Happy holiday Health Wonk Review

December 14th, 2017 by Julie Ferguson

Santa reading Health Wonk Review

First, let us go on record for saying that there is no sly political motive to our use of the term “holiday” in the title of this post. Admittedly, we have a bit of a liberal slant, but we have no aversion to using the phrase “Merry Christmas.” But ho, ho, ho, we do have an inordinate fondness for alliteration. Of course, we might have called it the Happy Hanukkah Health Wonk Review instead, but we wanted to encompass Hanukkah, Christmas, Kwanza, New Year’s, and even the dubious Festivus. Whatever your flavor or inclination, we wish you a merry, happy, joyful one. Pentatonix says it better than we ever could, so a bit of a seasonal interlude before we get to this week’s entries.

The Happy Holiday Health Wonk Review

*** First up, at Managed Care Matters, Joe Paduda is never one to shy away from calling it as he sees it and this week his submission takes on the GOP tax bill, which he describes as “a mess, riddled with math errors, contradictory language, and un-implementable directives.” Congressional leaders say they have reached some agreement and will vote before the end of the year, so Joe’s post will give context.

*** Roy Poses proves once again that the devil is in the details and he consistently makes it his blogging business to dig through the details to hold feet to the fire. At Heath Care Renewal, he tracks down more about a barely-reported Pfizer settlement for “alleged” anti-competitive behavior that nearly slipped through the radar. He says that the lack of negative consequences suggests that the impunity of top health care leaders is is worsening. Check out his post One Barely Noticed Settlement by Pfizer Suggests the Futility of Polite Protests about Health Policy.

*** How will the CVS purchase of Aetna affect the healthcare landscape? Jason Shafrin aka The Healthcare Economist weighs in with his informed observations.  And another of our regular wonks weighs in on the merger. David Williams of Health Business Blog posts CVS + Aetna. Are we sure this adds up? Despite talksthat this combo will lead to a revolution in care delivery, he remains a skeptic and talks about why.

*** Acknowledging that the individual market for health insurance has become unaffordable for many of the unsubsidized — particularly older would-be enrollees — Andrew Sprung outlines various ways to keep Modified Adjusted Gross Income (MAGI) below the subsidy line. Check out his post Steering clear of the subsidy cliff in the ACA marketplace at xpostfactoid.

***  Vincent Grippi of CareCentrix submitted a fun #CareTalk video podcast, featuring HWR regular David Williams teaming with John Driscoll of CareCentrix. In a point-counterpoint format, they spar about the implications of 2017 elections on healthcare (think Maine), move on to value-based healthcare and they close the 10 minute segment with a lightning round.

*** Brad Flansbaum of The Hospital Leader has an interesting post about Locums vs F/T Hospitalists, posing the question, do temps stack up? He reports on a JAMA study, adding his perspective. Now I must confess that the term “locums” was a new to me, but Brad gives it good context. But if you are curious to the origins, as I was, Wikipedia is your friend.

*** In his post The Positive Side of Sharing, InsureBlog’s Henry Stern has the latest on a reader’s experience with a Health Care Sharing Ministry. (He offers this spoiler alert: it’s actually been pretty good).

*** Shopping for individual health insurance or know someone who is? If your state uses HealthCare.gov, you have until December 15 to enroll, but in other states, you may be able to enroll as late as January 31. Victims of Hurricanes Irma and Harvey may also have extensions. Louise Norris has all the details in her  guide to buying individual health insurance at healthinsurance.org. For more, see Timothy Jost’s post on Health Affairs Blog: Open Enrollment Ends Friday—Except For Those Qualifying For Special Enrollment Periods.

*** For our post, we’re delving into our archives for an expose of a mysterious employer. Many have nothing but good to say about him, but others think he is not a good employer. Judge for yourself:

Santa’s workshop: “OSHA problems galore” say whistleblowers
The risks of being Santa
Is Santa Claus a bad employer?

 

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

November 30th, 2017 by Julie Ferguson

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

November 29th, 2017 by Tom Lynch

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.

Health Wonk Review and a tribute to our veterans

November 10th, 2017 by Julie Ferguson

At Healthcare Economist, Jason Shafrin has posted the latest compendium of posts from the health policy bloggers: Health Wonk Review: Quote-of-the-day Edition. He frames each submission with a pithy quote. While the overall shape and politics of the healthcare debate are still a primary theme of posts, there are other entries, including two videos. Grab a coffee and catch up on the latest thinking from the wonks.

This weekend, we pay tribute to our veterans and thank them for their service and sacrifice. We end with this advice: How to honor veterans: Hire one!

Job Loss, Wage Stagnation, Low Productivity: We’re Great Again!

October 30th, 2017 by Tom Lynch

A couple of years ago, as he finished his Gatling Gun presentation to conclude the Workers’ Compensation Research Institute’s annual conference in Boston, I asked the big-brained, really smart Bob Hartwig if he was alarmed at all that in the last 40 years inflation-adjusted hourly wages had risen only 4%. His answer: “Yes. Very.”

Since then, regardless of the playground-like antics in our nation’s capital, or maybe because of them, not much has changed. So, in this post I want to discuss some of the factors and trends that have contributed  to this economic wage crisis and suggest it played a powerful role in the rise of Donald Trump who, with rhetoric as sharp as the edge of an axe, seized on the frustration and outrage within the lower wage working classes whose nearly biblical devotion led to his election.

That it is a crisis has been borne out over time by a mountain of complex research that cannot be explained in a tweet. The latest brick in this ugly house was laid last week with the release of a study from The Hamilton Project at the Brookings Institution.

In The Hamilton Project at Brookings report, Jay Shambaugh, Ryan Nunn, Patrick Liu and Greg Nantz offer Thirteen Facts About Wage Growth with solid research buttressing each fact. The point of the paper is to explain why wages for production and non-supervisory workers have been stagnant for so long.

In order to explain the why, they first had to prove the point. To do that they divided the period since 1981 into four business cycles: 1981-90, 1990-2001, 2001-07 and 2007-17. They found that in the first three of those business cycles nominal wage growth (wage growth without any adjustment for inflation) averaged just a bit above 3%. In the last cycle, which started at the beginning of the Great Recession, growth has been 2.34%.

However, when one considers real wage growth (growth adjusted for inflation) each business cycle saw wages increase significantly less than 1%. Despite this 36-year run of bottom-of-the-bird-cage wage growth, according to the Bureau of Labor Statistics’s Inflation Calculator, what you bought for $1.00 36 years ago in 1981, the first year of this study, cost you $2.84 in September of 2017. This puts American workers in the position of trying to outswim a Navy Destroyer. Every moment they fall farther and farther behind.

The authors point out that our long-term wage stagnation can be traced to many trends, including the decline in US workers’ share of income.

The portion of national income received by workers fell from 64.5 percent in 1974 Q3 to 56.8 percent in 2017 Q2. Over the past few years the U.S. labor share has ceased falling, but this might reflect the ongoing economic recovery rather than any change in the long-run downward trend.

A number of factors have played a role in the fall in Labor’s share of income, including, but not limited to:

  • The long-term and continuing offshoring of labor intensive production;
  • The decline in union membership;
  • The decline in the real minimum wage;
  • The growth of non-compete contracts for even low-skilled workers;
  • The growth in income inequality between the top and bottom earners;
  • The continuing increase in the “education wage premium.”

To elaborate on a few of these factors:

Union Membership:  In 1956 about 28 percent of all workers belonged to a union; in 2016 that number was a little more than 10 percent. In the private sector, union membership has dropped to 5%. Regardless of what you think of unions, the fall in union membership directly correlates to an increase in wage inequality.

The Real Minimum Wage:  The Project Hamilton Report demonstrates how insidiously the federal minimum wage has limited wage growth among low wage earners. Since 1968 the real minimum wage (minimum wage adjusted for inflation) has fallen more than 20%.

Right now state minimum wages range from a low in Georgia of $5.50 to a high in the District of Columbia of $12.50. A number of states have passed legislation to gradually increase their minimum wage  over the next few years. Others have indexed theirs to the CPI. Regardless of what the states do, their minimum wage cannot be lower than the the federal minimum wage of $7.25 for any worker covered by the National Fair Labor Standards Act. If a worker in Georgia isn’t covered by the Act, however, $5.50 reigns.

The Education Premium:  The wage benefit of a college degree increased dramatically during the last two decades of the 20th century, leveling off around 2000 at an historically high level.

Bachelor’s degree holders ages 25 to 54 in 1979 could expect to earn 134 percent of the wages received by those with only a high school education, and advanced degree holders could expect to earn 154 percent. By 2016 the wage premiums for a bachelor’s degree and an advanced degree had risen to 168 and 213 percent, respectively.

Another way to look at the wage value of higher education is this: Although only 40% of the nation’s workers hold four-year college degrees (23% in 1979), in the top two earnings quintiles college graduates make up a clear majority, 78% in the top quintile. Only 15% of the bottom quintile are college graduates.

One last point about the Education Premium: In its most recent survey of college pricing, the College Board reports that a “moderate” college budget for an in-state public college for the 2016–2017 academic year averaged $24,610 (tuition, board and fees). It’s true that financial aid is available to most students. However, with the income of today’s low-wage earners falling farther and farther behind workers sitting serenely much higher on the economic pyramid, how do you think they’re going to manage to send their children off on a quest for a four year college degree, even at an in-state public college? This is a self-perpetuating educational death spiral.

Maybe you’re asking what this has to do with workers’ compensation?

Well, if US workers on the bottom half of the income scale have seen their wages lag behind the CPI for four decades, they are right now hard pressed to contribute to the country’s economic growth and viability. Moreover, when one of them suffers a lost-time injury at work, that worker will suddenly see his or her take home pay reduced because of state workers’ compensation laws, which will make it even harder to support a family. Research shows this, among other things, contributes to underreporting of workplace injuries.

For more information on this issue, see Bureau of Labor Statistics data and a recent New York Times economic report by Ben Casselman.

I have a hard time believing decades-long negligible wage growth, especially for those on the lower end of the income scale, can be anything but harmful for America, its economy and the quality of life of its workers. I suggest this is a significant cause of the frustration and outrage that led to the rise of the Tea Party and Freedom Caucus. Donald Trump saw this frustration, this outrage, as a mammoth opportunity and continues to feed it like red meat to a hungry lion. That type of divisive behavior can be nothing but destructive. But until our elected officials grow enough spine to do something meaningfully constructive and productive about it, I fear this situation will continue to divide and erode us as a nation.

That is terribly sad to contemplate.

 

 

 

Fresh Health Wonk Review, Disaster Edition

October 26th, 2017 by Julie Ferguson

Check out the latest Health Wonk Review: Disaster edition freshly posted by David Williams at Health Business Blog. David is a long-time HWR host and his business blog is a strong and authoritative voice in the health business sector – if he isn’t on your regular reading list, you should change that!

Just a few other quick updates:

A quick shout-out to esteemed colleague Joe Paduda of Managed Care Matters who is running for office in his home area of Onondoga County, New York. November 7 is pretty quick upon us. You can find out more at Paduda for Progress – if you are on Facebook, you can show him some love there ;-)

Because we’ve written about him quite a bit in the past, we didn’t want to miss this update on Don Blankenship of the Massey Coal Mining disaster infamy:  Supreme Court lets criminal conviction stand against coal executive Blankenship

Another issue we’ve posted about previously is the death of cell tower workers. We were interested to see that Washington state recently adopted tower safety worker rules – the third state in the nation to do so.

“North Carolina and Michigan also have telecommunication safety rules, but federal OSHA does not have comparable, specific regulations relating to communication tower work, according to L&I. “We hope our rules can serve as a model for other states to quickly stop these fully preventable worker fatalities,” Soiza said.”

 

California fires: Response and recovery health hazards

October 25th, 2017 by Julie Ferguson
A firefighter working in the California fires

Photo: Mike Blake / Reuters

In the wake of the devastating California fires, the massive debris field – formerly neighborhoods, homes and businesses – is now a toxic environmental brew that poses risks to cleanup and recovery workers and residents alike. Kirk Johnson discusses the environmental and health risks of the California fire cleanup in an article in the New York Times.

“In modern times this has got be an unprecedented event, and a major hazard for the public and for property owners,” said Dr. Alan Lockwood, a retired neurologist who has written widely about public health. He said an apt comparison might be the environmental cleanup after the terrorist attacks of Sept. 11, 2001, in New York, as debris and dust swirled through Lower Manhattan.

As could well happen too in California, Dr. Lockwood said, the health and environmental effects were felt long after the attack, in the chemicals or pollutants workers and responders at the site, and the public at large, may been exposed to as the cleanup went on.

The scope of the fire disaster in California is hard to comprehend:  Photos Capture Apocalyptic Aftermath Of California Wildfires. Also: and the Los Angeles Times Mapping the destruction from California’s wine country fires.

We’d be remiss if we didn’t offer a tribute to the 9,000+ hard-working firefighters on the front lines who risked life and limb to contain the fires, rescue people and save property. See NPR’s story by Eric Westervelt: In Northern California, Exhausted Firefighters Push Themselves ‘To The Limits’.

See the Atlantic‘s In Focus for a display of photos that document the danger and the destruction.

One interesting and little known aspect of the battle against the fires is that 30-40% of the firefighters battling the fires were prisoners, according to Mother Jones. About 4,000 low-risk prisoners save the state about $80 million a year. Inmates are volunteers who are trained in a four-week program, receive $2 an hour and earn a 2-day sentence reduction for every day served. Typically, they are low-risk felons.

“Career firefighters do things like flying in helicopters and driving bulldozers; inmate firefighters use hand tools, like chainsaws, axes, and rakes, to contain the fire by clearing out the vegetation around it. The prisoners participate in a four-week training process—the same process that other state firefighters go through—proving that they’re fit enough to work through brush in the heat of a fire while carrying up to 100 pounds of gear. They work in teams of about 15 people, supervised by a fire captain. When there’s a big fire blazing, the teams work in shifts of 24 hours, followed by a 24-hour break. When not tending fires, the inmates do other conservation work, often clearing brush to prevent future fires.”

Jaime Lowe of the New York Times reports on The Incarcerated Women Who Fight California’s wildfires. It talks more about how the program works and takes an up-close look at some of the female inmates on the front lines, including the very real risks they take. While many tout this as a win-win for both the state and the inmates, there are many limitations in terms of the rehabilitative value. Lowe says:

“C.D.C.R. says that the firefighter program is intended to serve as rehabilitation for the inmates. Yet they’re being trained to work in a field they will probably have trouble finding a job in when they get out: Los Angeles County Fire won’t hire felons and C.D.C.R. doesn’t offer any formal help to inmates who want firefighting jobs when they’re released.”

Further in the article, Lowe talks more about this:

When I visited Rainbow, I asked a Cal Fire captain named Danny Ramirez why the state wouldn’t increase the incentive to join the program by paying even a little bit more. He didn’t have a ready answer. Which brought up another puzzling aspect of the program: Why doesn’t the state get more out of its investment in training these women by hiring them when they’re released? Or at the very least, by creating a pathway to employment? Ramirez said the idea ‘‘to keep tags on the girls’’ had come up before. ‘‘Some of these girls leave very interested in what they got exposed to and say, ‘Oh I never knew this exists, how do I keep on doing this?’ And it’s hard when they get out there because they do have a lot of the same walls that they were facing before. But a program to keep them guided and keep them on that path and keep them focused on something instead of getting back into their old ways or old friends would be awesome.’’

 

Health Wonk Review’s “Pink Edition”

October 12th, 2017 by Tom Lynch

InsureBlog’s Hank Stern has posted the latest edition, the “Pink Edition,” of Health Wonk Review.

Why the “Pink Edition?” Because October is National Breast Cancer Awareness Month, and Hank and his team, Love, Hope and Faith, are doing their best to raise money to help eradicate this terrible disease. They’re participating in a walk to do just that on October 21, and Hank would love some help from the HWR community. Something to think about.

So, after making a donation to Hank’s worthwhile cause, we hope you’ll grab a cup of whatever suits you best, put your feet up and once again revel in all things health wonkery.

Workers’ Comp as Percentage of Payroll: NASI Report

October 10th, 2017 by Julie Ferguson

The National Academy of Social Insurance (NASI) recently issued its 20th annual report on Workers’ Compensation: Benefits, Coverage, and Costs. The study provides estimates of workers’ compensation payments—cash and medical—for all 50 states, the District of Columbia, and federal programs providing workers’ compensation.

The study showed that

  • Benefits per $100 of payroll fell from $0.92 in 2014 to $0.86 in 2015, the lowest level since 1980.
  • Workers’ compensation employer costs per $100 of payroll dropped to 1.32 in 2015, reversing consistent growth that began after the recession.
  • In 2015, workers’ compensation coverage extended to an estimated 86.3 percent of all jobs in the employed workforce, comprising more than 135 million workers.

Study authors say the drop partly reflects improved workplace safety. Also noteworthy:

“Both the incidence and severity of work-related injuries have declined steadily since 1990. In fact, according to the Department of Labor, the proportion of workers who experienced injuries that resulted in days away from work reached a 25-year low in 2015.”

The study encompasses state-by-state changes in coverage, benefits, and employer costs over the last five years. The state-level results show that between 2011 and 2015:

  • The number of covered workers increased in every state except West Virginia, with 11 states experiencing double-digit growth in covered employment;
  • The amount of covered wages increased in every state, and by more than 20 percent in 16 states;
  • Benefits per $100 of payroll decreased in all but three states, with the biggest declines in Illinois (-$0.33), Oklahoma (-$0.41), and West Virginia (-$0.52)—three states that implemented significant changes in their workers’ compensation systems during this period;
  • Employer costs per $100 of covered payroll increased in 24 states and decreased in 27 states. West Virginia, Montana, and Oklahoma experienced the largest reductions, with costs dropping more than $0.30 per $100 of covered payroll. Employer costs increased by more than $0.20 in Wyoming, Delaware, and California.

NASI workers comp infographic

News Roundup: Health Wonk Review and noteworthy news from around the web

September 28th, 2017 by Julie Ferguson

A fresh Health Wonk Review is hot off the press and the word for the day is “fatigue.” The 3rd congressional attempt at Affordable Care Act repeal ground to a halt last week after it became apparent that there weren’t enough votes in the the Senate to get it over the finish line. Brad Wright hosts this week’s Health Wonk Review: Repeal Fatigue Edition at Wright on Health, with wonks weighing in. But if you don’t want to read about ACA, never fear – the wonks weigh in on other health policy issues, too.

Here’s some other recent news that caught our eye:

NCCI: The Marijuana Conversation: What’s Next – Medical marijuana is currently legal in 29 states, as well as Washington, DC. It’s also legal for recreational use in eight states and Washington, DC. However, marijuana is still illegal at the federal level and is classified as a Schedule I drug under the federal Controlled Substances Act. NCCI’s “Marijuana Conversations” series explores questions from workers compensation insurers, employers, employees, regulators, and legislators. Each face unique challenges, complexities, and implications.

MSHA – David Zatezalo, Trump’s nominee for assistant labor secretary in charge of the U.S. Mine Safety and Health Administration, is a former coal exec whose mines logged a “pattern of violations.” It raises more than a few uneasy hen-guarding-the-chicken-coop questions about his appointment. His latest critic? Manchin will oppose Trump mine safety nominee, as per Ken Ward Jr. at the Charleston Gazette-Mail.

Dairy Workers: Suffocating in Manure – Jordon Barab of Confined Space talks about a recent Washington Post story on a truly horrific agricultural hazard, and just one of many. “There were 6,700 injuries on dairy farms with more than 11 employees in 2015 — a rate more than double the average for private industries. On those farms, 43 laborers died.” Barab notes that the article fails to mention that, “due to a 40 year old Congressional budget rider, OSHA is not allowed to set foot on farms that have ten or fewer employees. No inspections, even as a result of a worker complaint, and no investigation or citations, even if one or more workers is killed.”

Joe Paduda reports on a recent study by Princeton University’s Alan Krueger in his post at Managed Care Matters: Opioids responsible for a fifth of the decline in male workforce

Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive PainkillersNew York Time/Pro Publica

At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.

The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.

Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis.

Defending Against Cumulative Trauma – Roberto Ceniceros says that “Repetitive motion, or cumulative trauma injuries, stubbornly persist as generators of workers’ compensation claims and productivity losses year after year.” But remedies do exist – and he explores these in his article in Risk & Insurance.

Job loss due to medical care calendar vs. FMLA calendar – Dr. Jennifer Christian reminds physicians that they need to keep an eye in the calendar during worker recover, particularly in light of a recent court case.

Gig Economy Workers May See Benefits Relief – The Portable Benefits for Gig Economy Workers Act addresses a real need at a time when many people work in the gig economy and don’t have employer-provided benefits.

Quick takes