Yes, I know.  You read TheySaidWhat for the same reason you rubberneck. You simply can’t look away.  You were hoping this week we would be publishing the annual Deplorables Awards.

In 2022, we are not bestowing any Deplorables Awards because at this point most of the vendors who would otherwise qualify have crawled back into their holes.  Nonetheless, anxious readers need not be walk away empty-handed. There are enough Deplorables Award winners from 2021 and previous years (separate links) that I think we’re gonna need a bigger basket.  Yes, there are that many vendors striving to outstupid their competitors to win the Race to the Bottom in the quest to give cluelessness a bad name.

Healthcare Heroes of 2022

Last year, albeit with a less catchy moniker (“Healthcare Heroes”), we also started recognizing people and organizations that were doing the opposite, and helping to reduce healthcare waste, corruption and misinformation. Last year’s Healthcare Heroes can be accessed here, and would all requalify this year.

One addition to the vendors list would be Virta. I originally thought that all diabetes vendors were like Livongo, with their sleight-of-hand savings claims, and Better Business Bureau and Amazon ratings and reviews (“Obviously developed by people who are clueless about diabetes”)  that could make Dr. Duntsch blush.

Consequently, I started out being totally skeptical of Virta’s claims…but now am quite literally putting my money where my mouth is supporting those very same claims.

This year, we are going to highlight winners in two categories we overlooked last year – government and unions – that have done the most to reduce healthcare waste and corruption.  

From the government sector

We often say that we can’t rely on the government to tackle healthcare waste…until, apparently, we can. But that’s only because of the concerted efforts of a few committed people on both sides of the aisle, people who not just believe that the role of government is to curb corruption, but also do it.

First on that list would be Virginia McMillin, a longtime Senate HELP Committee staffer, when Sen. Alexander (R-TN) ran it. I first met Virginia in 2015. The circumstance was that Rep. Foxx (R-NC) was doing the bidding of the American Benefits Council to railroad the Preserving Employee Wellness Programs Act through her House committee. This bill would have given employers the right to, among other things, collect employee and family DNA in the name of wellness and fine people who didn’t measure up. I asked Tennessee resident and uber-concerned citizen Sally Pace to invite her to the World Healthcare Congress, where we were jointly able to convince her to make sure that bill – corrupt even by the standards of healthcare – died in the HELP Committee.

Ms. McMullin is recognized today because she was clearly the lead dog in the Consolidated Appropriations Act too. The full backstory is here, courtesy of Dave Chase.  The highlights:

It wouldn’t have happened if Virginia Heppner McMillin and her Senate staff colleagues hadn’t done the hard work to understand the deep conflicts-of-interest and dereliction of fiduciary duty in employer #healthplans.

Upon reading the explosive Marshall Allen ProPublica expose about how benefits brokers had up to 17 undisclosed revenue streams, Virginia dug in to understand how this was possible and the devastating ramifications. In short, the perverse incentives are a key enabler of why healthcare became the #1 driver of inflation, debt, poverty and bankruptcy for over two decades.

It’s not only difficult to understand the #healthbenefits industry, they had to craft legislative language that would get a hearing, be durable against attacks during Senate hearings and survive legal challenges.

Through their success, every non-government employer in the U.S. is now legally required to report on direct and indirect forms of compensation. Failing fiduciary duties is a personal legal liability for CFOs, CEOs and board members not covered by Directors & Officers liability policies which gets their attention.

On the local politics side, kudos to Julie Menin, the New York City Councilperson (from the Yorkville district where, as coincidence would have it, I cast my first vote at Julia Richmond High School), who recently introduced legislation to find as much as $2 billion in savings by auditing exactly how much city workers are paying for their health care at various hospitals, and making recommendations on ways to lower the prices. All told, roughly 10% of New York City’s entire budget goes to employee healthcare costs.

Extra kudos for this Profile in Courage because the largest employer in her district is also the most rapacious hospital, New York-Presbyterian’s Weill-Cornell Medical Center.  This is what elected representatives are supposed to do – stand up to the monied interests on behalf of their constituents. And yet very few do.

Rep. Foxx’s wellness scam was just the opposite: probably not one single person in her district was asking for a bill to let their employer collect their DNA.  But her financiers were, and that’s what counts.

The Union Runner-Up…

As they generally enjoy much more generous benefits than others, union members have traditionally not considered wages plus benefits to be a zero-sum game. Especially in the private sector, the connection between the two has been so attenuated that the unions would be 100% correct in that conclusion.  (There is also the tax issue. Wages are taxed. Health benefits aren’t.)

The corollary would be that unions would naturally distrust the idea that if they make concessions in benefits that are generally painless but save money, they could get much more back in wages. Management is largely to blame, because most proposals they put forward require that the union give up a significant benefit, as opposed to one such as the aforementioned Livongo, to get higher wages.

But when was the last time you saw management propose a reduction healthcare costs by adding a free benefit that demonstrably saves money?

One easy example: why not cover silver diamine fluoride for cavities at 100%, or even just cover it at all? Quizzify has posted at length about this. Everyone wins except the dentist. My wife’s plan doesn’t cover it at all…and yet the $39.92 I paid for my own cavity was half my 50% responsibiltiy for a drill-and-fill.

Or, as we covered last year, why not give pregnant employees free access to PreTRM, which (assuming the results are followed with a high-risk maternity program) achieves almost Nobel Prizeworthy increases in gestational age.

No, it’s always about us vs. them in healthcare negotiations.

Fortunately, there are two cases where unions and management are often on the same side of the table in health benefit strategies, and hence earn the awards for 2022.

The runner-up is New Jersey. The state runs and finances the health plan, with a commission comprised partially of representatives of several unions. The unions have put their most knowledgeable representatives on this Commission, representatives who are generally much better versed in healthcare financing than most benefits consultants, with none of the latter’s conflicts of interest. (The fact that certain vendors even exist is testament to the benefits consulting industry’s conflict of interest. Some choose instead to “partner” with vendors, so that they can collect money from both parties to a transaction.)

The magnitude of New Jersey’s spend is visible enough that the unions and management are generally aligned in demanding that the carrier and the hospital cartel (ER costs in New Jersey are #1 in the nation!) come to heel. I expect that 2023 will see them in the Winner’s Circle in this column.

…And the Envelope Please

But for 2022, the winner is the 32BJ Health Fund.  By federal law, this Welfare Plan is run by Trustees with equal representation from management and labor. Along with the trustees, the directors who run this fund are very knowledgeable and conscientious. Most importantly, they realize that a dollar saved is a dollar earned, meaning every dollar they save gets back to the members.

There are two reasons for this realization.

First, savings specifically go back to the rank-and-file. They don’t line the pockets of management. And not just on a small scale. The 32BJ Health Fund was able to (among other things) return a $3000 bonus to all eligible members by (also among other things) removing the aforementioned New York-Presbyterian Hospital system from their network. (Groups that remove hospitals can avoiding overcharging with Quizzify’s ER Sticker Shock Prevent Consent, to pay a very reasonable 200%-of-Medicare price for all non-electives, even out of network.)

Second, because 32BJ consists largely of people at the lower end of the pay scale, benefits are an outsized portion of total compensation and hence get far more attention than, for example, at the United Auto Workers, which has shown no particular interest in looking for win-win opportunities to reduce cost. Nor have the auto companies proposed any.

Whether you are union or management looking for solutions that perhaps your consultants have overlooked, or if you want to nominate a vendor for a Deplorables Award, you can contact me directly through this blog. 

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