ALWAYS IN JEOPARDY? The future of Medicare

 After two years of a pandemic that’s caused people to question health care, one would think a scheme to squeeze for-profit corporations between seniors and their Medicare benefits would result in protests. But as much of the press has focused on Critical Race Theory, mask-wearing, inflation, and Russia’s invasion of the Ukraine, it’s been a stealth attack on Medicare.

Resisting requests to drop a controversial health-care pilot program launched by Donald Trump, the Biden administration on Feb. 24 announced it’s redesigning and rebranding Direct Contracting, which critics say is another step toward privatizing Medicare.

Instead of ending Direct Contracting, the Centers for Medicare and Medicaid Services (CMS) gave the program a new name: ACO REACH (Accountable Care Organization Realizing Equity, Access and Community Health).

The program is set to take effect on January 1.

Under Direct Contracting, corporate participants were paid monthly by CMS to cover a specified portion of a patient's medical care. The companies – most of which are controlled by investors not health-care providers –are allowed to pocket funds they didn't spend on care.

Physicians for a National Health Program (PNHP) issued warnings about ACO REACH/Direct Contracting:

* ACO REACH will pay middlemen a flat fee to "manage" seniors' health, allowing them to keep 40% of what they don’t spend on care.

* Traditional Medicare beneficiaries will be automatically enrolled in ACO REACH entities without their full understanding or consent, and once enrolled cannot opt out of an ACO REACH unless they change primary-care providers.

* Like Direct Contracting, ACO REACH has virtually no limits on what type of company can participate; participants can be owned by commercial insurers, private-equity investors, and other profit-seeking firms, including current Direct Contracting entities.

* ACO REACH increases provider governance from 25% to 75%, but the companies are ultimately accountable to investors.

 

"ACO REACH is Direct Contracting in disguise," said Dr. Susan Rogers, a physician and PNHP president. "This new model doubles down on Direct Contracting's fatal flaws, inserting a profit-seeking middleman between beneficiaries and their providers.

"You can't slap a Band-Aid on a tumor and call it cured," she continued. “Direct Contracting—now ACO REACH—threatens the health of beneficiaries and the future of traditional Medicare. As physicians committed to the health of our patients, we urge HHS to abandon this rebranding effort and focus the agency's efforts towards strengthening and protecting traditional Medicare.

“The goal is to privatize all of Medicare through this program,” she added.

In Washington, Congresswoman Pramila Jayapal (D-Wash.) last month got 50-some House Democrats to sign a letter to Xavier Becerra, Secretary of Health and Human Services, demanding an end to Direct Contracting.

"Trump-era Direct Contracting is a major threat to Medicare coverage, hidden in bureaucracy," said Jayapal, chair of the Congressional Progressive Caucus, adding that she’ll “fight tooth and nail against any and all efforts to privatize Medicare."

Also in February, Sen. Elizabeth Warren (D-Mass.), chair of the Senate Finance subcommittee on fiscal responsibility and economic growth, blasted Direct Contracting, saying it features “corporate vultures … already scamming Medicare.

“President Biden should not permit Medicare to be handed over to corporate profiteers,” Warren said. “Doing so is going to increase costs … The Biden administration should shut down the Direct Contracting model.”

 

Besides seemingly endless TV commercials featuring celebrities such as ex-NFL quarterback Joe Namath and former sitcom star Jimmie J.J. Walker hawking Medicare Advantage, retired Americans have received letters from CMS letting them know that their physicians are now part of Direct Contracting.

Although the government correspondence notes, “Medicare benefits have not changed” and “no action needed,” it comes across as, “Nothing to see here … don’t worry.”

However, health-care advocates seem to be saying, “Be afraid. Be very afraid,” as it’s said in the film The Fly.

“What Direct Contracting does is turn the public side of Medicare into a corporate gold mine,” said Diane Archer, president of Just Care USA.

Traditional Medicare reimburses health-care providers at set rates.

“Medicare was designed as a lifeline for America’s seniors and those with disabilities, not a playground for Wall Street investors,” Rogers said. “If middlemen in health care actually saved money and improved outcomes, the U.S. wouldn’t have the most expensive and ineffective health-care system in the world. We don’t need to put seniors through another failed experiment to prove this.”

Medicare Advantage since the Reagan administration has inserted the involvement of private insurance companies, some of which have used “up-coding” (where insurers exaggerate patients’ medical needs and risk assessments to maximize payments, but then minimize actual services, keeping the difference).is private insurance offered instead of and through Medicare, which costs taxpayers more, Archer says.

Direct Contracting /ACO REACH is Medicare Advantage under another name, except it’s not voluntary.

“The insurance companies are making twice as much money from Medicare Advantage than they do from employer-sponsored health insurance,” according to Dr. Ana Malinow, a University of California-San Francisco pediatrics professor. “Workers have no more money, employers don’t, but who does? The government.”

Direct Contracting, which also added a third party when it launched in 2020, is worse, critics say, because it works with seniors who declined Medicare Advantage, and it’s difficult to opt out.

Traditional Medicare administrative costs are in the single digits; Medicare Advantage is limited by law to less than 15%; DC has no limits.

“If the government has its way, by the end of the decade, every beneficiary of the traditional, entirely public Medicare will have a private, for-profit entity jammed between them and their health care,” wrote said Chicago journalist BrankoMarcetic, author of Yesterday’s Man: The Case Against Joe Biden.

“The largest remaining segment of the U.S. health-care system not dominated by corporate hands will become something else,” he said in Jacobin magazine.

Women's History month: healing and hoping in public health and organized labor

March is Women’s History Month,  and this year’s theme is “Women providing healing, promoting hope” – a fine way to recall and appreciate women in health care and in organized labor, past and present.

Citing contributions of Native American women in the fight for climate justice, African American women presence in ending slavery and working for civil rights and the Voting Rights Act; suffragists leading in the passage of the 19th Amendment so no Americans would be denied the right to vote based on gender; and LGBTQ+ women working for justice, President Biden’s Feb. 28 proclamation on Women’s History Month also made a point of praising women unionists.

“Women of the labor movement are achieving monumental reforms to help all workers secure the better pay, benefits, and safety they deserve,” he said.

“Despite the progress being made, women and girls — especially women and girls of color — still face systemic barriers to full participation and wider gaps in opportunity and equality,” he added.

Women’s History Month has been traced to a week-long celebration of women’s contributions to culture, history and society organized by the school district of Sonoma, Calif., in 1978. Two years later, President Carter issued the first presidential proclamation declaring the week of March 8 as National Women’s History Week. The U.S. Congress followed suit in 1981, approving a resolution establishing a national celebration. Six years later, the National Women’s History Project successfully petitioned Congress to expand the event to the entire month of March.

Globally, International Women’s Day, a worldwide celebration of the economic, political and social achievements of women, first occurred on March 8, 1911, and the United Nations has sponsored International Women’s Day since 1975.

Currently, the nonpartisan National Women’s History Alliance designates the annual theme for Women's History Month.

“Women have long advocated for compassionate treatments and new directions in public health and in women’s mental and physical health, the Alliance said. “Women have also historically led the way in mending divisions, healing wounds, and finding peaceful solutions. This timeless work, in so many ways and in addition to so many other tasks, has helped countless individuals in our communities recover and follow their dreams.”

The theme is “both a tribute to the ceaseless work of caregivers and frontline workers during this ongoing pandemic and also a recognition of the thousands of ways that women of all cultures have provided both healing and hope throughout history.”

Indeed, women hold 76% of all health-care jobs, according to the U.S. Census.

Meanwhile, organized labor has benefited from the dedication and talents of many women for decades, from Mary Harris “Mother” Jones to Peoria native Betty Friedan, the ground-breaking feminist who also was an ardent unionist who in the 1940s and ’50s worked as a writer and activist for the United Electrical, Radio and Machine Workers of America (UE),

Today, the most visible women leaders include National Nurses United (NNU) President Deborah Burger; Mary Kay Henry, leader of the Service Employees International Union (SEIU); Liz Shuler, the first female president of the AFL-CIO; and Sara Nelson, international president of the Association of Flight Attendants (AFA).

Shuler grew up in a union household. Her father was a power-company lineman and she worked summers at Portland General Eletric while the University of Oregon. She first became active in union work as an organizer for the International Brotherhood of Electrical Workers (IBEW) Local 1245, and rose through the ranks.

“The coronavirus pandemic – coupled with our country’s prolonged shortage of jobs that provide living wages, good benefits, and adequate working conditions –  has created momentum for our movement on a scale we’ve never seen before,” Shuler told Harper’s BAZAAR. “For too long, women have been underpaid, undervalued, and expected to take on most of the unpaid care work. That’s why on the national level, we’re working to pass the Build Back Better Act, which will put gender equity at the center of our economic recovery where it belongs.”

Nelson as a young adult had to work four jobs, including as a substitute teacher and in sales, but in 1996 she was hired by United Airlines, where she’s worked since.

Early on there, a dispute over wages prompted Nelson to get involved in labor organizing. In 2002, when United declared bankruptcy, the union representing the airline’s flight attendants turned to then 29-year-old Nelson, who was active in the Boston Association of Flight Attendants union, to assume the role of chief of communications. In the years that followed, Nelson proved shrewd in the public relations department in both the face of the SARS outbreak that hurt international air travel, and after United attempted to cut workers’ pensions. By 2011, her impressive record in union commnications propelled her to international vice president, the union’s number-two leadership position, and three years later, she assumed the position of international president.

“I’m a representation of the people,” Nelson has said. “This is definitely not just about me. This is about whether or not our economy actually works.”

During 2019’s government shutdown, Nelson stepped up and said if the White House didn’t end it, she would consider calling for a general strike. Speaking at Reagan National Airport in Washington, Nelson advocated for the thousands of federal workers at U.S. airports.

“Many of these people are fighting for our country right now, and we are not paying them,” she said.

The next day, East Coast air traffic controllers didn’t show up for work, briefly grounding flights in New York, and hours later, President Trump announced a deal that reopened the government.

“I think that for the majority of people who were defined as essential workers—the majority of them being women and people of color—the pandemic shined a light on jobs that are oftentimes left in the shadows or cast aside,” said Nelson, who’s now organizing flight attendants at Delta Air Lines, one of the few airlines that still has a mostly non-union workforce.

History is still being made.

 

 

 

Unions organizing Illinois cannabis shops

 Legal marijuana is very popular and very profitable.

 Sales have skyrocketed even during – maybe especially during – the pandemic: almost $2 billion since recreational pot became legal in Illinois in January 2020, $10 million the first month pot was legal.

Last year, hundreds of millions of dollars was raised from sales, excise and local taxes, according to Gov. J.B. Pritzker’s office – some $100 million more than liquor. That revenue is funding social programs such as mental-health and drug-treatment services ($134 million), the state’s general-revenue and budget-stabilization efforts (also about $134 million), and administrative, public-education and local government aid (together about $60 million).

The industry has been predicted to generate 330,000 jobs nationally by the end of this year, and 63,000 new jobs in Illinois by 2025.

All that has meant cannabis workers’ increasing realization they need to unionize, and organized labor is responding.

“The solution to rebalancing our economy — making it work for all members of our communities, not just the wealthy few — is good jobs and a union for all working people,” commented Tom Balanoff, president of the Service Employees International Union Illinois State Council.

“No matter where we come from or the color of our skin, working people all want the same things: higher pay, thriving communities, and a fair shot at a good future,” he continued. “Don’t just take my word for it. Illinois cannabis workers themselves are speaking out for the good union jobs they and their families need to thrive.”

Workers at cannabis dispensaries are genuinely interested in organizing, not just following other, high-profile situations, from "Strike-tober" to ongoing activities at Amazon, Starbucks.

“Cannabis dispensaries are a real opportunity for labor, and have been for some time,” said Marc Parker, president of United Food and Commercial Workers Local 536 based in Marquette Heights. “I am also hopeful that Amazon, Starbucks and similar industries are not just a trendy situation. People working in these types of environments [have] real concerns in regards to safety, wages, benefits and the overall concern that their voice in the workplace will matter.”

Since UFCW unionized the first two cannabis dispensaries in Illinois – Cresco in Joliet and Sunnyside in Lake View – organizing has accelerated. UFCW nationwide has been hearing from cannabis workers seeking representation, and Central Illinois is no exception.

“UFCW Local 536 initially received multiple inquires from cannabis workers seeking representation,” Parker says. “Ultimately, our International awarded the jurisdiction of cannabis workers to UFCW 881 out of Chicagoland.”

Based in Des Plaines, Local 881 is UFCW’s Illinois and Northwest Indiana Local, representoing about 34,000 retail and food workers.

“Most cannabis workers are now reaching out to Local 881 directly,” Parker says, and “Local 536 will continue to refer cannabis workers to Local 881: (847) 294-5064.”

In greater Central Illinois, cannabis dispensaries are operating in Bloomington, Canton, East Peoria, Galesburg, Normal, Pekin, Peoria and Quincy.

In Illinois, there has been employer resistance. Several dispensary companies selling pot in several states have hired “union avoidance” consultants to fight their own workers.

Nevertheless, rank-and-file comments show some determination.

“They’re rolling in the money, and they’re not giving us any scraps,” said Patrick Vinson, a Curaleaf worker  in Mokena, speaking to the Chicago Sun-Times.

UFCW, which represents about 1.3 million workers in supermarkets, drugstores and nursing homes in the United States and Canada, has substantial resources and a mission statement of sorts about cannabis:

“We represent tens of thousands of cannabis workers across the U.S. in dispensaries, labs, delivery, kitchens, manufacturing, processing, grow facilities and more — helping workers secure better wages, protection from unfair discipline, and great benefits with a union contract.

 

“We have been instrumental in working to advocate for the good jobs provided by the medical and adult-use cannabis industry,” the international union added. “Wherever cannabis is legalized, the UFCW is committed to building a successful industry with a thriving, diverse and skilled workforce.”

Kim Cordova, president of UFCW Local 7 in Colorado, said, “When workers recognize their true value and their own solidarity, they win. We are honored to have the privilege to represent [those] workers.”

In Illinois, Teamsters Local 777 also is busy organizing cannabis workers, but mutual interest seems more prominent than a rivalry with UFCW. Plus, labor has plenty to do.

“As far as members, or potential members, of Local 536 in the industries that we represent, we were left with little choice when it came to the COVID pandemic,” says Parker. “We needed to report to work to allow the community to get the groceries they needed to feed their families, and to help take care of the elderly. Our members had a seat at the table to discuss and implement safety precautions. Those who were not part of the union, in our industries, did not have a voice to express their concerns in a meaningful way, and I am a firm believer that they should have a seat at the table.”

 

Some of Illinois’ cannabis retailers where workers are organizing

Enlightened in Schaumburg (Teamsters)

Cresco in Joliet (UFCW)

Curaleaf in Skokie (UFCW)

Greenleaf in Rock Island (UFCW)

Medmen in Oak Park (UFCW)

PharmaCann in Schaumburg (Teamsters)

Sunnyside in Lake View (UFCW)

Verilife in Ottawa (Teamsters)

Verilife in Romeoville (Teamsters)

Zenleaf in Highland Park (Teamsters)

Zenleaf in Lombard (Teamsters)

Illinois’ growing gambling is a harmless revenue stream ... WANNA BET?

 

Illinois is soaked with gambling, from lotteries and casinos to off-track betting and video slots in what seems like every gas station with a few square feet of seating over by shelves of over-priced junk food.

This month, things will probably accelerate, and March Madness is only part of it.

Betting on Bradley, Illinois State or other area teams can start under a new state law permitting wagers at state-licensed sportsbooks on the outcomes of games played by in-state college teams (but not on in-game plays, athletes’ performances, etc.).

Passed last fall, the law set March 5 as the deadline for the Illinois Gaming Board to allow sports bettors to sign up online from their computer or phone instead of registering in-person at sportsbooks at racetracks, casinos, etc. Physically, sportsbooks sites themselves aren’t casinos since there aren’t poker or table games, nor slots, roulette, etc. But since March of 2020, more than 90% of legal bets in Illinois were made online, so letting your fingers do the betting is the default position for most sports betting.

Ever since 2018, when the U.S. Supreme Court struck down the prohibition on states authorizing sports betting, it’s expanded faster than hungry greyhounds chasing a real rabbit around a fenced-in dog park.

Illinois’ legislature authorized betting on sports in 2019, and since March of 2020 Illinois gamblers reportedly wagered more than millions of dollars on college squads from outside the state.

Last March, Illinoisans bet $633.6 million in one month with NCAA and NBA basketball action, so this month, under the lure of Illinois colleges being part of the action, sports betting is sure to grow.

To what end?

To benefit schools (like the misleading promise when the lottery launched)?

To make up for state shortfalls in public-pension funding?

To establish better health care or child care?

To cut taxes?

Apart from such remote possibilities, sports betting could take off faster than Tom Ricketts unloading the Cubs roster. Already, in just the last several months, Illinois has entered the top three states (with Nevada and New Jersey) in the amount of money wagered, according to the state Gaming Board.

Raising revenue isn’t bad, of course, but in some ways it’s a hidden tax on many people who can’t afford the expenditure any more than they can easily drop dough on a Ponzi scheme or a long-shot corporate startup.

“Everyone starts out a loser, and most stay a loser, as far as betting goes,” commented Bill Krackomberger – who operates the KrackWins website and is frequently featured on VSIN (the Vegas Stats & Information Network).

“I’m trying to help people,” he told the Chicago Sun-Times. “It means more to me to have safe, responsible gambling.”

But gambling is Big Business. Operators (and states) count on the temptation of getting something for nothing. New Jersey gamblers placed $1 billion in wagers in one month for the first time in September. Big Business means political clout and resources to use sophisticated marketing to generate suckers (um, customers, that is).

“Let the buyer beware,” as Gilded Age capitalists sniffed.

In dozens of states that have legal sports betting, corporations are competing online and over the public airwaves in a frenzy comparable to ravenous sharks swirling around chum, and we are the chum.

(Not the “chums.”)

Some bettors could lose their week’s take-home pay, a chunk of their savings, or worse.  That’s so obvious that – in a minimal concession to risks – broadcast commercials include warnings about “problem gambling” and sports such as the NFL have programs on responsible betting.

It’s a problem as global as pandemics, of course.

“Children as young as 15 are losing large amounts of money gambling online in Ireland,” said Anita Bedell, executive director of Illinois Church Action on Alcohol and Addiction Problems in Springfield.

“They start gambling around age 11 in Australia, and there are 55,000 problem gamblers under the age of 16 in the UK,” she continued. “These countries are introducing reforms to limit bets and gambling advertising to address increases in underage gambling, suicide and addiction.”

True, sports betting – even about Illinois college teams – isn’t as short-sighted as previous administrations having seemingly made prisons seem like economic-development boons. However, promoting gambling is neither creative nor without unintended – and potentially harmful – consequences.

The law enabling sports betting on in-state college teams is scheduled to be automatically repealed on July 1, 2023, unless lawmakers extend it.

You can bet they will.