“Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.”
– Muhammad Ali
“If people are not laughing at your goals, your goals are too small..”
– Azim Premji
“Those who say your dreams are ridiculous have given up on theirs.”
– Unknown
Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong soul from the weak.
– Thomas Carlyle
“As the work is done for the employer, and therefore ultimately for the public, it is a bitter injustice that it should be the wage-worker himself and his wife and children who bear the whole penalty.”
– President Theodore Roosevelt, 1907
To permit every lawless capitalist, every law-defying corporation, to take any action, no matter how iniquitous, in the effort to secure an improper profit and to build up privilege, would be ruinous to the Republic and would mark the abandonment of the effort to secure in the industrial world the spirit of democratic fair dealing.
– Theodore Roosevelt, 1908
“The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”
– John Kenneth Galbraith
“Only a fool would try to deprive working men and women of their right to join the union of their choice.”
– Dwight D. Eisenhower
“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”
– Thomas Jefferson
“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”
– Andrew Jackson
“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”
– Abraham Lincoln
“Do not go where the path may lead; go instead where there is no path and leave a trail”
– Ralph Waldo Emerson
“Some men see things as they are and say why. I dream things that never were and say why not.”
– Robert F. Kennedy
“America’s health care system is neither healthy, caring, nor a system.”
– Walter Cronkite
“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”
– Karl Marx
“The secret of change is to focus all of your energy, NOT on fighting the old, but on BUILDING the NEW.”
– Socrates
“Every man takes the limits of his field of vision for the limits of the world”
– Arthur Schopenhauer
“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
– Arthur Schopenhauer
“You have enemies? Good. That means you’ve stood up for something, sometime in your life.”
– Winston Churchill
“No matter what people tell you, words and ideas can change the world.”
– Robin Williams
“There can be no equality or opportunity if men and women and children be not shielded in their lives from the consequences of great industrial and social processes which they cannot alter, control, or singly cope with.”
– Woodrow Wilson
“Although it is not true that all conservatives are stupid people, it is true that most stupid people are conservative.”
– John Stuart Mill
“The masters of the government of the United States are the combined capitalists and manufacturers of the United States.”
– Woodrow Wilson
“The test of our progress is not whether we add more to the abundance of those who have much it is whether we provide enough for those who have little.”
– Franklin D. Roosevelt
“Of all the forms of inequality, injustice in health [care] is the most shocking and inhuman[e]…”
– Martin Luther King, Jr.
Transforming Workers' Comp Blog 
Well done, Mr Richard.Very exhaustive & educative too.However,few links are broken.
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Thank you, Dr. Nath. Which ones are broken?
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Dr. Nath,
Those are not links. That is how WordPress converted my footnotes. If I had written this originally on WordPress, I would have put in my links. I may still do so over the weekend. Thanks for bringing it to my attention.
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The biggest regulatory challenge is ACA and ERISA for HIX. Their COOP program might offer their self-insured programs a risk-group pool for SHOP. ACA subsidy and Bronze deductible waivers are the lure for using the IRS 501(c)(29) coop health program. But will the regulations allow waivers and medical tourism? Nathan Cortez suggests the ACA has no statutory barriers, but the regulations are unknown. Perhaps these could be challenged under the Administrative Procedures Act but don’t know.
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ERISA does not impact Work Comp, only health care. Do not know what COOP or SHOP is, so you will have to explain. There are barriers in state WC laws that are going to have to be removed before this can happen.
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The COOP is the 501(c)(29) coop health care insurer under ACA for the state-controlled public option on exchanges. It will compete with private insurance for the Obamacare subsidies. This has small business programs under SHOP. If the self-insured programs could fall under SHOP to qualify for subsidies is undetermined. If HHS regulations will allow any overseas options is also unanswered, too. If not, then there are trade questions for the Mode 2 cross-border users and providers under GATS. There are WTO trade questions on public/private monopolies with designated providers. This cozy arrangement is trade protectionism, and WC or Obamacare exchanges are public monopolies with the private sector. If this creates an unreasonable trade barrier to foreign providers, then there are monopolistic characteristics. Obamacare creates a paradigm shift, and GATS will export that across our foreign borders under Mode 2 for both the consumer and providers. With Canadians coming down for care, the Canadian system might be the first to feel the impact from exchange fallout. See Health Tourism by David Reisman on page 22. Medical providers can already cross the 49th parallel for licensing (e.g. doctors), but medical providers might find the patient quota system under the Canadian Health Act is far too protectionist. Does the provincial public/private system create a trade barrier to foreign medical providers? British Columbia might find rationing is market protectionism, and Washington State providers are deterred from entering the Vancouver market. It is restrictive for consumers, too.
Nobody is really discussing this and I wonder about the MTA marketing machine for WTO trade issues. Their clients are more savvy about the WTO than Americans, but they might not know if Mode 2 liberalization will impact their domestic programs. Obamacare is really a potential game changer when the US Trade Representative files a WTO trade complaint against these foreign markets. From British Columbia, the Mode 2 migrations will flow into Australia, Singapore, Hong Kong, and China. BC might be forced into a new version of “exchange programs” under GATS.
WC is another area of related laws and precedents.
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How come no one in the US has heard of a COOP health care insurer for state-controlled public option on exchanges? There is not public option that I am aware of and I took an elective for my MHA degree on PPACA in the summer of 2011. You still did not explain what COOP stands for, or what SHOP stands for.
The rest of what you are saying is foreign to me as I do not have a background in foreign trade, trade agreements, etc. It would be interesting to see how this all plays out, but again, my initial thought was to look at legal barriers in the US to implementing Workers’ Compensation into medical tourism, not to look at international trade agreements and the WTO.
I really cannot answer you properly because I have no background in this. Sorry.
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Consumer Operated & Oriented Plan (COOP)(state-controlled coops on exchanges)
http://cciio.cms.gov/programs/coop/
IRS 501(c)(29) cooperative healthcare insurance organization
http://www.irs.gov/Charities-&-Non-Profits/New-Guidance-for-IRC-501(c)(29)-Qualified-Nonprofit-Health-Insurance-Issuers
SHOP is the small biz component of health exchanges and COOP must have their offerings
Click to access Small%20Employer%20(SHOP)%20Exchange%20Issues.pdf
This is California regulatory guidance. The overseas coverage has not been discussed yet in the federal regulations. This would allow for expansions of self-insured programs with waived deductibles. SHOP would qualify for the Obamacare subsidy. This would be helpful for MTA-type facilitators.
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This cozy arrangement is trade protectionism, and WC or Obamacare exchanges are public monopolies with the private sector. If this creates an unreasonable trade barrier to foreign providers, then there are monopolistic characteristics.
There is no Work Comp exchanges. Work Comp is a private insurance coverage in most states that is sold by commercial insurance companies. The exception to that is in OH, ND, WA and WY which are monopolistic states. This only applies to coverage, not to treatment or care, and if that was the case, then WA could not have a webpage listing doctors in foreign countries. You seem to conflate Workers’ Comp with Health Care and the two are not even closely similar.
There are laws in many states that limit medical providers to those licensed in that particular state to practice medicine, but this is not a trade barrier.
I met David Reisman at the MTA Congress, tried to email him to get a copy of his latest book, but he never responded to my email.
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ACA is not Work Comp programs.
Will monopolistic arrangements require market exchanges?
If there was a state monopoly like the provincial system in British Columbia, then perhaps yes.
You noted the four monopolistic state systems for work comp. This would mirror the BC health system as I understand it under Canada Health Act which is like ACA. Reisman suggests that Mode 2 cross-border providers and consumers would be impacted. Washington consumers might cross-borders into BC for a medical provider under Mode 2. The state monopolies might be trade protections because of public/private networks. The providers and consumers are impacted.
The public monopolies are potential trade barriers in BC for health care and WA for work comp.
The cross-border consumer and providers are subjected to these monopolies under Mode 2.
These impede any medical tourism under the bilateral free trade agreements for Canada and America, and WA/BC could become a monopolistic trade barrier in work comp and health care.
If WA adopted the Basic Health Plan in lieu of Health Exchanges, there might be a public/private monopoly for health care in this quasi-welfare system of low-income brackets. California has rejected this alternative under ACA. Medicaid should remain welfare and outside the domain of Mode 2. Even Medicare/Medicaid are shifting into the Obamacare exchanges systems. There are two waves of new paradigms from ACA and GATS that might open the closed doors for Mode 2 cross-border medical tourism. Then a free trade agreement is part of the architectural process of liberalization.
If you cannot achieve medical tourism objectives with ACA, then use the backdoor of treaties.
See Missouri v. Holland for the Treaty-Making Power and Interstate Commerce Clause for the impacts on cross-border migrations: http://en.wikipedia.org/wiki/Missouri_v._Holland
California’s Knox-Keene Act has limited powers for the regulation of immigrants under Baja Access. It is limited to 50 miles of a port of entry under Chy Lung v. Freeman, and this is plenary power for state regulation of cross-border medical consumers under Mode 2.
States are limited by federal powers of foreign commerce.
The Foreign Commerce Clause created their plenary power doctrine and a monopoly over the regulation of ports of entry under Gibbons v Ogden. New York and New Jersey were interstate regulation of licenses for ferry operators (passengers and goods). The plenary powers have a potential impact on Mode 2 for licensing regimes that prevent doctors from telemedicine and the jurisdictional issues.
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I don’t know who you are or where you are from, but it is obvious to me that you do not understand the difference between the US Work Comp system and health insurance.
I was a WC Claims Examiner and Claims Administrator in NY, and I also worked with WC Statistical Reporting to regulatory bureaus, so I know what I am talking about.
You said will the monopolistic arrangements need exchanges? How can I make this more simple to you? The Monopolistic states are only for the purposes of Work Comp insurance. The exchanges under ACA have nothing to do with Work Comp.
If there was a state monopoly like the provincial system in British Columbia, then perhaps yes. NO, THE MONOPOLY IS ONLY FOR THE SALE OF WORKERS COMPENSATION INSURANCE POLICIES AND THE REPORTING OF STATISTICS TO THE STATE AGENCY. CHOICE OF PHYSICIAN IS UP TO THE INJURED WORKER ,BUT IS GENERALLY LIMITED TO A DISTANCE FACTOR.
You noted the four monopolistic state systems for work comp. This would mirror the BC health system as I understand it under Canada Health Act which is like ACA. Reisman suggests that Mode 2 cross-border providers and consumers would be impacted. Washington consumers might cross-borders into BC for a medical provider under Mode 2. The state monopolies might be trade protections because of public/private networks. The providers and consumers are impacted. I don’t know anything about the British Columbia system, so I can’t comment, but you still seem to equate health care with work comp The two are as different as night and day. If a state that is a monopolistic state for work comp has a governor or legislature that wants to set up an exchange under ACA, or wants the federal government to do it, then that has nothing to do with their work comp program. Do you understand that? The only thing that is monopolistic is the selling of work comp policies, not treatment providers. WA does allow injured workers to seek treatment in certain other countries, but the list is small.
The public monopolies are potential trade barriers in BC for health care and WA for work comp. NO THEY ARE NOT!!!! CAN’T YOU UNDERSTAND THAT?
The cross-border consumer and providers are subjected to these monopolies under Mode 2.
These impede any medical tourism under the bilateral free trade agreements for Canada and America, and WA/BC could become a monopolistic trade barrier in work comp and health care.
And as far as Dr. Reisman is concerned, I not only met him, I spoke to him for some time before he gave his presentation. He seemed to me to be a typical academic airhead who felt it was beneath him to talk to someone who was not his intellectual equal. He was not a very friendly sort of person, and his presentation was boring and dull with the worst slides I have ever seen. One of the courses I took for my MHA degree was a Graduate Business Communications course, and we were taught to produce PowerPoint slides that would convey our message in as short amount of text as possible and be graphically appealing. Dr. Reisman’s slides were anything but appealing.
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