Some teaching hospitals have been pushing for the U.S. healthcare reform bills to include an expansion of monies to fund as many as 15% more doctor residency programs.

Is America underserved with medical doctors? What kinds of doctors do we need? Will more doctors fuel more demand for procedures and services, adding to the overall expense of our national healthcare system?

An answer to this question must start with an acknowledgement that some rural areas and some parts of urban areas are woefully underserved.

And most experts believe that we need more primary care doctors. Those doctors are in short supply, as new medical graduates tend to seek higher paying specialty positions. Those medical specialties are procedure driven, generating higher incomes.

In the California workers' comp world, medical treatment costs are a critical cost driver of system costs. Some might argue that we'd be better off to have more generalists treating California workers. In effect we already have many primary care doctors who practice "occupational medicine" in various industrial clinics. I'm not aware of any studies comparing the costs and outcomes of "occ med" treatments versus specialist treatments in California workers comp. Maybe there is such a study, but if not it would be interesting to see one.

Proponents of "occ med" believe that its good to have a gatekeeper who can provide needed care without the incentive to do lots of procedures or unnecessary tests.

But in some comp cases occ med doctors are slow to investigate conditions. Delaying ordering an MRI which eventually reveals a herniated disc requiring surgery is a delay which can have drastic economic impact on the worker.

The comp system aside, it's clear we need more primary care docs in the system overall. But is expanding residency programs the answer?

In a New York Times Op-ed piece "Doctors No One Needs" Shannon Brownlee and David Goodman argue that expanding doctor residency programs is not the answer:
http://www.nytimes.com/2009/12/23/opini ... ee.html?em

Stay tuned for my next post, commentary on the 2009 CHSWC report on Californa workers comp.

Julius Young
www.boxerlaw.com

You, dear reader, may have visions of sugar plums in your head as you wait for Dancer, Prancer, Comet and Cupid to alight on your roof on Christmas eve.

But meanwhile, some folks are stewing, some are hi-fiving, and some are agonizing over the healthcare reform bill that's to be consdiered tomorrow by the Senate.

Harold Meyerson's piece in the Washington Post reveals the
concerns many labor officials have about the funding of the reform under the Senate version. The concern is that in bargaining many unions took generous healthcare benefit packages in lieu of wage increases.

Many of those workers' plans will now be taxed (or taxed in future years as inflation affects the formula). Many rank and file workers could be disgruntled by this approach. Meyerson notes that this was an issue which brought many workers into the Obama column in the race against McCain. So the unions and the administration have a political problem to solve.

Here is Meyerson's piece;
http://www.washingtonpost.com/wp-dyn/co ... 02842.html

Stay tuned.

Julius Young
www.boxerlaw.com

Ending months of speculation about a coming vacancy on California's Workers Compensation Appeals Board, Governor Schwarzenegger has elected to reappoint Commissioner Ronnie Caplane.

Many folks in the comp community had assumed that Caplane would not be reappointed. A Democrat, Caplane is probably the most liberal member of the WCAB and has been a dissenter in several of the most important cases over the past few years.

Those who know Caplane know that she is a bright, engaging force on the WCAB. Although she had not practiced workers' comp law for many years (Caplane raised a family with Joe Remcho, a renowned lawyer who specialized in election law and constitutional law before his tragic death in an accident some years ago), Caplane proved to be a quick study.

It's to the Governor's credit that he has not moved Caplane aside to make room for a political hack looking for "a place to land". Given the complexity the workers comp law and the many post SB 899 reform issues which are still in play, stability on the WCAB is good.

Stay tuned.

Over the holidays I will be covering the 10 Top Events in California workers' comp in 2009 and providing commentary on the CHSWC 2009 report on California workers' compensation.

Julius Young
www.boxerlaw.com

There will be no filibuster on healthcare reform now.

In putting together a "manager's amendment" that distributes goodies to Nebraska and a number of other rural states, Harry Reid has shown his tactical brilliance. I've noted before that I see Reid as a historic figure.
Whether you like the healthcare reform package or not, it's clear that it's due to his tactical acumen.

In coming weeks we'll probably be noting various impacts for workers' comp if a bill eventually passes out of the House-Senate conference.

Today in a piece on Workcompcentral, insurance consultant Joe Paduda is noted as predicting that workers' comp will see post-healthcare reform pricing effects from hospitals and drug manaufacturers. Paduda theorizes that pressures on costs for hospitals and Pharma will cause them to look for revenue elsewhere, with workers' comp being a possible spot. Paduda is quoted as saying "Workers' compensation is the softest target around. It has been, and it will be."

But like so much about the healthcare reform debate, this is currently merely speculation.

If 30 million of the currently uninsured gain access to health insurance, it's likely that we'll see a drop in workers' comp claim frequency. There are going to be workers who don't want to go through the hassle of the comp system. Some of those workers will be discouraged from filing claims by their employers. It's easy to envision an employer telling a worker to use the combination of health insurance and state disability in lieu of reporting a work injury.

Since many small businesses and non-union shops may be the types of enterprises which gain coverage, it's easy to envision the "don't go the workers' comp route" strategy in that environment.

We already know that state disability is subsidizing workers' comp.
Here's a link to an earlier post I did, covering a study by UC Berkeley's
Frank Neuhauser and Anita Mathur:
http://www.workerscompzone.com/index.ph ... 110-154208

I'd love to hear from readers (jyoung@boxerlaw.com) what consequences-intended or unintended-they forsee for California workers' comp arising out of national healthcare reform. If you are a "stakeholder", how would reform affect your business and your clients? If you are an employer, how would the Senate passed "Cadillac tax" affect coverage on your own employees? What would be the long term affect on California workers' comp?

Meanwhile, it's not just Republicans and abortions rights activists who are attacking the bill. Jane Hamsher, a prominent blogger, was a co producer of the controversial film "Natural Born Killers". Here, from Hamsher's liberal/progressive standpoint, is a summary of the "Top 10 Reasons to Kill the Senate Health Care Bill":
http://www.huffingtonpost.com/jane-hams ... view=print

With all polls showing much public confusion and opposition, the
Administration's hard work is just beginning on this one:
http://www.politico.com/news/stories/1209/30834.html

Stay tuned.

Julius Young (jyoung@boxerlaw.com)
www.boxerlaw.com

Harry Reid appears to have put it together.

There's word this morning than Nebraska's Ben Nelson appears ready to vote for Reid's healthcare reform bill. So before Christmas we may see a vote sending it to House-Senate conference.

Here is the "manager's amendment" of the healthcare reform bill:
http://www.realclearpolitics.com/articl ... ndment.pdf

A summary of some of the last-minute deals cut by Reid can be found in this piece by Jeffrey Young in The Hill:
http://thehill.com/homenews/senate/7305 ... ive-for-60

Here is the December 19, 2009 analysis by the Congressional Budget Office ("the CBO") of the Reid amendments:
http://www.cbo.gov/ftpdocs/108xx/doc108 ... nagers.pdf

According to the CBO, Reid's plan would cost $871 billion over a 10 year period and would reduce the deficit by $132 billion over that 10 years.

The train is barreling down the track now.

Stay tuned

Julius Young
www.boxerlaw.com