Cognitive Dissonance - Episode 803: Not Medically Necessary

Episode Date: November 14, 2024

Avrion certo il langorino! Ovviamente non panino! No, no, no! Un boccone ricco di gusto! Si conosco il posto giusto! Siam d'accordo, su, su, via! Tutti alla piadineria! È tornata la solare! Con crudo e stracciatella!

Aggiungi salsa mango, aglio nero o peperone! Amerai ogni boccone! La piadineria... This episode of Cognitive Dissonance is brought to you by our patrons. You fucking rock. Be advised that this show is not for children, the faint of heart, or the easily offended. The explicit tag is there for a reason. Recording live from Glory Hole Studios in Chicago and beyond, this is Cognitive Dissonance. Every episode we blast anyone who gets in our way, we bring critical thinking, skepticism and irreverence to any topic that makes the news makes it big or makes us mad. It's skeptical. It's political. And there is no welcome. Matt today is doesn't matter. It's long form day. Long form day, long form day. That's what day it is. These stories last forever. And let me tell you. Because these problems never get solved. I was just gonna say, because some of these problems never go away, man.

You know how many times though have we talked about medicine and this type of industry, because it's such a disaster in our culture. It's a fucking trade rack, man. It's a fucking trade rack. So Tom, tell the people what we're talking about and give them the short synopsis. All right, this story is from ProPublica and the title of the article is,

EVA-Core. Wait, can we just start with- Let's just start with, God, you're missing one letter. For like, get Vanna to turn that letter around. When you're- You don't need to buy a ball. You only need one more consonant for Eva core. And when we spin it, we always land on your bankrupt. It plays that fucking boo boo boo sound. It's all whammies. Every time I hit the

button, it's always whammies. What you won a brand new MRI machine. Well, when you're at the branding meeting and you're like, alright so our business will be evil, but I don't think, to the core, it's evil to the core. It's evil to the core. But I don't want to trick people. Can we get, Jim you have any suggestions? We obviously can't call it an evil core.

Hey bro, knock that all off. Evil core. What? Everybody's doing the... What the fuck? Can't call the evil core bro knock that off What the fuck it's like that dude we found out afterwards that that crazy billionaire named his His company after Lord of the Rings And you're just like that what's his name teal? Yeah, be your teal name his company like after a palanthus after a bad thing Like the eyes that see into your fucking soul and there's a when your life Dude who made a fucking it the eye of Sauron his company. There's another person who's like yeah You know that cannibalism movie. Let's name our product after that

Soylent green like what the fuck is happening? It's like there's Brave New World, the drug in Brave New World was Soma. And now that's an actual pharmaceutical medicine. And you're like, that wasn't an accident. And that wasn't a good

thing. We're just, either your marketing team is the least red marketing team in the world. Part of me is like, part of me is like, is like all these people are just like, just come in their eye. Just come right in their eye. Fucking say something public.

I'm gonna come right in your eye. Hold it open. Like, Jesus. And if your insurance acquires it, you might be required to hold it open. You might be required to hold it open. Jesus. And if your insurance requires it, you might be required to hold it open. You might be required to hold it open. All right, I'm going to read the whole thing. EVACOR, the company helping U.S. health insurers deny coverage for treatments. Across the U.S., patients often receive denial letters from insurers refusing to cover necessary

treatments recommended by their doctors, from MRIs to life-saving procedures. Many insurers delegate these decisions to companies like EVA-Core, which earns profits by rejecting prior authorizations in order to cut healthcare costs. An investigation revealed that EVA-Core uses AI algorithms known as the DIAL to adjust denial rates, favoring profitability over patient care. Despite claiming to prioritize quality and necessity, EVA core's actions reportedly delay and deny essential medical care, impacting patients like John cup, who's

in the article. And he got denied a heart catheterization request and fucking died. Yeah. Multiple times. Not just- We only died once. This is just- Okay, I guess that's fair. That's true. He was too- That'd be fucking awesome though if he was like,

I'm so good! I'm so good! They like CPR him awake because they're like, we're still not going to give him 10 times a catheter. They CPR him for a while. They're like, we're not actually covering any more CPR. They make you stop here at CP and then you have to stop. Okay, we checked in your plan covers 36 pumps on your chest.

At the 37th pump, that's cash. Get a fucking credit card. Every time you do it, coins shoot out of him like fucking Sonic or whatever. It's a pump him and the coin shoots out of his... But no, he was denied multiple times the catheterization. Like, I guess he had a ventricle problem with his heart and they, the doctor said, look, you need this thing.

I'm going to send it up to the, to the people who do this sort of work because I have to get this approved through your authorization, through your insurance, because it costs money. And when they did, they said, no, we can't do that. We don't want to do it. And then, and then so they sent it back down and they said no. And then the doctor sent it again and said, most of the time, this is the crazy shit. The doctor's like, yeah, most of the time it takes two times to actually get them to say, oh yeah, so of the time it takes two times to actually get him to say yes.

Oh yeah. So you have to request it twice. Well that's fucking stupid to have to do that. Why are you doing that? And the reason why they do that is because they hope you walk away at one and not do it. So they don't have to fucking pay for it. So he requested it twice.

They came back a second time and said, sorry, it's not twice. We're not doing it again. And they suggested a different thing for him to do. So he goes out and he does this different thing. It's a stress test on his heart to see if they could, you know, change things or, or do something else for it. So he does the stress test and that night he dies. He dies that night after the stress test. They should have given him this procedure.

They questioned several cardiologists afterwards and all, but one of them said, yes, they should have given him this procedure, they questioned several cardiologists afterwards and all but one of them said, yes, you should have done it. The other one said, I don't know that there was enough information to actually do this procedure based on what was written. The all the other ones were like, no, you should have definitely done it.

Yeah, and I'll share some stories about, I'm sure our audience is prior authorization stories too. If you've ever had anything, if you ever had anything even remotely complicated happen in your medical life and you go, you try to go to the doctor and the doctor's like, all right, I want to order this test. And it's not your standard X-ray or blood work or whatever.

Many insurance companies, I work for a great big giant company and I have excellent insurance. But like Haley right now is going through some health stuff. And so we went to the doctor not that long ago, the doctor said, we want to try this medicine, right? It's called Motegrity. It's a stomach medicine.

I want to try this medicine. And the doctor said flat out, your insurance won't cover it. So we're going to have to fight with your insurance to get them to cover it. He just knew, he's like, no insurance is going to cover this medicine. It's expensive. We're going to have to fight them.

So I go home, I have the prescription. I call my insurance company. I'm like, all right, so I'm going to fight you. And I told them, I was like, I'm going to fight you until you cover this. So what's the first step in fighting you? And it was the funniest thing because they're like, oh yeah, I get it. This is not a covered medicine. So you're going to have to go through our prior authorization process. Then the lady actually said, which will get denied. Then we'll move you on to the appeals process. When you go to the appeal, she was great. When you on to the appeals process. When you go to the appeal

issue is great. When you go to the appeals process, make sure to tell your doctor to tell us this, that, and the other thing. And I'm taking notes. Oh, that's great. Yeah. So she told us how to work the system. She gave you the back end. She gave you the back end. That's actually a really good person. It was a really good person. That's a good person. Right? And I've actually had a few experiences where I've had to call and get various tests

or medications for Haley approved that were going to get denied. So they got denied first, then you have to call and you have to fight with them. And I've called and I will say that on more than one occasion I've said, look, my wife is sick, I need help. So I'm asking you as a person, what should I do? How do I move the ball forward? Do you know that works so often? When you just are like, all right,

it doesn't always work, but more often than not, if I do that with somebody and I appeal to them as a person, not just somebody answering a phone, and I'm like, what do I gotta do to get this out of this stage of the process to the next stage of the process? And then they're like, okay, here's how you do it. You're also recognizing the process there too.

And a lot of people don't want, what they don't want to do is be in the process. And so they come in and they, they, they reject the premise, right? And if they reject the premise, then everybody's like, fuck you, there's a premise. You got to stay with it. But you're saying I, I accept the premise. I just want to know what the next step is right now. And you, I think that that's something that people need to remember too, is that stay within the bounds of their rules

and you can probably work the system and then also do the things that you do, which is appeal to them. Yeah, I try to reach them at like a human level because I know that people will actually make these choices and they can say no. They are within their rights to say no to certain things. I'll tell you another quick story.

When Hailey got C. diff, which is a pretty serious intestinal infection, back in 2021, the best medicine for C. diff is a medicine developed specifically for it because it's an antibiotic-resistant infection, like MRSA, that kind of thing. So they developed a medicine called Difficit for C. diff. It's $4,000 for Diffisid.

It's like 99% effective though. The next step down is a medicine called Vancomyosin, which has about a 90% success rate. Nobody even told us about Diffisid. We didn't learn about it until months later. So many times the care that you're even offered or told is an option will be determined by what doctors think your insurance is likely to cover. So we weren't even told, I would have just paid out of pocket.

I would have been like, put on a credit card, I'll figure it out. Like 99% effective versus a one in 10 chance this recurse. I'll work a couple extra hours every night. I'll start six more podcasts, like whatever I gotta do. But like I would have been like, I'll just put on a credit card and figure it out. Like I gotta do something, I'm gonna get my wife well. But we didn't learn about it until like months after

when we heard about it separately, because she wasn't getting well. But like we heard about it separately and we were both like, what the fuck, why didn't anyone tell us? And the reason they don't tell you is because the care that you're offered is often bottlenecked by the reality of your ability to pay. Because they're just like, no one's gonna pay this.

And I get it, I get it. These companies like Evil Core, they're really interesting companies. We talked about, on another show, we talked about pharmacy benefit managers in the past. Yeah, yeah, they remind me of that a lot. There's a slate of companies now who are making their profit by reaching into the center

and not generating more revenue. There's no more revenue being generated. So what they're doing instead is reaching into the transaction and saying, all right, if we can't make our money through revenue Generation and we can't make our money by like bringing on more subscribers For example into our medical care system or into our insurance system The way that we can make money is by reducing the amount of care consumed We can make it so hard for you the the consumer, to get access to life-saving medical care

that you'll quit or die. And that's our business model. And what they do is they say to these companies, we will, the companies offer this basic program, and this is the upper echelon of this program, right? Most of the time, what they offer is this dial, what they call this dial, which is an AI algorithm that will sort of sort out all of your little requests.

All these requests are requested by doctors in an entire system. And all those doctors request these different procedures from all these other specialists. And they all go into one big pile and then the AI goes through them really quickly and says, yes, no, yes, no, yes, no, yes, no, yes, no. And they all go into the yes, no pile.

The nos go back to the people. No, you don't get it. And then the yeses go to an actual human being, a doctor who looks at these things. Now we'll talk about the doctors in a bit and about what they go through, but the doctors look at them and make a yes, no decision. So the doctors then have these says and yes and no.

And so then they create another pile of yes and no. Now they offer that system for a price, but the really high level of this system is where the HMO or the insurance company says to Evil Core, we're gonna get sued. We're gonna get sued. By who? I don't know, Evil Core.

By Evil Core? I'm only talking about Evil Core. But in any case, Eva Core, I'll be very careful when I pronounce it, Eva Core goes into cahoots with the insurance company and says, for every one that you deny, we will split the money with you.

So whatever gets denied, they're all still paying into this kitty for this procedure. That procedure doesn't get done, we get to keep the money. So let's do it, deny them, and then you will split the funds with you. And so this is a very good thing for them because it's very profitable. And many of the people who ProPublica interviewed happened to be ex-executives from EVA Core who said that's what they do.

That's what they... They did it on anonymity, but that's what they said they did. Now, EVA Core denies that that's what they, they did it on anonymity, but that's what they said they did. Now, Evacor denies that that's what they do, but all the people who they questioned that used to work there all say that's what they do. Yeah, and you know, it's been well adjudicated, I've looked this stuff up in the past because I've had to fight with it so much, it makes me crazy.

It's been well adjudicated that, it's illegal to practice medicine without a license, right? You can't practice medicine without a license. And I've always wondered, why is it that the insurance companies can deny my coverage that my doctor says is medically necessary? Isn't that practicing medicine without a license? And the reason that it's not,

and the courts have said that it's not, and it's been well established that it's not, is that they're not saying that you can't have this procedure, they're just saying, we won't pay for it. So you still can get it. You just gotta pay out of pocket for it. Now, that's absurd because the cost of medical care is so astronomically expensive and so wildly unaffordable

that it in all but words means that yes, you actually can't get it. But the courts have said, well, I mean, you actually can't get it. But the courts have said, well, I mean, you still could go buy it. You could just like pay for this shit out of pocket. There are in fact in Naperville, not far from where I live, there's an imaging center.

And the imaging center, I went there when I hurt my shoulder for an MRI. And that imaging center's entire business model is to do MRIs, cash, no insurance, cheap for all the people that can't get their insurance to cover MRIs. So you go and it's basically like an MRI mill. Like you go, you hand them your orders,

you stand in line, the MRIs. It's a whole like mill for imaging. Cause there's now there's business models set up based on the fact that people don't have access to care paid for by their insurance. And like the thing is the image quality is bad. My doctor said the image quality is bad. They're not good MRIs.

They're not good tech. They're just ripping through it. They're just ripping through it. They're not, this is like, but there's an entire industry now set up to recognize the reality that people are fucked by this. They're absolutely fucked by this.

And the last thing I want to say is like, we're always told that like this system is a system of choice, but nobody gets to pick or very few people get to pick their fucking insurance. Your insurance is whatever your company offers. That's the insurance you get. It's not like I can be like, well, I don't like Humana. I'm gonna go with Aetna or I don't like Aetna. I'm gonna go with Blue Cross Blue.

You don't get to make those sure you go, you get a job. The job gives you health insurance more often than not, and they pick. And you don't even know if they're gonna employ Evil Core or one of these pharmacy benefit managers because all this shit is hidden from you. Yeah, it's all behind a curtain. And I wanna address too that no matter what,

whatever the system is, someone is gonna have to make a decision on whether or not you get that care, right? We have in a lot of ways taken it out of the doctor's hands. The doctor requests it, but they don't get the ultimate decision on whether or not that care goes down to them. Right?

But even with Medicare, like for instance, with Medicare, with state sponsored healthcare, what happens is that the people who want these things still have to go through an authorization and request process. That still happens. I'm sure with other people who are listening

in other countries, there is an authorization and request process that they have to go through if they need something that is specialized from a doctor. They go to see their general guy, the general guy says, we need to do an MRI on your shoulder and then they send them to the MRI guy who does the MRI on their shoulder. Or in some cases, they might get denied that coverage in other countries. I don't

know, right? But they were saying the percentages are way different based on EVA core deciding on whether or not you get it or Medicare. Medicare was 8% of denials, 8% denial versus EVA core was something like, and I want to get the number right. Yeah. Medicare Advantage plans were 7%, but EvaCore almost 20% of the time in Arkansas, which requires the publication of denial rates. So they require denial rates to be public in Arkansas.

So we can tell they do it 20% of the time dude It's denials for dollars and it really is denials for dads denials for dollars. Yeah, absolutely. Yeah, that's what it is It this is a this is a company which is they go to the insurance company. They say we'll save you money We'll split the amount we save you and the way that they save money Like I said is it's so evil when you just recognize that they're not saving you money by increasing revenue. They're saving your money by saying this patient doesn't get treated. Let me read this. EVACORE markets itself to insurance companies by promising a three to one return on investment. That is for every dollar spent on EVACORE, the insurer will

pay out $3 less on medical care and other costs. EVA Core salespeople have boasted a 15% increase in denials according to the investigation, which is based on internal documents, corporate data, and dozens of interviews with former employees, doctors, industry experts, health care regulators, and insurance executives. And you know ProPublica covered their fucking bases on this because they're fucking baller. Almost everybody interviewed spoke on condition of anonymity because they continue to work in the industry. And then that goes into the 20% and the 7%.

20% versus 7% when it comes to Arkansas, EVA core, and Medicare. And I mean like, that's a huge difference, man. That's a huge difference. Let me tell you, if I hand you a percentile dice and I say you walk in and whatever you roll decides whether or not you get this coverage, you sure as shit want the 7% over the 20%.

You know what I mean? And that doesn't include the stuff that you have to jump through. You know how you, even this guy,'t include the stuff that you have to jump through. Right. You know how you, even this guy, even this poor guy who died in the story, he had to jump through hoops to say, hey man, I'll try again and I'll do it again

and I'll try again. I'll try to get past their algorithm again. That's 20% of people that they just don't cover period. And like having done this work myself to try to get coverage for things, it takes hours and hours to get this work done. It's like a whole, it's like your whole workday to try to get an answer. And sometimes you don't even get an answer that day. It's like a whole, it's like a whole- It's your whole work day to try to get an answer. And sometimes you don't even get an answer that day. It's hours. Do you ever look at your phone

and see how long you've been on? All the time. It's like, I'm not exaggerating when I say it's hours and hours. When you call, you can never get ahold of anybody quickly. You have to go through a series of menus, long, excessive hold times, transfers to, you know, this other department or this accelerated claims department

or this, you know, super fucking fancy claims, this ultra appeals, and every time they put you on hold, sometimes for an hour, sometimes longer, you're just waiting. And that system is also, no one is gonna sell me that that system of waiting is not set up to be interminably awful so that people drop out of it. Because I have the luxury of being able to say, I'll take a day off work and fight this.

I'll just call my boss and be like, yeah, I'm taking a day off work, I'm just gonna fight the insurance company, I'm gonna fight the insurance company all day. I've done it. Most people can't do that. So the more of those procedural barriers that they put in place to make it harder and harder

and harder and harder for you to do, the more likely the patient is, and it wouldn't even be necessarily a denial, to just drop out of the system. Just stop trying. Just stop even trying. Right now, Haley has to get an MRI. So she's got to get an MRI, but not a regular one.

She's got to get what's called a three T MRI. It's in there only done in certain locations. It's a whole thing. And we had to do the same thing. Like the doctor was like, okay, they're going to fight us about the approval. I need you to go, but we've, but the doctor was great. Their office was like,

they're going to fight you about the approval. We know what to do. Do this in this certain way, send us this information. This is what's going to happen. So they knew how to jump through that hoop and they got us through that hoop. But even that takes weeks. That's so crazy to me. It takes weeks to get through. And these are people that know how to fight it.

These are people that know how to fight it. We finally get an approval from the insurance company. But I think I probably spent of my time at least four hours. What's crazy to me is like they've built in to these insurance systems side quests. Yeah, man. Like it's a fucking side quest. Like I gotta go get a key to open a box to get a sword so then I can go into this other room and kill this spider and the spider nest is the ring that I need.

That's exactly it. I'm going to hold over my head to fucking shoot a laser down on the ground, open the door to get the princess. It's like a million different steps, man. It's insane. And it's maddening. And it's also really difficult because a lot of times when you get these folks on the phone, they are speaking using a terminology that's very difficult to understand.

And it's very difficult to keep straight. So, you know, you have to be fairly savvy. They're all TPS reports, is that what you're saying? Yeah, yeah, they'll use like fairly technical language. They'll like require you to fax things instead of email or otherwise send them. Oh, come on. Yeah, I mean, I've, I've, I've, I've been- We don't communicate by Pony Express anymore. I can't tell've, I've, I've, I've been. We don't communicate by Pony Express anymore.

I can't tell you, Cecil, how many times I've gotten on the phone and had the insurance company on one side and they're like, oh, you know, like your doctor has to do this thing. And the doctor is like, I got to do this thing. And I'll be like, we're getting on a call together. We're getting a conference call right now. I'm like, I'll call the doctor's office. You're going to wait.

And I'll just call the doctor's office. Be like, we're waiting for them. And we'll just sit there for an hour and be like, I'll take your time. office, you're gonna wait, and I'll just call the doctor's office. Be like, we're waiting for them, and we'll just sit there for an hour, and be like, I'll take your time. I one time got in the car with the insurance company and drove to the doctor's office with them on speakerphone, and I was like, we're resolving this today. You have to be an absolute fucking asshole bulldog

to get this stuff done very often. And so many people don't have the time or the energy or the luxury to be able to do that. And that system is on purpose. Those structural barriers are on purpose. Because every person who doesn't do that is somebody who's still paid an insurance premium without gaining access to their care. Wow. That is so fucked up that you have to do that. It's crazy. I mean, that's insane. We put these things in place for a reason though.

And you know, we go back to it a lot. It's the profit motive. And there's so much money to be made off of this. And we could, we've talked about it so many times that you could switch yourself over to Medicare for All or whatever it is. And you still have to pay more taxes, but you won't have to pay your insurance premiums anymore. And you wouldn't have to pay as many copays.

It'd be a lot less than that sense too. And it would change, I think, a lot of how people have to deal with this. And I think, you know, like, I think everybody in the country would look at this and say, I'll take the 7% over the 20% any day. I'll take the 7% over the 20% any day. I'll take the 7% over the 20% any day. And we're in this system where we're mired with this profit motive that has created a system that is, you know, one of the biggest boogie men. When they were talking about Obamacare, this was years ago,

this is before they had to slim it down, it was closer to this, but they were definitely never really going to do single payer healthcare. It was never going to happen in this country. And I remember everybody confused it. Obamacare for single payer healthcare back then. They didn't know. They had no idea what it was. They were just like, Oh, it's all, yeah. Obamacare is going to be single payer. That's what it was. It was death panels. It was all about death panels and they kept on bringing up that buzzword

or buzz phrase to try to convince people that that's what's gonna happen. And that's literally what happened to this guy. This guy got death paneled by an algorithm. Yeah, man. I remember at the time, I think we talked about it at the time, there's already death panels. It's your insurance company. Yeah. And they're 20% over seven. Right. And now

these guys are saying, we're an even more death focused to death panel. Yes. We'll sell more death and less panel. Yep. Like that's where the super, I remember that like during the buy, they were like, oh, you don't want some like unelected bureaucrat deciding whether or not you get healthcare. It's like, well, I'd rather actually have an unelected bureaucrat decide whether or not I get healthcare than somebody who's got a profit motive to deny me healthcare. The bureaucrat doesn't give a shit one way or the other. He's not like I get a bonus based on how many of these denials I do. Or a fucking AI that gets to change the dial

on how many they fucking turn up. Dude, how fucking unbelievably evil is that? How dystopian is that? Can we just turn over to an AI the decision on whether or not someone gets a life saving care? I am the death panel bot. Beep, bop, boop. You gotta remove the death panel

and then you move the jumper. So that's how it works. Hey look, I don't like the needles for the New York Times anymore. I don't like the fucking dial for the dial a death panel or whatever this fucking is. I want to read another piece here. EvaCore is the product of a massive decades long push by insurance companies to control healthcare costs. decades long push by insurance companies to control health care costs, they point to studies that show 20 to 45% of some medical treatments are wasteful and ineffective. To decrease such spending, insurers begin requiring doctors to seek permission for medical

care before agreeing to pay for it. A process known as a utilization review review as treatments become more complex, the reviews proved costly in themselves. And so like they're creating systems that, like we said earlier, take it out of the doctor's hand. Yeah. Right? They're creating another hoop to jump through. We talked about it earlier,

like the person who's qualified to decide whether or not you need this is the doctor. That's it. That's the person who is making this decision. They went through a lot of school to look across from you and say, I need to write on this piece of paper. And then the other person has to do what I write. Yep. That's it. There's nobody else that should be involved in that process. But this is why insurance is such a bad scheme to pay for medical care. It's always been a bad scheme because insurance is first and foremost a profit-based industry and business. Insurance is also a system set up to pay for things which are unlikely rather than a system set up to pay for things which are a certainty. Needing health

care is a certainty. Aeding healthcare is a certainty. A house fire is an unlikely event. Insurance makes sense for house fires and car accidents and floods. It does not make sense as a scheme to pay for certainty events, which is like the necessity for healthcare. Sure. I'll tell you a quick story too.

Like there's a woman that, Haley and I know, that needs a surgery and she wants to have that surgery done by, it's a very rare surgery, it's a difficult, it's only a handful of people that perform it. The best guy that she found is a guy that works out of the big medical center, I can't remember the name of, in Houston, in Texas.

I can't, MD Anderson. it's one of the best medical centers in the world. There's this guy that does it, he's one of the few people that does it. She wants to go see this guy. Her doctor says, go see this guy, he's the best in the world, it's a very delicate surgery, go see this guy. She has insurance.

She bought that insurance through the ACA, the Affordable Care Act. She's got excellent insurance coverage. The problem is that the specific insurance coverage that she has, this is in Texas, Texas does not allow her to import that insurance into that hospital, specifically Texas. So the hospital said, yeah, you're approved to do the surgery.

You need to bring us $96,000. That's the cost for the surgery. And need to bring us $96,000. That's the cost for the surgery. And she's like, but I has insurance. And they're like, oh, yeah, but it's through the ACA. And it won't, because it's through the ACA. If I had this, if I bought the plan through an employer, I can go.

That same thing through the ACA, Texas is like, no, we don't accept that here. You can't import that insurance into MD Anderson. $96,000 or go pound sand. So what is she supposed to do? And the answer is she doesn't know. She doesn't know. This is somebody who pays her premiums, needs care.

Her doctor says, go to this person, best person in the world, delicate surgery. Very important that she get it done in the right place, the right time. She has insurance. No, doesn't count here. This to me shows me again, the projection of the Republican Party because they were screaming and crying so long about how people are going to change how you get health care and how private insurance is the best thing you can get and why wouldn't we want any of that stuff. And then they create a rule to literally hamstring

the thing that allows you to get insurance that the government provides. Absolutely. They created a rule, a punitive rule, specifically for that because they didn't like it. Yeah, it's only for people who have coverage through the ACA. They essentially have their own death penalty. Yeah, man, yeah, 100%. And I mean, it. Yeah. It's only for people who have coverage through the ACA. They essentially have their own death panel. Yeah, man. Yeah. 100%. And I mean, it's Houston.

The only reason to go to Houston is to go to the doctor and then leave. That's it. There's no other reason. You only go to Houston to get surgery, either surgery you didn't want or surgery. Cause you wind up in with the ice. Kidneys out and everything in a bathtub. That's actually how you pay for a motel in Houston. Look, having stayed in motels in Houston, like if you lose a kidney or two, you came out of that thing. You're ahead. You're fine. It's better than smelling

Houston. And actually, to be honest, on your way out, if you hit the guy, the kidneys fly out of him. Like Sonic rings. I want to say, I want to read a piece of this article. This we were talking earlier about the doctors that Eva Core employed. A maternal fetal medicine physician in Colorado took a job as a doctor at Eva Core in 2018. The idea of ensuring safe medical practices appealed to her, but soon she grew convinced that Evaore was more interested in saving money.

EVA-Core rejected her suggestions for improving its maternal fetal healthcare guidelines. Her supervisor required her to decide at least 15 cases an hour or one every four minutes. She often reviewed requests by physician outside of her speciality. Nine months after starting at EvaCore, she quit, disappointed by the attitudes of some of her colleagues. Quote, most physicians who work at these places just don't care. Any empathy they had is gone. End quote.

God, that's fucking scary. That's fucking not only scary, but so dark. Yeah. Right? That here's a person who thought, I wanna go into this to just try to see if I can help get people coverage. And then she finds out it's exactly the opposite. I'm coming into this to not get people coverage,

but to un as much as I can deny people coverage. And I have to work at a weight of four minutes. I know your wife has been going through some shit. I don't think you could explain to the audience in four minutes what is wrong with her. No. Right? No, it would take me longer than that. It would take you longer than that.

Right? Right. Your case, I don't think is unique. No, not at all. And I think like people would have such a hard time, just a doctor wouldn't even be able to concisely put in a report that she could look in four minutes at many people and decide whether they needed that coverage because these things are so complex. You know, it's crazy because it's like,

the average time for a GP to spend with a patient, I think is something like seven or eight minutes. This cuts that in half. That was unacceptable. And now this is like four minutes and these are people, I also think it's really important to note the lack of empathy thing because one thing that is true is that when you go to the doctor,

even if it's seven or eight minutes, is you're physically in a room with a human being. Yeah. You're in a room with a person and you recognize the shared humanity of that space that you're in together. And having a fucking computer screen flash up that says, you know, Tom Curry, date of birth, blah, blah, blah, this, that, the other thing. That's not a person anymore. That's just beep bop boops, man. That's beep bop boops.

And you've lost the humanity. There should never be a time when doctors make patient decisions where they are not present in some way with that patient. Telehealth, fine, I get that. Like I'm a big proponent of telehealth. Telehealth in person, but like it should never be a beep-bop-boop of a faceless person.

Medicine can't be performed that way. Medicine outside of compassion doesn't function. So like, of course these people lost their empathy. They're not in a space, have you ever had a job where you've had to perform a certain number of functions per hour to work that fast? It's maddening. I remember like when I worked at the first two title

companies that I worked at, there would be a bunch of days where I'd come in, I'd be like, all right, I've got an eight hour day and I have 50 or 60 of these files that I have to fund today, like these deals that I have to fund today. And I'd be like, oh shit, that means I've got eight minutes per deal. Like if I work for this many hours

and I don't take any breaks, this averages out to like one of these things every eight minutes. It's so easy to make a mistake when you're working that fast. It's so easy because if your last one took 12 minutes, you're internally doing the math all the time, like, oh, fuck, that took a little too long.

I've got to cut a corner here, cut a corner here, cut a corner here to gain back your minutes to get your work done on time. That's a frightening way to do healthcare. Frightening way to do healthcare. I want to talk about the chilling effect that this has on doctors before we close. Quote, an EVA core executive called this the sentinel effect

at a legislative hearing in Kansas. It's like a sheriff coming to town. Once the doctors knew EVA core is watching, they make fewer inappropriate prior authorization requests," he said. Doctors, however, say that such decreases reflect how difficult it is to fight EvaCore and similar companies. Their entrance into the market frustrates doctors from making otherwise legitimate requests.

And this is, I mean, you can just tell that there's gonna be a frustration level on doctors that aren't gonna wanna do this sort of thing. And they're gonna be like, there's no way that this person who's coming in here is gonna do all the work that Tom's gonna do to try to fight all this. So I'm not even gonna do it.

I'm just not even gonna request it. I'll just say, ah, it's not it. And like, this also puts doctors under an immense amount of stress and pressure around things that have nothing to do with doctoring. Yeah. Doctors already, typically now, doctors work for these big managed care groups.

They work out here for like Northwestern or Dooley or Edward, one of these big managed care groups. There are very few private practice doctors left. They're a dying breed. There's almost none of them left. Almost everybody works for one of these managed care groups. Those managed care groups have expectations of those doctors to see a certain number of patients per day.

So they're under this gun. Now you're adding the extra stress of, you've got to see this number of patients per day and you've like turning fucking tables in a restaurant, you know, and like, and then also, you've got to know what their insurance is, and you've got to understand how to recommend the right procedures to the right patients

based on what this insurance probably means for their access to the care. None of that, none of that is in the best interest of the patients, none of it. All of that is in the best interest of the patients. None of it. All of that is in the best interest of people who are lining their pockets with this for-profit system and adding more for-profit into the system.

They're like, what if there were for-profits, actually? ["The New York Times"] Thanks so much for joining us for a long form episode. We're going to be back on Monday with another show and we're going to leave you like we always do with the skeptics creed. Credulity is not a virtue. It's fortune cookie cutter mommy issue. Hypno Babylon bullshit couched in scient, scientician, double bubble, toil and trouble, pseudo quasi alternative, acupunctuating, pressurized, stereogram, pyramidal, free energy, healing, water downward spiral, brain dead,

pan sales pitch, late night info docutainment. Leo Pisces, cancer cures, detox, reflex,lex, Foot Massage, Death in Towers, Tarot Cards, Psychic Healing, Crystal Balls, Bigfoot, Yeti, Aliens, Churches, Mosques, and Synagogues, Temples, Dragons, Giant Worms, Atlantis, Dolphins, Truthers, Birthers, Witches, Wizards, Frackin' killer robots in her house? She'd have gone...frackin' Nuts, Shaman Healers, Evangelists, Cons, conspiracy, double-speak stigmata, nonsense! Expose your sides.

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