Ep43 -- Breathtaking Failures

 Well folks, it's been two weeks since we had that little election here in the United States.  And I'm guessing a lot of you aren't experiencing that huge sense of relief we were anticipating when this soul-crushing campaign season finally came to an end.  I guess that for a lot of people, it has been replaced by something much, much worse.  And at the same time, we've been inundated with a wide variety of post-mortem analyses as to what went wrong on the Democratic side.  And I really don't want to get into that, but I read an article last week that seems to be a perfect illustration of a failure of government in general, to help people. And if you're a Democrat and you believe that the government should be actively doing things to help people, that government isn't always the problem, then I'm pretty sure that after you hear this story, you're going to be asking yourself why hasn't anyone helped these people, and why on earth would we expect these people to support a Democratic candidate who really just offered some amorphous promise to fight for them sometime in the future. 

Stay tuned. 

I'm Craig Boreth, and this is The Great Ungaslighting, a podcast about how we all get conned into accepting a manmade culture that's out of sync with our human nature, and how we can fight back and put the kind back into humankind. 

But first, a word about a sponsor. 

Now, obviously coming out of an election season in which corporate interests spent upwards of $2 billion to purchase government officials to serve exclusively their financial interests, there could be any number of massive humanity-devouring companies that I could feature on this week's episode.  In fact, the main story this week is about one such company, Lincare Holdings.  But this week's company that I'd never have as a sponsor, and obviously after this would never agree to be a sponsor, is one that just bugged me personally.  A few years ago, I made the switch from one of those big well-known deodorant companies, like Right Guard or Old Spice to one of the newer, less chemically brands. It wasn't an easy decision, since the old brands costs three or four bucks, and these newer, all-natural brands were like at least twice that.  But I thought, you know, one stick of antiperspirant lasts a long time.

So the increased cost per day really wasn't that much. By the way, this reminds me of my favorite line from any Seinfeld episode.  Kramer asked Jerry how often he cuts his toenails, and Jerry's response is perfect. He says, I would say every two and a half to eight weeks. It's perfect because it's impossible to narrow it down any more accurately than that.

Nobody could do it. And it's the same with deodorant. 

So I made the switch to the bougier product. I started with Schmidt's charcoal and magnesium and it worked great.  So one day I'm at Costco and I see this three-pack of deodorants from a company called Dr. Squatch. As in Sasquatch.  It was on sale, I think from like 28 bucks to 24 or something like that. So eight or nine bucks per stick, which is a lot.

It's got this cute little, big foot in a dinner jacket on the logo and the containers are huge, like way bigger than the standard we're all used to. So I of course think, great, it's more expensive, but I'm getting the Costco-size container. So it's probably a good deal.

And I liked the Dr. Squatch product too. It worked well, smelled good, and I got a good deal. What's not to like?  But. As I got down to the bottom of the first container I suddenly had this thought. What if there's like a false bottom in this thing? Like how could I figure out exactly how much product is actually in the container? I thought about cutting it open or weighing it full versus empty.

It was going to be this whole project.  And then I realized, you know, you could just look at the front of the product. The net weight is right there, required by law. At least while we still have some government regulations left.  It turns out the giant Dr. Squatch container has the exact same amount of deodorant in it as the standard-size product, 2.65 ounces. And I did a quick middle-school geometry calculation to figure out that this larger container uses about 40% more plastic than the standard size to deliver the same amount of product. 

So Dr. Squatch I got to say, I liked your product, but I cannot abide your bullshit packaging. 

And we're back. 

So last week Pro Publica published an article titled "How Lincare Became a Multi-Billion Dollar Medicare Scofflaw."  I highly recommend that you pause this podcast right now and go read the article. There's a link in the show notes, and while you're there definitely strongly consider donating generously to ProPublica. They're doing some of the most important investigative journalism in the country. And we're going to need them more than ever in the coming years.  Okay. So, let me just read the first paragraph of the article. 

For Lincare, paying multimillion-dollar legal settlements is an integral part of doing business.

The company, the largest distributor of home oxygen equipment in the United States, admitted billing Medicare for ventilators it knew customers weren’t using (2024) and overcharging Medicare and thousands of elderly patients (2023). It settled allegations of violating a law against kickbacks (2018) and charging Medicare for patients who had died (2017). The company resolved lawsuits alleging a “nationwide scheme to pay physicians kickbacks to refer their patients to Lincare” (2006) and that it falsified claims that its customers needed oxygen (2001). (Lincare admitted wrongdoing in only the two most recent settlements.)

Now you'll be happy to know that the government has taken action against Lincare with the Department of Health and Human Services, putting them on a sort of probation for five years within which time if they violate their probation they'll be forbidden from doing business with the government, which would basically put them out of business.  You'll probably be less happy and not terribly surprised to learn that this is the fourth time Lincare has been put on probation since 2001. And they're still going strong.  Now I'm less interested in the abundance of damning evidence ProPublica found regarding Lincare, including quotes from former employees stating that the company's position was basically if the potential penalty from illegal behavior is less than the profit generated by that illegal behavior, then go for it.  

What I'm interested in is what it must feel like to be someone who has been victimized by Lincare for years. And in particular, how someone in that position was likely to view the 20 24 presidential campaigns.  And the specific people we should get to know are the residents in and around Libby, Montana, a tiny town of about 3000 people, which sat near an open pit vermiculite mine that operated from 1963 to 1990.  That mine, which was owned by W.R Grace, blanketed the area in asbestos, constituting what the EPA called "the worst case of industrial poisoning of a whole community in American history."  Since then more than 2000 residents of Libby have been diagnosed with respiratory diseases. For which they need, that's right, oxygen equipment.  Enter Lincare Holdings.  

Lincare contracts with Medicare and Medicaid to rent oxygen machines to patients, whom they can bill for 36 months, after which time the patients can continue to use the machines free of charge.  Well, that's the rule. But as we've seen Lincare doesn't care much about rules.  Pro Publica interviewed an 80-year-old man living outside Libby who has been paying for his oxygen machine for 10 years. In total between the patient payments and charging Medicare Lincare collected over $16,000 for an oxygen machine that they sell for $800.  

Remember Lincare was already on probation during this time. And when charged with defrauding potentially tens of thousands of patients across the country,  the Department of Health and Human Services, which oversees Medicare and Medicaid, dropped the hammer and...put them on probation again.  Now, one practical reason why HHS can't go after Lincare is because they're the largest provider of these types of machines in the country. And if they shut it down, a lot of patients will suffer. And that's exactly how Lincare wants it.  In 2023 alone, HHS banned over 2000 small companies from working with Medicare. But behemoths like Lincare just keep going strong.  And the industry has lobbied hard over the years to make it this way. For example, in 1997 Congress set Medicare reimbursement levels specifically for oxygen equipment at a level that HHS called grossly excessive.  And that 36-month limit on payments, that might sound like a good deal for patients, but it's not nearly as good a deal as what was originally proposed before industry lobbyists successfully watered down the bill.  

So after all that, It seems Congress is finally poised to shake things up with the SOAR Act. That's S.O.A.R not S.O.R.E, which stands for Supplemental Oxygen Access Reform.  And what will that bill do, you might ask? It will further raise reimbursement rates and eliminate competitive bidding among oxygen equipment providers.  Of course, that law may also improve patients' access to oxygen, which patient advocates clearly support. But it will definitely make Lincare bigger, stronger, and more profitable and will very likely lead to more patients being screwed.  

Okay. So back to the political reality, swirling around all of this. And let me preface what I'm about to say with the fact that I believe Joe Biden has been the best president for working people since FDR. I don't think it was enough, and a lot of the effects of what he's done haven't been felt yet, and may never be felt based on what the next administration overturns or ignores.  But if you're that 80 year old guy outside Libby Montana, what difference does any of that make?  That vermiculite mine destroyed the lives of thousands of your neighbors. Our lack of real public health care means that partnerships with private companies like Lincare are just how we do healthcare business in this country. And the neoliberal trend towards monopolization allowed Lincare to become too big to care.  And all of these things happened because there wasn't strong enough government advocacy for the victims, for the people whose lives have been damaged or ruined by these things, and against the corporate interests that profited from them.  And I think the Democrats are to blame for that.  Now I get why they did it. They thought it was the only way to win elections. And it worked really well for Bill Clinton. But it led directly to Trump's win in 2016 and was perfectly expressed in the summer of 2016 in what should go down as among the dumbest things any politician has ever said, when Chuck Schumer confidently proclaimed: "For every blue collar Democrat we lose in Western Pennsylvania, we will pick up two moderate Republicans in the suburbs of Philadelphia."  And the fact that Schumer is still in a position of leadership in the Democratic party tells you pretty much all you need to know.  

So once again, back to that guy outside Libby, Montana.  When Kamala Harris promised to fight for regular people to end price gouging, to bring down healthcare costs, despite the chance that she might actually have done that and the fact that a Trump administration will definitely not do that, why should that guy believe her? The simple answer is he shouldn't. 

He's seen no evidence over the past 20 years that anyone in government gives a shit about him. So why wouldn't he want to burn it all down? Can you blame him? And in a weird way, the buffoon who tells outrageous lies about everything imaginable probably feels less insulting to him than the person who wants him to believe that they really care and wants him to believe they will help, and they might this time, they might, but he's heard it all before and things just keep getting worse.  

So,  what's the big takeaway from all this? I think. It's the opposite and much more optimistic take than from people who say Kamala Harris lost because of racism, misogyny, and hate. There was certainly some of that. But what I hear those people saying is the Democrats did everything right and they got pummeled.  So my question is, okay, then what do they do next time?  Assuming, of course, there is a next time. Do they do the same thing and hope for a different result? I would hope not. And I would hope that they look at places like Libby, Montana at all the things that went wrong there at the lives the government has failed there, and then rethink and reimagine the point and purpose of politics and government in this country.  

Well, that's it for this week, folks, please, everybody, hang in there. If you liked this episode, please share it with anyone you know who might also appreciate it. And until next time, be kind to yourself, cut each other, some slack, and use your damn turn signal.