Son of Medicare: Attack of the Machines

An Arm and a Leg

Society & Culture, Medicine, Health, Health & Fitness, Documentary

4.8 • 1.1K Ratings

🗓️ 21 March 2024

⏱️ 30 minutes

🔗️ Recording | iTunes | RSS

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Summary

Reporter Bob Herman from STAT News unpacks his blockbuster investigation about the country’s biggest health care company.

Covering the American health care system means we tell some scary stories. But this episode is almost like a horror movie.

It’s got some of Hollywood’s favorite tropes: Machines taking over. Monsters from separate franchises meeting face to face in a new movie, like Godzilla and King Kong, or Jason and Freddy. And a couple perceptive folks warning everyone, ”Hey, look, something really bad is happening!”

Those folks are Bob and his STAT News colleague Casey Ross. The monsters are United HealthGroup — a “behemoth” as one expert called them in an episode from last year — and Medicare Advantage, which we looked at in our last episode. And the “machines” belong to United.

Bob describes what some of United’s own employees said about the result: “For some of us, it's creating this moral crisis. Like we know that we are having to listen to an algorithm to essentially kick someone out of a nursing home, even though we know that they can barely walk 20 feet.”

Scary stuff. But Bob and Casey’s reporting has caught the eye of some powerful people in government, and right now, Medicare Advantage plans are on notice from the federal Centers for Medicare and Medicaid Services, the U.S. Senate is holding hearings, and the Department of Justice reportedly has an anti-trust investigation in the works.

Here’s a transcript of this episode.

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Transcript

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0:00.0	Hey there. So this is kind of a horror story, but it's not quite the kind of story it might sound like at first, because at first it might sound like a horror story about machines taking over, making all the decisions, and making terrible, horrifying choices, very age of artificial intelligence.
0:16.0	But this is really a story about decisions made by people for money.
0:27.0	It's also kind of a two-fer sequel, like those movies that pit two characters from earlier stories against each other like
0:32.8	you know Godzilla versus King Kong or alien versus predator although in this
0:37.4	case I got to admit the two monsters aren't necessarily fighting each
0:40.0	other let's get reacquainted with them. On one side, coming back from our very last
0:45.7	episode, we've got Medicare Advantage. This is the version of Medicare that's run by
0:50.3	private insurance companies. It's got a bright and appealing side
0:53.8	compared to traditional Medicare, the version of Medicare that's just run by the
0:57.4	federal government, because it costs a lot less month to month month saving people money on premiums and it often comes with extra benefits like dental coverage which traditional Medicare doesn't offer
1:09.1	I know
1:12.1	But Medicare Advantage can have a dark side, which is basically...
1:17.0	Well, you end up dealing with private insurance companies for the rest of your life.
1:22.0	You need something, a test, a procedure, whatever,
1:25.6	they might decide not to cover it, which can be scary. Our other returning monster, am I really calling them a monster? Well, last time we talked
1:36.7	about them in 2023, we had an expert calling them a behemoth, that's United
1:41.8	Health Group. You might remember they're not only one of the biggest
1:46.0	insurance companies and maybe not coincidentally the very biggest provider of
1:50.6	Medicare Advantage plans, they've also got a whole other business under the umbrella name
1:56.8	Optum. And Optum has spent the last bunch of years buying up a gazillion of their health care companies of every kind.
2:05.4	That includes medical practices, so they employ more doctors than anyone else by a huge
2:11.3	margin. It includes surgery centers and home health companies and
	...

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