Category Archives: insurers

Damned If You Do, Damned If You Don’t

“You can always count on Americans to do the right thing – after they’ve tried everything else.”

Winston Churchill

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.

Winston Churchill

 

Veering away from the usual topics covered in this blog, I thought about some recent articles I saw about the attempt to repeal and replace, or to simply repeal the Affordable Care Act (ACA), which the current political regime wants to do.

The first article, in yesterday’s [failing] New York Times, warned that repealing the ACA would make it harder for people to retire early. Those who retire early, before reaching 65, can get retiree coverage from their former employers, but not many companies offer that coverage.

Those early retirees poor enough could turn to Medicaid, and everyone else would have to go to the individual market. Without the ACA, health care coverage would be more difficult to get, cost consumers more where available, and provide fewer benefits.

According to the article, if the ACA is repealed, retiring early would become less feasible for many Americans. This is called job-lock, or the need to maintain a job to get health insurance.

This is one of the concerns the ACA was supposed to address, in that it would reduce or eliminate job lock. Repealing the law could, according to the article, affect employment and retirement decisions.

The second article, from Joe Paduda, also from yesterday, reported that improving healthcare will hurt the economy, and Joe lays out the arguments for doing something or doing nothing to improve health care and what effect they would have on economic growth.

For example, Joe states that healthcare employs 15.5 million full time workers, or 1 out of every 9 job. In two years, this will surpass retail employment. As Joe rightly points out, those jobs are funded by employers and taxpayers. He suggests that some experts argue that healthcare is “crowding out” economic expansion in other sectors, thereby hurting growth overall.

But Joe also points out that by controlling health care costs, employment will be cut, and stock prices for pharmaceutical companies, margins for medical device firms, and bonuses at health plans will also be affected.

So, if cost control and increasing efficiency works, these lost jobs, reduced profits, and lower margins, Joe says, will hurt the economy. The economy will suffer if the health care sector is more efficient, and since healthcare is also a huge employment generator and an inefficient industry, fixing that inefficiency will reduce employment and growth.

Thus, the title of this article, “Damned if you do, damned if you don’t.”

But wait, there’s more.

Yesterday, a certain quote has been making the rounds through the media. It was uttered by Number 45. “Nobody knew health care could be so complicated.”

Yes, it is complicated and complex, but does it have to be so? If we consider the second Churchill quote above, and realize that the UK, France, Germany, Canada, and many other Western countries have some form of single payer, then one must conclude that it is only the US that has complicated and made too complex, the providing of health care to all of its citizens.

There are many reasons for this, which is beyond the scope of this article or blog, but there is one overriding reason for this complexity…GREED. Not the greed of wanting more of one thing, but the greed of profit, as one executive from an insurance company stated recently.

This brings me to the last of the articles I ran across yesterday. It was posted on LinkedIn by Dave Chase, founder of the Health Rosetta Institute. He cited a segment on the Fox News Channel’s Tucker Carlson program, in which Carlson interviewed a former hospital president who said that pricing was the main problem with the US healthcare system.

Mr. Chase does not solely rely on Carlson’s guest in his article, but cites other experts in the field as evidence that pricing failure is to blame.

If we are to except this as true, then it buttresses my point that the overriding problem is greed, for what else is the failure to control prices but a symptom of greed inherent in the American health care system, and something that does not exist elsewhere in the Western world.

Which brings me to Churchill’s first quote above. Since we Americans have tried the free market system of health care wanting, and have tried a reformed free market system, perhaps it is time to go all the way to a government-sponsored, Medicare for All, single payer system.

The bottom line is: we’re damned if we do, damned if we don’t. The question is, which is the lesser of two evils.

UPDATE: Here is Joe’s take on what will happen to the ACA in the next two years. I agree with his assessment.

Deaf, Dumb and Blind, part Deux

Back in June, I wrote a post with the above mentioned title. Then, I was on a rant, now I am just reporting what my fellow blogger, Joe Paduda has written about today regarding a report from the U.S. Department of Labor (DOL) on the various state workers’ compensation systems.

This report harks back to one conducted in 1972 on the state of workers’ compensation then, but as Joe points out today, seeking a return to that Commission report and to that decades-old recommendations is absurd.

Rather than give you my take on this meeting from yesterday, here is Joe’s article. I always give credit where it is due, and he is due a lot of credit for his reporting.

It would seem that not only is the workers’ comp industry deaf, dumb and blind, but so is the federal government, if we are to take Joe at his word.

And in the meantime, who gets hurt while these eggheads, bureaucrats, nincompoops and sticks-in-the-muds do more study, research, look back forty years and pine for an economy and workforce that no longer exists? The injured workers.

And who, in the meantime, while the insurers, employers, and various stakeholders gouge and game the system, gets hurt, disabled or even dies? The injured workers.

It seems to me that the only thing that matters to the eggheads, bureaucrats, nincompoops, sticks-in-the-muds, insurers, employers, and various stakeholders is, how to screw the worker, save money by not paying adequate wages and benefits, make more profits off of someone’s disability, and not the care and treatment of the one who is disabled and forced into poverty.

Here is the perfect example of the state of affairs in workers’ comp, both inside and outside the industry:

hear-no-evil-see-no-evil-speak-no-evil

 

Interesting Article on PPO’s

Forbes.com has published an extensive article claiming that PPO’s have perpetrated a great heist [author’s words] on the American middle class.

According to the article,  trillions has been redistributed from the American workforce to the healthcare industry, creating an economic depression for the middle class.

The article consists of an interview conducted by author Dave Chase and Mike Dendy, Vice Chairman and CEO of Advanced Medical Pricing Solutions, Inc., a healthcare cost management company.

Here is the link to the full article:

http://www.forbes.com/sites/davechase/2016/09/05/have-ppo-networks-perpetrated-the-greatest-heist-in-american-history/#25489cd66d00

Is it any wonder why work comp is also so screwed up? Too many cooks (or is that crooks?) taking their “cut” out of the middle class.

But we keep insisting that we have the best health care system in the world, that our workers get the best care when they are injured and don’t need to have any alternatives explored to improve the care and treatment they get, and that the free market is the best way to provide health care. It’s free alright. Free for the greedy to become more greedy. But not for you and me.

Blocked Aetna-Humana Merger Reveals True Reason for Pullout from ACA

In an article yesterday in Business Insider, the recently blocked merger between Aetna and Humana is the reason given for Aetna’s sudden decision to leave the ACA exchanges.

Contradictory statements from Aetna in response to this decision, as to their ability to profit from the merger or not profiting from the exchanges, does not hide the fact that the bottom line is this:

The laws of Capitalism are incompatible with the goals of providing health care to everyone, even with all the fancy commercials and advertisements from the insurance companies that they are there for you.

BS!

They are not there for you, unless you are a top executive of the company, or a stockholder or shareholder, or investor. As the article states, this merger would have led to a consolidation of the health care industry to only three mega companies.

Do you want to wait until there is only one, a la the 1970’s movie, “Rollerball”, where corporations have dominated whole industries and replaced nations, or do you want to provide health care to all, no matter what their ability to pay, or if it makes a profit for some greedy bastards?

The choice is up to you.

Here is the link to the entire BI article:

http://www.businessinsider.com/aetna-humana-merger-reason-for-leaving-obamacare-2016-8

Big Insurer to Put Dispensing Docs on Notice

An article in Healthcare Finance yesterday reported that Aetna has put more than 900 opioid prescribing physicians on notice that they fall with the 1 percent of top opioid prescribers.

Here is the link to the article:

http://www.healthcarefinancenews.com/news/aetna-puts-more-900-physicians-notice-they-fall-within-top-1-percent-opioid-prescribers

What does this mean for workers’ comp?

It means that other insurers need to do the same for the physicians who prescribe opioids for injured workers, but as Joe Paduda recently reported, the drug spend is going down.

But he also said this, earlier this week,  “Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.”

This was for privately insured people, he continued.

“The dollar cost of the drug itself is the least of the cost issues; dependency is strongly associated with much higher utilization of drug testing, overdose treatment, office visits and (my assumption) higher usage of other drugs intended to address side effects of opioids.”

So just because Aetna is watching does not mean that the problem is going to go away any time soon.

Deaf, Dumb and Blind

It’s time once again for a rant. This rant is courtesy of my fellow blogger, Joe Paduda, who wrote an article today that criticizes members of the workers’ comp industry for not publicizing the positive things they do, but complain about all the negative press they have been getting.

As Joe writes, “Yep, it’s your fault that the popular press smacks you around, citing a few examples of alleged insurer screw-ups as proof that you’re all a bunch of cold-hearted, nasty, lazy incompetents motivated only by profit.

Joe was referring to reports from ProPublica, NPR, plaintiff lawyers, muckraking journalists and bloggers (including yours truly, as well as two women I have previously written about, and who are injured workers themselves), and calls for the industry to stop their bitching.

Most industry professionals may not realize that workers’ comp came into existence due to the writing of early twentieth century muckrakers as Upton Sinclair (The Jungle), Ida Tarbell, Lincoln Steffens, and many others.

He takes them to task for not publishing a case of the month, sending out a press release honoring an employee for going above-and-beyond in helping out an injured worker.

Joe says it is their fault because the reasons they don’t promote their good works are short-sighted, ignorant, and indefensible; in short, you are deaf, dumb and blind to reality.

From the day Edward Lloyd opened his coffee house in London in the 17th century, the insurance industry, and specifically, the workers’ comp industry has been dominated by Lloyd’s fellow countrymen and co-religionists.

The same holds true here in the US, but American pluralism (of a kind) has allowed some minorities to make it in the industry, but it is still mostly a white male, majority religion club (certain exceptions such as Saul Steinberg and Maurice Greenberg notwithstanding).

I know people in my family and in our extended social circle who have worked for insurance companies, and the highest level they have attained has been below that of the top executives. My first job in workers’ comp was with a company whose executives were not members of that club, but my boss was, and that was a reason some of us claims people were mistreated by him. Sheer resentment that he was not a member of the tribe and thus the board of directors. Let’s not pretend it does not exist. Why do you think some companies are called, “white shoe” companies?

Here is my take on this:

  1. You are resistant to change unless the change comes slowly, and from sources you trust and can control or dominate.
  2. As evidenced by Joe’s writing, you are unwilling to accept criticism from anyone who is not a member of the club or is from the lower ranks, or even someone who is on the outside looking in, as I am.
  3. You refuse to offer those with a passion for making workers’ comp better and opportunity to do so, and have laid off the best, brightest and hardest working people to save money on employee benefits, to cut payroll, costs, or because everyone else is laying people off, so why should you be any different. One of my LinkedIn connects writes a lot about millennials going into insurance, and many of you have complained online that you can’t find talented people. That’s because they are out looking for work.
  4. You refuse to accept any new idea, no matter who gives it, no matter what it is, and even have the nerve to criticize the idea and the person who promotes it. You continue to do the same things over and over again, and expect different results.
  5. You have elevated the laws, regulations, rules and statutes to the level of sacrosanctity, and that has frozen the industry in time, if not in place.
  6. Not one of my LinkedIn connections in the industry or in the insurance and risk management arena, who are hiring managers or executives have ever complimented me personally, save Joe, on my knowledge, my writing, or my passion for improving workers’ compensation. Crickets…
  7. You must dump the adversarial attitude pervasive among carriers, TPA’s, service providers, physicians, and employers. Not all injured workers are crooks. Treat them accordingly, and help those who really need help. Get emotional when you hear a sad story and work to fix it.
  8. STOP USING MEDICAL PROVIDERS WHO DELIBERATELY INJURE WORKERS, BOTH MEDICALLY AND EMOTIONALLY BY LYING TO THEM, DENYING THEM TREATMENT, OR JUST BEING GREEDY. Punish them by refusing to pay them or turning them into the legal authorities.
  9. Lastly, listen to the outsiders, even though they don’t have a job title, or are publishing anecdotal evidence of how bad some workers have been treated. Resist the snake-oil salesmen of opt-out like ARAWC and ALEC, whose agenda is both political and economic. They believe in an economy much like that when Edward Lloyd opened the coffee house. Ever wonder why Texas, and now Oklahoma are the only two states with opt-out? Because they are both states whose leaders in business and politics believe in laissez-faire, free market (free to the capitalist) capitalism. Don’t believe me? Here’s what Dwight Eisenhower said to his brother in a letter in 1954:

“Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history. There is a tiny splinter group, of course, that believes you can do these things. Among them are H. L. Hunt (you possibly know his background), a few other Texas oil millionaires, and an occasional politician or business man from other areas. Their number is negligible and they are stupid.”

The Koch Brothers are just like the Hunts were back then, so be careful about opt-out expansion. It is a ploy to abolish the progressive reforms the muckrakers helped to create.

That’s all I have to say. It’s up to you to change course and make things better, but know this, we are not your enemies. We want to help, and I want to help you now.  Don’t be deaf, dumb an blind to us.


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.

Where No One Has Gone Before: Or Will Captain Kirk Save Work Comp?

Tom Lynch, of LynchRyan published an excellent piece today about the bumpy ride workers’ comp has had since 1972, when a commission established by Richard Nixon made 19 recommendations for the improvement and uniformity of state workers’ comp standards.

As the Chairman of the Commission, John Burton suggested, “if we continue to advance at this rate, the 19 essential recommendations will be law throughout the land sometime in the 23rd century.”

“Hailing frequencies, open Captain.”

Tom is not the only one who wrote recently about the vested interests holding back progress and change. David De Paolo last week said the same when he wrote,

“Insurance companies are as much a vendor in either scenario as physicians, bill review companies, utilization review companies, attorneys, vocational counselors, etc. Each and every single one makes a buck off work comp, and each and every one has an interest in maintaining the status quo.”

Do we really have to wait until warp engines and transporters carry us off to far distant planets to have meaningful and substantial reform of workers’ comp that benefits the injured worker and minimizes the abuse by vested interests?

Or do we continue to illogically believe that nothing can change, and that new ideas are stupid and ridiculous and a non-starter? Or do we ignore those in the industry who blog about workers’ comp, but are impeding change by denying the credibility of the individuals presenting new ideas, or the ideas themselves?

These 19 recommendations should be looked at again and implemented, along any other ideas, outside of opt-out to bring injured workers better and less expensive medical care. To do otherwise is illogical.


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.