Latest / The Overlap / Luxury Bones, $39 Hugs, and "Subsequent Jet Engine Encounters": Why American Healthcare is a Scam

Transcript

Luxury Bones, $39 Hugs, and "Subsequent Jet Engine Encounters": Why American Healthcare is a Scam · The Overlap

0:15
Hello everyone and welcome back to the overlap.
0:17
I am Joshua.
0:18
Will is still out for the holidays, spending time with his family.
0:21
So it's just me today, which means we are skipping the small talk and getting right into the good stuff.
0:26
And when I say good stuff, I mean, we're diving into the head first chaotic nonsensical Rube Goldberg machine uh that was invented by human beings, the American healthcare system
0:38
yet again.
0:39
Now I know what you're thinking.
0:41
you see healthcare.
0:42
You think.
0:43
Skip button you think boring heavy confusing.
0:46
We're not doing that today.
0:48
We're not gonna sit here and read actuarial tables We're gonna poke the bear.
0:52
We're gonna look at this system for what it actually is the world's most expensive practical joke Now you always hear politicians say the health care system is broken.
1:00
We need to fix the broken system I am here to tell you that's a lie The system isn't broken to call it broken is an insult to the architects who actually built it
1:11
It's actually working perfectly.
1:13
It is a Ferrari, a finely tuned machine.
1:17
It just happens to be an engine designed to vacuum money out of your bank account and transfer it to shareholders portfolios.
1:26
That's not a bug, it's a feature.
1:29
To show you how absolutely crazy this system is, we have to take the logic of the American healthcare system and sort of apply it to like literally any other business.
1:39
Because if we ran...
1:41
a lemonade stand, the way we were in a hospital, we'd all be in prison.
1:45
So I want to sit there with you and I want you to imagine a restaurant.
1:51
Let's call it, I don't know, Chez American.
1:54
Five stars, very fancy.
1:56
You walk in, you're starving.
1:58
You sit down.
2:00
The waiter walks over very casually and says, ah can I get anything for you?
2:05
You say, can I see a menu?
2:06
The waiter just laughs and says, well, we don't do menus with like,
2:10
prices that kind of destroys the mystery.
2:13
You say, okay, well, how much is a hamburger?
2:16
The waiter says, well, that's a great question.
2:18
Who are you with?
2:19
Are you with the blue group, the Etna club?
2:22
Are you unaffiliated?
2:25
You tell them very succinctly that you're with the blue group.
2:29
He says, fantastic.
2:31
So a hamburger might be $12.
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It might be $600.
2:35
It's kind of a range depends on what kind of mood the algorithm.
2:39
is in today.
2:41
But you know, go ahead, live a little.
2:42
So you order the hamburger and you decide you're a little low on vegetables.
2:46
You haven't had some in a couple of days.
2:48
You order a side salad, you eat it.
2:50
It's okay.
2:51
You ask for the check.
2:53
The waiter looks at you absolutely offended.
2:55
Um, we don't settle up now.
2:58
Go home.
2:59
We'll send the bill to you later.
3:01
It'll be a surprise.
3:03
After about three weeks, you're just living your life when a letter arrives.
3:06
It's not a bill.
3:07
It's an EOB.
3:09
explanation of benefits, which is Latin for we're about to gaslight you.
3:14
It says the restaurant billed $450 for the hamburger, but your discount club, the blue club, got it down to $200 and you owe $50.
3:25
Not bad, right?
3:27
And then you see it, the red ink.
3:30
Side salad denied.
3:32
Reason?
3:33
Not necessary.
3:34
You call the restaurant.
3:36
Why was my salad denied?
3:37
I ate it.
3:38
It was fine.
3:40
And they tell you, well, the medical director of the blue group, Steve from accounting, he looked at your case and he decided that because you also ate a pickle with the hamburger,
3:52
the salad was kind of redundant.
3:54
So you owe us $85 for the lettuce.
3:58
And just when you're about to scream, you get a second bill.
4:02
This one's from the apex utensil partners, LLC.
4:05
They're charging you a hundred dollars.
4:07
Why?
4:09
Well, because while the restaurant was in network and the waiter was in network, the fork you used to eat your hamburger or the knife you used to put the mayonnaise on your
4:23
hamburger, whether or not you actually use those items is irrelevant.
4:27
Having the silverware there and available, the silverware was actually an independent contractor who is actually out of network.
4:36
If this happened to you at
4:39
chilies, you'd probably burn the building down.
4:43
You would be absolutely well within your rights to riot, complain, scream to the high heavens, and leave the worst Yelp review that that chilies has ever seen.
4:52
But in healthcare, we just kind of accept it and write the check, or maybe not.
5:01
We have normalized this insanity.
5:04
So why is it like this?
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Is it because doctors are evil?
5:08
No.
5:09
Most doctors are actually pretty decent human beings.
5:11
Is it because we're stupid?
5:14
Well, you know, no, it's because of something economists call the third party payer problem.
5:21
In a normal world, you'd buy a thing from a person.
5:26
I love when they call them widgets.
5:27
You'd buy a widget from a person, right?
5:31
You look at the price, you look at the quality and you go, yep, I'm gonna have that exact widget and you know what you're paying for it.
5:37
But in healthcare, you have a chaperone, the insurer.
5:41
You don't buy healthcare.
5:43
A chaperone or third party and mediator buys it for you using your money, but they don't tell you the price until after you've used it.
5:55
It's like sending your rich, eccentric uncle to buy you a car, but he hates you, and he owns stock in the dealership.
6:04
The structure kind of breaks the market.
6:06
Nobody's shopping, right?
6:08
Nobody knows what anything costs.
6:10
So the price has just flowed up into the atmosphere like a balloon that's lost its kid, right?
6:18
To keep the circus running, and boy, is it expensive, we're not paying for innovation.
6:24
That's the lie.
6:25
You hear all the time, yeah, but what incentive would there be to innovate?
6:29
We're paying a complexity tax.
6:32
The United States as a whole spends about a thousand dollars per person a year just on administration.
6:41
What does that mean?
6:42
Paperwork, literally all that billing and talking from the billing department to the medical director to the healthcare provider to the third party payer system to Visa to
6:53
MasterCard, all of that you're paying for.
6:56
And that's a grand out of your pocket every single year to
7:02
pay an insurance company to deny your claims.
7:07
Comparatively, and you know we love the northern Arctic Circle area, in Sweden they actually pay about $45 per person per year.
7:19
Because in Sweden, the doctor sends a bill and the government pays it.
7:24
That's it.
7:25
In America, you've got to have
7:29
an army of coders and billers and then there's adjusters and then managers to fight a war over every single aspirin and whether or not it's needed.
7:39
Well, who wins in that scenario?
7:40
Who's the bigger winner in this casino?
7:43
It's definitely the house, just like any other casino.
7:47
Let's check the scoreboard.
7:49
Andrew Witte.
7:50
He's the CEO of the United Health Care Group.
7:54
Don't at me.
7:54
I mean, that's just a fact.
7:55
Now, I don't know Mr.
7:57
Witte,
7:58
Personally, I'm sure he's a wonderful human being and I'm sure that he loves his mother and I'm relatively certain his mother loves him.
8:06
But in 2024, Andrew took home $26.3 million.
8:13
That is 348 times what the average employee at his company makes.
8:20
While people are starting literal GoFundMe campaigns to pay for insulin,
8:26
Andrew is making enough money to buy a small island every single quarter.
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See, it's not broken.
8:33
It's working great for Andrew.
8:36
And that's kind of the vibe today, right?
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We aren't here to be sad.
8:40
We're here to laugh at the emperor who isn't wearing clothes, right?
8:44
We're here to look at this absurdity and say, okay, you got us.
8:48
This is a scam, but at least we know how the trick's done.
8:51
Speaking of scams, let's talk about my favorite one.
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We have to talk about the fact that for some reason, the American medical system has decided that your teeth are not part of your body.
9:05
It's about to get ridiculous in here.
9:08
So we established the healthcare system is a restaurant that basically hates you.
9:12
But now let's talk about the strangest room in that restaurant.
9:16
Let's talk about the dental divide.
9:18
Have you ever stopped to really think about how weird it is that in America,
9:22
your mouth is considered a separate legal entity from the rest of your body.
9:27
According to the insurance industry, the human body stops at the neck.
9:30
Your heart, that's medicine.
9:32
Your lungs, also medicine.
9:33
Your kidneys, medicine.
9:35
But your teeth, your gums, the literal gateway to your respiratory and digestive systems, oh no, no, no, no, no.
9:43
Those are premium add-ons.
9:44
Those are seat warmers.
9:46
Those are, and Reddit has dubbed them this, luxury bones.
9:52
The logic here is more than fascinating.
9:56
The insurance companies have decided that the ability to chew food without screaming in pain or to not speak with a lisp is basically akin to getting heated seats in a luxury
10:08
sedan.
10:09
It's a nice to have, it's a perk, but it's not essential biology.
10:14
If you go to a cardiologist and say, hey, look, my heart hurts, your insurance says,
10:19
Watch your costs, but we've got to fix this.
10:21
This is your heart.
10:22
That's what you're paying for.
10:23
If you go to a dentist and say, my tooth hurts, I can't eat, your insurance says, well, you did need to lose weight.
10:29
How much do you really need to chew?
10:31
Have you thought about smoothies?
10:34
How did we get here?
10:36
How did we end up with a system where you need one card for your liver and a completely different, much worse card for your molars?
10:46
Like everything in American history, it starts with a mix of academic snobbery and a weird accent.
10:51
Let's go back to 1840.
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We're at the University of Maryland.
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Two men, Horace Hayden and Chapin Harris, kind of the fathers of modern dentistry.
11:03
walk into medical school.
11:04
say, hey, look, we have a new science.
11:06
It's called dentistry.
11:07
We fix teeth.
11:08
We treat gum disease.
11:10
We think that this should be part of the medical curriculum.
11:13
Can we join the club?
11:15
And the doctors at the University of Maryland looked at them and basically said, ew, no.
11:20
They rejected them.
11:22
They said dentistry was quote, a mechanical trade.
11:27
They viewed it as manual labor.
11:29
like being a barber or a hamburger flipper or a blacksmith.
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Real doctors didn't get their hands dirty with teeth.
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So Hayden and Harris said, well, fine, we'll start our own school with blackjack and fluoride.
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And they did.
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They started the first dental college.
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And from that moment on dentistry and medicine were two separate professions, different schools, different degrees, different cultures, different subject matter.
11:57
Fast forward to 1954.
12:00
This is where the insurance trap starts to snap shut.
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In the 50s, we had wage control.
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Unions in California and Washington wanted to get more money for their workers, but legally they couldn't ask for higher hourly wages.
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So they started asking for fringe benefits.
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We have all known these and if you're in a highly competitive industry, that is what you essentially win with.
12:26
and how you shop when they're all paying the same salary.
12:31
They went to the dental societies and said, can we build a prepayment plan for teeth?
12:39
And this is the key, right?
12:40
They didn't design it as insurance.
12:43
Medical insurance is designed for catastrophe.
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If you get cancer, the insurance pays hundreds of thousands of dollars, sometimes millions to save you.
12:53
Dental insurance, in quotes,
12:56
was designed as a maintenance plan.
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It was designed kind of like a coupon book.
13:01
What those coupon books we used to sell in high school to have basic things like funding our education and extracurricular programs?
13:11
Yeah, it was a coupon book for, I don't know, an oil change.
13:15
It basically covers your cleanings, maybe a filling or so a year, but it was never intended to cover a crash, right?
13:24
Like a major
13:26
a major situation.
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And that's kind of the most infuriating number in the entire healthcare industry, that annual maximum.
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If you have dental insurance now, go look at your card.
13:40
I'm not gonna wait for you.
13:42
You can pause this and go and look for it later.
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But somewhere on that insurance card or in your policy, it lists your annual maximum benefit.
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For most of us, that number,
13:54
is either a thousand dollars or fifteen hundred dollars per person.
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Sometimes there's a family number as well if you're on a family plan.
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That's the most that the dental insurance company will pay in a single year.
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After that, you're basically on your own.
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Now, here is the kick in the teeth, pun entirely intended.
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Do you know what the
14:21
standard annual maximum was in 1970.
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It was a thousand dollars.
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They have not changed that number in 54 years.
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Let's do the inflation math.
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I'm sorry, I'm struggling with the fact that it's been 56 years.
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since 1970.
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But to do the inflation math, because this is where kind of the scam reveals itself, if that $1,000 limit from 1970 had kept up with inflation, let's look it up here.
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1970.
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$1,000 in 1970.
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This calculator only goes up to 2024.
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So I assume it's a little more.
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It's actually over $8,000.
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$8,000.
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Now, an additional two years, and with the inflation we've seen there this administration, we're probably closer to $10,000 adjusted for inflation.
15:33
In 1970, $1,000 could literally buy you a mouthful of golden crowns.
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They didn't have all of the polymers and things that we have now, which are actually much cheaper than gold.
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They used gold, but an entire mouthful would have cost you right around $1,000.
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$1,000 a year could fix almost anything.
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In 2026, $1,000 gets you two cleanings, maybe an X-ray, and maybe half of a root canal.
16:04
So you pay your premiums every month you think you're covered.
16:08
One day, you're biting into a chip or taking a bite of sticky toffee and you crack a tooth.
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The dentist says, well, okay, you need a root canal, let's put a crown on it.
16:20
That's $2,500.
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Your insurance pays the first thousand dollars and then they tap out.
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And usually they negotiate the cost down for that thousand dollars.
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then you're required to pay the overage.
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Sorry pal, you hit the limit.
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The other 1500 bucks is on you.
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It's not insurance.
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It's basically a gift card, like a Walmart, Amazon gift card that runs out halfway through your shopping.
16:51
Can you imagine if car insurance worked like this?
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Hi, Geico.
16:56
Yeah, I totaled my car.
16:58
Okay, no problem.
16:59
We'll pay for the first thousand dollars of repairs.
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Good luck.
17:02
Wait, what?
17:03
I want to pause the snark for a second because while the math is stupid, the consequences are deadly.
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Let's talk about Diamante Driver.
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Diamante was a 12 year old boy living in Maryland, ironically the same state where the 1840 split happened.
17:21
This was back in 2007.
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uh Diamante came home one day complaining of a toothache, simple stuff he needed to have the tooth extracted.
17:30
It costs about $80 in 2007 to have a tooth extracted, but Diamante's mom was in between jobs.
17:39
So in between coverage, she was struggling with the Medicaid bureaucracy.
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She couldn't find a dentist who wouldn't take her insurance or perform the procedure for a price she could afford.
17:49
So they waited.
17:50
They tried to kind of manage the pain or a gel, you know, those sorts of things, but your teeth are connected to your body.
18:01
The bacteria from this tooth abscess leached into his bloodstream.
18:05
It traveled up.
18:06
It infected his brain.
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Diamante started actually having seizures.
18:11
He was rushed to the hospital.
18:13
He had to go through two emergency brain surgeries and spent six weeks in the ICU.
18:20
The total cost to the healthcare system for his hospitalization was $250,000, just a little bit more.
18:28
A quarter of a million dollars.
18:30
And at the end of it, the Amante died.
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I want you to sit for a second with the logic of that.
18:37
American healthcare system is willing to spend $250,000 on medical neurosurgery to try to save his life.
18:50
But it couldn't figure out a mechanism to pay 80 bucks to pull a tooth to save him from the infection in the first place.
18:58
because that tooth was a luxury bone as opposed to the brain, which apparently is a medical organ.
19:05
That distinction killed the 12 year old boy.
19:09
Okay.
19:10
Deep breath.
19:11
Let's get back to the absurdity.
19:12
Cause if we don't laugh, we're going to cry.
19:15
Uh, I know that from experience.
19:17
Let's talk about the missing tooth clause.
19:20
Now this sounds like a joke.
19:21
It sounds like a, you know, a weird elf that lives in the North pole, but it is a standard in every dental policy.
19:28
It states, will not pay to replace a tooth that was missing prior to the start date of this policy.
19:36
It's a preexisting condition exclusion for your mouth.
19:39
You remember the American care act got rid of preexisting conditions for medical care, but not for dental care.
19:46
So let's say you lost a tooth in 2021 because you didn't have any money in 2026.
19:51
You get a great new job.
19:53
You have dental insurance.
19:54
You think finally I can get a bridge.
19:55
I can get an implant.
19:56
can smile again.
19:58
You go to the dentist, they send in the claim denied.
20:03
Why?
20:04
Because the insurance company says, hey, we agreed to ensure the teeth you have.
20:10
We didn't agree to ensure the empty spaces.
20:14
And there are reports, and I love this because it's so evil, it's almost impressive, where people have called insurance sales reps saying, look, I have no teeth, I need dentures.
20:25
The sales rep goes, great.
20:26
here sign here for this plan the person pays the premium they go to get dentures and they're denied because all of their teeth were missing before they bought the plan that is
20:37
fraud that is is selling a swimming pool to a person who lives in the desert and telling him you don't cover water
20:45
This leads us to the final insult of the dental system, the class marker.
20:50
In America, teeth are the most visible sign of your economic status.
20:55
If you have straight, white, blindingly perfect teeth, you're rich.
21:00
You're employable.
21:02
You're moral.
21:04
If you have missing teeth or decay, society judges you instantly.
21:08
They think lazy, drug addict, unintelligent, unhireable.
21:13
So the poor people
21:15
get extractions.
21:17
Because Medicaid covers pulling teeth, but usually doesn't cover saving them.
21:24
The rich, they get veneers.
21:26
We've created a caste system based on enamel.
21:29
So that's the dental landscape.
21:31
It's a mess of neglect, historical accidents, and frozen math.
21:36
But at least with dentistry, the insurance companies are just cheap.
21:42
When we cross over into the world of general medicine, they stop being cheap.
21:46
They start being hostile.
21:48
So let's leave the land of luxury bones and talk about the denial industrial complex where basically an algorithm decides if you live or die.
21:59
We covered the restaurant that hides the prices.
22:01
We covered the luxury bones that don't count as a biology apparently.
22:05
But now we have to graduate.
22:08
We're leaving the land of neglect where the insurance company just
22:11
doesn't want to pay for your crown and we're entering the land of active hostility.
22:16
We're entering the denial industrial complex.
22:19
See, somewhere in the last 20 years, the business model of health insurance changed.
22:26
It used to be about managing risk.
22:28
Now it's about managing denials.
22:31
No isn't just an answer anymore.
22:34
No is the product.
22:36
It's the strategy.
22:38
And they've built a machine to say no.
22:40
Faster.
22:42
cheaper and more cruelly than any human ever could, more and more utilizing AI automatically.
22:50
Let's start with a company you've probably never heard of, but who likely controls your healthcare.
22:55
Evacore.
22:57
It sounds like the evil corporation from uh a sci-fi novel or some video game, uh but Evacore has a, you know, I could just see a spaceship out there with
23:11
EVA Core building a better tomorrow by denying your MRI today.
23:16
They are a quote, medical benefit management company.
23:20
They manage prior authorizations for over 100 million Americans.
23:25
They work for the big guys, Cigna, Aetna, United healthcare.
23:28
Their sales pitch to the insurance companies is very explicit.
23:32
They basically say for every dollar you pay us, we will save you $3 in denied claims.
23:39
How do they do it?
23:41
Do they carefully review every file?
23:43
Do they have an in-house team of house doctors sitting around on a whiteboard solving your case?
23:50
No.
23:51
They have an algorithm and increasingly AI.
23:54
Insiders actually call it the dial.
23:56
And this is not a metaphor.
23:58
It is a literal adjustment.
24:00
If an insurance company is having a bad financial quarter, maybe they paid out too many flu claims or the CEO needs another airplane.
24:09
They can call EVA Core and tell them to turn the dial.
24:14
They adjust the algorithms so that the threshold for approval gets higher.
24:20
Procedures that were automatically approved last month are suddenly flagged for manual review, which is code for we're going to stall until you give up this month.
24:29
They are calibrating your access to healthcare based on their quarterly stock performance.
24:35
But look, algorithms are abstract.
24:37
Let's talk about what this looks like when it actually hits a person.
24:41
I want to talk about Christopher McNaughton.
24:43
The story comes from an investigation by ProPublica.
24:47
uh Christopher was a student at Penn State, had a severe debilitating case of ulcerative colitis, UC.
24:55
And we're not talking about, you know, basic diarrhea.
24:58
Like we're talking about life-threatening inflammation, blood clots, arthritis.
25:03
He was restricted to eating the same bland meal for two years straight.
25:08
and was in and out of the hospital.
25:11
He goes finally and sees a specialist at the Mayo Clinic, arguably the best doctors in the world.
25:17
They found a treatment that worked.
25:19
It was basically a high dose cocktail blend of biologic drugs.
25:24
If you haven't seen biologic drugs, are, uh they compromise your immune system, but ultimately suppress your immune system to keep immunocompromised.
25:35
um
25:37
or immune attacks on your body suppressed.
25:44
So for the first time in years, Chris had his life back.
25:48
He could eat, he went to class, he was alive.
25:52
But the drugs are expensive.
25:54
Biologics are incredibly expensive.
25:56
And that flagged him in UnitedHealthcare's system.
25:58
He became a high dollar account.
26:01
So UnitedHealthcare assigned a specific team to him.
26:05
Now you might think, look, he's got a team to help coordinate his care.
26:08
No, a team to cut him off.
26:12
ProPublica obtained internal recordings of this team.
26:16
On one tape, a quote, nurse liaison, whose job it is theoretically to help with patients, was laughing with a colleague about the case.
26:25
She laughed and said that if the family tried to appeal the denial, it would be a waste of time because the insurer would still say no.
26:32
She was laughing about cutting this man's life support.
26:37
And then Dr.
26:38
Gerald Cates.
26:39
Dr.
26:39
Cates was the medical director, quote, who signed the denial letter.
26:44
Now, medical director sounds important.
26:46
It sounds impressive.
26:48
You picture a guy in a lab coat reading charts, thinking deeply.
26:52
However, in a sworn deposition, Mr.
26:55
Cates admitted the truth.
26:57
He admitted that he had not read Christopher's medical file.
27:00
He did not read letters from the Mayo Clinic.
27:03
He simply copy and pasted the nurse's recommendation into the system and clicked.
27:09
Agree.
27:11
It was a rubber stamp.
27:12
He overruled world renowned specialists without even looking at the patient or his file to save the company money.
27:22
This isn't medicine.
27:24
It's a bouncer at a club telling you that your name isn't on the list because the club is over capacity.
27:30
But even Dr.
27:31
Cates was too slow for the modern area.
27:34
He actually had to click a button.
27:36
Let's talk about Cigna.
27:38
Cigna actually developed a system called PXDX, Procedure to Diagnosis.
27:43
This system actually automates the denial process entirely.
27:47
An investigation found that Cigna doctors were signing off denials in batches.
27:53
You know what the average time spent on each claim was?
27:56
1.2 seconds.
27:59
1.2 seconds.
28:02
One Mississippi denied.
28:04
One Mississippi denied.
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You cannot even read a patient's name in 1.2 seconds.
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You can't read a diagnosis code in 1.2 seconds.
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They weren't reviewing his care.
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They were literally clicking select all, reject.
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In a two month period, a handful of doctors denied over 300,000 claims using the system.
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They have essentially turned the practice of medicine into a click farm.
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But you might say, know, your doctor can fight this.
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They can do peer to peer review.
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Yes.
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The peer to peer.
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Ideally, this is where your specialist talks to the insurance company specialist and they have a high level medical debate.
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In reality, it's kind of a joke.
28:47
If your neurosurgeon calls to argue for complex brain surgery, do you know who they get on the phone?
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It's usually a retired pediatrician or an OB-GYN who's been out of practice for 20 years.
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They are matching experts with random hires who reading from a script.
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There's actually a story of a doctor on Reddit who did a peer-to-peer for a stroke patient who needed rehab.
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Now, the insurance doctor on the phone literally said, I 100 % agree with you.
29:19
He absolutely needs inpatient rehab, but I am not empowered to overturn this denial.
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Not empowered.
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This is a phrase that should haunt you.
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The person on the phone agrees that you need care.
29:34
The doctor agrees that you need care.
29:37
The patient needs care.
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But the algorithm said no, and the algorithm outranks everyone.
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So we have a system where teeth are luxury items, your care is denied by a robot in 1.2 seconds, and the appeals process is rigged by people who aren't allowed to say yes.
29:57
But wait, there's more in the circle of hell.
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Let's say you navigate all of this.
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You get approved, you get the surgery, you survive.
30:06
Then you get to look at the bill.
30:09
And if you thought denials were creative, wait until you see the key where they charge you for a box of tissues.
30:16
Let's talk about the billing circus.
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This is the final seventh circle of hell.
30:23
We've navigated the restaurant that hides prices.
30:25
We learned that our teeth are luxury items.
30:27
We survive the algorithm that tries to deny our care in 1.2 seconds.
30:31
Now, let's assume you made it.
30:32
You got the surgery, you beat the system, you're being discharged now, and then you get the bill.
30:37
This is where American healthcare stops being a tragedy and starts being a dark comedy.
30:43
Hospital billing is based on a document called the Charge Master, which admittedly sounds like a He-Man villain and kind of, you know, don't know, um acts like them.
30:56
The Chargemaster is essentially a secret list of sticker prices for every single item in the hospital.
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And these prices have absolutely no relationship to reality, cost, or sanity.
31:11
I've got examples.
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Let's talk about a $39 hug.
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A few years ago, a dad posted his bill, his hospital bill on Reddit, after his wife had a simple C-section for birth.
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He was scanning the thousands of dollars in charges.
31:26
He saw a line item skin to skin after C-section cost 39.35.
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The hospital charged him $40 to hold his own child.
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Of course, Reddit being a cesspool of rage exploded and the hospital administrator responded and said, that, you know, that wasn't for the hug.
31:49
That was for the nurse's presence in the room while the hug occurred to ensure safety.
31:55
We have monetized even the first moment of human bonding, but it gets pettier.
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If you get a box of tissues in your room, it might show up on the bill as a mucus recovery system, cost $15.
32:09
If a nurse gives a frightened child a teddy bear to calm them down, that will be billed as a cough suppression device.
32:20
And Tylenol, just regular old acetaminophen, the stuff that maha says will
32:25
cause you to be autistic or something, the stuff you buy for pennies at CVS, hospitals routinely charge anywhere from $1.50 to $30 per pill.
32:38
That's like a 10,000 % markup.
32:41
If a gas station charged you $10,000 for a gallon of gas, they would literally be arrested for price gouging.
32:48
But when a hospital does it, it's cost recovery.
32:52
So how do they keep track of all this?
32:54
They use a coding system called ICD-10.
32:57
You might have a friend or family member who is a medical biller or coder, but now coding is important for data.
33:05
But in the U.S., it's kind of a minefield.
33:08
If your doctor uses even a slightly wrong code, the insurance company will deny the claim.
33:15
and the codes are magnificent.
33:17
I have a list here of a valid...
33:19
billable medical codes.
33:21
I'm not making these up.
33:22
I did validate them through the ICD-10.
33:25
Code W59.22, struck by turtle.
33:31
Apparently, I don't know, we have a problem with aggressive turtles in this country, but there is an ICD-10 code for it.
33:39
Code W5541, bitten by a pig.
33:44
Code V91.07XD,
33:49
Burn due to water skis on fire.
33:53
I have so many questions about the physics of that one.
33:57
My personal favorite though was code V97.33XD.
34:01
Sucked into jet engine subsequent encounter.
34:06
Subsequent encounter.
34:08
How did you survive the first encounter and why did you go back near a jet engine?
34:14
But the point of this complexity isn't just to be funny.
34:20
it's to create traps, right?
34:21
It turns reimbursement into a game of bureaucratic minesweeper, one wrong click and the money is gone.
34:29
Here's another thing that's not funny at all.
34:32
The ground ambulance.
34:34
So a couple of years ago, might remember Congress passed the No Surprises Act, which banned surprise billing for out of network ER doctors and air ambulances.
34:44
You know, you might call them helicopters, but there was a loophole.
34:48
Ground ambulances were excluded from this.
34:51
Why?
34:52
Because private equity firms own huge fleets of ambulances.
34:57
and they lobbied very hard to keep their ability to surprise bill you.
35:02
So we have stories like the Silva family in Colorado.
35:05
Their daughter was in a car crash.
35:07
The ambulance drove her to the hospital.
35:09
The bill was $3,000.
35:11
The insurance refused to pay for anything because the ambulance was quote, out of network.
35:17
The ambulance company sent the bill to collections and then garnished the mother's wages.
35:24
They ruined a family's finances for a ride that they had absolutely no choice in taking.
35:31
You can't shop around for an ambulance when you're bleeding on the side of the road.
35:35
Hold on, let me check the Yelp reviews for this paramedic.
35:38
It's extortion, plain and simple.
35:41
So here we are.
35:42
We have a system that hides prices, ignores your teeth,
35:47
a system that denies life-saving care in 1.2 seconds, and a system that charges you for holding your baby.
35:56
And we pay more for this, $1,000 a year, just in admin costs, than any other country on earth.
36:04
That brings us back to where we started.
36:06
Is the system broken?
36:08
No.
36:09
For Andrew Witte making $26 million a year, it's working frickin' great.
36:16
For the shareholders of UnitedHealthcare and Cigna, it is a gold mine.
36:20
But for us, for DeMonte Driver, for Christopher McNaughton's, it is a predation machine.
36:31
The third party payer problem, say that three times fast, the third party payer problem has destroyed the market.
36:39
We need to stop pretending that this can be fixed with a few tweaks to the tax code.
36:43
And we need to stop pretending that healthcare is a luxury product like a flat screen TV until we recognize that teeth are bones, just like any other bone, until we recognize that
36:55
no is not a medical opinion.
36:59
And until we recognize that healthcare is a human right, not a fringe benefit, we will continue to be customers in the restaurant in the seventh circle of hell.
37:10
And that's it.
37:12
That's the show.
37:13
I know, it's heavy, it's infuriating, but the first step to fixing this scam is seeing the scam.
37:22
If you enjoyed this episode or it made you angry in a productive way, do us a favor, share it, send it to a friend, send it to your uncle who thinks universal healthcare is
37:32
communism, send it to your dentist.
37:36
We grow by word of mouth, so if you think someone needs to hear this, please pass it along.
37:41
Also, please take a second to rate and review us on Apple podcasts and Spotify.
37:46
It kind of helps the algorithm find us.
37:49
And as we learned today, algorithms kind of run the world.
37:51
So we have to play nice with them.
37:54
You can find us on the socials.
37:55
We're on Blue Sky and Macedon.
37:58
Come say hi, tell us your worst healthcare horror story, or just send us pictures of turtles to watch out for.
38:03
uh Check out our website for all of our sources, charts and data we talked about today.
38:08
uh Will hopefully will be sitting in the chair next week.
38:11
He'll bring the optimism, I'm sure.
38:13
Until then, I'm Joshua.
38:14
Don't get struck by a turtle or sucked into a jet engine once or twice and try to stay out of network.
38:22
I appreciate you.
38:23
This has been The Overlap.