Prop 1 “YES” – kill the dangerous loopholes

The Prop 1 wording on the Nov. 5 ballot is not as clear as some people would have wanted, so we have to keep talking this up to make it sure it won’t fail. 

Here’s the message that needs spreading around:

 

All New Yorkers deserve the freedom to control our own lives, futures, and healthcare decisions, including our right to abortion. 

No New Yorker should be discriminated against, or taken advantage of, by those in power. 

Prop 1 is a NY state constitutional amendment that puts the power in the hands of New Yorkers, not politicians. 

This November, vote YES on Prop 1 to protect abortion rights and our freedoms.

From the NYCLU:

We might like to think we’re safe from these attacks here in New York, but the truth is there are dangerous loopholes in our state constitution that leave us vulnerable to the whims of politicians…

… laws aren’t enough, because they can be easily changed, as we’ve seen time and again in recent years as political winds shift.

When we enshrine a right in the state constitution, we protect it from political attacks.

That’s why we need Proposal 1, or what has been previously called the New York Equal Rights Amendment, which will protect our rights and reproductive freedoms — including the right to abortion. 

Proposal 1 will keep New Yorkers — not politicians — in charge of our personal decisions and will enshrine equal rights into our state constitution. 

More at New Yorkers for Equal Rights.

Make sure people know to look for Prop 1 on the ballot. Then vote “YES.”

 

 

So they just sacked CVS/Aetna prez Brian Kane

CEO Karen Lynch thought he really had to go when CVS’s income fell 9% in the 2nd quarter compared to last year at the same time. 

Mulgrew should be thrilled, then, that Marianne and the courts forced him out of the Aetna plan he built for retirees a couple of years ago. 

Whew. Dodged a bullet.


Hardly. 

Mulgrew couldn’t have cared less what would have happened to the retirees after a year or two when Aetna’s promises would no longer be viable. Prior authorizations won’t get in your way, he told us. Almost everything is free, you can see any doctor you want, go to all the hospitals you want.  What don’t people understand? The plan is the cat’s whiskers and all that.

According to Forbes, parent company CVS was having problems with its insurance businesses (Aetna) – particularly with Medicare Advantage, which had seen “higher costs from increased utilization of services from seniors.”

Wendell Potter puts it much more simply. The company was paying out too many claims in its Advantage plans. Brian Kane wasn’t doing his job.

Potter reports that CVS is planning to get rid of about 10% of Advantage enrollment, leaving these unfortunate rejectees to look around for the best personal health care solution in a swamp of underwhelming options. And looking to turn things around, CVS is apparently planning some operational changes described in this bit of corpo-speak:

It will initiate a “a multi-year expense management opportunity to deliver $2 billion in savings” that will include “streamlining and optimizing operations and processes.” Executives also plan to accelerate the use of artificial intelligence and automation across the company’s businesses.

We better start getting used to the health insurance strategies du jour,  which none of us learned about in high school. What’s become standard procedures in this for-profit industry is mind-bending obfuscation in how they work, coupled with our deep belief that a serious health catastrophe might leave us stranded physically and financially. 

In a guest column I wrote for the Examiner a couple of months ago called “Navigating the Medical Maze” (here) I tried to highlight how thick the industry has become with insider strategies meant to help Them, not Us. 

We no longer know what to expect from our coverage when even simple terms like “hospital,” “out-of-pocket medications,” or “skilled nursing” don’t actually guarantee the cost or extent of services, the medications or the equipment we’re being prescribed.

Here’s the handful of terms I included in that article:

Upcoding.  When providers are encouraged to assign inaccurate or additional codes for procedures in order to trigger a higher reimbursement from public agencies such as Medicare.

Overutilization.  Decisions on medical necessity are often subjective. Overutilization is when doctors are incentivized to prescribe or charge more for services and equipment because they know public or private insurance is picking up the tab.

Defensive medicine:  When doctors recommend tests or treatments not so much for their patient’s benefit but to protect themselves from potential lawsuits. 

Click-and-close: a term (used at Cigna) to describe how the company encourages staff physicians to review first-stage or questionable denials as quickly as possible, neglecting time-consuming research into guidelines, medical studies, and medical records. More money stays with the insurance company and often keeps patients from getting the vital but more complicated services they might need.

Direct-to-consumer advertising:  When patients are encouraged to ask their doctors for specific drugs, tests or equipment, a practice that frequently puts the doctor in the position of having to explain why these may not be in the patient’s best interest.

Pharmacy benefit managers:   These middlemen between insurance companies and the pharmacies run every aspect of the delivery of prescription drugs, from formularies, to prior authorizations and co-pays, to rebates. They profit at almost every stage in the supply chain.

Kickbacks: Rewards to medical professionals for prescribing specific procedures, equipment or drugs. Free vacations, cash, speaking positions, and research grants are some of the many kinds of gifts that can call into question the value of what you’re being prescribed.

That was a short list. We could easily add AI and automation to it, both of which just slipped off the tongue in the Forbes article.

I KNOW that Mulgrew is out of his depth with this stuff, just like the rest of us. 

How on earth do we get the union to put people in charge of these decisions not only to get us the best deal with this corrupt industry, but to stop pretending they know what they’re doing and stop lying to us to make us believe they’re on our side.

What’s going on with corrective legislation, fed and NYS

All stuck in committees.

I’ve updated the page tabs at the top of this website with recent bills and related info in five categories.

Under the tab Medicare for All

Just some background info on this topic.

Under the tab In Congress

Bills relating to Medicare for All.  They’re all sponsored and co-sponsored by Democrats, with the exception of our favorite spokesperson on this issue, the Independent senator from the great state of Vermont, Bernie Sanders. 

     NEW!  Added to the list of items and services in the most recent MfA bills (S.1655 and HR.1655) that are “medically necessary or appropriate to maintain health or diagnose, treat, or rehabilitate a health condition” are “gender affirming care, and reproductive care, including contraception and abortions.”

     The Senate version calls for a 4-year transition, the House version 2 years. The Senate bill got referred to a single committee (Finance), the House bill to seven of them.

     In addition to these bills, there are two letters from legislators – still only Dems + Bernie – asking for more protections against Medicare Advantage plan abuses.  

Under the tab Medicare Advantage

Lists some of the more important bills attempting to rein in the shenanigans of for-profit insurance companies.

Under the tab Pharmacy Benefit Mgrs

There’s much more bi-partisanship in these bills, but I’m not sure why.  

Under the tab New York Health Act

What’s going on with Single Payer in New York State.  

Mulgrew’s new resolutions: an exercise in futility

It’s hard to figure out what the heck Mulgrew’s saying when he talks about Medicare. I’m not even sure he knows himself.  

I’ve only been able to keep up with the UFT’s shenanigans with retiree healthcare by following Arthur Goldstein over at Union Matters, who’s indefatigable and we all benefit from reading his detailed posts. Kudos also, of course, to Marianne Pizzitola for the lawsuits she and the NYC Retirees pushed through the courts. We’re obviously safer and less financially stressed than we would have been without their fortitude and skills.

Yesterday we got a letter from Mulgrew telling us that said he had motivated a resolution on the AFT floor to seek federal legislation to protect Medicare and see it would never be diminished. “Our members pay into Medicare and Social Security throughout their careers, and we cannot let opponents chip away at these programs.”

It’s obvious that everyone who has a job pays into Medicare and SS. You don’t have to be a member of a union to want to keep these programs going once you’ve paid into them all your working life. Where could he going with this? And why now?

Maybe the Resolution he attached would clarify his position, so here it is in full: 

The First of the four Resolved clauses calls for “improving ... our healthcare safety net, including ... Medicare.”  That’s where I start to lose him. Is Mulgrew wanting to improve Medicare itself, meaning “Traditional Medicare” – Title XVIII of the Social Security Act created in 1965, the foundation of senior healthcare arrangements for all enrollees nationwide? Fighting for Traditional Medicare has never been on the UFT agenda as far as I know. It’s hardly within its purview.  

Perhaps, Mulgrew’s conflating two very different things: Traditional Medicare (=TM) on the one hand, and a TM + a supplemental arrangement of some kind – a combo, as it were – that the unions do have some control over. One of these arrangements that adds to TM is Senior Care, others offered by the OLR are Advantage plans. These plans are additional to TM. The union negotiates them with private companies to pick up what TM does not pay for, and without them, the sickest of us would certainly go bankrupt. The graphic left shows the differences.

The UFT has neither protected or improved our safety net over the past few years, which is why those courageous retirees filed lawsuits to block what was being foisted upon us. And they won: the courts ruled against the changes, saying these proposed arrangements would indeed cause irrevocable harm.

So right here in this First resolved, I’m not sure I know what part of healthcare delivery Mulgrew is trying to protect and improve. Might be Traditional Medicare, but he might want to be protecting the whole shebang:  TM + one of the supplemental arrangements in the blue and green parts of the chart.

The Second resolution is practically meaningless. No candidate at the federal or state level is currently trying to find a real solution to preserve “high-quality and affordable benefits.” The only way to do that would be to change the tax structure and cut the ravenous middlemen corporations out altogether – those giant entities that have taken over the healthcare industries from top to bottom, eating up Medicare dollars. That solution would be Single Payer, and I don’t hear anyone talking much about it these days. 

Like the rest of us, legislators seem to be stuck with the current healthcare delivery system, dependent as they are on lobbyist moneys that have been thrown at them to keep them from making too many waves. 

REMEMBER:  Traditional Medicare leaves a lot of costs on the table. Medicaid picks those up for people with lower incomes, and the rich can afford to pay them out of pocket.  It’s the middle-income people like us who feel the changes – in our pocketbooks when premiums, deductibles and copays change, and physically, when services and drugs are denied. The UFT has always favored the status quo, which is TM + private supplemental arrangements. It has fiercely opposed Single Payer, thwarting all attempts to eliminate those profit-driven middlemen companies. 

As for the Third resolution:  there are no “simple solutions” to healthcare. (I don’t even understand what Mulgrew means by “simple solutions to necessary changes” – and I don’t think he knows either.) If by “earned benefits” he’s referring in part to Traditional Medicare, that program has in no way been entirely successful or comprehensive. So much is left to Wall Street and monopolistic private entities. Nor do I think Congress would ever actually get rid of Traditional Medicare.  Not everyone has a sugar daddy like Clarence Thomas to pay their mother’s bills.

Now for the Fourth, where Mulgrew says they’ll seek federal legislation to ensure that Medicare and SS won’t be diminished. Exactly what form will that “seeking” take? The AFT won’t find big solutions with the lobbyists. And even if they could all agree to tweak something somewhere somehow, Mulgrew’s basically saying that TM is pretty good – even though you need supplemental insurance to pick up that hefty hospital deductible and a ton of copays for lengthy hospital stays, a Part B deductible, copays and 20% coinsurance for outpatient services or equipment. The Part B deductible is out of pocket, unless you’re lucky enough to be in a union that reimburses you for it. Because that’s how Traditional Medicare works on its own, no supplemental coverage to pay these parts of it.  Part D is not even contained in Traditional Medicare. It’s all managed by private companies, getting funds from the government.

I do want all that to change.  I don’t want the premiums, deductibles, copays in TM. Is TM what Mulgrew and the AFT want to protect?  

I’m thinking not.  I’m thinking Mulgrew just conflates Traditional Medicare (Parts A and B on their own, no supplements) with the way the union delivers Medicare to us, which is TM + the private, for-profit “supplemental” plans that keep us from going bankrupt (Sr Care and the Advantage plans).   

If I’m correct, it means he favors a system where pieces of our benefits are controlled by industrialists who want to make money off of healthcare. That system most definitely will never be in our interest, and he shouldn’t be spending our dues money trying to shore those plutocrats up.