Posts Tagged ‘reports’

COVID-19 Analysis from Jennifer Christian, M.D., M.P.H.

Monday, September 21st, 2020

I have written before of my great admiration for Dr. Jennifer Christian and for her Work Fitness and Disability Roundtable (WFDRoundtable@groups.io). The Roundtable is a mainstay for clinicians and other health care professionals.

I thought this morning’s Roundtable post by Jennifer to be particularly thoughtful and thought-provoking, so I asked her if she would allow us to republish the post in its entirety here at the Insider. She very kindly gave permission.

I think Jennifer is one of those brilliant three or four folks I’m lucky enough to know who think around corners. Her mind makes intuitive leaps where others (like mine) plod along.

Here is Jennifer’s post:

How many people have some pre-existing immunity to COVID-19

There is growing uncertainty about what this fall and winter is going to look like with regard to the COVID-19 pandemic.  Are we going to have a second, and possibly even bigger wave of worldwide infections — or is the biggest part of this pandemic over and done with once each geographic area has had its first wave?

A new review from the British Medical Journal says researchers may have been paying too much attention to antibodies and too little attention to a second part of the human immune system that protects against and reacts to infections:  T cells.   More on this in a moment…..

But first, a reminder.  We are in the middle of the first large-scale pandemic with a new and highly contagious respiratory pathogen since the field of immunology was born!   Immunology is still quite young compared to other specialty areas in biological science and medicine.  It was only in the mid-20th century that advances in cell biology started making it possible to study the detailed processes that make up the immune response in detail.  That has led to much deeper understanding of the mechanisms by which vaccines work, to the development of the first cancer chemotherapy agents that selectively killed rapidly-proliferating immune cells, and to the development of immune-modulating drugs, which enable the transplantation of organs by muting the body’s natural rejection of foreign tissues.

The appearance of HIV/AIDS in the 1980’s again precipitated huge leaps in funding for research to increase our understanding of the immune system, which in turn highlighted the function of T cells and other previously unrecognized aspects of it.   However, in comparison to other bodily systems and organs, our knowledge of the human immune system is still primitive — it’s obvious there is much left to learn — and some of what we don’t know may seem very basic!

If you’re an immunologist, virologist, epidemiologist — or a public health officer trying to figure out how to protect and guide your local population — this is the overwhelming challenge of a lifetime.  Personally, I hope that the media and the general public will remember that this pandemic has attacked our society at the very edge of what is known.  All of those professionals are working at a feverish pace to observe carefully, assemble enough data to be confident they have enough to detect a real pattern if it’s actually there, make sense of what they are seeing, and then figure out the implications for action.  Let’s agree to be forgiving of the fact that “the facts” have not all been revealed to us yet, and “the scientists” simply don’t yet know everything we wish they did.

Back to the T cell story.   Researchers have shown that people with the most severe cases of COVID-19 (the ones in ICU and who are most likely to die) often have low T cell levels.  But some other puzzling data has appeared. For example:

  • some countries — and especially some areas within those countries that had bad initial outbreaks — have not seen widespread new infections despite having relaxed protective restrictions; and,
  • blood tests in a noticeable fraction of people with no record of exposure to SARS-CoV-2 virus show some of the T cells reacting weakly to it anyway — indicating a potentially partial immune response.

This has led scientists to start wondering whether we really know enough about the human immune system’s ability to develop partial T cell “cross-reactivity” to families of closely-related viruses and whether that might predictably and reliably reduce the severity of illness or even reduce the likelihood of getting ill at all when a new-but-related virus appears.   And, that, of course, raises some possibilities that need to be investigated:

  1. Does cross-reactivity explain why some geographic areas that had first pandemic peaks are not seeing second ones — because the people who got sick had no immunity and were more susceptible, and most of the remaining ones have some limited immunity which is protecting them?
  2. Does cross-reactivity explain some of the disparity between people who get deathly sick from COVID-19 and people who are exposed to the virus but never get infected, or, if they do, remain asymptomatic or have only mild illness?  Note that there are two  possibilities:  Cross-reactivity could be making the illness worse or it might be making it less severe — we don’t know yet.
  3. How could cross-reactivity be protective if it develops after prior exposure to coronaviruses, because children are the least likely to get a severe case of the disease and adults are the most susceptible to severe COVID-19 illness and death?  (Children have not had a lifetime of colds, and thus less opportunity to be exposed to coronavirus and develop partial-immunity to SARS-CoV-2)

In short, my best advice as of 21 September 2020 is:

  1. Stay tuned for further developments in the factual realm – both changes in case counts and new research results;
  2. Hope for the best but prepare for the worst as autumn approaches and we all retreat indoors.

Sisyphus Must Have Felt Like This

Wednesday, September 16th, 2020

The COVID-19 boulder, full of facts, lies, information, misinformation, disinformation, and just plain delusional thinking keeps rolling back down the mountain. Try as we might, it’s certainly difficult to make sense of COVID-19. But we keep trying, anyway. As in:

Unions during COVID-19

I have written previously about the perplexing case of union participation in America. In 1960, about a third of hourly workers belonged to unions. In January of this year, the BLS reported that number had dropped to 10.3%. Yet, in the same press release, the BLS reports:

Nonunion workers had median weekly earnings that were 81 percent of earnings for workers who were union members ($892 versus $1,095).

Right now we won’t get into why this puzzling paradox exists, except to say we now have another log to throw on the pyre.

A new study authored by researchers at George Washington University, the University of Pennsylvania Perelman School of Medicine and the Boston University School of Medicine, published in Health Affairs, found that having a unionized workforce at a nursing home greatly reduces the likelihood that residents or staff will die from COVID-19. From the study’s Abstract:

Health care worker unions were associated with a 1.29 percentage point mortality reduction, which represents a 30% relative decrease in the COVID-19 mortality rate compared to facilities without health care worker unions.

The study analyzed data from more than 300 nursing homes in New York from March 1 through May 31. The authors conclude the unionized health care workers in the nursing homes were able to negotiate for more PPE, higher pay, and better working conditions.

During the pandemic, New York has suffered nearly 7,000 nursing home deaths, more than any other state except New Jersey.

My take on this? If you have loved ones who may be headed for a nursing home, it might be a good idea to ask if the staff is unionized.

Avoiding medical care during COVID-19

Since early in COVID-19, we’ve known that many people, fearful of the disease, have put off getting routine, or, in some cases, emergency medical care. What we have not known is what demographic groups are doing that and to what degree. Now, the CDC has put a full stop period to that issue.

In its 11 September weekly Morbidity and Mortality Report, the CDC published a comprehensive analysis concluding 40.9% of U.S. adults delayed or avoided medical care as of June 30. This includes urgent or emergency care (12%) and routine care (32%). Regarding what population segments are doing this, the study had this to say:

The estimated prevalence of urgent or emergency care avoidance was significantly higher among the following groups: unpaid caregivers for adults versus non-caregivers (adjusted prevalence ratio [aPR] = 2.9); persons with two or more selected underlying medical conditions† versus those without those conditions (aPR = 1.9); persons with health insurance versus those without health insurance (aPR = 1.8); non-Hispanic Black (Black) adults (aPR = 1.6) and Hispanic or Latino (Hispanic) adults (aPR = 1.5) versus non-Hispanic White (White) adults; young adults aged 18–24 years versus adults aged 25–44 years (aPR = 1.5); and persons with disabilities§ versus those without disabilities (aPR = 1.3).*

So, Mary, taking care of her aged mother at home, foregoes either emergency or routine care at nearly three times the rate of Sarah, her next door neighbor who is not burdened with an aged relative, because she doesn’t want to bring COVID-19 home to Mom. Even more troubling is that people with two or more co-morbidities forego care at nearly two times the rate of people without such underlying conditions.

The CDC’s paper advises that, “… urgent efforts are warranted to ensure delivery of services that, if deferred, could result in patient harm.”

Enough said.

*By way of example for the statistically challenged, an adjusted prevalence ratio of 2 means that the prevalence of cases among a study group is 2 times higher than among the control subjects. It’s calculated through a series of regression analyses. There. Now you know.

U. S. life expectancy

COVID-19 has sucked all the air out of any national attempt at healthcare reform, while revealing in sharp detail the foundational flaws in the current system. Eventually, however, America is going to have to confront this issue in a meaningful manner. Healthcare cost in America is still twice the average of all 37 member countries of the Organization for Economic Cooperation and Development (OECD), and Americans still have poorer health and lower life expectancy than the average of the member countries (78.7 versus 79.5)

In its latest Health At A Glance publication, the OECD updated its life expectancy data, as shown here:

There are many cracks in our healthcare house that Jack built. Ignoring them is not a strategically viable plan for improvement, improvement that all citizens deserve.

To quote the venerable A. E. Housman, “Terrence, this is stupid stuff.” Another example of our woebegone healthcare system.

Trump’s Nevada rally

Last night, during an ABC-TV Town Hall Meeting President Trump once again pilloried cities and states run by Democrats and blamed their leaders for any problems with the response to COVID-19.

A little contextual background is required here. On 14 April, Trump asserted “absolute authority” to control the nation’s response to the pandemic, saying, “When somebody is president of the United States, your authority is total.” He made it clear he would be in charge and the states would have to fall in line.

Two days later, he reversed himself on a call with all the governors, telling them, “I’ve gotten to know almost all of you, most of you I’ve known and some very well. You are all very capable people, I think in all cases, very capable people. And you’re going to be calling your shots.”

Since then, he has repeatedly repeated the “You’re on your own” line. The result, of course, has been that we have seen 51 different plans and approaches  with varying degrees of success.

Nevada, one of the “you’re on your own” states, is still in the midst of a tough fight against the disease with a Daily Positivity Rate of 7.1% and a Cumulative Positivity Rate of 10.2% as of 10 September.

On 24 June, Nevada Governor Steve Sisolak imposed certain restrictions, among them the requirements that all Nevada residents wear masks when in public and that no more than 50 people, socially distanced, congregate in one place.

Enter Donald Trump and his the-sky-is-the-limit indoor rally of last Sunday evening at Xtreme Manufacturing in Henderson, Nevada. Fire officials estimated the size of the crowd was 5,600 people, nearly all of whom were maskless (except for the people right behind Trump who were constantly on full TV view).

Just as we saw in Tulsa after his previous rally, we’ll probably see a spike in cases in Nevada in two to three weeks.

Beyond the nonchalant and willful endangerment to peoples’ lives, what bothers me most of all about this event is Donald Trump’s cavalier and metaphorical raising high of his two middle fingers to Nevada’s scientifically-based efforts to keep its citizens alive. After repeatedly telling the nation’s governors they should do what they think they need to do to combat COVID-19, this “law and order” president, without compunction of any kind, imperiously violates the law while telling his large crowd Nevada’s Governor Sisolak is “a hack” and “weak.”

Allow me to close with Joseph Welsh’s question to Senator Joe McCarthy on 9 June 1954: “Have you no decency, sir?”

 

A Puzzlement Before The WCRI’s Annual Conference

Tuesday, March 3rd, 2020

Thoughts and questions before heading to the Workers’ Compensation Research Institute’s (WCRI) annual conference this week in Boston.

Despite the erstwhile efforts of certain folks to put a big lid on scientific data and bury it all deep in the ground, the U.S. Bureau of Labor Statistics (BLS) continues to publish interesting and compellingly thought-provoking work. Take the paradox of union membership and earnings, for example.

Beginning of the paradox: Non-union wage and salary workers earn only 81% of what union members earn. Union workers in 2019 earned an average of $1,095 per week, as opposed to $892 for non-union workers, a difference of $203 per week, which, if you’re doing the math, is $10,556 per year.

The difference in earnings for men and women is stark: Men in unions earn an average of $1,147 per week, which contrasts with non-union earnings of $986. The difference here is $161 per week, or $8,372 per year. Unionized women, on the other hand, earn less than the men, but way more than non-unionized women: $1,018 versus $792, a difference of $226 per week, or $11,752 per year.

Clearly, union members earn significantly more than non-union workers.

So, will somebody tell me why union membership has been declining for decades? Every year, God bless ’em, the brainiacs at the BLS tell us by just how much, which is the second part of the paradox.  In January, 2020, BLS published data for 2019, which showed the union membership rate for wage and salary workers to be 10.3%, down 0.2% from 2018. Of course, our workforce is made up of both private and public sector workers, and here the public sector saves the day. The union membership rate of public-sector workers, at 33.6% is more than five times higher than the 6.2% rate for private-sector workers.

Some say the reason for declining union membership is the hefty annual dues union members have to pay. Well, the most any worker will pay in dues to the International Brotherhood of Electrical Workers for 2020 is $492; for the United Auto Workers, it’s $843.84. It doesn’t seem as if sky-high dues can be the answer.

I don’t know whether WCRI, or anyone else for that matter, has studied whether there is a statistically significant difference in workers’ compensation injuries and costs between union and non-union wage and salary workers. Might be interesting to find out whether the 10.3%, in addition to earning more, has better workers’ compensation performance

Hope to see you in Boston

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

Monday, January 21st, 2019

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

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

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

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

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

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

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

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

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

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

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

At The Bottom Looking Up

Tuesday, November 13th, 2018

What does a nation owe its citizens with respect to health care?

For nearly all members of the Organization for Economic and Cooperative Development (OECD), the answer is guaranteed, high-quality, universal care at reasonable, affordable cost. For OECD founding member America, the answer seems to have become an opportunity to access care, which may or may not be of high-quality at indeterminate, wildly fluctuating and geographically varying cost.

It is indisputable that the US devotes more of its GDP to health care than other countries. How much more? For that answer we can turn to many sources, roughly all saying the same thing. The OECD produces annual date, as does the World Health Organization, among others. Another reliable and respected source is The Commonwealth Fund, which conducted a study of eleven high income OECD members including the US. The collection of health care cost data lags, so data from this study is mostly from 2014. Here is the cost picture:

As you can see, in 1980, US spending was not much different from the other ten OECD countries in the study. While high, it was at least in the same universe. But now, at 50% more than Switzerland, our closest competitor in the “how much can we spend” sweepstakes”, we might be forgiven for asking, “What in the name of Hippocrates happened?” As if this weren’t enough, the 2014 GDP percentage of spend, 16.6%, has now risen to nearly 18%, according to the CMS.

So, what do we get for all that money? We ought to have the highest life expectancy, the lowest infant mortality rate and the best health care outcomes in the entire OECD. But we don’t.

For many readers, it is probably galling to see both the UK and Australia at the top of the health care system performance measure and at the bottom of the spending measure. In the early 2000s, each of these countries poured a significant amount of money into improving its performance, and the results speak for themselves.

Consider all of this mere background to the purpose of this blog post.

Last week, we wrote about the terrible, 40-year stagnation of real wage growth in the US, pointing out that in that period real wages in 1982-1984 constant dollars have risen only 4.5%. But, as we have seen, health care spending did not follow that trajectory. This has resulted in tremendous hardship for families as they have tried to keep pace with rising health care costs. For, just as US health care spending has risen dramatically since 1980, so has what families have to pay for it.

To put this in perspective, consider this. Since 1999 the US CPI has risen 54%, but, as the chart above shows, the cost of an employer offered family plan has risen 338%. If a family’s health care plan’s cost growth had been inflation-based, the total cost to employer and employee would be $8,898 in 2018, not $19,616. In 2018, the average family in an employer-based plan pays 30% of the plan’s cost ($6,850), plus a $2,000 deductible, plus co-pays that average $20 whenever health care is accessed, plus varying levels of co-pays for drugs.

On top of all that is the enormous difficulty people have in trying to navigate the dizzying health care system (if you can call it that). American health care is a dense forest of bewildering complexity, a many-headed Hydra that would make Hesiod proud, a labyrinthine geography in which even Theseus with his ball of string would find himself lost.

With wages and health care costs growing ever farther apart, America has a crisis of epic proportion. Yet all we can seem to do is shout at each other about it. When do you think that will end? When will we begin to answer the question that this post began with: What does a nation owe its citizens with respect to health care? When will our nation’s leaders realize we can actually learn from countries like Australia, the UK, Switzerland and all the other high performing, low cost members of the OECD? Continuing on the present course is no longer a viable option.

 

Note: You may be questioning The Commonwealth Fund’s research. To put your mind at ease about that, here are the study sources:

Our data come from a variety of sources. One is comparative survey research. Since 1998, The Commonwealth Fund, in collaboration with international partners, has supported surveys of patients and primary care physicians in advanced countries, collecting information for a standardized set of metrics on health system performance. Other comparative data are drawn from the most recent reports of the Organization for Economic Cooperation and Development (OECD), the European Observatory on Health Systems and Policies, and the World Health Organization (WHO).

 

 

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.

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

Monday, October 30th, 2017

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.

 

 

 

Workers’ Comp as Percentage of Payroll: NASI Report

Tuesday, October 10th, 2017

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

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.

 

Update On Medical Marijuana

Friday, March 3rd, 2017

Yesterday, while attending WCRI’s Annual Conference in Boston, we wrote about the National Academy of Sciences (NAS) new research results concerning the effectiveness of  medical marijuana (cannabis) in the treatment of chronic pain. The NAS research concluded there is “conclusive support” that cannabis is effective with respect to chronic pain. A number of states are allowing cannabis to be employed in this regard.

However, marijuana is federally illegal in any usage, medical or otherwise.

We learn today from the Boston Globe that a bill was introduced in the US House of Representatives by Virginia Representative Thomas Garrett yesterday to remedy this situation. From the Globe’s story:

A freshman Republican representative from Virginia introduced legislation this week that would end the federal prohibition on marijuana use and allow states to fully set their own course on marijuana policy.

The bill seeks to remove marijuana from the federal Controlled Substances Act and resolve the existing conflict between federal and state laws over medical or recreational use of the drug. It would not legalize the sale and use of marijuana in all 50 states — it would simply allow states to make their own decisions on marijuana policy without the threat of federal interference.

‘‘Virginia is more than capable of handling its own marijuana policy, as are states such as Colorado or California,’’ Representative Thomas Garrett said in a statement. Neither recreational or medical uses of marijuana are allowed in Virginia.

Senator Bernie Sanders introduced a similar bill last year, but no one would co-sponsor it, and it never even got a hearing. Garrett, however, has four co-sponsors already.

We will continue to watch this.