To use one of my old North Carolina sayings, the workers' comp community has a dog in this hunt.

The hunt for healthcare reform. The eventual shape of any reform could have profound secondary consequences for comp.

I've had some interesting conversations with various friends (NOT comp community members) this week about the national debate that rages. Most people "get it" that the system is broken. Everyone seems to know someone who lost their coverage, can't get coverage, or who can't afford their co-pays.

But I've met few folks who want to pay higher taxes to fund such a system. And many of the folks who do have good coverage are leery of being taxed on it. It's human nature to want change, but we don't like being asked to pay for change.

An elderly family friend notes that the elder community where she lives is petrified that any reform will reduce care for seniors in an effort to ration care. The fear is that a commission to study costs or comparative outcomes may cut coverage for old folks.

Debate about such a commission has been one of the sticking points between House Democratic "Blue Dogs" and Congressional leaders including L.A.'s Henry Waxman:
http://thehill.com/leading-the-news/wax ... 07-24.html

Another friend says that's just what we should be doing. Why should we spend large amounts on people at the very tail end of their lives? We've got to limit care for elderly, he says.

At the same lunch, another friend objects. How can we limit care for the elderly without addressing "behaviorally caused" healthcare problems? How many times do we pay for hospital care for overdoses or infections of IV drug users? What about care for people who refuse to stop smoking or who insist on engaging in risky sexual behaviors? Why pick on the elderly, he argues. How dare you argue for limits on senior's care? That's ageist, he says. Better to place limits on public funding for care for those who don't take care of themselves.

The lunch discussion continues. Can we ethically set limits on what care we will pay for depending on the circumstances that caused the problem? Should a semi-healthy 88 year old (who paid large amounts of taxes) get less care than a 40 year old Tenderloin alcoholic or a 350 lb. junk food -eating diabetic or a crank-snorting teenager who overdoses?

Around the lunch table, another friend raises a slightly different argument. Should a disabled minimum wage earner who has paid little in taxes receive hundreds of thousands of dollars in pain management treatment? Should there be some proportionality between what one "contributes" and what one "receives"? It's a harsh argument. An argument totally antithetical to the principles underlying the workers' comp system.

These are uncomfortable discussions. People's prejudices seep into their formulations. Lifestyle choices of the less fortunate or less educated are ridiculed by some in the group. There's a sense of moral superiority and coldness to some of the discussion.

At the lunch there is also discussion of the role that cultural diversity and economic disadvantage play in this. Would we ration healthcare in a way that might disproportionately ration care in rural areas or economically disadvantaged parts of cities? Economically disadvantaged folks are going to need more healthcare, some say. Others note that reform could limit access to elective and diagnostic procedures now
covered under some gold-plated plans favored by the well-to-do.

And others noted that we already ration in a fashion. Patients without insurance must go to public hospitals and clinics. Those providers usually triage care, so the poor and uninsured rarely get full-spectrum care.

Half of the lunch crowd thinks Obama is trying to do too much. They say that there's a problem with the system, but no immediate crisis.
Doing nothing, or something small, is preferable to jamming a major reform that isn't consensus-based and revenue-neutral. This group worries about new entitlements. The Congressional Budget Office report on the current options being discussed scared the bejeezus out of them.

Some of the others are disappointed in Obama. One favored Canadian-style "single payer". Now Obama won't even commit himself to a plan that includes a public option.

Another criticizes Obama for being wimpy. In his view, it's not clear what the President wants. Yes, the President wants a bill. Yes, the President wants universal coverage and to "bend the cost curve". But how? It's August and the White House still has not endorsed any particular solution. Maybe they could have shown the way by giving a couple of alternatives?

As you can see, there was no consensus at the lunch.

There's no consensus on Capitol Hill at the moment, either. It appears that there will be no vote before the summer recess.

Here are 2 views. Ezra Klein of the Washington Post thinks that a bill will emerge; Peggy Noonan says that it won't:

Ezra Klein:
http://voices.washingtonpost.com/ezra-k ... e_end.html

Peggy Noonan:
http://online.wsj.com/article/SB1000142 ... 32364.html

The Blue Dogs:
http://www.house.gov/melancon/BlueDogs/

Do we live in a "No-Can-Do America?":
http://www.washingtonpost.com/wp-dyn/co ... 02712.html

A good summary of the issues and pros and cons of changes that are "in play":
http://www.nytimes.com/2009/07/26/opini ... nted=print

Stay tuned.

Julius Young
www.boxerlaw.com

It 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:
http://seiu1000.org/authorization_vote/Default.aspx

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.

Julius Young
www.boxerlaw.com

No 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

Stay tuned.

Julius Young
www.boxerlaw.com

More 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.

Stay tuned.

Julius Young
www.boxerlaw.com

A 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

Stay tuned.

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:
http://www.wcexec.com/articles/WCE01-20090716-001.html


Julius Young
www.boxerlaw.com