Category: Health Care Issues

Jun
11

Low prices every day = higher taxes

Posted by Joe Paduda on Friday, June 11th, 2021 | Comments

Cheap stuff isn’t cheap…you always pay way more than you think…because the hidden costs of that cheap stuff are damn expensive.

Two examples…

Walmart’s slogan is “Save people money so they can live better.”

McDonald’s mission statement includes “make delicious feel-good moments easy for everyone.”

The two giants (and McDonalds franchisees) employ over 4 million workers, paying wages that are significantly higher than the Federal minimum (which is $7.65 an hour) – but certainly not a “living wage.” McDonald’s shift workers make less than $10 an hour; Walmart’s was a lot higher, almost $15 an hour.

In just 6 states, 15,000 Walmart and McDonalds workers and many of their families are on Medicaid. Undoubtedly tens of thousands more get their healthcare from free clinics or in hospital ERs. This is especially true in states that did not expand Medicaid – looking at you, Florida, Mississippi, Arkansas, Alabama, and a dozen more.

The median cost of Medicaid – which is NOT per employee, but the employee and dependents enrolled in Medicaid – is about $8000. If we figure just 20% of Walmart and McDonalds’ employees on Medicaid have dependents, taxpayers in those six states are paying $120 million a year for Walmart and McDonalds’ employee healthcare. 

Add to that the cost of uncompensated care for the uninsured – which is subsidized by overcharging privately-insured workers and workers’ comp payers – and its blindingly obvious cheap stuff is far from cheap.

This isn’t just Walmart and McDonalds; workers at Uber, DollarGeneral, Fedex and Amazon and many other companies get their health insurance – and supplemental food aid – from you, the taxpayer. In fact, more than half of Medicaid enrollees are employed by private companies.

Make no mistake – I’m not blaming McDonalds or Walmart or any other company for doing what they are doing – or rather not doing.  Americans are addicted to buying lots of stuff (a lot of which is redundant or really not needed) and demand low prices.

What does this mean for you?

These companies are giving us what we demand, and we are paying a hefty price for cheap stuff. 

 

 

Jun
4

Good luck with the truck.

Posted by Joe Paduda on Friday, June 4th, 2021 | Comments

Let’s get real.

You and your kids are driving 80 mph on a highway, when a truck suddenly veers in front of you.  Since you are a quick-thinking insurance person, you estimate your chance of dying if you hit that truck at about 40 percent – just a bit better than even odds.

Or, you can swerve off the road – where your chance of dying is 1 percent – about 1 in 100.

This…

Or this…

What do you do?

That’s the question facing vaccine skeptics.

Vaccine skepticism is driven by memes, misunderstood data, a lack of understanding of basic math, pure laziness, demagoguing, and social media’s incredible ability to publicize nonsense.

Recently I had an electronic conversation where a COVID vaccine skeptic (my characterization, not their’s) cited “publications and VAERS” as sources for their concerns…I don’t know what publications the commenter was referring to; the only reference provided was a 14-month old TV report.

[reminder – if you discuss or debate, provide credible sources – ideally primary source – for your opinions.  Do your homework and don’t be lazy.  If you spout unsupported opinions – looking at you TJ – be prepared to be skewered.]

Leaving that aside, let’s talk VAERS, the vaccine reporting service run by the CDC and FDA. VAERS accepts reports from providers, vaccine recipients (or those who say they had a vaccine, parents, and “others” of any adverse event regardless of proof that it was caused by the vaccine. And VAERS reports can show deaths due to ANY CAUSE – could be drunk driving, hang gliding, heart attack, cancer, whatever.

Want proof ?A few years back VAERS accepted a report of a doc who felt like he was becoming the Incredible Hulk after a vaccination.  

VAERS is often misrepresented by Vaccine Skeptics lying about “problems” and deaths allegedly caused by the vaccine. [Here’s a great review of VAERS reporting issues]

Ok, the data.

VAERS received 4,178 reports of deaths (0.0017% of all who received the vaccine) between Dec. 14, 2020 and May 3, 2021. Remember about 165 million of us have had at least one shot. [source above]

Even if ALL 4,178 deaths were “caused” by a vaccine – and there is ZERO evidence that’s the case –  reality is your chance of dying from a COVID vaccine is far less than getting struck by lightning.

Compare that to your chance of dying from COVID – I ran the numbers here for a 55 year old white man from zip code 92111 with no pre-ex. The risk is .07 percent.

This person is 40 times MORE LIKELY TO DIE OF COVID than from an “adverse event” after you get a Covid vaccine.

What does this mean for you?

Science always wins…or, put another way,

Good luck with the truck.

Jun
2

It’s not about you.

Posted by Joe Paduda on Wednesday, June 2nd, 2021 | Comments

Highly credible data shows today’s infection rate among the unvaccinated is as high as it was back in January.

Remember January?

Shutdown restaurants. Remote “learning”. No family gatherings. No high school sports. No fans at professional sports. No concerts or weddings or parties or fun.

80,000 of our friends, parents, grandparents, colleagues, and loved ones died of COVID in January.

If you aren’t vaccinated, don’t think you’re safe.  You are not. Your chance of getting COVID is the same as it was back in January.

But that’s not the worst of it.  Research shows the variants are more infectious, and in some states this is driving a hospitalization rate double what it was in January.

What does this mean for you>

Unless you don’t care about leaving family, friends, kids, parents, and loved ones with nothing but memories of you, get vaccinated. 

Jun
1

COVID nonsense

Posted by Joe Paduda on Tuesday, June 1st, 2021 | Comments

Ok, time for a brief fact-check on some of the nonsense circulating out there.

Some sources are claiming the CDC “changed testing thresholds to “virtually eliminate” COVID-19 cases among vaccinated individuals.”

That’s flat-out wrong. The reality is the CDC changed its guidance to local health departments about testing samples from COVID patients that had been vaccinated before they tested positive for COVID. The CDC will sequence the COVID virus’ genes to gain information on the spread and characteristics of variants.

The change is necessary because using a testing protocol with >28 cycles provides samples that can’t be used to sequence COVID genes. This has NOTHING to do with counting the number of cases or the criteria used to define if a patient has been infected with COVID.

I won’t bore you with the details behind these idiotic claims, except to note the reporters obviously don’t understand science, or math, or English.

Then there’s this.

The meme creator is either a) an idiot or b) a liar, or, c) most generously incredibly lazy.

In fact, the vaccines used here in the US – Moderna, J&J, Pfizer –  have been subjected to rigorous peer-revised studies that have proven safety and efficacy.  A simple Google search yields hundreds of articles about the peer review process, results, methodology in many prestigious journals including the BMJ, New England Journal of Medicine, the Lancet and hundreds of others.

Liability protection is “being offered” as well – and is part and parcel of Federal Law. There’s also a specific mechanism set up to protect those harmed by vaccines.

From FactCheck:

CICP gives benefits to individuals, or to estates of individuals, “who sustain a covered serious physical injury as the direct result of the administration or use of covered countermeasures,” including COVID-19 vaccines, according to the program’s website.

What does this mean for you?

Beware of people peddling nonsense. Check their facts, ask for sources, and trust credible research.

May
24

Bipartisanship at last!

Posted by Joe Paduda on Monday, May 24th, 2021 | Comments

An excellent article by Washington Monthly’s Eric Cortellessa described a Senate antitrust hearing focused on hospital and health care system consolidation.

Believe it or not, the problems created by hospital consolidation have brought bipartisanship to the Senate, with arch-conservative Josh Hawley and liberal icon Richard Blumenthal agreeing that consolidation is bad.

Hawley opined”private equity and their [sic] intervention here is actually helping drive consolidation in a way that is unhealthy in this industry and can be particularly harmful for rural communities…”

Blumenthal: “incentives and self-interest of the private equity funds drive the finances rather than respect and care for the patients who are there or the professional staff who ensure quality care.”

It’s not just private equity – most consolidation is driven by massive health care systems looking to dominate markets and thereby control pricing. And that’s exactly what happens.  According to chair Amy Klobuchar, “hospital prices are 12 percent higher in monopoly markets compared to those with four or more competing hospitals.”

That’s one reason profits are zooming for hospital companies Tenet, UHS, HCA and CHS.

What does this mean for you?

Nothing good.

 

May
5

Comp’s culture of catastrophizing

Posted by Joe Paduda on Wednesday, May 5th, 2021 | Comments

At the height of the COVID crisis last year, some research organizations, brokers/consultants and “thought leaders” were gravely forecasting how awful this was going to be for workers’ comp.

Sure, we didn’t know what was going to happen, although careful and thorough research would have indicated things weren’t headed towards the “awful”.

Instead, we heard:

  • investment returns were going to suffer;
  • profits were in deep peril; and
  • workers’ comp was going to be the “go to” insurer for COVID due to presumption

These could have happened, but the data clearly indicated these outcomes were pretty unlikely.

Then there’s “social inflation”, a term describing some rather nebulous and ill-defined “drivers” which are allegedly increasing the cost of insurance claims. [There are a host of methodological problems with the research cited in the link and with this study as well]

Social inflation is being blamed for all manner of problems – jury awards (many drastically reduced on appeal), ‘increased litigation”, “broader definitions of liability, more plaintiff-friendly legal decisions.”

This from Fitch’s Robert Mazzouli, [emphasis added]

A high-profile litigation example in the U.S. is the so-called opioid crisis – drug companies have been accused of playing a harmful role in the extensive overuse of opioid medications, with the overuse blamed on both medical prescriptions and illegal sources.

Read that again.

“So-called opioid crisis?” What planet is this guy living on?

Not this one. There is overwhelming evidence against Purdue and other members of the opioid industry.

Not sure where these experts get their information, as research indicates the various “problems” attributed to social inflation are overstated or exaggerated.

What’s abundantly clear about these two issues is workers’ comp insurance people have no idea what’s really driving their business. Instead of doing the hard work to figure out how to address over-spending on claims, too many blame outside forces.

COVID and “social inflation”‘s impact on work comp is insignificant compared to opioids and facility costs.

Opioids drove up workers’ comp rates and claims and claim duration. Yet few work comp insurers have figured out how to help long-term patients reduce or eliminate opioids.

Facility costs are the fastest-growing part of medical spend, driven by:

  • the failure of some states to expand Medicaid;
  • (mostly for-profit) health systems’s amazing ability to over-charge workers’ comp payers and get away with it;
  • changes in reimbursement by Medicare;
  • reliance on PPOs to address facility costs; and
  • grossly inadequate medical bill review

What does this mean for you?

Instead of blaming external issues, work comp execs should focus on understanding medical drivers and how healthcare impacts workers comp.

May
3

Recklessness and Responsibility

Posted by Joe Paduda on Monday, May 3rd, 2021 | Comments

The Greatest Country on Earth will not conquer COVID.

Misinformation by “thought leaders” and their followers is the primary reason.

The CDC ‘s experts no longer believe herd immunity is possible. Instead COVID will become woven into the fabric of everyday life, with new variants popping up from time to time, killing the most vulnerable and sickening thousands of us. Lest one think that’s not a big deal, recall the most common version of COVID now circulating in the US came from Britain – and this version is 60% more transmissible than the “original” version. More concerning still, future variants may well be more lethal.

While there are many factors contributing to the herd immunity problem, the biggest driver is vaccine uptake (which contributes to the variant problem).

from US Dept of Health & Human Services via NYTimes

Of course, this doesn’t help.

Sturgis ND during Bike Week

Which leads to the key question – why?

Why don’t people get vaccinated? Why don’t they mask up and physically distance?

Mostly because they listen to “thought leaders”, influencers and friends who spread misinformation.

The key takeaway.

Those of us who have followings, however modest, have a moral and ethical responsibility to use that influence for good. Re-posting and re-tweeting inflammatory, wrong, and just plain stupid “information” is reckless and irresponsible.

It can also be deadly.

Do your research before publishing anything – and don’t just check “sources” that always support your thinking.

When you make a mistake, own it. Correct it publicly and apologize.

I’ve made my share of mistakes, so I’m certainly not immune; a few examples are here, here, here, here, and here.

Mar
17

COVID quick update

Posted by Joe Paduda on Wednesday, March 17th, 2021 | Comments

Quick takes on stuff you need to know – and most of it is good news indeed.

Eli Lilly has what may be one of the more promising treatments, a cocktail of two unpronounceable drugs showed strong results in a recently-completed double-blind trial involving 769 patients.  The bamlanivimab-etesevimab duo cut the risk of hospitalization and death by 87% versus placebo.

Unlike the hydoxycholoroquine “research” touted by the former occupant of the White House, this is real science by reputable scientists which shows the drug has a positive impact.

Other research indicates the Pfizer vaccine works to stop the Brazilian variant; since I’m getting my first shot – and it’s the Pfizer version – Monday, that’s good news indeed. Pfizer also believes its vaccine will work against the South African variant as well.

These are all good news, as economists believe an economic recovery is highly dependent on stopping COVID.  One stated: “The vaccine is truly incredible…. It’s the best kind of stimulus we could want.” Excellent podcast for your morning walk or pm drive is here.

Terrific research out of CWCI last week; in their annual meeting, Alex Swedlow, Rena David and colleagues provided a lot of information on what’s happened with claim counts, costs, claim duration, and treatment timing. One very bright spot – February saw a huge drop in COVID workers’ comp claims. Rena also reported that “many workers with non-COVID claims got faster treatment than before the pandemic…” A big chunk was via telemedicine, which hit 25% of office visits in April and May, then dropped to about 18% in October. [thanks to WCC’s Mark Powell for his reporting]

I’m hoping to interview Alex and will provide more intel in a future post.

What does this mean for you?

Science, people. 

Feb
25

Worker comp payers – hold on to your purses and wallets

Posted by Joe Paduda on Thursday, February 25th, 2021 | Comments

Two news items hit the virtual desk this morning; hospitals will lose more than $50 billion this year, and consolidation among hospitals and health systems is continuing, isn’t improving quality, and is increasing health systems’ leverage over payers.

The bad awful financial picture for hospitals comes after a pretty bad 2020, a year in which operating margins were slashed in half.

Of course financial problems are the main driver behind consolidation as health systems with stronger balance sheets take over struggling competitors. Physician practices hammered with revenue declines driven by far fewer patient visits, fewer elective surgeries, and more uninsured patients are also being acquired by health systems.

For payers – especially for workers’ comp payers – the balance of power has shifted to providers. With control over many hospitals and thousands of physicians, systems like Sutter Health in California can dictate terms to huge group health buyers.

I find it ironic indeed that the online ads next to the reporting on the consolidation problem in general and Sutter Health in specific include this one. Payers’ ability to control costs in consolidated health care markets is…challenging at best.

What does this mean for you?

If you operate in Alabama, Florida, Louisiana, Arkansas, Kansas and a bunch of other states, your facility costs are going up. 

Feb
16

COVID update #56

Posted by Joe Paduda on Tuesday, February 16th, 2021 | Comments

COVID is likely to become an endemic disease, one that is with us forever. It will morph, adapt, and change over time, evolving constantly as the virus does what all “living” things do – seek to survive and propagate.  Like all pandemics, our fortunes will wax and wane.  At times new variants will be more or less infectious, more or less deadly, more or less controllable.

We humans will develop immunity to a greater or lesser degree depending on multiple factors; what variant we’re exposed to, how old we are, our unique genetic makeup, other co-morbidities, whether or not we have decent, accessible healthcare, where we live and what we do and who we do it with.

credit Down to Earth

Most important will be whether we listen to science, exercise caution, and protect ourselves and others…or cross the stupid line.

The good news. 

The world’s focus on developing vaccines has been hugely successful; a year after the virus emerged about 150 million people have been vaccinated. That is a truly stunning accomplishment, all the more so because the most successful vaccines to date have relied on a never-before used model (mRNA).

Here in the US we just learned that the Biden Administration has secured enough doses of the Pfizer and Moderna vaccines to get every resident inoculated by mid-July. If J&J’s vaccine gets approved, the single-dose mechanism will significantly speed up the vaccination process.

The bad news is 100,000 of us died of COVID in January, and some of the new variants appear to be more infectious and others may be more deadly.

So, we are racing to develop herd immunity before the virus’ ability to adapt and change overcomes current vaccines’ ability to control it. 

What’s worse is this did not have to happen. Between eliminating the budget of a key government entity tasked with early identification of infectious diseases, promoting useless and dangerous COVID treatments, refusing to encourage people to wear masks and politicizing public health, we can clearly see what happens when we elect incompetent politicians.

Trump et al failed us miserably, but they aren’t the only ones at fault. The conduct of a Governor whose administration failed to report nursing home deaths and another Governor (of a state with death rates among the highest in the nation) that actively lied about COVID is reprehensible. In Cuomo’s case, blaming the coverup on fears the Trump Administration would use the death count as a political cudgel is no excuse.

What does this mean for you?

We all need to accept that COVID is never going away.