National Health Care Reform Could Harm Work Comp

Friday, June 19, 2009 | 0

By Eugene F. Keefe

Synopsis: Universal health care — Is it the dumbest thing we have ever done as a society? How will it affect workers' compensation?

Editor's comment: What government program is run "well?" How do you like the U.S. Postal Service that is now hemorrhaging money? Does anyone feel the Social Security Administration operates efficiently? Do we all understand Medicare is presumed dead within a decade?

 
Try to imagine a truly poor person, let's say a bag-man or bag-lady in Chicago . They don't want to sleep on a park bench or under a bridge in January. If they have a sore back or a painful shoulder or demonstrate psychiatric impairment (what bag-person isn't somewhat impaired?), they may soon be able to go to a hospital and have the government provide three square meals and a warm bed and round-the-clock care. Someone please tell me how to eventually kick them out of the warm hospital into the cold or snow? Utilization review? By a government worker whose job it will be to spend our tax money?

We will all have to keep a watchful eye on that issue that may be coming to a medical institution near you shortly. Some observers are telling us the program cost will exceed $2 trillion dollars we simply don't have.

On the WC side, as our nation edges closer to universal health care, the implications for workers' comp are both profound and troubling. Policy makers in Washington may be inclined to ignore the special needs of the workers' compensation community and create problems for employers, insurers, TPAs and hearing officers who deal with comp issues.

There are a number of key reasons why reform of health care may undermine the ability of states to deliver a quality workers' compensation system.

• The overall goal of the broader health care system is to preserve the life and health of individuals and families. This system provides treatment from conception up to the moment of death.
• In contrast, the workers' compensation system provides treatment only to workers who are in the course and scope of employment.

• The general health system provides defined services to individuals and families. Virtually any illness or injury is covered, including many forms of mental illness.
• In contrast, workers' compensation covers only what occurs during work and is proven to be work-related, with an almost phobic disregard for mental impairments.

• In the broader health care system, premiums for coverage are paid by individuals and their employers. Depending upon the plan, individuals and their family members assume at least some of the cost of treatment, through premiums, co-pays and deductibles.
•  In workers' compensation, employees never pay premiums and are never charged co-pays or deductibles. Thus, only the employer who purchases mandatory coverage and their insurer has the incentive to control costs. We are seeing a tremendous fight in Illinois over who gets to control medical costsclaimant attorneys or the employers. That fight will continue for years to come.

•  The new mandates for health insurance coverage come from Washington , D.C.
•  Workers' compensation, in contrast, is strictly a state program. New federal mandates (for example, total and unfettered patient choice of doctor) may well conflict with long-established state systems.