A Medical Story

I had a conversation with the clerk at my pharmacy the other day. I was picking up a prescription for a family member and he said “You know it costs $XXX?”

“Yes, and I still don’t know why you ask me. It’s not like we don’t need the script.”

“Well, we let people know because when they hear the price, sometimes they don’t want it.”

I paused. “No. It’s not that they don’t want it, they can’t afford it. There’s a difference.”

“Yeah, I guess you’re right.”

“Words matter. They change how you think.”

This is as close to quoting as I can remember and nothing like the political fan-fic you usually read online about “let me tell you what happened when I told this person a thing-or-two.” It wasn’t a confrontational conversation and it happened pretty sporadically and I didn’t feel particularly proud afterwards. We so often think of storytelling as reading to children, instead of how the choice of words we use to describe our experience then inscribes that experience onto our conscious. I left frustrated.

There are a lot of nuances to the Humana-Medicare fraud story that came across the news-feeds a few days ago. I saved it with the intention on writing about the piece, not because I am someone who regularly comments on the health insurance industry, but because it is complementary to some of my research and what I think about all the time. This story and its $200 million dollar headline is not how we’ve been trained to think about insurance fraud, and that’s the point.

We have seen those local news investigations of the person on disability payments for back issues, somehow able to build a deck in the behind their house, or the person who, in conjunction with their doctor, fudges the severity of their symptoms to get more coverage for medical supplies that they would not normally be entitled to. These are the stories about fraud that we’re used to: the individual scammers, the advantage-takers, but where does the overpayment to Humana enter into this narrative. For the wider audience, it doesn’t.

Humana has a huge presence on daytime cable television, along with other Medicare supplemental programs promising to put more money in your social security check every month by switching to their insurance. None of these commercials (easily) disclose that you’re forgoing part of Medicare (hence the refund) only to pay that money to the separate insurance company. It’s a boon for the corporations and seems like a no-brainer to the hapless person wanting an extra $100 in their Medicare check every month.
Yet, still, that is a story told about individuals, the lonely seniors unable to see through the smoke and mirrors of television advertisements. The “boomer” generation taught to trust the evening news and the sales pitches in the commercial breaks never unlearned that trust. Even after Watergate, they turned to television to get the information they needed. The channel hardly mattered, and, when it comes to insurance advertising, still doesn’t. There are a lot of generational generalizations in those previous sentences, but there are sparks of truth within. We still think of Medicare (or any health insurance) fraud as an individual problem. We tell the stories of individual people scamming the system, which allows us to shake our heads and feel better about how we aren’t the scammers and maybe the system is the problem.

I don’t believe in universal truths (aside from the lack of universal truths) but something I find to be a consistent occurrence is that any system created by humans can be exploited by humans. The Humana-Medicare story suggests that the largest exploiters of the system are at the corporate level. Yet we never tell the story like that. We always focus on the man building the deck, or the woman with too many diabetic supplies. We focus our attention and our scorn on targets that are the same size as us: individuals that can be outed and shamed. We understand the individual scam because we perpetuate them ourselves in any number of ways: we drive a little fast, we needle our way out of jury duty, we find advantages to pay less in tax, etc. Perhaps we get upset not at the scam, but at the scammer being caught. It tightens the rein on all of us.

Or at least that’s the impression. The watchdogs will start scrutinizing individual actions more closely, because that’s where the story takes us, if not the data. The story is the reality and if multiple people committing $100 a month in Medicare fraud is the scourge presented, then where does the $200 million assessment against Humana fit into that story. Honestly, it doesn’t. We won’t cancel our individual Humana plans because by purchasing them in the first place, we’ve agreed ith the idea that the corporation is a better adjudicator of our health care than government-funded Medicare. We have already sided with the individual over the communal in our story – the individual as the mighty sovereign of liberty and the individual as the mighty sinner in violation of justice and fair play.

Justice, sovereignty, fair play, are all stories. We tell ourselves these stories day in and day out in order to feed and reinforce the world view of our communities. And that community is a story of people telling the same stories in the same way. Humana is a corporation that told a number of small stories in distorted ways that entitled them to receive more money than they were owed. The federal audit is telling that same story from a different point of view.

NPR only uses the word “fraud” in two places: one, while describing what extrapolation is to the readers, and two, in one of the story tags: “medicare fraud.”