Feeling like a hostage

The city and its workers, like many other employers and employees in western Pennsylvania are caught in the fight between UPMC and Highmark BC/BS.

I can’t help but feel UPMC is holding us hostage.

As most already know, UPMC refused to negotiate a new agreement with Highmark, one of the region’s largest health insurance providers, after Highmark agreed to buy into the troubled West Penn Allegheny Health Systems. The Allegheny system was in danger of financially collapsing without finding a partner. If that were to happen, hospitals would likely have been shuttered and a lot of people left without services or health care providers. In addition, it would have given UPMC a near monopoly in the Pittsburgh metropolitan area.

UPMC announced that since Highmark would be a provider, not just an insurer, it could not do business with it. As a result, there would be no new contract when the current contract with Highmark expires on June 30, 2012.

Those with Highmark BC/BS insurance would be “out of system” and have to pay much higher fees for using a UPMC hospital and the many doctors and others who are either employed directly by or are contractually within the UPMC system.

I find it ironic that UPMC does not want to do business with Highmark because it would be both a provider and an insurer, when that is exactly how UPMC operates.

The UPMC propaganda machine has been working overtime on putting its spin on things. City council has received two very pointed letters from UPMC officials, and UPMC has really been on the front-end of the media push, at least in northwestern Pennsylvania.

In the latest letter, Gregory Peaslee, UPMC senior vice president, noted that UPMC is very concerned that the city’s employees continue to have access to UPMC physicians and hospitals.

I bet not has concerned as I am. City employees do not have a lot of choice. UPMC is the local hospital and most of the local doctors are in the UPMC system. Sure, someone could go to Titusville or Clarion, but the truth is UPMC has a local monopoly and has just moved to strengthen that.

Bear in mind, the city and its employees selected Highmark BC/BS over competing plans, including UPMC Health Plan, because it was the best value.

To make its position more palatable, or at least sound that way, UPMC has announced it has gotten four other insurers to come on board. There is some argument that that will result in more competition than has existed in the past in western Pennsylvania and therefore lower comparable costs going forward.

Still, I can’t help by view what UPMC is doing as a squeeze play and yet another attempt to assert its hegemony in the region.

Face it, UPMC has not exactly been a gentle giant when it comes to dealings with the remaining independent local hospitals in the region, such as Titusville or Clarion. If you doubt that, talk to the people in the know at those facilities.

The merger of our local hospital(s) into UPMC brought us a beautiful, new hospital. I’m not sure what other benefits have accrued.

Many “back office” jobs have been shipped off to Pittsburgh. It strikes me that a lot of people are now sent to UPMC’s Pittsburgh centers for procedures that use to occur locally and we have not gained the promised increase in specialists, and in fact have fewer of some than we did before.

And now UPMC is saying it won’t play ball with the city’s current health care insurance provider.

I’m sure Highmark BC/BS is no business saint – I’ve had my share of disputes with them – but UPMC is really something else.

In response to the question

Anonymous has left a new comment on your post "The ORA, the County and Just What Do We Expect": Hi John. I miss your insight and additional source of information. Did you give up on your endeavor?

I guess the honest answer is I did give up for a while. The reasons are many.

First, I reached a point where I wasn’t sure I had much to say worthwhile and also began to question whether more than a handful of people cared in any case. I also feared I was in danger of becoming “snarky” about a couple of things that went on, and I don’t like that in others, let alone myself.

On a more personal level, I went through a bit of a mentally down period dealing with the continued frustration of unemployment and trying to hustle and complete some freelancing and consulting work. On the upbeat side, I’m once again gainfully employed, but have been awfully busy settling into the new job and we are also now grandparents (Samantha Audean Bartlett) and I have to say that has been the focus of a lot of my life.

And there is yet one other reason I hadn’t posted for the past two months: my computer ineptitude resulted in getting me locked out of the blog site after I changed a number of e-mail addresses and servers. Obviously, I’ve figured that out.

I do have a sense of not meeting a commitment I made, and for that I apologize.

As nearly everyone knows, I am running for re-election to city council. It was a difficult decision. I don’t really find serving on council fun, but I do believe I am an important voice and I do enjoy serving the city (There being quite a difference between fun and enjoy.) I do not want this blog to be a campaign tool, but I suppose to some extent that cannot be helped for better or worse.

So, time to comment on a couple of recent city issues.

First, council has taken some criticism – one individual in particular – about the purchase of a new aerial platform truck for the Fire Department. Believe me, no one on council spent $940,000 without a lot of thinking and soul searching.

Personally, I don’t think we had a choice. Our old snorkel truck would soon be unable to pass certification of the aerial devices. No responsible person would ask any firefighter or any other worker to use equipment that was dangerous and that could endanger lives if it failed.
Repairs to the snorkel would have run a couple of hundred thousand dollars or more with no guarantee of how long it would remain serviceable. Everyday parts for repair of the non-chassis equipment were also becoming increasingly difficult to find.

There are those who argue the city does not need a platform truck. I have to disagree, and I understand that insurance rating agencies do as well. Only a platform truck can reach the top floors for rescue and/or get water above four of the senior citizen high-rises, a number downtown buildings and our larger apartment complexes. In addition, even the lower buildings in our downtown by virtue of having joined walls, etc. require an aerial attack. Hitting them with streams of water from the ground is not sufficient. It becomes the difference between losing a building and losing a block. I’ve also been told by a number of firefighters, that given some of the slopes in residential areas, the aerial is important there as well.

(In the interest of full disclosure, my son is an Oil City firefighter.)

Our fire chief was able to secure a federal grant that covered more than a third of the cost of the truck. That money might not have been there if we waited out of hope for some better times, and the cost of the equipment would only increase.

And finally, a quick note on two other city items.

YESSS!, as you all know the city received Main Street Program designation. A Main Street manager should be aboard shortly. I firmly believe the future is looking increasingly bright for our downtown.

And, I’m deeply concerned about the 2012 budget, and we haven’t even started talking about it yet. Times remain tough, but you have to keep enough intact to be poised for a revival.