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| Shuffle |
Benjamin Flaherty is an addict. He’s sober now, and keen to help other addicts get that way. You might think that’s a position that everyone would share, but in his documentary Shuffle, which opens in New York on 16 January, he reveals a secretive industry dedicated to something else: to putting vulnerable people in situations where they will relapse again and again, because each relapse presents another opportunity to drain their health insurance policy. It’s a deeply disturbing film, and all the more so because the story it captures was emerging for Benjamin himself as he filmed it. Rehab had saved his life, and realising that services posing as rehab were killing other people hit him hard.
“I was floored,” he says. “I mean, that was a large part of the reason for making the film. I consider myself a fairly educated, well read person, stay current on news and stuff, and I just had no idea. Obviously, being well educated and informed has nothing to do with this, but I felt naïve, I guess, because not only had I not heard of it, but I had just been through treatment and had a great experience. And so I felt this sort of cognitive dissonance – this completely clashed with the experience that I had and what I knew to be true about that world. I just wanted to go understand, and I figured I should bring a camera with me if I was going to go do that.
“At the outset I was like, ‘Let's go hang out in this world for a while.’ It's very funny – I laughed too – because my sponsor was very supportive but, like, ‘This is not what you should be doing.’
“I think that I was conscious of that. In the early days of producing and shooting the film. I was still going to meetings all the time. And certainly when I was traveling in these places, I would go to meetings, and that was kind of a refuge. But I talk to people. I think I also naively thought that somehow because I was sober, it would protect me a little bit from this, which is also not true. I remember a few days where at the end of the day, I found myself sitting on the end of a hotel bed just like, ‘What in the absolute..?’ You know.
“I don't think I ever really felt like, ‘Oh, I'm going to go drink or do whatever.’ A lot of the substances involved in this were not my drug of choice. Maybe if it had been similar, I would have been at more risk for that. But it was the emotional thing that was the hard part. Just watching people stay sick, watching people hurt themselves and be encouraged to do that, paid to do that. It was all just really disturbing. And, you know, trying to witness that and observe that and be present for that without influencing that too much is also a challenge.
“I didn't feel obligated to any ethics of documentary filmmaking. I felt obligated to this other human. Like, ‘What do I owe this person? What am I responsible for here in this moment?’ Because this is where it does matter, so there’s always that back and forth in my mind about where the line is. But it was always done with their participation. I suppose you can make an argument where, like, were they always in a state to consent to things? And it's like, yeah, they were. You know what I mean? We spent a lot of time together, and I only turned the camera off in two moments of filming. And in both of those moments, the participant that I was filming asked me to turn it back on because they thought it was important that this be seen.
“I have a lot of respect for that. I mean, this is their film, and without their willingness to expose themselves and share of themselves over such a long period of time, this film like this wouldn't exist.
“I didn't think of myself as a journalist. I really never have. I was coming at this more from a human place where there's perhaps less boundaries. And also, you know, boundaries aren't my strong suit as a person who struggles with a variety of things – let's be clear about that. So it was a recipe for a tough situation. But look, I had a lot of support. And also, the connection that I was able to develop with the people in the film, it wasn't a participant and subject or filmmaker and subject film. We were together in it. The camera was on for a smaller portion of the time than people might imagine. A lot of time we were just together and it didn't always make sense to be filming.”
We talk about the challenge of balancing the human stories with the vast amount of information that the film conveys about the scandal he uncovered.
“That’s probably what took so long,” he says. “The editorial process of the film was probably three and a half years, and a lot of that was just wandering through the dark, because it's an enormous amount of information. I was also very fascinated by it. So, of course, I want to tell you all of it. That's not helpful.”
There's never room for that in a film, I note.
“Yeah, no. And it's also potentially complicated. And the last thing I wanted to do was bore people or frustrate them. So it was a constant sort of, ‘How much do we give? How much is enough to give? How much do we need to inform people of so they understand, and so there can be some sense of discovery?’ Because for me, it was like an immediate, like, ‘What is this? How can anyone do this?’ But then it built and revealed itself into this massive thing. Oh my God. And so I was hoping that there would be that in the film. And, you know, that's not to my credit. I worked with a lot of talented people, particularly because I'm not a journalist.
“We hired an investigative journalist as a consultant. Her name is Belle Cushing. She's fantastic. She's worked with Vice and in a lot of different places, and what I wanted to know was, as an investigative journalist, how would you explain this fraud? How would you parse this information out? What's necessary, what's not? So her and I had a series of long conversations. She watched the film, looked at a lot of documentation, and then we just started talking about what was necessary and how to put this together, and in what order to put that in the film. That was incredibly helpful. Once we had those chunks, we could move them around.
“Then, of course, we had the stories in the film, and we hired in succession two great editors, Robin Schwartz and Jackie Soohen, who stepped in, and I worked with them for about a month each just on recutting the film, bringing the emotion of it to the forefront and balancing out those emotional stories with the more technical aspect of the fraud and how the money flows.”
Was it helpful that he didn't uncover it all at once? It could have been really intimidating to take on something on that scale otherwise, I suggest.
“Yeah, it would have been really overwhelming. There was a huge learning curve. I think that's also part of the reason why it took so long to make the film. There was some sense that this was bigger than I knew, and I think that was part of the chase – I wanted to find out how much bigger, you know? So it really did take a while.
“I still come to new understandings of this through the people we've met in screening the film and having conversations. You know, we were talking to some people at a policy institute last week, very educated people on economics and healthcare policy, and they were like, ‘Oh, yeah, it's because of this or that.’ I'm like, ‘Oh man, that's another thing.’ So I'm still learning.”
One of the challenges seems to be figuring out the motivations of everyone involved, because it seems that at least some people at a policy level thought that they would really be helping people, because they're trying to shift things towards a health care narrative.
“I think that a lot of this that is well intended,” he nods. “Most of it is probably well intended. The effects of those policies is a different question. You know, in the US there's other examples of laws that are designed to help people that have some sort of adverse consequences. For example, the Americans with Disabilities Act and the Fair Housing Act. Those are designed to protect an important part of the population. Well, those same laws prevent the inspection and regulation of sober homes, which means that pretty much anyone can own a sober home and do whatever they want with it and no one will ever know. That's a problem.
“We shouldn't get rid of the law because it protects some people. It needs to stay protecting those people, so how do we accommodate things? And I think it goes back to what we started off by saying: that the stigma of addiction still is very prevalent. The narratives that we tell ourselves about addiction and people who struggle with it are very embedded, they're very subconscious. Addiction is hard. Addicts fail, addicts lie. Relapse is normal. All these things. All of those things also happen to be very profitable.
“I just think it's important that we all be more aware of that, because it's like, what are the motivations? What are the questions? I heard someone say this yesterday: something that's well intended is more easily forgiven. And that's not helpful here.
“They were started by people with good intentions. Well, here's the effects of those intentions. We need to deal with them. And that's my hope, because obviously, a very small percentage of the people who need treatment in this country have access to it. And I thought, at the very least, that those people who did have access were getting a fair shake. And they're not, you know? And that's to say nothing of the millions of people who don't have access. You know, what's interesting is that there are more private substance abuse treatment clinics in this country than there are McDonald's restaurants.”
That’s quite a fact, I say.
“For real! 15,000 plus private treatment centers and 13,000 plus McDonald's. Now, how is it possible that the majority of people who need treatment don't have access to it? Yeah, because I don't know anyone who doesn't have access to McDonald's. You know what I mean? No one's experiencing a bad barrier to McDonald's. That tells us something important. It's not about treating everyone. Well, then who is it about treating? It's about treating people who can afford it. What does that mean? Who are those people and why is that true?
“I started asking myself a lot of questions like that when I got into it, because I think it's important to understand how we find ourselves in these situations. It's not just the policy. It's a lot of these other issues. It's the stigma of addiction. It's the narratives that we tell ourselves about addiction. You know, a lot of those fold perfectly into this fraud. Someone who spends six years in treatment and goes to 30 treatment centers just can't get it right.
It tell him that it reminds me of stuff that's come out before about people in mental health treatment in the US at clinics which just drain insurance policies.
“You know, what's shocking is it's like you could take a piece of transparency paper, draw this fraud out and graft it onto mental health facilities, nursing homes, anything where there's insurance and a transaction involved. It's happening in Medicare and Medicaid. I mean, there was the issue in Minnesota happening with the Medicaid fraud, and it seeped its way into that. But yeah, the mental health facilities are very closely related to the substance abuse because many of these places are now offering dual diagnosis. They'll treat both. That's just their way of saying when the insurance stops paying for your substance abuse treatment, they can put in for your mental health treatment.
“I don't want to say any of this to shy people away from going to get help, because I think treatment changed my life. I’m an advocate of people seeking help. I do think that there's some simple things people can understand for themselves to keep themselves safer.
“First of all, always stay local. Don't let anyone tell you that you need to go anywhere away from home for treatment, for a variety of reasons. Mostly it's because that's where support is. But so stay local, and stay as close to medical care as you can. Most people, myself included, thought that addiction treatment was medical care. It's not medical care. It's behavioral health care, which is different and subject to different licensing and regulations and all of those things. So stay as close to medical care as you can.
“If you're looking for treatment, if you have a doctor, call your doctor. If you have insurance, there’s a nurse number on the back of your card. You can call them, tell you where you live, and they'll give you a list of places near you. That's a great resource. You know, you can actually go to your local hospital, or call your hospital. They'll probably have a local referral service, if not something available at the hospital. I would start there, and I would be surprised if somebody couldn't find a solid potential place to go get some help if they followed a few of those steps.
“Beyond that, you know, 1-800-Numbers, social media, those places are not safe places to be getting treatment. If someone's offering help, your first question as a person maybe needing it is ‘Why?’ Why are they offering this? You know, it's a very lucrative business. People are treating it as a business and not as a necessary form of healthcare.”
There are some interesting interviews in there with brokers who say that they thought that they were helping people.
“Yeah. I mean, I think maybe at first for some of them, for sure. I know one of their stories very well: someone who was speaking in meetings and ‘Oh, that's all I have to do.’ Yeah, well, you have to speak, but you also have to, like, you know – it's this slippery slope. It's a very insidious way of indoctrinating people into things, manipulating people. I mean, you could easily make an argument that in the beginning, many of those brokers are as much a victim of this as anyone else. They're all being recruited for a purpose.
“The question then is, you quickly realise you're not helping people, and then it becomes easy to ignore for a variety of reasons, greed being the main one. You know what I mean? But many of these people are in recovery themselves. I know I had, as part of my addiction or part of my struggles, I wasn’t great with money. There are a lot of people who, in early recovery, want to transfer the focus of that from a substance to something else. Money's a great place to go for that, so it's just a really tough situation.
“I remember sitting in AA meetings early in recovery, and they have the 12 steps on the wall, but they also have the 12 traditions. I always thought they were boring, but one of them was that AA would remain forever independent and would not take outside donations, and essentially that money and recovery should not mix. Early in sobriety I didn't quite get that. I get it now, loud and clear. I get people have to make a living and all of that, but this is an industry where if the profit and recovery potential aren't moving in the same direction – and they aren't – then we have a big problem.”
