Workers Memorial Day – April 28.

April 26th, 2019 by Tom Lynch

Today, just in time for Worker Memorial Day this coming Sunday, the Bureau of Labor Statistics (BLS) released employee injury and fatality data for 2017 contrasted with 2016. I guess you know the Great Recession is really over when worker injuries and fatalities reach pre-recession levels.

Compared with 2016, worker fatalities declined in 2017 – by 43 – from 5,190 to 5,147, a negligible and statistically insignificant difference of 0.8%.

Curiously, transportation incidents make up only 6% of non-fatal worker injuries, but 40% of fatalities. Essentially, 3% of all employment transportation incidents result in fatalities. Think about that the next time you merge into traffic on the freeway.

If you’ve ever wondered why car and truck manufacturers now devote so much effort to robotic, AI safety enhancements for their machines, you only have to look at the chart above to understand. They’re banking that taking the human out of the picture will reduce fatalities and sell more vehicles. In the end, everything reduces to economics.

Here at the Insider, we offer heartfelt condolences to the families and friends of the 5,147 men and women who died on the job in 2017. May they rest in peace.

After Catching Bus, Dog Still Doesn’t Know What To Do. But The Bus Just Got Bigger!

March 26th, 2019 by Tom Lynch

In February, 2018, a Texas-led coalition of 20 states sued the federal government claiming the Affordable Care Act is unconstitutional in its entirety. The states argued that after Congress in December 2017 gutted one of its major provisions, a financial penalty for not having health insurance, known as the “individual mandate,” the rest of the law became unconstitutional.

In June, 2018, the US Department of Justice announced it would not defend the suit, which prompted a counter-coalition of states, led by California, to step in to defend the law. In the Brief, the Trump Administration, while refusing to defend, had agreed the individual mandate was unconstitutional, but argued this only invalidated the ACA’s preexisting condition protections and not the remainder of the ACA. This was ironic, indeed, because the part of the ACA with the most public popularity is the part protecting preexisting conditions. Attorney General Jeff Sessions pointed out he had made the not-to-defend decision after conferring with the President.

In December, Judge Reed O’Connor, of the 5th Circuit Court, ruled in favor of the Texas coalition and declared the entire Affordable Care Act unconstitutional. Very few legal scholars, make that nearly none, thought Judge O’Connor’s ruling would stand. Many died-in-the-wool conservatives, make that nearly all, thought the same. We wrote about this in a “Dog Catches The Bus. Now What?” post.

Last night, the Department of Justice sent a two-sentence letter to the U. S. Court of Appeals for the Fifth Circuit saying the DOJ now supports Judge O’Connor’s ruling that the entire ACA be struck down. Further, it will shortly file a Brief endorsing the decision. Here’s the letter:

The Department of Justice has determined that the district court’s judgment
should be affirmed. Because the United States is not urging that any portion of the
district court’s judgment be reversed, the government intends to file a brief on the
appellees’ schedule.

So, in two sentences, the DOJ went from everything in the ACA, except the preexisting conditions part, is constitutional, to everything is unconstitutional.

Reaction in Republican circles has not exactly been one of untold delight. In fact, so far, it’s been as quiet as midnight in Death Valley. So, what was William Barr thinking and why did his minions send the midnight missive?

Here’s a thought. Since most of the heavy money is on Judge O’Connor’s ruling being overturned somewhere along Appellate Way, could the DOJ have sent its billet doux with the intention of showing its ultra-conservative allies that it’s with them all the way, while all the while realizing it will never have to put the ACA toothpaste back in the tube? Think about it.

After all, you have to admit it’s easier to think about that than about what will happen if O’Connor’s ruling becomes the law of the land.

We’re goin’ right straight back to 2010
And start the healthcare war all over again!

God help us.

It Really Is The Prices, Stupid!

March 21st, 2019 by Tom Lynch

Trying to understand American health care these days is a little like trying to do the breast stroke through molasses. A lot of effort for not much progress.

The scope of the issue is vast. In 2017, US health care spending grew 4.6%, exactly double the growth rate of inflation, to $3.5 trillion. In 2018, it grew another 4.4% to $3.65 trillion. That’s 18% of US Gross Domestic Product (GDP). To put this in perspective, consider this: $3.65 trillion is more than the entire GDP economies of Italy and Spain – combined! It is $1 trillion more than the entire GDP of France and  equals that of Germany’s $3.6 trillion GDP.

Each of the health care players say they want to do something about this, just as long as you don’t touch their particular slice of the pie. And, because the health care lobby dwarfs every other one, we’re reduced to nibbling around the edges.

In 2003, Uwe Reinhardt, Gerard Anderson, Peter Hussie and Varduhi Petrosyan published their seminal work, It’s The Prices Stupid: Why The United States Is So Different From Other CountriesThey examined health care data from 30 OECD countries for the year 2000. Here is the basic conclusion from their Abstract:

U.S. public spending as a percentage of GDP (5.8 percent) is virtually identical to public spending in the United Kingdom, Italy, and Japan (5.9 percent each) and not much smaller than in Canada (6.5 percent). The paper also compares pharmaceutical spending, health system capacity, and use of medical services. The data show that the United States spends more on health care than any other country. However, on most measures of health services use, the United States is below the OECD median. These facts suggest that the difference in spending is caused mostly by higher prices for health care goods and services (my emphasis) in the United States.

In 2017, Reinhardt died, after which his co-authors decided to re-examine their original conclusions and publish their findings as a tribute to him. Their new paper, It’s Still The Prices, Stupid, which they published in January, 2019, concluded that their original conclusions were “still valid.”

The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article’s publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US. Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, US policy makers should focus on prices in the private sector.

Another way to look at this is to compare the growth of health care utilization with the growth of prices. This produces some highly informative, surprising and, sometimes confounding, data. For example, from 2012 through 2016, US hospital in-patient prices rose 24.3%, yet in-patient utilization decreased 12.9%. I guess all that hospital consolidation has really lowered hospital prices, hasn’t it? During that period, and due primarily to the opioid epidemic, prescription drug utilization was the only medical service whose utilization rose, and it was up only 1.9%, despite the prices of prescription drugs rising 24.9%.

Question: Who has the most skin in this game?

Answer: Employers and the 156,199,800 people who work for them.

That answer is why I believe Warren Buffet, Jamie Diamond and Jeff Bezos, three major employers, have formed their joint health plan, Haven, and hired Atul Gawande to run it.  They have given Dr. Gawande time and a lot of money not just to slow the spending growth in their respective companies, but to reverse it. Buffet has spoken loudly about how health care costs place America at a competitive disadvantage. He has been vocal in his criticism of Republicans’ devotion to reducing corporate taxes, which, at 1.9% of GDP, are now the lowest among advanced nations and pale to near insignificance when compared to the health care costs borne by employers. He has said, “Medical costs are the tapeworm of American economic competitiveness.” Further, they are a major cause for little or no real wage growth.

More proof for his point: According to the US Census Bureau, employer sponsored insurance plans (ESIs) cover 56% of the US population. In 2018, the year we hit $3.65 trillion, the average annual premium for a family in an ESI was $19,616, of which employees paid an average of 29%, or $5,688. Employees in family plans also had an average deductible of $2,788, plus co-pays. So, even without the co-pays, employees are paying more than $8,000 for an ESI family plan. In 2019, we will blow through $20,000 for the cost of an ESI family plan. This is patently unsustainable and leads to two inescapable conclusions: First, Washington has not fixed this, and, given past experience, it is doubtful it ever will, regardless of efforts by progressives. Second, employers are the only people with the leverage and urgent incentive to do anything constructive. They need to stop worrying about corporate taxes, get on the Buffet, Bezos and Diamond bus, and throw all the muscle they have at the American health care fiasco.

 

Robots In The Manufacturing Sector – We’re Lagging Behind

March 14th, 2019 by Tom Lynch

In 2013, Oxford professors Carl Frey and Michael Osborne published what became a highly read, highly cited and highly criticized study suggesting that machines could replace 47% of America’s jobs over the following 25 years. This landed like a stink bomb on the robotic revolution.

The study, which examined more than 700 US occupations, found that jobs in transportation, logistics, and administrative and office work were at “high risk” for automation. “We identified several key bottlenecks currently preventing occupations being automated,” said Dr. Osborne when the study was released. “As big data helps to overcome these obstacles, a great number of jobs will be put at risk.”

Following the study, academics and pundits jumped into the middle of the debate to argue its conclusions. In 2015, Forrester Research’s J. P. Gownder authored The Future Of Jobs, 2025: Working Side By Side With Robots and updated it two years later in 2017. Gownder concludes that, yes, AI will replace many jobs, but it will also create many jobs. He suggests a net job loss of perhaps 9.1 million, or about 7% of the workforce. Seven percent isn’t 47%, but 9.1 million jobs are a lot of jobs. And a lot of people who could be swept away by the rise of the robots.

So, clearly, the robots are coming. And, just as clearly, there is now, and will continue to be, human collateral damage. We should do everything in our power to help the millions of people the robots will displace. It would be outrageously stupid, and immoral as well, not to do that.

But if you believe development and adoption of robots is essential to keep the country competitive and prosperous, then you should be concerned, because other countries are outpacing us. By long shot.

A new report from the Information Technology & Innovation Foundation (ITIF) finds the US ranks 7th in the world in the rate of robot adoption in the manufacturing sector.

When controlling for worker pay, the situation is even more bleak. In that case, we’re 17th in the world.

The report relies on International Federation of Robots data for industrial robot adoption rates but adjusted the rankings to control for differences in manufacturing worker pay. The decision to use robots usually weighs the cost savings that can be achieved when a robot can perform a task instead of a human worker, and those cost savings are positively related to the worker compensation levels. Higher wages lead to faster payback, making more robots a more economical investment.

On a compensation-adjusted basis, the report found that southeast Asian nations significantly outperform the rest of the world in robot adoption, with South Korea, Singapore, Thailand, China, and Taiwan the top five nations, in that order. Moreover, China’s rate of robot adoption is so high, fueled by massive government subsidies, that if China and South Korea’s respective growth rates continue, by 2026 China will lead the world with the highest number of industrial robots as a share of industrial workers, when controlling for compensation levels.

Robert Atkinson, ITIF’s President, has some sensible suggestions for how we can catch up. Policy makers should listen to him.

Rob Restuccia Passes The Torch

February 25th, 2019 by Tom Lynch

Every once in a while in life, if you’re lucky, you’ll come to know and work with a person whose commitment to service, whose dedication to justice, whose devotion to helping the less fortunate among us live full and healthy lives is both humbling and inspirational. For me, such a person has been Rob Restuccia.

Rob is a founder of Health Care For All and Community Catalyst. Health Care For All was instrumental in making Massachusetts a first-in-the-nation model of near-universal health coverage in 2006, and Community Catalyst played a vital role in the passage of the Affordable Care Act in 2010 and its successful defense against repeal in 2017.

Since late-2003, Rob and I have served together on the Board of Commonwealth Care Alliance (CCA), a Massachusetts HMO serving dual-eligible beneficiaries, meaning they qualify for both Medicare and Medicaid. They are the sickest of the sick and the poorest of the poor, and they represent about 5% of the nation’s population, but consume 35% to 40% of our health care costs. As a founding Board member, Rob has been a constant north star to staying true to our mission. He is one of the reasons CCA has been the highest rated plan of its kind in the nation for each of the last two years. But much more than that, Rob is one of the reasons tens of millions in this country now have health insurance and no longer have to face impending disaster because they cannot afford the health care they need.

Now, Rob is dying.  Five months ago he was diagnosed with pancreatic cancer, a terrible disease. The cancer was too advanced for surgery. He tried chemotherapy, but that was unsuccessful. So, he has chosen to seek the highest quality of the life that remains, not the greatest quantity.

Today, the Boston Globe ran an op-ed by Rob. It is his farewell, his swan song, and it is beautiful. It is also a clarion call to continue the battle for universal health care, the kind every other developed nation on earth has, except America. It is a call that we treat health care as a basic, human right, not a privilege. If you do nothing else today, please read Rob’s articulate and rational argument for the cause to which he has devoted his life. In the article, he writes, “Though I will not live to see it, I am convinced the march toward universal, affordable, equitable, quality health care is unstoppable. The next generation of advocacy leaders will continue the work I leave unfinished.”

We will all be poorer with the passing of Rob Restuccia, whose entire, all too brief life has been dedicated to service to others. We can learn much from this brilliant and accomplished icon, both in the way he’s lived, and now in the way he’s dying.

The Wizard Behind The Curtain – Addendum To Drive Home The Point

February 14th, 2019 by Tom Lynch

Among other things, yesterday’s post made a point about the way the PBM system (if you can call it that) makes it difficult for uninsured Type 1 diabetics to buy insulin, because of price. To beat that horse even deader, here is an excerpt from a Kaiser Health News article, in partnership with NPR, published yesterday entitled, Insulin At A Fraction Of US Cost:

Almost one year to the day after her daughter’s diagnosis, Lija Greenseid and her family were visiting Quebec City, Canada, in July 2014. Her daughter’s blood sugar started spiking and Greenseid feared her insulin might have gone bad, so she went to a pharmacy. With no prescription and fearing that her daughter’s life was on the line, Greenseid was prepared to pay a fortune.

Instead the box of insulin pens that normally costs $700 in the U.S. was only around $65 or so.

“At that point I started tearing up. I could not believe how inexpensive it was and how easy it was,” Greenseid said.

“I said to [the pharmacist], ‘Do you have any idea what it’s like to get insulin in the United States? It’s just so much more expensive.’ And he turned to me and said, ‘Why would we want to make it difficult? You need insulin to live.’”

The more Greenseid traveled with her family, the more they realized how inexpensive insulin was everywhere except in the United States. In Nuremberg, Germany, she could get that $700 box of insulin pens for $73. The same box was $57 in Tel Aviv, Israel, $51 in Greece, $61 in Rome and $40 in Taiwan.

“We get so accustomed in the United States to thinking that health care has to be difficult and so expensive that people don’t even consider the fact that it could be so much easier and less expensive in other places,” Greenseid said. “In fact, that is the case in most countries.”

Take a moment out of your busy day and think about that. Please.

And answer this question: Do you  believe America’s 1.3 million Type 1 diabetics  who require insulin every day ─ just to stay alive ─ should be forced to pay hundreds, even thousands, of dollars a month for that medicine? Or are they not worthy enough to be treated like their fellow diabetics the world over?

The Wizard Behind The Curtain – Part 2

February 13th, 2019 by Tom Lynch

Let me tell you a story.

The year is 2015, and a workers’ compensation consultant is sitting in a highly respected insurer’s plush conference room. The consultant is meeting with the insurer’s Senior Vice President of Claims to negotiate price for an innovative specialty medicine program. What kind of program? Doesn’t matter.

The consultant has come armed with pro formas showing all costs of the program. Down to the penny. The problem is the insurer and the program are miles apart on what the insurer will pay the program’s doctors for each patient encounter. The Senior Vice President says, “Look, this isn’t exactly in our fee schedule, but the closest we can come to what is in the fee schedule is to pay your folks $85 per visit.” Hearing this, the consultant once again begins to explain why the fee needs to be $150 per visit.

This goes on for another half hour. The Senior VP finally says, “Well, maybe we could go to $91 per visit, but it’s the best we can do. Take it or leave it.” The consultant offers $140, but won’t go lower, because to do so would torpedo the program, which has demonstrated far more success, accompanied by significant cost savings, than others of its kind.

And then, it happens. The Senior Vice President in that plush conference room of this highly respected insurer says, “Hang on a minute. I’ve got it. You’re a specialty program, so we have a little latitude there. Charge us $300. We’ll pay you $150, and save our insureds $150 in the process.”

And that was how it was done. And it’s perfectly legal.

I tell that story by way of analogy.

Now let’s dream a bit. Imagine for a moment you are a pharmaceutical company CEO. You produce drugs that help sick people be healthy. Trouble is, the great big US healthcare system in which you operate makes Rube Goldberg seem like Thomas Edison. And in the center of your part of it sit pharmacy benefit managers, PBMs.

As we saw in Part One, the PBM industry has evolved in a rather chaotic way since Pharmaceutical Card System, Inc., invented the plastic benefit card in 1968. Over the intervening years, pharmacies and PBMs have developed into sometimes incestuous relationships. Today, three PBMs, Express Scripts, CVS Caremark and Optum RX, control 78% of the market. They wield tremendous power in drug pricing in a system designed to be opaque.

Essentially, the PBM’s job is to negotiate with pharmacies and drug companies, like yours, on behalf of their insurer and health plan clients. They create formularies, negotiate prices down (you give them a big discount in return for your drug being listed in their formulary), return some of the savings, called rebates,  to the clients (nobody really knows how much), and keep some for themselves. Seems simple, right? Well, it’s not. It’s infinitely more complicated and complex. And because only a very few actually understand PBMs, they remind me of the shenanigans in The Wizard Of Oz. However, it is that way only because we have allowed it to happen over the last four decades.

But back to you, Here’s your issue as a drug company CEO: You know, regardless of what price you set for your super-duper drug, you’re going to have to give a lot of it back as a discount to the PBM so it can give rebates to its clients. What’s a busy CEO to do?

Well, one answer is to set the price, the list price, so high that you’ll be able to provide a generous discount and still make what your finance folks say you must have for a profit. Just like in my analogy from above.

In a weird sort of way, this works most of the time for patients, but only if they have health insurance. What happens if they don’t? This is where things get sticky. Uninsured people get stuck paying the full list price, the one you inflated in order to provide the discount that allows you to make a profit and PBMs to (kind of) save money for their customers. This has been especially difficult for some uninsured Type 1 diabetics, who, as we have written previously (here and here), have had great difficulty paying for the insulin they need to take every day ─  just to stay alive.

Many employers have had enough of this. According to the National Business Group on Health, 75% of surveyed employers believe the rebate system does not serve to lower prices for employees, and 91% believe an alternative, more simple approach is required. Then there is CMS’s Alex Azar, of Ely Lilly fame, who wants you to price your drugs like Europeans do, which is a water fall lower than prices in the US. And let us not forget the current occupant of 1600 Pennsylvania Avenue, who, as yet unable to fulfill a campaign promise about a wall, has an outside chance of fulfilling one about drug prices.

Neither the healthcare industry, nor the US Chamber of Commerce like any of this. I imagine it might also be a bit awkward for quite a few US legislators who have been significant beneficiaries of the healthcare industry’s largesse, largess of the campaign contribution variety.

Regardless, I’m an optimist, and I keep hoping that in some way the wizard behind the healthcare curtain will go ‘poof,’ and be gone. Silly me.

 

 

The Wizard Behind The Curtain – Part One

February 1st, 2019 by Tom Lynch

Suddenly, everybody’s out to get Pharmacy Benefit Managers, or PBMs. CMS, state legislatures, state Medicaid officials, a boatload of experts and even Donald Trump, who appears to actually and sincerely believe PBMs have created a rigged system.

The issue, what you and I pay for medicine, is getting a lot of ink and airtime. As well it should. Drug prices in the US are nearly twice as high as other developed nations. How did it come to this, and are PBMs a big part of the problem or are they a modern Horatius at the Bridge holding back an invading army of even steeper costs?

The PBM industry was born in the late 1960s when Pharmaceutical Card System, Inc., (PCS) invented the plastic benefit card. By the mid-1970s, PCS was serving as a fiscal intermediary by adjudicating drug claims. In other words, it was a prescription Third Party Administrator (TPA). By working for insurers and health plans, PCS (later AdvancePCS) and others figured out that they could leverage the buying power of their clients to negotiate lower drug prices.  And until around 1992, that’s they did. During that approximately 20 year period, PBMs saved insurers, health plans and consumers money by driving physicians and patients to use lower cost generic drugs. This was a valuable service for all.

In 1992, however,  PBMs began to change their focus. As noted by the Wall Street Journal in August, 2002, from 1992 through 2002, PBMs had “quietly moved” into marketing expensive brand name drugs. Since then, two major problems have emerged.

First, there is an incestuous relationship between PBMs and pharmacy companies. This occurred over three periods.

From 1968 through 1994, pharmaceutical companies acquired PBMs. For example, in 1994 Eli Lilly bought PCS for $4 billion and SmithKline Beecham bought Diversified Pharmaceutical Services (from insurer UnitedHealth) for $2.3 billion. But the FTC saw anti trust implications these deals created and ordered the acquisitions to stop and the pharmaceutical firms to divest the PBMs.

So, Eli Lilly sold PCS Health Systems to Rite Aid for $1.5 billion,  SmithKline Beecham sold Diversified Pharmaceutical Services to Express Scripts for $700 million and Merck spun off Medco Health Solutions, the PBM for 68 million Americans at the time.

The third PBM evolutionary period, the one we’re now living in, has seen mergers between PBMs and PBMs with pharmacy chains. In 2000, Advance Paradigm bought PCS for $1 billion, and changed the name to AdvancePCS; in 2003 Caremark bought AdvancePCS for $5.6 billion; and in 2007, CVS bought Caremark for $26.5 billion. Similar long and winding roads have resulted in three PBMs, CVS Caremark, Express Scripts and OptumRX cornering 78% of the nation’s PBM business, serving 266 million Americans. Revenue for these three firms in 2017 was about $300 billion. And these costs are growing at an accelerated pace. According to the American Academy of Actuaries:

In some years, prescription drug spending growth has far exceeded the growth in other medical spending, while in others it has fallen below other medical spending growth. Over the next decade, however, the Centers for Medicare and Medicaid Services (CMS) projects that spending for retail prescription drugs will be the fastest growth health category and will consistently outpace that of other health spending.

Which brings us to the second big problem. The one everyone’s talking about.

More about that next week. After the Patriots win Super Bowl LIII!

Low Wage Workers Pay More For Health Care Than High Wage Workers

January 21st, 2019 by Tom Lynch

Anyone who can rub two brain cells together knows America spends more, much more, on health care than any other developed nation, as this chart from the Organization for Economic and Cooperative Development  (OECD) shows.

Also well established is the sad fact that in terms of health care outcomes our brethren in the OECD – Canada, England, Germany and France, for example – fare better than we.

Now, recent data published by the Bureau of Labor Statistics show lower wage workers pay more for health insurance than higher wage workers in employer provided plans.

What this means is: The employee portion of the monthly premium for family coverage paid by the lowest 10% of earners is $612, while the monthly premium for the highest 10% is $488. The lowest 10% of earners pay 25% more than the highest 10%. Similar results for single coverage.  Look at the light blue and light green bars in each of the strata in the chart. The more you make, the less you pay.

This is wacky. And terribly unfair. But wait, there’s more.

For every year in the 21st century, this has been getting worse.

From 2000 through 2018, health insurance costs for a single person in an employer-provided health plan rose 179%; family coverage rose 204%. During this same period, the Consumer Price Index was up 49%, while earnings for hourly employees grew by 48%. So, essentially, workers’ pay matched inflation, meaning real wages, wages adjusted for inflation, did not move as health care costs continued their rocket ride to the moon.

I keep thinking this cannot continue. I keep thinking Herb Stein was right: If something cannot go on forever, it will stop. And I keep being proven wrong. The fact is, up until the mid-1980s, our health care system was like a typical family home with its two bedrooms, a bath and a half and a nice little two-car garage. Today, it seems like the 1,000-room, maze-like Windsor castle where you need a map and a guide to find your way around. Vested interests litter the landscape, and any change gores somebody’s ox.

How can we possibly stop this runaway train? Many placed hope in the Affordable Care Act, but look what’s happened to that. The new generation of Democrats yearns for “Medicare For All,” but has yet to figure out how to pay for it. Others suggest “Medicaid For All,” but Medicaid is a state-based system, and every state has its own version. I’d love to see a single payer system, but, looking at the lunacy behind our current government shutdown, can you envision that cresting over the horizon, given all the work and bi-partisanship it would take? When I look at the health care horizon, I see the Four Horsemen of the Apocalypse coming over the rise.

Certainly, there are pockets of innovation and excellence around the nation, but we have no national, systemic approach to fix to the problem of extraordinary high costs, and it’s hard to imagine this congress, or any congress, doing anything about that. At more than $8 billion dollars, the health care industry spends more on lobbying than any other industry, and that’s not about to change, once again proving Mark Twain right: We have the best government money can buy.

I believe the work done in those “pockets of excellence” will gradually lead to improved health for Americans who can afford to pay for it. It’s the “can afford to pay for it” part that sickens me.

A Message To Our Readers

January 19th, 2019 by Tom Lynch

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Due to a technical error (mine!), yesterday’s blog post was transmitted incorrectly. The post was meant to detail how lower wage workers pay more for employer provided health insurance than higher wage workers. We will publish the corrected post on Monday.

Thanks to the many readers who alerted us to the problem.

Tom Lynch