Thursday, September 17, 2009, 10:50 AM - Political developmentsKorcula,Croatia.....
It seems like a good time to be out of the country.
From this little medieval town of Korcula on a small island, purportedly the home of Marco Polo (Venice and Genoa had a whopper of a sea battle near here on September 9, 1298), the antics of modern day America seem strange....
Kanye West epitomizing the buffoonery of much of hip hop culture in particular and celebrity culture in general.....A Congress where over 100 members refuse to chasten a member who blurts out an insult in the middle of a key Presidenal address...a culture where the concept of "country first" is being made into a joke as some opposition politicians admit that they seek the President to "fail". Town halls attended by angry constituents with weapons.....
And news emerging that in many states, failing to disclose that you are married to a wife-beater is a valid excuse to deny coverage as a "pre-existing condition":
http://www.huffingtonpost.com/2009/09/1 ... 86029.html
Time to go drink some of Korcula's quince grappa and savor the grilled squid. Maybe that quince grappa will shed light on what's going on at home?
An interesting recent column by David Brooks of the New York Times raises the issue of whether we have have national gridlock. Brooks refers to a theory from Mancur Olson that's explicated in a recent book by Jonathan Rauch, "Demosclerosis". The theory seems to be that advanced democracies get schlerotic. Interest groups get entrenched. It's hard to get anything done (sound like workers' comp to you?)
The Senate subcommittee healthcare reform plan submitted by Senator Max Baucus was barely in print before we learn that it's not good for coal miners whose generous health packages would be taxed (Jay Rockefeller), not good for Nevada (Harry Reid, who notes that Nevada can't shoulder increased the Medicaid costs the Baucus plan would envision), and not good for Maine (Olympia Snowe), with its relatively expensive healthcare system there.
That's a lukewarm reception, if there ever was one.
More quince grappa, please.
Does Croatia have any lessons for us in the healthcare debate? After all, it was truly a socialist state that's abandoned socialism.
I have no firsthand experience with the healthcare system here. But apparently in the rush to privatize healthcare there has been much unhappiness with what occurred. The old system gave universal coverage and focused on preventive health. The new system, more market -based, resulted in some access problems and less emphasis on prevention and less availability to vulnerable groups. Here's the American Journal of Public Health analysis of Croatia's healthcare transition:
According to a Croatian study, privatisation (with some rationing and fee controls) has led to control of costs, but access problems and much consumer unhappiness:
This shows how difficult it is to get to that "sweet spot" of workable reform.
Time to trundle back down these winding streets as the wind whips off the Adriatic. Stay tuned.
FYI, The original article on Demosclerosis:
http://www.jonathanrauch.com/jrauch_art ... l_article/
Monday, September 14, 2009, 01:21 PM - Political developmentsIt's looking grim for "the public option" in healthcare reform.
Maine Senator Olympia Snowe, is a key potential swing vote in the Senate on healthcare reform. Snowe today said there is "no way" a healthcare reform with a public option can pass out of the Senate:
http://www.bloomberg.com/apps/news?pid= ... Sy1YRWktbc
And yet some Democratic progressives appear determined to torpedo any reform without a public option:
http://www.huffingtonpost.com/2009/09/1 ... 83756.html
Jane Hamsher's Firedoglake.com blog has been at the forefront of the effort to shore up support for a "public option":
http://campaignsilo.firedoglake.com/200 ... s-buzzing/
The progressives have been fighting a valiant fight. But it's not worth
circling the wagons and opening fire on this one. It's time for progressives to start counting votes and living in the real world.
So it looks like we'll see a plan emerge that encourages insurance "co-ops". The details aren't clear, and in any event the plan will be changing.
Will these work?
Michael Hitzlik of the Los Angeles Times penned an excellent reminder of the California experience with insurance exchanges. California tried them before, and they didn't work, so there are many lessons here:
http://www.latimes.com/business/la-fi-h ... ?track=rss
Sunday, September 13, 2009, 01:58 PM - Political developmentsI love the internet.
I can be here in Hvar, Croatia, on holiday, with an espresso in one hand and gelato in the other, meanwhile reading the latest newsworthy bits about California. Cafe wi-fi is sweet.
Yachts pull up and depart, as a steady stream of Italians and Croats from Split and Zagreb sit in cafes on the lido, settling into their Ogusko and Karlovacko beers. Lots of folks who seem to have a lot of time on their hands. In comes a yacht that surely cost upwards of $1mil. It's named "Toys for Boyz", apparently flagged in the English Channel island of Jersey.
.Coastal Dalmatia is basically unspolit. Dominated by Venice and the Austrians/Hungarians in a feudal fashion for centuries, the region has little industry and some of the clearest ocean and skies you'll ever see.
Few reminders of the Tito Communist period are visible. And the region largely escaped direct devastation from the 1980s/90s bloodbath from nationalism in the Balkans.
What's here vaguely reminds one of the island of Catalina, off the coast of L.A., except that there are vast fields of lavender and vineyards here.
The thought of L.A. brings me back to workers' comp. Using wi-fi while I sip my espresso, lo and behold I see that Los Angeles is having trouble with increasing costs generated by workers comp. Here's the L.A. Times article:
http://www.latimes.com/news/local/la-me ... 4818.story
Many of L.A.'s increased costs appear to be due to employment law suits under FEHA and ADA laws. That's not surprising. Many employers are cavalier about complying with their obligation to engage in a good faith interactive process of reasonable accommodation. The demise of the voc rehab benefit has upped the ante for employers.
Thursday, September 10, 2009, 07:46 AM - Political developmentsRecently I did a post on reports that surfaced of backroom talks between CHSWC members on a "grand bargain" comp reform. Those talks were leaked on Workcompcentral.com and in an e-blast from CSIMs, and perhaps other places.
CHSWC executive director Christine Baker was quoted as denying awareness of the talks, which apparently resulted in a draft that looked a lot like an internal CHSWC document. PD benefit increases were under consideration, with proposed cost savings in the UR/QME process and lien procedures, among others.
Some of those proposals were intriguing, such as a COLA-type factor for PD benefits. Some were mean spirited, such as prohibiting PD advances. And some, such as abolishing the ability to rebut the PD schedule, were just not wise from the disabled worker standpoint. There was an upfront hostility to lawyers in the draft.
The prospect of an emerging back room deal caused concern on the part of many observers. It brought back memories of 2004. Attorneys and other stakeholders were shut out of the 2004 negotiations which resulted in SB 899, with disastrous results for many working folks.
Last week, both California Labor Federation's Angie Wei and employer spokespersons were quoted as saying that talks had stalled after release of the document.
Today, Workcompcentral's Jim Sams reports on an interview with John Duncan, Director of the Department of Industrial Relations. Duncan
apparently believes that the DWC will meet the 1/1/2010 deadline for updating the 2005 PD rating schedule. But he is quoted as saying "I'm
not going to preclude a grand legislative understanding that preempts our regulatory obligation in some action".
So is it let's make a deal time?
This could happen in various ways. Until the last legislative gavel falls, a bill could be gutted and serve as a vehicle for a grand bargain. But the legislature has huge remaining issues on its plate, prison reform and water policy reform. And many legislators may be reluctant to rubber stamp a late back room deal, particularly if it isn't well vetted to a range of system stakeholders.
Many of those stakeholders are political allies and campaign contributors of key legislators, so it would appear unlikely that the process could or would move in the same way as the 2004 reform. Unlike 2004, where legislators were acting in the shadow of threats of a workers' comp initiative, there is not a current sense of a comp crisis.
Another option could be a special legislative session, but Duncan apparently declined to say that was an option in the Workcompcentral
interview. It's hard for this observer to see the Governor calling a special session to deal with comp. It's been his signature issue. Revisiting it would be an admission that the system was not fixed, or not fixed properly. And with the governor's juice fading, that's risky.
But what is apparent is that the employer community recognizes that there will be a revision of the PDRS somehow. It's required by statute. There's already a template, the 2009 PDRS revise that was never adopted. Whether employers are on the verge of a deal or whether they mis-timed their strategy remains to be seen.
I'm on my way to a week on the azure waters of Croatia's Dalmatian Coast, but what would I like to see while I'm gone?
I'd like to see Senator DeSaulnier's Senate Industrial Relations Committee take the lead in holding some hearings on the PDRS revision and the various proposals being circulated for counterbalancing cuts. Let's shine a bit of light on what some of the proposals would cost.
What savings could be achieved, and how would these affect the system?
Care should be taken to inquire as to how any proposals would affect an individual's right to seek justice and redress for the effect of the injury on their wage earning capacity. Proposals that will lead to more "cookie cutter justice" need to be explored carefully.
Applicant attorneys and doctors should be ready to price out system savings they would propose. Nobody wants to negotiate in public, but there should be a way to put some numbers on systemic change proposals.
There may in fact be ways to improve delivery of medical treatment, ways to streamline the UR/QME process, and ideas to improve the lien process. I would not reflexively reject innovative ideas on those things.
Labor representatives should drop the canard that they are the only negotiating voice for injured and disabled workers. That's not credible and, frankly, offensive. Many of us who represent disabled workers-union members or not-are in this together for the long haul. Many of us have relationships with labor locals that go back decades.
Such hearings could also clarify the proper role of CHSWC in all of this. There has been some concern about CHSWC members or its staff preparing proposals that are not vetted to its own members and officials.
Any hearings should be done in a deliberative fashion, not rushed.
If healthcare reform in Washington appears to be gathering steam, hearings could examine how those changes may affect workers' comp in California.
We've seen what happens when the votes are taken before the print
on the bill is dry. It's not pretty.
Thursday, September 10, 2009, 12:51 AM - Political developmentsIn case you missed President Obama's healthcare speech tonight, here's the link for you:
http://www.whitehouse.gov/the_press_off ... alth-Care/
The President's plan seems eminently reasonable. His address did a good job of summarizing the need for reform. Listening to it, I could only wonder why he hadn't done this months ago.
But the big unknown is how realistic the cost estimates are. Will the Congressional Budget Office again expose holes in the cost projections?
In the last few months we've seen on several occasions that cost projections were widely off the mark.
This was all glossed over somewhat glibly in the speech. But in the coming weeks cost projections may be at the heart of the debate. Until a consensus on that is reached, it will be difficult for any plan to gain traction.