Archive for the ‘Misc.’ Category

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

Tuesday, March 26th, 2019

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.

Robots In The Manufacturing Sector – We’re Lagging Behind

Thursday, March 14th, 2019

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.

A Message To Our Readers

Saturday, January 19th, 2019

Image result for graphic of oops!

 

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

It Is Time

Monday, November 5th, 2018

This is not a piece about insurance or health care. It won’t make the cut for Health Wonk Review and it will probably cost us readers (Well, 15 years has been a pretty good run). What this piece is is one that addresses the health of our nation.

Today, the Bureau of Labor Statistics (BLS) released a chart showing gains in productivity and hourly wages from Q3 2017 to Q3 2018. It looks remarkably similar to the chart BLS released at the end of Q2. Impressive Productivity and Output gains in both quarters. And, if you didn’t know better, you’d think Hourly Compensation is rising pretty well, too.

However, look to the far right of both charts to see the change in Real Hourly Wages, which are wages after inflation is factored in. The Trump administration and most of the press have trumpeted (pun intended) the nominal wage increase of 2.8% for Nonfarm Business and 2.2% for Manufacturing in Q3, 3.2% and 2.5%, respectively, in Q2, without saying a thing about the negligible, and in some cases decreasing, Real Wages.

Real Wages for Nonfarm Business during this one-year period (Q3 to Q3) are up a measly 0.1%, after rising an anemic 0.5% in Q2; Manufacturing Real Wages in Q3 are actually down 0.4% after being down 0.2% in Q2. And this is not a new phenomenon. In the 40 years since 1979, Real Wages for hourly and non-supervisory workers have increased by a total of only 4.5%. During that same period, the CPI has risen 247.7%.

These are not “alternative facts.”

Since the day Donald Trump and his cronies got the keys to the kingdom, Real Wages per week have risen from $349 to $351 in constant 1982-1984 dollars. Two bucks! For the mathematically inclined among you, that’s an increase of 0.005%. During the same period, the Dow Jones average has grown 20.9%, and that counts the recent decline. I like the stock market as well as the next guy, but barely one-third of families in the bottom 50% of earners own stocks, according to the Federal Reserve. The fact is, lower-income Americans don’t have extra money to put into stocks, and a third of workers don’t have access to a 401(k) or another retirement plan, according to Pew.

The facts make clear that since Republicans took control of everything, the economic gains  have gone to the top earners. Folks in the middle and lower end have, to a large degree, been left by the wayside. Inequality reigns supreme. It is beyond baffling that these people who continue to get the smelly end of the stick resolutely remain, seemingly unperturbed, in the center of Mr. Trump’s base. Look at the enthused, smiling faces at his rallies. Sociologists have written about this, but I have yet to see anything that explains it fully.

Regardless, tomorrow is Election Day. Many of us have already voted. Many more will exercise the option tomorrow. Predictions call for a large turnout, large being defined, God help us, as perhaps a little more than half. I’m now in my eighth decade, and I cannot recall a more consequential election.

Many Americans (as well as some of my friends) are highly satisfied with the tax law changes, the rise in the stock market and the new makeup of the Supreme Court. In exchange for those they allow, without condemnation, the bullying behavior, the constant hyperbole, the ad hominem attacks and the non-stop lying.

It is time for the better angels of our nature to rise to the challenge. It is time to demand decency, and it is time to reject the abject vulgarity that oozes from the awesome edifice where John Adams, Thomas Jefferson and Abraham Lincoln once lived and guided the nation. It is time to raise up America to its true potential. It is time for America to become once again the world’s beacon of hope. Maybe tomorrow America will say, “It is time.” To quote John Milton, “Hope springs eternal.”

Perhaps it is fitting to end this non-insurance piece with the words John Adams wrote to his wife Abigail at the end of his first day residing in the yet-to-be-completed new White House in 1800. Franklin Roosevelt had the words engraved onto the mantel of the White House State Dining Room in 1945. Adams wrote, “May none but honest and wise men ever rule under this roof.” I wonder if the current occupant has ever seen those words.

Summertime reading: Fresh Health Wonk Review & news on our radar

Thursday, July 12th, 2018

Catch up with he latest news and thinking on health care policy issues – Peggy Salvatore has a fresh Health Wonk Review July 2018: Summer’s Coming Around Again edition posted at Health System Ed blog. Topics range from opioids and Purdue Pharma to high deductible plans and the cost of end-of-life care – grab a coffee and check it out!

A few other recent news items on our radar:

NCCI has issued a new a new Insights report on Post-Traumatic Stress Disorder in Workers Compensation. Several states are currently exploring the issue of PTSD injury compensation – it comes up frequently for police, firefighters and other first responders.
Speaking of trauma, if PTSD is on your radar, the New York Times reviews various books on how people recover from trauma, including one by Elizabeth Smart. See Adversity Needn’t Thwart or Define You. Here’s How to Cope.

Work comp drug costs have dropped by over a billion dollars over the last eight years, largely driven by sharply lower opioid utilization. Learn more about this in the 15th annual Survey of Prescription Drug Management in Workers’ Comp via Joe Paduda, CompPharma.

A new Lockton study says that nearly 70% of denied workers’ comp claims are converted and those claims can cost up to 50% more.

Top causes of high-dollar workers’ comp claims. Safety National recently completed a review of its largest workers’ comp claims and uncovered certain trends employers should be aware of.

WCRI Study Compares Hospital Outpatient Payments Across 35 States

Florida’ Supreme Court in Workers’ Compensation – David Langham

12 fast-rising technologies to get ready for

Trump’s trade war has started. Who’s been helped and who’s been hurt?

The U.S. labor shortage is reaching a critical point

Dispatches From the Front Lines of the Battle For Workplace Safety: Short Stuff – Jordan Barab

Cyber-Risk Costs Resist Overall Trend – Businesses’ total cost of risk declined in 2017, but cyber insurance rose 33%.

Cancer prevalence among flight attendants compared to the general population

Who Will Be Sued When A Robot Causes Harm?

Bezos, Buffett, Dimon Name Dr. Atul Gawande CEO of New Healthcare Company

One Man and a Hand Truck

Fentanyls and the Safety of First Responders: Science and Recommendations

It’s The Zip Code, Stupid! Update

Thursday, May 10th, 2018

At the end of February 2018, we wrote about a May 2017 study in JAMA Internal Medicine that concluded that where one lives is a bigger factor in health care outcomes than actual health care. This from our February post:

Geography is the biggest X-Factor in today’s American Hellzapoppin version of health care. The study analyzed every US county using data from deidentified death records from the National Center for Health Statistics (NCHS), and population counts from the US Census Bureau, NCHS, and the Human Mortality Databas and found striking differences in life expectancy. The gap between counties from lowest to highest life expectancy at birth was 20.1 years.

And, surpirse, surprise, it turns out if you live in a wealthy county with excellent access to high level health care, like Summit County, Colorado (life expectancy: 86.83), you’re likely to live about 15 years longer than if you live, say, in Humphries County, Mississippi, where life expectancy at birth is 71.9 years.  So, yes, Zip Code matters.

The concept of  zip code influence seems to be gaining traction. Today, from AIS Health Daily, we learn  a number of Blues Plans are planning on targeting the “where you live” problem with innovative strategies. Here is the AIS Daily release:

Blues Plans Work to Combat “ZIP Code Effect”
The Blue Cross and Blue Shield Association (BCBSA) recently launched the Blue Cross Blue Shield Institute, a subsidiary of BCBSA created to address social and environmental issues, as evidence mounts that health outcomes may be affected as much or more by social determinants of health as they are by actual medical care.
The Blue Cross Blue Shield Institute says it will address what it calls the “ZIP code effect,” which encompasses transportation, pharmacy, nutrition and fitness deserts in specific neighborhoods. It is partnering with Lyft, Inc., CVS Health Corp. and Walgreens Boots Alliance to address transportation and pharmacy deserts. The institute says it plans to deal with fitness and nutrition deserts in 2019.
Meanwhile, Highmark Inc. will launch a transportation initiative this summer to provide rides for members with chronic health conditions who live in a transportation desert. The service will begin in Pittsburgh as a pilot.
On April 17, Highmark’s Allegheny Health Network opened its Health Food Center, which acts as a “food pharmacy” where patients who lack access to food can receive nutritious food items, education on disease-specific diets and additional services for other social challenges they may face.
Other Blues plans also are addressing social determinants of health. For instance, Blue Cross and Blue Shield of North Carolina intends to invest part of its savings from the Tax Cuts and Jobs Act of 2017 into community health programs.
At Independence Blue Cross, the Independence Blue Cross Foundation’s Blue Safety Net Program offers “mobilized services” to medically underserved communities. The IBC Foundation sponsors the Philadelphia Eagles Youth Partnership’s Eagles Eye Mobile to conduct free vision screenings and eye exams and provide prescription glasses to under-insured and uninsured children.
We salute the Blues for recognizing the problem and trying to do something productive about it.
Final thought: If you do not subscribe to AIS Health Daily, you should.

A look back, a look ahead

Friday, January 12th, 2018

2017 work comp recap, 2018 ook ahead

We thought we’d get a drone’s eye view of the work comp landscape and related matters with a retrospective of the 2017 goings on and a look ahead at predictions and trends for 2018.

Work Comp Wire: Leaders Speak: 2017 Year in Review, Part One and Part Two

Business Insurance: Most read workers comp stories in 2017

Business Insurance: Court rulings challenge workers comp sector in 2017

Risk Management: Year in Risk 2017

Insurance Information Institute: Global insured catastrophe losses could reach record in 2017

Insurance Journal: Top Insurance Journal National Stories of 2017

Insurance Insights: 2017 Recap – A Look Back at the Insurance Market

Joe Paduda: How’d I do on my 2017 workers’ comp predictions?

Evil HR Lady: The 2017 Employment Law Year in Review

Fistful of Talent: Events From 2017 That Will Make a Lasting Impact in the Workplace

MedRisk: 2017 Industry Trends Report

Business Insurance: Most read Off Beat stories in 2017

Insurance Thought Leadership: Insurtech: The Year in Review

Insurance Journal: 2017 ‘One of Worst’ for U.S. Weather with 15 Events Costing $1 Billion or More

PropertyCasualty360: 6 ways cybersecurity changed in 2017

Gizmodo: The Great Data Breach Disasters of 2017

Gallup News: The Best Workplace Articles of 2017

Fortune: 34 Business Books You Won’t Be Able to Put Down

USA Today: Year in review: The 50 stories from 50 states that moved us in 2017

The Atlantic: 2017 in Photos: How the First Months Unfolded, Part 2 and Part 3

Google: Year in Search – 2017

A look ahead at what’s in the cards for 2018

Joe Paduda: Predictions for work comp 2018 part 1 and 2018 part 2

Willis Towers Watson: Marketplace Realities 2018: Workers compensation

Marsh: Webcast: Workers’ Compensation: Looking Ahead to 2018

Sedgwick identifies risk and benefits industry trends to watch in 2018 (PDF)

Sedgwick: Navigating 2018 (PDF)

Think Advisor: 5 Big Questions About Health Insurance for 2018

Bloomberg: Health Insurance Marketplaces for 2018

Claims Journal: Tips on Setting Claims Goals for 2018

Gallup News: Are You Ready to Respond to 2018’s Biggest Healthcare Trends?

Littler: Ready or Not, Here It Comes! 2018 Brings New Labor & Employment Laws, Primarily at the State Level

Forbes: 10 Workplace Trends You’ll See In 2018

CNN: Here’s where the minimum wage is going up in 2018

HR Daily Advisor: 2018 Trends to Watch: 6 Trends That Will Impact Employers

Forbes: 3 pitfalls to enterprise risk management in 2018

Insurance Though Leadership: 2018 Predictions on Cybersecurity

Fresh Health Wonk Review and a big roundup of recent work comp news

Thursday, November 30th, 2017

Andrew Sprung has the most recent compendium from the health wonks  at xpostfactoid:

Late Days of Empire Edition: Health Wonk Review. The wonks’ entries are reflecting the healthcare market chaos of the times – check it out! Also note that two weeks from today, we’ll be hosting the next edition here at Workers Comp Insider!

 

Other workers comp news of note along with general interest items that caught our attention:

Net neutrality & why you should care: If you are a blog afcianado – or if you just like a free an open internet, please make your voice heard about net neutraility. Don’t let the internet service providers do to the internet what cable companies did to TV – make your voice heard in favor of Net Neutrality which is at serious risk or being rescinded. See RIP net neutrality: FCC chair releases plan to deregulate ISPs. This requires immediate action: the vote is December 14. Make your voice heard.

Purdue Pharma: In this weeks’s HWR, Joe Paduda talks about how Purdue Pharma is trying to limit legal liability in the many state suits. Related, there was an excellent recent article in Esquire by Christopher Glazek that is well worth a read: The Secretive Family Making Billions From the Opioid Crisis.

Blankenship for Senate? Convicted coal baron Don Blankenship announced his intention to challenge Joe Manchin for a senate seat in West Virginia. We’re talking about Don Blankenship who was CEO of Massey Energy Co. at the time of a 2010 Upper Big Branch mine disaster that killed 29 miners. We have opinions on Blankenship that we’ve expressed over the years. Hint: thumbs down for the senate.

Grain Bin deaths: Over $1.8 Million in Proposed Fines Following Fatal Grain Dust Explosion – OSHA has proposed $1,837,861 in fines against Didion Milling Inc. following a May 2017 grain dust explosion that killed five workers and injured 12 others, including a 21-year-old employee who suffered a double leg amputation after being crushed by a railcar. We hope the fine will stick – see our prior post Walking down the grain – and the fines.

Gripping read: Atul Gawande’s twitter pointed us to a remarkable story in Emergency Physician’s Monthly: How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History. Hats off to the incredible medical teams!

Nail salons: US nail salons: the challenge to protect workers from toxic chemicals – Critics mock an EPA scheme to create ‘healthy salons’, but Julia Carrie Wong hears how it is tackling an ‘epidemic’ of health problems from staff, many of whom are Vietnamese immigrants.

Jennifer Christian posts Avoid “one-size-fits-all” thinking in evidence-based medicine, which challenges a blind spot in current thinking – worth a read. From our vantage, Dr. C is always in the forefront of new occ med thinking.

Bionic safety? medGadget has news that Ford is trialing the Exoskeleton to help prevent worker injuries. The device is made by Ekso, a company that devlops full-body exoskeletons for paralyzed people, but the firm thins the technology can prevent injuries in workers who perform physically difficult repeat tasks, such as operating the overhead machinery.

More news – quick links

The American Health Care Paradox: A Lot Of Money For Poor Results

Wednesday, November 29th, 2017

Here’s something all Americans can agree on: Health care costs way too much. But way too much in reference to what? Well, how about the rest of the developed world? How about wealthy countries, our peers, in the OECD, the Organization for Economic Cooperation and Development?

The OECD was formed in 1961. Headquartered in Paris with a membership of 35 nations, the OECD’s mission is to promote policies that will improve the economic and social well-being of people around the world. Annually, it performs comparative analyses of issues affecting its members. One such issue is health care.

Want to know about health care spending around the world, infant mortality, life expectancy, doctors and nurses per capita and a host of other health care topics? The OECD is the place to go.

Which brings us to American health care, which I suggest is a classic paradox. On the one hand, on a per capita basis, we spend 41% more on health care than our wealthy nation peers in the OECD and 81% more than the entire 35-nation OECD average.

OECD Health Care Funding – 2015

(Light blue – Private Funding; Dark blue – Public Funding)

As you can see, while our public funding (Medicare, Medicaid, etc) is comparable to many of the other 34 countries in the OECD, Germany, France and the UK for example, private funding in the US is more than 100% greater than Switzerland, our closest competitor, and 300% greater than the OECD average.

This might be fine if we got what we paid for, but that is not the case. As an example, consider something that should be important to us all: life expectancy. In the US, life expectancy at birth is 78.8 years (76.3 for men; 81.2 for women). In the UK, it’s 81 (79.2 for men; 82.8 for women). In Japan, life expectancy at birth is a whopping 83.9 (80.8 for men; 87.1 for women).

What about infant mortality, the number of deaths of children under one year of age, expressed per 1,000 live births? Our infant mortality rate of 6.1 is 45% higher than the UKs, at 4.2, and 265% higher than Japan’s 2.3 rate.

Curious about obesity? Our obesity and overweight rate is exceeded only by New Zealand’s.

And stop for a moment and consider cancer. Judging by the television ads, one would think the US has more cancer treatment centers than golf courses. Yet our death rate from cancer per 100,000 people is 188. Mexico’s is 115; Japan’s, 177.

In fact, just about the only metric in which we lead the world is smoking cessation. So, yes, it’s paradoxical. Sort of like a big-market baseball team spending gazillions more for players than any other team, only to finish out of the running.

And now, into the fray trots the Republican tax reform plan, which is looking more and more like it will actually become law. This plan would cause 13 million people to  find health insurance unaffordable, which means their new PCP will be their old PCP, the local emergency room where costs are stratospherically higher than anywhere else. In addition, $25 billion will be cut from Medicare, which, although it’s only 4% of the total Medicare budget of $588 billion, can’t be good as more and more baby boomers age into Medicare.

Fixing health care in America is going to take time and a lot more money, but we have to start somewhere, sometime. It’s hard to see where the Republican tax plan even approaches trying to do that.

Automation Designed To Keep People Safe Can Produce The Opposite Result Through No Fault Of Its Own

Monday, September 18th, 2017

A fascinating article in today’s Daily Alert from the Harvard Business Review describes how our dependence on automation can erode cognitive ability to respond to emergencies.

In “The Tragic Crash of Flight AF447 Shows the Unlikely but Catastrophic Consequences of Automation,” authors Nick Oliver, Thomas Calvard and Kristina Potocnik, professors and researchers at the University of Edinburgh Business School, report on their analysis of the horrific crash of Air France flight 447 in 2009. Their research, recently published in Organizational Science, describes in riveting detail the series of preventable cascading events that led to the deaths of all 228 passengers and crew.

Although the crash of AF447 is a transportation tragedy, it also can serve as a stark reminder that employees who depend on technology, especially technology that controls dangerous work, say self-driving 18-wheel trucks, for example, need a lot of training to take the right steps when technology reacts to emergencies. Without that training, the authors contend, the cognitive ability to take manual control and successfully deal with the emergency is problematic at best.

The authors provide an example:

Imagine having to do some moderately complex arithmetic. Most of us could do this in our heads if we had to, but because we typically rely on technology like calculators and spreadsheets to do this, it might take us a while to call up the relevant mental processes and do it on our own. What if you were asked, without warning, to do this under stressful and time-critical conditions? The risk of error would be considerable.

This was the challenge that the crew of AF447 faced. But they also had to deal with certain “automation surprises,” such as technology behaving in ways that they did not understand or expect.

The point here is the technology offering up the “automation surprises” was doing exactly what it was programmed to do. The technology did not fail; the pilots, all three of them, failed in their response to the “surprises.”

We are now at the beginning of a monumental shift in the way work (and play) is done. The natural gravitational movement of artificial intelligence assuming more and more control in our daily lives is unstoppable. Think of how it has brought tremendous improvements in air safety. To prove that, consider this astounding statistic: In 2016 the accident rate for major jets was just one major accident for every 2.56 million flights. But this bubble of safety can breed terrible complacency. How humanity deals with and prepares for the rude “automation surprises” that will surely come along on the way to the future should be a critical component in the thinking of organizational leaders and safety professionals.