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Wednesday, May 26th, 2021

Immunity Passports and Herd Immunity

As time passes, we are learning more and more about SARS-CoV-2, the virus that causes COVID-19. One of the things we are learning is how much we have yet to learn.

For example, a current and pervasive meme involves antibodies an infected person’s immune system makes to combat COVID-19.

Following his bout with the virus in October, 2020, during which he was given an “antibody cocktail,” Donald Trump famously said, “Now you have a president who doesn’t have to hide in a basement like his opponent. You have a president who is immune. Which is a very important thing, frankly.” Although the disgraced former president also said he wasn’t sure how long his “immunity” would last, the cult-of-Trump within the American public heard his “now I’m immune” message loud and clear.

Even before Trump’s “I’m immune” message, six months before, actually, his White House Rasputin, Scott Atlas, from Stanford’s Hoover Institute, told Fox’s Tucker Carlson it was “good news that the virus spreads widely and without risk to the vast majority of people. That’s good news, because we have a better chance of developing population immunity.” He went on to say this “would allow people to develop their own antibodies, and eventually enough people would develop their own antibodies to block the network of contagion.”

Herd immunity from having had the disease is a belief that won’t die. Two months ago “Health Coach” Christian Elliot published a mega-viral blog post entitled Eighteen Reasons I Won’t Be Getting A Covid Vaccine. One of the reasons? “I already had Covid.”

Reputable journals, newspapers and website have published fact-based research debunking this “I’m immune because I had it” drivel. As far back as 24 April 2020, around the same time Scott Atlas was mythologizing with Tucker Carlson, The World Health Organization (WHO) tried to put the matter to rest when it published Immunity Passports in the context of COVID-19. From the beginning of the article:

Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

For the article, the WHO reported on 17 studies investigating whether having had COVID-19 produces antibodies (it does) that prevent recurrence of the disease (unknown). Seventeen studies, and not one reporting having had COVID-19 prevents short or long term reinfection.

To make it even clearer, further on the WHO said:

As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.

But none of this stopped Donald Trump from perpetuating the medical myth the following October after his recovery.

This Alice-down-the-rabbit-hole thinking just confirms once again there has never been a fact that Trumped a deeply held belief.

Fifty-three percent, eh?

The Gallup organization made news this week with its latest poll in which it reported 53% of Republicans believe Donald Trump was cheated out of the presidency. This has been confirmed over and over again in the six months since the election—an election Joe Biden won by more than seven-million votes. Makes it seem as if a big swath of the country thinks a fraudster sits in the Oval Office.

But does it really? Let’s look a little deeper.

For decades, Gallup has surveyed the party affiliation of Americans, that is, U.S. adults identifying with the Democratic Party or who said they are independents leaning toward the Democratic Party; and, U.S. adults identifying with the Republican Party or who said they are independents who lean toward the Republican Party. In recent years, the gap between the two, a Democratic advantage, has been between four and six percentage points. In the first quarter, 2021, that gap grew to nine percentage points.

In Gallup’s Q1 survey, 25% of U.S. adults identified as Republicans and 15% as Republican-leaning Independents, for a total of 40%. This compares with 30% identifying as Democrats and 19% as Democratic-leaning Independents, totaling 49%. Thus, the nine point gap.

Now, back to the 53% of Republicans who believe Trump was cheated. Fifty-three percent of 25% is 13.25%. Fifty-three percent of 40% is 21.2%. Presuming not every, single Republican-leaning Independent believes Biden stole the election, we can say somewhere between 13.25% and 21.2% of U.S. adults believe the stolen election Big Lie. I’m betting it’s closer to the bottom number.

And that, my friends, is Donald Trump’s true base.

Who needs an independent commission?

The last time a violent mob invaded Washington, D.C. was 24 August 1814 during the War of 1812 when the British set fire to the White House and the U.S. Capitol, destroying the Senate Chamber and the Library of Congress. They burned most everything to the ground. Only torrential rains stopped the blaze. President James Madison wasn’t at the White House when this occurred, but his wife Dolly was. She took command and rescued everything she could. After that, with American soldiers escorting her, she was able to make her escape.

Two-hundred-seven years later, on 6 January 2021, a weaponized and organized mob of our fellow citizens stormed the Capitol in a violent insurrection. Five people died and the mob trashed the place to the tune of $30 million, according to the Architect of the Capitol. President Donald Trump wasn’t in the Capitol when the mob arrived, but his Vice President Mike Pence was. With the mob chanting, “Hang Mike Pence,” the Secret Service, like the soldiers who helped Dolly Madison, spirited Pence and his retinue out of the building to safety.

Thus far, 494 people have been arrested and charged for participating in the insurrection. They are from all parts of America and from all levels of society. Knowing the who, what, how, and why of this national obscenity seems to me to be a not too radical idea, the responsible thing to do. However, Republicans in Congress maintain that, because congressional committees are looking into the matter, an independent commission is unjustified and a waste of time and taxpayer money. They say the country needs to look forward, not back.

Being kind about this type of argument, I have to say it is full of what makes the grass grow green and tall. Perhaps the summit of Republican silliness was reached last night when Mitch McConnell, calling the whole thing a “purely political exercise,” told reporters that democrats, “would like to continue to debate things that occurred in the past,” as if investigating an assault on Democracy during which a violent mob was trying to find the Vice President of the United States in order to kill him was something akin to investigating how a new city parking lot strangely came to be on the corner of 6th and 7th. McConnell couldn’t even call the insurrection what it was; for him, it’s now just a “thing in the past.”

It is a tremendously sad commentary on our current society that the U.S. Senate, because of Republican opposition, will most likely not  approve an investigation by an independent commission into the 6 January insurrection. People, what have we come to?

History will not be kind to us in this moment. It will give us what we deserve.

A Day For Gloating!

Tuesday, April 27th, 2021

In early 2003, I was honored to be part of a group that wanted to bring better health care to some of the neediest citizens of the Commonwealth of Massachusetts. Dr. Bob Master, former Commissioner of the state’s Medicaid program, had the idea that if a number of us put our collective heads together we could actually do that. With him leading the effort, we created Commonwealth Care Alliance (CCA), an HMO dedicated to serving people who were dually eligible for both Medicare and Medicaid. These were the Commonwealth’s sickest of the sick and poorest of the poor. Paradoxically, their health care was woebegone, but the cost of providing it was astronomical.

CCA was a Dual Eligible Special Needs Plan, known in the business as a D-SNP. D-SNPs were created by the Medicare Modernization Act of 2003 (MMA), and are overseen by the Centers for Medicare and Medicaid Services (CMS). The potential afforded by the MMA was what intrigued Bob Master. He realized that if correctly harnessed, the power of the MMA could do a world of good for people at the lower end of the health care totem pole. And he was right.

Over the years, CCA took on the persona of The Perils Of Pauline, going from crisis to crisis. Our Board, comprised mostly of academics and clinicians, constantly fought above its weight. But, thanks to health care leaders in Massachusetts who saw the value of what we were trying to do, we were always rescued from our own folly. With their help, we grew and thrived—precariously.

In November, 2015, after Bob Master retired as CEO, the Board made the best decision in its history, hiring Chris Palmieri to take over the reins. Chris was a health care executive possessed of zeal, deep dedication to the cause and profound intelligence. Under his leadership CCA  for three years running was ranked number one in its class of health care providers nationally. I chaired the Board during this time and had a ring-side seat to the growth and respect CCA achieved.

During this time, the Board was deeply concerned about the diversity of our employees. We wanted them to look like the thousands of members we served. Great effort went into making that happen. It wasn’t easy, but management established protocols and stuck to them.

My term as Board Member and Chair ended 31 December 2019, but, as you can imagine, I have avidly followed the organization, especially as it navigated the terrible 2020 COVID-19 pandemic. During the last year, under Chris’s leadership, CCA has continued to perform at a superior level. I never doubted that it would.

Today, though, is special. Today, the Boston Globe published its rankings for diversity in hiring of all Massachusetts firms. When I saw that CCA ranked Number One in the Commonwealth!, I thought my chest would burst with pride. This is a remarkable achievement, brought about by the entire organization taking to heart the idea that all of us, working together, are better than some of us, working in ethnic, gender, racial and demographic silos.

Slowly, America is moving to a more inclusive society. After the darkness of the last four years, we are coming into the light. Although much work remains, diversity accomplishments and the recognition that comes with them, as demonstrated by Commonwealth Care Alliance, will propel us toward becoming all that we can be, not what we have been.

It’s Always Been Tough Being A Nurse. Now It’s Worse.

Thursday, April 22nd, 2021

The OSHA Incidence Rate of work injuries (cases per 10,000 workers) for nurses is 12.7; for all other industries, it’s 3.8. Moreover, 40.8% of all nurse injuries involve physically dealing with patient needs, like moving, turning and lifting them, resulting in the highest rate of sprains and strains of all professions.

That nurses experience high rates of injuries is nothing new. Lynch Ryan’s very first client, the year was 1984, was a community hospital where injuries to nurses caused the hospital’s workers’ compensation insurance experience to be nearly three times worse than its peers in Massachusetts. We solved that by creating the concept of modified duty, returning injured employees to work with physician-specified physical restrictions prior to complete recovery.

What is less well known is that America’s health care workers, principally nurses, are victims of violence in the workplace at three times the rate of all other industries, including manufacturing and construction. Among registered nurses, what the Bureau of Labor Statistics (BLS) calls “violent events” make up 12.2% of all occupational injuries; for all other industries it’s 4.2%. Clearly, nursing has been a challenging profession since the time of Florence Nightingale.

The COVID-19 pandemic has made things even worse. A new Washington Post – Kaiser Family Foundation Poll reveals roughly three out of ten health care workers are considering leaving the profession and more than half report being “burned out” due to the overwhelmingly horrific year they’ve just spent trying, and often failing, to save the lives of COVID inflicted patients.

Couple this potential decrease in health care workers with the BLS’s projection (as of 9 April 2021) that health care jobs will be the fastest growing segment of the economy from 2019 to 2029:

Employment in healthcare occupations is projected to grow 15 percent from 2019 to 2029, much faster than the average for all occupations, adding about 2.4 million new jobs. Healthcare occupations are projected to add more jobs than any of the other occupational groups. This projected growth is mainly due to an aging population, leading to greater demand for healthcare services.

So, we were already facing a future serious shortage of health care professionals. Now, the pandemic threatens to thin the ranks even more. Despite this, enrollment in baccalaureate nursing programs increased nearly 6% in 2020, to 250,856, according to preliminary results from an annual survey of 900 nursing schools by the American Association of Colleges of Nursing. In order to hit the BLS projection of 2.4 million new jobs, nursing enrollment will have to grow at this rate every year. That is a tall order.

Meanwhile, occupational injuries, violence events, and, now, illnesses due to the pandemic will continue to plague the health care sector. Try as I might, I have been unable to find any kind of cohesive national strategy to confront and deal with this looming health care catastrophe.

Just another example of our sweeping a coming disaster under the rug for posterity to trip over.

How Far We Must Go

Wednesday, April 21st, 2021

In 1675, the first and one of the deadliest wars ever fought on what is now American soil began. Fifty-six years after the sailing of the Mayflower, the tenuous Native American-Puritan bonds, built with careful distrust, burst asunder with disastrous results for everyone.

In 1616, European traders had brought yellow fever to Wampanoag territory, which covered present day Provincetown, Massachusetts, to Narragansett Bay, Rhode Island. The epidemic wiped out two-thirds of the entire Wampanoag Nation (estimated at 45,000 at the time). So, when the first batch of Puritans landed in 1619, Massasoit, Sachem of the Wampanoags, was on high alert. He waited until 1621 to meet the new immigrants, and then forged a guarded relationship between his people and theirs. In late-March, 1621, he and Governor John Carver signed the Wampanoag-Pilgrim Treaty. In the Treaty the two peoples agreed to do no harm to each other, to come to each other’s aid if attacked by third parties and to have equal jurisdiction over offenders: if a Wampanoag broke the peace, he would be sent to Plymouth for punishment; if a colonist broke the law, he would be sent to the Wampanoags. In addition, the Wampanoag leaders agreed to tell neighboring indigenous nations about the treaty.

For fifty years, the entente, occasionally fraying, held. But as more and more English immigrants arrived with weapons native Americans had never seen, and as the new immigrants began asserting themselves more and more over the indigenous nations, it became a when, not an if, a war would break out.

When Massasoit died in 1665, his son Philip became Sachem. Philip had few of his father’s diplomatic skills, and his people were becoming more and more angry at the dictatorial actions taken by the white people. After three of his trusted lieutenants were executed by the pilgrims in a woeful miscarriage of justice, Philip had no choice but to go to war if he wished to remain in power. In 1675, he did just that.

King Philip’s war brought tragic consequences for all. As so often happens, the white settlers of Plymouth Colony grossly underestimated the tactical skill of the warring indigenous nations, but in the end European firepower won out. Before the war, historians estimate about 80,000 people lived in New England. Nine-thousand died during the fourteen months of King Philip’s War, more than 10% of the total population. Proportionately, that’s more than in both the Civil War and the Revolution. One-third of the towns in New England lay in ashes, farms were abandoned and the fields lay fallow. Philip was hunted down in Rhode Island’s Misery Swamp and killed. His body was quartered and pieces hung from trees. The man who killed him, John Alderman, sold his severed head to Plymouth Colony authorities for 30 shillings.

And so we come to war’s end in 1676, and Josiah Winslow, the governor of Plymouth Colony, had a problem. Namely, what to do with hundreds of native Americans—surviving leaders of King Philip’s War and their families.

Winslow decided to get rid of them by loading them all, including Philip’s wife and nine-year-old son, onto several ships bound for the Caribbean, one of which, ironically, named Seaflower.

As Nathaniel Philbrick writes in his masterful Mayflower (Viking Penguin, 2007):

In a certificate bearing his official seal, Winslow explained that these Native men, women and children had joined in an uprising against the colony and were guilty of “many notorious and execrable murders, killings and outrages.” As a consequence, these “heathen malefactors” had been condemned to “perpetual slavery.”

Thus, joining Rome and other ancient societies, our white ancestor enslaved a conquered people.

Yesterday, 345 years after the Seaflower sailed from Plymouth harbor, a jury of his peers, a diverse jury, convicted Derek Chauvin on all three counts of murder in the death of George Floyd. What struck me most, the image that cannot be unseen, is the smirk on Chauvin’s face as he kneeled the life out of a man who did not look like him. I imagine it to be the same look Governor Winslow had on his face as he signed the certificate condemning hundreds of indigenous people, who did not look like him, into perpetual slavery.

How far we’ve come. How much, much farther we must go.

 

If Not For The Water: Georgia’s Stick In The Eye Of Democracy

Monday, April 5th, 2021

Major League Baseball and Major League Corporations are turning on the state of Georgia. The baseball All-Star game, originally scheduled for Atlanta’s Truist Park in July, is picking up its bats, balls and gloves and heading somewhere else, depriving the stadium of more than 43,000 fans and all the money they bring with them.

This, of course, is due to the Georgia Election Integrity Act, a 98-page, nearly 2,500-line piece of legislation signed into law by Governor Brian Kemp a week ago Friday behind locked doors in the presence of nobody but six older white guys and a painting of Calloway Plantation. None of the more than 100 people the Calloways enslaved are pictured in the painting. In addition to MLB, the Coca Cola and Delta Airlines corporations, headquartered in Georgia, sharply criticized what they considered terrible voter suppression by the majority Republican legislature.

Coca Cola and Delta did not stand alone. The following major corporations have issued sharply condemnatory statements: Merck, Porsche’s North American operations, headquartered in Georgia, Georgia-based UPS, Mercedes-Benz, Microsoft President Brad Smith, Bank of America Chairman and CEO Brian Moynihan, Cisco CEO Chuck Robbins, Home Depot, headquartered in Georgia, JPMorgan Chase CEO Jamie Dimon, American Express, Facebook, and Viacom CBS.

Texas, a few states to the west of Georgia, appears ready to pass similar legislation, prompting American Airlines and Dell, both based there, to issue similar strongly worded rebukes before any legislation has been voted and enacted. Texas Governor Greg Abbott says he will sign the legislation when, not if, it reaches his desk. And Lt. Governor Dan Patrick, the powerful Senate leader, slamming the corporations’ criticism, said, “Texans are fed up with corporations that don’t share our values trying to dictate public policy.”

As of March 24, legislators have introduced 361 bills with restrictive provisions in 47 states, according the Brennan Center for Justice, which tracks voting legislation around the country. Arizona, alone, has 23 in the hopper.

It seems that the irresistible force is about to meet the immovable object as corporate America issues a ringing indictment of what it considers perfidious attempts by red states to restrict voting rights. What caused this immediate and strong opposition? MLB traditionally takes a long time to decide anything, let alone a law about voting.

I submit it has everything to do with water.

More than half of the Georgia Election Integrity Act deals with absentee and early voting. Reading those parts is like trying to negotiate the Labyrinth without Theseus’s ball of twine. However, there is one, immediately understandable sentence found on page 73, a section of which reads:

No person shall…offer to give…any money or gifts, including, but not limited to, food and drink, to an elector…within 25 feet of any voter standing in line to vote at any polling place.

Violation of this section is a crime, albeit a misdemeanor.

The state of Georgia holds primary elections during or near summer. Summer is hot in Georgia, and the state is the seventh most humid in the country. Voting lines can be long in Georgia, and will be longer now due to the new law decreasing voting places and limiting drop boxes to either one per county or one per 100,000 people, whichever is smaller. People standing in long lines in the summer heat will get thirsty. Perhaps they will not have brought water with them. The urge to give a drink of water to a thirsty person in a long line in the Georgia heat is something very human, very Christian. What is neither human nor Christian is having to do so by putting the drink on a 26 foot pole.

This is the one thing that got America’s immediate attention, one person in particular: the President of the United States, who, during his first press conference, called it “sick.” Nielson reports 32 million people watched him live.

Biden calling out the provisions dealing with absentee ballots or early voting would have left many saying, “Well that’s a matter of opinion. He’s a Democrat, so, of course, he’ll criticize a new law Republicans wrote.”

But there’s no “matter of opinion” about the water. It’s a Black and White thing (the whole law is, but this part is special). If Georgia’s Republican legislators had told the genius who came up with it, “Now, hold on, son, we can get what we want without this,” it would have been ever so much harder to get corporate America to go full out in opposition.

Republicans in Georgia, especially Governor Kemp, are not backing down. No, they’re doubling down. But they’ve now set something in motion that will be hard to stop. And former friends in high places are aligned against them. In the long run, the Georgia Election Integrity Act may prove to be the best thing that ever happened to the Democratic Party in Georgia — and beyond.

 

Reflections On WCRI’s Recent Virtual Annual Conference: In A Word, It Was Excellent

Tuesday, March 30th, 2021

COVID-19 impact analysis

Last year, the Workers’ Compensation Research Institute held its Annual conference in Boston at the Westin Hotel on 5 and 6 March. The ballroom was full. COVID-19 was talked about in the conference and on the breaks, but it was too new to be on the Agenda. Everyone was doing elbow bumps instead of hand shaking. Four days after the conference wrapped, Governor Charley Baker declared a Massachusetts State of Emergency. The WCRI conference was likely the last one held in the City before everything shut down.

At that time, per the Johns Hopkins University COVID-19 Dashboard, the nation had seen ~139,000 cases and 2,425 deaths. In Massachusetts, where the conference was held, there had been 4,955 cases and 48 deaths.

The following month, the National Council on Compensation Insurance (NCCI) issued a Research Brief titled, COVID-19 and Workers’ Compensation: Modeling Potential Impacts. 

NCCI’s analysis projected a best case scenario, in which loss costs would increase $2 billion, and a worst case scenario, in which they would increase $81.5 billion, or 250% more than then current total loss costs. Willis Towers Watson also released a scenario-based analysis that suggested pretty much the same thing.

Also in April, the California Workers’ Compensation Insurance Rating Bureau (WCIRB) projected loss costs if conclusive (rebuttable) presumptions were provided to front line workers, something Governor Gavin Newsom actually did through Executive Order one month later, so the “if” became a “done.” The WCIRB report concluded costs would range “from $2.2 billion to $33.6 billion with an approximate mid-range estimate of $11.2 billion, or 61% of the annual estimated cost of the total workers’ compensation system prior to the impact of the pandemic.

A year later, at this week’s virtual annual conference, WCRI Economist Olesya Fomenko, Ph.D., reported results from her analysis of workers’ compensation claims in WCRI study states for Q1 and Q2, 2020. This period, ending 30 June, encompassed the pandemic’s first of what has been up to now three surges.*

Her data and presentation slides are preliminary, but more than likely will stand up to future scrutiny. Her findings confirmed what most students of COVID-19 were intuitively thinking. To wit, it does not appear that, at least through the study period of two quarters, COVID-19 would deal a death blow to the workers’ compensation industry. Claims in her analysis of 27 study states are plentiful, but relatively inexpensive. There is wide variation in the geographic distribution of claims, probably because COVID-19 surged at different times in different states. New York is not among the WCRI study states, but during the period of Fomenko’s analysis, it was the state with more COVID problems than any other. A lot more.

During the study period, Massachusetts, Connecticut and New Jersey had the most reported claims. Massachusetts claims were 42% of all reported claims in the study states and 59% of all lost time claims. Dr. Fomenko suggested that the presence of presumption laws, pay without prejudice (in the case of Massachusetts) and other compensability issues (in New Jersey) might is some way contribute to the high numbers in those states.

Looking at Massachusetts for a moment might be instructive.

At the top of this column we showed Massachusetts with relatively few cases as of early March, two-thirds of the way through Q1. Let’s look at Massachusetts now, at the end of Q1 a year later. The state has been hit hard, but has also rebounded. Here’s a look at the state by county:

As you can see, no county has had less than 3,000 infections, and three have had more than 10,000. But what came of those infections? How did the patients make out medically? Here is a look at cumulative cases from 9 March 2021 through yesterday, 29 March 2021.

There have been 17,130 total deaths since the beginning of the pandemic, but 97% of infected patients have recovered. Deaths are at 3%, which is less than the 5% predicted by the CDC one year ago. And this is the case for most of the country, and is one of the reasons Dr. Fomenko’s data shows claims to be relatively inexpensive.

NCCI Analysis

The WCRI studies define the concept of “early days.” So do those from the National Council on Compensation Insurance (NCCI). The point is, however, that analyses from both organizations appear to be congruent and complementary.

The lasting costs of COVID-19 to the workers’ compensation industry, aside from deaths, are going to come from permanent total and permanent partial disability awards. To that end, in October, 2020, NCCI published a Research Brief updating the Brief cited earlier in this column and titled, COVID-19 And Workers’ Compensation: Permanent Disability. These costs will be significant. NCCI’s analysis determined the average age of hospitalized COVID-19 patients at 49.5 years old. Average life expectancy allows for about 30 more years of benefits. The organization writes:

Given that severe cases are expected to have a higher likelihood of permanent disability, particularly PTD injuries, NCCI
assumed that all PTD claims would occur in this symptom grouping (infections and lung claims). Adjusting our PTD rate to between 0.0% and 1.5% to be applicable to only severe cases, we observe a PTD rate between 0% and 10% (= 1.5% / 15%) using the default Critical Care Rate from the NCCI Hypothetical Scenarios Tool.

Permanent Partial Disability cases are another matter. Here the frequency will be higher as well as the costs:

One interpretation of this assumption could be that moderate cases behave more like infection claims which tend to have a
near-zero PTD rate. If we compare the lung and infection PPD rates, we observe that lung claims have about twice the
likelihood of a PPD injury compared to infection claims. To the extent that moderate cases of COVID-19 behave like
infection claims and severe cases behave like lung claims, then a similar difference in the PPD rate may be expected. Under
this view, the Severe PPD rate would range between 40% and 50% with an implied Moderate PPD rate ranging between
20% and 25%.

With assumptions it clearly states contain wide variability, NCCI suggests the following COVI-19 benefits by injury type:

We’ll continue to follow the NCCI analyses as well as WCRI’s ongoing research.

Interview by John Ruser, PhD, with John Howard, MD, MPH, JD, LLM, MBA

John Howard is the longest serving Director of the National Institute for Occupational Safety and Health, three terms and counting. He is a legend in the field, and WCRI attendees got a good look at why during this wonderful interview by John Ruser. Howard, who has more letters after his name than there are years in elementary and high school combined, put on quite a show.

Some people are one inch wide and ten miles deep; others ten miles wide and one inch deep. Howard seems to know no inch or mile boundaries.  His subject was The Future of Work, and he made a number of highly interesting and prescient points, even going so far as to describe Aristotle’s concerns about automation in the ancient world of 350 BCE.

Asked about fears of jobs disappearing because of Artificial Intelligence and automation, Dr. Howard pointed to a study showing that in 2018 there were 60% more jobs than existed in 1940. Jobs have always gone away, but they’ve been replaced, and then some, by new jobs.

He’s concerned about a safety ergonomic vacuum employers are going to have to manage somehow. He believes employers are facing a “real challenge” adjusting to the new Work From Home paradigm.

My question is: How do employers deal with, let alone manage, workers’ compensation claims bound to occur while working in the home. You’re at your desk or dining room table working, get up for lunch, fall down the stairs and break an arm. Is that compensable? Is your employer going to make you prove it actually happened while you were actually working, and not just taking Junior out to the back forty for a little tag football?

And what responsibility does an employer have with respect to OSHA’s General Duty Clause, the one about providing a safe and healthful workplace?

If anyone can figure this stuff out, my money’s on John Howard.

Conclusion

Under trying circumstances, WCRI did an admirable job of hosting its 2021 Annual Conference. I’m told attendees gave it high marks, as well they should have. At the end of the second day, Dr. Ruser announced next year’s conference as being back in Boston’s Copley Westin Hotel on 15 and 16 March 2022. And I have a suggestion: After this ridiculously stressful year, it would be helpful and probably appreciated to devote a session to the impact of COVID-19 on employee mental health. A lot has happened in the last year to the field of Behavioral Health. It seems to have fitted in quite well to the new paradigm called Telehealth. It would be interesting to learn about that.

 

* Yesterday, CDC Director Dr. Rochelle Walensky said, “We do not have the luxury of inaction. For the health of our country, we must work together now to prevent a fourth surge. I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet.” Walensky said she is now feeling a sense of “impending doom.”

**The Future of Work: The Economist is presenting a discussion on 8 April, at 4 pm, EST. To reserve a place, go here.

The Georgia Election Integrity Act: A Desperate Attempt By The Republican Party To Retain Power

Monday, March 29th, 2021

There was already a perfectly fine election statute in the state of Georgia. Perfectly fine. Chapter 2 of Title 21 of the Official Code of Georgia Annotated had just completed governing the November election for President and the January election for two US Senate seats. The Presidential election had withstood lawsuits and multiple audits and been judged to have been exemplary on all counts. It was a perfectly fine statute, except for one thing: The wrong people won. And they were Democrats.

The Republican elites, who currently hold the key to the Governor’s office, as well as majorities in both the Georgia House of Representatives and Senate, could not abide that. Something had to be done. And something was. Senate Bill 202 amended the perfectly fine Chapter 2 of Title 21 of the Official Code of Georgia Annotated. It became the Election Integrity Act.

The Election Integrity Act was signed into law last Friday by Governor Brian Kemp behind locked doors, no reporters allowed, in the presence of six other aging white guys (and a photographer, for whose presence and work we are grateful) and in front of a painting of the Calloway Plantation, where, in the mid-19th century, more than 100 Black Slaves toiled day and night to make the very white Calloway family ever so comfortable and rich.

As Governor Kemp, who, ironically, served as Georgia’s Secretary of State from 2010 to 2018, was getting ready to sign this obviously much-needed legislation, State Representative Park Cannon, who is Black, knocked on the locked door asking to be let in to observe. For her trouble, she was arrested by three burly state troopers and hauled off in handcuffs, and now faces two charges: willful obstruction of law enforcement officers by use of threats or violence and preventing or disrupting general assembly sessions. Video taken at the time showed none of that.

After the unfortunate interruption, Kemp signed the amended legislation, shook hands with the six aging white guys, and that was that.

That was that, that is, until certain people, including the current President of the United States, upset with the whole thing, noticed the wording in lines 1,872 through 1,881, which is this:

So, unless you have a 26 foot pole with a drink on the end of it, you’re not giving water to anyone standing in the Georgia Sun patiently waiting to cast a ballot. If you do, you’ll share Representative Cannon’s fate. In his nationally broadcast press conference, President Biden called this provision of the law, “sick.”

A new national study led by economist Keith Chen of the University of California, Los Angeles, found voters in predominantly black neighborhoods waited 29 percent longer, on average, than those in white neighborhoods. They were also about 74 percent more likely to wait for more than half an hour.

The new food and drink prohibition quite understandably got a lot of press attention. It oozes racism. But throughout the amended statute one will find other instances of intentional voter suppression. For example:

  • Drop boxes: Created by emergency rule due to the pandemic, these proved extremely popular during the two elections in question. In heavily democratic Fulton County, alone, 146,000 votes were made by absentee ballots placed in drop boxes. Republicans noticed immediately.

“As soon as we may constitutionally convene, we will reform our election laws to secure our electoral process by eliminating at-will absentee voting,” the Georgia Senate Republican Caucus wrote in an 8 December email. “We will require photo identification for absentee voting for cause, and we will crack down on ballot harvesting by outlawing drop boxes.”

The result in the Election Integrity Act: No more than one drop box per county. Officials, at their discretion, may place others, but no more than one per every 100,000 voters.

  • Voter challenges: In Georgia, voters are called “electors.” Prior to the new legislation, any elector could challenge the qualifications of anyone applying to register to vote or could challenge anyone whose name appeared on a list of registered electors. The Election Integrity Act added the following sentence: There shall not be a limit on the number of persons whose qualifications such elector may challenge. One can imagine an entire group of people being challenged.
  • Mobile Voting Buses: Under the old legislation, groups could use buses, approved by the Secretary of State, as mobile voting centers. Two were used in predominantly minority Fulton County (I cite Fulton County again, because in his infamous call with Secretary of State Raffensperger, President Trump mentioned the County 11 times in his quest to get Raffensperger to find him 11,780 votes). The Election Integrity Act prohibits Mobile Voting Buses.
  • Absentee Ballots: The Election Integrity Act, which is 2,427 lines long, devotes more than 1,450 to redesigning Georgia’s entire absentee ballot system. It is obvious Georgia’s Republican Party abhors the very thought of absentee ballots, even though a significant number of Republicans vote by absentee ballot. The law prohibits no-excuse absentee ballot application, as well as the universal sending of absentee ballot applications to all registered voters. Absentee ballot violations are considered felonies by the new legislation.
  • The Secretary of State: Until Brian Kemp signed the Election Integrity Act, the Secretary of State, as in most U.S. states, was responsible for conducting elections. But Raffensperger and those in his office angered many fellow Georgia Republicans during the presidential and senate races, because, after exhaustive audits, they found no fraud significant enough to change anything. The new law strips him of his authority by creating an Elections Board, whose chairperson will be elected by the legislature. The Secretary of State is now an ex-officio, non-voting member of the Board.

It is understandable why Georgia republicans are going to such lengths to suppress minority voting. Consider this from statistics from Georgia’s Secretary of State:

  • Since 2000, the percentage of white voters in Georgia has decreased from 68% to 58%. At the same time, the Black voting percentage has increased from 27% to 33% of total voters.
  • From 2000 through 2019, Georgia’s eligible voting population grew by 1.9 million; 48% were Black. White growth was only 26%.
  • The majority of single-race Blacks live in the South – 59%

As the proportion of white voters in the nation continues to shrink, the Republican Party is shrinking right along with it. It is unmovably the Party of Barry Goldwater and his small tent, Ronald Reagan and his “welfare queen,” and, of course, Donald Trump and his racist white supremacy. It is exhibiting all the characteristics of the self-cannibalistic rat snake that cannot stop itself from eating itself. Georgia’s Election Integrity Act is nothing more than a desperate attempt by the aforementioned aging white guys to blunt the impact of an irresistible demographic force.

In the end, it will fail.  Democracy will prevail.

The WCRI And Sidney Powell’s “No Reasonable Person” Nutty Defense

Tuesday, March 23rd, 2021

Interesting day today at the first 3-hour day of the Workers’ Compensation Research Institute’s virtual and strange two-day conference where all the presenters looked as if they’d really rather be in the Grand Ballroom of Boston’s Westin Hotel. I’ll have a wrap up of the two-day, six-hour conference after it ends tomorrow. But for today…

In early February, 2021, an Associated Press-NORC* poll found 65% of Republicans believed Joe Biden was not legitimately elected President of the united States. One week ago, a Monmouth University National Poll found exactly the same thing. Nothing had changed in a month and a half. Why do you suppose that is?

 

 

You don’t have to be Albert Einstein to know that since the election, in fact since well before it, authority figures in the Republican Party, including the President, insisted the only way Donald Trump could lose the election would be through massive fraud. One of the leaders of this disinformation campaign is the lady pictured here: Attorney Sidney Powell, Trump’s on-again off-again lawyer in his attempt to overturn the election result.

Powell manufactured far-fetched claim after monstrously far-fetched claim of election fraud beginning two days after the election. Powell and her team of conspiracy theorists filed more than 60 lawsuits around the country that all died in court. But that didn’t stop her and her sidekick Rudy Giuliani from sharing their bird-brained ideas from the stage of the Republican National Committee in a November press conference carried on C-Span. Neither did it stop them from doing the same dozens of times on Fox News and Fox Business, never challenged by anybody from the network.

When none of that worked, Powell went for the big time and won the Gold Medal for the craziest claim of 2021 (thus far). To wit, Smartmatic and Dominion Voting Systems conspired with Venezuela’s communist leadership, ditto with Cuba, and “likely” China to create software to fix the election for Joe Biden against Donald Trump. On 8 November on Fox Business she was interviewed by Maria Bartiromo and claimed Dominion created a secret “algorithm to calculate the votes they would need to flip. And they used the computers to flip those votes from Biden to—I mean, from Trump to Biden.”

In late January, after the Dominion Voting Systems leaders had heard this lie a few thousand times, they had enough and sued Powell, Giuliani and others for $1.3 billion for defamation. That’s billion.

Yesterday, Powell’s defense team responded to the lawsuit. It’s 90-page filing can be summarized in two words: Just kidding.

In legalese, what her lawyers said was, “no reasonable person would conclude that [Powell’s] statements were truly statements of fact.” Moreover, her high-priced defense team writes that Dominion itself “characterize(s) the statements at issue as ‘wild accusations’ and ‘outlandish claims,’” and that “Such characterization of the allegedly defamatory statements further support Defendants’ position that reasonable people would not accept such statements as fact…”

In otherwords, if the company she defamed considers the accusations off-the-chart lunacy, then nobody else could ever possibly believe them.

Finally, the Powell team claims she never knew her accusations were false. “In fact,” they write, “she believed the allegations then and she believes them now.” So, she’s not guilty; she’s just crazy.

This would all be riotously funny if it weren’t so deadly serious. Deadly, as in five people died and more than 140 were injured at the Insurrection of 6 January, a day, to quote Franklin Roosevelt, “that will live in infamy.”

But notwithstanding the Insurrection, could Sydney Powell’s defense team actually be right? Would no one believe her claims, as well as all the other ridiculous claims made by Trump apologists, because they are all so nutty? The early February AP-NORC and the mid-March Monmouth University polls, as well as the Insurrection itself, appear to give the lie to that defense. Sixty-five percent of Republicans still believe Biden cheated his way to the Oval Office. They’re getting that belief from somewhere. And unless we figure out how to disconnect this significant faction of the American public from the Big Lie, it will continue as a grotesque cancer on our society.

In the 1930s, Joseph Goebbels made famous the Big Lie.

“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”

We have seen this movie before. And it never ends well.
________________
* The National Opinion Research Center at the University of Chicago, founded in 1941 whose name is now officially NORC.

 

Our Unending Tragedy: America’s Middle East Fiasco

Sunday, March 21st, 2021

Hubris is the one word that defines war to me. I’m reminded of that when I think of our experiences in the Middle East over the last nearly 30 years, and when I consider my own odyssey in Vietnam.

We’ve been in Afghanistan since invading the country on 7 October 2001. After 20 years, like the dog that caught the bus, we still have no idea what to do next, which is exactly what President Biden and his team are trying to figure out now.

In a superb piece for The New Yorker (8 March issue), Dexter Filkins makes a compelling case that after America leaves, the Taliban will once again command the country with Sharia law. Although the Trump administration went through the motions of trying to craft a power-sharing deal between Afghanistan’s President Ashraf Ghani and the Taliban to let America save a bit of face as it leaves, a Talib leader Filkins met with said, “We’re not sharing power with anyone.” And he meant it.

I can’t help thinking that when we do pull our last troops from the country, Afghanistan will be in precisely the same position as it was before the twin towers came down. So much for $130 billion and 22,266 American casualties.

Yesterday, 20 March, was the 18th anniversary of America’s second invasion of Iraq. The war officially ended on 15 December 2011, but it wasn’t until three days later, on the 18th, that the last 500 troops left the country. During that nearly eight-year war, 4,497 Americans died in combat and more than 32,000 were wounded, wounds that echo resoundingly to this day.

In Iraq and Afghanistan we never figured out what to do next.

Just as in Vietnam.

In 2005, I wrote a column for the Boston Globe comparing the Iraq war to my own experiences in Vietnam. In memory of the Iraq anniversary, I want to share that column here. It’s as true now as it was then.

Where Have All The Soldiers Gone

Listening to all the arguments about the Iraq war is like being at a rappers’ convention; it’ll make your head spin. It reminds me of another national mistake, one that I was part of, 40 years ago.

I graduated from college in June 1967, without a care in the world, a thought in my head or a desire to find a job.

My grandfather, the retired chief of police for Haverhill, Massachusetts, population 65,000 or so, was chairman of the local draft board. He and my grandmother lived with us. Every Monday night someone would drive to our house, pick up Grampie and take him to the weekly meeting of the draft board where a group of older men would decide the fate of a group of younger men.

One night during dinner Grampie looked across the table and said, “Tommy, I can’t keep you out of this any longer. It doesn’t look right.” I hadn’t known that he was keeping me out of anything, and it took me a minute to figure out that he was talking about the draft.

My father, sitting at the head of the table, put down his fork, but didn’t say a word. During World War II, after slogging through Italy and France for three years, he’d been seriously wounded and left alone to die in an army field hospital corridor. He didn’t die, but it was eight months before he was well enough to be discharged for home. My dad knew war.

When my grandfather spoke of the draft, Dad immediately decided that what happened to him wasn’t about to happen to his first-born. So he and Grampie determined on the spot that I would become a card-carrying, uniform-wearing, quasi-killing machine in the Army Reserve: a weekend warrior. And the very next afternoon I found myself, along with the two of them, sitting on the porch of the Lawrence Army Reserve unit’s commanding officer, signing on for six years of weekly drills and two-week summer camps.

I started going to the drills with the other reservists. Every Monday night we’d march around the Reserve Center’s parking lot, a small sea of out-of-shape, overweight 20-somethings in olive drab, singing cadence and lusting for battle. Well, the simulated kind, anyway. “I want to be an airborne ranger.”

Today, members of the Army Reserve and National Guard are fighting courageously, many of them dying, in Iraq. More than 425,000 have been deployed. More than 95,000 have served two or more 18-month tours. Clearly, these men and women, as well as their families, are making large sacrifices every day.

But in the late 1960s, because of the draft, there were only two kinds of people in the Army Reserve. There were veterans of the Korean conflict, men who had been to war, but had decided to stay in the Reserves for the camaraderie, and, then, there were the rest of us, all college grads who knew the right people, or whose parents did, and had joined the Reserves to avoid Vietnam, and we’d march around playing silly soldier games to do it.

I did that for three months. Then a high school friend, Bobby Schena, came home in a coffin. Then another friend and then another, each in his individually wrapped, olive green shroud.

In Fenruary,1968, to the consternation of my father (“Have you lost your mind, Tom?”), the displeasure of my grandfather and the utter disbelief of my peers in the Army Reserve, I joined the regular Army to become a real airborne ranger, went to Officer Candidate School at Fort Benning, then Airborne, then Ranger, and in 1969 found myself, a newly minted second lieutenant, passing through Saigon and heading north. I was in a C-130 with a planeload of young soldiers who did not know the right people and had no idea of why they were there or what they were in for. Most were teenagers, lonely souls far from home. Regardless of who they were, all of them, all of us, eventually became somebody’s cannon fodder, and more than 50,000 of us didn’t make it out alive. Like my dad, we all learned to know war.

Now, nearly 40 years later, our country is in an awful, no-win position, maneuvered there by men with names like Cheney, Wolfowitz, Pearl, Kristol, Feith and, of course, Bush. All of them did know the right people and either had deferments, lots of them, or, like the president, were weekenders. Although it appears to have been fine for weekenders of Mr. Bush’s social and political status to skip those tiresome drills if they proved inconvenient.

What these “neocons” know of war they got from a board game. In their clueless imperialism they have managed to move their game pieces, us, to the brink of an obscene disaster, an American and global tragedy.

A lifetime spent walking war’s sanitized sidelines, never hearing that unforgettable, but very special, sound a bullet makes as it whizzes past your ear, prevents one from appreciating the chaotic hell of war and from grasping how terrifying it really ought to be to rip men and women from the fabric of their families to face the horrifying prospect of fighting and dying in a strange land for a counterfeit cause.

This new national nightmare is certainly sad, but what is sadder still is that nobody, not I, not you and, least of all, not the egotists that tossed us into this deepest of pits, has any idea of how to get us out without causing even more harm than we already have. Posterity will be tripping over America’s arrogance for a long time to come.

In the pantheon of man-made catastrophes, this has been a monumental achievement.

What Is The Real Reason Republicans Oppose The American Rescue Plan?

Friday, March 5th, 2021

At this moment, the Senate is debating the American Rescue Plan, the Biden administration’s $1.9 trillion stimulus proposal currently enjoying deep and wide bipartisan popularity across the country. Consequently, of course, not a single Republican senator will vote for it.

Why is this?

The Federal Reserve, not what you’d call a radically socialist organization, the Treasury Department, and nearly all reputable economists back the plan. A highly credible Morning Consult / Politico National Tracking Poll, with a 2% margin of error, conducted two weeks ago from 19 through 22 February, reported 66% of all registered voters considered stimulating the economy a “Top Priority,” and 76% of registered voters support the $1.9 trillion plan. And the icing on the cake — 60% of died-in-the-wool Republicans support it.*

Additionally, 63% of small business owners support the $1.9 trillion stimulus plan, according to the Q1 2021 CNBC|SurveyMonkey Small Business Survey, including 46% of Republican entrepreneurs.

With that kind of support, what possible reasons could congressional Republicans have for doing “everything we can to fight it,” as Mitch McConnell proclaimed this week?

There are a few reasons, and, is so often the case in political argument, most of them are nothing more than sound bites.

For example, Republicans claim the proposal is “replete” with giveaways having nothing to do with the pandemic. They object to the plan’s $350 billion aimed at helping cities and states, most notably the $10 billion (less than 1% of the entire plan) to shore up pension plans or lower future taxes.

Let’s look a little more closely at Republican opposition to city and state aid. No municipality — red or blue — has designed its fiscal affairs to withstand a simultaneous public-health crisis and economic lockdown. Unlike the federal government, states and cities cannot print or borrow money at near-zero interest rates. Most are constitutionally required to balance their budgets. When a pandemic annihilates their sales and income tax revenues — while dramatically increasing their Medicaid and health-care outlays — states have little choice but to lay off public-sector workers, cut social services, and/or raise taxes. All of those measures would make our current economic woes worse. There is no economic theory to support a stimulus strategy that combines massive stimulus at the federal level and simultaneous austerity at every lower level of government. If you believe that governments can improve economic welfare by filling in shortfalls in private incomes and consumer demand, then forcing state governments to reduce employment and spending is economically indefensible.

In the face of this, there is no coherent theoretical argument behind the GOP’s opposition to fiscal aid for states. But that hasn’t stopped it from trying. Unfortunately, every strata of our nation’s economy, from business, small and large, to the public sector’s 20.2 million federal , state, county and city employees, to nuclear families and single Moms, to you and me — all are in need.

On the other hand, I’d be interested in knowing just how much economic need our elected representatives and senators are experiencing at this moment. Would you?

*To be precise, this is the exact wording of the question in the Tracking Poll. It can be found on page 229 of the 368 page report: “Would you support or oppose a $1.9 trillion coronavirus relief package that provides up to $1,400 in direct payments to Americans making less than $75,000 a year, $350 billion in emergency funding for state and local governments, funding to support K-12 and higher education to re-open, and extends increased unemployment benefits until September 2021?”