John Oliver opened his latest episode of Last Week Tonight with footage of Donald Trump’s partial demolition of the East Wing of the White House to make room for his $300m, 90,000sq ft gilded ballroom. “Those images are distressing, especially when you know it’s all to build a giant ballroom in a style best described as ‘Med Spa Versailles’,” he said. “And yet, the demolition of the White House, a metaphor that, if anything, is too on the nose, was just the tip of Trump’s iceberg this week.”
Oliver also noted Trump’s demand that the justice department pay him $230m as restitution for the legal cases it pursued against him when he left office in 2021 – a demand that would be rubber-stamped by two members of his own cabinet.
“I should say, Trump has said he’d donate any settlement to, in his words, ‘charity or something’,” Oliver noted. “But incredibly, we’re still not done, because Trump also posted an AI video of himself dumping shit on No Kings protesters, abandoned trade negotiations with Canada after seeing a TV ad he didn’t like and authorized a $20bn bailout to Argentina to ensure that their experiment with libertarianism works out.”
But Trump’s “most shocking” move in the last week was approving military strikes against boats allegedly smuggling drugs to the United States. So far about 40 “so-called narco terrorists” were killed, “even though the administration has not provided public evidence for its claims”, Oliver said. “Even if they have some, I’ve watched enough JAG to know that the typical approach to drug boats is to intercept them and arrest the suspects, not murder them with no due process.”
Trump also plans to launch strikes on suspected drug traffickers in Venezuela without congressional approval, saying: “We’re just going to kill people. They’re going to be, like, dead.”
Said Oliver: “You know, the kind of chilling statement you expect to hear from a serial killer or the mastermind behind Panera Bread’s Charged Lemonades, but not ideally the president of the United States.”
“Between tearing down the White House, trying to use the justice department to pay himself and proudly sharing AI footage of him literally shitting on Americans, the president’s now also appointed himself judge, jury and executioner of foreign citizens,” he added. “And it is infuriating that neither Congress nor the courts seem to be interested in putting a stop to any of this because we are supposed to live in a country of checks and balances.”
In his main segment, Oliver shifted focused to the extra-confusing business of Medicare – which, “on a scale of one to Inception, is basically a Tenet, and I don’t say that lightly”.
Oliver focused on Medicare Advantage, a partially private-sector alternative to the traditional government-funded Medicare, covering hospital stays, doctor visits and drugs, while offering extra benefits like dental and vision coverage or debit cards to help pay grocery bills.
“It’s pretty appealing on the surface,” said Oliver, as the up-front costs are low. But the host, of course, looked into the hidden drawbacks – for one, the plans come at an inflated cost to taxpayers, “which is a bit weird, as a big part of the argument for creating this system over two decades ago was that bringing in private insurance could help control costs.
“The whole argument was that this would expand choice, and companies would do a better job at controlling costs than the government,” he explained. “And look, some things are better when the private sector is involved. Take novelty slippers – only through competition in the free market do you get innovations like hairy feet slippers, creepy Marge Simpson slippers, Sigmund Freud slippers.
“But sadly, the private sector hasn’t done as well with Medicare as it has with slippers, because these plans have never saved the government money.” A Medpac report from last year estimated that Medicare Advantage had cost the government an extra $591bn over 18 years, partly because major companies involved need to make profits for their investors.
One way to inflate profits is to bill for more serious conditions or complications than a patient actually has, so that the government pays a higher rate. “And while insurers will claim they’re just being thorough,” said Oliver, “they’ve been repeatedly accused of essentially pulling a Munchausen by paperwork.” In 2022, the New York Times found that eight of the 10 biggest Medicare Advantage insurers had submitted inflated bills, according to federal audits. Four of the five largest payers had faced federal lawsuits alleging that efforts to overdiagnose patients had crossed the line into fraud.
Oliver cited one example from the company Independent Health, in which a woman from one of their Medicare Advantage plans was coded for prostate cancer because, according to internal emails, “when a married couple has any disease, both were assigned to that disease.”
“Which is both ridiculous and also, kinda romantic,” said Oliver. (Independent Health did not admit liability, but did pay $98m to settle a False Claims Act suit from the government – “you know, the exact kinda thing you do when you’re not liable for something,” Oliver joked.)
And while these plans aren’t good for taxpayers, Oliver argued that they weren’t good for patients, either, as providers fall out of network easily, leading to huge bills; some areas don’t have any in-network providers at all. And when someone does find a provider, they may be hampered by “prior authorization” – a potentially grueling and expensive process of approval to even see the provider in the first place.
“The thing is, delaying, underpaying or denying care doesn’t just hurt patients; it hurts hospitals, too, particularly in rural areas,” said Oliver, as those hospitals do not have the time or resources to constantly appeal decisions that deny reimbursement.
“When you take all this together, you get a system where the incentives are clearly set up for insurance companies to make you look as sick as possible on paper, while doing as little as possible to help you when you actually need it,” he summarized.
What can be done? As Oliver had said many times before, “so many of these problems go away if we had single-payer healthcare. We could get closer to that by making regular Medicare more expansive and easier to navigate, and getting rid of that 20% gap in coverage. But at the very least, we should be calling Medicare Advantage by a different name, and ideally one without the term Medicare anywhere near it,” because “they’re just not the same”.
At the policy level, with TV doctor Mehmet Oz in charge of Medicare, “for now, we’re kind of fucked,” Oliver concluded. But in the meantime, he cautioned viewers considering these plans to call their state health insurance assistance programs for independent advice, and to “at least understand the drawbacks of Medicare Advantage”.
