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HBO Last Week Tonight with John Oliver 11:18 PM ET JOHN OLIVER: Yeah, the whole argument was 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 them? I don't know, probably because of something deep-rooted in my psyche stemming from 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 their investors, and they've 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 illnesses you're listed as having, because insurers are entitled to extra money when their patients are diagnosed with conditions that are costly to treat. 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 going to 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. Though, 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 know a board-certified therapist who can see them. He's out of network though, so fuck you. So, what can we do? 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 percent 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.
