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(c) 2014 Jon L Gelman, All Rights Reserved.

Tuesday, January 1, 2013

Workers’ Compensation 2013 – What Happens on the Other Side of The Fiscal Cliff?

The fiscal reality is that workers’ compensation is in greater jeopardy than ever before as the debate in Washington is not about the deficit at all. The debate is about government spending which includes health care.

Overall health care devours 18 percent of the US economy and amounts to 25% of the Federal budget.

Medical treatment for injured workers continues to be delayed, denied and limited under current workers’ compensation programs. Medical costs continue to be shifted to other programs including employer based medical care systems and the Federal safety net of Medicare, Medicaid, Veterans Administration and Tricare.

While a trend continues to emerge to offer “Opt Out” and “Carve Out Programs,” they are not global enough to solve the critical budget deficit issues. The latest emerging trend is for employers to utilize ERISA based medical care plans to efficiently delivery medical care. In NJ a limited alternate dispute-resolution procedure between unions and employers has been introduced. See “NJ Care Outs –Another Evolutionary Step” authored by David DePaolo.

The US economy continues to be very weak. This in an ominous signal for the nation’s workers’ compensation program which is starved for premium dollars. Premiums are based upon salaries and real median incomes continued their dramatic decline over the last decade from $54,841 in 2000 to $50,054 in 2011. There just may not be enough dollars available in the workers’ compensation programs to pay for present and lifetime medical care.

Even the present Federal system leaves much to be desired. Whether Federal rationing medical care becomes a reality is unknown. Physicians are under economic scrutiny as the “Doc Fix” to limit provider fees continues as a cloud over all medical programs. The agreement reached by Congress still does not resolve the 26.5% percent cut reimbursement cut to physicians who treat Medicare patients. The law merely "freezes" payment to physicians.

Workers’ compensation programs presently structured provide no real economic incentive to monitor and compensate for more favorable medical outcomes. On the other hand, the Federal government, with broad and sweeping regulatory ability, is able to continue to make strides in many areas including present incentives to hospitals and proposed incentives to physicians to provide medical treatment with fewer complications and ultimate better outcomes


Steven Ratner in the NY Times points out the dramatic increase in the nation’s health care costs. He wrote, “…no budget-busting factor looms larger than the soaring cost of government-financed health care, particularly Medicare and Medicaid.”



Solving the economic gridlock of the country will require an approach to re-invent a medical program for injured workers. A global single-payer program under Federal control will eliminate duplicative administrative State and private efforts. The Federal government has the clout to provide efficient enforcement and co-ordination.

Now that we are on the other side of the fiscal cliff, the opportunity to be creative is possible. The US needs to transition to a single-payer health care system subsuming a medical care program for injured and ill workers who suffer both traumatic and occupational conditions.

Read more about the "single-Payer System" and workers' compensation

Workers' Compensation: A Single Payer System Will Solve the ...
Nov 29, 2012
The question is whether the nation will recognize that the US needs tol take the bold step previously taken by the European Community, finally adopt a single payer medical care program. The perpetual cost generator that ...
http://workers-compensation.blogspot.com/

NJ Urged to Adopt Single Payer System for Workmens Comp
Jun 06, 2011
NJ Urged to Adopt Single Payer System for Workmens Comp. A coalition that has been formed in NJ is urging that the Garden State follow the lead of Vermont and establish a single-payer system. Single-payer movements ...
http://workers-compensation.blogspot.com/

Vermont Single Payer System Called the Dawn of A New Era
Apr 03, 2011
The proposed state based Vermont Single-Payer health care system, that would embrace workers' compensation medical care, is gaining momentum. A recent article in the New England Journal of Medicine, citing increased ...
http://workers-compensation.blogspot.com/

RICO Issues Can Be Cured With A Single Payer Medical System
Mar 22, 2011
Vermont's proposed single payer system would seperate medical care from indemnity. Vermont's single proposed single-payer system would likely also provide a primary care doctor to every resident of Vermont. This would ...
http://workers-compensation.blogspot.com/
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