1 00:00:27,761 --> 00:00:34,267 [cheering and applause] 2 00:00:34,268 --> 00:00:35,935 >> john: welcome, welcome, 3 00:00:35,936 --> 00:00:39,272 Welcome to last week tonight! 4 00:00:39,273 --> 00:00:40,006 Ire back! 5 00:00:41,008 --> 00:00:41,574 And we've missed a lot since 6 00:00:41,575 --> 00:00:41,974 We've been away. 7 00:00:41,975 --> 00:00:42,508 The iran war continued to 8 00:00:42,509 --> 00:00:43,142 Escalate, with no end in sight, 9 00:00:43,143 --> 00:00:43,776 We learned don junior's wedding 10 00:00:43,777 --> 00:00:45,778 Weekend was bankrolled by a 11 00:00:45,779 --> 00:00:47,280 Russian oligarch-- but don't 12 00:00:47,281 --> 00:00:48,915 Worry, his dad says he paid it 13 00:00:48,916 --> 00:00:51,083 All back, so nothing to see 14 00:00:51,084 --> 00:00:52,351 There-- and ted cruz went on 15 00:00:52,352 --> 00:00:53,286 Espn's college game day, where 16 00:00:53,287 --> 00:00:54,787 The crowd gave him the exact 17 00:00:54,788 --> 00:00:57,523 Reception he deserves: 18 00:00:57,524 --> 00:01:03,296 >> they're producing enormous 19 00:01:03,297 --> 00:01:04,830 Value and enormous skill, but it 20 00:01:04,831 --> 00:01:06,232 Also puts reasonable rules in 21 00:01:06,233 --> 00:01:07,300 Place, so for example, every 22 00:01:07,301 --> 00:01:10,303 Player gets one free trade. 23 00:01:10,304 --> 00:01:10,937 >> john: i do not like that man 24 00:01:10,938 --> 00:01:13,472 Ted cruz. 25 00:01:13,473 --> 00:01:14,807 I do not like him on the news. 26 00:01:14,808 --> 00:01:15,808 I do not like him talking 27 00:01:15,809 --> 00:01:17,310 Sports. 28 00:01:17,311 --> 00:01:18,110 I do not like him wearing 29 00:01:18,111 --> 00:01:22,315 Shorts. 30 00:01:22,316 --> 00:01:22,915 I do not like him on tv, i do 31 00:01:22,916 --> 00:01:25,818 Not like him trying to flee. 32 00:01:25,819 --> 00:01:27,320 I do not like him in a tux, but 33 00:01:27,321 --> 00:01:31,324 I love him being told he sucks. 34 00:01:31,325 --> 00:01:35,328 [cheering and applause] 35 00:01:35,329 --> 00:01:37,330 Also this week, kash patel 36 00:01:37,331 --> 00:01:38,965 Appeared before the senate 37 00:01:38,966 --> 00:01:40,833 Judiciary committee and answered 38 00:01:40,834 --> 00:01:42,335 Questions about changes to fbi 39 00:01:42,336 --> 00:01:43,469 Hiring rules, making certain 40 00:01:43,470 --> 00:01:44,837 Types of conduct that had 41 00:01:44,838 --> 00:01:46,606 Previously be disqualifying, 42 00:01:46,607 --> 00:01:47,840 Suddenly potentially okay 43 00:01:47,841 --> 00:01:49,275 And one of those types of 44 00:01:49,276 --> 00:01:50,309 Conduct was pretty striking. 45 00:01:50,310 --> 00:01:50,910 >> why would you even get into 46 00:01:50,911 --> 00:01:55,848 Bestiality? 47 00:01:55,849 --> 00:01:56,882 >> we are not into bestiality. 48 00:01:56,883 --> 00:01:58,851 >> john: look, if you ever find 49 00:01:58,852 --> 00:02:00,853 Yourself defensively saying "we 50 00:02:00,854 --> 00:02:02,855 Are not 'into' bestiality", 51 00:02:02,856 --> 00:02:03,856 You've already lost the 52 00:02:03,857 --> 00:02:04,857 Argument. 53 00:02:04,858 --> 00:02:06,292 And incredibly, that exchange 54 00:02:06,293 --> 00:02:07,360 Continued: 55 00:02:07,361 --> 00:02:10,229 >> these changes didn't start 56 00:02:10,230 --> 00:02:10,663 With you, did they? 57 00:02:10,664 --> 00:02:11,030 >> no. 58 00:02:11,031 --> 00:02:12,365 >> someone came to you and 59 00:02:12,366 --> 00:02:12,765 Recommended them? 60 00:02:12,766 --> 00:02:15,868 >> yeah. 61 00:02:15,869 --> 00:02:19,372 And when you saw bestiality-- i 62 00:02:19,373 --> 00:02:21,140 Say this with respect-- the 63 00:02:21,141 --> 00:02:28,148 Person who recommended it, why 64 00:02:33,887 --> 00:02:34,420 Didn't you just say, "what 65 00:02:34,421 --> 00:02:34,987 Planet did you parachute in 66 00:02:34,988 --> 00:02:35,888 From? 67 00:02:35,889 --> 00:02:36,489 Why do i want to lead with my 68 00:02:36,490 --> 00:02:40,393 Chin and get into bestiality?" 69 00:02:40,394 --> 00:02:41,894 >> john: that's amazing. 70 00:02:41,895 --> 00:02:43,896 I just wish kennedy had kept 71 00:02:43,897 --> 00:02:45,898 Going on. 72 00:02:45,899 --> 00:02:46,432 "mr. Patel, explained what 73 00:02:46,433 --> 00:02:49,402 Constitutes bestiality. 74 00:02:49,403 --> 00:02:49,669 Hand job? 75 00:02:49,670 --> 00:02:50,403 Mouth stuff? 76 00:02:50,404 --> 00:02:52,405 Also, exactly when does gentle 77 00:02:52,406 --> 00:02:53,406 Petting crossed the line? 78 00:02:53,407 --> 00:02:54,907 And please, speak into the 79 00:02:54,908 --> 00:02:55,908 Microphone so history can 80 00:02:55,909 --> 00:02:57,910 Remember your answer." 81 00:02:57,911 --> 00:02:58,544 And look, i'd absolutely love to 82 00:02:58,545 --> 00:02:59,278 Spend the rest of the show 83 00:02:59,279 --> 00:03:00,413 Talking about that exchange. 84 00:03:00,414 --> 00:03:00,946 I have a particular set of 85 00:03:00,947 --> 00:03:01,580 Skills, and discussing that clip 86 00:03:01,581 --> 00:03:02,214 For forty minutes would finally 87 00:03:02,215 --> 00:03:02,648 Utilize all of them. 88 00:03:02,649 --> 00:03:03,916 You think i don't want to show 89 00:03:03,917 --> 00:03:05,918 You a clip of the ass-shaking 90 00:03:05,919 --> 00:03:06,919 Donkeys from encanto live at the 91 00:03:06,920 --> 00:03:07,920 Hollywood bowl? 92 00:03:07,921 --> 00:03:09,422 Of course i do! 93 00:03:09,423 --> 00:03:10,423 You think i don't want to show 94 00:03:10,424 --> 00:03:12,925 You that other clip of kennedy 95 00:03:12,926 --> 00:03:13,559 Talking about sex that we're all 96 00:03:13,560 --> 00:03:16,429 Thinking about right now? 97 00:03:16,430 --> 00:03:17,329 >> i can't wait to have your 98 00:03:17,330 --> 00:03:17,530 Cock-- 99 00:03:17,531 --> 00:03:22,435 >> john: stop! 100 00:03:22,436 --> 00:03:24,437 Stop! 101 00:03:24,438 --> 00:03:25,938 We don't have time for it! 102 00:03:25,939 --> 00:03:27,440 And i don't like it either, but 103 00:03:27,441 --> 00:03:31,444 We don't have time! 104 00:03:31,445 --> 00:03:32,078 Unfortunately, we have something 105 00:03:32,079 --> 00:03:32,645 Different planned this week. 106 00:03:32,646 --> 00:03:33,279 Because we're actually going to 107 00:03:33,280 --> 00:03:33,913 Dive straight in with our main, 108 00:03:33,914 --> 00:03:34,547 And only story tonight, which 109 00:03:34,548 --> 00:03:35,081 Concerns health insurance. 110 00:03:35,082 --> 00:03:35,948 The thing supposed to cover 111 00:03:35,949 --> 00:03:37,416 Anything bad that happens to 112 00:03:37,417 --> 00:03:38,951 Your body, except eyes and 113 00:03:38,952 --> 00:03:40,953 Teeth, as those cost extra. 114 00:03:40,954 --> 00:03:41,520 They're the guacamole of the 115 00:03:41,521 --> 00:03:43,956 Face. 116 00:03:43,957 --> 00:03:45,458 Specifically, we're going to 117 00:03:45,459 --> 00:03:46,959 Talk about united healthcare, 118 00:03:46,960 --> 00:03:47,593 The country's largest insurance 119 00:03:47,594 --> 00:03:49,462 Company. 120 00:03:49,463 --> 00:03:50,596 As you undoubtedly know, almost 121 00:03:50,597 --> 00:03:51,464 Two years ago, its then-ceo, 122 00:03:51,465 --> 00:03:53,466 Brian thompson, was shot in 123 00:03:53,467 --> 00:03:54,467 Midtown manhattan while going to 124 00:03:54,468 --> 00:03:55,968 An investor conference. 125 00:03:55,969 --> 00:03:56,969 And that killing was, 126 00:03:56,970 --> 00:03:58,471 Noticeably, not exactly met with 127 00:03:58,472 --> 00:04:00,973 Universal sympathy. 128 00:04:00,974 --> 00:04:02,241 In fact, in some quarters, there 129 00:04:02,242 --> 00:04:03,476 Was even support for luigi 130 00:04:03,477 --> 00:04:04,777 Mangione, the suspect who's 131 00:04:04,778 --> 00:04:07,480 Since admitted to the shooting. 132 00:04:07,481 --> 00:04:09,081 >> this ivy league hottie named 133 00:04:09,082 --> 00:04:10,483 Luigi is the robin hood that we 134 00:04:10,484 --> 00:04:14,987 Never knew that we needed. 135 00:04:14,988 --> 00:04:16,489 >> this is like a regular, 136 00:04:16,490 --> 00:04:18,491 Everyday person becoming our 137 00:04:18,492 --> 00:04:21,494 Hero, our vigilante. 138 00:04:21,495 --> 00:04:22,128 >> universal health care now or 139 00:04:22,129 --> 00:04:23,996 Free luigi. 140 00:04:23,997 --> 00:04:26,565 >> john: yeah, luigi had a lot 141 00:04:26,566 --> 00:04:27,500 Of fans, many of whom-- like 142 00:04:27,501 --> 00:04:30,503 That guy-- supported him by 143 00:04:30,504 --> 00:04:30,936 Wearing green hats. 144 00:04:30,937 --> 00:04:31,504 Which must be so weird for 145 00:04:31,505 --> 00:04:35,508 Nintendo. 146 00:04:35,509 --> 00:04:37,576 This guy's been mario's sidekick 147 00:04:37,577 --> 00:04:39,011 For decades without controversy, 148 00:04:39,012 --> 00:04:39,612 It'd be like finding out every 149 00:04:39,613 --> 00:04:40,646 Mario kart game had oj simpson 150 00:04:40,647 --> 00:04:43,516 As a playable character. 151 00:04:43,517 --> 00:04:45,885 But that was just the beginning. 152 00:04:45,886 --> 00:04:47,019 A sign depicting luigi as a 153 00:04:47,020 --> 00:04:48,587 Saint was projected on a new 154 00:04:48,588 --> 00:04:49,255 York building like his album was 155 00:04:49,256 --> 00:04:51,524 About to drop. 156 00:04:51,525 --> 00:04:53,025 And supporters showed up at his 157 00:04:53,026 --> 00:04:54,160 Arraignment dressed in shirts 158 00:04:54,161 --> 00:04:56,028 That said things like "i love 159 00:04:56,029 --> 00:04:58,030 Italian boys," and "cougars for 160 00:04:58,031 --> 00:04:58,264 Luigi." 161 00:04:58,265 --> 00:05:01,033 And, look, let's just get this 162 00:05:01,034 --> 00:05:01,634 Straight out of the way: luigi 163 00:05:01,635 --> 00:05:03,536 Is hot. 164 00:05:03,537 --> 00:05:06,539 There's no way around that. 165 00:05:06,540 --> 00:05:07,540 In fact, he's so hot, they even 166 00:05:07,541 --> 00:05:09,108 Had to acknowledge it on the 167 00:05:09,109 --> 00:05:10,543 News: 168 00:05:10,544 --> 00:05:12,545 >> so much of, you know, the 169 00:05:12,546 --> 00:05:13,145 Clips we were watching at the 170 00:05:13,146 --> 00:05:14,180 Top of this segment are driven 171 00:05:14,181 --> 00:05:16,048 By the fact that this is-- this 172 00:05:16,049 --> 00:05:16,549 Is an attractive person. 173 00:05:16,550 --> 00:05:17,149 >> you know, we've got to drop 174 00:05:17,150 --> 00:05:18,984 The banner to show why. 175 00:05:18,985 --> 00:05:19,585 >> and it is deeply troubling 176 00:05:19,586 --> 00:05:22,555 That we are celebrating this 177 00:05:22,556 --> 00:05:23,122 Person who's committed cold 178 00:05:23,123 --> 00:05:24,056 Blooded murder-- 179 00:05:24,057 --> 00:05:25,224 >> yeah. 180 00:05:25,225 --> 00:05:26,559 >> because, you know, he clearly 181 00:05:26,560 --> 00:05:28,561 Went to the gym. 182 00:05:28,562 --> 00:05:31,063 >> john: yeah, someone on that 183 00:05:31,064 --> 00:05:32,565 Panel said, "drop the banner", 184 00:05:32,566 --> 00:05:34,600 So viewers could understand the 185 00:05:34,601 --> 00:05:35,067 Full extent of luigi's 186 00:05:35,068 --> 00:05:36,068 Attractiveness. 187 00:05:36,069 --> 00:05:37,203 Cheeky pecs peeking out is 188 00:05:37,204 --> 00:05:39,071 Insufficient. 189 00:05:39,072 --> 00:05:40,573 We are the fourth estate and we 190 00:05:40,574 --> 00:05:43,576 Will show all four rows of abs. 191 00:05:43,577 --> 00:05:44,176 But it's not "just" that luigi 192 00:05:44,177 --> 00:05:46,579 Was handsome. 193 00:05:46,580 --> 00:05:49,081 One reason many found it hard to 194 00:05:49,082 --> 00:05:50,649 Completely condemn the murder is 195 00:05:50,650 --> 00:05:52,585 That so many americans are 196 00:05:52,586 --> 00:05:54,587 Furious with united healthcare. 197 00:05:54,588 --> 00:05:55,120 In fact, shortly after the 198 00:05:55,121 --> 00:05:56,589 Shooting, when a poll asked "how 199 00:05:56,590 --> 00:05:58,123 Much responsibility do you think 200 00:05:58,124 --> 00:05:58,724 Each of the following had for 201 00:05:58,725 --> 00:06:01,093 The killing?" 202 00:06:01,094 --> 00:06:02,695 78% said the killer held some 203 00:06:02,696 --> 00:06:03,596 Responsibility, which, of 204 00:06:03,597 --> 00:06:07,600 Course. 205 00:06:07,601 --> 00:06:08,667 But 69% also blamed "denials for 206 00:06:08,668 --> 00:06:10,102 Health care coverage by health 207 00:06:10,103 --> 00:06:11,604 Insurance companies". 208 00:06:11,605 --> 00:06:13,105 In fact, one of united's 209 00:06:13,106 --> 00:06:15,107 Executives even coincidentally 210 00:06:15,108 --> 00:06:16,609 Alluded to public anger at the 211 00:06:16,610 --> 00:06:19,612 Investor meeting taking place 212 00:06:19,613 --> 00:06:21,113 "on the day of the murder", and 213 00:06:21,114 --> 00:06:23,616 Claimed it was all misdirected: 214 00:06:23,617 --> 00:06:25,117 >> in no way you would design 215 00:06:25,118 --> 00:06:28,120 Something as complicated and as 216 00:06:28,121 --> 00:06:30,122 Contradictory and as difficult 217 00:06:30,123 --> 00:06:32,625 To navigate as the system we all 218 00:06:32,626 --> 00:06:33,259 Find ourselves in today, because 219 00:06:33,260 --> 00:06:35,127 Nobody designed it. 220 00:06:35,128 --> 00:06:37,296 It simply evolved. 221 00:06:37,297 --> 00:06:38,631 >> john: oh, i get it, it's not 222 00:06:38,632 --> 00:06:39,732 United's fault the system's like 223 00:06:39,733 --> 00:06:40,232 This. 224 00:06:40,233 --> 00:06:42,134 Nobody designed it. 225 00:06:42,135 --> 00:06:43,636 It just evolved naturally. 226 00:06:43,637 --> 00:06:46,105 It presumably all started when 227 00:06:46,106 --> 00:06:47,139 This nasty bitch crawled out of 228 00:06:47,140 --> 00:06:48,641 The ocean and therefore, 229 00:06:48,642 --> 00:06:52,144 Regrettably, out of network. 230 00:06:52,145 --> 00:06:53,646 And not long after that, that 231 00:06:53,647 --> 00:06:55,147 Same guy gave an address to his 232 00:06:55,148 --> 00:06:56,148 Company's employees, and offered 233 00:06:56,149 --> 00:07:02,655 A pretty direct piece of advice. 234 00:07:02,656 --> 00:07:03,289 >> i'd encourage you to tune out 235 00:07:03,290 --> 00:07:04,456 That critical noise that we're 236 00:07:04,457 --> 00:07:05,157 Hearing right now. 237 00:07:05,158 --> 00:07:06,759 >> john: wow. 238 00:07:06,760 --> 00:07:09,161 If someone shooting your 239 00:07:09,162 --> 00:07:10,663 Insurance division's ceo won't 240 00:07:10,664 --> 00:07:12,164 Make you listen to 'critical 241 00:07:12,165 --> 00:07:12,831 Noise,' i'm not sure anything 242 00:07:12,832 --> 00:07:14,166 Will. 243 00:07:14,167 --> 00:07:15,167 Because it's pretty much the 244 00:07:15,168 --> 00:07:18,671 Ultimate yelp review. 245 00:07:18,672 --> 00:07:20,239 That man's andrew witty, and at 246 00:07:20,240 --> 00:07:21,573 That point he was the ceo of 247 00:07:21,574 --> 00:07:22,675 Unitedhealth group. 248 00:07:22,676 --> 00:07:24,176 That's the company that owns 249 00:07:24,177 --> 00:07:26,679 United healthcare, y'know, in 250 00:07:26,680 --> 00:07:27,313 The same way that alphabet owns 251 00:07:27,314 --> 00:07:28,180 Google or benson boone owns 252 00:07:28,181 --> 00:07:31,183 Backflipping. 253 00:07:31,184 --> 00:07:32,685 I know other people must have 254 00:07:32,686 --> 00:07:34,219 Backflipped before him, but i 255 00:07:34,220 --> 00:07:36,188 Cannot name a single one. 256 00:07:36,189 --> 00:07:38,624 And, while you're undoubtedly 257 00:07:38,625 --> 00:07:39,692 Familiar with united healthcare 258 00:07:39,693 --> 00:07:41,193 As an insurer, because it served 259 00:07:41,194 --> 00:07:43,195 Almost 50 million people last 260 00:07:43,196 --> 00:07:45,698 Year, you may be less aware of 261 00:07:45,699 --> 00:07:46,765 The sheer scope of its parent 262 00:07:46,766 --> 00:07:49,201 Company, united health group. 263 00:07:49,202 --> 00:07:51,203 Last year, it took in $447 264 00:07:51,204 --> 00:07:52,705 Billion, making it the third 265 00:07:52,706 --> 00:07:53,405 Largest company by revenue in 266 00:07:53,406 --> 00:07:54,707 The u.s. 267 00:07:54,708 --> 00:07:57,209 That's behind only amazon and 268 00:07:57,210 --> 00:07:58,711 Walmart, and above apple. 269 00:07:58,712 --> 00:08:05,719 It's almost unimaginably 270 00:08:07,220 --> 00:08:08,120 Massive, as it doesn't just own 271 00:08:08,121 --> 00:08:08,754 United healthcare, it now also 272 00:08:08,755 --> 00:08:09,388 Has subsidiaries touching almost 273 00:08:09,389 --> 00:08:09,989 Every aspect of our healthcare 274 00:08:09,990 --> 00:08:10,222 System. 275 00:08:10,223 --> 00:08:11,223 In fact, as the washington post 276 00:08:11,224 --> 00:08:12,725 Put it, "in many parts of the 277 00:08:12,726 --> 00:08:14,059 Country, a patient could be a 278 00:08:14,060 --> 00:08:15,227 Unitedhealth customer from 279 00:08:15,228 --> 00:08:17,229 Cradle to grave, starting with 280 00:08:17,230 --> 00:08:18,797 Obstetric care and ending with 281 00:08:18,798 --> 00:08:19,732 Hospice services." 282 00:08:19,733 --> 00:08:21,400 And you should know: that was 283 00:08:21,401 --> 00:08:23,736 Their aim all along. 284 00:08:23,737 --> 00:08:25,237 In fact, in 2007, unitedhealth 285 00:08:25,238 --> 00:08:25,871 Group's then-ceo, stephen 286 00:08:25,872 --> 00:08:28,741 Hemsley-- who recently returned 287 00:08:28,742 --> 00:08:30,275 To that role-- said the company 288 00:08:30,276 --> 00:08:31,744 Was trying to be "a health care 289 00:08:31,745 --> 00:08:33,979 System unto itself." 290 00:08:33,980 --> 00:08:35,748 Which is a pretty far cry from 291 00:08:35,749 --> 00:08:37,316 "hey, nobody designed this, the 292 00:08:37,317 --> 00:08:39,251 System just evolved naturally 293 00:08:39,252 --> 00:08:39,952 From the fertile crescent of 294 00:08:39,953 --> 00:08:46,960 Mesopotamia." 295 00:08:47,260 --> 00:08:48,260 And the very fact that one 296 00:08:48,261 --> 00:08:48,827 Company controls so much of 297 00:08:48,828 --> 00:08:49,762 America's healthcare is what 298 00:08:49,763 --> 00:08:50,396 Makes it so infuriating when you 299 00:08:50,397 --> 00:08:50,929 See just how bad people's 300 00:08:50,930 --> 00:08:52,765 Experiences with it can be. 301 00:08:52,766 --> 00:08:56,769 In fact, if you just search for 302 00:08:56,770 --> 00:08:57,770 "united healthcare" on tiktok, 303 00:08:57,771 --> 00:08:58,570 It won't take you long to find 304 00:08:58,571 --> 00:08:59,071 Videos like these: 305 00:08:59,072 --> 00:09:01,774 >> i am frustrated. 306 00:09:01,775 --> 00:09:03,275 I'm living in pain. 307 00:09:03,276 --> 00:09:04,410 And you guys are denying 308 00:09:04,411 --> 00:09:06,045 Everything. 309 00:09:06,046 --> 00:09:07,780 What is wrong with you? 310 00:09:07,781 --> 00:09:10,282 United healthcare, get it the 311 00:09:10,283 --> 00:09:10,783 Fuck together. 312 00:09:10,784 --> 00:09:16,288 >> i have a surgery that's been 313 00:09:16,289 --> 00:09:20,292 Canceled four times due to 314 00:09:20,293 --> 00:09:20,859 United healthcare denying a 315 00:09:20,860 --> 00:09:21,927 Claim. 316 00:09:21,928 --> 00:09:24,296 >> i want somebody to go tell 317 00:09:24,297 --> 00:09:24,930 United healthcare to eat a giant 318 00:09:24,931 --> 00:09:29,301 Dick. 319 00:09:29,302 --> 00:09:29,902 >> john: yeah, "telling united 320 00:09:29,903 --> 00:09:31,804 Healthcare to go fuck itself" 321 00:09:31,805 --> 00:09:33,872 Has become an entire genre of 322 00:09:33,873 --> 00:09:35,307 Internet video, like "unboxing 323 00:09:35,308 --> 00:09:37,876 Products" or "horny whispering" 324 00:09:37,877 --> 00:09:39,144 Or "someone doing a dance trend 325 00:09:39,145 --> 00:09:40,813 With their friend who's not 326 00:09:40,814 --> 00:09:42,314 Quite as good at dancing as they 327 00:09:42,315 --> 00:09:43,315 Are, which you feel is why they 328 00:09:43,316 --> 00:09:43,949 Picked that friend in the first 329 00:09:43,950 --> 00:09:45,818 Place." 330 00:09:45,819 --> 00:09:47,820 And look, luigi's upcoming 331 00:09:47,821 --> 00:09:49,655 Sentencing is obviously going to 332 00:09:49,656 --> 00:09:52,324 Get a lot of media attention. 333 00:09:52,325 --> 00:09:52,925 But it's important that noise 334 00:09:52,926 --> 00:09:55,894 Doesn't drown out the broader 335 00:09:55,895 --> 00:09:56,962 Frustration with united that his 336 00:09:56,963 --> 00:09:58,897 Case also revealed. 337 00:09:58,898 --> 00:09:59,898 So given all that, tonight, 338 00:09:59,899 --> 00:10:00,499 Let's talk about unitedhealth 339 00:10:00,500 --> 00:10:02,434 Group. 340 00:10:02,435 --> 00:10:03,836 How it makes so much money, how 341 00:10:03,837 --> 00:10:04,837 Big it's gotten, and what that 342 00:10:04,838 --> 00:10:05,904 Means for all of us. 343 00:10:05,905 --> 00:10:07,840 And let's start with the aspect 344 00:10:07,841 --> 00:10:08,841 Of united you're probably most 345 00:10:08,842 --> 00:10:10,075 Familiar with, the fact its 346 00:10:10,076 --> 00:10:11,343 Insurance division has a 347 00:10:11,344 --> 00:10:12,845 Well-earned reputation for 348 00:10:12,846 --> 00:10:15,347 Denying claims. 349 00:10:15,348 --> 00:10:16,748 So much so, in fact, the shell 350 00:10:16,749 --> 00:10:18,350 Casings for the bullets fired at 351 00:10:18,351 --> 00:10:21,353 Brian thompson were inscribed 352 00:10:21,354 --> 00:10:22,387 With "deny, delay, depose"-- a 353 00:10:22,388 --> 00:10:23,355 Reference to a common criticism 354 00:10:23,356 --> 00:10:25,390 Of the insurance industry that 355 00:10:25,391 --> 00:10:26,859 They "delay, deny, defend". 356 00:10:26,860 --> 00:10:28,360 Basically, delay processing 357 00:10:28,361 --> 00:10:29,862 Claims, deny paying them out, 358 00:10:29,863 --> 00:10:31,063 And, if necessary, then defend 359 00:10:31,064 --> 00:10:32,998 That denial. 360 00:10:32,999 --> 00:10:34,366 Now, united will say that's 361 00:10:34,367 --> 00:10:36,368 Completely unfair. 362 00:10:36,369 --> 00:10:43,376 It loves to repeat the argument 363 00:10:43,877 --> 00:10:44,510 That it actually pays out 98% of 364 00:10:44,511 --> 00:10:45,377 All "eligible" claims under the 365 00:10:45,378 --> 00:10:46,778 Terms of members' plans. 366 00:10:46,779 --> 00:10:47,379 Which sounds great! 367 00:10:47,380 --> 00:10:48,147 But remember, the company itself 368 00:10:48,148 --> 00:10:48,881 Is the one determining what is 369 00:10:48,882 --> 00:10:50,382 And isn't "eligible." 370 00:10:50,383 --> 00:10:51,884 And the glimpses of data that 371 00:10:51,885 --> 00:10:52,885 Are publicly available suggest a 372 00:10:52,886 --> 00:10:55,387 Very different picture. 373 00:10:55,388 --> 00:10:56,889 For instance, when kff examined 374 00:10:56,890 --> 00:10:58,891 A group of 37 million claims 375 00:10:58,892 --> 00:11:00,893 Under united's obamacare plans, 376 00:11:00,894 --> 00:11:02,761 They found that in 2024, nearly 377 00:11:02,762 --> 00:11:03,896 One in five in-network claims 378 00:11:03,897 --> 00:11:05,397 Were denied. 379 00:11:05,398 --> 00:11:07,399 But it's not just denials, 380 00:11:07,400 --> 00:11:09,034 There's also the practice of the 381 00:11:09,035 --> 00:11:10,903 Company requiring "prior 382 00:11:10,904 --> 00:11:12,871 Authorization" for certain 383 00:11:12,872 --> 00:11:14,873 Treatments, which can be the 384 00:11:14,874 --> 00:11:15,407 Bane of both patients' and 385 00:11:15,408 --> 00:11:16,909 Doctors' existence. 386 00:11:16,910 --> 00:11:17,509 Just listen to this doctor who 387 00:11:17,510 --> 00:11:19,411 Had to get permission from 388 00:11:19,412 --> 00:11:20,946 United to prescribe someone a 389 00:11:20,947 --> 00:11:21,914 Cheap, basic blood pressure 390 00:11:21,915 --> 00:11:23,415 Drug. 391 00:11:23,416 --> 00:11:24,616 >> i just got a prior 392 00:11:24,617 --> 00:11:26,518 Authorization from 393 00:11:26,519 --> 00:11:29,421 Unitedhealthcare for lisinopril. 394 00:11:29,422 --> 00:11:31,423 I hope the whole board at 395 00:11:31,424 --> 00:11:32,024 Unitedhealthcare gets diarrhea 396 00:11:32,025 --> 00:11:39,032 Tonight. 397 00:11:40,433 --> 00:11:42,501 >> john: yeah, i get it. 398 00:11:42,502 --> 00:11:43,602 And in the interest of balance, 399 00:11:43,603 --> 00:11:44,937 I should say that man doesn't 400 00:11:44,938 --> 00:11:46,939 Speak for all doctors. 401 00:11:46,940 --> 00:11:47,539 In fact, one actually issued a 402 00:11:47,540 --> 00:11:48,440 Response to that video, that 403 00:11:48,441 --> 00:11:49,308 Took a different tack: 404 00:11:49,309 --> 00:11:50,008 >> now, as frustrating as it is 405 00:11:50,009 --> 00:11:51,109 For us to have to do prior 406 00:11:51,110 --> 00:11:52,444 Authorizations and other 407 00:11:52,445 --> 00:11:54,446 Ridiculous paperwork for the 408 00:11:54,447 --> 00:11:56,448 Insurance companies, i don't 409 00:11:56,449 --> 00:12:03,455 Think as healthcare 410 00:12:03,456 --> 00:12:04,489 Professionals, it is appropriate 411 00:12:04,490 --> 00:12:05,090 For us to be wishing ill upon 412 00:12:05,091 --> 00:12:05,958 Other people. 413 00:12:05,959 --> 00:12:06,558 Except for the board of united 414 00:12:06,559 --> 00:12:07,459 Healthcare. 415 00:12:07,460 --> 00:12:10,796 Yes, may they have explosive 416 00:12:10,797 --> 00:12:11,430 Diarrhea, not just tonight, but 417 00:12:11,431 --> 00:12:16,468 Every night. 418 00:12:16,469 --> 00:12:17,469 [cheering and applause] 419 00:12:17,470 --> 00:12:17,869 >> john: perfect. 420 00:12:17,870 --> 00:12:18,737 In fact, i'll go a step further. 421 00:12:18,738 --> 00:12:19,471 I hope they get diarrhea every 422 00:12:19,472 --> 00:12:20,038 Night and then have to pay a 423 00:12:20,039 --> 00:12:22,007 Fuck ton of money out of pocket 424 00:12:22,008 --> 00:12:22,507 To treat it because the 425 00:12:22,508 --> 00:12:23,475 Gastrointenstinal distress 426 00:12:23,476 --> 00:12:25,143 Associated with the guilt of 427 00:12:25,144 --> 00:12:26,878 Being a healthcare executive 428 00:12:26,879 --> 00:12:27,479 Turns out to be a pre-existing 429 00:12:27,480 --> 00:12:29,481 Condition. 430 00:12:29,482 --> 00:12:31,483 And on the patient side, 431 00:12:31,484 --> 00:12:34,486 Fighting claim denials or 432 00:12:34,487 --> 00:12:35,087 Seeking "prior authorizations" 433 00:12:35,088 --> 00:12:35,721 Can be a massive time suck, too. 434 00:12:35,722 --> 00:12:37,422 Take these parents, whose 435 00:12:37,423 --> 00:12:38,991 Workplace insurance is 436 00:12:38,992 --> 00:12:39,558 Administered by united, and 437 00:12:39,559 --> 00:12:40,492 Whose child has a rare 438 00:12:40,493 --> 00:12:42,894 Neurological disorder: 439 00:12:42,895 --> 00:12:44,997 >> your experience with your 440 00:12:44,998 --> 00:12:46,498 Insurer, if you had to sum it up 441 00:12:46,499 --> 00:12:47,499 In one word, what would that 442 00:12:47,500 --> 00:12:48,500 Word be? 443 00:12:48,501 --> 00:12:52,004 >> frustrating. 444 00:12:52,005 --> 00:12:53,505 Like her physical and 445 00:12:53,506 --> 00:12:54,106 Occupational therapy, it's the 446 00:12:54,107 --> 00:12:54,706 Same claim every month, and 447 00:12:54,707 --> 00:12:55,507 Every month they'll deny it 448 00:12:55,508 --> 00:12:57,576 Because instead of looking at 449 00:12:57,577 --> 00:13:00,512 All of her diagnosis, they look 450 00:13:00,513 --> 00:13:01,146 At the top line and go punch it 451 00:13:01,147 --> 00:13:03,015 In the computer and say, nope, 452 00:13:03,016 --> 00:13:03,515 Denied. 453 00:13:03,516 --> 00:13:06,518 >> it's hours a week, if not 454 00:13:06,519 --> 00:13:06,718 More. 455 00:13:06,719 --> 00:13:09,288 >> and every time we have to 456 00:13:09,289 --> 00:13:09,921 Call in it's a different claims 457 00:13:09,922 --> 00:13:13,025 Rep we have to deal with. 458 00:13:13,026 --> 00:13:13,625 >> to bathe without drowning, 459 00:13:13,626 --> 00:13:14,259 Emmy needs to be strapped into 460 00:13:14,260 --> 00:13:15,527 This chair. 461 00:13:15,528 --> 00:13:17,029 Amid the maddening fight to get 462 00:13:17,030 --> 00:13:19,031 One covered, carrie says a 463 00:13:19,032 --> 00:13:19,631 Unitedhealthcare rep had this 464 00:13:19,632 --> 00:13:23,035 Suggestion. 465 00:13:23,036 --> 00:13:24,970 >> they said that we should find 466 00:13:24,971 --> 00:13:26,571 A way to give her a bath, either 467 00:13:26,572 --> 00:13:28,040 Us getting in the bath with her 468 00:13:28,041 --> 00:13:30,542 Or just wiping her down was 469 00:13:30,543 --> 00:13:30,942 Sufficient enough. 470 00:13:30,943 --> 00:13:32,044 >> john: wipe her down? 471 00:13:32,045 --> 00:13:33,545 She's not an iphone you just 472 00:13:33,546 --> 00:13:34,546 Sneezed on, she's a fucking 473 00:13:34,547 --> 00:13:37,549 Human being. 474 00:13:37,550 --> 00:13:38,116 And while thankfully, those 475 00:13:38,117 --> 00:13:39,051 Parents did finally get that 476 00:13:39,052 --> 00:13:40,052 Chair, it was only after a 477 00:13:40,053 --> 00:13:42,554 Prolonged back-and-forth. 478 00:13:42,555 --> 00:13:43,121 In fact, when their daughter 479 00:13:43,122 --> 00:13:45,090 Outgrew that chair and needed a 480 00:13:45,091 --> 00:13:47,059 New one that cost $1,800, they 481 00:13:47,060 --> 00:13:48,226 Opted to skip the hassle of 482 00:13:48,227 --> 00:13:49,061 Dealing with united again, and 483 00:13:49,062 --> 00:13:50,829 Paid for it with donations 484 00:13:50,830 --> 00:13:52,064 Coordinated by his employer. 485 00:13:52,065 --> 00:13:54,900 But at that point, having 486 00:13:54,901 --> 00:13:55,567 Insurance sure looks an awful 487 00:13:55,568 --> 00:13:57,135 Lot like not having it. 488 00:13:57,136 --> 00:13:59,071 Because if you're paying 489 00:13:59,072 --> 00:14:00,572 Premiums, but still having to 490 00:14:00,573 --> 00:14:02,040 Take up a collection for medical 491 00:14:02,041 --> 00:14:06,578 Equipment, what exactly is 492 00:14:06,579 --> 00:14:07,579 Insurance for? 493 00:14:07,580 --> 00:14:08,947 They're just sending you mail 494 00:14:08,948 --> 00:14:09,514 You don't want to open, and 495 00:14:09,515 --> 00:14:10,148 Forcing you to have phone calls 496 00:14:10,149 --> 00:14:10,782 That make you angry, and we all 497 00:14:10,783 --> 00:14:11,583 Know that's supposed to be your 498 00:14:11,584 --> 00:14:15,087 Nana's job. 499 00:14:15,088 --> 00:14:15,754 "no, new york's not under sharia 500 00:14:15,755 --> 00:14:20,592 Law, nana. 501 00:14:20,593 --> 00:14:21,226 Also, what do you mean, i 'sound 502 00:14:21,227 --> 00:14:22,594 Like i put on weight', how's 503 00:14:22,595 --> 00:14:25,097 That possible?" 504 00:14:25,098 --> 00:14:26,598 And the thing is, far too often, 505 00:14:26,599 --> 00:14:29,601 United's denials can seem to be 506 00:14:29,602 --> 00:14:31,103 Completely at odds with medical 507 00:14:31,104 --> 00:14:32,337 Advice patients are getting. 508 00:14:32,338 --> 00:14:33,605 Take this story, of a woman who 509 00:14:33,606 --> 00:14:35,107 Was fighting cervical cancer: 510 00:14:35,108 --> 00:14:37,709 >> several years ago, kate 511 00:14:37,710 --> 00:14:38,443 Weissman was diagnosed with 512 00:14:38,444 --> 00:14:38,677 Cancer. 513 00:14:38,678 --> 00:14:40,612 Because her cancer was so close 514 00:14:40,613 --> 00:14:42,114 To her vital organs, her doctors 515 00:14:42,115 --> 00:14:43,115 Wanted to use a very special 516 00:14:43,116 --> 00:14:46,118 Type of treatment called proton 517 00:14:46,119 --> 00:14:46,618 Beam radiation therapy. 518 00:14:46,619 --> 00:14:48,620 Basically, the radiation is 519 00:14:48,621 --> 00:14:49,688 Beamed exactly where it needs to 520 00:14:49,689 --> 00:14:50,622 Go and it protects the organs. 521 00:14:50,623 --> 00:14:52,624 But guess what? 522 00:14:52,625 --> 00:14:53,625 Her insurance company, 523 00:14:53,626 --> 00:14:57,129 Unitedhealthcare, said, nope, 524 00:14:57,130 --> 00:14:57,629 We're not paying for it. 525 00:14:57,630 --> 00:14:58,296 >> john: yeah, that's maddening. 526 00:14:58,297 --> 00:15:00,132 That woman's own doctors got 527 00:15:00,133 --> 00:15:01,700 Overruled by people who had no 528 00:15:01,701 --> 00:15:04,136 Experience with her case. 529 00:15:04,137 --> 00:15:04,636 Which is ridiculous. 530 00:15:04,637 --> 00:15:06,138 It's kind of like how sex ed at 531 00:15:06,139 --> 00:15:08,140 Catholic school is taught not by 532 00:15:08,141 --> 00:15:10,208 Medical professionals, but by 533 00:15:10,209 --> 00:15:11,143 Sister henrietta, who's never 534 00:15:11,144 --> 00:15:12,644 Even had sex. 535 00:15:12,645 --> 00:15:13,645 Except for, y'know, that one 536 00:15:13,646 --> 00:15:15,147 Summer in italy. 537 00:15:15,148 --> 00:15:16,448 The convent sent her there to 538 00:15:16,449 --> 00:15:18,650 Study, but it was so hot, and 539 00:15:18,651 --> 00:15:20,352 The sea was so sweet, and 540 00:15:20,353 --> 00:15:22,387 Valentina was so beautiful. 541 00:15:22,388 --> 00:15:23,155 They spoke in different tongues, 542 00:15:23,156 --> 00:15:24,823 But connected in a way that 543 00:15:24,824 --> 00:15:26,158 Transcends language. 544 00:15:26,159 --> 00:15:29,661 It was perfect, pure, one could 545 00:15:29,662 --> 00:15:30,195 Even say holy, but all too 546 00:15:30,196 --> 00:15:30,662 Brief. 547 00:15:30,663 --> 00:15:32,164 And when the air cooled, and 548 00:15:32,165 --> 00:15:33,665 They parted for the final time, 549 00:15:33,666 --> 00:15:34,633 The pain was like nothing she'd 550 00:15:34,634 --> 00:15:35,667 Ever known. 551 00:15:35,668 --> 00:15:37,803 To this day, whenever she sees a 552 00:15:37,804 --> 00:15:38,670 Shock of red hair, she yearns to 553 00:15:38,671 --> 00:15:40,672 Sprint down the street, to spin 554 00:15:40,673 --> 00:15:42,174 Valentina around, to take her 555 00:15:42,175 --> 00:15:43,175 Face in her hands. 556 00:15:43,176 --> 00:15:43,909 But each time, she lets the 557 00:15:43,910 --> 00:15:45,277 Moment pass. 558 00:15:45,278 --> 00:15:46,278 They probably wouldn't even 559 00:15:46,279 --> 00:15:50,182 Recognize each other now. 560 00:15:50,183 --> 00:15:52,184 And yet henrietta still keeps 561 00:15:52,185 --> 00:15:52,818 Her greatest treasure, a secret 562 00:15:52,819 --> 00:15:54,186 Between the pages of her bible: 563 00:15:54,187 --> 00:15:57,189 A white lily, browned and 564 00:15:57,190 --> 00:15:57,789 Brittled with time, nestled in 565 00:15:57,790 --> 00:15:59,691 The book of psalms. 566 00:15:59,692 --> 00:16:01,326 And that's why you should never, 567 00:16:01,327 --> 00:16:05,197 Ever have sex. 568 00:16:05,198 --> 00:16:08,700 Not even once! 569 00:16:08,701 --> 00:16:12,704 [cheering and applause] 570 00:16:12,705 --> 00:16:14,206 Now, united healthcare insisted 571 00:16:14,207 --> 00:16:15,207 In that woman's case that "three 572 00:16:15,208 --> 00:16:17,209 Independent radiation 573 00:16:17,210 --> 00:16:19,211 Oncologists agreed that proton 574 00:16:19,212 --> 00:16:21,213 Beam therapy was not safer or 575 00:16:21,214 --> 00:16:21,813 More effective than the proven 576 00:16:21,814 --> 00:16:28,821 Standard of care." 577 00:16:29,222 --> 00:16:30,021 But here's the thing about that, 578 00:16:30,022 --> 00:16:30,589 Highly-esteemed oncologists 579 00:16:30,590 --> 00:16:33,725 Advocating on her behalf, 580 00:16:33,726 --> 00:16:34,392 Including five who also teach at 581 00:16:34,393 --> 00:16:35,227 Harvard medical school, with the 582 00:16:35,228 --> 00:16:36,228 Sixth, presumably, sick of 583 00:16:36,229 --> 00:16:37,696 Having to hear about how the 584 00:16:37,697 --> 00:16:38,263 Other five teach at harvard 585 00:16:38,264 --> 00:16:39,064 During every fucking 586 00:16:39,065 --> 00:16:40,232 Conversation. 587 00:16:40,233 --> 00:16:41,233 Meanwhile, one of united's 588 00:16:41,234 --> 00:16:42,334 Ob-gyns who helped deny that 589 00:16:42,335 --> 00:16:44,236 Woman's appeals wasn't even 590 00:16:44,237 --> 00:16:45,737 Board-certified in gynecologic 591 00:16:45,738 --> 00:16:47,239 Oncology. 592 00:16:47,240 --> 00:16:48,740 She did, however, co-found a 593 00:16:48,741 --> 00:16:50,242 Tattoo laser removal business 594 00:16:50,243 --> 00:16:51,309 And apparently once violated the 595 00:16:51,310 --> 00:16:52,744 State's medical code by allowing 596 00:16:52,745 --> 00:16:54,746 An unlicensed individual to 597 00:16:54,747 --> 00:16:55,380 Perform laser-based procedures. 598 00:16:55,381 --> 00:16:56,948 And i'll be honest, i personally 599 00:16:56,949 --> 00:16:58,383 Wouldn't want my cancer 600 00:16:58,384 --> 00:16:59,751 Treatment being decided by that 601 00:16:59,752 --> 00:17:00,919 Person, even if they are 602 00:17:00,920 --> 00:17:02,587 Probably destined to become 603 00:17:02,588 --> 00:17:03,188 Deputy secretary of health and 604 00:17:03,189 --> 00:17:05,757 Human services. 605 00:17:05,758 --> 00:17:08,260 Now, in the end, her parents 606 00:17:08,261 --> 00:17:10,262 Paid $95,000 out of pocket to 607 00:17:10,263 --> 00:17:11,763 Cover the treatment, which, in 608 00:17:11,764 --> 00:17:14,266 Happy news, did actually work! 609 00:17:14,267 --> 00:17:15,767 But having access to wealthy 610 00:17:15,768 --> 00:17:17,769 Parents just cannot be the 611 00:17:17,770 --> 00:17:18,603 System to get badly-needed 612 00:17:18,604 --> 00:17:19,271 Healthcare. 613 00:17:19,272 --> 00:17:22,274 Even if it is, apparently, the 614 00:17:22,275 --> 00:17:22,807 System that lets you be in 615 00:17:22,808 --> 00:17:24,776 Charge of hbo. 616 00:17:24,777 --> 00:17:26,678 Yeah, my soon-to-be business 617 00:17:26,679 --> 00:17:27,245 Daddy has a literal business 618 00:17:27,246 --> 00:17:32,784 Daddy. 619 00:17:32,785 --> 00:17:34,286 And, to be very clear, i deeply 620 00:17:34,287 --> 00:17:34,619 Respect that. 621 00:17:34,620 --> 00:17:35,287 And i'd never make fun of you 622 00:17:35,288 --> 00:17:36,988 For it, unlike that pesky 623 00:17:36,989 --> 00:17:40,292 Stephen colbert. 624 00:17:40,293 --> 00:17:41,793 And, look, it's frustrating 625 00:17:41,794 --> 00:17:43,261 Enough when united's medical 626 00:17:43,262 --> 00:17:44,796 Experts are coming to bad 627 00:17:44,797 --> 00:17:45,063 Decisions. 628 00:17:45,064 --> 00:17:46,798 But in some cases, there's 629 00:17:46,799 --> 00:17:49,301 Evidence people are barely 630 00:17:49,302 --> 00:17:49,668 Involved at all. 631 00:17:49,669 --> 00:17:50,936 Because former employees of one 632 00:17:50,937 --> 00:17:51,803 United company have said that, 633 00:17:51,804 --> 00:17:53,805 When determining how long to 634 00:17:53,806 --> 00:17:55,307 Cover patients' stays in skilled 635 00:17:55,308 --> 00:17:57,309 Nursing facilities to recover 636 00:17:57,310 --> 00:17:57,909 From injuries, they'd rely 637 00:17:57,910 --> 00:17:59,811 Heavily on an algorithm called 638 00:17:59,812 --> 00:18:01,413 "nh predict", which would 639 00:18:01,414 --> 00:18:02,814 Routinely come up with a date 640 00:18:02,815 --> 00:18:03,882 Earlier than they felt was 641 00:18:03,883 --> 00:18:04,816 Appropriate under medicare 642 00:18:04,817 --> 00:18:06,818 Guidelines. 643 00:18:06,819 --> 00:18:08,320 And as this former case manager 644 00:18:08,321 --> 00:18:09,821 Explains, there were real 645 00:18:09,822 --> 00:18:10,455 Problems if she tried to contest 646 00:18:10,456 --> 00:18:12,324 That. 647 00:18:12,325 --> 00:18:12,991 >> you've got all this 648 00:18:12,992 --> 00:18:14,326 Experience. 649 00:18:14,327 --> 00:18:15,827 Can you use your human judgment 650 00:18:15,828 --> 00:18:18,830 Instead if you saw that it was 651 00:18:18,831 --> 00:18:19,030 Wrong? 652 00:18:19,031 --> 00:18:21,833 >> wouldn't that be great? 653 00:18:21,834 --> 00:18:25,337 Unfortunately, no. 654 00:18:25,338 --> 00:18:27,339 The expectation was i would stay 655 00:18:27,340 --> 00:18:28,340 Within 3% of that estimated 656 00:18:28,341 --> 00:18:30,342 Discharge date. 657 00:18:30,343 --> 00:18:32,344 But by the time i stopped 658 00:18:32,345 --> 00:18:34,846 Working, it was down to 1%. 659 00:18:34,847 --> 00:18:37,849 >> one percent. 660 00:18:37,850 --> 00:18:39,050 >> john: it's true! 661 00:18:39,051 --> 00:18:41,853 And employees have said 662 00:18:41,854 --> 00:18:42,654 Deviating from that one percent 663 00:18:42,655 --> 00:18:43,355 Could mean exposing themselves 664 00:18:43,356 --> 00:18:45,357 To discipline, including 665 00:18:45,358 --> 00:18:45,824 Possible termination. 666 00:18:45,825 --> 00:18:46,391 And look, unitedhealth group 667 00:18:46,392 --> 00:18:48,860 Will claim those were 668 00:18:48,861 --> 00:18:49,527 S medical 669 00:18:50,096 --> 00:18:50,962 Directors, and that they were 670 00:18:50,963 --> 00:18:51,463 Consistent with medicare 671 00:18:51,464 --> 00:18:58,471 Coverage criteria." 672 00:19:02,875 --> 00:19:03,508 But, here's the thing - if a 673 00:19:03,509 --> 00:19:04,876 Company essentially forbids its 674 00:19:04,877 --> 00:19:05,877 Case managers from deviating 675 00:19:05,878 --> 00:19:06,511 More than 1% from an algorithm, 676 00:19:06,512 --> 00:19:07,045 That company is run by an 677 00:19:07,046 --> 00:19:07,312 Algorithm. 678 00:19:07,313 --> 00:19:08,346 And that is very dangerous, 679 00:19:08,347 --> 00:19:08,847 Because as we all know, 680 00:19:08,848 --> 00:19:09,347 Algorithms can make huge 681 00:19:09,348 --> 00:19:09,614 Mistakes. 682 00:19:09,615 --> 00:19:10,382 It's why, for instance, hbo 683 00:19:10,383 --> 00:19:13,385 Suggested that you watch this 684 00:19:13,386 --> 00:19:13,985 Show after you caught up with 685 00:19:13,986 --> 00:19:14,886 Euphoria. 686 00:19:14,887 --> 00:19:17,889 Why would it do that? 687 00:19:17,890 --> 00:19:19,391 No one's hot here, no one's on 688 00:19:19,392 --> 00:19:19,958 Drugs, and no one's getting 689 00:19:19,959 --> 00:19:22,494 Laid. 690 00:19:22,495 --> 00:19:23,128 I am the ontological opposite of 691 00:19:23,129 --> 00:19:25,563 Euphoria. 692 00:19:25,564 --> 00:19:26,898 And look, everything you've seen 693 00:19:26,899 --> 00:19:28,400 So far is basically par for the 694 00:19:28,401 --> 00:19:29,300 Course in the insurance 695 00:19:29,301 --> 00:19:29,901 Industry. 696 00:19:29,902 --> 00:19:31,403 United may be worse in some 697 00:19:31,404 --> 00:19:32,971 Ways, but they're not much of an 698 00:19:32,972 --> 00:19:34,906 Outlier. 699 00:19:34,907 --> 00:19:35,907 Where united's genuinely 700 00:19:35,908 --> 00:19:36,908 Different, though, is in its 701 00:19:36,909 --> 00:19:39,010 Size. 702 00:19:39,011 --> 00:19:39,577 Because, remember: it's the 703 00:19:39,578 --> 00:19:40,245 Third largest company in 704 00:19:40,246 --> 00:19:42,414 America. 705 00:19:42,415 --> 00:19:43,415 And the way it got that big was 706 00:19:43,416 --> 00:19:45,316 By expanding into other, 707 00:19:45,317 --> 00:19:45,917 Non-insurance areas of 708 00:19:45,918 --> 00:19:47,419 Healthcare. 709 00:19:47,420 --> 00:19:48,987 Over the years, it's engaged in 710 00:19:48,988 --> 00:19:50,422 Something called "vertical 711 00:19:50,423 --> 00:19:50,755 Integration." 712 00:19:50,756 --> 00:19:51,923 Basically, instead of acquiring 713 00:19:51,924 --> 00:19:53,425 More and more competitors in the 714 00:19:53,426 --> 00:19:54,926 Insurance field, united's 715 00:19:54,927 --> 00:19:56,494 Focused on acquiring more and 716 00:19:56,495 --> 00:19:57,062 More parts of the healthcare 717 00:19:57,063 --> 00:19:58,997 Industry. 718 00:19:58,998 --> 00:20:00,432 And to be fair, it's not the 719 00:20:00,433 --> 00:20:02,333 Only company doing this. 720 00:20:02,334 --> 00:20:02,934 Cvs health, for instance, has 721 00:20:02,935 --> 00:20:03,935 Built a similar 722 00:20:03,936 --> 00:20:05,437 Vertically-integrated behemoth 723 00:20:05,438 --> 00:20:06,938 As, in addition to its 724 00:20:06,939 --> 00:20:09,474 Drugstores, it also owns a 725 00:20:09,475 --> 00:20:10,475 Massive insurer, aetna, and a 726 00:20:10,476 --> 00:20:13,445 Pharmacy benefit manager, cvs 727 00:20:13,446 --> 00:20:14,079 Caremark, while also having its 728 00:20:14,080 --> 00:20:15,046 Own medical clinics, all of whom 729 00:20:15,047 --> 00:20:16,514 Subtly share the same heart in 730 00:20:16,515 --> 00:20:17,048 Their logo. 731 00:20:17,049 --> 00:20:21,453 And honestly? 732 00:20:21,454 --> 00:20:21,953 I do appreciate that. 733 00:20:21,954 --> 00:20:22,454 When i'm picking up my 734 00:20:22,455 --> 00:20:23,555 Prescriptions at cvs after 735 00:20:23,556 --> 00:20:24,756 Spending 45 minutes asking 736 00:20:24,757 --> 00:20:26,958 Someone to unlock every shelf 737 00:20:26,959 --> 00:20:27,492 For me, it is nice to feel 738 00:20:27,493 --> 00:20:29,961 Loved. 739 00:20:29,962 --> 00:20:33,965 I'm so sorry for wanting to shop 740 00:20:33,966 --> 00:20:39,971 At your store. 741 00:20:39,972 --> 00:20:41,606 But amazingly, united is even 742 00:20:41,607 --> 00:20:42,173 Bigger. 743 00:20:42,174 --> 00:20:44,976 It has about 2700 subsidiaries, 744 00:20:44,977 --> 00:20:47,145 Including "primary care clinics, 745 00:20:47,146 --> 00:20:48,480 Surgical centers, urgent care 746 00:20:48,481 --> 00:20:50,482 Centers, home health agencies, 747 00:20:50,483 --> 00:20:52,984 Hospice agencies, mental health 748 00:20:52,985 --> 00:20:54,486 Agencies, a pharmacy benefit 749 00:20:54,487 --> 00:20:57,489 Manager and plenty more." 750 00:20:57,490 --> 00:20:57,989 To name just a few. 751 00:20:57,990 --> 00:20:58,790 Through its subsidiary optum, 752 00:20:58,791 --> 00:20:59,491 Unitedhealth group directly 753 00:20:59,492 --> 00:21:00,125 Employs about 9,000 physicians, 754 00:21:00,126 --> 00:21:00,759 And has non-exclusive contracts 755 00:21:00,760 --> 00:21:01,226 With some 80,000 more. 756 00:21:01,227 --> 00:21:01,993 Meanwhile, another united 757 00:21:01,994 --> 00:21:02,627 Subsidiary, optumrx, manages 62 758 00:21:02,628 --> 00:21:04,496 Million patients' prescriptions. 759 00:21:04,497 --> 00:21:06,998 The company even has its own 760 00:21:06,999 --> 00:21:07,999 Bank, optum bank, which has 761 00:21:08,000 --> 00:21:08,533 Twenty billion dollars in 762 00:21:08,534 --> 00:21:11,002 Assets. 763 00:21:11,003 --> 00:21:12,537 And the company will claim that 764 00:21:12,538 --> 00:21:13,304 All of its acquisitions have 765 00:21:13,305 --> 00:21:15,006 Helped it "coordinate and align 766 00:21:15,007 --> 00:21:16,007 Incentives" to deliver what 767 00:21:16,008 --> 00:21:17,509 Industry leaders refer to as 768 00:21:17,510 --> 00:21:20,011 "value-based care." 769 00:21:20,012 --> 00:21:26,017 And that notion-- that all its 770 00:21:26,018 --> 00:21:27,018 Subsidiaries really add up to 771 00:21:27,019 --> 00:21:27,652 More than the sum of their parts 772 00:21:27,653 --> 00:21:28,219 -- is something they love to 773 00:21:28,220 --> 00:21:28,820 Hammer home in upbeat ads like 774 00:21:28,821 --> 00:21:29,420 This one, about the company's 775 00:21:29,421 --> 00:21:30,889 Prescription benefits: 776 00:21:30,890 --> 00:21:32,023 >> before mark even picks up his 777 00:21:32,024 --> 00:21:33,024 Prescription, unitedhealth group 778 00:21:33,025 --> 00:21:35,527 Goes into action. 779 00:21:35,528 --> 00:21:36,694 Mark's doctor gets real-time 780 00:21:36,695 --> 00:21:38,496 Information to prescribe the 781 00:21:38,497 --> 00:21:39,063 Most effective, lowest cost 782 00:21:39,064 --> 00:21:40,532 Medication. 783 00:21:40,533 --> 00:21:41,533 Mark's medical and pharmacy 784 00:21:41,534 --> 00:21:43,535 Information are connected, 785 00:21:43,536 --> 00:21:44,602 Allowing clinical experts to 786 00:21:44,603 --> 00:21:45,537 Hone-in on any possible risks 787 00:21:45,538 --> 00:21:48,039 With the prescription. 788 00:21:48,040 --> 00:21:48,573 And mark's about to get a 789 00:21:48,574 --> 00:21:51,042 Discount at the counter. 790 00:21:51,043 --> 00:21:52,043 Working behind the scenes to 791 00:21:52,044 --> 00:21:53,545 Ensure quality and savings. 792 00:21:53,546 --> 00:21:55,547 This is what healthcare can do 793 00:21:55,548 --> 00:21:57,048 When it's caring and smart. 794 00:21:57,049 --> 00:21:58,082 Unitedhealth group. 795 00:21:58,083 --> 00:21:59,050 >> john: well that sounds nice, 796 00:21:59,051 --> 00:22:00,552 Doesn't it! 797 00:22:00,553 --> 00:22:02,153 It almost makes united seem more 798 00:22:02,154 --> 00:22:04,055 Like a farm-to-table restaurant 799 00:22:04,056 --> 00:22:05,557 Instead of a massive 800 00:22:05,558 --> 00:22:08,059 Data-sharing panopticon. 801 00:22:08,060 --> 00:22:10,061 But owning all these companies 802 00:22:10,062 --> 00:22:11,563 Is hugely helpful to united's 803 00:22:11,564 --> 00:22:12,130 Bottom line, and in ways you 804 00:22:12,131 --> 00:22:14,065 Might not expect. 805 00:22:14,066 --> 00:22:17,068 For instance, if you ask united 806 00:22:17,069 --> 00:22:17,702 Healthcare, the insurer, they'll 807 00:22:17,703 --> 00:22:18,369 Insist they barely make money at 808 00:22:18,370 --> 00:22:18,636 All. 809 00:22:18,637 --> 00:22:20,738 They'll claim their insurance 810 00:22:20,739 --> 00:22:21,306 Profits are only around five 811 00:22:21,307 --> 00:22:22,073 Percent. 812 00:22:22,074 --> 00:22:23,575 They'll also point out that 813 00:22:23,576 --> 00:22:24,142 Their insurance profits are 814 00:22:24,143 --> 00:22:25,076 Capped, because under the 815 00:22:25,077 --> 00:22:27,078 Affordable care act, they're 816 00:22:27,079 --> 00:22:28,079 Required to spend 80 to 85% of 817 00:22:28,080 --> 00:22:30,582 The premiums they collect 818 00:22:30,583 --> 00:22:31,416 Directly on patient care, or on 819 00:22:31,417 --> 00:22:33,585 Quality improvements. 820 00:22:33,586 --> 00:22:34,586 What they don't say quite as 821 00:22:34,587 --> 00:22:36,588 Loudly, though, is that that 822 00:22:36,589 --> 00:22:37,589 Only applies to the insurance 823 00:22:37,590 --> 00:22:40,091 Side of the company. 824 00:22:40,092 --> 00:22:41,593 Unitedhealth "group", on the 825 00:22:41,594 --> 00:22:42,227 Other hand, makes a shit-ton of 826 00:22:42,228 --> 00:22:45,096 Money. 827 00:22:45,097 --> 00:22:46,431 And one of the key ways it can 828 00:22:46,432 --> 00:22:47,098 Do that is through its 829 00:22:47,099 --> 00:22:48,733 Vertically integrated model, 830 00:22:48,734 --> 00:22:50,602 Because it's often on both sides 831 00:22:50,603 --> 00:22:51,135 Of billions of dollars in 832 00:22:51,136 --> 00:22:57,609 Transactions. 833 00:22:57,610 --> 00:22:58,643 Very basically, when united's 834 00:22:58,644 --> 00:22:59,310 Insurance arm is paying out that 835 00:22:59,311 --> 00:23:00,111 Mandatory 80 to 85 percent on 836 00:23:00,112 --> 00:23:00,712 Healthcare, the company on the 837 00:23:00,713 --> 00:23:01,613 Other end of that transaction is 838 00:23:01,614 --> 00:23:04,616 Often also united. 839 00:23:04,617 --> 00:23:05,683 And it can use its ownership of 840 00:23:05,684 --> 00:23:06,818 One part of the healthcare 841 00:23:06,819 --> 00:23:10,121 System, very much to its 842 00:23:10,122 --> 00:23:10,588 Advantage in another. 843 00:23:10,589 --> 00:23:11,623 Take "upcoding". 844 00:23:11,624 --> 00:23:13,124 It's the practice of making a 845 00:23:13,125 --> 00:23:15,126 Patient look as sick as possible 846 00:23:15,127 --> 00:23:16,628 On paper, to make more money. 847 00:23:16,629 --> 00:23:18,129 For an example of this concept, 848 00:23:18,130 --> 00:23:19,631 Just watch this scene from the 849 00:23:19,632 --> 00:23:20,632 Fox medical drama "the 850 00:23:20,633 --> 00:23:22,133 Resident", where an outside 851 00:23:22,134 --> 00:23:23,635 Consultant is telling a roomful 852 00:23:23,636 --> 00:23:24,702 Of doctors how she wants them to 853 00:23:24,703 --> 00:23:27,138 Upcode: 854 00:23:27,139 --> 00:23:28,139 >> now, to simplify, doctors and 855 00:23:28,140 --> 00:23:29,707 Nurses at chastain need to 856 00:23:29,708 --> 00:23:31,643 Charge more per procedure. 857 00:23:31,644 --> 00:23:34,145 For example, ear infection. 858 00:23:34,146 --> 00:23:36,648 Typically billed to insurance as 859 00:23:36,649 --> 00:23:38,149 Service code one at about... 860 00:23:38,150 --> 00:23:40,652 Yeah? 861 00:23:40,653 --> 00:23:42,320 >> $200. 862 00:23:42,321 --> 00:23:44,155 >> but what if that ear 863 00:23:44,156 --> 00:23:44,722 Infection took a trip to the 864 00:23:44,723 --> 00:23:45,657 Brain? 865 00:23:45,658 --> 00:23:46,658 That's now a code four. 866 00:23:46,659 --> 00:23:48,159 Serious. 867 00:23:48,160 --> 00:23:49,661 Costly. 868 00:23:49,662 --> 00:23:52,163 We can bill in the thousands. 869 00:23:52,164 --> 00:23:53,164 Illness is unpredictable, so 870 00:23:53,165 --> 00:23:54,666 Billing must be proactive. 871 00:23:54,667 --> 00:23:55,667 Right? 872 00:23:55,668 --> 00:24:00,171 It's called upcoding. 873 00:24:00,172 --> 00:24:01,673 Think... "cute." 874 00:24:01,674 --> 00:24:02,173 Code. 875 00:24:02,174 --> 00:24:02,340 Up. 876 00:24:02,341 --> 00:24:03,174 To. 877 00:24:03,175 --> 00:24:04,676 Excellence. 878 00:24:04,677 --> 00:24:06,844 >> john: yeah, turns out 879 00:24:06,845 --> 00:24:08,179 Upcoding is so common, they're 880 00:24:08,180 --> 00:24:15,187 Making fun of it on network tv. 881 00:24:17,690 --> 00:24:18,222 Which is just wild to me. 882 00:24:18,223 --> 00:24:19,057 It's being explained in the same 883 00:24:19,058 --> 00:24:19,691 Place where people watch 884 00:24:19,692 --> 00:24:20,291 "survivor", "dancing with the 885 00:24:20,292 --> 00:24:20,758 Stars" and "tracker". 886 00:24:20,759 --> 00:24:21,292 Oh, you've never heard of 887 00:24:21,293 --> 00:24:21,559 "tracker"? 888 00:24:21,560 --> 00:24:22,694 Over 16 million people watch it. 889 00:24:22,695 --> 00:24:23,695 More people have watched 890 00:24:23,696 --> 00:24:30,201 "tracker" than have ever watched 891 00:24:30,202 --> 00:24:31,703 A single episode of this show. 892 00:24:31,704 --> 00:24:32,103 What's it about? 893 00:24:32,104 --> 00:24:32,737 I dunno, jeremy tracker tracking 894 00:24:32,738 --> 00:24:33,338 Things? 895 00:24:33,339 --> 00:24:34,706 There's no way to know. 896 00:24:34,707 --> 00:24:36,207 But people fucking love it. 897 00:24:36,208 --> 00:24:37,875 And while it's not strictly 898 00:24:37,876 --> 00:24:38,710 Necessary to understand the rest 899 00:24:38,711 --> 00:24:40,712 Of this story, i'd be remiss if 900 00:24:40,713 --> 00:24:41,846 I didn't tell you that, in that 901 00:24:41,847 --> 00:24:42,714 Same episode, that consultant 902 00:24:42,715 --> 00:24:43,715 Gets in trouble after ordering a 903 00:24:43,716 --> 00:24:46,117 Patient get an expensive mri he 904 00:24:46,118 --> 00:24:46,684 Doesn't need, and then this 905 00:24:46,685 --> 00:24:47,719 Happens: 906 00:24:47,720 --> 00:24:48,653 >> mr. Reynolds, do you know how 907 00:24:48,654 --> 00:24:50,722 An mri works? 908 00:24:50,723 --> 00:24:51,389 It has incredibly powerful 909 00:24:51,390 --> 00:24:53,224 Magnets. 910 00:24:53,225 --> 00:24:54,459 Magnets that will rip anything 911 00:24:54,460 --> 00:24:55,126 Metal out of your body. 912 00:24:55,127 --> 00:24:56,761 Anything at all. 913 00:24:56,762 --> 00:24:58,229 Do you have anything metal in 914 00:24:58,230 --> 00:25:03,735 Your body, mr. Reynolds? 915 00:25:03,736 --> 00:25:04,736 Mr. Reynolds has a penile 916 00:25:04,737 --> 00:25:05,370 Implant, a metal-based penile 917 00:25:05,371 --> 00:25:08,239 Implant. 918 00:25:08,240 --> 00:25:08,873 How much is your penis worth to 919 00:25:08,874 --> 00:25:09,474 You, mr. Reynolds? 920 00:25:09,475 --> 00:25:09,907 Say, in a lawsuit? 921 00:25:09,908 --> 00:25:10,341 A million dollars? 922 00:25:10,342 --> 00:25:11,109 Five million dollars? 923 00:25:11,110 --> 00:25:12,577 >> stop the machine! 924 00:25:12,578 --> 00:25:14,345 >> john: yes! 925 00:25:14,346 --> 00:25:15,747 More shows should be brave 926 00:25:15,748 --> 00:25:16,748 Enough to have a character ask 927 00:25:16,749 --> 00:25:18,249 The question, "how much is your 928 00:25:18,250 --> 00:25:20,251 Penis worth to you?" 929 00:25:20,252 --> 00:25:22,253 You know how many times "the 930 00:25:22,254 --> 00:25:22,720 Pitt" has asked that? 931 00:25:22,721 --> 00:25:24,756 Fucking zero. 932 00:25:24,757 --> 00:25:27,759 Take back that emmy. 933 00:25:27,760 --> 00:25:30,762 Now, in that clip, doctors were 934 00:25:30,763 --> 00:25:31,329 The ones being encouraged to 935 00:25:31,330 --> 00:25:32,764 Upcode so their hospital could 936 00:25:32,765 --> 00:25:34,766 Charge insurers more. 937 00:25:34,767 --> 00:25:35,767 But as we discussed in our 938 00:25:35,768 --> 00:25:37,802 Episode on medicare advantage, 939 00:25:37,803 --> 00:25:39,270 Insurance companies can also 940 00:25:39,271 --> 00:25:40,772 Benefit from upcoding, to get 941 00:25:40,773 --> 00:25:44,776 More money from the government. 942 00:25:44,777 --> 00:25:45,376 Very basically, under medicare 943 00:25:45,377 --> 00:25:46,277 Advantage, the government will 944 00:25:46,278 --> 00:25:47,278 Pay insurers a higher rate for 945 00:25:47,279 --> 00:25:47,812 Patients with more serious 946 00:25:47,813 --> 00:25:49,280 Conditions. 947 00:25:49,281 --> 00:25:51,282 That was meant to discourage 948 00:25:51,283 --> 00:25:51,883 Them from cherry-picking only 949 00:25:51,884 --> 00:25:54,786 The healthiest people. 950 00:25:54,787 --> 00:25:55,386 But obviously, that also means 951 00:25:55,387 --> 00:25:56,287 That the sicker insurance 952 00:25:56,288 --> 00:25:57,688 Companies can make their 953 00:25:57,689 --> 00:25:58,289 Customers look, the more money 954 00:25:58,290 --> 00:26:00,291 They can then claim. 955 00:26:00,292 --> 00:26:01,292 And it turns out, as 956 00:26:01,293 --> 00:26:02,860 Unitedhealth has gobbled up 957 00:26:02,861 --> 00:26:06,798 Medical practices through its 958 00:26:06,799 --> 00:26:07,365 Optum subsidiary, doctors at 959 00:26:07,366 --> 00:26:07,965 Those clinics have said it's 960 00:26:07,966 --> 00:26:10,301 Placed enormous pressure on them 961 00:26:10,302 --> 00:26:10,902 To code patients intensively. 962 00:26:10,903 --> 00:26:12,804 Although, fun fact, they don't 963 00:26:12,805 --> 00:26:18,309 Use the acronym "cute". 964 00:26:18,310 --> 00:26:22,313 That would obviously be 965 00:26:22,314 --> 00:26:22,613 Ridiculous. 966 00:26:22,614 --> 00:26:23,247 Instead, their coding guidebook 967 00:26:23,248 --> 00:26:23,748 Tells doctors to use the 968 00:26:23,749 --> 00:26:24,382 Mnemonic "treatment, assessment, 969 00:26:24,383 --> 00:26:24,982 Monitor, plan, evaluation, and 970 00:26:24,983 --> 00:26:27,318 Referral", or "tamper." 971 00:26:27,319 --> 00:26:31,823 And i don't know, guys. 972 00:26:31,824 --> 00:26:32,457 Personally, i might've picked an 973 00:26:32,458 --> 00:26:33,491 Acronym with a less negative 974 00:26:33,492 --> 00:26:33,825 Connotation. 975 00:26:33,826 --> 00:26:34,392 Because what kinds of things 976 00:26:34,393 --> 00:26:37,328 Does someone tamper with? 977 00:26:37,329 --> 00:26:37,929 So far i've got evidence, and, 978 00:26:37,930 --> 00:26:40,832 End of list. 979 00:26:40,833 --> 00:26:42,867 And while united will claim they 980 00:26:42,868 --> 00:26:43,835 Have robust safeguards to ensure 981 00:26:43,836 --> 00:26:45,336 Accurate coding, it's reportedly 982 00:26:45,337 --> 00:26:46,404 Pressured its doctors to code as 983 00:26:46,405 --> 00:26:49,841 Many conditions as possible by 984 00:26:49,842 --> 00:26:50,441 Offering bonuses to those who 985 00:26:50,442 --> 00:26:50,942 Coded aggressively, and 986 00:26:50,943 --> 00:26:52,343 Reviewing the performance of 987 00:26:52,344 --> 00:26:53,845 Those who weren't coding as 988 00:26:53,846 --> 00:26:54,045 Much. 989 00:26:54,046 --> 00:26:55,346 In fact, doctors have even 990 00:26:55,347 --> 00:26:56,347 Described being emailed a kind 991 00:26:56,348 --> 00:26:58,916 Of "leaderboard" that compared 992 00:26:58,917 --> 00:26:59,884 Them locally, and nationally, by 993 00:26:59,885 --> 00:27:01,619 The percentage of their medicare 994 00:27:01,620 --> 00:27:02,353 Advantage patients that they'd 995 00:27:02,354 --> 00:27:03,354 Diagnosed with certain chronic 996 00:27:03,355 --> 00:27:04,856 Diseases. 997 00:27:04,857 --> 00:27:08,359 And all this aggressive coding 998 00:27:08,360 --> 00:27:08,926 Has made united a fuckton of 999 00:27:08,927 --> 00:27:10,361 Money. 1000 00:27:10,362 --> 00:27:12,363 In fact, one study found it 1001 00:27:12,364 --> 00:27:13,865 Receives 12 billion dollars a 1002 00:27:13,866 --> 00:27:14,866 Year in additional payments 1003 00:27:14,867 --> 00:27:16,367 Because of "higher coding 1004 00:27:16,368 --> 00:27:18,870 Intensity" alone. 1005 00:27:18,871 --> 00:27:20,972 And that's by no means the only 1006 00:27:20,973 --> 00:27:22,373 Way united pressures doctors. 1007 00:27:22,374 --> 00:27:24,375 Those in formerly independent 1008 00:27:24,376 --> 00:27:25,877 Practices acquired by optum have 1009 00:27:25,878 --> 00:27:26,878 Said it's also overhauled their 1010 00:27:26,879 --> 00:27:28,913 Schedules, with some required to 1011 00:27:28,914 --> 00:27:29,881 See three to four patients an 1012 00:27:29,882 --> 00:27:30,882 Hour, and complaining they 1013 00:27:30,883 --> 00:27:34,385 Barely found time to eat or pee. 1014 00:27:34,386 --> 00:27:34,886 In fact, one doctor in 1015 00:27:34,887 --> 00:27:36,621 Massachusetts who retired after 1016 00:27:36,622 --> 00:27:37,622 Optum acquired her practice 1017 00:27:37,623 --> 00:27:38,956 Said, "i feel just like an 1018 00:27:38,957 --> 00:27:40,625 Amazon warehouse worker, where 1019 00:27:40,626 --> 00:27:41,893 All i'm doing is 20 minutes, 20 1020 00:27:41,894 --> 00:27:42,660 Minutes, 20 minutes, 20 1021 00:27:42,661 --> 00:27:47,899 Minutes." 1022 00:27:47,900 --> 00:27:49,033 Which obviously isn't great! 1023 00:27:49,034 --> 00:27:49,600 Doctors shouldn't feel like 1024 00:27:49,601 --> 00:27:50,735 Amazon warehouse workers. 1025 00:27:50,736 --> 00:27:51,402 Not even amazon warehouse 1026 00:27:51,403 --> 00:27:53,404 Workers should feel like amazon 1027 00:27:53,405 --> 00:27:54,906 Warehouse workers, but that's a 1028 00:27:54,907 --> 00:27:56,874 Story for another show we've 1029 00:27:56,875 --> 00:27:59,410 Already done. 1030 00:27:59,411 --> 00:28:01,846 And the thing is, because 1031 00:28:01,847 --> 00:28:03,414 United's so massive, even 1032 00:28:03,415 --> 00:28:08,920 Doctors who don't work directly 1033 00:28:08,921 --> 00:28:09,554 For them can wind up negatively 1034 00:28:09,555 --> 00:28:10,321 Impacted by them, and sometimes 1035 00:28:10,322 --> 00:28:10,922 In surprising ways. 1036 00:28:10,923 --> 00:28:12,924 Take "change healthcare." 1037 00:28:12,925 --> 00:28:13,357 It's a united-owned 1038 00:28:13,358 --> 00:28:14,392 Clearinghouse that processes 1039 00:28:14,393 --> 00:28:15,927 More than a third of all u.s. 1040 00:28:15,928 --> 00:28:17,428 Claims between pharmacies, 1041 00:28:17,429 --> 00:28:19,430 Doctors, hospitals and insurers. 1042 00:28:19,431 --> 00:28:21,933 That's a lot! 1043 00:28:21,934 --> 00:28:22,934 But there are real hazards to 1044 00:28:22,935 --> 00:28:23,501 Letting one company be that 1045 00:28:23,502 --> 00:28:24,602 Dominant. 1046 00:28:24,603 --> 00:28:26,604 Something that became painfully 1047 00:28:26,605 --> 00:28:28,940 Clear in february 2024, when it 1048 00:28:28,941 --> 00:28:30,074 Was subject to a massive russian 1049 00:28:30,075 --> 00:28:31,943 Ransomware attack. 1050 00:28:31,944 --> 00:28:33,544 >> at this busy new hyde park 1051 00:28:33,545 --> 00:28:34,946 Medical practice, claims cannot 1052 00:28:34,947 --> 00:28:36,447 Get submitted, doctors aren't 1053 00:28:36,448 --> 00:28:38,849 Getting paid, procedures aren't 1054 00:28:38,850 --> 00:28:39,183 Getting needed 1055 00:28:39,184 --> 00:28:40,952 Pre-authorization. 1056 00:28:40,953 --> 00:28:42,520 Change health, owned by 1057 00:28:42,521 --> 00:28:43,955 Unitedhealth, which handles much 1058 00:28:43,956 --> 00:28:46,257 Of the nation's medical records, 1059 00:28:46,258 --> 00:28:47,458 Was hacked three weeks ago. 1060 00:28:47,459 --> 00:28:49,760 >> a huge part of that system is 1061 00:28:49,761 --> 00:28:51,295 Down, and the people responsible 1062 00:28:51,296 --> 00:28:52,463 For making it work aren't 1063 00:28:52,464 --> 00:28:54,599 Stepping up to the plate. 1064 00:28:54,600 --> 00:28:56,467 >> ronald laszlo went 10 days 1065 00:28:56,468 --> 00:28:58,469 Without medicine he needs to 1066 00:28:58,470 --> 00:29:00,471 Prevent a transplanted kidney 1067 00:29:00,472 --> 00:29:01,472 From being rejected, because the 1068 00:29:01,473 --> 00:29:02,540 Pharmacy couldn't get 1069 00:29:02,541 --> 00:29:03,975 Authorization. 1070 00:29:03,976 --> 00:29:07,478 >> the bottom line is, it could 1071 00:29:07,479 --> 00:29:09,480 Kill you. 1072 00:29:09,481 --> 00:29:10,481 >> john: that's obviously awful. 1073 00:29:10,482 --> 00:29:12,416 But what makes it especially 1074 00:29:12,417 --> 00:29:13,184 Infuriating is that apparently, 1075 00:29:13,185 --> 00:29:14,485 One reason the system was so 1076 00:29:14,486 --> 00:29:15,486 Easy to hack is that the 1077 00:29:15,487 --> 00:29:17,488 Company's portal did not have 1078 00:29:17,489 --> 00:29:19,991 Multi-factor authentication. 1079 00:29:19,992 --> 00:29:22,360 Which is just insane. 1080 00:29:22,361 --> 00:29:24,495 As a rule, medical record 1081 00:29:24,496 --> 00:29:26,564 Platforms should be required to 1082 00:29:26,565 --> 00:29:27,498 Have operational security at 1083 00:29:27,499 --> 00:29:28,499 Least as good as the buffalo 1084 00:29:28,500 --> 00:29:35,507 Wild wings app. 1085 00:29:39,011 --> 00:29:39,577 And notice i didn't even say 1086 00:29:39,578 --> 00:29:40,511 Better, there. 1087 00:29:40,512 --> 00:29:41,145 I just said at least as good as 1088 00:29:41,146 --> 00:29:41,746 The app that lets you order a 1089 00:29:41,747 --> 00:29:42,413 Bacon-smashed hatch chili burger 1090 00:29:42,414 --> 00:29:42,980 With a whole chocolate fudge 1091 00:29:42,981 --> 00:29:46,517 Cake for dessert. 1092 00:29:46,518 --> 00:29:47,518 At least meet that fucking bar. 1093 00:29:47,519 --> 00:29:48,586 Now, the good news for all those 1094 00:29:48,587 --> 00:29:49,053 Doctors' offices whose 1095 00:29:49,054 --> 00:29:51,188 Businesses were massively 1096 00:29:51,189 --> 00:29:52,123 Disrupted by that hack is that 1097 00:29:52,124 --> 00:29:55,092 United-- through its bank 1098 00:29:55,093 --> 00:29:55,693 Subsidiary-- quickly offered 1099 00:29:55,694 --> 00:29:56,827 Them no-interest bridge loans. 1100 00:29:56,828 --> 00:29:58,195 Basically, it was using one part 1101 00:29:58,196 --> 00:29:59,597 Of its company to clean up a 1102 00:29:59,598 --> 00:30:00,564 Mess that another part had just 1103 00:30:00,565 --> 00:30:03,534 Made. 1104 00:30:03,535 --> 00:30:04,268 Unfortunately, the bank then 1105 00:30:04,269 --> 00:30:05,536 Caused a different problem by 1106 00:30:05,537 --> 00:30:07,038 Demanding full repayment of 1107 00:30:07,039 --> 00:30:08,539 Those loans little more than a 1108 00:30:08,540 --> 00:30:10,508 Year later, even threatening to 1109 00:30:10,509 --> 00:30:12,043 Withhold insurance payments from 1110 00:30:12,044 --> 00:30:13,210 If providers 1111 00:30:13,211 --> 00:30:15,546 Didns 1112 00:34:45,483 --> 00:34:45,916 Doctor, to get him a 1113 00:34:45,917 --> 00:34:46,417 Prescription for a more 1114 00:34:46,418 --> 00:34:47,818 Affordable alternative. 1115 00:34:47,819 --> 00:34:49,820 Which they apparently didn't. 1116 00:34:49,821 --> 00:34:52,823 But the thing is, even if they 1117 00:34:52,824 --> 00:34:53,824 Had, as anyone who's ever dealt 1118 00:34:53,825 --> 00:34:55,826 With an overworked doctor's 1119 00:34:55,827 --> 00:34:58,362 Office can tell you, getting a 1120 00:34:58,363 --> 00:34:59,830 New prescription isn't a quick 1121 00:34:59,831 --> 00:35:00,064 Process. 1122 00:35:00,065 --> 00:35:02,333 It takes time. 1123 00:35:02,334 --> 00:35:02,933 And unfortunately, cole needed 1124 00:35:02,934 --> 00:35:05,836 Those meds immediately. 1125 00:35:05,837 --> 00:35:06,470 Because i'll let his father pick 1126 00:35:06,471 --> 00:35:07,838 Up the story from there. 1127 00:35:07,839 --> 00:35:09,707 >> he says cole called him 1128 00:35:09,708 --> 00:35:10,240 Minutes after leaving the 1129 00:35:10,241 --> 00:35:12,843 Walgreens. 1130 00:35:12,844 --> 00:35:13,944 >> i could sense that, you know, 1131 00:35:13,945 --> 00:35:15,346 He was having an asthma attack. 1132 00:35:15,347 --> 00:35:16,347 His purpose of the call was 1133 00:35:16,348 --> 00:35:17,414 Simply to ask about his 1134 00:35:17,415 --> 00:35:18,349 Insurance. 1135 00:35:18,350 --> 00:35:19,650 And i said, don't worry about 1136 00:35:19,651 --> 00:35:21,719 That, just get to the hospital. 1137 00:35:21,720 --> 00:35:22,553 >> a roommate drove cole to the 1138 00:35:22,554 --> 00:35:24,355 Hospital, but cole was 1139 00:35:24,356 --> 00:35:24,989 Unconscious by the time they got 1140 00:35:24,990 --> 00:35:26,457 There. 1141 00:35:26,458 --> 00:35:28,859 He died days later. 1142 00:35:28,860 --> 00:35:29,860 >> he couldn't get his advair 1143 00:35:29,861 --> 00:35:31,862 That night and we were told by 1144 00:35:31,863 --> 00:35:35,366 His roommate that it was over 1145 00:35:35,367 --> 00:35:36,367 $500, and, you know, cole had to 1146 00:35:36,368 --> 00:35:40,371 Make a decision that night of 1147 00:35:40,372 --> 00:35:42,239 Paying that exorbitant price for 1148 00:35:42,240 --> 00:35:44,875 His medicine or other bills, and 1149 00:35:44,876 --> 00:35:46,377 Apparently he-- well, not 1150 00:35:46,378 --> 00:35:46,910 Apparently, he walked out 1151 00:35:46,911 --> 00:35:47,878 Without it. 1152 00:35:47,879 --> 00:35:48,545 >> john: that's an absolute 1153 00:35:48,546 --> 00:35:49,380 Tragedy. 1154 00:35:49,381 --> 00:35:49,880 And it was completely 1155 00:35:49,881 --> 00:35:52,383 Preventable. 1156 00:35:52,384 --> 00:35:54,585 This is the richest country in 1157 00:35:54,586 --> 00:35:55,386 The history of the world, and 1158 00:35:55,387 --> 00:35:56,453 Yet, for some reason, our 1159 00:35:56,454 --> 00:35:57,988 Current health system still 1160 00:35:57,989 --> 00:35:58,889 Forces people to walk away from 1161 00:35:58,890 --> 00:36:00,557 Medicine that will literally 1162 00:36:00,558 --> 00:36:01,158 Keep them alive, because they 1163 00:36:01,159 --> 00:36:08,166 Can't afford it. 1164 00:36:08,400 --> 00:36:08,966 So what can we do about all 1165 00:36:08,967 --> 00:36:09,166 This? 1166 00:36:09,167 --> 00:36:10,367 Well, i'd argue the broadest 1167 00:36:10,368 --> 00:36:10,934 Solution is to find a way to 1168 00:36:10,935 --> 00:36:11,902 Transition to a single payer 1169 00:36:11,903 --> 00:36:13,037 Healthcare system. 1170 00:36:13,038 --> 00:36:15,406 That would solve many of the 1171 00:36:15,407 --> 00:36:19,910 Problems you've seen tonight. 1172 00:36:19,911 --> 00:36:20,411 [cheering and applause] 1173 00:36:20,412 --> 00:36:21,578 And though getting anywhere 1174 00:36:21,579 --> 00:36:22,046 Close to that feels a 1175 00:36:22,047 --> 00:36:23,914 Ridiculously long way off, i 1176 00:36:23,915 --> 00:36:24,548 Don't think it's unreasonable to 1177 00:36:24,549 --> 00:36:25,883 Say that at the very least, 1178 00:36:25,884 --> 00:36:26,950 Unitedhealth group should not be 1179 00:36:26,951 --> 00:36:27,985 Allowed to exist in the form it 1180 00:36:27,986 --> 00:36:33,424 Currently does. 1181 00:36:33,425 --> 00:36:33,924 [cheering and applause] 1182 00:36:33,925 --> 00:36:34,525 There's actually a bipartisan 1183 00:36:34,526 --> 00:36:35,092 Bill right now, sponsored by 1184 00:36:35,093 --> 00:36:35,626 Elizabeth warren and josh 1185 00:36:35,627 --> 00:36:36,427 Hawley, that'd separate the 1186 00:36:36,428 --> 00:36:37,428 Payer and provider roles in 1187 00:36:37,429 --> 00:36:38,929 Healthcare, so that united 1188 00:36:38,930 --> 00:36:40,931 Couldn't be in the situation 1189 00:36:40,932 --> 00:36:42,933 Where it can just pay itself. 1190 00:36:42,934 --> 00:36:45,402 And while that's clearly not 1191 00:36:45,403 --> 00:36:46,036 Going nearly far enough, it's at 1192 00:36:46,037 --> 00:36:53,044 Least a start. 1193 00:36:58,450 --> 00:36:58,982 And i know united may well 1194 00:36:58,983 --> 00:36:59,616 Continue to try to "tune out the 1195 00:36:59,617 --> 00:37:00,217 Critical noise", or argue that 1196 00:37:00,218 --> 00:37:00,884 "nobody designed this system, it 1197 00:37:00,885 --> 00:37:01,218 Just evolved." 1198 00:37:01,219 --> 00:37:01,719 But what's clear is that 1199 00:37:01,720 --> 00:37:05,956 Everyone but them wants it to 1200 00:37:05,957 --> 00:37:06,957 Work very differently. 1201 00:37:06,958 --> 00:37:07,958 Because right now, the way 1202 00:37:07,959 --> 00:37:08,525 Companies like united exist, 1203 00:37:08,526 --> 00:37:09,893 They're at best pointless, 1204 00:37:09,894 --> 00:37:10,494 Time-wasting middlemen, and at 1205 00:37:10,495 --> 00:37:13,464 Worst, algorithmically driven, 1206 00:37:13,465 --> 00:37:14,064 Ruthless arbiters of who lives 1207 00:37:14,065 --> 00:37:15,466 And who dies. 1208 00:37:15,467 --> 00:37:17,468 And until such time as they've 1209 00:37:17,469 --> 00:37:19,536 Made significant changes-- or, 1210 00:37:19,537 --> 00:37:21,071 Much more likely, had those 1211 00:37:21,072 --> 00:37:22,473 Changes forced upon them-- 1212 00:37:22,474 --> 00:37:24,975 Then, in the words of my new 1213 00:37:24,976 --> 00:37:26,977 Favorite health care provider: 1214 00:37:26,978 --> 00:37:28,979 >> may they have explosive 1215 00:37:28,980 --> 00:37:29,980 Diarrhea, not just tonight, but 1216 00:37:29,981 --> 00:37:33,984 Every night. 1217 00:37:33,985 --> 00:37:35,986 [cheering and applause] 1218 00:37:35,987 --> 00:37:37,654 >> john: exactly. 1219 00:37:37,655 --> 00:37:39,590 And now, this. 1220 00:37:39,591 --> 00:37:40,691 >> announcer: and now, behold 1221 00:37:40,692 --> 00:37:43,560 The symphony of chaos that is 1222 00:37:43,561 --> 00:37:45,496 Postgame interviews at women's 1223 00:37:45,497 --> 00:37:46,330 College softball. 1224 00:37:46,331 --> 00:37:47,498 >> i knew i had to come through 1225 00:37:47,499 --> 00:37:48,999 With my team. 1226 00:37:49,000 --> 00:37:51,001 I feel like this year more than 1227 00:37:51,002 --> 00:37:52,503 Ever, i have kind of been 1228 00:37:52,504 --> 00:37:53,504 -- i. Have taken on kind of a 1229 00:37:53,505 --> 00:37:54,304 Leadership role. 1230 00:37:54,305 --> 00:37:56,607 I know i had to get it done. 1231 00:37:56,608 --> 00:37:58,609 And i was just thinking about 1232 00:37:58,610 --> 00:38:00,077 Megan and this team, and how 1233 00:38:00,078 --> 00:38:01,512 Much they have had my back this 1234 00:38:01,513 --> 00:38:02,012 Whole year. 1235 00:38:02,013 --> 00:38:05,015 I just wanted to make something 1236 00:38:05,016 --> 00:38:06,016 Happen. 1237 00:38:06,017 --> 00:38:07,518 >> no, i think it's just 1238 00:38:07,519 --> 00:38:09,019 Trusting my preparation and the 1239 00:38:09,020 --> 00:38:09,686 Coaches. 1240 00:38:09,687 --> 00:38:10,521 Just having a plan for us and 1241 00:38:10,522 --> 00:38:12,523 Getting us ready to compete, you 1242 00:38:12,524 --> 00:38:13,023 Know? 1243 00:38:13,024 --> 00:38:15,025 >> caroline, you had great 1244 00:38:15,026 --> 00:38:16,693 Speed, you had great movement, 1245 00:38:16,694 --> 00:38:18,529 Just hitting some key spots. 1246 00:38:18,530 --> 00:38:20,164 Tell me about the sort of 1247 00:38:20,165 --> 00:38:20,664 Scouting report. 1248 00:38:20,665 --> 00:38:22,533 >> whoever we have to play next 1249 00:38:22,534 --> 00:38:23,534 Week, we will prepare. 1250 00:38:23,535 --> 00:38:25,536 Cages, everything we need to do 1251 00:38:25,537 --> 00:38:27,037 For whoever we play. 1252 00:38:27,038 --> 00:38:29,039 >> did you know coming up to the 1253 00:38:29,040 --> 00:38:30,607 Plate in your final at bat, you 1254 00:38:30,608 --> 00:38:32,643 Were only a double play away? 1255 00:38:32,644 --> 00:38:33,744 I don't think you heard that, 1256 00:38:33,745 --> 00:38:35,546 Did you come xp when i heard a 1257 00:38:35,547 --> 00:38:35,846 Little bit. 1258 00:38:35,847 --> 00:38:37,047 >> you had to battle through a 1259 00:38:37,048 --> 00:38:37,214 Lot. 1260 00:38:37,215 --> 00:38:39,183 What is a game like this evening 1261 00:38:39,184 --> 00:38:40,617 Mean for you to come out and be 1262 00:38:40,618 --> 00:38:42,052 So dominating? 1263 00:38:42,053 --> 00:38:43,720 >> i'm just so blessed. 1264 00:38:43,721 --> 00:38:45,055 I want to give all the credit to 1265 00:38:45,056 --> 00:38:46,190 My lord and savior. 1266 00:38:46,191 --> 00:38:47,558 >> we try every day to be there 1267 00:38:47,559 --> 00:38:50,060 For each other and have each 1268 00:38:50,061 --> 00:38:50,561 Other's backs. 1269 00:38:50,562 --> 00:38:51,662 >> coming into it, we knew that 1270 00:38:51,663 --> 00:38:54,064 They would be a great team, they 1271 00:38:54,065 --> 00:38:54,398 Would attack. 1272 00:38:54,399 --> 00:38:55,232 >> we are going to come back and 1273 00:38:55,233 --> 00:38:57,067 Get this run right here, but we 1274 00:38:57,068 --> 00:38:59,203 Never have doubt in our dugout. 1275 00:38:59,204 --> 00:39:01,071 >> i think it was just our 1276 00:39:01,072 --> 00:39:01,505 Preparation before. 1277 00:39:01,506 --> 00:39:03,073 We watched a lot of film before 1278 00:39:03,074 --> 00:39:03,907 The game, we were super excited 1279 00:39:03,908 --> 00:39:05,075 To get to it. 1280 00:39:05,076 --> 00:39:06,076 We couldn't wait to start 1281 00:39:06,077 --> 00:39:07,578 Playing this week. 1282 00:39:07,579 --> 00:39:09,213 So we were just super excited 1283 00:39:09,214 --> 00:39:10,581 And focused on that. 1284 00:39:10,582 --> 00:39:12,683 All of us were excited for each 1285 00:39:12,684 --> 00:39:14,284 Other's success and we thought 1286 00:39:14,285 --> 00:39:16,086 Yesterday we were ready to see 1287 00:39:16,087 --> 00:39:16,253 It. 1288 00:39:16,254 --> 00:39:19,223 We saw a lot of it at the mound, 1289 00:39:19,224 --> 00:39:21,258 They all came through. 1290 00:39:21,259 --> 00:39:22,593 [cheering and applause] 1291 00:39:22,594 --> 00:39:23,760 >> john: that's our show, 1292 00:39:23,761 --> 00:39:25,095 Thanks so much for watching, 1293 00:39:25,096 --> 00:39:27,598 We'll see you next week. 1294 00:39:27,599 --> 00:39:28,098 Good night! 1295 00:39:28,099 --> 00:39:29,099 Thanks, that was obviously a 1296 00:39:29,100 --> 00:39:31,268 Tough show to put together. 1297 00:39:31,269 --> 00:39:33,604 Unitedhealthcare is a difficult 1298 00:39:33,605 --> 00:39:33,871 Opponent. 1299 00:39:33,872 --> 00:39:34,605 But we just tried to be there 1300 00:39:34,606 --> 00:39:35,606 For each other. 1301 00:39:35,607 --> 00:39:37,374 I really want to thank megan and 1302 00:39:37,375 --> 00:39:38,609 The whole team, all of us were 1303 00:39:38,610 --> 00:39:40,611 Really excited for each other's 1304 00:39:40,612 --> 00:39:41,111 Success. 1305 00:39:41,112 --> 00:39:43,113 We never have doubt in our 1306 00:39:43,114 --> 00:39:43,614 Dugout. 1307 00:39:43,615 --> 00:39:45,115 That's something i always say. 1308 00:39:45,116 --> 00:39:47,184 We never have doubt in our 1309 00:39:47,185 --> 00:39:50,555 Dugout, that's my classic