Politics — No comments
10
Jul 10

Dispatch from our dysfunctional Health Care system

Here in the US we enjoy the world’s most expensive socialized health care system. The system provides insurance through private, for profit, insurance companies where most people get insurance through their employer. Depending on the employer you can choose between a limited set of health care options. All these have one thing in common: they are expensive, complicated, confusing, annoying, and ultimately result in loss of productivity of the American worker. And that’s if you’re lucky to be employed and have health insurance at all!

I call our system “socialized” because we get socialized health care. The patient experience is one where your doctor sees you for mere minutes before they need to run off and see another patient. There is no personal relationship with your doctor whatsoever, unless while you remain healthy. Our pets, who all see private doctors, in contrast, have wonderful personal relationships with their veterinarians. Going to the vet is a completely different experience, where everyone knows our names and the names of our dog and cats, and the vet takes ample time examining the critters and discussing treatment options with us.

So, here’s a short story of dealing with our system. Is this a story of hardship, life and death, financial ruin? No, sorry. Fortunately the family is healthy and we’re financially stable. This is a story of for-profit companies choosing the most rational path: denying health care, therefore maximizing profits. It’s a story of ridiculous bureaucracy that results in overhead costs that aren’t spent on the actual care. One of the compelling reasons to adopt a single payer system was to vastly simplify administrative procedures, therefore reducing much of the overhead. But we’re not going there. Even after Obama’s Health Care reform, the current system remains in place. In this story you see our dysfunctional system at work.

A Change of Employer

It all started in the end of 2008 when I switched to a new employer. The first thing you do when you join a new place is pick the Health Care option that’s best for you. It’s typically about which doctors you need to keep seeing. Our family has been going to the Palo Alto Medical Foundation (PAMF) for years, and all I had to do was pick the plan that had a deal with that clinic so that my current doctors would be “in network”. There was only one choice: Guardian’s PPO, subcontracted to Interplan.

The first time you go to see your doctor after such a change, you’re asked to see the administration and give them the new insurance information. In my case the information was pretty simple. Guardian sent me a card containing my name, my employer, our group plan number and finally my own member ID. I passed on this information to PAMF and forgot about this altogether.

Claims and their Paper Trail

When you go see the doctor you are charged your co-payment, which can vary depending on your plan. Then the health care provider bills your insurance company for the services provided. If all goes well, the insurance company accepts the claim, pays the health care provider and you’re done. You receive a statement from the insurance company explaining what happened (the instance, the amount billed, the amount covered) and you also receive a statement from the provider showing how much the insurance has paid and asking you to pay for the rest, if insurance did not cover you fully.

The statement from the health care provider is pretty simple. The one from the insurance company is incomprehensible. Typically it’s accompanied by “codes” that indicate the reason something was not covered. The amount covered also can depend on various factors, including deductibles, and percentage of coverage based on an idealized expected total for the given procedure. The point of this is that it’s non trivial to figure out what these statements are saying and it’s non trivial to understand exactly what your health plan provided.

The Story

In 2009 I had to see a doctor for something. After a while I got a bill from the provider for about 100 dollars. I thought that was a bit strange, but assumed there was a small deductible in the plan and just paid it. That month I was probably too busy to look into it as I was doing the bills and the amount was not significant enough to trigger alarms.

This happened a couple of more times, and I paid again. Then I got a bill for $800. That one caught my attention. What was going on? Was the health care plan covering anything at all? Strangely, I noticed I had not received any statements from the insurance company. I assumed PAMF had misplaced the data I gave them on my first visit and called them to find out. Nope. They had all the data and we painstakingly double checked it all. It all matched. And yet, the insurance company claimed that my “identity cannot be verified”. That is, they had my name, employer name, group plan and member id and somehow this was not enough to match the claim to my person. Mission accomplished. Claim denied, more profits this quarter. Continue reading →

Uncategorized — No comments
06
Jun 10

World Cup Fever? Not here.

Almost everywhere you go in the world the World Cup is an overwhelming presence. Nobody can talk about anything else. No TV program can avoid focusing on it. It’s impossible to walk around cities without seeing soccer jerseys, news about the Cup plastered everywhere and a rising level or nervousness that drives people to ask incessantly: when, oh when does it finally start?!

But not in the US. And more specifically not even in the San Francisco Bay Area where there’s a large population of foreigners. The only hint I got that the World Cup was upon us was a pamphlet from DirecTV MAS (the Spanish language package) containing the schedule of games and information about the participating teams.

Of course, I did not need the reminder. I’m among the many that define life as “a succession of those 4 years that seem to fill the void between World Cups”.

As the Cup approaches, the level of intensity rises and I find myself constantly distracted and with an irrepressible urge to consult World Cup related news every five minutes. Who else got injured in the latest friendly? What new colorful news item comes out of Maradona’s rule as head the Argentinian squad.

The lack of prominence of the World Cup in the US results in an unexpected benefit: it is possible to record games and get back home at night without knowing the results, something that would be unthinkable in any soccer country. Of course you can always make matters worse for yourself by wearing a team’s jersey or any other World Cup related article of clothing, in which case chances are someone will approach you and talk to you about games you have not yet watched. But even if you keep a low profile, you still have to deal with your well intentioned co-workers. After all, the only reason to record games is that you still need to go to work, right? Here in Pacific time, the last game of the day takes place at 11:30AM, a rather inconvenient time to step out of the office.

So, I’ve emailed the following message to my whole company, in the hope that they’ll comply and I’ll be able to continue going to work during the Cup: Continue reading →

Education — No comments
01
May 10

Save the Music!

The Redwood City Education Foundation produced this video to call attention to the rather deplorable fact that all projections indicate that due to the huge budget shortfall we’re facing instrumental music will be cut next year in the Redwood City School District… Watch.

YouTube Preview Image

The Redwood City Education Foundation is fighting hard to prevent this one and more cuts but raising funds before June when the School District needs to finalize its budget. If we manage to raise enough by then we can save instrumental music. Donate, volunteer, organize, spread the word, and read all about it in RCEF’s Save the Music page.

And here are additional action items, from an email sent by Georgia Jack, one of the organizers of RCEF’s Save the Music efforts:

Donate to help us reach our minimum goal of $100,000 to maintain 5th through 8th grade instrumental music programs for all of our students in all 17 elementary and middle schools.

Participate in the Groovin’ in the Grove (GIG) concert event on May 29, 2010, being held at Sequoia Unioin High School’s Carrington Hall and Grove area AND the 4th of July Fun Run taking place in downtown Redwood City before the parade. For more information see: www.rcef.org/groovin and www.rcef.org/funrun

Education — 4 comments
16
Mar 10

Redwood City Teachers Union Meeting with Parents

On March 16th, Redwood City school parents held a meeting with officials from the Redwood City Teachers Union to discuss impending cuts. The District is proposing a 5 day reduction in the school year and is relying on the savings from that to address part of the shortfall expected in next year’s budget.

Panel participants: Lisa Carlos, moderator. Bret Baird, president of the RWC Teachers Union. William Crowe, president elect. Kim Combs, Classified Union Rep. Jean Martin, member of RCTA. Ara Prigian, CTA representative.

The next section has my notes from the meeting, edited for readability, and without my own editorial comments. You can stop at the end of that if you’d like, or go on to my rather bleak take on the proceedings.

Notes from the meeting

The organizers pose 3 questions to get the discussion started:

  1. Where is the union in the process of negotiating for this current year and what is your hope of where this process will lead?
  2. How confident are you that the union’s position represents a majority of your constituents with this current contract?
  3. What are you suggestions to the district for balancing the budget in the coming year?

Lisa introduces the panel and lets the current president of the Union answer the three questions.

Bret welcomes everyone for coming, and thanks all for the work of the PTAs, the Redwood City Education Foundation, and finally parents in the classroom.

He starts with question #3. The position of the union is not to fire, hire or evaluate. The union does not take positions on this. Individuals can take positions, but the union does not. If the union takes a position it favors some members over others. Their job is to look for the best contract and working conditions, salary and benefits.

On question #1. Currently at “impasse”. At the second day of negotiations, the Union said they would not be involved in suggesting cuts, and then the District got up from the table, interrupting negotiations. Bret points out the “impasse” has never been reached so quickly. This year the Governor allowed districts to reduce the number of school days by 5 days, a reduction that requires negotiation with the teachers’ union. Bret implied that the School Board move to impasse quickly to force arbitration in the hope of forcing the Union to accept the 5 day cut. Currently waiting for arbitration to begin.

The Union is hoping for the status quo. They claim the mid-year cuts and current expectations of further cuts are projections based on the the Governor’s January speech. CTA claims our District is on the conservative side on these matters, cutting early. The Union’s job is to act as check and balance to ensure things are done properly.

On question #2. He’s very, very confident that their position reflects the position of a majority of the members. They did a survey and got results back. Many of the members are upset about the mid-year cuts. The Union is an extremely democratic organization where everyone can speak at meetings. Any teacher can come raise issues and so can anywhere else. They meet the first Monday of every month at Red Morton.

Lisa: district website has papers with the current proposals from the District and the Union. Officials from the District were not invited to this meeting. After some discussion on why the School Board is not here, and what’s confidential during negotiations, Lisa asked the audience to submit their questions.

Questions from the audience:

Has the suggestion been made to furlough District office workers instead of teachers? How about “furlough Fridays” like in Sacramento? Ara: furlough is unpaid. It’s a bad term. 3 days a month for DMV and other state workers. It’s mandatory to have an 180 day school year, but they allow a maximum of 5 days to be removed after negotiation with the local union. Unpaid days for teachers, no education for kids. The proposal is to remove 4 instructional days and 1 non instructional teacher day. Yes, administrators took some days too, but they work a longer year. Administrators reach the top of their salaries quicker than the teachers (6 years rather than 24 years).

What are the other points of contention for the contract? Just the cuts in teacher days. For 08-09 teachers took 0% salary increase. This year the union accepts the status quo, leaving everything the same. No salary increases. This in itself helps the district save money. 4.5M cut this year, already done. 0% increase and then the cuts, and also 0% last year. If you keep the contract going as is, the union will go into negotiations immediately for next year. Continue reading →

Education — 7 comments
14
Feb 10

RWC Mid-Year Cuts: unfortunately just the beginning

The Redwood City School Board met on 2/10/2010 to discuss recommendations for mid-year cuts. The meeting was very well attended, very long and incredibly emotional. After 1 hour of various unrelated business, we got into the meat of things. Raul repeated his excellent presentation which clearly explains the deplorable financial situation of school districts around our State (If you have not seen it, read it now: Special Board Meeting Mid-Year Cut 2.3.10).  And there were some small updates from the previous week: incredibly, the situation is looking even more grim now and we’re projecting a higher shortfall than before due to new information from Sacramento.

In the next section of the meeting people had the chance to address the Board. Many people spoke, concerned about the various cuts currently under way. We heard from teachers, parents, staff and even a principal. There was crying, there was yelling, there were some accusations, but by and large the speakers were polite and made their points eloquently. Most of the comments had to do with the removal of teachers from classrooms in the middle of the year and the impact on kids, specially Kindergartners. 8th graders from McKinley made a statement in support of their math teacher, soon to be laid off.

The Board members listened stoically, saving their responses and commentary for the end. When that time came they asked the administrators for some clarifications, discussed the situation and eventually voted to approve the cuts as proposed. (I left at 11:30PM before the vote took place.)

I don’t envy them at all. Their job is to be responsible adults and keep our School District functioning under extremely adverse circumstances. They all pointed out that none of these cuts are good and that we’re making them because we really have no choice. And they reminded us that given the financial outlook, these cuts are just the first, a small sample of the cuts that are coming.

Why Mid-Year Cuts?

Basically, because the district has no choice. The district has to maintain a 3% cash reserve to avoid being taken over by the State. Current cash reserves are around 3.69%. The State Controller has warned that California might not have enough money to pay salaries in the months ahead and the district might need some of the reserves for that. And the situation can get even worse if the State decides to impose a mid-year cut retroactively like they did at the end of last year. Cuts made now also mean fewer cuts to be made for next year’s budget although this is little consolation as we expect massive cuts then regardless.

So, cuts need to be made. What can get cut? In Redwood City not much. The district has already been cutting every year to reach our current situation where 85% of the budget goes to salaries. At this point any non trivial cuts require reducing staff.

And because of various contracts the district has very little choice of who can get cut in the middle of the year. The jargon here is a bit confusing for outsiders like me, but my understanding is that the district can’t lay off teachers when they’ve been employed for 75% of the school year, which requires cuts to happen very soon. “Temporary teachers” get chosen first. Their positions can be filled with teachers that currently work in the district but outside the classrooms. And it seems we’re even lucky in Redwood City that we have other teachers that can take over.

What are the Cuts?

The cuts and some of the rationale is outlined in this letter from the superintendent. You can see them here as well. For each cut, the first number is how much we save this year followed by how much we save the following year:

  • 9 temporary classroom teachers: 261K/764K. Positions to be back filled by credentialed teachers in the district but not currently working within the classroom.
  • 1 accountant: 23K/87K. The administration would pick up extra work.
  • 5 custodians: 67K/256K. Currently school classrooms are on an ABC schedule, cleaned every 3 days. Now they will be cleaned once a week. Restrooms, cafeterias and nurses’ rooms will be cleaned every day.
  • Reduce RSP instructional aides to 3 hours: 60K/229K. Impacts 25 employees in the district.
  • 1 office manager at Roosevelt: 23K/55K. This is a vacant position.
  • 1 system manager, position currently vacant: 39K/105K.
  • 1 classroom teacher at Newcomer: 82K/82K.
  • Plato learning program: 25K/25K.
  • Freeze budget for library books and materials: 23K/31K.

The district is still hoping to reduce the work year for all employees by 5 days, for a possible further reduction this year of 1.3 million. Negotiations are at an impasse with the teacher’s union. Mediation will begin on March 17th. The union notified the district they won’t move until mediation takes place.

The following were originally considered for mid year cuts but were rejected at this point: these will not be cut right now:

  • Increase class sizes to 31 at grades K-3.
  • 1 transportation dispatcher.
  • 10.7 library aides.

Of course, we expect all these to be cut at the end of the year as possibly the deepest cuts in recent memory are expected, their magnitude depending on the level of funding supplied by the State.  As always, our dysfunctional State won’t be able to pass the budget in reasonable time and the school district will be required to make worst case cuts in advance of next school year. And now the projected shortfall has grown, to between 4.7 and 13.7 million dollars.

Raul noted that current funding is about the same of 2006/2007 but we now serve 1000 more students. We reduced our budget by 17% in the last three years. Per student funding went from 5500 per year to 4700 per year in 2009/2010. The situation is expected to get worse in the next few years. The public education system is being dismantled in front of our very eyes. Continue reading →

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