Later this month, we will mark the 100 year anniversary of New York’s horrific Triangle Shirtwaist Fire, an event that claimed the lives of 146 garment workers – young girls and women – who had been locked in the sweatshop to prevent theft. Most died in stairwells, jumping down the single elevator shaft, or by hurtling themselves from 9th story windows in desperate attempts to escape the fire. PBS recently ran a special on this disaster. (If you missed it, you can watch online: Triangle Fire). My colleague Jon Coppelman has also written about the fire in his post The Original “No Exit”.
This fire was a watershed event that galvanized the nation. It occurred in an era where there were no regulations or labor protections. Workers often worked 12 hour shifts, 7 days a week. There were no child labor laws or safety mandates. Ironically, the day before the Triangle Fire, New York courts had struck down the state’s first compulsory workers compensation law as unconstitutional.
This tragedy, along with some of the horrific mine disasters that resulted in wholesale loss of life, were catalysts which led to the enactment of various worker protections – including statutory workers’ compensation.
Meanwhile, today in Wisconsin …
We think this bit of history is an important backdrop to what’s going on in Wisconsin today.
Wisconsin has the distinction of being the first state in the union to have enacted a workers’ compensation law that survived legal challenge in May of 1911. In fact, the state of Wisconsin has a long, storied and sometimes bloody history of being on the front lines for worker rights. Workers and labor unions were in the forefront of the fight for the 8-hour day and the 40-hour work week. In 1932, Wisconsin was the first state to enact unemployment compensation.
To any who know this history, it comes as no surprise that, once again, Wisconsin is on the front lines in the battle for labor’s future.
It’s the budget, stupid – or is it?
The ostensible issue, according to Governor Walker, is that the state of Wisconsin is broke and a large part of the problem lies with overly generous benefit packages of public workers – teachers, prison guards and the like – which are said to be crippling the state. He called on unions to do their part and to make a sacrifice for the greater good.
All that might be well and good. The unions have indicated their willingness to take a financial haircut. But the part of Governor Walker’s Budget Repair Bill that is going over somewhat less well is a call for the elimination of collective bargaining — and therein lies the rub.
With a Republican majority in Wisconsin’s House and Senate, the bill was all but a given until the Democratic senate contingent fled the state to prevent a vote. Since that time, there have been massive protests over three weeks and the so-called Fab 14 remain holed up in un-named Illinois’ hotels. And there has been no shortage of drama in this story: an embarrassing and revelatory 20-minute prank call to Governor Walker from an impersonator of corporate financier David Koch; and a sheriff’s refusal to play the role of “palace guard”, among other things.
Part of national union busting agenda?
Critics of Walker’s Budget Repair Bill say that the issue is not about budget balancing or overly generous benefits, but an ideological push to eliminate or curtail public unions – in a phrase, union busting. Opponents say that this is a corporate-funded campaign to eliminate public unions in Wisconsin and other states, and to privatize many institutions that are currently staffed by public workers. No less a staunch Republican than former Congressman and now host of MSNBC’s “Morning Joe” program, Joe Scarborough, has publicly called Governor Walker’s actions, “Un-American.”
In Wisconsin, suspicions are high because Koch enterprises funded a large part of Walkers gubernatorial campaign. The fact that the budget bill contains a provision authorizing Walker to conduct no-bid sales of some state properties also heightens suspicion. Many are troubled by his plans for privatization of some public services. In his prior role as Milwaukee County Executive, Walker also used budget emergency as a justification for privatizing security guards, a move that proved less than successful.
Other states have also embarked on this path: Ohio may be making more headway in curtailing unions. In Indiana, Democratic legislators have followed Wisconsin’s lead and left the state to postpone a vote. In Rhode Island, nearly 2000 teachers have been dismissed. Other states may be contemplating similar measures, although some may be a bit shy of action given the shifting public sentiment, which favors retention of collective bargaining and has given Walker a black eye – to a point where voters say they would not elect him again if they had a do-over. (see Wisconsin Public Research, Rasmussen, USA Today/Gallup, Public Policy Polling and various other polls. )
It’s uncertain what will happen in the next chapters, but we will be watching. It is clear this is another watershed point in labor history, a public policy fork in the road, perhaps the beginning of the end of the movement that was propelled into mainstream America by that terrible fire 100 years ago. While polling indicates that sentiment is currently on the side of the teachers in this dispute, the future of public unions is under serious threat. Is the role of unions obsolete? Has the public dialogue achieved an equilibrium between the rights of workers and those of management?
At Lynch Ryan, we have great respect for unions, which have historically played a critical check-and-balance role in labor-management power dynamics. They have also been in the forefront of the fight for worker safety and other worker protections. We also admire and respect many employers we have been privileged to work for who are perceptive and wise enough to manage their companies so well that unions are not needed. We’d like to say that all employers are this enlightened and do not need union checks and balances to do the right thing, but unfortunately our experience tells us that this is not always the case.
Posts Tagged ‘Wisconsin’
Health Wonk Review: Stormy Weather
Thursday, February 3rd, 2011This dramatic satellite shot from NOAA captures the scope of the blizzard that swept across the country in the last few days. Being snowbound offered our contributing bloggers lots of time to think about all things healthcare, and in that arena, the climate is almost as stormy as the weather. The Florida judge’s ruling against the Health Care Act was much on the mind of several of our bloggers, as was the State of the Union address — both of which occurred since our last compilation. We have a lot of good submissions this week – grab a cup of cocoa to take the chill off and dig in.
Managed Care Matters – Hosting has its privileges, so we kick off this issue with a nod to the blogger who did the heavy lifting last issue, Joe Paduda. One thing we love about Joe is that he is never one to mince words, as evident in this week’s submission, Paul Ryan’s blatant hypocrisy – and the abject failure of mainstream media. Joe takes the Wisconsin representative to task, along with most of his colleagues in the GOP and the mainstream media. He finds today’s hand-wringing over healthcare related debt insincere from the same players who ignored yesterday’s elephant in the room. Also see his related post: If health reform is overturned.
The Apothecary (posted at Forbes) – Avik Roy’s post Florida v. HHS: Why Vinson’s Ruling Might Stand offers a detailed discussion of the four components of Judge Vinson’s Monday ruling, with an emphasis on why the lack of a severability clause might be the key factor in overturning the entire law.
California Healthline – With talk of rolling back the Patient Protection and Affordable Care Act dominating the news, Dan Diamond reminds us that this isn’t the first time that Congress has considered overturning a major health law. He wonders if the battle over the 1988 Medicare Catastrophic Coverage Act and its repeal 17 months later mightn’t hold some lessons for today.
Colorado Health Insurance Insider – Louise Norris suggests that any debate on healthcare should be based first and foremost on facts rather than rumors. She puts on her detective hat in considering whether a Colorado Representative’s vote was swayed by debunked info from an E-mail forward. She thinks the public debate should be informed by a higher standard and offers some clues for spotting suspect chain-mail claims
Disease Management Care Blog – Jaan Sidorov considers Atul Gawande’s recent essay The Hot Spotters and asks if targeted care management is something new? Jann says that while The New Yorker article might garner the glitteratis’ attention, the practice of identifying and reaching out to patients at risk is a standard MO in many commercial insurance plans. “What’s next, Dr. Gawande,” he asks, “discovering that there are machines that use electromagnetic radiation to take pictures of people’s insides?”
Health Affairs Blog -Tim Jost offers an analysis of Judge Vinson’s decision invalidating the Affordable Care Act, while his co-bloggers opine about the implications of the Sate of the Union speech and its aftermath: Kavita Patel on health care and the State Of The Union; Len Nichols who suggests being honest for a change, and Joe Antos with a taste of budgets to come.
Health AGEnda – In his post on the the John A. Hartford Foundation’s blog, Chris Langston poses a good question: Why are Medicare’s innovations more secret than the Joint Strike Fighter?. He champions the idea that we should be more nimble, transparent and collaborative in sharing innovations and improvements in care, particularly in terms of knowledge that we as taxpayers have already purchased.
Health Beat Blog – Maggie Mahar suggests that when it comes to electronic health records, perhaps we should walk before we run. She likens the mad stampede of EHR implementation to a market bubble with too many sellers, too many buyers, and too little information. In light of this, she tackles the question of whether Congress should defund the conversion to EHRs as some are proposing.
Health Business Blog – What makes you sad? For David Williams, it comes down to three words: US biogenerics policy. David makes the case that the debate on biogenerics misses the point: There are better, safer, faster ways to bring down the cost of biotech drugs while preserving incentives for innovation.
Health Care Renewal – Roy Poses makes a strong contribution to this week’s roundup with his post Big Door Keeps On Turning. He lists examples of health care leaders going from government to industry and then back to government again. He asks if this revolving door, with its constant interchange among corporate and government health care leaders, is a sign of how corporatist health care has become and if we can we really expect a cozy corporate leadership class with no fixed loyalty to any organization to put the care of individuals and populations ahead of their personal interests and relationships?
Health News Review Blog – Gary Schwitzer enlists the help of Harry Demonaco, director of the Mass. General Hospital’s Innovation Support Center in turning a critical eye on health screening advice issued by Prevention magazine, which advised readers, “If you haven’t had these cutting-edge screenings, put this magazine down and call your doctor. Now.” This is cited as another bad example of screening madness in US health care journalism, which promotes and fosters screening outside the boundaries of the best evidence.
Healthcare Economist – Jason Shafrin informs us that home health services are among the fastest growing services that Medicare provides. In thinking of reform to control this rise in spending, he turns to MedPAC’s 2011 Home Health Reform Recommendations.
Healthcare Technology News – Rich Elmore and Paul Tuten discuss the launch of pilot projects enabling secure direct messages among healthcare stakeholders in their post about Direct Project implementations taking flight. They offer project details and note that this is a very big deal, as reflected in the related briefing by David Blumenthal (National Coordinator for Health IT), Aneesh Chopra (US CTO) and Glen Tullman (CEO Allscripts) among other federal and industry participants.
healthyimagination – In December, scientists and healthcare professionals shared groundbreaking research an NIH symposium focused on health disparities. Lisa Cappelloni shares some of the novel approaches aimed at eliminating health inequities in her post Advancing Minority Health: New Minds, New Methods.
The Hospitalist Leader – Bradley Flansbaum offers A Hospitalist’s Lament, a thoughtful essay on the issue of end of life care and advance directives. In the light of controversies like death panels and care rationing, he states that our country may be at least a decade or two away from having a sophisticated discussion on this subject. He illustrates the complexity of the surrounding issues through an intriguing exercise conducted with his colleagues.
Improving Population Health – David Kindig is another contributor who listened closely to the State of the Union address, and asks if one could find any mention of population health, public health, or prevention in the speech. While he didn’t hear those phrases directly, he was heartened by the speech addressing two major drivers of health — education and jobs.
The Incidental Economist – Austin Frakt says that cost shifting is not well understood and has become a political football. He sheds light on the topic in the first of a series of posts: Hospital cost shifting: Brief history and possible future.
Insure Blog – As the oft-quoted Andy Warhol line goes, we will all have our 15 minutes of fame. But in the world of insurance, fame may be measured in cents rather than minutes, if Hank Stern’s post about Ceridian’s 2-cent Moment is any measure. In this case, the company made headlines when a cancer patient was denied coverage over a 2 cent shortchange. Or was there more to this story than the headlines? Hank digs a little deeper and offers his two cents on the matter. (Oh, and kudos to Hank & crew for Insure Blog’s 6 year blogiversary – quite the landmark!)
John Goodman’s Health Policy Blog – In his post The Case For Health Insurance, John states that everyone should have access to health insurance, and notes that real insurance involves a pooling of risks. “The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won’t be able to pay claims. The business of insurance is the business of pricing and managing risk.”
The Notwithstanding Blog – Genomic medicine, end-of-life care, and rationing are three “hot” areas of medicine and health policy in which much stock is given to the opinion of bioethicists. Our blogger at the Notwithstanding Blog (written by a first-year medical student) says that he has a bad feeling in observing the near-uniformity with which the bioethics establishment has opposed medical advancement and patient empowerment, and uses the lens of public-choice analysis to argue that the deference shown to their prescriptions is at least partially misplaced.
Pizaazz – In his post about how early career physicians use Facebook, Glenn Laffel reviews a study that should give some comfort to those who worry that physicians will misuse the social networking site by failing to protect patients’ protected health information.
Workers Comp Insider – In the niche area of occupational illnesses and injuries, Jon Coppelman demonstrates that some villains contributing to skyrocketing health care costs might lie entirely outside the delivery system. He examines the curious spike in carpal tunnel injuries reported by guards at an Illinois correctional facility in his post John T. Dibble’s Sympathetic Ear.
That wraps up this issue! Next up to bat: Louise Norris at Colorado Long Term Care Insider on February 16!
The Cost of Volunteers
Wednesday, February 23rd, 2005In case you haven’t noticed, the Insider cannot resist conundrums. We like to explore the ragged edges where conflicting views of reality play out their destinies. Which leads today to the interesting topic of volunteers. Are volunteers ever considered employees for the purposes of workers compensation? Are employers liable for the actions of their volunteers, just as they are for the actions of employees?
This blog was triggered by a recent case in Wisconsin, where a volunteer for Christ King church was delivering a statue of the Virgin Mary to a parishioner. In her haste to do the good deed, she ran a redlight and crashed into the vehicle of one Hjalmar Heikkinen, an 82 year old barber. Heikkinen suffered permanent paralysis. In the perennial search for justice (and deep pockets), his attorneys included the church in his suit, under the theory that the volunteer driver was actually their “employee.” It’s basically the same legal principle that says a private delivery business can be held liable for one of its employees who causes a crash while driving for work.
Plaintiff attorneys zeroed in on several lines in the church’s insurance policy, which indicated that volunteers doing church work are explicitly covered. Church attorneys noted the Legion of Mary meets and conducts its business without church guidance, but the other sides’ filings said the Legion of Mary was chartered at Christ King in 1968 with the help of a parish priest and noted the group was listed in several church publications.
At this point, the jury has awarded Heikkinin $17 million. How much personal liability coverage do you suppose the volunteer had under her auto insurance? Is it any wonder that the plaintiff attorneys sought to call in a higher authority?
Volunteers under Workers Compensation
Some states recognize the rights to workers compensation for volunteers, especially when it comes to volunteer firefighters. Some states, such as California, give employers a choice of whether or not to include volunteers. The University of California at Northridge has opted to cover volunteers for work related injury, even though they are not required to do so. I think it’s the right choice, given that it probably doesn’t cost them anything to do it. Because comp premiums are based upon payroll, and because the volunteer payroll by definition is zero, adding the volunteers does not cost them anything. In addition, it creates the same “exclusive remedy” path for volunteers that exists for regular employees, so injured volunteers cannot bring suit against the university for work-related injuries.
Even though volunteers do not make any money, if they suffer serious injuries in the “course and scope” of their volunteer efforts, they may try to assign a dollar value to the services, in order to come up with an indemnity payment. This is an issue that many hospitals — with their huge cadres of volunteers — must face from time to time.
Liability for the Actions of Volunteers
Our Wisconsin saga does not involve comp coverage for the volunteer (although she may opt to file a comp stress claim, after all she has gone through!). What’s at stake is liability for the actions of a volunteer. In this case, the insurance policies appear to explicitly include volunteers. In any event, I would surmise that the same issues arise here as with independent contractors: who controls the work? If the employer controls how the volunteer work is carried out, I expect that liability will follow. In the case of the Wisconsin church, you could argue that they have an obligation to check the driving records of any volunteer who drives as part of their donated work. This is a can of worms, indeed!
One of the best summaries of the issues for churches can be found at a United Church of Christ website. In the meantime, institutions relying on the services of volunteers to carry out their work should keep in mind the first law of capitalism: there is no such thing as a free lunch.
Company Docs in the 21st Century
Friday, February 11th, 2005Frustrated with the high cost of providing medical insurance for its 12,000 employees, Quad/Graphics decided to set up its own health care system. In an article in the Wall Street Journal (available by subscription only), staff writer Vanessa Fuhrmans describes a fast growing company that was able to think way out of the box to solve an intractable problem. Quad/Graphics spends about $6,000 per employee on medical costs, fully 30% less than the average company in its home state of Wisconsin.
This is certainly not a model that most companies could replicate. You need a large concentration of employees in just a few locations. Perhaps even more important, you need a high level of trust between management and workers. Fuhrmans points out that Quad has a long history of harmonious relations between management and workers. If the workers distrusted management, they would not entertain the idea of going to management’s own doctors — not just for their own medical services, but for their entire families as well.
Quad employs its own internists, pediatricians and family practitioners. It operates its own labs, pharmacies, and rehab centers. They contract directly with local hospitals and specialists for advanced care. It is also important to note that doctors’s bonuses are tied to patient evaluations and health outcomes — unlike our mainstream medicine which values the number of contacts above all. Quad doctors have a full half hour to spend with patients, which leads, naturally enough, to a highly effective disease prevention program.
Workplace Injury
The article did not address how workplace injuries were handled, so I sent Ms. Fuhrmans an email inquiry. She responded within minutes, explaining that Quad does indeed handle many of its own workers’ compensation cases. “This is where they see a lot of their savings.” It makes perfect sense that workers would trust the same physicians who treat their families to manage workplace injury and illness. I would surmise that their in-house rehab facilities are quite capable of managing workplace injuries. Even though “occupational medicine” was not listed in the article as an available specialty, a progressive company with an inhouse medical capacity would naturally keep a strong focus on returning injured employees to full duty as quickly as possible.
The Quad model has been so effective, other employers have contracted with QuadMed LLC to provide in-house services. The article cites Briggs & Stratton and Rockwell Automation, both of which have asked QuadMed to operate full-service clinics for their employees in Wisconsin.
Confidentiality Conundrum
Fuhrmans points out that employees do have some concerns about privacy issues. They obviously don’t want personal details about their health (or the health of family members) to end up in a supervisor’s hands. Quad medical staff sign confidentiality agreements, promising to keep patient information within the clinic. Their computer systems are separate from those of the factories.
This is all well and good. But there certainly is an opportunity for ethical tensions. Here’s just one example. A worker comes to the clinic with a knee injury suffered while playing hockey on the weekend. He cannot afford to miss any time from work. Should the doctor release him to regular duty? Let’s assume the worker does continue at his job. What if he comes in the next day claiming that work has aggravated (or even caused) his knee problem? How should the doctor respond?
It is not difficult to envision doctors getting caught in the middle of some very challenging issues. Workers’ compensation places tremendous leverage in the doctor’s hands. The assumption is always that the doctor is a disinterested party. But when the doctor is in effect an employee of the same company, this may create the potential for a conflict of interest.
Finally, I wonder about the separation between Quad and QuadMed. Is the latter a “third pary medical provider” and thereby subject to lawsuits for malpractice? Federal confidentiality standards are very strict on the personal health side (and more flexible on the workers’ comp side). Once again, it is not hard to imagine circumstances where the doctors are truly caught in the middle.
Quad/Graphics deserves a lot of credit for tackling the health care dilemma directly. In many respects, it’s the classic American story. Faced with a huge national problem, creative managers figure out a way to solve it on the local level. From our perspective, the roots of the solution lay in the fundamental trust that existed between management and workers. There is simply no substitute for that kind of trust, which may be the most powerful collateral for change in the ever-challenging world of business.
Communication pays dividends
Monday, December 29th, 2003From Wisconsin, land of many lakes, come three refreshing case histories depicting the many benefits that can accrue when employers heighten communication with employees. The unifying theme? “Aggressively listening to employees pays huge dividends.”
At a local corrugated box plant of the Weyerhaeuser Company, an employee-based safety campaign reduced accidents involving lost work time from 20 in 1999 to none in 2002, and only one in the past year. The company implemented the Triangle of Prevention (TOP) program with members of Paper, Allied-Industrial, Chemical and Energy Workers Union (PACE). This is an excellent example of how unions and management should be sitting on the same side of the table when it comes to worker safety.
The two other examples in the article aren’t directly related to workers comp, but are instructive nonetheless. An employee-based redesign of production process flow reduced in-plant idle inventory to the point where a furniture manufacturer could eliminate a warehouse and save more than $150,000 annually; employee-based innovations at a health network enhanced patient service, improved patient care, added employee benefits, and significantly reduced employee turnover.
We’ve seen the collective power of employee ownership many times in our travels. Are you listening hard enough to your employees? If not, it might be a good time for some New Year’s resolutions.
