Quiz: Health care cuts? or Health care savings?

New copay

You go to your doctor. There’s a $15 copay. Last year, there was no copay. Cost or Savings?

If you said “that’s a cut” you are like most of us, a real person. You are picking up $15, and the city is no longer paying that part of the cost.

If you said “that’s a savings” you might be Michael Mulgrew, Harry Nespoli, Eric Adams, or some corporate lawyer or manager or executive officer for Emblem or another big insurance company. That’s money you get to keep

Avoid a copay

You are experiencing pain, and think about going to the emergency room, but think about the cost (copay jumped several years ago from $50 to $150) and decide that it’s probably not serious, and take tylenol instead. Cost or Savings?

You are getting less health care than you would have. The cost scared you away. That is a cut, right? Less care?

But you might have said that’s a savings: if you are Mulgrew, Nespoli, Adams, or an Insurance Executive. That’s an emergency room visit that you might have had to pay for, and now you didn’t. High fives for jacking up copays!

(I was in this situation, but I went to the ER. That triple-digit copay was a cost to me, a savings to Mulgrew.)

Approval for a procedure that should not need approval

Because of a family history of cancer, you need a special diagnostic procedure every year. But this year a guy who works for an insurance company calls to say that your procedure has been approved. Cost or Savings?

If you are a regular person, neither. You need the test, you will get it.

But if you are Michael, Harry, Eric or a stockholder in Emblem or Aetna or Alliance of whatever monster insurance company is involved, that’s a savings. Sure, the guy on the phone did not stop you from getting your test. But he’s sitting there, drawing a salary. And he’s earning his keep (or the insurance company would not otherwise employ him). How does he earn his keep? He’s denying procedures. You were lucky. Some other schlubs are getting denied. And when that guy called you, he was normalizing the process where non-doctors decide whether or not you get the healthcare you need.

Denied care, but get approved on appeal

You move from Medicare to Medicare Advantage, and are denied a preauthorization, but appeal, and get the necessary care approved. Cost or Savings?

If that’s you, and there was no rush, that’s pretty neutral, although annoying. But if you had the same pancreatic issue as this guy, that requires almost immediate diagnosis, that is a horrible, potentially deadly, cut.

For Mulgrew, Nespoli, Adams, this is a savings. Delaying health care will discourage many (but not you!) from using the service they need. Less health care for many means savings for the leadership of the UFT and MLC, and for Mayor Adams. But they even save on you – delaying your care means they hold the money longer. How much could that be? Well, how many retirees can they delay?

Denied care, lose your appeal

Denied care, lose your appeal?

You lose.

Mulgrew/UFT leadership/Nespoli/Adams save.

Stay with a convenient radiologist

Get your CT scan in the hospital connected to your GP? And pay $100 copay?

You lose.

MLC and crew save.

No copay. But a surprise bill

Go for a doctor’s visit. Covered. No copay. But then get billed $19.61 or $23.58 or something that feels suspiciously like a copay?

You lose.

Mulgrew saves.

Adjusting our Language

So here’s the deal. If you are a leech (insurance company), inhuman (financial overseers of NYC), or a labor leader more concerned with power and patronage than with protecting your members, go ahead, call all of these savings.

But what are they calling savings?

• Less healthcare for you and me
• Longer waits for you and me
• Bigger copays for you and me
• Procedures denied for you and me
• More bureaucratic hoops to get procedures approved
• Extra bills for you and me

So for the rest of us, and I assume you are more like me than like Mulgrew, let’s stop saying “cost savings” when we are talking about health care. These are cuts. They are trying to give us less health care, and charge us more for it.

Administrative Code 12-126

The City – Renee Campion from the Office of Labor Relations signed the letter, but it’s for Adams and the financial overlords – also Nespoli for the MLC and DC37, and Mulgrew and Unity leadership want to amend 12-126. Why? To make changes so they can institute health care savings.

If you followed closely, you get it. “Health Care Savings” is what they say when they mean “Health Care Cuts.” Mulgrew et al want to charge you more for health care, and give you less of it.

Say no. Do not allow them to amend 12-126. Tell your city council member – “I like my health care. I love my family. Do not amend 12-126.”