Comptroller Lander Attacks Plans to Reduce Medicare as he Declines to Register Medicare Advantage Contract Pending Litigation

“As a matter of public policy, beyond the scope of our office’s specific Charter responsibility for contract registration, I am seriously concerned about the privatization of Medicare plans, overbilling by insurance companies, and barriers to care under Medicare Advantage.... Recent investigations identified extensive allegations of fraud, abuse, overbilling, and denials of medically necessary care at 9 of the top 10 Medicare Advantage plans, including CVS Health, which owns Aetna.  ... ‘Once corporations privatize every inch of the public provision of health care, we may never get Medicare back... Brad Lander

Wow! Brad Lander goes on my very small list of politicians I still vote for.... NYC Retirees

Friday, June 9, 2023

Good news. With the deadline to opt out (June 30) of MulgrewDisadvantateCare fast approaching, Brad Lander tosses a monkey wrench into the Mayor Adams/MRC/UFT deal to drag city retirees out of Medicare into the privately managed, profit making Aetna plan, due to take effect on Sept. 1. As you can see above, Lander went further than just talking about the specifics but went after the general attack on Medicare by the insurance lobby and its allies - our own union.

Fundamentally, the UFT/Unity backing of this change is anti-union and anti-worker. But with a union leadership that dovetails with the corporate wing of the Dem party, why expect anything else? We've noticed that some of the rhetoric coming from the mouth of Randi Weingarten and crew turn calls for Medicare for all into MedicareAdvantage for all --- meaning the standard neo-liberal attacks on government run programs as Medicare is. 

Last week, the lawsuit was filed by retirees and yesterday a bill was supposed to be introduced by Charles Baron to the city council, with a large demo outside of retirees but that was postponed until next week - most likely June 22 - Thursday. It's important to have big crowds at these rallies -- politicians notice.

With Adams facing an election in two years, I imagine Lander has put himself into the running as retirees will vote heavily to oppose Adams and Lander just gave himself a leg up. Yes, politics do matter. Even it we don't win the medicare case, we can punish Adams in the next election - and Mulgrew too - both in 2025.

But there is some skepticism in that the Mayor can overrule Lander and will probably do so, so don't go crazy. However, Lander went much further than the narrow legal issues and raised crucial points we have been trying to raise at the UFT - that they were helping kill the only public option. 

Nick has notes at NAC on the story:

New Action – UFT

Mulgrew: the Comptroller is worried about MAP. Why aren’t you? -

Yes, Mayor Adams may reverse Lander’s decision. But we now have well positioned allies refusing to sign off on retiree healthcare cuts. And that bodes well for the future, even if it does mean our dear beloved Unity-led UFT leaders may need to find their ‘healthcare savings’ elsewhere, as their debt to the City passes its due date. And yes, with the spotlight on retirees, we should expect those cuts to land on in-service teachers, who have been promised the absurd: an ‘equal or better replacement to GHI at 10% cheaper of a cost.’

When will that replacement be announced? You better bet it won’t be until after Mulgrew tries to ram through a mediocre contract—and that process will start as early as next week. So, before we vote on a TA, let’s make sure we ask – what will only 90% of our current health plan look like, and how will we afford it on a pay-cut?

Make no mistake: we can’t win the battle against healthcare cuts solely on the good graces of well-positioned politicians. Ultimately, we need to situate ourselves to be able to stop anti-labor backroom deals. As Mulgrew is keen to remind us at DAs and executive board meetings, health care is a part of our overall compensation. Well, we vote on whether to accept what the City offers us in economic compensation. So, both now and when we’re retired, we deserve a vote on changes to medical coverage too. Since UFT leadership doesn’t see the problems everyone else sees with reducing our coverage and tossing retirees onto MAP, we need a formal and permanent mechanism to keep them from doing so.

I'm hitting all my docs before Sept. 1 - braving the smoke today to keep a cardiology appointment - I do preventive maintenance - like having my car checked regularly. I think today is a stress test which I think will show I have slowed down since the last one -- I'm thinking it's my weight which I can't seem to lose - probably due to the cheese cake at UFT Ex Bd meetings. Or maybe it's the stress of seeing my own union try to reduce my healthcare.

The email below was sent by a large medical group here in Delray Beach regarding their feelings about Aetna.  It's an important read regarding their past dealings with Aetna.  

 

Here is Lander's complete statement:

 

FOR IMMEDIATE RELEASE
June 8, 2023

Chloe Chik, (646) 761-2914 cchik@comptroller.nyc.gov press@comptroller.nyc.gov

Comptroller Lander Declines to Register Medicare Advantage Contract Pending Litigation

New York, NY – The Comptroller’s Office declined to register the City’s contract with Aetna to transfer City retirees to a Medicare Advantage program for their health care coverage. A pending lawsuit, brought on behalf of retirees, questions the City’s authority to enter into such an agreement.   Comptroller Brad Lander issued the following statement:  “The Comptroller’s Bureau of Contract Administration carefully reviewed the City’s contract with Aetna and returned the contract to the Office of Labor Relations without registering it. Pending litigation calls into question the legality of this procurement and constrains us from fulfilling our Charter mandated responsibility to confirm that procurement rules were followed, sufficient funds are available, and the City has the necessary authority to enter into the contract.  “As a matter of public policy, beyond the scope of our office’s specific Charter responsibility for contract registration, I am seriously concerned about the privatization of Medicare plans, overbilling by insurance companies, and barriers to care under Medicare Advantage.   “I appreciate the work of the Municipal Labor Council and the Office of Labor Relations to negotiate improvements to the Aetna contract to address some of the concerns raised by retirees. However, the broader Medicare Advantage trends are worrisome. Recent investigations identified extensive allegations of fraud, abuse, overbilling, and denials of medically necessary care at 9 of the top 10 Medicare Advantage plans, including CVS Health, which owns Aetna.   “As health care activist Ady Barkan wrote last month, noting that half of Medicare enrollees nationwide have been transferred from traditional Medicare to private Medicare Advantage plans: ‘Once corporations privatize every inch of the public provision of health care, we may never get Medicare back.’”

###

 

Why Is Being Mandated to Pay Auto Insurance Not a Tax?

When both the left and the right think the Supreme Court was wrong on Obamacare I don't know whether I'm coming or going ------

I line up with Reality-Based Educator in most ways. Certainly on the single payer -- extend Medicare to all position on health care (See his comment below this post at NYC Educator.)

Before going on, your homework is to check this LINK: http://www.counterpunch.org/20...
 
I have been most influenced by my wife who spent 35 years working in hospitals on the admin/billing end. She dealt with all the blood-sucking insurance companies and had the most respect for the government people at Medicare who were the most responsive and competent and caring to try to do the right thing. OK, so it's just anecdotal but don't expect me to bother doing any real research other than talk to her.

Anyway, she has been a confirmed single-payer advocate. But as she pointed out when I sent her RBE's comments, we weren't getting that so she was rooting for SCOTUS to back Obamacare. In fact, I've rarely seen her so engaged in a political outcome as this one. (I was fairly ho-hum in comparison.)

I am caught between RBE and my wife but as a hard head lean toward RBE -- except that coming down as anti-Obamacare lines me up with Republican slime.

Then at the gym yesterday I got into 2 discussions with anti-Obamacare people, one a UFT member and the other a right leaning businessman who hates Obama with a passion -- he opened the discussion by saying, "I hear Obama is moving to Egypt to join his brothers." In both discussions I brought up the car insurance issue - I know the response is that it is states not feds -- but the concept is sure the same as a mandate.

Apparently the UFT member didn't know that at 65 he will be tossed out of his health care program and MANDATED into medicare, a truism since, oh, the mid-60s. So why not just extend that to all? Expensive -- yes. But as my wife points out less expensive than the other options. And as my wife always says, if they got the fraud out of the system it would be real manageable. Imagine if hey hired people like my wife who knows the system inside and out to be bounty hunters -- offer them a % for finding fraud. I could buy that pink Cadillac.

I asked the right winger who is in his 70s if he was unhappy with medicare. Not. Then I brought up the deals about keeping us from buying drugs in Canada. Know what he said? Exactly what the UFT member said to me a few minutes before --- Canada doesn't regulate their drugs as effectively as the FDA -- you know, that awful fed govt agency. He read an article. I asked if he checked to see if any of the drug companies were behind that article (bet they were.). He smiled and wandered off --- finding it easier to work out than argue with me.

Here is RBE's comment followed by a response by NYC Educator:

Yesterday's SCOTUS ruling was a loss, in my opinion.  The federal gov't now has the legal right to force everybody to buy crappy private insurance - no matter how little money you have or whether you'll actually be able to use it once you pay for the premiums.  You don't buy the crappy, expensive insurance, you get penalized via the IRS.  Yesterday's ruling also enshrines the private insurance monopoly.  Say goodbye to ever getting single payer. And finally, those of us with health insurance provided by our employers will soon be dropped from these plans, as the Obama plan rewards companies that drop employer-provided health insurance and penalizes companies that do provide it.

Here's a good quote on Obamacare:

"What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they'll do that. Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster. "

Marcia Angell, Harvard Medical School, editor-in-chief of the New England Journal of Medicine

And here's another:
"The real losers in the latest Supreme Court decision, however, are the people of the United States. Not those who will be  required to go out and buy some over-priced, minimal coverage, rip-off insurance plan offered by the private insurance industry, or to pay a  “tax” to the IRS for not doing so, but everyone. This is because the  Affordable Health Care Act is not affordable. It does little or nothing to control health care costs, which are destined
to continue to gobble up an ever increasing amount of the total US Gross Domestic Product as well as of corporate profits and families’ incomes.

The new federal version of Romneycare simply prolongs the day when the US finally does what it should have done decades ago, should have  done during the first Clinton administration, and should have done at the start of the Obama administration: namely expanding Medicare to  cover all Americans.

Instead of going for this option when he had broad and enthusiastic support as the newly elected president, Obama deliberately shut out all discussion of the Canadian-style approach to national health coverage — a national program of government insurance for all, with doctors’ rates and hospital charges negotiated by the government — and instead devised a
scheme that leaves the whole payment system in the hands of the private insurance industry, and effectively lets doctors and hospitals charge what they can get away with.
Obama did this because he was a huge recipient of money from all sectors of the health care industry — the insurance companies, the hospital companies, the American Medical Association, the big pharmaceutical firms, and the medical supply firms.

ObamaRomneyCare is at its core an enrichment scheme for nearly all elements of the Medical Industrial Complex, with the possible exception of the lowly family practice physician, nurses, and hospital workers."


LINK: http://www.counterpunch.org/20...

NYC Educator

It also insures my daughter and all children of insured families to age 26, and I have read it provides subsidies for some. Tax is minimal, like one percent, and I believe a program like this can be improved. I agree with much of what you wrote, however. Much of the negativity presented already exists, so you're right, that does not represent improvement.

Big Guvment

I was listening to Mike Francese on the FAN yesterday. I have been a Mike fan since he started there 21 years ago. I used to call him up off air to ask for advice about a former student who had become a great high school basketball player. So I feel this long-term relationship with him.

But I am disconcerted when Mike enters into the political arena, which he did with his attack on the proposed health care changes yesterday. Mike takes the view that government can't do anything right. The corollary must be that private is better.

Well, I just had a day and a half of nightmare private plumbing, where a 10 minute job turned into hours. And 10 minutes after the guy left, the place leaked like a hole in a dike without a finger. And I actually know something about plumbing, having done lots of work on my own, including installing baseboard heating. I mean I can solder a joint. And sweat it. And put on the flux. This guy was a destroyer and I ended up with more work needed than when he started.
Hey, Mulgrew, where are all those apprentice plumbers you were working on?

I find Mike's take interesting since he knows his sports, none of which is under government control – at least the last I looked. Well, if you consider that politicians who run government are happy to subsidize any stadium that comes their way, I guess they are involved in sports. But has Mike looked at the privately managed NY Mets lately? Or the Knicks? How about the classic decade long failures in sports management like the San Diego Rockets. Or, even better, J-E-T-S!!!

This lauding of private over public leaves out so much about the enormous failures and errors privately managed organizations make all the time. Microsoft has been notorious for numerous errors in judgment and has wasted billions. Anyone remember Bob? Their bloated software is known not to work until they sell you 3 versions. They can waste these billions because they were brilliant in setting up a monopoly.

This is all pretty funny since Bill Gates thinks he knows what's wrong with public schools, yet brought the Microsoft ethos by getting the first iteration of small schools wrong. Now in the 2nd iteration, he is looking at teacher quality. Guess what Bill? Maybe on the third try you'll get it right. Try class size reduction.

How about all those captains of the financial meltdown? Can you spell A-I-G? How was that private management? The guvment owns so much of them and they don't seem to be doing worse.

Now I read that former Ebay chairwoman Meg Whitman, a McCain advisor (how did that work out) is running for governor of California. Whitman's errors at Ebay in recent years became legendary. Even I scratched my head when she bought SKYPE. (See recent NY Times on this one.) I'm not picking on women here, but how did Carly Fiorina (another McCain advisor who went down in flames) do at HP?

Now when it comes to health care, my wife knows a thing or two. She deals with the thievin' insurance companies and medicare all the time. In terms of competence, guvment wins all the time. (Right now she is looking forward to retirement so she won't have to deal with the the crew at GHI and HIP who don't know who covers what and when.)

So, Mike. Take a broad look at guvment and private and give us a balanced view.

The Great Healthcare Debate

I was going to write this as an addendum to another post, but since NYC Educator put up this great post today (In Which I Face Down the Grim Socialist Machine), comparing his experiences in emergency rooms in the US and the dreaded Canadian single payer system (MUST READ), I'll put my 2 cents in here.

We went into the city to meet a group of friends at the Metropolitan Museum yesterday afternoon. Someone should have sent us to an emergency room for leaving a beautiful Rockaway on a sunny afternoon, but traffic was smooth and we made it in about 40 minutes and I found a parking spot on 86th street off 5th Ave. Not bad.

We met up with our friends, did some museum stuff and then on to the main event - dinner a few blocks away - $35 restaurant week, 3 course delicious dinner.

One couple, a former teacher and a former cop, started talking about all the anti-Obama health care emails they were getting, especially from other teachers. "He has to be stopped," our friend said. "Before the government takes over our health care."

This is not some town hall meeting where people are riled by right wing agitators. These are people from Brooklyn.

My wife, who works in health care, got that look in her eye. She works with all the scuz ball thieving insurance companies and says flat out, medicare is the most efficient and easiest to work with. Thus her support for a single payer system.

The former cop has medicare and his wife will have it fairly soon. So we ask, gently, do they want to give that up? "No, of course not," they say. "Did you know that is a government program?" They didn't. Obama has screwed up big time if they don't.

Did we change their minds? I doubt it.

My take on this? Real health care reform is basically dead. Obama waffled in trying to be a centrist and satisfy all parties and he will end up with tiny changes that will do little good and keep costing a fortune. Now, in the face of the right wing town hall attacks, there are attempts to mobilize that same spirit that he had in the campaign. But I can say as an educator who watched Obama accept the corporate driven ed reform agenda hook, line and sinker - the one area he didn't have to waffle on because he had the teacher unions sucking up – the thrill is gone. I'll just move to Canada or France when I get sick.


Addendum

We got on the line that suggests paying $20. Now I get museumitis after less than an hour and I figure an hour in the museum is worth about 3 bucks. When I hand over $6 and say "two" I get that "cheap bastard" look of disgust. But she hands me two little blue pins.

We go past the security guard who glares at us. The pins look like everyone else's but I'm sure it has an invisible dye that broadcasts "THESE PEOPLE ARE CHEAP."

Well, to make a long story short, the temple of Dendur was ok. Lots of space for such a small temple. I was looking for the Nile to flood while we were standing there.

When I used to take my classes to the MET in the 70's, I think I took them out to pretty much that very spot that the part of the MET houses it when it was still an open field and kids could roll around on it. Then we were off to the great playground across the street on 85th St, where my kids got to mix with all the kids there with their nannies, while I joined them on the benches. Once in a while it felt nice to be nanny for a day. Except they had one and I had 25.

Thursday, June 19th, 5:00 pm - Protest: "National Day of Protest

Join New Yorkers on Thursday June 19th for a day of protest against health insurance profiteering. We will speak-out against the proposed privatization of GHI and HIP and claim Health Care as a basic human right! We will mourn the countless victims of the health insurance industry while marking June nineteenth – a day commemorating the emancipation of slaves in North America. The NYC action is one 17 others nation-wide in solidarity with activists in San Francisco, CA who will be protesting the annual meeting of 38,000 health insurance executives. On June 19th join fellow New Yorkers in declaring our emancipation from for-profit healthcare and support for the single-payer national health insurance bill H. R. 676.

Bring friends & signs.

5:00 pm - Meet at Office of GHI, 441 9th Avenue (34th & 9th)
5:30 pm – March to United Health, One Penn Plaza, (34th St. btw. 7th & 8th)
(A/C/E or 1/2/3 to 34th Street)

For more info on the movement to oppose GHI/HIP privatization:
http://nyc.indymedia.org/en/2008/06/97606.shtml
http://www.myspace.com/saveourhealthcare

For more info on the movement for Single-Payer National Health Insurance:
http://www.healthcare-now.org/
http://www.phimg.org/V2/

March Organizers
Healthcare Now!, The Coalition Against Privatization, Private Health Insurance Must Go! & Physicians for a National Health Program (Metro Chapter)

Supporters
Teachers for a Just Contract (UFT), Independent Community of Educators (UFT), the Take Back Our Union Coalition (TWU Local 100), The Hunger Action Network of NY State, Gangbox: The Construction Worker's News Service, UFT Retirees, D.C. 37 rank-and-file members, D.C. 37 retirees, Socialist Party USA (NYC), & Socialist Action.

More Info: (718) 869-2279, noprivatization@yahoo.com (request flyer)

Cartoon by graphic artist Gary Martin

Hunting Down Bad Teachers

The nationwide focus on quality teaching is curious when compared to lack of focus on quality of physicians, where mistakes lead to people dying. At Friday's ICE meeting, Michael Fiorillo raised a very valid point in comparing the way the US health care and education systems are perceived. He surmised that in reality, the US education system compares rather favorably internationally in comparison to the health care system, where US infant mortality rates are somewhat shameful, among a bunch of other negative stats. Let's say that in poor areas, they are no worse than comparable to each other. Yet, why isn't the Mayor finding a million dollars to root out bad doctors? (I won't even get into the legal profession here.)

I understand the focus on the desire to get rid of “ineffective” teachers but I would love to get people to tell me how to define that. I know plenty of teachers who ended up at private schools and are are considered to be good teachers because the NYC system spit them out due to large class sizes and unruly kids. “Effectiveness” is a relative term. In my first year if I kept the kids from swinging from the lights I was considered effective.

I was part of a group mentoring Teaching Fellows and stories abound of some of them floundering in one school but flourishing in another.

Look at your own schools and from what you can see, what is the % of lousy teachers? Try rating your colleagues in order of effectiveness. Would that list match the administrators’ list? The parents and students’ lists? (I was in Spain 2 years ago at a school where the principal was elected by teachers, parents and kids.) Most bad teachers find a way to migrate out of the classroom, all too often to supervisor’s chair.

There will always be a bell curve of teacher quality no matter what is done and everyone will have some teachers who are great, average and poor. The way to improve quality is to make conditions as ripe as possible for good teaching to take place. But what is occurring is a quota system where principals have to show results in getting rid of some teachers and they often pick on the most vulnerable personality wise, often loners without popular support in the school. In other cases, they pick on teachers who might be good teaching a whole class but struggle in the workshop model. Many have found this to occur when they were slow to adapt to the major changes Diana Lam and Carmen Farina forced down people's throats.

With so many 20-year plus veteran teachers under attack we have to ask, what if they get rid of them all and replace them with first year newbies of unknown quality, many of whom may be worse than the people they are replacing? Are the kids better off?

After the meeting Loretta Prisco sent this item.

A Third of New York’s Worst Repeat Offender Doctors
Continue to Practice Without Licensing Consequences

Statement of Laura MacCleery, Director, Public Citizen’s Congress Watch Division

Nov. 16, 2007

We are shocked – but not surprised – by recent revelations that a New York doctor risked exposing more than 600 people to deadly diseases due to a terrible hygiene practice.

While state health officials delayed public release of the information to patients, the state’s medical board also has let this avoidable public health disaster go utterly unaddressed, incredibly finding no evidence of wrongdoing by the anesthesiologist, Dr. Harvey Finkelstein of Plainview, N.Y.

We immediately took another look at the National Practitioner Data Bank, a record of medical malpractice payments. We found that from 1990 to 2007, only a scant third of doctors with 10 or more medical malpractice payouts had a reportable licensure disciplinary action.

That shoddy record of discipline for the worst offenders deserves a close look by state lawmakers. The “I’ll scratch your back” culture in medicine, in which doctors have claimed they are competent to police themselves, must end before more people are killed by criminal negligence.

To add this insult to patients’ injuries, rather than moving swiftly to address the problem with a subpoena, the state health department took months to negotiate a voluntary agreement from Finkelstein to release patients’ names. Health officials must change their lax attitude and adopt an enforcement mentality, particularly when lives are at stake.

Rate of Discipline Among New York Doctors Who Have Made Medical Malpractice Payments

Number of Payment Reports	Number of Doctors Who Made Payments	Sum of These Payments	Subset of Number of Doctors who had One or More Reportable Licensure Actions	Pct. of Doctors Who Made Payments Who had One or More Reportable Licensure Actions	Pct. of Total Dollars Paid Out Statewide
Total	15624	$8,801,597,900	920	5.9	100.0
1	9435	$2,547,679,350	393	4.2	28.9
2 or more	6189	$6,253,918,550	527	8.5	71.1
3 or more	3057	$4,369,937,700	332	10.9	49.6
4 or more	1631	$3,032,795,700	213	13.1	34.5
5 or more	960	$2,173,580,200	141	14.7	24.7
10 or more	127	$482,470,250	40	31.5	5.5

Source: National Practitioner Data Bank

[The data above reflects information from entire period reported in the NPDB database, and includes payments (both settlements and jury verdicts) reported from September 1, 1990 through June 30, 2007, according to the NPDB Public Use Data File Format Specifications File (http://www.npdb-hipdb.hrsa.gov/pubs/stats/Public_Use_Data_File.pdf).]

Sicko Union

We saw Michael Moore's "Sicko" the other day - at the behest of our 23 year old cousin who just graduated from college. It's nice to see interest in the issue of health insurance from the younger generation. But then again, faced with the prospect that they may have no health insurance, who can blame them?

There is no question the movie will have an impact on the debate, though I always have issues with some of the methods Moore uses in all his movies, especially his disingenuousness. There was also a feeling of exploitation. When you are up against the powerful forces arrayed aghast you on this issue, I guess some of it is justified, though in some cases Moore's case is weakened in his uncritical admiration for, say France, where certain elements of society do not seem exactly enamored, despite free health care. And when Moore points to the fact that so many other services are paid for in the public arena, like schools, I guess he isn't aware of the privatization efforts of people of BloomKlein ilk - by the way, Mike, examining what they did to education in NYC would be a fitting topic for your next documentary. Call it "Sicko II."

But this is about the UFT and the health care issue, inspired by a comment on ICE-mail by Sean Ahern:

"As the owner of HIP does UFT Inc. qualify as a health insurance company? When was the last time our so-called union called for a single payer national health insurance plan? Could it be that their business interests trump all others?"

Now, some members of the UFT will say, "Why should we care about universal health care? We have a pretty good plan." While "Sicko" points to the fact that even people with health plans can find themselves in financial risk at some point, I will take the road of saying that a union that has the resources the UFT has, should be out there fighting for such a basic right for all people in society, especially since so many of our students may not exactly be getting the best health care. Think that affects the job teachers can do?

But I haven't seen the UFT making too many of the political points that unions used to make. And don't expect the AFT to do any more when it has new leadership. As Sean says, they are business unions functioning more in support of the status quo than interested in changing it.