The eye-glazing scam of Medicare drug plans

Six tiers and none of them mean a fucking thing.

CORRECTION: An earlier version of this article erroneously claimed Simon Lovell had passed away; I misremembered my contribution to a 2015 medical fundraiser for Mr Lovell as a contribution to a funeral expenses fundraiser. My sincere apologies to Mr Lovell (and I’m delighted to learn I was wrong!).

Indie bookstores can change your life. In 2007, I wandered into NYC’s St Marks’ Bookstore (RIP) and picked up a book from the recommended table: “How to Cheat at Everything,” by Simon Lovell, and I learned how to spot a scam. It’s a skill I use every day, especially when analyzing how corporate America works the US government:

https://memex.craphound.com/2007/02/02/how-to-cheat-at-everything/

I grew up in countries — Canada, the UK — with universal health care and now I live in the US. The NHS and OHIP aren’t perfect, but neither set off my scam-meter the way that the American system does. The whole thing is a scam, top to bottom.

Here’s a key lesson from Lovell’s book: “complexity in a proposition bet is only there to make it harder for you to figure out the odds.” In other words, if a grifter at a bar tells you that they’ll pay you 3:1 if you can do X, and 5:1 if you can do Y, and 9:1 if you can do X and Y, all of those different payouts are solely there to confuse you.

If you want to see this in action, just visit any casino and ask a croupier to explain the craps payout lines to you, and try to do the odds in your head while you get that explanation. What’s the least-worst bet on the craps table? (There are no good bets on a craps table). Without a spreadsheet and several hours of analysis, you probably can’t know.

The flamboyant, mind-clouding complexity in US health care starts with health insurance. Insurance, after all, is just a proposition bet: “If you contract this illness, we pay this much; if you need this drug, we pay this much. Pay an extra $20/month, and we’ll reduce your co-pay by this much, but only once you’ve covered your deductible. Pay $3/month more and your deductible goes down by this much. Oh, and here’s your HSA, which will accrue tax-free savings you can use for some of this. What’s a before-tax…