Tag Archives: Employment

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According to the article, if the ACA is repealed, retiring early would become less feasible for many Americans.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.

EMPLOYMENT WANTED

Very talented, detail-oriented, highly motivated, visionary thinker with extensive Risk Management, Property & Casualty Insurance, and Workers’ Compensation Claims experience, Risk Management Information Systems, Insurance Data Processing and Workers’ Compensation Statistical Reporting experience, possesses B.A. in Liberal Arts, an M.A.in History, and a Master’s in Health Administration degree (MHA), actively seeking a rewarding, and challenging position.

Willing to work hard, willing to learn, willing to teach, salary commensurate with experience, both professional experience and life experience.

Successful blogger with excellent written and verbal skills, strong financial and organizational skills, as well as  strong analytical and problem solving skills, .and can think outside the box.

Has strong knowledge of economic, social and political issues, as well as strong interest in global issues, including the growth and development of medical tourism.

Location is flexible, provided it is amendable, would consider non-US positions provided relocation is included. Strong English language proficiency, willing to learn others as well.

Will consider consulting opportunities. Contact me by email at: richard_krasner@hotmail.com or by phone, +1-561-738-0458, or cell, +1-561-603-1685. Resume/CV will be provided upon request, or can be viewed on blog or LinkedIn profile.

Court Rules Obesity a Disability: What It Means for Medical Tourism and Workers’ Compensation

The Wall Street Journal reported yesterday that a Federal district court had ruled last week that obesity, by itself, may be a disability, separate from an underlying physiological condition. This confirmed an earlier article in the Wall Street Journal last month that discussed the rising risk of lawsuits on grounds of obesity discrimination.

In an article written by Gregory J. Millman, a senior columnist for Risk & Compliance Journal, and the author of last month’s article, Judge Stephen N. Limbaugh, Jr. (wonder if he’s related to you-know-who), a judge in the U.S. District Court, plaintiff Joseph Whittaker sued his employer on the grounds that his employer had “terminated his employment because of his disability and in retaliation for the charge of discrimination, threatened to terminate business with other entities if those entities employ plaintiff.”

Attorneys for the employer moved to dismiss the case, citing that obesity was not a disability under the Americans with Disabilities ACT (ADA), and they cited language from the Equal Employment Opportunity Commission (EEOC), that “except in rare circumstances, obesity is not considered a disabling impairment.”

Judge Limbaugh rejected that argument, and noted that it rested on case law that applied before the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), which “rejected the unduly restrictive approach” to determining whether a plaintiff suffered from a disability. Judge Limbaugh also pointed out that the EEOC’s language had been “omitted following the ADAAA.”

The case is still in litigation, but an attorney who represents employers in labor and employment cases said that “I think we will see a lot more cases like this over the next few years.” The attorney also said “that employers should probably assume that obesity, at least severe obesity, constitutes a disability regardless of whether there is an underlying physiological condition involved, and seek a reasonable accommodation if the disability interferes with job performance.”

Corporate Wellness is one of the hottest areas of health care today, given the alarming increase in obesity among the American population. Related diseases such as High Blood Pressure, Diabetes, and Kidney Disease are something all employers need to address if some of their employees are obese.

This case, and many others like it, would suggest that rather than terminating an obese employee, employers would be better served if they kept the employee working and tried to get them appropriate medical care from a corporate wellness program. This would have a tremendous effect on the company’s health care costs, and on the employee’s self-esteem, knowing that his or her employer is looking out for their health, rather than firing them for having a disability.

In my White Paper, I discussed a case in California, in which an obese employee of a convalescent home, who fell while working as a cook, went to the Duke University clinic to lose weight. A friend had suggested he go there after his doctor and two of the employer’s doctors recommended that he lose weight. But as the employer did not direct the employee to a specific weight-loss program, the employee was free to choose he wanted to go. The Supreme Court of CA ruled in favor of the employee. (For a discussion on choice of medical provider see my posts, Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation  and Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation).

What does this mean for Medical Tourism?

The case in Missouri described in Gregory Millman’s article, and many others that will undoubtedly follow, presents a great opportunity for the medical tourism to capitalize on the corporate wellness programs employers might consider offering their obese employees as an alternative to expensive lawsuits stemming from wrongful termination because of a disability.

This was apparent to me when I attended the Medical Tourism Association’s 5th World Medical Tourism & Global Healthcare Congress in October of 2012. Executives from American Express and Google conducted a fireside chat on the topic of innovations in global benefits and employee wellness. Other companies such as Colgate-Palmolive, Cigna, and Disney made presentations there.

Weight-loss surgeries such as gastric bypass surgery and gastric sleeve surgery are areas where medical tourism can be of tremendous value to employers with obese employees. If those employees are part of a corporate wellness program, and have been unsuccessful in losing weight through diet and exercise, may be willing to undergo surgery to lose weight.

Ruling obesity a disability will mean more of these surgeries will be performed, and with more Americans getting health care through the ACA, medical tourism destinations will be one way in which those surgeries can be obtained by employers willing to pay for their employees to have surgery. The lower cost and higher quality of care in many destinations in the Western Hemisphere region will be a further enticement to employers looking to retain these employees and avoiding lawsuits over discrimination.

What this means for Workers’ Compensation?

That a Federal judge has made a preliminary ruling in a case of employment discrimination will have serious repercussions for the workers’ compensation industry, because if this case decides that obesity is a disability, many obese workers’ compensation claimants will file claims for workers’ compensation benefits citing their work environment as a contributing cause of their obesity. That would add significant costs to the initial claim, whether from a slip and fall or some other cause of injury.

While this may take many years to work its way through the courts and through workers’ compensation boards and other entities, employers would be wise to be proactive and incorporate a wellness program in their companies, so that obese employees can lose weight through diet and exercise, or baring that course of action, get surgery to lose the weight. Workers’ compensation carriers should also consider corporate wellness as a means to prevent workers’ compensation claims from expanding beyond the initial cause of injury,

The same constraints to getting surgery mentioned above would also apply to workers’ compensation claims, if obesity is considered a compensable medical condition. Anyone worried about what effect obesity as a disability will have on workers’ compensation claims, should be willing to consider alternatives to long, drawn-out lawsuits, workers’ compensation hearings and court cases, and charges of wrongful termination because of obesity. Medical tourism could be a viable option.