The eye-glazing scam of Medicare drug plans

Six tiers and none of them mean a fucking thing.

Cory Doctorow
6 min readMay 4, 2022


A craps table surrounded by excited gamblers; amid the casino chips are various pharma tablets, some spilling out of a pill bottle. Image: Chris Martin (modified) CC BY 2.0: Christine Dela Cerna (modified) CC BY-SA 3.0:

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:

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…