You want health insurance with terrible customer service? Forget Obamacare–try Blue Cross Blue Shield of Illinois

There’s not much more to my post than the headline: I’ve just concluded my sixth phone call with BCBS of Illinois (having been hung up on the first five times by an automated phone tree which sends you directly to an automated service-satisfaction survey without first giving you any service to be satisfied about). This means I spent the better–or worse–part of two hours trying to find out why BCBS sent me a bill for my January premium I’d already paid on-line.

I went straight to Blue Cross to buy health insurance because I don’t qualify for a subsidy and didn’t see any reason to grapple with–or burden–healthcare.gov. But every time you hear that payments made on the government Website might not be transferring properly to the insurers, please remember that payments made on the Blue Cross Website suffer from the same disability. And while there’s a live chat on Healthcare.gov which at least connects you to a person who can explain the problem, Blue Cross has made sure to keep its product completely untouched by human hands. I finally got through by calling corporate headquarters and explaining first to the corporate operator and then to local customer service and then finally to national customer service (after local stayed on the line with me for ten minutes to assure that national actually picked up) that a bill dated 12/12 should have included an electronic payment made on 12/2, and that no, the bill and my payment hadn’t “crossed in the mail.” In the words of the great Eric Clapton, “How many times must I explain myself ‘fore I can talk to the boss?” though by “Forever Man” I doubt he meant “man with whom you have to stay on hold forever.”

In short (I know, other people’s customer service nightmares are a bore while one’s own is fascinating), everyone who complains about the f***-ups of Obamacare ought to take a second a remember the last time s/he had to deal with a private insurer. In fact, the worst thing about the Affordable Care Act is that it leaves the insurance companies in the picture, and us to their continued tender mercies.

Of interest to Chicagoans (possibly)

As some of you might know, I was one of a pair of “Dueling [theater] Critics” unceremoniously bounced from Chicago Public Media for being too expert.  (I am not making this up.)  However, you can’t keep a good battle down, and my colleague Jonathan Abarbanel and I have resumed our role as the Bickersons of Chicago theater on a podcast of our own design and creation.  You can hear us on soundcloud every Friday morning and/or subscribe to us on iTunes.

See you at the theater!

What Detroit means

The first thing I thought about Detroit is that the state’s appointment of a receiver demonstrated the Republican governor’s profound indifference to the democratic process of a Democratic city, not to mention a white governor’s profound indifference to a black city.   This may be true, but it’s also true that Detroit’s finances are such a catastrophe that, like New York in the 1970s, it seems to need an outsider to get its house in order. It helps that the trustee is African-American, though not very much: even temporary government without the consent of the governed should cause us alarm.

The second thing I thought about Detroit is that selling off the collection of the Detroit Institute of Art, which the trustee estimates would be sufficient to retire all of the city’s debt, is the best of a number of bad options. Museums nationwide are hyperventilating at the prospect, but they also think it’s sensible to keep on hand huge numbers of items that no one ever sees.  I don’t quarrel with the need to have a deep collection for research purposes, but I also don’t see why it’s considered bad form verging on unethical to sell the parts of the collection you’re not using in public to sustain the parts of the collection you ARE using in public, and at the same time not coincidentally making the sold pieces available to the public, albeit in a different location.

If there had been a Great Fire of Detroit, and the whole city destroyed, no one would argue that recreating the city’s art collection should take priority over food and shelter for the city’s people.  The years of financial mismanagement have incinerated Detroit just as surely as a physical fire; why shouldn’t we pay more attention to basic needs than to cultural institutions?

And isn’t the whole function of assets to provide financial security when income doesn’t suffice? Again, I wonder about the racial composition of those who champion the inviolability of the collection as against the racial composition of those who think it might be necessary to dispose of it. The state’s Attorney General has opined that the city may not sell them because they’re held in trust for the citizens.  But “The United States shall guarantee to every State in this Union a Republican Form of Government,” and I don’t notice anyone’s raising a ruckus about the loss of that part of our patrimony.

The third thing I thought about Detroit is that the bondholders’ interests are being given absolute priority over the interests of current and former employees, whose pensions are at stake. This is the case in Illinois as well, where at least some portion of the pension “crisis” could be solved by refinancing the debt and stretching out repayment but where that solution is not even considered because the bondholders don’t like it. I understand the value of the municipal bond market to cities’ ability to expand infrastructure but municipal bond investors are investors and should be prepared to accept some pain when they toss their dollars into what’s obviously a money pit.

And the fourth thing I thought about Detroit is that it’s Americans’ closest analogue to what’s casually referred to as “the European debt crisis,”  throughout which salvaging the Euro has meant satisfying bondholders at the expense of people who’d like to work or collect their pensions.   Very few commentators seem aware that the real crisis is one of self-government (or its destruction), or that the Germans have managed to do through economics what they couldn’t do through war, that is, run Europe.  When externally-imposed austerity hit Greece, all I could remember was the bumper sticker from the era of the junta: “Greece: Democracy born 508 BC, died 1967 AD.”  Or, this time around, “reborn 1974, killed again 2011 or -12 A.D.”  As the saying goes, same s**t, different day.

Back to Detroit: if I were trustee, I’d sell off DIA’s assets in a heartbeat and use the proceeds to protect employee pensions. If there was anything left for the bondholders, fine; if not, too bad: it’s the pensioners who paid their share and are entitled to what they were promised. Even after years of trashing public employee unions (brought to you by the Heritage Foundation and other fronts for wealthy people who don’t like to pay taxes or see working people make reasonable money), there must be some court somewhere willing to recognize that the obligation of contracts shall not be impaired.

Of course, I would never be chosen trustee, but that’s not the point. The point is, my solution is what would happen if Detroit were still governed by its people. Detroit: Democracy died 2013 A.D.

Community Reinvestment Comes to Health Care

I have no idea what the nonprofit community would do without Rick Cohen of the Nonprofit Quarterly: if there’s an issue affecting nonprofits he’ll have a fresh and useful perspective on it, and this article about the Community Health Needs Assessments required by the  Affordable Care Act is no exception.

What struck me most was Cohen’s point that CHNAs could do for health care what the Community Reinvestment Act did for real estate lending: make large institutions pay attention to the communities where they do business.  Whatever its weaknesses, CRA did make a serious dent in the once-common practice of red-lining, refusal to lend in poor neighborhoods, and we can expect CHNAs to make a similar change in the culture of nonprofit hospitals.  Simply providing an emergency room isn’t sufficient community service, and if a nonprofit hospital fails to grasp that it jeopardizes not only its Federal health-care dollars but the tax-favored status of the rest of its income.   We know that because the provision calls for enforcement by the IRS as well as the Department of Health and Human Services.

This sort of positive pressure from the legislature to improve community health services is far more effective than the purely negative pressure courts can supply by rejecting a hospital’s claim of charitable status (as in the Provena case in Illinois). Because the point isn’t to play “gotcha” with nonprofit hospitals—it’s to supply communities with the maximum benefit possible from the health care resources already available.

Once again the more you know about the Affordable Care Act, the better you like it.   And “Obamacare,” intended as an epithet, sounds more and more like a well-deserved tribute.

cross-posted with The Nonprofiteer: www.nonprofiteer.net

Wise words, sadly earned, by Senator Mark Kirk

I published something today about the sad demise of the the Community Living Assistance Services and Supports Act (CLASS). CLASS was a component of health reform designed to help people who live with a variety of disabilities live more independently and (whenever possible) to stay in their homes. It’s a brilliant article. I hope that you read it.

Then, by chance I encountered a Sun-Times interview today with Illinois’ Republican Senator Mark Kirk. About a year ago, Kirk suffered a stroke. He’s been slowly and courageously recuperating ever since. He suffers from paralysis on the left side of his body. He has difficulties with the left side of his face.

In describing his ordeal and his recovery, Kirk noted the following:

“I will look much more carefully at the Illinois Medicaid program to see how my fellow citizens are being cared for who have no income and if they suffer from a stroke,” Kirk said.

He said in general a person on Medicaid would be allowed 11 rehab visits in Illinois. “Had I been limited to that I would have had no chance to recover like I did. So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face.” [italics added.]

The simple truth in these comments commands respect. Kirk required aggressive rehabilitation services at one of America’s finest facilities for patients recovering from stroke. Such a profound physical ordeal–and one’s accompanying sense of profound privilege in securing more help than so many other people routinely receive—this changes a person.

Politicians and policy analysts often speak in the abstract about difficult tradeoffs and the need to trim waste in programs such as Medicaid. I’ve expressed contempt for conservatives who conduct such conversations at such very great personal distance from the people intimately affected by service cuts in essential programs. Of course, we liberals conduct many of these same conversations at the same psychological distance, too.

Caring for my brother-in-law Vincent has certainly changed my perspective. Whatever the issues are, they aren’t about some group of faceless other people anymore.

Vincent, intellectually disabled since birth, has not physically suffered in the way Senator Kirk has. He does face other challenges. Vincent is, officially, a pauper. He swipes his food assistance and his Social Security over to the group home that provides for his daily needs.

He is entitled to keep $50 per month for personal discretionary spending. That’s not a lot. It’s expected to cover every shirt, McDonald’s hamburger, or ESPN magazine. That $50 is even less now. Vincent requires podiatry care for a complicated toe problem that has already required multiple hospitalizations. Illinois Medicaid no longer pays the $17/month he requires for this care. Illinois has dropped adult dental coverage—another punishing blow for too many people.

Vincent has us to help him address these difficulties. Many of his friends and housemates aren’t so lucky. They’ve outlived their primary caregivers, or they’ve outlived these relationships. For some, their closest contact with a living relative is a birthday card and maybe a Christmas dinner.

I wish Senator Kirk all the best in his return to work this week. I should mention that I didn’t vote for him. Indeed, I walked door-to-door for his Democratic opponent. I will do so again.

Yet as Washington gets down to brass tacks in negotiating budgets and social policy, I’m glad that Senator Kirk will be there. I hope his personal experiences will help him temper his party’s tough positions on Medicaid and so many other things. He has special reason to know better.

Politics and physics

When I was in the eighth grade I had Mr. Nadrowski for science, and one day he called Stephen Chilcote up to the front of the class and told him to push against the cinder-block wall until it fell over.  As Chiclet obediently pushed and the rest of us watched, Mr. Nadrowski kept up a descriptive patter: “So there he is, beads of sweat are popping out on his forehead, his muscles all straining; but you know what?  He’s not doing any work!”  His point was that from a physics standpoint no work occurs unless the object responds to the force; if the wall didn’t move, Stephen’s efforts didn’t count.

This seems to be the definition of “work” Republicans are using to complain that President Obama isn’t doing enough to fix the economy.  They build a cinder-block wall of legislative refusal and then criticize him for failing to push it over.

And when he does manage to move objects despite the cinder-block—by the Executive Order modifying immigration or the administrative maneuvers necessary to maintain contraception as a component of basic health-care—his opponents hyperventilate about Obama’s terrifying expansion of Presidential power.  From the people who created the Constitutionally bogus “signing statement,” that’s chutzpah enough to topple the canonical instance: the boy who, having murdered his parents, asks for leniency because he’s an orphan.

So let’s do some real work of our own.  If you’re interested in actually moving objects—Obama canvassers from Illinois to Iowa, and Iowa Democratic voters from their homes to the polls—please join my Wednesday evening phone bank, beginning this week (July 11) and continuing through the election.  Contact me off-line for details, but bear in mind that Iowa votes early, beginning on September 27: if we’re going to knock over the wall, we’ve got to do it over the summer.

Illinois DMV doesn’t take Visa cards?

I needed to renew my drivers’ license this week. Our DMV is normally only open until 5pm. Fortunately, it is open late on Wednesdays. Unfortunately, Wednesday’s closing time is….. 5:30. Given its inconvenient location, I thus found myself coming home on the 3:58 commuter train.

I got to the DMV in time, only to discover that this is the only place I have ever been that takes credit cards but doesn’t take Visa. And no, since you ask: Unlike my CVS, the local bar and grill, and many other facilities that want your cash money, this large facility serving hundreds or thousands of people every day did not have an ATM machine. While I was there, a stream of baffled drivers asked the cashier, “You don’t you take Visa? Why not?” She had no idea. Continue Reading…

Sauce for the gander

Illinois State Representative Kelly Cassidy has introduced a proposal requiring men who ask their doctors for Viagra to sit through a film showing treatment of its most common side effects, including that mythical four-hour erection.  Apparently it’s not a pretty sight.  Her proposed amendment to the Ultrasound Opportunity Act (obviously named by Eric Blair) parallels the Act’s requirement that women go through a medically unnecessary ultrasound before having an abortion.

Rep. Cassidy, a serious and thoughtful legislator, has declined thus far to accept a suggested friendly amendment requiring these same men to have a pointless and un-anesthetized anal probe.   Nor does anyone recommend modifying the proposal to require colonoscopies, because those would actually benefit the men, and therefore not be parallel to a vaginal invasion at all.

As I stood on a street-corner yesterday leading chants of “Birth control is basic health care!” and “Women are not livestock!” (the latter because the ultrasound bill and other Illinois proposals restricting women’s rights have been sent to the reliably and fanatically anti-choice Agriculture Committee), I wondered if I’d somehow fallen through a wormhole and ended up in 1963.  Hell, even Mad Men has gone further than that.

But if the Republicans want to fight the presidential election on this issue, they can bring it on:  Democrats at every level will win in a landslide.

 

Illinois and the amazing disappearing property tax exemption

When Harold Pollack wrote about the recent Illinois Department of Revenue decision to withdraw property tax exemptions from three hospitals, he naturally focused on the impact of the decision on health care.  But those of us who work in other areas of the nonprofit sector are worried by the decision as well–or, if we aren’t, we ought to be.

Though the Revenue Department’s ruling and the Supreme Court decision on which it was based both concern hospitals, there are now working their way through the Illinois court system a pair of cases challenging the property tax exemptions of luxury retirement communities.  The plaintiffs are taxing districts which would otherwise be collecting big bucks from the communities, one of which is located on prime Chicago Gold Coast real estate–just around the corner, as it happens, from Northwestern’s Prentice Women’s Hospital, which will now (barring court intervention) have to pay property taxes on its equally valuable swath of land.  Lower courts have already ruled both retirement facilities unworthy of property tax exemption, and lawyers involved in both cases expect victory in the face of appeal based on the precedent of the hospital cases.

So what’s really going on here?  Certainly withdrawing tax exemptions from wealthy organizations sitting on expensive land makes sense from the standpoint of municipal budgets, which here as elsewhere are stretched beyond breaking.  So the Illinois Department of Revenue is following Willie Sutton’s [apocryphal] advice to go where the money is.

But what the Illinois Supreme Court has now said is that there are only three categories of tax-exempt real property under the Illinois Constitution: schools, churches and “charities.”  Further, the Court said, a “charity” is not simply any nonprofit organization, or even any nonprofit organization entitled to 501(c)(3) status and tax-deductible donations under the Internal Revenue Code.  A “charity” for Illinois property tax purposes is an agency that gives things away.  How many things?  Worth how much?  This remains unclear: perhaps a “charity,” like “pornography,” is simply something a court knows when it sees it.

And if the question is, “Are you a charity?” will the YMCA of Metropolitan Chicago be able to pass muster?  Will the Museum of Contemporary Art?  Will the Lookingglass Theater?  All three are located within spitting distance of the now-taxable hospital and retirement home.  So they’re likely targets for the next round of investigations.  What do they give away?  Worth how much?

(Just to confuse things even further: the Illinois constitutional standard is that only church property used for religious purposes is exempt; supplementary holdings are not.  I’m not aware of a parallel ruling about schools, but would expect the same standard to apply.  So if a charity owns property not used for charitable purposes–like, oh, vacant property the YMCA may someday use as a camp–will that be taxable?  If so, then it’s not even enough to be a charity–you have to be doing charity.)

As a consultant to charities, I’m supposed to be jumping up and down and screaming about this terrible precedent; but actually I’m not.  It’s long past time for us to ask the question whether arts organizations are genuinely charities.  (I’d ask the same question about well-endowed educational institutions and churches, but the Illinois Constitution prevents me from getting any reward for doing so.)  My only concern is how unaware nonprofit executives and Board members seem to be of the implications of these decisions.  Asked about her agency’s risk of having its property taxed, one executive dismissed the issue: “We’re a nonprofit–everything we do is charitable.”

Well, no.

This argument is playing out around the country.  What’s unique about Illinois is that the discussion is taking place in the courts rather than the legislature or the city council.  This interferes with any effort by nonprofits to rouse public opinion–or even themselves–in defense of their privileges.  Instead, the property tax exemption is going the way of the Cheshire Cat, bit by bit until there’s nothing left but the smile.

Let the Illinois nonprofit beware.