POINT OF VIEW

Profits and health care? Those things just don't mix

Posted

One of us is a retired New York City teacher and union member, one of many public employee union members in the northwest Bronx. The other is on her health plan.

Public employee union leaders throughout the state are quick to point out how much workers have sacrificed in wages in order to maintain decent quality health insurance. They recognize that rising premiums and cost-sharing have been most responsible for the pressure to sacrifice wage increases.

According to the U.S. Department of Health and Human Services, average private employer family plan premiums in New York state rose 74 percent between 2008 and 2017, despite only 15 percent general inflation over that period. Deductibles rose 111 percent.

At the same time, insurance company profits have gone through the roof, and the millions in salaries paid to their chief executive officers is frankly embarrassing, given the number of people in the state unable to afford health services — especially among the working poor, and older adults with chronic conditions.

Yet the Municipal Labor Committee — made up of leaders of the city’s public employee unions — collaborated with Mayor Bill de Blasio to actually increase the role of profit-taking in public employee health plans. In a backroom deal they claim will save the city $600 million a year, the health coverage of 250,000 city retirees — currently based on traditional public Medicare — is being scrapped and replaced by a private Medicare Advantage plan run by for-profit Empire Blue Cross Blue Shield. They claim, against all evidence, that private insurance companies can deliver quality care, save huge sums, and still generate strong profits.

A small part of the savings will come from the extra funds provided to Medicare Advantage plans by the federal government. Most, however, will come from reducing health care services. Where traditional Medicare requires little or no prior authorization, Medicare Advantage plans insist on it — forcing physicians to justify MRIs and CAT scans, surgeries, and many other procedures and medicines with potentially life-and-death decisions made not by attending physicians, but by insurance company staff members.

In addition to claim denials and delayed care, prior authorization increases the wasteful paperwork that has been worsening the work conditions and morale of physicians.

Indeed, prior authorization and claim denials have led many physicians to reject being second-guessed, and refuse Medicare Advantage patients. Some have already said they will not accept patients in the new city plan — set to begin in 2022 — despite program manager and union leader promises that the plan will maintain the full complement of current providers.

The new plan promises free gym memberships — of little value, of course, to retirees in their 80s and 90s with complex chronic conditions who are now fearful their medications and therapies will be disrupted.

Traditional Medicare works. It is a hugely popular program, and provides a powerful sense of security for older adults and their families. Why trade it in for a program specifically designed to increase insurance company profits, shareholder value, and executive salaries?

Other advanced countries have universal affordable health care systems because they limit the role of private insurers. Following decades of astronomical increases in premiums, cost-sharing and wasteful spending on administration, we too should eliminate profit-taking in our health insurance system.

Traditional Medicare, the alternative to Medicare Advantage, is a simple, efficient, single-payer program. So is the proposed New York Health Act, which would expand and improve on Medicare and provide all New Yorkers with affordable and comprehensive insurance, including coverage for long-term care in the home.

The legislation generates its savings by eliminating the private insurer middleman.

Northwest Bronx politicians have spoken favorably about the New York Health Act. Jeff Dinowitz co-sponsors the bill in the Assembly, and Alessandra Biaggi is a co-sponsor in the senate. Jamaal Bowman co-sponsors the national Medicare for All Act in Congress. Even Mayor de Blasio has, in the past, expressed support for the legislation.

We in the northwest Bronx need to press them to get the job done. And those of us connected to the municipal unions must press our leaders to drop Medicare Advantage and get behind the New York Health Act.

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