Written and edited by Norm Scott:
EDUCATE! ORGANIZE!! MOBILIZE!!!
Three pillars of The Resistance – providing information on current ed issues, organizing activities around fighting for public education in NYC and beyond and exposing the motives behind the education deformers. We link up with bands of resisters. Nothing will change unless WE ALL GET INVOLVED IN THE STRUGGLE!
Message to Unity Caucus defenders of profit making healthcare - You've been misinformed
Contributing to the high costs of privately managed healthcare are: high executive salaries(often based on the price of the stock), advertising (those Joe Namath ads), high administrative costs (significantly higher than Medicare), profits, stock buybacks, dividends higher employee turnover - compare benefits to Medicare employees ---and are they unionized compared to employees of private insurers? So how can moving out of Medicare and into plans controlled by these companies save the city money? Unless those savings come out of our hides. And by the way, do you think these jacked up prices have anything to do with inflation?
ANTM initiated cash dividends in early 2011 and has raised its dividend ever since. Share
buyback activity was resumed last June, considering its solid solvency
position. ANTM expects to buy back shares worth $1.6 billion for 2021
and around 60% of the target has been achieved so far.
Note: American Federation of Government Employees
AFGE Local 1923 was chartered as a labor organization in October 1959,
representing approximately 30,000 employees nationwide that are employed
in the Social Security Administration, Centers for Medicare and Medicaid Services (formally HCFA), Veterans Affairs, Department of Defense, and the National Mediation Board. Local
1923 is the largest federal union in the country with over 8,000
members and continuing to grow.
....the median pay of health insurance executives in 2018 was $7.7 million. Fourteen CEOs made more than $46 million each....There’s nothing wrong with companies trying to make the most profits as
long as the market is kept fair, transparent, and accountable. The
personification of corporate entities is an utter mistake. It places
them at an unfair advantage, more so the sophisticated, or as I like to
call it, twisted policymakers need to realize what happens when private
markets get involved in public policies and politics.....The Insurance Industry will always Strive to keep Healthcare Costs High - To
maximize their profit, insurance executives take decisive strategies to
exploit income... to widen their profit margin,
insurers often utilize various avenues, including lobbying, manipulating
the social determinants of health and sickness, legal kickback
privileges, ..the term “nonprofit” is misleading, as numerous nonprofit
organizations even take in millions of dollars annually and consistently
run in the dark
... the total incentives are toward less medical care because
the less attention to patients, the more money kept in the pocket.
In the year, 2020 insurance companies spent over $80,428,145 for 166 clients..
Above are a few key takeaways from this 2 year old article which carries lots of important lessons for our union leaders who know not what they've done.
If a Government is going to compel you to buy Insurance, shouldn’t the Insurance be nonprofit?
he
concept of a nonprofit organization is misleading, as it sounds like
the latter system is built solely on humanity and care for others. For
that reason, we often hear criticism such as healthcare has become
for-profit and insurance companies or healthcare institutions, in
general, should be not for profit- if they meant to deliver quality
medical care for everyone.
The
notion's rhetoric elevates almost every soul; however, it is
practically far from reality. Because some of the most robust insurance
systems and managed care organizations in the United States are
nonprofit (like Kaiser Permanente) yet in 2019, the leading managed care
organization had $7.4 billion in revenue. And it is one of the biggest
and the first provider of Medicare advantage and participant of the
Affordable care Act (ACA). Therefore, most managed care systems that
have partnered up with ACA are nonprofit.
A
nonprofit organization (NPO) (also notorious as a non-business entity,
not-for-profit organization, or charitable institution) is traditionally
applied to promoting a particular social cause based on shared values.
It is designed to use its revenue surplus to reinvest rather than divide
its proceeds to the organization’s shareholders, leaders, or
affiliates. A Nonprofit organization is to serve as the public extension
of a government’s revenue department. For that reason, they are
exempted from paying tax on the money that they receive for their
organization. They can operate in religious, scientific, research, or
educational settings.
Nonprofits’
critical slants apply to liability, trustworthiness, rectitude, and
openness to every person who has invested time, money, and faith in the
organization. The former is something that is the subject of
considerable controversy.
Not
distributing its profits to any private individual is the crucial
difference between nonprofits and for-profits. Besides that, the
executives of the system still get salaries and salary raises. In
reality, the term “nonprofit” is misleading, as numerous nonprofit
organizations even take in millions of dollars annually and consistently
run in the dark. A few are vision Service Plan, Red Cross, Volunteers
of America, United Way, and Pride Industries.
To
fulfill a nonprofit’s mission and vision, the company needs a steady
stream of income. Think of programs like “service” and fund development.
To support earnings, one must raise awareness. Raising money, ongoing
community involvement, finding opportunities for others to help,
formulating the annual fund extension & public relations plan, and
making it all happen with the support of the Executive Director, Board
of Directors, and an army of excellent volunteers.
What is health insurance?
Insurance
entails collecting funds from many insured entities, also known as
exposures, to pay for the losses that some may acquire. Therefore, the
covered entities are immune from price risk. The set value of the latter
is dependent upon the frequency and severity of the event occurring. To
be an insurable risk, the risk insured against must meet specific
characteristics. Insurance as a financial emissary is a money-making
enterprise. They are also a considerable portion of the financial
services industry.
Health
insurance is coverage that embraces the whole or a part of the risk of a
person sustaining medical expenses, spreading the risk over many
persons. By approximating the overall risk of “health risk” besides
“health system costs” over the “risk pool,” an insurer develops a
finance structure, such as a once-a-month premium or personnel tax, to
provide the money to pay for the healthcare aids specified in the
insurance negotiation.
Insurance is a business, hence for-profit
Health Insurance industries are not charity organizations.
Like every other business, they will pivot their strategies and often
even their vision and mission to maximize profit. Unfortunately, the
mainstream public holds a different mindset. The average soul believes
that healthcare costs can only be paid for by the third-party entity,
which often pertains to the for-profit insurance industry.
To
maximize their profit, insurance executives take decisive strategies to
exploit income. Governments and or private organizations regulate the
modern insurance industry. Nonetheless, to widen their profit margin,
insurers often utilize various avenues, including lobbying, manipulating
the social determinants of health and sickness, legal kickback
privileges, and maintaining non-transparency to factitiously present
costs and high patient premiums. For instance, health Insurers are
collecting details on public information. They can predict our health
costs based on more information that happens, and R & D like race,
marital status, how much T.V. we watch, whether we smoke, or even buy
plus-size clothing. These are data that could raise our health premium
rates.
Along
the way, insurance companies have partnered up with administrations
through subsidies and legislative loopholes. Affordable Care Act and
Medicare Advantage are a couple of many scenarios where insurance
companies have tapped into the public funds. Even with full access to
the taxpayer’s money, 3rd party payers have still maintained flexibility
to patients under ACA via co-pays and deductibles. For example, the
eligible patient for ACA not uncommonly pays a co-pay as high as $300
for a simple chest X-ray.
Some
advocates of universal healthcare coverage propose Forcing insurance
companies to become nonprofit organizations, notwithstanding the
possible constitutionality clause of such a move by the administration.
Besides, there are already 3rd party payers that are practically not for
profit, still making billions of dollars for their executives.
The Insurance Industry will always Strive to keep Healthcare Costs High.
The
insurance industry will always want to make the public ancillary on
their mission. And to prevail, will refuse to be transparent, deter
accountability, and manipulate governments to pave their way for
ultimate financial reign. Legal kickback is one such example.
Kaiser
Permanente (K.P.) in northern California (the frontrunner of the
managed care system) functions as a parasol for many medical groups, the
Permanente Medical group. While K.P. is seemingly a nonprofit, the
medical groups that form the network are for-profit companies. About 50%
of the Kaiser Permanente umbrella’s profits return to these for-profit
entities. In 1973, the CEO of Kaiser introduced the network’s business
model. In the circle of K.P., Permanente Health Plan, and Permanente
Medical Group, the total incentives are toward less medical care because
the less attention to patients, the more money kept in the pocket. For
instance, based on the experience of a person I know, the agency
pocketing $500 per month government subsidy on behalf of the eligible
patient, charging $60 per visit of co-pay and $300 for Chest X-ray.
Plus, no charge for Annual holidays and labs, but if labs are ordered
via wellness program, include co-pay. Guess what!? They order the annual
labs via wellness programs.
U.S. Government can’t set Prices on Insurance.
Price
fixing is an agreement amongst competitors that raises, lowers, or
stabilizes prices or competing terms. Commonly, the antitrust laws
dictate that each entity establishes rates and other terms on its own,
outwardly agreeing with a competitor or creating a monopoly. When
consumers choose what insurance coverage to buy, they expect the price
to be determined unobstructed based on supply and trade, not through a
behind-door agreement among competitors. The latter is something that is
often overcome by various indirect strategies. When business rivals
agree to restrict competition and create a monopoly, the result is often
higher prices, which we are experiencing today. Therefore, price-fixing
is a primary concern of government antitrust enforcement.
A plain agreement between competitors to fix rates is not only unethical but almost always illegal.
Illegal
price fixing transpires whenever two or more competitors agree to
raise, lower, or stabilize the price of any goods or service deprived of
any valid excuse. Price-fixing schemes are every so often worked out in
secret and can be hard to uncover.
Invitations
to regulate prices also can raise solicitudes, as when one competitor
announces that it is willing to end a price war if its rival is prepared
to do the same. The terms are so specific that adversaries may observe
this as an offer to set prices collectively.
Price
fixing relates to prices and other terms that affect prices to buyers,
such as shipping fees, warranties, discount programs, or financing
rates. The antitrust investigation may occur when competitors discuss
current or future prices, Pricing policies, Promotions, Bids, Costs,
Capacity, Terms or conditions of sale, including credit terms,
Discounts.
Identity
of customers, Allocation of customers or sales areas, Production
quotas, R&D plans but all happens in the real world, particularly in
the face of developing sophisticated technologies such as Artificial
Intelligence and Big Data analytics.
Government Partnership with the Insurance Industry is a Mistake
When
governments subsidize private companies to provide public benefits,
whether part or all of the service’s cost on behalf of the individual,
they take certain risks to control — the expense of the insurance
premium. Analysis based on 2017 data from more than 9 million people
suggests that health insurance companies have an incentive to charge
higher premiums in low-income areas because of how subsidy amounts are
arranged. That is because consumers with less money are more likely to
qualify for higher tax credits. The government absorbs most of the cost.
On the other side, insurers will charge lower prices in higher-income
populations. Consumers are less likely to receive a significant tax
credit and might become reluctant to buy coverage if they think premiums
are too expensive.
The patient premium under the subsidized system will ultimately depend
on their neighbors, say some scholars. For instance, If you live near
people who are needier than yourself, you will be affected otherwise
than if you live near wealthier people. This system, like the one we see
with ACA, has created a new class of Uninsured. The U.S. Census
Bureau’s annual report on health insurance coverage shows that uninsured
Americans rose from 2017 to 2018. The rising uninsured rate stalks
largely from Obamacare’s letdown to deliver affordable health insurance
premiums. Concomitantly, individual market premiums spiked out of
control. Centers for Medicare & Medicaid Services (CMS) data
demonstrates a considerable enrollment drop among unsubsidized patients
on the single market. The latter does not get federal premium tax
extensions. From 2016 to 2018, unsubsidized enrollment declined by 40%.
Insurance Industry Lobby the Government
The insurance industry’s lobbying practice is an open secret. In the year, 2020
insurance companies have spent over $80,428,145 for 166 clients, almost
65% of which were former government employees. The latest does not
include managed care systems, such as the Kaiser foundation health plan.
Although lobbying is legal entertainment for corporate entities, particularly given their personification
status, it is ethically and logically an unfair practice. Because it
places individuals at a significant disadvantage, not to mention that
subsidizing the same entity that has lobbying power over the same
government is an utter conflict of interest and Ludacris. That is even
more troublesome when they are exempt from tax payments under the, not
for profit formation.
The Nonprofit Insurance Industry will neither help the Healthcare Industry nor will it be Practical.
By the numbers, the median pay of health insurance executives in 2018 was $7.7 million. Fourteen CEOs made more than $46 million each.
Therefore, whether an entity is nonprofit or not does not necessarily
affect their salaries. (Although they may not have stock options)
According to a survey, total direct compensation (the sum of base salary plus annual incentives and long-term incentives) for health insurance CEOs increased 12% from
2018 to 2019, while the companies themselves experienced a 6% rise in
total revenue during the same period. Total direct compensation for
health insurance CEO is
outpacing most other top executives as much as 1.5 to 2.4 times faster.
#HCWB
As
of 2019- St. Louis, Missouri, the chief at Ascension Health earned
$13.6 million; the CEO at the “Nonprofit” Kaiser Foundation in Oakland,
California, secured $10.7 million.
There’s nothing wrong with companies trying to make the most profits as
long as the market is kept fair, transparent, and accountable. The
personification of corporate entities is an utter mistake. It places
them at an unfair advantage, more so the sophisticated, or as I like to
call it, twisted policymakers need to realize what happens when private
markets get involved in public policies and politics.
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