Health Care Savings

October 19, 2019, I experienced abdominal pain. Maybe a touch of food poisoning – it’ll pass. But no, it only got worse. I was breaking into cold sweat. The pain was getting worse. Some sort of blockage? Appendicitis? Worse? I considered the emergency room, thought about it, delayed, but with another burst of pain, I went.

The pain must have hit 9. I almost passed out. The doctor quickly diagnosed a kidney stone. An IV drip was amazing. The blood work showed a really high white blood count. Sign of an infection. They were getting ready for emergency surgery. After a scan they hesitated. They did more blood work – the wbc came down – it must have been elevated by the pain. The next morning they sent me home.

I called this piece “Health Care Savings” – but where’s the savings?

• For me? No savings.
• For the hospital? No savings.
• For the City? So, that’s interesting. It’s not really the City. I’ll get back to that.

But whoever pays the bills had two chances at savings, and cashed in on one of them.

First Savings – I Paid Extra

The obvious savings was my copay. I paid a $150 copay. Before the previous round of negotiations, it had been a $50 copay. So that’s a $100 LOSS for me, and a $100 SAVINGS for – for who exactly? Good question.

Because the union leadership and the City agreed that too much was being spent on healthcare, they agreed to work together to hold down costs. My copay absolutely did not go to the union – but the union absolutely got credit with the city for all of the additional copay money. The union meets its “cost savings” obligation by members paying for what the city used to pay for.

Second Savings – (didn’t happen) –

I paused before I went to the emergency room. That copay, $150, is significant. The “savings” (to the city, with credit to the union for meeting its obligation to lower costs) would have occurred if I had not gone to the ER. UFT leadership was quite open with us, people were using the ER when they didn’t need to – and the stiff copay was meant to decrease ER visits.

But I really had to go. That pain was intense – I almost passed out from it. And abdominal pain? A blockage, given my family history, would have been an emergency. Appendicitis would have been an emergency. The kidney stone might have been an emergency (I am glad they controlled the pain and waited and looked again – and realized it was not an emergency – all the same, I still underwent a procedure in January to have it removed). And there was no way I could know which of these it was, or none of them at all. Teledoc? Without a doctor feeling my belly, without bloodwork, without a CAT scan, and without appropriate (non-opiate) pain-killers? Urgent Care? That’s now a fifty dollar copay, for someone who would have sent me to the emergency room.

Nobody stopped me from using the medically necessary services. They just made me pause. They almost discouraged me from doing what I had to do.

When Someone Says “Savings”:

• Ask, who is saving?
• What are they saving?
• Who is it costing?

In my case, the City, with the UFT leadership’s help, saved money by taking it out of my pocked. In my case, the City, with the UFT leadership’s help, tried to save by discouraging me from using medically necessary services. They did not succeed.

Member pays more. Member gets less service. Whoever is saving, it’s not the member.

A year and a half ago I closed like this:

I only thought for one second about the copay. How about a beginning teacher, with debt? Is the copay high enough to discourage someone at the bottom of our pay scale from making a medically necessary trip to the Emergency Room?

How about we stop calling health care concessions “cost saving changes” and start calling them “life threatening changes”? And then how about we stop making them.

– Triple Digit Copays

The next questions should be: why does the union leadership participate in reducing the benefit to members – and are there alternatives.

Triple Digit Copay