Category Archives: change

Healthcare CEO’s Reject Single-Payer

There are many reasons why the US is the only industrialized nation that does not have a single payer health care system.

One deep seated reason has to do with the foundational value system of the US, from the time of the early settlers whose religious convictions lined up with the rising middle class of 17th century England’s economic values (i.e., the Protestant Ethic).

But another reason — at least for the foreseeable future — as my fellow blogger, Joe Paduda wrote a while back when talking about Bernie Sanders’ plan, is that the health insurance industry will not blow up their businesses and start all over from scratch.

To prove Joe’s point, Modern Healthcare.com published an article last week that explored the opinions of healthcare CEO’s on the ACA and the subject of single-payer health care.

Here are the key takeaways from the article:

  • the nation’s top healthcare leaders overwhelmingly back the ACA
  • support its goal of pushing providers away from fee-for-service medicine and toward delivering value-based care
  • while the Republican Party and its presumptive nominee continue to stand by their “repeal and replace” slogan, the sector’s CEOs overwhelmingly reject that idea, in large part because they are unimpressed with the GOP’s attempts to articulate what it would replace it with.
  • only a small group supports moving to a single-payer system, which has been a central theme of Democratic presidential candidate Bernie Sanders
  • The overwhelming message from the survey, was that the next president and Congress should stay the course set by President Barack Obama and the ACA.
  • But healthcare leaders are also looking for the nation’s political leadership to reject complacency and look for ways to improve what they see as a far-from-perfect piece of legislation.

Here are the survey results, as published today by Don McCanne of PNHP:

The CEO Power Panel includes 110 top leaders of hospitals, insurance companies, physician groups, trade associations and other not-for-profit advocacy groups. The second-quarter survey on policy options that the next president and Congress might address attracted 86 respondents, a 78% response rate.

Future of ACA

Do you support Congress and the next president in:

Repealing and replacing the Affordable Care Act?

2.3% – Yes

67.4% – No

29.1% – It depends on the details

1.2% – No opinion

Expanding the ACA’s subsidized private insurance plan system to achieve universal coverage?

34.9% – Yes

15.1% – No

48.8% – It depends on the details

1.2% – No opinion

Scrapping private insurance in favor of expanding an enhanced Medicare to cover the entire population (single payer)?

9.3% – Yes

61.6% – No

29.1% – It depends on the details

Other insurance issues

Allowing private insurers to sell individual and family policies across state lines under national rules that preempt state rules?

52.3% – Yes

20.9% – No

24.4% – It depends on the details

2.3% – No opinion

Expanding the use of health savings accounts to pay premiums and meet costs under high-deductible plans?

74.4% – Yes

11.6% – No

12.8% – It depends on the details

1.2% – No opinion

Creating subsidized high-risk pools to cover people with preexisting conditions?

43.0% – Yes

16.3% – No

36.1% – It depends on the details

4.7% – No opinion

Medicare

Raising Medicare eligibility to age 67?

54.7% – Yes

23.3% – No

22.1% – It depends on the details

Expanding means testing within Medicare, such as higher co-pays or reduced benefits for high-income seniors?

50.0% – Yes

18.6% – No

30.2% – It depends on the details

1.2% – No opinion

Moving to a universal Medicare Advantage system with a means-tested defined contribution (premium support) for seniors?

28.2% – Yes

20.0% – No

48.2% – It depends on the details

3.5% – No opinion

Gradually expanding Medicare to cover everyone over age 55 who doesn’t have private insurance?

21.4% – Yes

48.8% – No

28.6% – It depends on the details

1.2% – No opinion

Delivery system reform

Taking aggressive measures to curb rising prescription drug prices such as allowing imports and authorizing the CMS to negotiate prices?

70.6& – Yes

9.4% – No

20.0% – It depends on the details

Repealing delivery system reforms such as value-based payment, accountable care organizations and the use of quality measures included in the Affordable Care Act?

03.5% – Yes

83.5% – No

11.8% – It depends on the details

01.2% – No opinion

So, it is apparent that as long as the health care industry continues to profit from the status quo, and supports the ACA, the likelihood of single payer will be remote at best, despite what the Sanders’ campaign seeks.

Things will only change when the entire system collapses of its own weight from complexity, waste, fraud, abuse, and excessive cost so that no CEO’s opinion will matter. People will demand a single payer system because no one will be able to afford having insurance.

The ancient Greeks, among other people, discovered the science of dialectics, or the study of change. Dialectics says that the seeds of change come from within, and that change does not happen until certain conditions are met, and change becomes inevitable. We are not yet at that point, but it is slowly moving in that direction.


 

I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Advertisements

Average Medical Costs in Work Comp Leveling Off

Once again it is time to look at the average medical costs for lost-time claims in workers’ comp. as reported last week in the NCCI State of the Line Report at the 2016 Annual Issues Symposium.

Those of you who have read my White Paper, or have followed this blog for sometime, know that this is an annual meeting of industry people in Florida to look at what is happening in workers’ comp.

It is not a conspiracy meeting of insiders looking to harm injured workers, as one deranged individual has suggested. [Emphasis added]

But rather, it is one way in which insurance personnel can understand where the workers’ compensation insurance market is headed. And the word this year, from Joe Paduda’s reporting last week is “Transitioning”.

Workers’ comp is transitioning and what it is transitioning into has been discussed previously by both Joe and Peter Rousmaniere, and that I have described in earlier posts.

One aspect of this transitioning has to do with automation and the development of artificial intelligence that will make many current jobs obsolete [remember that Twilight Zone episode with Burgess Meredith and Fritz Weaver where the State declared them both ‘obsolote’?]

Another part of this transitioning relates to the so-called ‘gig economy’ of companies like Uber and Lyft, Airbnb, etc., as well as the move of some jobs to part-time from full-time status, whatever the reason given.

But let’s move on to the issue at hand, which is, what is the average medical cost for lost-time claims this year. As you will see in the first chart, the average medical cost for lost-time claim dropped 1% from 2014, where there had been an increase from 2013 of 3%.

Chart 1.

Avg Med Cost 2016

Unlike past charts, this year’s chart shows that there are two years of preliminary data, 2014 and 2014. Compare that to last year’s chart, found here, as well as the two previous years, 2014 and 2015.

In 2014, the average medical cost per lost-time claim was $28,800; in 2015, the average medical cost dropped a mere $300 to $28,500, not very significant, but perhaps signalling a leveling off. You will notice in my previous articles and in my White Paper that I included a trendline that always showed the cost increasing, but it is apparent by looking at this year’s chart that there seems to be a flattening occurring.

According to Kathy Antonello’s report, the two key takeaways are:

  •  Medical severity change has moderated in recent years
  • The 2015 average medical cost is 1% lower than the 2014 value

Another factor to consider is how much of the total claim cost does medical payments per claim represent. As shown in the second chart, medical costs have remained at 58% of total claim cost, with indemnity (lost wages) representing the rest.

Chart 2.

Ind Med Split

As you can see, medical costs have risen significantly since 1981. Another way to view the change in average medical cost and its apparent leveling off can be seen in the third chart.

Chart 3.

WC Ave Med Cost

Chart 3 indicates that the cumulative change in excess of medical care inflation from 1995 to 2015 has joined the cumulative change in average medical cost from 1995 to 2015p in leveling off.

What this means, according to Ms. Antonello, is that workers’ comp medical costs per claim have risen at a much faster pace than indemnity over the past thirty years, medical inflation has outpaced wage growth, medical lost-time severity has increased 214% since 1995, and the corresponding increase in medical lost-time severity over and above the increase in medical price inflation is 55%.

What this also indicates is that workers’ comp is changing, and many predict that in a few years, workers’ comp as we have known it will disappear. Then perhaps treating injuries to certain body parts as knees, backs, shoulders, etc., common to both workers’ comp and general health care won’t be separated into different silos, but rather paid for as one medical expense under an employer’s health plan or even a single payer plan.

Either way, medical travel, given the predicted shortages of physicians and nurses, may present itself as a viable alternative, and not be subjected to antiquated laws and statutes that restrict an injured worker from getting medical care wherever they want to. And if predictions about artificial intelligence and automation are correct, then it won’t really matter, since very few individuals will be hurt on the job in the future.

There is an old Chinese curse: “May you live in interesting times.”


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Blog is now viewed all over the world in 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

Angry People Buy Guns, Smart People Write Articles

While perusing my email today, I chanced upon the scriblings of the self-styled, right-winger who had called medical travel a hoax and my idea a non-starter.

This individual saw fit to announce to the world that he had recently purchased 1000 rounds of ammunition, and said that it was for him and his wife.

The point of his rantings was something about letting in new ideas into workers’ comp, and called me an angry man. Funny, if I am angry, then how come he’s the one who bought ammo?

It must be obvious that he is the angry one, just like all the rest of his kind who shoot first (their mouths, then their guns) and ask questions later.

One is not angry if they advocate for an idea they believe will benefit injured workers, when the person calling you angry, buys 1000 rounds of ammo. One is visionary and forward-thinking, unlike the gun nut who shoots his mouth and gun off.

I am not really worried. You see, one day, he will be dead, and hopefully so will his outright hatred and disgust for medical care outside the “good ole US of A”, where we all know only Americans are good at providing quality medical care.

And I also know that when the space plane is made available later in this century for commercial flights, traveling to “Turkishmaninacanstan” will take no more time than going from NYC to Washington, DC, and maybe even less so.

No, the really angry man is the one who, making up for his shortcomings, both physical and mental, needs to buy 1000 rounds of ammunition to hold off new ideas in workers’ comp. Why? So that the status quo stays the status quo.

Or maybe, the only new ideas he likes are the ones that conform to his racist, bigoted, xenophobic hysteria, and that is why he needs 1000 rounds of ammo.

 

Trouble Ahead for Workers’ Comp

The Denver Business Journal today published an article by Steve Doss, VP of Commercial Lines at CCIG.

Here are the key takeaways from Conning, a Connecticut-based investment management company for the insurance industry:

  • Accident frequency has increased. A stronger U.S. economy has meant more inexperienced workers have joined the workforce, so high-hazard occupations like transportation and construction have seen increases in work-related injuries since 2012. For example, non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.
  • Accident severity is rising. The Bureau of Labor Statistics reports that construction fatalities rose 5.6 percent from 2013 to 2015, and manufacturing fatalities rose 9.3 percent from 2013 to 2014. In addition, hospital and drug costs – the biggest expenses associated with workers’ compensation claims – are rising faster than inflation.
  • Evidence of cost-shifting. The Affordable Care Act may be driving physicians and hospitals to “leak” group health cases into the workers’ compensation system, where they can charge more for the same services than under a group health contract, according to Conning.

For those of you not familiar with workers’ compensation, and those of you who are, what each of the bullet points mean, in simple terms is this:

  • More accidents,
  • Degree of accident injury increasing and,
  • Cost-shifting is occurring.

Isn’t time to stop and realize that whatever programs are implemented, whatever analytical or predictive modeling techniques are utilized, whatever the so-called “experts” say is the cause of this or that problem, whatever so-called “reform” or work comp alternative is attempted, wouldn’t it be prudent to think outside the box, and outside the borders of your limited minds?

Schopenhauer said the following:

“Every man takes the limits of his field of vision for the limits of the world”

Those of you who will not listen to other ideas, no matter how far-fetched they may be, have limited your field of vision and taken them as the limit of the world. The world is globalizing, health care included.

Aerospace technology will very soon allow us to travel to any part of the world in under four hours. Don’t believe me? Ask Boeing why they are running commercials that tout that very same possibility.

Those who cite judges as saying no to medical travel must ask yourselves this question: Do doctors sentence people to death? (By that I mean execution, not natural death from disease or incompetence)

Those who say the laws won’t allow it, should know that laws can be changed, and laws written in the era of the horse and buggy should not dictate to the post-modern, jet-age, and soon-to-be sub-orbital space plane age. Would you like to live under the laws of Caesar or Charlemagne?

And finally, those who say the injured workers won’t go abroad to get better medical care, have you ever asked them, or are you just putting your words in their mouths?

Methinks you all doth protest a bit too much for the sake of injured workers and myself. Look in the mirror and ask yourselves why workers’ comp is failing. The answer is staring right back at you.

Tuesday Evening Catch-up (Not ‘Ketchup’)

Now that my company has left from the weekend, and my recent job interview came and went (did not get the job), I want to catch up on two items from yesterday that caught my attention, and will impact the future of workers’ comp.

The first item comes from Joe Paduda.

Joe’s article, “What Job?” asks the question, “what job will injured workers return to?”, and states that many of the high-injury rate jobs that drive a lot of work comp premiums and services won’t exist in ten years, and a lot of low-injury rate jobs will disappear as well.

One industry that Joe sees as suffering jobs disappearing is the trucking industry, where the replacement of long-haul drivers with autonomous driving will leave many without employment. The trucking industry employs 3.5 million drivers and pays $40,000 a year.

Along with the loss of trucking jobs, are those jobs that depend on, and support the truckers and the trucking industry such as people who work at truck stops, wait staff, hotel staff, and mechanics.

To further the discussion, Tom Lynch, in Workers’ Comp Insider.com writes that artificial intelligence is going to bring change on a monumental scale.

According to Tom, “I suggest it is not hyperbole to predict that we are on the verge of an epochal change, something like a kind of mass extinction, and what’s going extinct is an enormous number of jobs. This change might be even more significant than humanity’s evolution from an agrarian to an industrial economy.

Tom mentions a report that Joe cites that suggests up to 47% of jobs run the risk of going the way of the Woolly Mammoth by 2025.

It is highly controversial and its conclusions have been hotly debated.

Even so, Tom says that the most conservative naysayers agree that the figure is at least 16% (but that figure doesn’t take into account the jobs that the AI revolution will create, estimated at about 9%, for a net job loss of 7%).

Regardless, he says, millions of jobs will be lost.

The next item is from Stephanie Goldberg of Business Insurance.

Stephanie reported that the Oklahoma Workers’ Compensation Commission unanimously ruled that the state’s opt-out law is unconstitutional.

The commission ruled that provisions of the Oklahoma Employee lnjury Benefit Act are “inoperable,” unconstitutionally depriving injured workers of equal protection and access to the court, according to Ms. Goldberg.

The ruling is immediately appealable to the state’s Supreme Court, so if they uphold the ruling, it would leave Texas as the one and only state with an opt-out option. Tennessee has not voted on the law this year.

A History Lesson: What it Means for the Health Care and Workers’ Comp Industries

Allow me to take off my blogger’s cap, and put away my MHA degree, and write about something I do know a lot about, and that is American history. After all, the MA after my name means “Master of Arts”.

On September 6, 1901, President William McKinley, was shot by Leon Czolgosz, an anarchist, and died on September 14th. McKinley, who had been re-elected the previous November, was succeeded by his second Vice-President, Theodore Roosevelt.

When Roosevelt became the 26th President, the course of American history changed forever, or so it seemed, through most of the twentieth century. The fact that it did not completely change the course of history is the subject of this essay.

You are probably wondering what impact this all has on the American health care system, and workers’ compensation in particular.

The answer to that can be found in a statement made decades later by the anti-tax lobbyist and Bush 43 White House aide, Grover Norquist, who said, “his goal is to bring America back to what it was “up until Teddy Roosevelt, when the socialists took over…

It was Roosevelt who first proposed national health insurance that future presidents, both Republican (Nixon) and Democrats wanted to create. Roosevelt also passed the Pure Food and Drug Act of 1904, which created the FDA, and led to food and drug safety.

For several decades in the late 19th century, progressive reformers had unsuccessfully tried to change things, and not always peacefully, as the various riots and bombings and strikes can attest to.

But after Roosevelt, and after his defeat in the 1912 election, progressives moved closer to the Democratic Party, first under Woodrow Wilson, then twenty years later, under Teddy’s cousin, Franklin.

It was during Taft’s last years in office, and Wilson’s first years, when workers’ comp laws were enacted by states. And in the years to follow, such reforms as direct election of senators, the right to vote for women, end of child labor, the right of unions to strike and bargain collectively were won, and unemployment insurance, social security, welfare, and many other social programs were created.

But some thirty-five years ago, that began to change, when men like Norquist became President, Senators, and Congressmen, and a slow process of destroying the social safety net began.

We are seeing this in the resistance to, and threat of repeal of the ACA, the assault on statutory workers’ comp through the expansion of opt-out, and the corruption of the workers’ compensation system by carriers, employers, judges, lawyers, physicians, and service providers.

To illustrate this point, David De Paolo wrote today about responses to two previous posts he wrote, in which several respondents made threatening remarks towards persons’ unknown, who had heaped further injury on already injured workers.

While I do not advocate personal harm towards any one claims person (I was one myself a long time ago, and was threatened, or so I was told, but never by whom), I have expressed the opinion that those who inflict pain on those already in pain, are inviting trouble. But that is to be directed towards the system, not a person.

In response to an article by Jodi Mathy about the employee experience of claim management, I said that such action should be,

“Not against claims people, but against a system that causes pain to people who are already in pain. WC was supposed to ameliorate the harshness of the laissez-faire, industrial revolution, not redistribute wealth. If that was the case, claims awards would be in millions.”

To further drive home this point, I quoted the following:

Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

Now before any of you see red stars, or hammers and sickles before your eyes, calm down. I only quoted him because what he said was true when he wrote it, and could be true again in the future, if we allow ourselves to be deluded by those like Norquist who want to go back and party like it’s 1899.

So if you are afraid of socialism, just remember these inconvenient truths, or facts. One, many of us alive today would never have gone to college without socialism. Two, our parents would not have gone to college either, especially those who fought in WWII, Korea, and other conflicts. Three, our parents would not have been able to retire to Florida, Arizona, or anywhere else without Social Security, and would not have gotten medical care after 65 without Medicare, and if they were poor, Medicaid.

Four, all of you no doubt has flown for both business or pleasure. Do you not like the idea that there is a federal agency, the FAA that regulates airlines, and oversees airports? What about interstate highways, railroads, cruise ships, etc.? All of that because of socialism, although a limited form of socialism.

Last week, the GOP elected a new speaker, Paul Ryan. A while back, it occurred to me that since Ryan was a devotee of Ayn Rand, and Rand Paul was running for president, that there was a curious connection between the three of them. If you take Ayn Rand, then Rand Paul, then Paul Ryan, put their names together, you get “AynRandPaulRyan”, and if you take Ryan’s name, drop the “R” and move the “y” after the “a”, you get back to where you started.

It doesn’t mean anything, but it is curious, given their libertarian values.

And getting back to where we started, i.e., in 1789, is no way to run a modern, post-industrial society, so yes, history does matter, and both health care and workers’ comp will be the worse off if we forget it, as per Santayana.