someone you know
is considering one of these plans:
first, if you can afford to buy
a Medigap plan
and enroll in traditional Medicare,
you should do that.
But if you can't,
you should at least understand
the potential drawbacks
of Medicare Advantage.
And whatever you do, do not call
those broker numbers on TV.
Because they won't give you
unbiased advice.
They get much higher commissions if
they funnel you to Advantage plans.
So, if you want independent advice,
you can call your state health
insurance assistance programs.
You can find your state's number
at this website.
And while I know it is basically
impossible to escape these ads now,
we thought the least we could do
is provide one for you
that is technically accurate.
- Al, did you make the call?
- What call?
The Feldmans said we may be able
to get additional benefits
with Medicare Advantage,
right here in our own ZIP Code!
- Our ZIP Code?
- Yeah, the ZIP Code we live in?
It covers the 8.6 square miles
of our neighborhood.
Yeah, I know what a ZIP Code is.
But, honey, we already have Medicare,
so we don't need to call anyone.
Al, do you listen?
I said, Medicare Advantage!
It has all the letters
of the word "Medicare"
but none of the actual Medicare.
Wait a minute,
it's not regular Medicare?
No, that's why we need to call.
The Feldmans said
their Medicare Advantage plan
has dirt cheap premiums.
- Did you say dirt cheap?
- Yes, Al, of course I did!
What is wrong with you today?
With Medicare Advantage,
you'll get free gym memberships,
a grocery allowance
and a nurse will come
to our house.
- For a threesome?
- You'd love that, wouldn't you, Al?
No, not for a threesome!
The nurse will come to our house
so that she, or he, can diagnose us
with a bunch of diseases
that we don't have and our doctors
don't even know anything about!
But what about conditions I actually
have, like my diabetes?
Not only will they cover it,
but I will suddenly
have diabetes too.
- Why?
- Because it's romantic, Al. Kiss me!
- Hold on!
- What?
Do we at least get
to keep our doctors?
Well, we get to choose from
a list of doctors,
but they're mostly just grocery stores,
local middle schools,
a JCPenney
and an abandoned Chuck E. Cheese.
Did you say Chuck E. Cheese?
And,
if you find a doctor that's covered,
you'd better hope that the building
that he, or she, works in is too.
Otherwise, you might be getting
your prostate checked out
in the parking lot,
and not in the fun way!
This is starting
to sound like a bad idea.
No! No, it isn't! I want
a Medicare Advantage plan, Al!
Plus, the premiums are so low,
think of all the money we could save!
Sure, the care might be worse,
but that's okay,
because we're not sick right now
in this very moment!
- But, what if we get sick later?
- Well, then we're fucked, Al.
But that's a later problem.
Right now, we're active.
You golf and I play pickleball
with Paul Feldman twice a week.
I didn't know you played
pickleball with Paul Feldman.
Yeah, I've been playing
with Paul for years. He is great.
In fact,
I think I'm in love with him.
Did you say you're in love
with him?
Yes, Al, he fucks like a Toyota
and loves like a Subaru.
Now please, call the number
and get us a doctor
so that he can treat our herpes.
Herpes?
Is that one of these fake diagnoses?
No, Al, we both have herpes now.
Don't call this or any other
number on your screen.
Medicare Advantage
is not traditional Medicare.
It's administered
by private insurance.
Your doctor
may or may not be covered.
And if you or your wife is playing
pickleball with Paul Feldman,
seek medical attention immediately
because you have herpes now.
Paul Feldman
gave you both herpes.
That's our show,
thanks so much for watching.
We'll see you next week, good night!
Dirt cheap premiums.
Dirt cheap premiums.
Dirt cheap premiums.