New Teaching Contract

[Irulan]

To clarify, what I meant by "Cadillac Plans" was this
-very low copay ($5-20) per visit
-low deductible (not multi thousand dollar)
--low out of pocket maximum (less than about 1k)
-full availability of prescriptions (no exclusions) for a reasonable cost
And of course coverage for everything. These plans, out of pocket, are very expensive. Anyone remember the days when plans like these were what most people got from their employers?

There are plenty of plans out there that "cover" many things, but as many of us have pointed out, the coverage has to be applied to huge deductibles, huge out of pocket maximum, and sometimes exclusions. Mental health care and prescriptions are usually the first things removed from plans to reduce the cost.

[malkin]

A couple years ago my employer switched us from a $0 deductible plan to a $3000 deductible/HSA and told us that we would now be 'empowered' in our health care decision making.

[Crankin]

Yes, insurance for teachers is outrageously expensive. I had it through my employer in AZ, for just me, because, back then, it was free. I was also covered by my DH's plan, once he graduated college and had a professional job.
That said, once I moved here, I never took the school district insurance. It was outrageously expensive, although it did cover pretty much the same things my plan covered through DH's work.
We pay 294.00 a month for what Irulan called Cadillac coverage (Blue Cross PPO). My employer offers the same plan, for twice the cost to the employees. No deductibles, no referrals needed, and it includes vision care. Our dental insurance is another 44.00 a month. He works for a successful company, but I also think the risk pool has something to do with this. The average age of the employees is young and they are mostly healthy. That said, our insurance paid 100% of DH's stents and angioplasty, as well as paying 18K for an experimental procedure that DS had to cure his Raynauds, back in 2003. They also paid for all of my second opinions at Brigham and Women's back in 2007.
It's a sad fact of life that there is this inequity, but, on the other hand, my clients, who have Mass Health, also have access to most of the same benefits I have. When my older son first graduated, he bought his own insurance, through our health care connector (part of the universal care bill here) that helps working people without benefits find insurance. He paid about 200.00 a month.

[Pax]

Holy crap, I've got it made and didn't realize it! I pay $52 a month for an HMO with $20 office visits, $10/$26/$45 prescription co-pays, and a $200 fee if I use the emergency room.

[Irulan]

Um, yeah. And you were wondering why people are talking about the cost of health care?

[Crankin]

I know I'm lucky. In addition to the above, we have unlimited mental health benefits and prescriptions are 20.00, 30.00 or 50.00. ER visits are 200.00, but that just went up from 50.00.
Our task will be to find similar coverage when DH stops working. We will be able to afford to pay a good amount, but we are more concerned with the continuity of coverage. DH takes 4 prescriptions, and even though he is incredibly healthy since his surgery, he cannot stop taking them. My Prolia is also covered, but I did have to go through some weird mail order pharmacy that Blue Cross insists I use, where incredibly stupid people with really thick regional accents constantly barrage me with phone calls. I now have it arranged that they call my doctor directly to deal with shipping the injection to her.

[Jen12]

Well, as a substitute teacher, I don't get benefits at all, so I pay out of pocket for my insurance.
The system is preposterous. I was looking into dental and you can't really get individual dental insurance. You have to be on a group plan to get some type of coverage. It needs an overhaul system-wide. Teachers aren't the only people getting the short end of the stick.

[girlontheroad]

I am self employed and got to learn all this last year when my cobra coverage ran out. Crankin one thing that saved me was that my state requires if you can't get coverage elsewhere which I couldn't because of pure existing conditions at the time, and you are just coming off an employers plan the company has to offer you one to two plans that are comparable to your previous coverage. The key is not to let it lapse. That allowed me to have similar coverage when other options were not available to me. It currently costs me $1200 a month but the benefits are good. A very nice person told me about this requirement on the phone when they told me they couldn't cover me or I would have been in trouble. The thing that floors me about insurance is the difference in negotiated costs it gives you. I just had major surgery that the hospital charged $60,000 for and which they accepted about 7,000 for with the negotiated rates. Had I not had insurance I would owe the whole $60,000. As opposed to my max out of pocket of $6000. And that was just the hospital bill. My insurance premiums more than paid for themselves this year even with the increase but the whole thing seems like a scam when you look at what gets paid. And I realize how fortunate I am to be able to pay the premiums.

[Crankin]

Well, our situation isn't really related to Cobra; more retirement that may occur before one or both of us are eligible for Medicare and various Medicare supplements. In all reality, we are pretty sure we can work out a deal with the company to continue the benefits, if we pay a larger portion and DH would be willing to stay on in a consultant role. The company doesn't have very many employees in their fifties (all younger), and the CEO is the same age as my DH and he can't fathom why people stop working.

[OakLeaf]

You know what's most distressing to me about this thread?

The expressed and implied resentment toward others who have barely adequate coverage.

What Irulan described as "Cadillac" coverage (a metaphor that was devised to set working stiffs against each other) is barely adequate. It's more like a Nissan Versa with 100,000 miles on it. It'll get most people where they need to go most of the time, but if you put any serious demands on it, you'll find it isn't enough.

Take my coverage, just for example. By today's standards, it's good coverage. I might consider a higher deductible lower coverage plan if it were available to me, but because I have a couple of minor but chronic pre-existing condition, I'm stuck with the conversion plan that I transferred from COBRA in the early 1990s. I'm not insurable on the open market, and I'm not eligible for open enrollment unless I go uninsured for six months, and I'm not ready to take that risk. I'm aware that I'm very lucky to be able to afford EITHER my insurance premiums OR the medical care I need, so go ahead and resent me for my good luck. But I want to illustrate what so-called "Cadillac" coverage really is.

Just take physical therapy - something lots of us have been through and many more will need. My plan gives me 20 sessions. That's plenty for someone who's working out a bit of plantar fasciitis or a back strain. Have a stroke or get in a serious accident? Not so much. Remember that so-called "out of pocket maximums" apply only to benefits that are covered in the first place. So, if you need months of physical therapy, after the first 20 sessions they're all out of your pocket. My deductible is $500, my out of pocket maximum is $2000, and I wound up paying over $10,000 out of pocket last year ... yep, the equivalent of almost four months' premiums. And that's with relatively minor injuries, no hospitalization, no surgery, no scans outside of a few plain films, no super expensive medications.

Also: manual manipulation counts as "physical therapy" and it's subject to the session limit regardless of whether it's performed by a PT and billed as PT, or performed by a DO and billed as OMM. But a hand injury that's normally rehabbed by an occupational therapist with stretching, strengthening and massage - the same modalities a PT would use - is not covered at all, because it's OT.

Dental? (got my sixth crown this year) Zilch. Vision? (thank goodness my vision at least is uncomplicated and I'm just wearing single vision contacts) No coverage there either. Mental health coverage? That depends on the diagnosis (talk about crazy). Acupuncture? Forget about it. But it covers my prescriptions and my allergy shots, covers the emergency room when I need it. So that's considered "Cadillac" coverage.

That's what I pay, I don't have a choice of insurance, but I'm lucky enough to be able to afford it. Think about how most people would be able to pay for insurance. Think about what someone who's really sick or badly hurt would have to pay.

Then you start to understand why there are constantly fundraisers for people to cover their medical expenses ... let alone their living expenses while their ability to work is reduced or nonexistent. And you really understand whose interests it serves to have us resenting each other, rather than the ones who are profiting from all this.

[Veronica]

I started this thread to kind of work for myself how I felt about this new contract since I have to vote on it. Much of my resentment is towards my union - they insist teachers at a site all be treated the same, regardless of performance. We have years of testing data to look at and some teachers just stink at their jobs. They continue to teach as if we have the clientele we had 15 years ago and refuse to adapt. It's likely that because of the school's declining test scores, we're going to start receiving the "assistance" of coaches which means an increase in meetings and paperwork for all of us, including the few teachers whose test scores are not declining. Yet this same union thinks this variance in benefit compensation is fine. And yes, I do resent those teachers who refuse to adapt and whine every time we have any sort of staff development designed to help them becoming better at engaging their students.

We'll never get anything into the contract about teacher performance unfortunately.

Since the change in benefit compensation really doesn't affect me, I've come to the conclusion to not let it affect my voting decision. I appreciate hearing from all of you about how important good health insurance really is. I've had the good fortune to have no significant health issues and since I'm on Thom's plan, I never really paid attention to how much we pay.

Veronica

[Crankin]

Veronica, I felt exactly the same way. I ended up going from a right to work state where the union was just something I could say no to (and I was also part of a merit pay program) to a highly unionized and politicized teaching force. Usually, I am a true blue Massachusetts liberal, but these teachers sickened me for the same reasons you state. They just hated the kids, couldn't deal with working with kids from different cultures and viewed anything innovative as "extra." Well, they mostly left or retired and I stayed. When I left in 2007, I was one of the oldest teachers in the school, and I had only been there 9 years. What scared me was that a few of the younger teachers were taking up the "cause." I would have gladly accepted the chance to have my pay based on my performance. My kids' test scores were always the highest in grade 7 English. What other professional job has the same pay for everyone, irregardless of their performance?

[Koronin]

I know when I looked at insurance when my husband was unemployed it was horribly expensive and there was no way to afford it. (Couldn't afford Cobra either). I ended up with insurance through the restaurant I worked for at the time, but in truth that insurance was not really worth anything unless you ended up in the hospital. I actually was shocked the first time I looked for insurance after graduating college and moving. My dad retired from GM and always had great insurance. I've just been surprised how horribly expensive it is. Currently through my husband's work we do have very good insurace, low co-pays, $5 for generic prescriptions (20% for non generic), we pay just over $200 a month out of his paycheck. Dental and vision are less than $10 per paycheck and are together in a plan that is sperate from the health. I agree with the rest of you that health care costs are crazy.

[Irulan]

Currently through my husband's work we do have very good insurace, low co-pays, $5 for generic prescriptions (20% for non generic), we pay just over $200 a month out of his paycheck. Dental and vision are less than $10 per paycheck and are together in a plan that is sperate from the health. I agree with the rest of you that health care costs are crazy.

These kinds of plans, as wonderful as they are for those who have them, are part of the problem in that real costs are hidden. I mean, if you are paying $2400 a year for coverage, and a handful of change, that doesn't begin to cover the actual costs of checkups, regular visits, prescriptions etc for two people assuming you have regular type issues.... but then again, the system is so screwed up, who knows what things really cost, eh?

We were out to dinner a few weeks ago and one of the guys works for Big Pharma, regional sales rep or something. For some reason the conversation got on to health care costs, and he was saying it was so great that no one had to pay more than $5 for a prescription. I was all, "what planet do you live on?" He was, "you can get yours at Walmart for $5, right?"
Well, the answer is absolutely not. He didn't believe me at first but It's not on the list. My plans doesn't cover it, and it's $300/month at most box stores last time I checked. Thank God for Costco Pharmacy.