What is Tiered Care?

And why you should be concerned

Yesterday I took my wife out to get her a new car. We’re concerned because of the tariff thing. Tariffs, as you likely know, are taxes the government charges on imported goods. The problem with tariffs is these charges are often passed on to the consumers. Lately, tariffs seem to come and go with no predictable pattern. But a car is a big purchase, and we don’t want to have to pay 25% more for one next month or next year.

I’m no financial expert, and I won’t presume to predict where the economy is going. But I understand there could soon be extra charges, and avoiding them seems the way to go right now. You can do that with a car, if you so choose. You may not be so lucky when it comes to your health care.

Imagine if someone were placing tariffs on your health care. This hospital has no tariffs, so it costs this much. This hospital has low tariffs, so it costs that much, and that hospital has high tariffs, so it costs a whole hell of a lot. (I’ll give examples later.)

If you’re a regular reader, you know I’m heavily invested in a battle to preserve traditional Medicare. The sides on this battle are unusual. Our champions are Marianne Pizzitola and NYC Retirees. Our enemies continue to be Michael Mulgrew and UFT Unity, who created this mess in the first place. The Unity bloggers (when they aren’t mired in baseless, juvenile invective) are shouting about union interference, but I’m glad of it.

If Unity continues to shirk their responsibilities, I’ll take help wherever I can get it.

Wouldn’t you?

If you’re in service, you may consider yourself lucky. Maybe you won’t need to worry about this stuff until later. I regret to inform you that’s not correct. There’s a city law that says if they diminish retiree benefits, they must equally diminish in-service benefits. And while Mulgrew, Unity, and their BFFs in the Municipal Labor Committee (MLC) have not yet succeeded in diminishing Medicare benefits, they’ve already agreed to do so for everyone else.

You’re probably tired of hearing me say that Mulgrew agreed to a 600 billion dollar annual savings, forever, in exchange for a three-year contract. Here’s the thing—he and the MLC also agreed to a 10% cut across the board cut in health savings. So if you’re in-service, or a non-Medicare eligible retiree, you’re facing a new plan the city will pay less for, one way or another.

Do you think the people who made these awful deals can negotiate a plan as good or better than what you have for 10% less? Me neither.

Unity is big on opposing premiums, but they agreed to them as a possibility. Another possibility, and a far more likely one, is that we use tiered co-pays. That means you will pay X to go to this hospital, Y to go to that one, and Z to go to the other. For example, here are some suggested hospital costs:

Tier 1—H&H—city hospitals—no co-pay

Tier 2—preferred hospitals—$500 inpatient, $250 outpatient

Tier 3—Non-preferred hospitals—NYU, NY Presbyterian, Westchester Medical Center—$2500 inpatient, $1250 outpatient

Imagine you’re in a wheelchair and live alone. Or simply imagine you need an ambulance. If you live a block from NYU, the ambulance may take you to the closest hospital, and you may be in no condition to object. Or you may not even know until you get the bill.

I had a doctor who dropped me while I was using GHI. I asked him why. “Because they pay shit,” he responded. Another way to expand the network would be by placing doctors in tiers as well. Perhaps if that doctor charged me a hundred bucks instead of fifteen, he’d have been happier. After all, plenty of members already pay a hundred bucks to go to Urgent Care facilities. Mulgrew’s suggested to the DA he wanted to charge 400. Maybe he’ll get his wish in the new plan. Who can say?

Our leaders like to present exorbitant co-pays as punishing the facilities or doctors. Like tariffs, though, it’s you picking up the actual cost.

Maybe NYU will get fewer city employees coming through their doors, but that will be cold comfort if you’re the one shelling out 2500 bucks you needed for something else.

Geof Sorkin is certainly free to send out emails, claiming it’s a “fight to improve health care.” However, we all know their actual obligation is saving the city money by whatever means they can muster. They’ve been stymied, at least so far, in their efforts to screw Medicare-eligible retirees. However, in-service members are in for a harsh surprise.

They could, as Sorkin suggests, have co-pays “decrease or at least stay the same.” However, that doesn’t preclude their rising as well, depending upon where you go. And they could certainly make this more of a national plan with an option for you to pay more, depending upon where you end up.

Here’s something worth remembering, though—When Michael Mulgrew’s scheme to dump retirees into an inferior Medicare Advantage plan appeared, he presented it as the bestest thing ever. He dismissed those of us who questioned him as conspiracy theorists who “spew lies” and “fairy tales.” This man ostensibly represents us, and even as he claims we lack empathy, deliberately displays none of his own.

He was confidently spouting lies everywhere until retirees kicked his ass in the last election. Then he changed his tune and claimed to oppose Medicare Advantage. But he’s never admitted it was inferior, and all his actions suggest he still supports it. He regularly opposes our legislative actions to protect ourselves, and managed to dissuade a NY Senate member who wanted to bring up our bill.

It’s quite clear Mulgrew and Unity are scrambling to satisfy all the awful, counter-productive deals they and MLC agreed to. It’s also quite clear that tiers are included in the new plan. Though Sorkin does not even mention the word tier in his email, you can find the “optional tiered network” mentioned on the top of page two of the MLC letter, below, which came out the day before Sorkin wrote his. You think, maybe, there’s something he doesn’t want us to know?

Evidently, the care we now receive would be tier two. You may be able to avoid costs by using city hospitals. If your doctors are affiliated with NYU (as are several of mine) or NY Presbyterian, well, too bad for you. Maybe you can skip dating, drive that 2004 Hyundai another eight years, skimp on school supplies, or cancel those dance lessons you’d been coveting. Regardless, we need a change, ASAP.

When you get your yellow envelope, any day now, check the first box for A Better Contract. Then follow the instructions and mail it in.

We can no longer afford Michael Mulgrew’s boneheaded deals. Now is our chance to send him a message. Vote ABC!

Thanks to Marianne and Daniel