Friday, July 24, 2009, 08:47 AM - Political developmentsIt was a Sacramento late nighter. The California Senate has voted in favor of the budget compromise and as of early morning Assembly approval looks imminent.
Here's a good summary of what's in the budget:
http://www.californiaprogressreport.com ... ses_b.html
The Senate version includes $1 billion from a sale of SCIF and continued state worker furloughs as well as oil drilling off Santa Barbara and the expected social service and education cuts.
Various groups now gear up to sue to block various provisions. More on all that later.
Will the SEIU "push back" with strikes? Here's a link to their strike authorization vote page:
Meanwhile, Insurance Commish Poizner has released a review of CIGA, the California Insurance Guarantee Association. CIGA is the entity that pays claims against insolvent insurers. CIGA is funded from assessments against solvent insurers. For wonks out there, the report on CIGA required reading:
http://www.insurance.ca.gov/0250-insure ... -03-09.pdf
The report makes a number of recommendations in the areas of board governance, TPA administration procurement and contracts, audits, legal contract bill review, and information technology, among others.
In coming days I'll be covering the SCIF "sale" that's been included in the budget.
Monday, July 20, 2009, 09:19 AM - Political developmentsNo short term relief for state workers in the budget deal?
That's what appears to be shaping up:
http://www.californiaprogressreport.com ... erm_r.html
Saturday, July 18, 2009, 02:43 PM - Political developmentsMore on the possibility of an SEIU strike that could affect personnel at the WCAB boards:
http://www.californiaprogressreport.com ... ers_w.html
From the Sacramento Bee:
http://www.sacbee.com/capitolandcalifor ... 36145.html
A strike of clerical personnel at the WCAB could bring activity at the district offices to a crawl. Clerks and secretaries open and process the mail, handle calendaring, and many other functions necessary to keep the system running.
Thursday, July 16, 2009, 10:27 PM - Political developmentsA major priority for unions has been the so called "card check".
That's the Employee Free Choice Act, which would have required employers to immediately recognize a union when a majority of workers sign a card indicating that they want to join a union. This has been touted as a way to bolster union membership, which has been in decline for decades.
Aggressive union busting tactics and unfriendly labor relations board rulings have made organizing workers tougher. Card check would simplify union organizing and make it more difficult for employers to intimidate workers interested in a union.
But the current reality is that there aren't enough votes in the U.S. Senate to move the card check bill in its proposed form. A number of Democrats have qualms about the bill, including Senator Feinstein.
So there's word today that the bill will be amended and watered down.
The new bill will require shorter union campaigns and faster elections.
While this would be an improvement over current law, it's a bitter pill for the organized labor movement. Hopes had been high that a Democratic controlled Congress would pass a strong card check law.
This comes at a time when many unions are under great pressure, particularly public-employee unions who may see large layoffs or furloughs due to budget problems at the state and local level.
Here's some more information on the card check bill:
http://www.nytimes.com/2009/07/17/busin ... r=1&hp
On another note: Workers Comp Executive reported today that the sale of part of SCIF (or its reserves or book of business) is still alive. The Executive noted that they have heard that the proposed sale is one item that will be used by the Big 5 to balance California's budget. That's despite the fact that SCIF's board has taken a stand against a sale. If the Executive's story is correct, we're entering a very uncharted time in California's workers' comp. Look at the following:
Wednesday, July 15, 2009, 09:57 PM - Medical treatment under WCSometime over the next month we'll see a definitive health reform package emerging from Congress.
Congressional committees in the House have advanced a plan; various Senate committees are working on a plan. High earning doctors and lawyers may be surtaxed. Or those high earners may find their deductions limited. Or perhaps regular working folks who have insurance through their employer or union will be taxed. Your can of soda and your Snickers bar may be taxed.
And all of this may happen on a party line vote.
But whatever reform emerges, many are afraid that it will lead to "rationing". The fear of "rationing" has been a rallying call for many who oppose reform. These critics fear that government bureaucrats with green eyeshades will limit access to treatments, resulting in arbitrary denials of lifesaving help.
What is "rationing"? What are the philosophical issues behind it? Below I'll share a link to an analysis of "rationing" by Princeton bioethics professor Peter Singer.
But first, note that we already have a type of "rationing" in California's comp system. In adopting the ACOEM guidelines (part of MTUS, the medical treatment utilization system), California has elected to do a form of rationing. Healthcare dollars (from comp premiums and self-insured reserves) are allocated only to certain preferred treatments.
Injured workers wishing non-preferred treatments must jump through procedural hoops and show substantive rebuttals to overcome the rationing.
It's all part of one trend in healthcare, which is focused on "effectiveness
research". Groups of doctors (or healthcare administrators) may set standards. Those standards are debatable, and the quality of the standards depends on the quality of the underlying research and politics that went into the evaluation process. Moreover, such standards may take a "one size fits all" approach to healing.
In the national healthcare reform debate, holding down costs are key.
Employers have been dropping healthcare coverage for workers, and the escalation of medical costs threatens to swamp our economy. It's not sustainable.
Like an invasive weed species, healthcare costs threaten to crowd out other national priorities.
One solution may be "rationing". In essence, setting controls on how much our system can pay, or is prepared to pay, for healthcare. And working backwards from those numbers to what we'll cover, with an option for people to supplement coverage if they so choose.
That's where we're probably headed as a nation, like it or not. The actual rationing decisions would come later, in enabling regulations and policies away from the klieg lights of Fox and CNN.
This sort of thinking won't go over well in workers' comp, where the philosophical underpinning is that the employer is liable for whatever treatment is necessary to "cure or relieve" the effects of the injury.
But if there is ultimately a system that adopts some "rationing", it will put increased pressure on workers comp systems to do the same.
Peter Singer's article does an excellent job of exploring some of the philosophical choices that are involved in "rationing". Here's the link:
http://www.nytimes.com/2009/07/19/magaz ... nted=print