Retirees of Stanford
Peer Networking on Medical Benefits and Other Retiree Issues
revised September 20, 2012
Retirees of Stanford is a natural constituency, a newsletter and support group. Let me know if you are interested. I'd like to hear from you. This web page is a blog of sorts. That's how it turned out.
There are a great many forces at work, both nationally and locally at Stanford, to adapt health care by involving patients as co-partners in the choices which are contributive to cost and outcome. I see need for enhanced transparency and candor among all parties to that end. Is it wise to deny patient access to their Doctors' post-appointment notes? Clearly a complex example that can be debated.I have this link from Stanford: Health care reform: That's about what the "Supreme Court ruling means to Stanford employees?" I can't put my hands on a comparable release with respect to Retirees.
Stanford Benefits offers a nice summary of documents to be familiar with before you set a retirement date. If you've been laid off, and may be eligible for Stanford retirement, use the same list, but make an early appointment and trip to the EDD Unemployment office. Take an observant friend with you when you are talking to Stanford Benefits.
message from Jack Truher, April 2008
message from Jack Truher, April 2007
Stanford's retiree medical benefits are a non-guaranteed gratuity.
Lorie Johnson, president of the nurses union, has said in various explanations of a recent union contract settlement,
The Stanford hospitals' nurses union was restrained in part because Stanford has previously established boundaries on benefits by proclamation which has gone unchallenged by nearly the entire muted body of staff. Such staff passivity will continue to be exploited by Stanford management until the staff at large organizes collectively, hardly an activity under much discussion recently.
I am shocked on the point that Stanford "doesn't offer medical insurance after retirement for those hired after 1997". We know that Stanford has put limits on the medical benefit growth rates for more recent hires, but I have been unaware of any class of permanent Stanford or Hospital employee without retirement benefits? That is an ominous discovery. Is this a precedent?
Medical insurance after retirement is not guaranteed for either current retirees, or all future retirees: Provost Etchemendy reiterated this boundary for clarity and with little resistance over two years ago. For planning purposes, current Stanford staff should think of the retirement medical benefit only as a GRATUITY.
... Provost Etchemendy clarified to staff and retirees in his December 8, 2004 Tresidder meeting, "the retiree medical benefit is not a guarantee benefit."
I recorded that Etchemendy presentation. The provost was largely but not entirely correct to explain that staff had no effective contract rights to the medical benefit which all Stanford faculty and staff so wrongly believed was assured as promised. There are provisions in law as to implied contract, prevailing practices, issues of presumption. When before a jury in such circumstances, employers can lose the argument for intent and contract rights. There is little sympathy for obfuscation. Given the University's unlimited wealth for legal action, the Provost's position will surely prevail now.
Here is what Provost Etchemendy said in 2004 as to Stanford employees' non-existent rights to medical benefits:
For now, Stanford's medical benefits are properly managed for most participants, viewed as a well-earned benefit for the older class of retirees covered, and so appreciated by Stanford's currently retired staff and faculty. Working employees should, however, understand that in the prevailing "race to the bottom", there are no guarantees. In absence of an employee organizing effort, nowhere in sight, Stanford's medical benefits may be denied to future retirees - in part or altogether, consistent with California's "at will" employment environment.
Because the great majority of Stanford employees have waived their rights to organize for collective bargaining rights, they should expect nothing better. Indeed, expect worse.
-- Jack Truher
Find a September 1, 2005 essay by Jack on how medical insurance is becoming increasingly actuarial, and something about Long Term Care Insurance.
Jack's basic critique (in adobe acrobat) on Stanford's
Entry for December 15, 2004
After receiving BenefitSU's notice of the false overcharging, I responded in writing on November 19, 2004, objecting to their oversimplified explanation for discrepancies, which nearly doubled retiree cost in one instance from $457 to $897 monthly. (Download this pdf file to desktop for Adobe Reader and/or then for Print.)
As BenefitSU's letter admits, these extradinarily overpriced benefit charges were only corrected after repeated complaints about the price increase by some affected retirees. I would like to be informed by retirees involved in this peculiar process of price control.
Entry for November 5, 2004:
This page captures my encounters with Stanford's Health Benefits plan Benefit Fairs for the years 2003-2005, including my experience of the current enrollment period. So you have a record of my skeptical struggle to understand and adapt to these benefit plans in mid-course of their development. Everybody's situation is different. This year will be the first time I actually enroll as a retiree. In the previous years, I knew I was in familiarization training. One has to learn about how Medicare interaces with Stanford's plans, and how a retiree transitions from various some status conditions to another. Yes, it's that complicated.
Every person I encountered this week was well prepared and helpful. In previous years, I left without the same sense of positive exchange in every, or perhaps most, instances. Some of that was undoubtedly my own lack of familiarization or preparation. The informational meeting and two Fairs this week were not so crowded when I arrived. I have been returning to a number of the Benefit Fairs over these three years, knowing that I had to become more comfortable with the terminology and my own family's needs within the available plans. I been maintaining my own running summary and comparison of the plans, which comparison has been updated for health benefits year 2005. (Download this pdf file to desktop for Adobe Reader display and for color Printing.)
(Correction, updating to November 20, 2004: My comparison of the plans has not been updated yet with the BenefitSU pricing corrections explained in my Nov. 20, 2004 Entry.)
I left the Retiree Informational Presentation and two of the Benefits Fairs encounters this week feeling that I was courteously and wisely advised and assisted. I got the sense that I was encountering a competent and well prepared team of professionals.
As to the the cost and value of the Health Benefit plans themselves, there is much variation. Some of the costs have changed very little for much the same coverage. Out of area dollar cost may jump from 30-46% in this single year for some retirees, who suffer from these changes in very individual ways.
My family's experience this week left me quite satisfied with the process and the resulting findings.
Entry for October 1, 2004:
The State of California operates the Office of Patient Advocate which on October 1, 2004, released its report for 2004, which is also the first link in column of lists at bottom of this page. This report ranks HMOs and Medical Groups for patient satisfaction and more objective criteria, as explained in a newspaper article of the same date on the survey.
Here is a chronological record of links on university-faculty/staff communications concerning the proposed reductions of university contributions to employee health benefits:
(1) May 28, 2004, Stanford Daily, news story
Provost tells Fac Sen of cuts for future retirees
(2) June 2, 2004, Stanford Daily, Letters to the Editor, by Jack Truher
Retirees must educate themselves about changes in health benefits
(3) June 2, 2004, Stanford Report
Future cuts proposed to retiree medical and retirement benefits
(4) June 2, 2004, Stanford Report, Faculty Senate meeting of May 27, 2004
Retiree Medical Plan
My guess is that a reduction in benefits for retirees will be the result for all retirees, past and present. Unless the Daily article was misleading in this regard, for the University to focus the announcement only as impacting "future retirees" is just that.
Here's a few lines from the Daily story on the announcement. Check back back later. I may have a better interpretation and more facts.
"For retired staff to currently receive medical benefits, the sum of their years of service at Stanford and their age have to add up to 75. The employee also has to have worked at Stanford for a minimum of 10 years. The retiree can then receive annual benefits equal to $3,176 if he is under 65 and $2,472 if he is over 65.
The new plan would pay retirees a medical benefit equal to $100 for every year of service. Under both plans a spouse receives 60 percent of the retiree's medical benefit, and the benefits would be adjusted annually for inflation."
What the University announced is that health benefits will be reduced for everybody. Price rationing is Stanford's notion of equitable health care for everybody. Not mine. Working employees of high income will be enabled to keep up with this class-based wealth transfer with no problem. Stanford's wealthy high-ranking insider employees don't care. They live way above cost.
Who gets squeezed most in this planned cost transfer are the lower paid employees and the poorer retirees of the future, often scheduled for living already at the poverty level. For these "loyal employees", past or present, when their health care benefit costs rise, other essentials become unaffordable.
What Stanford is doing is limiting its liability for the future, most particular limiting overhead to operating expenses. Indemnification is what health care insurance is about - asset protection. The question is whose assets are being protected: the University's or the employees? The medical establishment is quite prepared to drive any of us into abject poverty in the event of a persisting, serious illness. Most important for the University to do is to make affordable options to protect employees against catastrophic loss. How will that primary objective be affected?
I have been reading Stanford's annual employee and retiree literature on health benefits for some years. There has not been any language in these annual information packets that limit employee or retiree health benefits to a fixed dollar value by any proscribed schedule projected into future years. There certainly were dollar limits in a given year. That limit was the cost of the lowest cost plan, invariably Kaiser. The University negotated plans that included such catastrophic asset protection.
If the University enters these agreements with a previously self-imposed dollar subsidy limit, what does that do to the negotiation on behalf of the employee? Beyond protecting the University's operating expenses, the employee or retiree asset protection becomes at risk, protected only by the employee's "ability to pay". The result will inevitably be that lower income employees's protection from the medical establishment's state-enforced cost recovery practices will be compromised. That is my apprehension of the moment.
What follows is background, written before May 2004:
Stanford provides health benefits to retired former employees, whose interests would be served by a readily accessible, volunteer, peer network which enhances a constructive relationship between Stanford and its retirees. Stanford tends to communicate exclusively by proclamation to subordinates. Contrary to expectations, this web site is here to assist development of an independent affililation of Stanford retirees.In late April 2004, EEOC ruled that employers can alter health benefits for retirees over 65, such that their benefits are less than for working employees. Not surprising to me. That's how things work now at Stanford, folks. Indeed there has been no condition of parity discussed or acknowledged by anyone at the University. If it were announced, there would be a major accounting debate on what parity means. A couple of recent articles covers this better than I could, one in the Chronicle from the New York Times, and another from the San Jose Mercury.
Stanford's primary benefit to retirees is administration of Medicare-based health plans. There is a consistent pressure toward reducing medicare benefits to retirees, who lack any bargaining leverage with their former employers. Facing government-led payment-reductions, physicians are retiring early or refusing medicare patients altogether. HMOs have unilaterally terminated health insurance for tens of thousands of retirees in the bay area. Company sponsored retiree health insurance is becoming more costly. All over the country, companies are limiting access, terminating retiree insurance, reducing benefits, and raising benefits. Stanford tries to remain competative with prevailing retiree insurance, but is that good enough when the norm is dropping so fast? An outstanding article on these developments appeared in the San Jose Mercury on December 7, 2000. An online version can be found here .
New Entry: Stanford's requirement for loyalty from staff has often be rewarded unevenly. Some people retire into near poverty or worse. Many years ago, I became aware of lower paid employees who have exercised major influence and been major contributors in departmental activities. But their modest modest salaries did not allow for decent living conditions in retirement. Stanford's outsourcing efforts at poverty wages have compounded my perceptions in this regard. Last year, only after a student fast on main quad, Stanford's President reversed a policy from the last decade - and committed to a "living wage" for contract Union workers. Some comparable commitment to lower-paid retirees would be appropriate as well. A illustrative story on this subject appeared recently in the San Jose Mercury. I will add more personal observations on the Stanford record here eventually.
Recent interest: Here's my own interpretation of the recent and controversial medicare legislation supposedly for "prescription drug coverage", but actually for a whole lot else.
Costs for 2004: Compare the premium changes from year 2003 to year 2004 in Stanford's over-65 retiree health insurance premiums. Find some clarification of terminology on this page in the next paragraph.
Stanford's annual Health Benefits literature invariably lacks a glossory of terms. A well-written source for terms and strategy is a page from the California Medical Association on terminology. Explore the CMA home site.
A couple of cautions for 2004:
1. We have cause to be shocked by Stanford's newly limited terms for securing rights to group health insurance. Those retirees who have other health insurance options for next year, but might want to use Stanford's group health insurance in future years, should NOT select "No Coverage" as has been true in the past. Selecting this "No Coverage" option waives and disavows your rights forever to future health coverage from Stanford. The language chosen in the 2004 Enrollment Form is ominous: "Unless you choose (1. postpone coverage) or (2. active coverage), you will not be eligible for Stanford University retiree medical or dental coverage in the future". This preposterous waiver was not explained or justified in the accompanying literature from Stanford, offers no attendant benefit to the employees, and should have been highlighted by luminescent warnings that only idiots would voluntarily waiver earned retirement rights to group insurance. The University asks for a "buy-out" of an earned right to health insurance, a value which goes uncompensated. This is loss of value, and someone ought to make note of it. The real meaning of this change is hard to grasp. Work very hard, and you find about a hundred words of explanation on page seven of the "BenefitSU News for Fall 2003". There only, you find that "If you drop medical plan coverage after January 2004, you will not be allowed to re-enroll". The actual form that retirees are sent explains none of the background, and there will be some misunderstandings or errors in choices, if not outright neglect. The default for non-response appears to be irretrievable loss of insurance rights. The unintended consequences alone of this action cries out for some exposure. Anyone presented with this choice should choose "Postpone Coverage" or or remain fully covered under a Stanford plan.
2. Some early retirees, under 65, who have moved out-of-local-area geographically can expect a substantial increase of Stanford insurance premium for 2004,in addition to higher deductable costs. The more expensive "supplement" plans could cost an out-of-area retiree double last year's costs. The bargain-basement plans cost increase is less. In a typical example, the premium increases this year from $140 to $196.95. The year before, the premium was $98 or so. The deductible cost to retiree increases this year from $300 to $500 and the out of pocket from $2000 to $3500. These numbers are from reports I have received from concerned out-of-area retirees, and from University persons who have reason to know. I have yet to study the details. I suspect there is some cause for alarm to the out-of-area retirees, who usually left the Bay Area because they could not afford to live here.
Some Experience from the November 2003 Enrollment Period
When my private insurance company learns of some changes in Federal Law that might effect the company client constituencies, I get a blitz of notification to get involved in the public debate. Nothing like that happens at Stanford. Stanford's style has always been "Take it, or Leave it."
I was laid-off in 1996 after 31 years at Stanford. I have never used any of Stanford's benefits since. Zero. My spouse's part-time employee insurance is better. I studied the alternatives thoroughly, and will continue to do so. Pretty soon, we will all be stuck with medicare and what Stanford elects to allow us.
Stanford has no obligation for retiree parity with employee insurance benefits. What are the rules of equity? The government intends that medicare not keep up either. We're in a different era now. There will be times when former Stanford employees ought to have some sort of network.
Stanford's health benefits are intended to be competitive with other major employers' retiree coverage. That's what Stanford intends to do. But there's no rule of parity with active Stanford employees. In the era of "race to the bottom", it seems to me there should be some public discussion of how steep that downhill slope goes without notice.
Employees were increasingly intimidated into silence by many factors in recent years. Stanford become a much more repressive place to work in the 90s than it was in the 60s when I began as an employee. But finally self interest has to be advocated by the parties affected. Retirees at Stanford have no representation, and none is expected in our lifetime. But some moderate self-expression and adult participation would be a welcome growth of relationship, both for employees and retirees of what was once realistically known as "the Stanford family".
The increasing transfer of cost for health benefits to retirees over age 65 at Stanford is a result of the cost-profit vs benefit struggle involving hospitals, insurance companies and medical providers, employers, government political interests, and other constituencies. Maintaining functional parity of retiree health benefits, as compared to active employees, is not a legal requirement of the University. Each of us retirees would do well to form an informed opinion on whether Stanford's transfer of cost ratio to retirees over age 65 is inevitable, reasonable, or in the long-term interest of active employees.
A point of interest is about Medicare part B: Can you escape the ten percent per year surcharge in part B medicare premiums, additively, that occurs if, for any reason, you choose not to pay for part B? Answer: the government medicare web site answers that. But getting that surcharge forgiven isn't always easy to accomplish in practice.
A succinct discussion of health care for elders by a distinguished physician educator is worth a look.
The following links might be helpful in the future. The first two items relate to Medicare drug benefit bill in Congress, November 2003.
Some Relevant Links
Add your suggestions to these interests already expressed by Stanford retirees:(1) casual networking among Stanford retirees of like experience and interests. (2) notification to local retiree enthusiasts on certain of Stanford's many public seminars and events. (3) improvement in retiree benefits: e.g. academic discounts on computer or software purchases as available to staff and faculty. (4) access for former employees to pursue their personal technical projects, using laboratory or shop facilities by mutual agreement.
join our free, private email distribution list
day phone 408-732-1859