Troubled workers’ comp system shows need for single-payer health care

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Illinois Single Payer Coalition

By Johanna Ryan with Anne Scheetz, MD
Johanna Ryan is a workers’ comp paralegal and a member of the Illinois Single-Payer Coalition.
Anne Scheetz, MD, a member of Physicians for a National Health Program and a founding member of the Illinois Single-Payer Coalition, cared for many patients with work-related health problems before her retirement from clinical practice.
Thursday, Sept. 15, 2016

Please sign up as a supporter, persuade your union to do the same, and make sure to get involved. References:
– Number of Illinois workers’ comp claims
– Gov. Bruce Rauner’s turn-around agenda
– Illinois occupational illness and injury statistics

In Illinois and around the nation, big business has labeled workers’ compensation a system in crisis. Illinois Gov. Bruce Rauner has depicted it as a millstone around the necks of Illinois employers, who he claims are shelling out too much money to treat injuries that might not even be work-related. Rauner and other Republican governors have made “reforming” workers’ compensation a key part of their pro-business agenda.

However, any worker who has had to use the system lately knows the real “workers’ comp crisis” is too little health care, not too much. In Illinois, as in most states, your employer is required to carry standard workers’ comp insurance. But it’s private companies like Liberty Mutual, Travelers and AIG/Chartis that provide the coverage — and they would much rather pay lawyers to fight your claim than pay doctors to help you get well.

Under the system they’ve created, a worker hurt on the job is actually at higher risk of being denied medical care (or having their treatment cut short) than a worker who falls getting out of the bathtub at home.

We believe the best way to fight the growing attacks on workers’ compensation is to take private insurance companies out of the picture. A public, single-payer health care system, financed by taxes rather than insurance premiums, would accomplish these goals:

– Eliminate delays and outright denial of care and the resulting long-term adverse effects on workers’ health;
– Take medical decisions out of the hands of insurance companies and place them where they belong: in the hands of patients and their doctors; and
– Make prevention the preferred approach to work-related health problems by strengthening our public health infrastructure.

This is the type of health care system workers in almost every other wealthy industrialized nation take for granted. Here in the USA, it has been endorsed by the United Mine Workers, National Nurses United, the Machinists’ Union, Amalgamated Transit Union and many others. Single-payer health care is a pro-active, rather than a reactive, approach to workers’ health. It is an ambitious program, but workers deserve no less.

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To get medical care in a workers’ comp case, it’s not enough to show it’s necessary. You must also prove it’s related to a workplace injury. This can be especially hard for “wear-and-tear” injuries like carpal tunnel syndrome or tendonitis, but it can also affect the worker who falls off a ladder or is struck by a forklift.

Private insurers love to litigate these cases – they know it has a chilling effect on the next worker who thinks about filing a claim. So they’re happy to spend several thousand dollars to have you examined by an employer-friendly medical specialist who will declare your work injury was just a “minor strain,” and your current symptoms are due to chronic arthritis, an old football injury or some other cause. No PT for you, pal, and definitely no surgery.

Rauner wants to make the standard for causation even higher, by requiring that an accident at work must be more than 50 percent responsible for an injury compared to all other causes. He also wants the records made by the treating physician — the one who actually knows the patient and who assessed the problem at the time of its occurrence — to count for less, and the opinions of those employer-friendly “independent medical examiners” to count for more.

Such changes taken together would gut workers’ compensation. Employers who are reckless with workers’ health will be even more confident they can get away with it. Workers’ risk of injury will increase, and their access to care and compensation will decrease.

In theory, workers’ comp expenses should give employers an incentive to make the workplace safer. It would be nice if that were the case. Unfortunately, it’s hard to find anyone in the field who believes it. Workers’ comp costs are much like the legal fines and penalties paid by drug companies — just a cost of doing business, which is never big enough to make them change their ways.

Employers are fond of moaning about the high cost of workers’ comp, and make a public scandal out of any individual case of cheating, real or alleged. But the real root of rising costs is litigation, not featherbedding or fraud. Private workers’ comp carriers have made Illinois a happy hunting ground for insurance defense lawyers, even as the number of workers’ comp claims in the past decade has shrunk by more than a third. The changes Rauner proposes would make this much worse.

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Take the example of one injured worker we know: A woman who’s been waiting a year and a half for repair of her torn rotator cuff, precisely because of this type of dispute. She now has neck and back problems too, thanks to months of trying to use her trapezius muscles to compensate for her damaged shoulder. Ask any doctor: when she finally gets her surgery, the results will be worse than average on account of all that delay.

A single-payer health care system would cover the care she needed, with no questions asked. Her lawyers could concentrate on fighting to get her disability payments and an eventual cash settlement; we wouldn’t have to to fight over medical care. Our client could at least get her surgery and physical therapy, even if the workers’ comp carrier denied her weekly benefit checks. She could recover and be working a new job while she waited for her shoulder claim to settle.

Relying on workers’ comp claims filed by individuals (or their next of kin) to enforce respect for workplace safety just doesn’t make sense. Would we depend on lawsuits alone to keep poisoned or spoiled foods off the market? Workplace safety, just like food safety, is a public health issue. We need public enforcement bodies, with real power, and with real penalties for violations.

According to an AFL-CIO report, in 2015, Illinois only had enough Occupational Safety and Health Administration (OSHA) inspectors to inspect all job sites only once every 143 years. The average penalty for a fatality investigation, of which there were 56, was $8,553. This clearly falls short of what’s needed to enforce workplace safety standards and protect workers’ lives. (A few states, such as Washington, have public workers’ compensation insurance funds with some limited powers over workplace safety. Unions in Washington strongly support this system. When Liberty Mutual and other private insurers tried to enter the market a few years ago, labor fought the measure through a statewide referendum and won.)

Wouldn’t we all be better off under a single-payer system that guaranteed treatment for any illness or injury, without a legal battle over the cause? Such a system would not only be cheaper, but it would provide better care. There was a time when most specialists welcomed workers’ comp patients. However, given endless payment delays and litigation hassles, those days are fast becoming history.

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Instead of seeing the best doctors, too many injured workers have to put up with pro-employer “occupational health” clinics, or third-rate providers who pad their bills with useless charges to compensate for long payment delays.

Imagine if everyone, from janitors to CEO’s, carried the same health insurance card! You would choose your own doctors and other care providers. No specialist would turn you away because of the type of insurance you had. You and your doctor – not your employer’s workers’ comp carrier, or any other insurance company, would make decisions about tests, surgery, physical therapy, medical equipment, and other care.

All care would be paid for by progressive taxes, and free at the point of service. Hospitals would not shut down in low-income neighborhoods if the residents had the same high-quality insurance as everyone else. No one would lose their health insurance through leaving a job, going on strike, or for any other reason.

Also, injured workers could get immediate care without having to prove to anyone exactly where, when or how they got hurt.

Workers’ comp lawyers (and we’d still need them) could concentrate on fighting for compensation – and we wouldn’t see clients dropping their claims or settling for pennies because they were desperate for medical care.

A strong public health system, the foundation on which primary care and specialty care must rest in order to be effective, would make protection of workers’ health a high priority.

That’s what a single payer system could offer all of us, union or nonunion. It sounds like a better way to us.

Troubled multi-employer plans show need for single-payer

Thursday, June 18, 2015

Thursday, June 25, 2015

This is a 2-part series that examines the role of multi-employer health care plans versus single-payer health insurance.

Anne Scheetz, MD, is a member of Physicians for a National Health Program and a founding member of the Illinois Single-Payer Coalition. Hale Landes is a member of IBEW Local 134 and the Illinois Single-Payer Coalition.

Multi-employer or Taft-Hartley plans — a “made-in-America” source of health coverage and other benefits for more than 20 million U.S. workers, retirees, and their families — are under serious threat.

The threat has two sources: the Affordable Care Act (ACA), and the fragmented, for-profit nature of the U.S. health care system, which the ACA re-enforced, rather than corrected.

Some union leaders held up the multi-employer plans as a good model for health system reform. In contrast to private for-profit health insurance companies, the plans, by law, serve their members, not passive investors.

They are more efficient than the insurance companies, devoting less than 10 percent of their outlay to administrative expenses (and more than 90 percent to health care), as opposed to the insurance companies’ 15 to 20 percent.

They tend to have high actuarial value, covering on average 87 percent of enrolles’ health care expenses, as compared to 90 percent for the platinum plans (which most people cannot afford) offered on the insurance exchanges, and 60 percent for the bronze plans.

Needless to say, this recommendation was not adopted. On the contrary, the ACA not only left the for-profit insurance companies in charge of health care, but created new disadvantages for multi-employer plans.

Perhaps most importantly, the ACA does not allow low-income workers who are enrolled in multi-employer plans to qualify for the government subsidies that are available to low-income people who buy insurance from for-profit insurance companies on the insurance exchanges.

Multi-employer plans are nonetheless taxed to pay for the subsidies, just like the insurance companies whose customers can benefit from them.

The ACA presents numerous other challenges to multi-employer plans as well, such as the unfunded mandate to cover children up to age 26; and administrative burdens whose costs will shift money away from health care.

Still other challenges apply to all workers. Penalties for companies that don’t offer health insurance are much less than the cost of insurance, do not apply to those that employ less than 50 workers, and do not apply to part-time workers. Employers are responding by cutting the number of employees, cutting hours, and sending employees to the insurance exchanges, among other practices that harm workers and their families.

The so-called Cadillac tax, which penalizes plans with high premiums, or, in the case of the multi-employer plans, high benefit payments, will also hurt the plans, and will most hurt those plans with a large number of older and sicker enrollees.

The National Coordinating Committee for Multi-employer Plans and many unions have responded to the problems posed by the ACA by lobbying for various amendments, and a few have called for its repeal.

Yet, the plans face serious challenges — even without the ACA.

Costs throughout the health care system are escalating. The consolidation of hospitals and physician practices allows providers to drive up prices. Prices for specialty drugs are rising almost 20 times as fast as prices for conventional drugs, and the prices of even some old and standard drugs are increasing faster than the rate of inflation. Administrative costs are increasing — for the whole system, they now total at least $350 billion per year.

The question of who will pay these increasing costs — employers or workers — has become a frequent cause of contract disputes. At best, workers have sacrificed wage increases to pay for health care, and this trend will continue.

The increasing costs are a significant challenge to worker solidarity. Some workers are denied equal benefits based on hours of work or length of employment, weakening union strength just as it is most needed. As is happening throughout the health care system, the funds are shifting more costs to their enrollees through co-pays for some services, a policy that penalizes the sick and burdens most those earning the lowest pay.

Amending the ACA — a very difficult task, given its complexity, will not solve these problems. Even a health reform modeled on the multi-employer plans would not solve these problems.

The solution is a single-payer health care system, also called expanded and improved Medicare for all. This reform proposal is the only proposal to address all of the problems faced by the multi-employer plans and all workers.

Under a single-payer program, everyone is covered for all medical care with the single payer being the government. Its administrative simplicity is the principal source of cost containment (traditional Medicare’s administrative overhead is only 2 percent). Insurance company marketing, underwriting, profits, and outrageous executive compensation would be eliminated. Furthermore, since everyone would be in the same system, the single payer would also be the single buyer of drugs, medical equipment, and services, thus able to enforce reasonable prices.

Financing would be by a progressive tax. Those who have the most would pay the most, while everyone would receive the care they need when they need it.

In contrast to the current situation, which workers are pitted against each other, under a single-payer system, we will all have an interest in making that system better. A single-payer system promotes rather than undermines, social solidarity.

Other benefits include free choice of providers, instead of the narrow networks that are now commonplace; no interruptions in coverage due to job changes, illness, or retirement; and a much more just workers’ compensation system.

A single-payer health care system is the only way to take health benefits off the bargaining table, leaving unions free to bargain over wages and working conditions.

Union support for a single-payer health care system is strong, although not yet universal. The website of Unions for Single Payer Health Care lists more than 600 labor groups that have endorsed the national single-payer bill, HR 676, the Expanded and Improved Medicare for All Ac,t whose chief sponsor is John Conyers of Michigan. The groups include more than 150 central labor councils from around the country; and 25 groups, including three labor councils, from Illinois.

Fifteen major unions and other labor groups support the Labor Campaign for Single-Payer, which works more on the state level. These include National Nurses United (NNU) for whom a single-payer health care system is an essential aspect of nurses’ professional obligation to advocate for their patients; Young Workers; the National Education Association (NEA); United Electrical, Radio, and Machine Workers (UE); and the Coalition of Labor Union Women (CLUW), among others.

At the 2014 AFL-CIO Convention, delegates affirmed their support for a single-payer system; and activists with the Labor Campaign challenged organized labor to “finish the job” of health care reform by making health care a human right.

On July 30 of this year, NNU will lead the celebration of Medicare’s 50th anniversary with the message: “Medicare – as American as apple PIE: Protect, Improve, Expand.”

Illinois’s single-payer bill, the Illinois Universal Health Care Act, currently HB 108, has been introduced in each General Assembly since 2007 by chief sponsor Mary Flowers of Chicago. Although it will not pass in the near future, it articulates the vision of the single-payer movement for the people of Illinois and the U.S., and serves as an educational and organizing tool. The Illinois Single-Payer Coalition and its Labor Outreach Committee work with local labor groups, as well as the national organizations toward a future guarantee for all people of access to all necessary health care, and of financial protection in the case of illness or injury.

Labor is surely the sector that can best lead the way to the solidarity expressed in the single-payer movement’s slogans: “Everybody in, nobody out,” and “One nation, one health plan.”