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The Mayor is Determined to Destroy the Last Remnants of Health Security

(MSCC) John Mudd, February 19, 2023

On Monday, January 9th, 2023, The New York City Council held a Hearing to Consider Legislation Amending Administrative Code to Preserve Healthcare Choice for Retirees. But amending the code does nothing to preserve choice. That crafty notion presented throughout the hearing was refuted; the groans and rebuttals from city workers and retirees filling the main floor and balcony said as much. To view the hearing click here.

My name is John Mudd. I’m with the Midtown South Community Council (MSCC). We’ve been serving the public for 38 years. We take issue with deplorable health, hunger, homelessness, and housing conditions. 

MSCC joins the city workers and retirees in the fight to stop the Administrative Code 12-126 from being amended—doing otherwise will be a threat to their health.

Union leaders gave plenty of reasons for the need to cover rising hospital and drug costs at the expense of the retirees. They used impassioned speech: “ensure, preserve, and protect” union member choices, while accusing the retirees of lying. They riled the crowd while twisting reality and defending their integrity, job, and intent.

The first three panels, including a Zoom call of union and city representatives with their willingness to work within the destabilizing and broken system of care to set the terms for the public, was apparent.

Daniel Pollock, of The City’s Department of Labor Relations, gave a particularly worrying declaration when he said, “I want to be clear, this isn’t about whether the Advantage plan proceeds, we are planning on moving forward with that plan. We think this amendment is necessary to provide the choices for the retirees.” 

UFT President, Michael Mulgrew, said it’s about a fight for healthcare costs. Henry Gorrido, Executive Director of District Council 37, NYC’s largest municipal employee’s union with 150,000 members and nearly 89,000 retirees, and other union representatives, said the bill provides choice. A panelist decried, “We have to keep the city going.” An agreeable bunch, they assured us that, they’ve done everything in their power to work within a system to hold down costs. But the cost is outpacing the budget, and with no ‘stabilization’ funds available, we’re short 1.8 billion (600 million annually) to cover the costs of healthcare. 

We’re going to do everything in our power to serve our members. We’ve got 75% of care given without the need for prior authorization. I believe they are earnest in their efforts, but not in their retiree’s health. I wouldn’t want to be the 25% having to get an authorization during some medical emergency, and I don’t believe insurers should dictate how doctors should care for the public.

Henry Gorrido said COVID testing had increased costs. Were they drafting funds to help the healthcare industry to their billions during a pandemic which was mismanaged and federally funded by our government?  

Gorrido also said to the committee, “Do the right thing but not the popular thing.” Shall we allow a broken system to take over the last remnants of quality care? Are we to give up on the last bastion of fighting against corporate care and insane rising costs that will ultimately worsen the health crisis?

When questioning the union representatives as to why there was so much resistance to changing this code, they gave a host of answers including: the narratives were not presented well; they weren’t allowed to explain the truth of it because de Blasio wanted to push it through; they were still dealing with the ghost of the past; they don’t understand the program and who will pay for it; it was rolled out wrong; fear of the unknown becoming the enemy of the public good; change is hard; change has to be made, nobody likes change; and my favorite…they were up against a “cottage industry” focused on how to stop the Medicare Advantage Plan.

After selflessly fighting against the “cottage industry”; the peppered arguments, theories, and lies in righteous defense of their integrity to protect their members; and Henry Garrido’s quote from Dr. Martin Luther King—who is no doubt turning over in his grave hearing his name used to support a corporate health insurers’ interest—another insulting narrative came to light…

Councilman Lincoln Restler’s question of the day, the “Union is doing the best they can in an earnest heartfelt way and we have people who are truly fearful of what this means for their healthcare,” and what “We’re all struggling with is the inability to communicate to them, that it is not as devastating as they think it is. The crux of the challenge…how can we compromise and work toward a path to negotiate the interests” of the healthcare industry and force “the compromises necessary to move forward…”

I’m not sure why there would be any support for the few union representatives, when they do not have the support from the “cottage industry.” The “cottage industry” of members should take precedence, despite the fact the Union-affiliated PACs Put Millions to Work for New York City Council Candidates

Not a hardline to follow. It is known the Mayor is operating aggressively and wants the Council Members’ vote to change the Administrative Code, thereby agreeing to an Advantage Plan, before sharing the contractual agreement with Aetna—the insurer who will benefit from this deal. Also known and conclusive: the “average citizens’ preferences continue to have essentially zero estimated impact upon policy change, while economic elites are still estimated to have a very large, positive, independent impact.” —Princeton’s Martin Gilens, Professor of Politics and Northwestern University’s Benjamin I. Page Gordon S. Fulcher Professor of Decision Making, 2014

But why would anyone get behind a mayor who would negotiate with an insurance company when you have the awesome power of 124 unions with a million-plus members collectively? That’s voting power. Now who should dictate the terms to the private profit motivated insurance company?

The various arguments led to the bottom line—the funds not being there. Journalist Bob Hennelly, Work-Bites, writes, “The Adams administration and the MLC had claimed time was of the essence because its Health Stabilization Fund, created in 1984, used to cover healthcare obligations and help defray premium costs, is running out of money, putting at risk the premium-free health care that active and retired city employees continue to enjoy.” The only salvation (as it is in every disaster capitalist scenario) is to give away the farm to Aetna (a healthcare conglomerate) to underwrite an Advantage Plan—to serve their bottom line during a continual rise in costs and deterioration of healthcare—for the city’s employees and retirees, that will have them come back to capitulate on another day. 

The administrative change will allow the mayor to do an end runaround to sell the care for city workers and retirees to an insurer when things are fairly secure. They’ve avoided the majority of traps and pitfalls the rest of the population may find themselves in with their insurance plans—that is the social contract they agreed upon, and the city needs to hold up their end.

The grumbling amongst the retirees whose healthcare is endangered by a pact between the Mayor and Union heads who subordinate themselves to the healthcare industry continued throughout the meeting. Everyone understands the dangling carrot this Advantage Plan offers; the ploy of dividing various groups; the likelihood of a return in a few years to negotiate away their health; and the grey haired years means they’ve accumulated some time on this earth and they do not need to comprehend or accept the theoretical reasoning cooked up by the union heads, Mayor, and other political representatives who are willing to sell their care to an industry that will trade lives for their bottom line. 

Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs,”—Harvard Gazette, September 2009

And many pay with their lives. One case in point: Bart, a guy who is not quite ready for death, but who is facing a determined healthcare system wishing to kill him. Bart is 74 year-old, retired, with an income of $1,000 a month. He’s a quiet man who lives by himself in a rent-controlled apartment one floor below me. He reads philosophy, science, and some fiction, watches movies, does a little writing, swims, and eats takeout. Estranged from his brother and two sisters who live in Colorado, he leads a somewhat lonely existence. But it’s a modest life deserving of basic health security.

Bart thought he was going to the hospital for a simple procedure. A few days prior, we’re chatting in the hallway, and he tells me he’s going to have his aorta replaced. I was taken aback by the seriousness of it. He tells me, “It means they have to open up my rib cage.” 

He seemed to have a certain confidence in his medical care. After all, he is covered by an Advantage Plan, and there were a lot of fingers in the pie to give him supplemental support too. There is Northwell, Life Science Implant Card, Meditronics, UnitedHealthcare, Humana, and AARP, which the United Healthcare G-supplemental Plan is purchased through.

Turns out, Bart spent two months in a coma, at NYU Langone Hospital on 75th Street, teetering between life and death. In the first few weeks of his hospital stay, United Healthcare gifted him with a “Notice of Denial of Medical Coverage.” Having been in a coma, he was unable to appeal the decision.

Very soon after awakening, the hospital—or my guess—the insurance company, had him hastily shipped to the Regency Nursing Home in Yonkers for rehab. Away from the few friends and neighbors who know him from the building—Rakeeb, Lucio, Mercedes, and me. Not surprisingly, it seems, the expedited move caused complications, because no sooner than he arrived at the Regency he was rushed to a nearby hospital for a week or so before being returned to the inferior care of the Regency Nursing Home once more. 

Bart’s been in a dark place ever since, wishing to die. He’s confused and unsure of how he ended up in a hospital in Yonkers. He’s complained about the food, noisy neighbor, bedsores, and being left in dirty diapers. Bart says he’s not getting enough PT time. Frustrated, he lashes out at the attendants. Rakeeb and I can vouch for the facility’s lack of staff, poor management, and non-nurturing environment. We’ve witnessed overly-drugged patients lounging and wandering the hallways.

What bestowed him this service was the gap between expenses and profits. Was there a better supplemental insurance to give him better care? You would need a crystal ball to see your future needs to pick the right plan. Working in the now to protect Bart from being buried in debt, I took a crash course of the various confusing Medicare plans: the A, B, C, D, E, F, G. The multiple plans with multiple coverage, seems like a useful way for insurance companies to avoid paying. You know, like when you purchase flood insurance, but your insurance won’t pay because it came from a backed up sewage drain caused by a storm and not the tidal wave.

And because of Bart’s complicated care and required daily dialysis, his insurance ended. His sister, who is less estranged now because of Bart’s health crisis, has helped to secure better insurance coverage: The supplemental G plan, so that his medical bills would be paid and his care would continue. As of January 1, 2023, United Healthcare Supplemental Plan started withdrawing $278.25 a month from Bart’s bank account. And there are limits to how long they’ll pay that I have yet to sort out. They just don’t want to be locked into long-term costly care.

Bart is receiving Social Security—his total income for the year puts him below the poverty line. His rent is a modest $700, plus the $278.25 for insurance…add phone, electric and gas…and how will he eat? Unfortunately, Bart is not the only one. There are a lot of elderly people in the city who are equally cost-burdened.

We’re in a critical point in time, where suffering is at an all-time high. It’s clear who’s responsible for destabilizing an important pillar of our society. They’ve stolen the Medicare name to entice people into an “Advantage Plan”—a misnomer that strips away care and adds to their own bottom line. Resolving the issues of rising costs, broken systems of health, requires a little more thinking than extracting the health and wealth from the backs of the city workers, retirees, and aging Medicare recipients and giving it to the private profit system of care. 

The testimonies throughout the hearing were overwhelming; they provided nuance and options to explore. The abundance of fresh ideas presented could be harnessed not only to find solutions for funding, but to decrease costs, and improve oversight and administration for more efficient delivery of care. Health expert and activist, Wendell Potter, whose introduction and testimonial can be viewed here, suggests several solutions for exploration in subsequent articles, such as the “Participant Eligibility Audit” to uncover “payment for care that was never delivered–and also approving wildly inflated claims. The audits could sniff out erroneous payouts as it did with one claim last year that resulted in a $1.5 million overpayment arising from the duplicate payment of a single claim.” Other cost saving measures can be found using carriers with lower Medigap coverage,  “upgrading its computer system so that it could administer benefits for current and retired workers directly rather than by contracting with one of the big insurance companies, which charge hefty fees as third-party administrators.” Sue Ellen Dodell’s testimonial recommends several solutions, including, “competitive bids for the Senior Care Medicare Supplemental planconsolidation of the MLC’s welfare funds for increased purchasing power and reduced administrative costs,” and review of “the last three years of Emblem’s annual “Statement of Experience” which details members’ usage of the GHI-CBP plan – the City has refused to share them despite our FOIL requests.” Sarah Shapiro, retired teacher and member of CROC (Cross-union Retirees Organizing Committee), says, “The city could create a self-insurance plan. Stuart Eber, Chairperson of the Council of Municipal Retiree Organizations (COMRO) and President Emeritus of the NYC Managerial Employees Association, suggests forming an independent panel with the Medicare recipients, Independent Budget Office, the MLC, the Comptroller’s Office, the Public Advocate’s Office, the Administration, and the City Council…to find alternate means of saving $600 million or more dollars a year in health care costs without imposing premiums or eliminating Medicare. These testimonials, along with others submitted throughout the night and uploaded to the NYC Council’s website separate fact from fiction and offer alternative solutions and a pathway forward.

We ask you to stop those who drive disparity and trade lives for profits. We ask you to secure health for dignity’s sake and for future generations. The people need a health plan, unencumbered and equally dispensed, to ameliorate the health crisis, not an unimaginative wealth extraction plan. We’re asking you to work with us for a greater analysis of the crisis, safeguard what is, and build a system of care and security for the future.

Midtown South Community Council, 331 W 38th St., NY, NY 10018, midtownsouthcc.org, 917-520-3009