Saturday, February 27, 2016

Why Are Our Copays Going Up!!???

Just this month, I wrote three long (and dense) pieces describing the healthcare crisis that NYC Employees are facing. Feel free to read it. I ended the last piece by telling readers to:

"...expect the union and the city government to come up with a common sense solution. This solution would include
  • Minor payroll deductions from everyone's paychecks (say 2% of the total cost?)
  • An increase in co-pays (because what's the point if we can't all punish the sick and the elderly)
  • A further reduction in the actual amounts that the health insurance providers pay to health care providers. .."




Well, It looks like the first attempt to offset rising healthcare costs has happened. Last night, the UFT Welfare Fund sent members and email describing a significant rise in copays for any city employee seeking healthcare. I'm pasting those increases below this post.

But before you see them, please read these three important observations:

1. This is not necessarily the last increase in our healthcare costs. The city can still call for premiums to be deducted and Emblem can still follow the practice of paying providers so little that our doctors make the decision to turn around and bill us for the difference.  Those are still two very real possibilities that will also offset the rising costs. So make sure you're aware of that. (Deductibles are still possible but I just don't want to think about that)

2. These increases are a direct result of the city's decision to pay less into the Health Insurance Premium Stabilization Fund (HISP). Direct. The unions have allowed the city to pay $153 million less into this fund this fiscal year. That difference must be made up. It is being made up through the copay increases that are posted below. This is important: We, city employees who see doctors, are paying for the mayor's healthcare savings.

3. It doesn't have to be this way, but this effects the least amount of people. In order to make up the $153 million difference, premiums of roughly $25 per paycheck would have to be deducted from each of the city's 250,000 employees. As I wrote in the past, that -avoiding payroll deductions for GHI and HIP members- is the ultimate goal of both the city and the unions (and they all share that goal together).

(JTBC: I support small payroll deduction for all employees. We are union employees, after all. We should share the boom. We should share the burden as well. That's unionism. But from a political standpoint, this 'solution' effects the least amount of people. That's Realpolitik at work in the 21st century. The ones who need the care the most -the folks who visit the doctor- will shoulder the burden).



The chart below lists the GHI changes that will take effect in the coming months:

GHI – CBP BenefitsCurrent CopayNew Copay
PRIMARY CARE PHYSICIAN – PCP (PARTICIPATING GHI DOCTOR)$15$15
ADVANTAGE CARE PHYSICIAN – ACP GENERALIST (PCP)$15No copay
ADVANTAGE CARE PHYSICIAN – ACP SPECIALIST$20No copay
NON-ADVANTAGE CARE PHYSICIAN SURGICAL SPECIALIST$20$30
ALL OTHER SPECIALISTS$20$30
EMERGENCY ROOM$50$150
URGENT CARE FACILITY$15$50
MRI/CT (HI-TECH RADIOLOGY)$15$50
DIAGNOSTIC LAB (BLOOD, XRAY ETC.)$15$20
PHYSICAL THERAPY$15$20
ALL PREVENTIVE SERVICES INCLUDING IMMUNIZATIONS, MAMMOGRAPHY, COLONOSCOPY AND PRESCRIPTIONS FOR CONTRACEPTIONNo copay
The following chart shows the changes affecting HIP subscribers:

HIP BenefitsCurrent CopayNew Copay
HIP Preferred Network (new)No copayNo copay
HIP Non-Preferred PhysicianNo copay$10




Tuesday, February 23, 2016

The Secretive Teachers

A reformer's car broke down in front of a school after hours. He knocked on the door to ask for help and, sure enough, the school was filled with teachers preparing for the following day. Despite knowing who he was, they were more than happy to help. The shared with him their food, let him use their phones to call for a tow and made him feel comfortable and welcomed as he waited for it to arrive.

As he was leaving he heard a wonderful nose. "What was that??" he asked.

"We're sorry" replied the pedagogues. "We can't tell you because you're not a teacher".

Troubled by the response, yet grateful for all of the help he had received, the reformer climbed into the tow truck and went on his way to have his car repaired.

Many years later, the reformer was driving near the same school when his car broke down again. Confident he would receive help, he knocked on the school door. Once again, the teachers opened their hearts to him, sharing their food, allowing him to use their phone to call for a tow truck and making him feel comfortable and welcomed as he waited.

When the tow truck arrived, he heard the same wonderful noise that he remembered hearing years ago. "What was that??" he asked. "Please tell me!".

Once again, the educators replied "We're very sorry but we cannot tell you because you are not a teacher".

"No, no" he responded. "You can't do this to me again. I simply must know. Isn't there any way I can find out?"

"Well" replied one of the teachers. "Go to college for four years and successfully study psychology and pedagogy. Then pass a four hour test in Liberal Arts and Sciences, followed by another in an area of content specialty and finally a last demonstrating your expertise in understanding the many facets of teaching. When that's done be a probationary teacher for four years to learn the trade. Establish real relationships with the parents of each and every student you teach. Demonstrate commitment and loyalty to your school community, commitment and loyalty to the greater community that school serves and the commitment and loyalty to the profession of teaching. .Study the results of your students and your teaching practices. Improve each and every year and make sure you know how each and every one of your students learn best. Arrive early. Stay late and graciously accept unhelpful advice from people who don't really know the job. Be aware of the bad press from the newspapers and TV, suffer ignorant comments from friends, strangers and politicians alike about how you don't have a real job and should be working harder; all while maintaining a magnanimous, teacher-like demeanor.  Do these things while working on a second college degree and make sure you earn three-quarters of the pay that people with similar educational backgrounds have. Once all of that is done, examine this student's paper, then come back here and tell us just one thing: Why doesn't Dan like to learn? Answer this question correctly, and we will gladly show you this wonderful, blissful noise".

So off the reformer went back to college. As requested, he was educated in the background of human psychology and pedagogical techniques. He passed each of his state exams and struggled, but successfully worked, through his probationary teaching period. He earned a required Masters' Degree, suffered all of the benighted comments traditionally shared by people who aren't part of the profession and did so while carrying the name -teacher- with honor. He arrived early each day and stayed late each night.  He learned his students, perfected his craft and did all of this at 3/4 of the pay that his friends and peers earned. And, when he knew he was ready, he took out and examined the paper he had been given years before.

Elated that he would finally learn the true nature of this wonderful, blissful noise, he ran to the school, and burst through the doors looking for the teachers -who he now knew would be there.


"Dan doesn't like to learn because he doesn't understand the vocabulary. But a few vocabulary games will build his confidence and get him engaged."

The teachers, immediately recognizing who he was, smiled from ear to ear, then silently walked him to a special room on the side of the school. They turned they key to the door and welcomed him in to the place where he, at long last, could understand the true nature and composition of this, the most wonderful noise in the world.


But he can't tell you what it is because you're not a teacher.